A transdiagnostic evaluation of contrast avoidance across generalized anxiety disorder,major depressive disorder,and social anxiety disorder

BackgroundThe contrast avoidance model (CAM) proposes that persons with generalized anxiety disorder (GAD) are sensitive to sharp increases in negative emotion or decreases in positive emotion (i.e., negative emotional contrasts; NEC) and use worry to avoid NEC. Sensitivity to and avoidance of NEC could also be a shared feature of major depressive disorder (MDD) and social anxiety disorder (SAD).MethodsIn a large college sample (N = 1409), we used receiver operating characteristics analysis to examine the accuracy of a measure of emotional contrast avoidance in detecting probable GAD, MDD, and SAD.ResultsParticipants with probable GAD, MDD, and SAD all reported higher levels of contrast avoidance than participants without the disorder (Cohen’s d = 1.32, 1.62 and 1.53, respectively). Area under the curve, a measure of predictive accuracy, was .81, .87, and .83 for predicting probable GAD, MDD, and SAD, respectively. A cutoff score of 48.5 optimized predictive accuracy for probable GAD and SAD, and 50.5 optimized accuracy for probable MDD.ConclusionA measure of emotional contrast avoidance demonstrated excellent ability to predict probable GAD, MDD, and SAD. Sensitivity to and avoidance of NEC appears to be a transdiagnostic feature of these disorders.