A BRIEF ECOLOGICAL MOMENTARY INTERVENTION FOR GENERALIZED ANXIETY DISORDER: A RANDOMIZED CONTROLLED TRIAL OF THE WORRY OUTCOME JOURNAL: Research Article: Worry Outcome Journal for GAD
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BACKGROUND: The efficacy of many cognitive behavioral component interventions has not been examined, with worry outcome monitoring among them. METHODS: To address this issue, 51 participants with clinical levels of generalized anxiety disorder were randomly assigned to a treatment or control condition for 10 days. The treatment condition consisted of a brief ecological momentary intervention termed the Worry Outcome Journal (WOJ). WOJ participants recorded worries and tracked their outcomes, rating worry distress, interference, and expected outcome probabilities. Thought log (TL) control participants completed a record of their everyday thoughts and rated associated distress. All participants made four entries on paper each day when randomly prompted by text message. They then entered their paper contents online each night. After 30 days they reviewed their contents electronically and completed follow-up measures. RESULTS: Primary results revealed significant reductions in worry for WOJ users compared to TL users at postintervention. A marginally significant difference was found at 20-day follow-up and treatment gains were maintained. Secondary analyses showed no harmful increases in worry beliefs for WOJ users, as well as preliminary evidence for decreases in beliefs about the uncontrollability of thoughts in both groups. CONCLUSION: The WOJ may be a viable therapist-independent treatment for reducing worry, even after only 10 days of use.
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A worry outcome journal led to greater pre-post reduction in worry (d=-0.59) than a thought log, and was marginally superior on pre- to 20-day follow-up (d=-0.52), with gains maintained.
“The worry outcome condition led to greater pre-post reduction in worry (d = −0.59) and was marginally superior to the thought log on pre- to 20-day follow-up (d = − 0.52), with gains maintained over the follow-up period.”
From Psychotherapeutic treatments for generalized anxiety disorder: cognitive and behavioral therapies, enhancement strategies, and emerging efforts (2022) · cites this paper as [105]
EMA/EMI have shown good results in other psychological disorders, such as substance use, anxiety, and major depressive disorders.
“EMA/EMI have shown good results in other psychological disorders, such as substance use disorders (e.g., smoking cessation), anxiety disorders (e.g., social anxiety disorder, generalized anxiety disorder), and major depressive disorders (LaFreniere and Newman, 2016; Colombo et al., 2019; Linardon et al., 2019; Miralles et al., 2020).”
From Efficacy of an internet-based psychological intervention for problem gambling and gambling disorder: Study protocol for a randomized controlled trial (2021) · cites this paper as LaFreniere and Newman, 2016
The study had a dropout rate of only 11%, which was significantly lower than the typical range of 24-50% observed in mental health RCTs delivered via smartphones.
“Our study also had a dropout rate of only 11%, which was significantly lower than the typical range of 24–50% observed in mental health RCTs delivered via smartphones [97-99].”
From Treatment condition as a moderator and change in trait mindfulness as a mediator of a brief mindfulness ecological momentary intervention for generalized anxiety disorder (2024) · cites this paper as [97]
The citation is attached to the claimed typical 24–50% dropout range, not the citing authors’ own 11% rate. The source paper’s Procedure and Method Participants sections describe a mobile-phone-assisted trial and its participant retention, but do not report a typical dropout range for smartphone-delivered mental health RCTs (searched: 24–50%, dropout, attrition). (LLM, conf=0.76)
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Cho, S., Przeworski, A., & Newman, M. G. (2019) · Elsevier eBooks · doi:10.1016/b978-0-12-813004-9.00012-8 · Cited by 6 · see citing works
Self-citationZainal, N. H., & Newman, M. G. (2024) · European Psychiatry · doi:10.1192/j.eurpsy.2024.1750 · Cited by 3 · see citing works
“The fundamental basis for the SM control condition was drawn and modified from the rationale used in a recent brief app intervention [49, 50].”
MethodSelf-citationZainal, N. H., & Newman, M. G. (2024) · Psychological Medicine · doi:10.1017/s0033291724001958 · Cited by 3 · see citing works
Self-citationZainal, N. H., Tan, H. H., Hong, R. Y. S., & Newman, M. G. (2025) · JMIR Mental Health · doi:10.2196/67210 · Cited by 6 · see citing works
Self-citationZainal, N. H., & Newman, M. G. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.120963 · Cited by 2 · see citing works
Self-citationThe Use of Technology to Augment Clinical Care in Depression and Anxiety Disorders: An Evidence Map
Maher, A. R., Apaydin, E. A., Raaen, L. B., Motala, A., Shanman, R., & Hempel, S. (2019) · RAND Corporation eBooks · doi:10.7249/rr2177 · Cited by 2 · see citing works
Short-Term Efficacy of a Worry Postponement Intervention for Generalized Anxiety Disorder
Tallon, K. (2021) · doi:10.32920/ryerson.14653938.v1 · Cited by 2 · see citing works
Baik, S. Y., & Newman, M. G. (2023) · Elsevier eBooks · doi:10.1016/b978-0-323-91497-0.00264-2 · Cited by 2 · see citing works
Self-citationSchwob, J. T., & Newman, M. G. (2026) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2026.103160 · Cited by 1 · see citing works
Self-citationRinner, M. T. B., & Gloster, A. T. (2020) · doi:10.1002/9781119189909.ch2 · Cited by 1 · see citing works
Darharaj, M., Roshanpajouh, M., Amini, M., Shrier, L. A., & Habibi, M. (2023) · Internet Interventions · doi:10.1016/j.invent.2023.100669
Gérardy, M., Bogaert, L., Newman, M. G., Hallford, D. J., & Raes, F. (2026) · Behaviour Research and Therapy · doi:10.1016/j.brat.2026.105116
Self-citationTextor, L., Rico, M. W., Trozzolino, L., Rose, R., Bystritsky, A., Schraufnagel, T. J., Distler, M. G., & Khalsa, S. S. (2026) · Progress in brain research · doi:10.1016/bs.pbr.2026.09.007
- Authors
- LaFreniere, L. S., & Newman, M. G.
- Affiliations
- Pennsylvania State University (US)
- Corresponding author
- LaFreniere, Lucas S.
- Venue
- Depression and Anxiety
- Publisher
- Hindawi Limited
- Published
- 2016-04-07
- Volume
- 33
- Issue
- 9
- Pages
- 829-839
- ISSN
- 1091-4269 (ISSN-L)
- OpenAlex
- W2336137886
- Cited by
- 40
- References
- 70
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 7 · 2023: 10 · 2022: 1 · 2021: 4 · 2020: 5 · 2019: 4 · 2018: 3 · 2017: 1
- FWCI
- 3.79
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Depression and Anxiety (publishedVersion)
- PubMed (publishedVersion)
- SSRN Electronic Journal (submittedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Keywords
- generalized anxiety disorder, ecological momentary intervention, cognitive behavioral therapy, worry reduction, worry beliefs
- MeSH terms
- Adult, Anxiety Disorders, Female, Humans, Male, Psychotherapy, Brief, Surveys and Questionnaires, Self Care, Self Disclosure, Students, Therapy, Computer-Assisted, Writing, Cognitive Behavioral Therapy, Treatment Outcome, Stress Disorders, Traumatic, Acute, Young Adult, Text Messaging
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