Change in resting state functional connectivity following working memory training in individuals with repetitive negative thinking

BACKGROUND

Repetitive negative thinking (RNT) symptoms, which are characterized by pervasive, uncontrollable negative thoughts, are common in individuals with mood, anxiety, and traumatic stress disorders. Inability to regulate the contents of working memory is a hypothesized etiological factor in RNT, suggesting that training to improve working memory may be beneficial. This study examined the effects of working memory training on resting state functional connectivity (rsFC) in individuals with elevated RNT and whether such changes would be associated with clinical improvement.

METHODS

We conducted a secondary analysis of pre-post resting state data collected as part of a randomized controlled trial [NCT04912089] of working memory training interventions (n=42) compared to a waitlist control group (n=23). We hypothesized that individuals completing training would show increased rsFC between the two key intrinsic connectivity networks - default mode network (posterior cingulate cortex; PCC) and frontoparietal network (dorsolateral prefrontal cortex; dlPFC). We explored whether magnitude of rsFC change was associated with change in RNT symptom severity.

RESULTS

rsFC increased between the PCC and regions including frontal and parietal cortex in the training group relative to waitlist. Increased connectivity between the PCC and superior frontal cortex was associated with RNT symptom reduction.

CONCLUSIONS

These data provide evidence that working memory training can modulate neural circuitry at rest in individuals with RNT. Results align with accounts of working memory training effects on large-scale neurocircuitry changes and suggest that these changes may contribute to clinical promise of this type of intervention on transdiagnostic RNT symptoms.

The associations between repetitive negative thinking, insomnia symptoms, and sleep quality in adults with a history of trauma

BACKGROUND

Posttraumatic stress disorder (PTSD) and sleep disturbance are highly comorbid and repetitive negative thinking (RNT) is associated with both sleep disturbance and PTSD. However, few studies have examined the association between RNT and sleep disturbance in individuals exposed to trauma, with and without PTSD.

METHOD

Associations between trait-level and trauma-related RNT, insomnia, and sleep quality were investigated in a trauma-exposed MTurk (N = 342) sample. Additionally, PTSD symptom severity was tested as a moderator of the associations between RNT and insomnia and sleep quality.

RESULTS

Trait-level RNT predicted poorer sleep quality and greater insomnia, regardless of PTSD severity. Trauma-related RNT was also associated with greater insomnia, though the effect was moderated by PTSD severity such that it was significant for participants with low and moderate, but not severe, PTSD. Both trait- and trauma-related RNT were associated with several specific aspects of sleep quality, including: sleep disturbances, daytime dysfunction, use of sleep medications, sleep onset latency, and subjective sleep quality.

CONCLUSIONS

This study demonstrates significant associations linking RNT with insomnia and sleep disturbance in trauma-exposed individuals. Clinically, results suggest that it may be helpful to target both general and trauma-related RNT in sleep interventions for trauma-exposed individuals with insomnia.

Probability, cost, and interpretation biases' relationships with depressive and anxious symptom severity: differential mediation by worry and repetitive negative thinking

People high in depressive or anxious symptom severity show repetitive negative thinking, including worry and rumination. They also show various cognitive phenomena, including probability, cost, and interpretation biases. Since there is conceptual overlap between these cognitive biases and repetitive negative thinking - all involve thinking about potential threats and misfortunes - we wondered whether repetitive negative thinking could account for (mediate) these cognitive biases' associations with depressive and anxious symptom severity. In three studies, conducted in two languages and cultures, cost bias and (in two studies) interpretation bias only predicted symptom severity via worry and repetitive negative thinking; this suggests these biases are actually associated with repetitive negative thinking, rather than with symptoms. In contrast, probability bias showed direct relationships with depressive (all studies) and anxious (two studies) symptom severity, suggesting its relationships with symptoms are partly independent of repetitive negative thinking. These results show the value of studying relationships among the various cognitive features of psychopathology. Furthermore, new interventions which target cognitive biases in depression or anxiety must show that they can improve upon cognitive behavioural therapy, which is already widely available, targets both repetitive negative thinking and probability bias, and is highly effective.

Examining the relationship between subtypes of rumination and non-suicidal self-injury: A meta-analytic review

INTRODUCTION

Non-suicidal self-injury (NSSI) is a highly prevalent maladaptive behavior, often used to cope with intense negative affect. Rumination is an emotion regulation strategy that leads to fixation on and exacerbation of (typically) negative affective states. However, studies examining the relationship between rumination and NSSI have yielded mixed results, showing high degrees of heterogeneity.

METHODS

The present study conducted meta-analyses (k = 50) of the association between overall rumination and NSSI, and independent meta-analyses for each of four subtypes of rumination (general, depressive, brooding, reflection rumination). Potential moderators that may influence the magnitude of these relationships were also examined.

RESULTS

A small-to-moderate positive association between rumination and NSSI was found independent of rumination subtype. Moderating effects included NSSI outcome measure and study design for overall rumination and general rumination, respectively. Race was found to moderate the relationships between both brooding and depressive rumination and NSSI, though in inverse directions. An analysis of effect heterogeneity across studies suggested that undetected moderators may be present.

CONCLUSION

Results of this study support the relationships between rumination subtypes and NSSI and identify factors that may impact these relationships. Continued research is needed to understand this association, particularly in more varied subtypes of rumination and cognitive-affective moderators.

A systematic review of the relationship between generic and specific metacognitive beliefs and emotion dysregulation: A metacognitive model of emotion dysregulation

Although a probable association between metacognitive beliefs (also termed 'metacognitions') and emotion dysregulation has been suggested in the literature, the evidence is still sparse and inconclusive. The current study aims to present a comprehensive evaluation of the literature examining the association between metacognitive beliefs and emotion dysregulation. In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, a search was conducted on PubMed and Ebsco. A manual search of reference lists was also run. Search terms were 'metacognitions/metacognitive beliefs/positive metacognitive beliefs/negative metacognitive beliefs/cognitive self-consciousness/beliefs about the need to control thoughts/cognitive confidence/negative beliefs about thoughts concerning uncontrollability and danger/AND difficulties emotion regulation/emotion dysregulation'. A total of 19 studies met the inclusion criteria. In both non-clinical and clinical populations, a higher endorsement of dysfunctional metacognitive beliefs was found to be associated with emotion dysregulation and vice versa. A higher endorsement of metacognitive beliefs may be associated, either directly or via maladaptive forms of mental control (e.g., worry, rumination and suppression) to emotion dysregulation. Metacognitive beliefs could be the potential therapeutic target in clinical interventions aimed at reducing emotion regulation difficulties.

A Personalized, Transdiagnostic Smartphone Intervention (Mello) Targeting Repetitive Negative Thinking in Young People With Depression and Anxiety: Pilot Randomized Controlled Trial

BACKGROUND

Repetitive negative thinking (RNT) is a key transdiagnostic mechanism underpinning depression and anxiety. Using "just-in-time adaptive interventions" via smartphones may disrupt RNT in real time, providing targeted and personalized intervention.

OBJECTIVE

This pilot randomized controlled trial evaluates the feasibility, acceptability, and preliminary clinical outcomes and mechanisms of Mello-a fully automated, personalized, transdiagnostic, and mechanistic smartphone intervention targeting RNT in young people with depression and anxiety.

METHODS

Participants with heightened depression, anxiety, and RNT were recruited via social media and randomized to receive Mello or a nonactive control over a 6-week intervention period. Assessments were completed via Zoom sessions at baseline and at 3 and 6 weeks after baseline.

RESULTS

The findings supported feasibility and acceptability, with high rates of recruitment (N=55), uptake (55/64, 86% of eligible participants), and retention (52/55, 95% at 6 weeks). Engagement was high, with 90% (26/29) and 59% (17/29) of the participants in the Mello condition still using the app during the third and sixth weeks, respectively. Greater reductions in depression (Cohen d=0.50), anxiety (Cohen d=0.61), and RNT (Cohen d=0.87) were observed for Mello users versus controls. Mediation analyses suggested that changes in depression and anxiety were accounted for by changes in RNT.

CONCLUSIONS

The results indicate that mechanistic, targeted, and real-time technology-based solutions may provide scalable and effective interventions that advance the treatment of youth mental ill health.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12621001701819; http://tinyurl.com/4d3jfj9f.

