Are Changes in Joviality Associated With Cognitive Behavioral Treatment Outcomes? Examining an Emerging Treatment Target

• Published in: Psychotherapy (Chicago, Ill.) Ill.), 2023-12, Vol.60 (4), p.477-487
• Main Authors: Spencer-Laitt, Daniella, Long, Laura J., Woodard, Lauren S., Jaso, Brittany A., Cardona, Nicole D., Fong, Saige R., Farchione, Todd J.
• Format: Article
• Language: English
• Subjects: Anxiety; Anxiety Disorders - therapy; Cognition; Cognitive Behavior Therapy; Cognitive Behavioral Therapy - methods; Emotions; Female; Human; Humans; Major Depression; Male; Negative Emotions; Positive Emotions; Symptoms; Transdiagnostic Treatment; Treatment Outcome
• ISSN: 0033-3204; 1939-1536; 1939-1536
• DOI: 10.1037/pst0000498

The present study expands on the growing body of research on the effects of cognitive behavioral therapy (CBT) on positive affect. More specifically, we explore how CBT may promote increases in the Joviality subscale of the Positive and Negative Affect Schedule-Expanded Form (PANAS-X), a measure of self-rated affect that captures positive emotions, including joy and excitement, and how change in joviality may be associated with concurrent symptom change. We utilized data from a randomized equivalence trial comparing the efficacy of the unified protocol (UP) for transdiagnostic treatment of emotional disorders, a transdiagnostic CBT, against various well-established single disorder protocols (SDP) and waitlist control. First, we generated affect profiles for patients receiving CBT (either UP or SDP) or waitlist control, based on their baseline and posttreatment positive affect (PA) and negative affect (NA), compared with a clinical reference sample. We found that the affect profile for most patients receiving CBT shifted from high NA/low PA to low NA/high PA. Further, participants receiving CBT were more likely than individuals in the waitlist control to achieve this outcome. We then examined the PANAS-X Joviality subscale, which has been subject to very limited previous research. Change in joviality was associated with improvement in symptoms of both anxiety (B = −0.81, p = .00) and depression (B = −0.94, p = .00). Joviality increased more rapidly in individuals with more severe anxiety but not severe depression. We discuss the possible clinical implications of these preliminary results, including the role of treatment innovations incorporating a focus on increasing positive affect, particularly the emotions associated with joviality, while simultaneously decreasing negative affect. Clinical Impact Statement Questions: What is the pattern of change in positive and negative affect over the course of CBT? Are existing CBT treatments increasing typical positive emotions such as joy or excitement? If so, is this associated with concurrent reductions in anxiety and depression? How can clinicians more effectively target typical positive emotions in CBT? Findings: Typical positive emotions (captured under the subscale of Joviality) increase during CBT and are associated with change (reduction) in anxiety and depression, at a particularly rapid rate for high severity anxiety disorders. Meaning: Targeting joviality directly through the strategies discussed could po