Treatment of worry and comorbid symptoms within depression, anxiety, and insomnia with a group-based rumination-focused cognitive-behaviour therapy in a primary health care setting: a randomised controlled trial

Introduction

Repetitive negative thinking (RNT) has been described as a maintaining transdiagnostic factor for psychopathology within the areas of depression, anxiety and insomnia. We investigated the effects of rumination-focused cognitive-behaviour therapy (RF-CBT) in a group format at a primary health care centre on symptoms of depression, anxiety, insomnia, RNT, and quality of life. The participants presented clinical symptom levels of worry and at least two disorders among anxiety disorders, major depressive disorder, and insomnia disorder.

Methods

A randomised controlled superiority parallel arm trial was used. 73 participants were included and randomised in pairs to either group-administered RF-CBT or a waiting list condition. The primary outcomes were self-rated worry and transdiagnostic symptoms (depression, anxiety, and insomnia). Intention-to-treat analyses of group differences were conducted using linear mixed models. Adverse side effects and incidents were presented descriptively.

Results

Group RF-CBT significantly reduced self-reported insomnia at post-treatment and self-reported insomnia and depression at the 2 month-follow-up, relative to the wait-list control group. There was no significant difference in change in RNT, anxiety, or quality of life.

Discussion

The current study suggests that group-administered RF-CBT may be effective for insomnia and potentially effective for depression symptomatology. However, the study was underpowered to detect small and moderate effects and the results should therefore be interpreted with caution.

Intensity of repetitive negative thinking in depression is associated with greater functional connectivity between semantic processing and emotion regulation areas

BACKGROUND

Repetitive negative thinking (RNT), a cognitive process that encompasses past (rumination) and future (worry) directed thoughts focusing on negative experiences and the self, is a transdiagnostic construct that is especially relevant for major depressive disorder (MDD). Severe RNT often occurs in individuals with severe levels of MDD, which makes it challenging to disambiguate the neural circuitry underlying RNT from depression severity.

METHODS

We used a propensity score, i.e., a conditional probability of having high RNT given observed covariates to match high and low RNT individuals who are similar in the severity of depression, anxiety, and demographic characteristics. Of 148 MDD individuals, we matched high and low RNT groups (n = 50/group) and used a data-driven whole-brain voxel-to-voxel connectivity pattern analysis to investigate the resting-state functional connectivity differences between the groups.

RESULTS

There was an association between RNT and connectivity in the bilateral superior temporal sulcus (STS), an important region for speech processing including inner speech. High relative to low RNT individuals showed greater connectivity between right STS and bilateral anterior insular cortex (AI), and between bilateral STS and left dorsolateral prefrontal cortex (DLPFC). Greater connectivity in those regions was specifically related to RNT but not to depression severity.

CONCLUSIONS

RNT intensity is directly related to connectivity between STS and AI/DLPFC. This might be a mechanism underlying the role of RNT in perceptive, cognitive, speech, and emotional processing. Future investigations will need to determine whether modifying these connectivities could be a treatment target to reduce RNT.

Corrigendum: A multiple-baseline evaluation of acceptance and commitment therapy focused on repetitive negative thinking for comorbid generalized anxiety disorder and depression

[This corrects the article DOI: 10.3389/fpsyg.2020.00356.].

Effects of Induced Mindfulness at Night on Repetitive Negative Thinking: Ecological Momentary Assessment Study

BACKGROUND

Repetitive negative thinking (RNT) is a cognitive risk factor for various disorders. Although brief mindfulness-based interventions (MBIs; lasting 20-30 minutes or shorter) are effective tools to reduce RNT, the effect of a minimal (5-minute) MBI remains largely unknown.

OBJECTIVE

We investigated the acute changes in RNT induced by a 10-day minimal MBI (body scan before sleeping) using an ecological momentary assessment (EMA) administered during the MBI training phase. In addition, we examined longer-term effects on the postintervention and 2-month follow-up assessments for questionnaire-based RNT and psychological distress.

METHODS

A total of 68 participants (community sample, aged 18-55 years; n=58, 85% women) were randomly allocated to either the intervention group (n=35, 51%) or the no-training control group (n=33, 49%). Both groups completed a 10-day EMA phase of RNT, during which only the intervention group performed a daily 5-minute body scan before sleeping.

RESULTS

The intervention group showed a significantly larger reduction in questionnaire-based RNT than the control group at the follow-up assessment (for growth-curve modeling analysis [GMA], d_GMA=-0.91; P<.001), but this effect was not observed during the EMA phase or at the postintervention assessment. Furthermore, the intervention group showed significantly larger decreases in stress both at the postintervention (d_GMA=-0.78; P<.001) and follow-up (d_GMA=-0.60; P<.001) assessments than the control group. We found no intervention effects on depressive and anxiety symptoms.

CONCLUSIONS

A 5-minute body scan before sleeping reduces RNT and stress when continued for at least 10 days; however, the results suggest that this effect only appears with some time lag because no acute changes during and immediately after the intervention emerged for RNT.

The relationship between sleep disturbance and obsessive- compulsive symptoms: the mediation of repetitive negative thinking and the moderation of experiential avoidance

Background

Studies have found that sleep disturbance is associated with obsessive-compulsive symptoms. This study aimed to elaborate on the mediating and moderating mechanisms between these two variables. We hypothesized that repetitive negative thinking plays a mediating role in the relationship between sleep disturbance and obsessive-compulsive symptoms, and experiential avoidance plays a moderating role.

Method

This study included 639 Chinese adults. A questionnaire survey was used to assess sleep quality, obsessive-compulsive symptoms, experiential avoidance, repetitive negative thinking, and depression symptoms. A moderated mediation model was established.

Results

After controlling for depressive symptoms, repetitive negative thinking partially mediated the positive correlation between sleep disturbance and obsessive-compulsive symptoms. This indirect relationship was significant in individuals with lower experiential avoidance levels. Particularly, the relationship between sleep disturbance and repetitive negative thinking was significant among individuals with lower experiential avoidance levels, but not among individuals with higher experiential avoidance levels.

Conclusion

This study demonstrated that repetitive negative thinking partially mediated the impact of sleep disturbance on obsessive-compulsive symptoms. The findings suggest that when providing support to individuals with sleep disturbance and obsessive-compulsive symptoms, assessing their level of experiential avoidance is necessary for performing targeted interventions. Individuals with low experiential avoidance may benefit from a clinical intervention targeting repetitive negative thinking to improve sleep quality and obsessive-compulsive symptoms.

Trait repetitive negative thinking in depression is associated with functional connectivity in negative thinking state rather than resting state

Resting-state functional connectivity (RSFC) has been proposed as a potential indicator of repetitive negative thinking (RNT) in depression. However, identifying the specific functional process associated with RSFC alterations is challenging, and it remains unclear whether alterations in RSFC for depressed individuals are directly related to the RNT process or to individual characteristics distinct from the negative thinking process per se. To investigate the relationship between RSFC alterations and the RNT process in individuals with major depressive disorder (MDD), we compared RSFC with functional connectivity during an induced negative-thinking state (NTFC) in terms of their predictability of RNT traits and associated whole-brain connectivity patterns using connectome-based predictive modeling (CPM) and connectome-wide association (CWA) analyses. Thirty-six MDD participants and twenty-six healthy control participants underwent both resting state and induced negative thinking state fMRI scans. Both RSFC and NTFC distinguished between healthy and depressed individuals with CPM. However, trait RNT in depressed individuals, as measured by the Ruminative Responses Scale-Brooding subscale, was only predictable from NTFC, not from RSFC. CWA analysis revealed that negative thinking in depression was associated with higher functional connectivity between the default mode and executive control regions, which was not observed in RSFC. These findings suggest that RNT in depression involves an active mental process encompassing multiple brain regions across functional networks, which is not represented in the resting state. Although RSFC indicates brain functional alterations in MDD, they may not directly reflect the negative thinking process.

Combining transcranial direct current stimulation with group cognitive behavioral therapy developed to treat rumination: a clinical pilot study

Background

As part of repetitive negative thinking (RNT), rumination is a maladaptive cognitive response style to stress or negative mood which can increase the risk of depression and may prohibit complete recovery. Cognitive behavioral therapy (CBT) and transcranial direct current stimulation (tDCS) both proved to be effective in decreasing rumination. However, the combined effects of tDCS and CBT interventions on rumination have not yet been explored. The first aim of this pilot study is to investigate whether the combination of tDCS and CBT has an accumulating positive effect on modulating state rumination. The second aim is to assess the feasibility and safety profile of the proposed combined approach.

Method

Seventeen adults aged 32-60 years, suffering from RNT, were referred by their primary care professional to participate in an 8-week group intervention for RNT ("Drop It") comprising 8 sessions of CBT. Before each CBT session, patients underwent one double-blinded prefrontal active (2 mA for 20 min) or sham tDCS (anode over F3, cathode over the right supraorbital region) combined with an internal cognitive attention task focused on individual RNT, i.e., online tDCS priming. During each session, the Brief State Rumination Inventory was used to assess state rumination.

Results

A mixed effects model analysis revealed no significant differences between the stimulation conditions, weekly sessions, or their interaction in terms of state rumination scores.

Conclusion

Overall, the combination of online tDCS priming followed by group CBT was found to be safe and feasible. On the other hand, no significant additional effects of this combined approach on state rumination were established. Although our pilot study may have been too small to find significant clinical effects, future larger RCT studies on combined tDCS-CBT treatment protocols may reevaluate the selection of internal cognitive attention tasks and more objective neurophysiological measurements, consider the optimal timing of the combination (concurrently or sequentially), or may add additional tDCS sessions when following CBT.

Association between Bullying Victimization and Aggression in Lebanese Adolescents: The Indirect Effect of Repetitive Negative Thinking-A Path Analysis Approach and Scales Validation

(1) Background: The purpose of the present study was to validate the Perseverative Thinking Questionnaire (PTQ) and the Buss-Perry Aggression Questionnaire-Short Form (BPAQ-SF) and test whether repetitive negative thinking plays an indirect role in the relationship between bullying victimization and aggression among Lebanese adolescents. (2) Methods: This cross-sectional study was conducted between January and May 2022 and included 379 Lebanese adolescent students (64.9% females, mean age 16.07 years). (3) Results: The three-factor solution of the PTQ and the four-factor solution of the BPAQ-SF showed excellent model fit. PTQ mediated the association between bullying victimization and physical aggression, verbal aggression, hostility, and anger. (4) Conclusions: This study expands on previous research by showing that repetitive negative thinking, an impactful socio-cognitive factor for students' mental health, has a mediating (indirect) effect on the cross-sectional relationship between bullying victimization and aggression. This suggests that interventions aiming to prevent aggressive behaviors among adolescent students may be more effective if focused on repetitive negative thinking.

Minority stress, repetitive negative thinking, and internalizing symptoms in sexual minorites: Does cognitive content matter?

BACKGROUND

The Psychological Mediation Framework theorizes that repetitive negative thinking (RNT) mediates the relationship between minority stress and mental health, and this theory has been consistently supported by previous research. Yet, it is unclear whether the process or content of RNT is more important in the development of internalizing symptoms in sexual minorities. Consequently, the goal of the current study was to use structural equation modeling to determine whether there are significant indirect effects of repetitive negative thought content in the relationship between minority stress and internalizing psychopathology.

METHODS

Measures of RNT, internalizing symptoms, and proximal minority stress were completed online by 205 cisgender sexual minority adults. Structural equation modeling was used to examine indirect effects of proximal stress on internalizing symptoms through content-independent RNT, depressive rumination, and sexual orientation-related rumination.

RESULTS

Significant direct effects of proximal minority stress on internalizing symptoms were observed. Indirect effects of proximal stress on internalizing symptoms were observed for content-independent RNT and depressive rumination, but not sexual orientation-related rumination.

CONCLUSIONS

The current study provides evidence that the process and affective valence of RNT contributes more to internalizing symptoms in sexual minorities when compared with sexual orientation-related content. Theoretical and clinical implications are discussed.

The effect of psychological treatment on repetitive negative thinking in youth depression and anxiety: a meta-analysis and meta-regression

BACKGROUND

Depression and anxiety are prevalent in youth populations and typically emerge during adolescence. Repetitive negative thinking (RNT) is a putative transdiagnostic mechanism with consistent associations with depression and anxiety. Targeting transdiagnostic processes like RNT for youth depression and anxiety may offer more targeted, personalised and effective treatment.

METHODS

A meta-analysis was conducted to examine the effect of psychological treatments on RNT, depression and anxiety symptoms in young people with depression or anxiety, and a meta-regression to examine relationships between outcomes.

RESULTS

Twenty-eight randomised controlled trials examining 17 different psychological interventions were included. Effect sizes were small to moderate across all outcomes (Hedge's g depression = -0.47, CI -0.77 to -0.17; anxiety = -0.42, CI -0.65 to -0.20; RNT = -0.45, CI -0.67 to -0.23). RNT-focused and non-RNT focused approaches had comparable effects; however, those focusing on modifying the process of RNT had significantly larger effects on RNT than those focusing on modifying negative thought content. Meta-regression revealed a significant relationship between RNT and depression outcomes only across all intervention types and with both depression and anxiety for RNT focused interventions only.

CONCLUSION

Consistent with findings in adults, this review provides evidence that reducing RNT with psychological treatment is associated with improvements in depression and anxiety in youth. Targeting RNT specifically may not lead to better outcomes compared to general approaches; however, focusing on modifying the process of RNT may be more effective than targeting content. Further research is needed to determine causal pathways.

Associations between repetitive negative thinking and resting-state network segregation among healthy middle-aged adults

Background

Repetitive Negative Thinking (RNT) includes negative thoughts about the future and past, and is a risk factor for depression and anxiety. Prefrontal and anterior cingulate cortices have been linked to RNT but several regions within large-scale networks are also involved, the efficiency of which depends on their ability to remain segregated.

Methods

Associations between RNT and system segregation (SyS) of the Anterior Salience Network (ASN), Default Mode Network (DMN) and Executive Control Network (ECN) were explored in healthy middle-aged adults (N = 341), after undergoing resting-state functional magnetic resonance imaging. Regression analyses were conducted with RNT as outcome variable. Explanatory variables were: SyS, depression, emotional stability, cognitive complaints, age and sex.

Results

Analyses indicated that RNT was associated with depression, emotional stability, cognitive complaints, age and segregation of the left ECN (LECN) and ASN. Further, the ventral DMN (vDMN) presented higher connectivity with the ASN and decreased connectivity with the LECN, as a function of RNT.

Conclusion

Higher levels of perseverative thinking were related to increased segregation of the LECN and decreased segregation of the ASN. The dissociative connectivity of these networks with the vDMN may partially account for poorer cognitive control and increased self-referential processes characteristic of RNT.

Support from friends moderates the relationship between repetitive negative thinking and postnatal wellbeing during COVID-19

BACKGROUND

Increasing evidence has linked repetitive negative thinking (RNT) to postnatal depression and anxiety, yet the factors moderating this relationship have been minimally investigated. During the COVID-19 pandemic of 2020, social restrictions imposed to reduce viral transmission limited access to social support, which is critical to postnatal psychological wellbeing - potentially intensifying RNT.

OBJECTIVE

We examined whether perceived social support (from friends, family, and a significant other) played a moderating role in the relationship between RNT and maternal postnatal anxiety and depressive symptoms.

METHODS

A sample of women (N = 251) who had given birth in the preceding 12 months completed an online battery of standardised measures during the COVID-19 'lockdown' of May 2020.

RESULTS

As predicted, social support moderated the relationship between RNT and depression such that the association between RNT and depression was stronger for women who reported lower levels of social support. Interestingly, this finding emerged for social support from friends only; for support from family and significant other, social support did not play a moderating role. Further, and unexpectedly, overall social support did not moderate the relationship between RNT and postnatal anxiety, however, social support from friends was a significant moderator.

CONCLUSIONS

High levels of perceived social support from friends (but not family or significant others) buffered the effects of RNT on depression and anxiety during the postpartum period. Strategies to bolster peer social support may be a valuable inclusion in interventions to prevent and treat postnatal depression and anxiety.

Reciprocal Relations of Worry, Rumination, and Psychopathology Symptoms After Loss: A Prospective Cohort Study

Bereavement can precipitate symptoms of depression, prolonged grief disorder, and posttraumatic stress disorder. Targeting repetitive negative thought (i.e., worry, rumination) in treatment may help reduce post-loss psychopathology. Yet, evidence on longitudinal associations of depressive rumination and worry with post-loss psychopathology symptoms has been mixed and the directions of effects are still unclear. Recently bereaved adults (78% female) completed questionnaires assessing depressive rumination (brooding), worry, and depression, prolonged grief and posttraumatic stress symptoms 11 times in 1.5 month intervals. We applied random-intercept cross-lagged panel models (RICLPMs) to examine reciprocal within-person associations between worry and psychopathology symptoms, between rumination and these symptoms, and between worry and rumination. Main findings were that worry showed reciprocal relationships with psychopathology symptoms (although worry did not consistently predict prolonged grief symptoms). Depressive rumination was predicted by psychopathology symptoms, but not vice versa. Worry showed reciprocal relations with depressive rumination. Findings suggest that worry may be part of a downward spiral, enhancing psychopathology symptoms following loss, whereas depressive rumination is solely a consequence of such symptoms.

Cognition and Non-Suicidal Self-Injury: Exploring Relationships with Psychological Functions

OBJECTIVE

Non-suicidal self-injury (NSSI) is strongly associated with difficulties in emotion regulation, but its relationships with maladaptive cognitive processes are less clear.

METHOD

The current study examined relationships between self-reported NSSI (presence, number of methods, frequency, recency, duration, functions) and negative cognitive processes (rumination, worry, self-criticism, perceived burdensomeness, thwarted belongingness) among 1,357 undergraduates. Cognition variables were submitted to exploratory factor analysis (EFA), and relationships were examined between the resulting factors and NSSI history (among the full sample) and NSSI severity and functions (among those with a history of NSSI).

RESULTS

The EFA derived two higher order cognitive factors: repetitive negative thinking (RNT) and negative self-perception (NSP). Both RNT and NSP were significantly higher among participants with than those without a history of NSSI. Among those with NSSI, NSP, but not RNT, was positively related to lifetime NSSI frequency and number of methods, as well as recency (presence in the past 12 months) and total duration (in years) of NSSI engagement. Moreover, RNT and NSP were positively associated with aggregate intrapersonal (but not interpersonal) functions of NSSI. The two cognitive factors demonstrated differential relationships with the individual intrapersonal NSSI functions.

CONCLUSIONS

Higher order categories of cognitive risk factors may have unique relationships with functions and severity of NSSI, with possible implications for more targeted approaches to risk assessment and intervention.HighlightsNegative thinking and self-perception were higher in people who engage in NSSI.Negative self-perception was associated with greater NSSI severity.Negative thinking and self-perception had different relations to NSSI functions.

Repetitive Negative Thinking and Sexual Functioning in Portuguese Men and Women: A Cross-Sectional Study

Objective: Repetitive negative thinking (RNT) is a transdiagnostic process involved in the development and maintenance of emotional disorders that negatively affect sexual functioning. However, empirical evidence for the role of RNT on sexual functioning is still lacking. The current study aimed to investigate the role of RNT on sexual functioning in men and women by examining differences in RNT between men and women and between individuals with and without subclinical sexual difficulties. It also aimed to investigate the predictive role of RNT on sexual function indices in men and women. Methods: A total of 424 participants (270 women) completed online a sociodemographic questionnaire and Portuguese versions of the Persistent and Intrusive Negative Thoughts Scale, the Female Sexual Functioning Index, and the International Index of Erectile Function. Results: The main findings showed that women scored significantly higher than men on the RNT. Similarly, individuals with subclinical sexual difficulties scored significantly higher on the RNT compared with individuals without sexual difficulties. RNT was a statistically significant and negative predictor of sexual functioning in women and men. The role of RNT on sexual functioning in women and men was found, with men and women with subclinical sexual difficulties more likely to express persistent and intrusive negative thoughts compared with men and women without sexual difficulties. Conclusions: In summary, RNT appears to be a negative predictor of sexual functioning in both women and men, suggesting that individuals with more intrusive and negative persistent thoughts also have more difficulty in their sexual response.

Treatment experiences during a cognitive behaviour therapy group intervention targeting repetitive negative thinking: A qualitative study

OBJECTIVES

Treatment of repetitive negative thinking (RNT) focuses rather on individual than group cognitive behaviour therapy (CBT) treatment. Additionally, little is known on how clients experienced these interventions. This study investigates clients' experiences on participating in a CBT group intervention targeting RNT (RNT-G).

DESIGN

Of the 80 participants, 11 were randomly selected for an in-depth, semi-structured interview after treatment. Interviews focused on what participants experienced as important on group aspects, offered interventions, homework tasks, and possible changes.

METHODS

All participants were adults, diagnosed with major depressive disorder and/or generalized anxiety disorder and being currently in mental health care treatment. After transcribing the interviews, analyses were performed according to the guidelines of thematic analysis.

RESULTS

Four major themes were identified. First, the group format itself was experienced as an important factor of change. The experiences about the different offered interventions during the group formed a second theme. A third theme related to changes in family or professional life and dealing with RNT as a result of the intervention. Finally, group participation, social interactions, and mental health care treatment were experienced as mutually influencing during the intervention.

CONCLUSIONS

The results of this study shed some light on which treatment interventions were perceived as beneficial during the RNT-G and should therefore be emphasized in treatment. Further, they indicate that the treatment in a group format was experienced as helpful by the participants. Finally, a positive mutual influence between the group intervention and the ongoing individual treatment was experienced.

The relationship between repetitive negative thinking, sleep disturbance, and subjective fatigue in women with Generalized Anxiety Disorder

Objectives

Fatigue is a prominent symptom of Generalized Anxiety Disorder (GAD). However, the pathways contributing to elevated fatigue in GAD are poorly understood. Sleep disturbance, also prominent in GAD, only partially explains elevated fatigue in GAD. Repetitive negative thinking (RNT) is a cognitive feature of both GAD and sleep disturbance, and RNT has recently also been associated with elevated fatigue. Therefore, this study assessed whether elevated fatigue in GAD is accounted for by a combination of sleep quality and RNT.

Design

Between‐group, correlational design in 64 primarily university‐educated women with and without a GAD diagnosis.

Methods

Women completed self‐report questionnaires assessing RNT experienced in the past few days, previous night’s sleep quality, and current physical and mental fatigue. Hierarchical linear regressions were conducted to assess whether the relationship between GAD status and fatigue is accounted for by RNT and sleep quality.

Results

Women with GAD reported lower sleep quality, and higher RNT and physical and mental fatigue, compared to women without GAD. Sleep quality partly accounted for group differences in both types of fatigue (β’s > −0.4), whereas RNT fully accounted for group differences in both types of fatigue (β’s > 0.29). The relationship between RNT and both types of fatigue was fully accounted for by sleep quality (β’s > −0.39).

Conclusions

These findings indicate that heightened RNT amongst women with GAD may be associated with elevated physical and mental fatigue via its detrimental effects on sleep quality. Interventions that reduce RNT may help to alleviate fatigue symptoms in women with GAD.

Practitioner points

Women with Generalized Anxiety Disorder (GAD) have elevated fatigue and repetitive negative thinking (RNT), and poorer self‐reported sleep quality, relative to women without GAD.

Whereas sleep quality only partially accounts for elevated fatigue in GAD, RNT fully accounts for elevated fatigue, and the relationship between RNT and fatigue is fully accounted for by sleep quality.

These findings provide novel evidence that women with GAD may have elevated fatigue because of the detrimental effects of RNT on sleep.

These findings suggest that targeting RNT in treatment for GAD may help to reduce fatigue in GAD, by improving sleep quality.

Repetitive negative thinking is associated with impaired verbal learning but not executive functioning in individuals with eating disorders

Objective

Repetitive negative thinking (RNT) is an important symptom in the development and maintenance of eating disorders (EDs). RNT Research on RNT's effect on cognition in EDs is scarce. This investigation focused on associations between RNT and cognition in individuals with EDs.

Methods

Ruminative Response Scale (RRS) was used from Tulsa-1000 study (T-1000) data (eating disorders-ED, Major Depressive Disorder-MDD, and healthy subjects) who were propensity matched to examine associations with cognitive performance. RNT was examined across groups and we quantified the associations between scores for RNT, depression, executive function, and learning/memory from the T-1000 study. A linear regression analysis was conducted to determine predictors of disability.

Results

RNT was similar in ED and MDD participants, and more intense than in controls. RNT was significantly correlated with verbal learning/memory in the control (r = 0.514, p = 0.006) and ED groups (r = -0.447, p = 0.020), but this relationship had opposite slopes in either group. Increased RNT was associated with decreased verbal learning/memory ability in ED participants while in controls, increased RNT was associated with increased ability. Comorbid depression in the ED group acted as a potential moderator of the above relationship between RNT and EF. Among ED patients, depressive symptom severity was the best predictor of disability.

Discussion

The differential association of RNT with cognitive abilities in ED and MDD patients suggests depression is not a mediator of RNT-mediated cognitive dysfunction in EDs. This necessitates a better understanding of the mechanistic relationship between RNT and diverse types of cognitive functioning.

Infant carrying is associated with reduced maternal repetitive negative thinking and increased maternal mental health

INTRODUCTION

Mental disorders, such as postnatal depression, are common in mothers. Repetitive negative thinking has been identified as a cognitive factor underlying the resulting difficulties in mother-infant interactions.

METHOD

The present online survey investigated associations between infant carrying (baby-wearing) and maternal repetitive negative thinking and positive mental health.

RESULTS

Repetitive negative thinking was significantly lower, and positive mental health was significantly higher while carrying compared to overall levels. There were no relations between maternal mental health and frequency of carrying. Maternal activities during carrying are portrayed.

CONCLUSION

These results are the first indication that carrying could be a low threshold, easily administered intervention method for maternal mental health problems.

Bedtime repetitive negative thinking moderates the relationship between psychological stress and insomnia

Research suggests that psychological stress is associated with insomnia, but there is limited research on vulnerabilities that might amplify this association, particularly in college students. Based on a sample of 507 undergraduates, the current study demonstrates that the observed positive correlation between self-perceived stress and insomnia severity is moderated by the tendency to engage in repetitive negative thinking (RNT) at bedtime. Additionally, separate analyses of those who scored below/above the threshold for insomnia (non-insomniacs vs. insomniacs) revealed that the interaction between stress and these negative bedtime cognitions differed qualitatively between the two groups. In insomniacs, the stress-insomnia relationship was dampened for those with lower levels of bedtime RNT, but amplified for those with higher levels. For non-insomniacs, the stress-insomnia relationship was stronger for those with minimal bedtime RNT, while higher levels of bedtime RNT appeared to overshadow this association. To develop a better understanding of the contribution of stress and RNT to clinically relevant levels of insomnia, future studies should take into account the dissimilar patterns of moderation seen in non-insomniacs and insomniacs, either through prospective screening or separate analyses. Findings from the current study suggest that insomnia treatments that can simultaneously reduce stress and address bedtime RNT may be optimal.

Does repetitive negative thinking mediate the relationship between perfectionistic concerns and cognitive test anxiety?

BACKGROUND AND OBJECTIVES

Test anxiety, particularly cognitive test anxiety, is negatively associated with academic performance. Previous research has demonstrated that higher levels of perfectionistic concerns predict higher levels of cognitive test anxiety but has not explored potential mediators of this relationship. This study investigated whether repetitive negative thinking mediated the relationship between perfectionistic concerns and cognitive test anxiety in a non-clinical, academic sample.

METHODS

Participants were Australian university students (N = 129, 32 male, 94 female, 3 non-binary), aged between 18 and 53 (M = 23.96; SD = 6.88), recruited through convenience and snowball sampling. Participants completed an online questionnaire assessing demographics, repetitive negative thinking, perfectionistic concerns, and cognitive test anxiety.

RESULTS

Mediation analysis yielded a total model accounting for 43.5% of variance in cognitive TA. Perfectionistic concerns significantly accounted for 10.6% of variance direction (F(1, 127) = 12.21, p < .001, R2 = .106), and 32.5% indirectly through RNT (F(2,126) = 30.81, p < .001, R2 = .329).

CONCLUSIONS

Findings demonstrate that RNT significantly mediates the relationship between perfectionistic concerns and cognitive test anxiety in this sample. Importantly, these findings may direct future studies towards investigating the effectiveness of targeting repetitive negative thinking in interventions to mitigate levels of cognitive test anxiety.

Validation of the Child version of the Perseverative Thinking Questionnaire of repetitive negative thinking in young people with diagnosed depressive and anxiety disorders

This paper sought to provide the first validation of a transdiagnostic measure of repetitive negative thinking – the Perseverative Thinking Questionnaire‐Child version (PTQ‐C) – in young people diagnosed with anxiety and depressive disorders. Participants (N = 114) were 11‐ to 17‐year‐olds with complex and comorbid presentations seeking treatment through Child and Adolescent Mental Health Services. Confirmatory factor analyses best supported a three‐factor model for the PTQ‐C; however, hypotheses of both perfect and close fit were rejected, and a subsequent bifactor model suggested minimal unique variance for each subscale. Results demonstrated good internal consistency, convergent validity and divergent validity for the total score and three PTQ‐S subscales: core characteristics, perceived unproductiveness, and consumed mental capacity of negative repetitive thinking. PTQ‐C scores did not account for additional variance in anxiety symptoms once worry was considered, indicating that retention of a content‐specific measure may be warranted in clinical samples. Findings emphasize the importance of validating clinically relevant measures which were developed with subclinical populations in samples with diagnosed mental health disorders.

Child maltreatment and cognitive vulnerabilities: Examining the link to posttraumatic stress symptoms

Research attempting to identify pathways from childhood maltreatment to adulthood posttraumatic stress symptoms (PTSS) implicates cognitive vulnerabilities that may increase risk for mental health concerns. The present study examined two cognitive vulnerabilities and their relation to PTSS amongst individuals with and without childhood maltreatment histories: attentional control and repetitive negative thinking (RNT). This research surveyed college students (N = 376) on constructs of interest. Results revealed that attentional control and RNT demonstrated significant indirect effects on PTSS (95% CI =.0003, .0336 and 95% CI =.0643, .1857, respectively). Findings suggest that childhood maltreatment severity was related to decreased attentional control and increased RNT, which were then both related to increased PTSS. Interventions for increasing attentional control and decreasing RNT should be implemented and evaluated for young adults with early adversity currently experiencing PTSS.

Examining Working Memory Performance in Adult Psychosomatic Inpatients

Background

There is cumulating evidence that working memory (WM) processing is impaired in individuals suffering from a psychosomatic and a psychological disorder. However, it is unclear how repetitive negative thinking (RNT), depressive symptoms, and patient characteristics (i.e., age and incapability to work) contribute to WM impairments. The present study examines how these factors affect WM performance in highly distressed adult psychosomatic inpatients.

Methods

Seventy-six inpatients (M _age = 52.7, SD = 8.4) from a psychosomatic rehabilitation clinic performed a two-block WM updating task, with accuracy and reaction time as indicators of WM functioning.

Results

Multivariate mixed effect model results show that accuracy and reaction time significantly decreased from WM Block 1 to WM Block 2. Higher levels of RNT, more severe depressive symptoms and higher age were associated with worse WM accuracy in Block 1. None of these variables were significantly associated with WM reaction time (in Block 1).

Conclusion

From a clinical perspective, the results suggest that screening for the presence of high RNT levels, severe depressive symptoms or higher age may help to identify patients with impaired WM functioning and to intervene on these important patient characteristics early in the rehabilitation process.

Repetitive negative thinking, metacognitive beliefs, and their interaction as possible predictors for problematic cannabis use

The metacognitive formulation of addictive behaviours considers repetitive negative thinking (RNT) and metacognitive beliefs as two important processes involved in the development and maintenance of addictive behaviours. To date, very limited research has investigated the implication of these processes in problematic cannabis use. The present study was aimed at exploring the association between RNT, metacognitive beliefs, and cannabis use in a sample of 157 problematic cannabis users. Participants were administered measures of cannabis use severity, RNT, metacognitive beliefs, anxiety, and depression. Multiple regression analysis showed that metacognitive beliefs (cognitive confidence, beliefs about the need to control thought, and cognitive self-consciousness) were independent predictors of problematic cannabis use and related problem severity when controlling for RNT and negative affect (anxiety and depression). Furthermore, RNT predicted problematic cannabis use severity only for users with low levels of negative beliefs about thoughts concerning uncontrollability and danger. These data suggest that metacognitive beliefs and RNT may be two relevant cognitive processes for understanding problematic cannabis use. More generally, it enables the consideration of cannabis use from the perspective of self-regulation theories, and more specifically cognitive regulation, thus offering several theoretical and clinical implications.

Measurement Invariance of Disorder-Specific and Transdiagnostic Measures of Repetitive Negative Thinking

BACKGROUND

Repetitive negative thinking is conceptualized to be a transdiagnostic process linked to the development and maintenance of psychopathology. Prior research distinguishes between disorder-specific exemplars (worry, rumination) and transdiagnostic measures of repetitive negative thinking with differences across disorders reported. However, establishing the measurement invariance of these measures is necessary to support meaningful comparisons across clinical groups.

METHOD

Bayesian structural equation modelling was used to assess the approximate invariance of the Ruminative Response Scale, Penn State Worry Questionnaire, and the Repetitive Thinking Questionnaire across individuals with a principal diagnosis of either depressive disorder, social anxiety disorder, or generalized anxiety disorder.

RESULTS

All scales demonstrated approximate measurement invariance across the three disorder groups. The depressive disorder group reported a higher level of rumination than the generalized anxiety disorder group (Δµ = 0.25, 95% Credibility Interval [0.06, 0.45]), with no difference between the generalized anxiety disorder and social anxiety disorder groups. The depressive disorder and generalized anxiety disorder groups did not differ in their levels of trait repetitive negative thinking, but the social anxiety disorder group was markedly lower than the generalized anxiety disorder group (Δµ = -0.21 [-0.37, -0.05]). Similarly, levels of worry did not differ between the generalized anxiety disorder and depressive disorder group but were lower in the social anxiety disorder group than the generalized anxiety disorder group (Δµ = -0.23 [-0.41, -0.06]).

CONCLUSIONS

The Ruminative Response Scale, Penn State Worry Questionnaire, and Repetitive Thinking Questionnaire are measuring trait repetitive negative thinking in a consistent manner across individuals with a principal diagnosis of depressive disorder, social anxiety disorder, or generalized anxiety disorder. This supports their use in transdiagnostic contexts and indicates that it is appropriate to directly compare the scores on these measures between diagnostic groups.

Repetitive Negative Thinking and Eating Disorders: A Meta-Analysis of the Role of Worry and Rumination

The role of worry and rumination in eating disorders (EDs) is controversial. This meta-analysis of the literature is aimed at clarifying the relationship between repetitive negative thinking (RNT) and EDs. In accordance with the PRISMA criteria, a comprehensive search of the literature was conducted on PubMed and PsycInfo from inception to March 2021. Search terms: “eating disorder/anorexia/bulimia/binge eating disorder” AND “worry/rumination/brooding/repetitive thinking”. A manual search of reference lists was also run. Forty-three studies were included. RNT was found to be associated with anorexia, bulimia, and binge eating disorder. A moderating effect was found for “presence/absence ED diagnosis” and “subtype of ED symptom”. ED patients showed higher RNT than the general population. No differences were observed for age or between worry and rumination in the magnitude of their association with EDs.

Adverse childhood experiences and repetitive negative thinking in adulthood: A systematic review

BACKGROUND

It has been proposed that repetitive negative thinking (worry and rumination) may be more common among adults who have been exposed to childhood adverse experiences, leading to emotional disorders and other adverse outcomes. The current study aims to present a comprehensive evaluation of the literature examining the relationship between the exposure to childhood adversities, repetitive negative thinking and clinical outcomes in adulthood.

METHODS

In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, a search was conducted on PubMed and Ebsco. A manual search of reference lists was also run. Search terms were 'childhood adversity/childhood abuse/childhood neglect/early loss event AND worry or rumination'.

RESULTS

A total of 18 studies met the inclusion criteria. In both non-clinical and clinical populations, worry and rumination seem to be common among adults exposed to childhood abuse or childhood neglect. Among adults who have been exposed to childhood adversities, rumination seems to be associated with worse clinical outcomes such as severe psychiatric symptoms, depression, dysphoria, suicidal ideation, cognitive complaints, post-traumatic stress symptoms and aggression.

CONCLUSION

Early experiences of abuse and neglect may be associated with a tendency to engage in repetitive negative thinking, such as worry and rumination, in adulthood. Among adults, with a history of childhood adversities, tailored treatment to reduce repetitive negative thinking should be considered.

The Association Between Maladaptive Metacognitive Beliefs and Emotional Distress in People Living With Amyotrophic Lateral Sclerosis

OBJECTIVE

Approximately half of all people living with amyotrophic lateral sclerosis (ALS) experience persistent or recurrent emotional distress, yet little is known about the psychological processes that maintain emotional distress in this population. The self-regulatory executive functioning (S-REF) model specifies that maladaptive metacognitive beliefs and processes are central to the development and maintenance of emotional distress. This study explored whether maladaptive metacognitive beliefs are associated with emotional distress after controlling for demographic factors, time since diagnosis, and current level of physical functioning.

DESIGN

In a cross-sectional design, 75 adults with a diagnosis of ALS completed self-report questionnaires. Participants had a mean age of 60.40 years, mean duration of symptoms 63.92 months, and male:female gender ratio of 14:11.

MAIN OUTCOME MEASURES

Questionnaires assessed emotional distress (HADS, adapted for ALS), physical functioning (ALSFRS-R), repetitive negative thinking (RTQ-10), metacognitive beliefs (MCQ-30), and demographic factors.

RESULTS

Maladaptive metacognitive beliefs explained additional variance in emotional distress after controlling for age, gender, time since diagnosis, physical functioning, and repetitive negative thinking. Repetitive negative thinking partially mediated the relationships between positive and negative metacognitive beliefs and emotional distress.

CONCLUSIONS

These data support the utility of the metacognitive model in understanding emotional distress in people with ALS. Examination of the temporal relationship between maladaptive metacognitive beliefs and emotional distress in people living with ALS may help to guide the development of therapeutic approaches.

Stressors, Repetitive Negative Thinking, and Insomnia Symptoms in Adolescents Beginning High School

OBJECTIVE

Although the first year of high school may represent a particularly stressful time for adolescents, no research addresses how stressors are related to insomnia symptoms during this time. Thus, we examined how stress relates to concurrent and prospective insomnia symptoms in adolescents beginning high school (Aim 1). Additionally, we assessed repetitive negative thinking (RNT) as a mediator (Aim 2). We also evaluated whether the pattern of associations differed for boys and girls (Aim 3).

METHODS

Adolescents (N = 502; M age = 14.22 years; 58.2% girls; 91.2% Hispanic/Latinx) completed questionnaires about stressors related to beginning high school (e.g., school performance, peer pressure), family support, RNT, and insomnia symptoms at the beginning and end of their first year of high school. Multiple group structural equation models assessed relationships between these variables and evaluated differences between boys and girls.

RESULTS

School/leisure conflict and low family support were directly associated with insomnia symptoms at both times, and RNT mediated these relationships in both boys and girls. In girls, peer pressure and low family support were indirectly associated with Time 1 and Time 2 insomnia symptoms via RNT. In boys, school performance was indirectly associated with Time 1 and Time 2 insomnia symptoms via RNT.

CONCLUSIONS

Stressful experiences at the beginning of high school negatively affect sleep in adolescents both in the short and long term. Pediatric psychologists should educate adolescents and their parents about the risk of sleep problems during this time period and provide strategies for stress management and for proper sleep hygiene.

A Transdiagnostic Approach to Sexual Distress and Sexual Pleasure: A Preliminary Mediation Study with Repetitive Negative Thinking

Sexual distress is a core characteristic of sexual dysfunction; however, little is known about its correlates. In the current study, we aimed to contribute to the understanding of both sexual distress and its positive counterpart, sexual pleasure, by taking a transdiagnostic approach to sexual distress using two types of repetitive negative thinking: worry and rumination. Because sexual activity mostly occurs in a dyadic context, we also looked at the potential mediating effect of co-worry and co-rumination, and we used them as mediators. Our preliminary exploratory quantitative study used a cross-sectional design, with a sample of 206 partnered heterosexual people. We used path analysis with parallel mediation, with structural equation modelling being performed using lavaan designed for R environment. Overall, our results show that repetitive negative thinking is associated with both sexual distress and sexual pleasure, and that neither co-rumination nor co-worry mediates these associations. The exception is the indirect effect of rumination on sexual pleasure that is mediated by co-rumination. These results demonstrate that a transdiagnostic approach to sexual distress is a new field worth exploring, and they contribute to establishing the relevance of a cognitive approach to sexual dysfunction.

Gender differences in avoidance and repetitive negative thinking following symptom provocation in men and women with spider phobia

OBJECTIVES

Women's greater prevalence of anxiety disorders compared to men is widely assumed to be partly due to gender differences in cognitive and behavioural factors that perpetuate anxiety, such as repetitive negative thinking (RNT) and avoidance. However, past studies assessing this assumption have not controlled for gender differences in baseline symptom severity, the type of stressful life experiences against which RNT and avoidance are measured, or emotional reactivity to these experiences.

DESIGN

Using a two-group design, the present study controlled for these confounds by comparing avoidance and RNT in relation to a controlled symptom provocation task in spider phobic men and women with equivalent spider fear severity on the Fear of Spiders Questionnaire.

METHODS

Participants engaged in a behavioural approach test (BAT) involving a live spider, during which they were assessed for avoidance (physical proximity to the spider) and subjective distress. Two weeks later, participants reported on their levels of negative affect and RNT experienced during the preceding weeks in relation to the BAT.

RESULTS

Women exhibited greater avoidance and reported greater RNT than men, despite reporting comparable distress and negative affect. Gender remained a significant predictor of avoidance when accounting for distress and also remained a significant predictor of RNT when accounting for depressive symptoms and negative affect.

CONCLUSIONS

These results provide in vivo evidence that heightened avoidance and RNT may perpetuate anxiety symptoms in women independently of gender differences in symptom severity, daily experiences, or emotional reactivity.

PRACTITIONER POINTS

Following symptom provocation, men and women with spider phobia differ in cognitive and behavioural coping responses. Women exhibit greater avoidance and repetitive negative thinking than men, and these differences are not attributable to gender differences in symptom severity or emotional reactivity. These findings provide novel evidence for gender differences in maintaining factors that perpetuate anxiety disorders whilst accounting for confounding factors present in prior research.

Social anxiety disorder in children: investigating the relative contribution of automatic thoughts, repetitive negative thinking and metacognitions

BACKGROUND

Social anxiety disorder (SAD) is common in youths. However, our understanding of SAD in children is inferior to that of SAD in adolescents or adults, and it is unclear if known adult SAD maintenance mechanisms may also operate in children with SAD.

AIM

The paper sets out to investigate the specificity of positive automatic thoughts, social threat negative automatic thoughts, repetitive negative thinking, positive and negative metacognitions in predicting SAD symptoms and diagnoses in clinically anxious children.

METHOD

We enrolled 122 clinically anxious children aged 7-13 years; of these, 33 had an SAD diagnosis.

RESULTS

SAD symptoms correlated positively with social threat negative automatic thoughts, repetitive negative thinking, and negative metacognitions, and negatively with positive automatic thoughts. Linear regression indicated that, of these variables, only social threat negative automatic thoughts predicted social anxiety symptoms. Logistic regression indicated that social threat negative automatic thoughts, a higher number of diagnoses and negative metacognitive beliefs specifically predicted the presence of SAD diagnosis.

CONCLUSIONS

Our findings suggest that content-specific social threat negative automatic thoughts was the only variable that specifically distinguished both higher levels of social anxiety symptoms and diagnoses.

Restrained Eating and Vegan, Vegetarian and Omnivore Dietary Intakes

There are a significant number of studies on cognitive restraint among individuals with varying dietary patterns. Although most research has found that vegetarians report higher levels of cognitive restraint compared to non-vegetarians, many studies have contributed inconsistent results. The aim of the current study, therefore, was to assess any differences between groups with varying dietary patterns on cognitive restraint and other disordered eating pattern. The second objective was to examine determinants of cognitive restraint in individuals adhering to a vegan diet, a vegetarian diet and an omnivore diet. Two-hundred and fifty-four participants with varying dietary patterns completed the Three-Factor Eating Questionnaire, the Perseverative Thinking Questionnaire and the Eating Habits Questionnaire. Our results indicated that both vegetarian and vegan groups showed a significantly lower cognitive restraint, lower emotional eating and lower uncontrolled eating than those who followed an omnivorous diet. In addition, these both groups following a plant-based diet have shown more cognitions, behaviours and feelings related to an extreme focus on healthy eating (orthorexia nervosa) than group following an omnivorous diet. There were no significant differences between the groups in perseverative thinking. Core characteristics of repetitive negative thinking was a significant predictor of cognitive restraint in vegans. Feeling positively about healthy eating predicted cognitive restraint among vegetarians. Problems associated with healthy eating and feeling positively about healthy eating predicted cognitive restraint among individuals following an omnivorous diet. Knowledge of predictors of cognitive restraint may serve as a psychological intervention goal or psychoeducation goal among individuals with varying dietary patterns.

Relationship between life skills, repetitive negative thinking, family function, and life satisfaction in attempted suicide

BACKGROUND

Impaired life skills, family dysfunction, negative thinking and low life satisfaction may predispose to suicidal behavior. There is paucity of study that examined these variables in suicide attempt.

AIMS

This study was conducted to know the levels and the relationships of these variables in attempted suicide.

SETTINGS AND DESIGN

Hospital-based cross-sectional.

MATERIALS AND METHODS

In this hospital-based cross-sectional study, 328 participants with a history of attempted suicide were assessed using socio-demographic and clinical pro forma, life skills profile (LSP), perseverative thinking questionnaire (PTQ), satisfaction with life scale (SLS), and family assessment device (FAD) after obtaining informed consent.

STATISTICAL ANALYSIS

Descriptive statistics, Mann-Whitney U and Kruskal-Wallis-H test and regression analysis.

RESULTS

Results revealed a mean scores on PTQ, LSP, SLS, and FAD to be 29.93 (standard deviation [SD] =13.5), 21.32 (SD = 13.5), 15.71 (SD = 6.8), and 26.46 (SD = 4.57), respectively. In linear regression analysis (R ² = 0.815, df = 3, F = 475.715, P = 0.001), LSP score had a statistically significant positive association with PTQ score (beta = 0.861, t = 32.76, P = 0.001) and FAD score (beta = 0.068, t = 2.79, P = 0.0046); while negative association with SLS score (beta = -0.078, t = -2.92, P = 0.004).

CONCLUSIONS

The study findings suggest of impaired life skills, life dissatisfaction, impaired family function, and elevated repetitive negative thinking pattern in attempted suicide. Better life skills have a positive association with higher life satisfaction, family function, and low repetitive thinking and thus seem to have a protective effect against suicidal behavior in the population.

A Multiple-Baseline Evaluation of Acceptance and Commitment Therapy Focused on Repetitive Negative Thinking for Comorbid Generalized Anxiety Disorder and Depression

Repetitive negative thinking (RNT) is a core feature of generalized anxiety disorder (GAD) and depression. Recently, some studies have shown promising results with brief protocols of acceptance and commitment therapy (ACT) focused on RNT in the treatment of emotional disorders in adults. The current study analyzes the effect of an individual, 3-session, RNT-focused ACT protocol in the treatment of severe and comorbid GAD and depression. Six adults meeting criteria for both disorders and showing severe symptoms of at least one of them participated in the study. A delayed multiple-baseline design was implemented. All participants completed a 5-week baseline without showing improvement trends in emotional symptoms (Depression Anxiety and Stress Scale - 21; DASS-21) and pathological worry (Penn State Worry Questionnaire; PSWQ). The ACT protocol was then implemented, and a 3-month follow-up was conducted. Five of the six participants showed clinically significant changes in the DASS-21 and the PSWQ. The standardized mean difference effect sizes for single-case experimental design were very large for emotional symptoms (d = 3.34), pathological worry (d = 4.52), experiential avoidance (d = 3.46), cognitive fusion (d = 3.90), repetitive thinking (d = 4.52), and valued living (d = 0.92 and d = 1.98). No adverse events were observed. Brief, RNT-focused ACT protocols for treating comorbid GAD and depression deserve further empirical tests.

Examining the Interrelation Among Change Processes: Decentering and Anticipatory Processing Across Cognitive Behavioral Therapy for Social Anxiety Disorder

As evidence grows supporting certain mechanisms of change in psychological treatments and we improve statistical approaches to measuring them, it is important that we also explore how mechanisms and processes are related to each other, and how they together affect treatment outcomes. To answer these questions about interrelating processes and mechanisms, we need to take advantage of frequent assessment and modeling techniques that allow for an examination of the influence of one mechanism on another over time. Within cognitive behavioral therapy, studies have shown support for both decentering, the ability to observe thoughts and feelings as objective events in the mind, and anticipatory processing, the repetitive thinking about upcoming social situations, as potentially related mechanisms of change. Therefore, the current study examined weekly ratings of decentering and a single-item anticipatory processing question to examine the interrelation among these change mechanisms in 59 individuals who received a 12-weeks of Cognitive Behavioral Group Therapy for social anxiety disorder. Overall, these results found that both anticipatory processing and decentering changed over the course therapy for clients. Change in both anticipatory processing and decentering was related to outcome. The bivariate latent difference score analysis showed that anticipatory processing was a leading indicator of change in decentering, but not the reverse, indicating that change in anticipatory processing is leading to change in decentering. It may be that with the focus on cognitive reappraisal in this treatment, that reducing anticipatory processing is freeing up the cognitive resources for decentering to occur.

Repetitive Negative Thinking, Depressive Symptoms, and Cortisol in Cancer Caregivers and Noncaregivers

OBJECTIVES

To examine the effect of informal cancer caregiving and repetitive negative thinking (RNT) on depressive symptoms and salivary cortisol levels.

SAMPLE & SETTING

The sample was recruited from a hospital bone marrow unit and caregiver support organizations. It included 60 informal cancer caregivers (52% partners) of individuals with cancer who provided care for a median of 27.5 hours per week for 12 months, and 46 noncaregiver participants.

METHODS & VARIABLES

In this cross-sectional study, participants completed questionnaires assessing RNT and depressive symptoms and provided saliva samples to measure cortisol levels.

RESULTS

Cancer caregiving and RNT, but not the interaction, were associated with more depressive symptoms. RNT, but not cancer caregiving, was associated with salivary cortisol. A disordinal interaction effect suggests that cancer caregiving was associated with lower cortisol levels, and RNT in noncaregivers was associated with higher cortisol levels.

IMPLICATIONS FOR NURSING

Given that RNT is related to depressive symptoms and cortisol, connecting cancer caregivers who experience RNT to resources and the development and evaluation of brief nurse-led interventions to reduce RNT in informal cancer caregivers seems warranted.

Does Repetitive Negative Thinking Influence Alcohol Use? A Systematic Review of the Literature

Over the past 20 years, researchers have used various methodologies to assess different forms of repetitive negative thinking (RNT) and their influence on alcohol consumption. Contrasting results between clinical and general populations were observed. To summarize the current literature on RNT and alcohol use, a systematic review was conducted according to the Preferred Reporting for Systematic Review and Meta-Analysis (PRISMA) guidelines (Moher et al., 2009). Among the 27 included studies, the seven conducted among patients with alcohol use disorder (AUD) and the three focusing on other adult samples demonstrated a strong positive association between RNT and alcohol use or alcohol-related problems, regardless of the form of RNT. The results were more heterogeneous in the 17 studies conducted among adolescents and students, leading the authors to conclude that the results varied as a function of the severity of alcohol use. The results of this study suggest to focus on RNT from a transdiagnostic perspective in AUD. This processual approach may improve AUD treatment and relapse prevention. Finally, some gaps in the literature must be addressed: (1) the gender differences in the link between RNT and alcohol use and (2) the specific influence of RNT on alcohol use among young adults.

Concrete vs. Abstract Processing in Repetitive Negative Thinking: Distinct Functional Effects on Emotional Reactivity and Attentional Control

Repetitive negative thinking (RNT) is a transdiagnostic process linked to emotional regulation impairment and involved in mood, anxiety, eating disorders and addictions. Attentional disengagement impairment is one of the factors hypothesized to be responsible for the recurrent and uncontrollable character of RNT. The aim of the present study was to empirically test this hypothesis with evaluation of disengagement from negative and RNT-related stimuli separately. Sixty participants were randomly allocated to one of three experimental conditions: abstract RNT, concrete RNT, and control condition (distraction). The change in their negative affect (PANAS) and their attentional disengagement impairment (exogenous cueing task) were measured. The analysis revealed that participants in abstract RNT condition presented higher emotional reactivity comparing to concrete or distraction conditions. The results indicated no differences between induction conditions in attentional disengagement. However, participants after concrete RNT induction had longer mean response times in exogenous cueing task comparing to control induction suggesting that they detected presented stimuli slower than participants in control condition. The results raised an important, from clinical point of view, question of distinctive impact of two types of RNT on emotional reactivity and attentional processes.

Assessing Beliefs Underlying Rumination About Pain: Development and Validation of the Pain Metacognitions Questionnaire

Metacognitions, which are beliefs about our own thinking processes, can modulate worry and rumination and thereby influence emotional distress. This study aimed to develop a self-report measure of unhelpful pain-related metacognitions which might serve as a clinical and research tool to better understand pain catastrophizing, a significant risk factor for adverse pain outcomes. Two phases of validation are presented. Phase 1 reports on how the Pain Metacognitions Questionnaire (PMQ) was empirically developed through a qualitative study of 20 people with chronic back (n = 15) or knee (n = 5) pain in secondary or tertiary care and then validated in a large internet sample of people experiencing pain (N = 864). Rasch analysis yielded a 21-item scale with two dimensions (positive and negative metacognition) assessing how useful and problematic people believe rumination about pain to be, respectively. In Phase 2, further validation using a new sample (N = 510) replicated initial findings. Both PMQ subscales have good retest reliability (r = 0.76, r = 0.72) and internal consistency (0.86, 0.87). They correlate negatively with mindfulness and positively with pain intensity, disability, anxiety, depression, catastrophizing, rumination, and metacognition. The PMQ also predicts unique variance in catastrophizing when other variables are controlled and predicts 'patient' status for pain catastrophizing. Sensitivity analysis yielded preliminary suggestions for clinically meaningful cut-offs. Unhelpful pain metacognitions can be validly and reliably measured using a self-report instrument. Future studies using the PMQ might shed new light on pain-related thinking processes to develop better interventions for people prone to worry and rumination about their pain.

Psychometric Properties and Measurement Invariance Across Gender and Age-Group of the Perseverative Thinking Questionnaire-Children (PTQ-C) in Colombia

Recent research has found that repetitive negative thinking (RNT) is an important transdiagnostic process both in adult and child psychopathology. This finding has led some authors to design content-independent measures of RNT that can be administered across disorders. One of these instruments is the Perseverative Thinking Questionnaire (PTQ) and its version for children (PTQ-C). This study presents the Spanish translation of the PTQ-C and its psychometric analysis in a sample of 1,127 Colombian children and adolescents (8-18 years old). All items obtained good discrimination indexes, and internal consistency was excellent (.93). A cross-validation study was conducted to analyze the factor structure of the PTQ-C, which strongly supported the one-factor structure. Measurement invariances across gender and age-group (8-12 and 13-18 years old) were also found. The PTQ-C scores for older boys were lower than for younger boys, whereas the inverse pattern was found for girls. The PTQ-C showed strong correlations with measures of pathological worry, emotional symptoms, and psychological inflexibility. In conclusion, the Spanish translation of the PTQ-C appears to be a valid and reliable measure of RNT.

Neural Correlates of Cognitive-Attentional Syndrome: An fMRI Study on Repetitive Negative Thinking Induction and Resting State Functional Connectivity

Aim

Cognitive-attentional syndrome (CAS) is the main factor underlying depressive and anxiety disorders in the metacognitive approach to psychopathology and psychotherapy. This study explore neural correlates of this syndrome during induced negative thinking, abstract thinking, and resting states.

Methods

n = 25 people with high levels of CAS and n = 33 people with low levels of CAS were chosen from a population-based sample (N = 1225). These groups filled-in a series of measures of CAS, negative affect, and psychopathology; they also underwent a modified rumination induction procedure and a resting state fMRI session. Resonance imaging data were analyzed using static general linear model and functional connectivity approaches.

Results

The two groups differed with large effect sizes on all used measures of CAS, negative affect, and psychopathology. We did not find any group differences in general linear model analyses. Functional connectivity analyses showed that high levels of CAS were related to disrupted patterns of connectivity within and between various brain networks: the default mode network, the salience network, and the central executive network.

Conclusion

We showed that low- and high-CAS groups differed in functional connectivity during induced negative and abstract thinking and also in resting state fMRI. Overall, our results suggest that people with high levels of CAS tend to have disrupted neural processing related to self-referential processing, task-oriented processing, and emotional processing.

Could repetitive negative thinking interfere with corrective learning? The example of anorexia nervosa

Identifying processes that may interfere with corrective learning during treatments for anorexia nervosa (AN) may help to improve the effectiveness of existing interventions. We propose that certain cognitive processes characteristic of the AN temperament may help explain previous findings in AN suggesting difficulty updating previously learned associations and learning from feedback. Specifically, we hypothesize that engagement in repetitive negative thinking (RNT), including worry and rumination, could interfere with corrective learning that is critical to the success of behavioral treatments. In doing so, we draw from existing work in anxiety and mood disorders linking RNT to the maintenance of symptoms and poorer response to cognitive-behavioral treatments. Next, we outline hypothesized mechanisms through which engagement in RNT before, during, and after exposure to aversive stimuli could interfere with learning in AN. We then provide recommendations for how these hypothesized associations could be tested in future research. Although prior work has suggested that RNT processes are common among individuals with AN, this work has been primarily descriptive in nature. We propose that extending this work through direct examination of the impact of active engagement in RNT on corrective learning could aid in identifying AN maintenance processes that could be explicitly targeted in treatment.