Rumination and Worry: Factor Analysis of Self-Report Measures in Depressed Participants

Experience sampling methodology study of anxiety and depression in adolescents with epilepsy: The role of metacognitive beliefs and perseverative thinking

Emotional distress is common in young people with epilepsy (YPwE). According to the Self-Regulatory Executive Function (S-REF) model, maladaptive metacognitive beliefs and perseverative thinking are fundamental in the development and maintenance of emotional distress. As emotional distress and perseverative thinking can highly fluctuate over short intervals in YPwE, it is important to account for this variability when testing the utility of psychological models. Experience sampling methodology (ESM) was therefore used to explore the momentary relationship between metacognitive beliefs, perseverative thinking, and emotional distress in YPwE. Eighteen participants diagnosed with epilepsy (aged 12-17 years) completed the 10-day ESM period. Participants were prompted to complete the ESM assessment five times daily. The ESM assessment assessed participant's momentary levels of metacognitive beliefs, perseverative thinking (i.e., worry and rumination), and emotional distress (i.e., anxiety and depression). A series of multilevel regression analyses indicated that metacognitive beliefs were significantly positively associated with worry, rumination, anxiety and depression. After controlling for worry and rumination, respectively, metacognitive beliefs did not account for additional variance in anxiety or depression. Findings provide preliminary support for the utility of the S-REF model for emotional distress in YPwE. Metacognitive therapy, which is underpinned by the S-REF model, may be an appropriate intervention for emotional distress in YPwE. Future studies should assess the mediational relationship between metacognitive beliefs, perseverative thinking, and emotional distress using time-lagged models.

The Bi-factor model of repetitive negative thinking: Common vs. unique factors as predictors of depression and anxiety

BACKGROUND AND OBJECTIVES

Different forms of repetitive negative thinking (RNT) have traditionally been conceptualized as being distinctly linked to specific disorders. However, emerging evidence suggests that a common process lies at the core of different RNT manifestations. This common process might also largely explain the link between RNT and psychopathology. To examine the latent factor structure of RNT, we compared three structural-equation models, assuming (a) a common factor across different RNT measures (single-factor model); (b) scale-specific factors for each RNT measures (separate-factor model); and (c) both a common and scale-specific factors (bi-factor model). We additionally tested whether these latent factors predicted depression and anxiety at a follow-up time-point.

METHODS

A community sample (N = 523) completed an online assessment comprising measures of rumination, worry and content-independent RNT as well as depressive and anxiety symptoms at baseline (t1) and three months later (t2).

RESULTS

The bi-factor model showed the best fit to the data among the three models. Moreover, the common factor of the bi-factor model significantly predicted depression and anxiety three months later. Next to the common factor, some but not all scale-specific factors additionally predicted symptoms.

LIMITATIONS

The study was conducted in a non-clinical sample and the assessment of psychopathology was restricted to depressive and anxiety symptoms.

CONCLUSIONS

The findings support transdiagnostic conceptualizations of RNT, which highlight common aspects of different forms of RNT as well as the relevance of RNT across different diagnostic categories.

Relationships between depression, anxiety, type D personality, and worry and rumination in patients with coronary heart disease

Psychological distress, including depression and anxiety, and Type-D personality are prevalent in patients with coronary heart disease (CHD) and associated with poor cardiovascular outcomes. Worry and rumination may be among the core features responsible for driving psychological distress in these patients. However, the nature of associations between these constructs remains to be delineated, yet they may have implications for the assessment and treatment of CHD patients. This study aimed to (1) explore the factorial structure and potential overlap between measures of depression, anxiety and the Type-D personality factors known as negative affectivity and social inhibition, and (2) examine how these constructs relate to worry and rumination in a sample of 1,042 CHD outpatients who participated in the in the cross-sectional NORwegian CORonary Prevention study. We conducted confirmatory factor analyses (n = 1,042) and regression analyses (n = 904) within a structural equation modeling framework. Results showed all constructs to have acceptable factor structure and indicated an overlap between the constructs of depression and negative affectivity. Worry was most strongly associated with anxiety, whereas rumination was most strongly associated with depression and negative affectivity. The results suggest conceptual similarities across the measures of depression and negative affectivity. They further suggest that intervention efforts could benefit from targeting worry and/or rumination in the treatment of CHD outpatients presenting with symptoms of psychological distress.

The Relationship Between CBT-Mindedness and iCBT Outcomes Amongst a Large Adult Sample

Background

Predicting response to cognitive behavior therapy (CBT) assists efforts to enhance treatment outcome when predictive factors are modifiable prior to, or during, treatment. The extent to which clients hold beliefs and attitudes consistent with CBT (termed CBT-mindedness) is a relatively new concept with research suggesting it predicts response to CBT amongst small samples of adults with anxiety. This study aimed to investigate CBT-mindedness amongst a larger clinical population receiving internet-delivered CBT (iCBT).

Method

1132 adults with anxiety, depression or mixed anxiety and depression who accessed iCBT with or without therapist support via the THIS WAY UP clinic completed a brief self-report measure of CBT-mindedness along with measures of distress, anxiety, and depression. Measures were completed pre- and post-treatment.

Results

The 3-factor structure of the CBT Suitability Scale (CBT-SUITS) was confirmed and scores were unrelated or very weakly related to symptoms/distress. CBT-mindedness increased amongst treatment completers. CBT-mindedness predicted post-treatment distress (but not symptoms), and change in CBT-mindedness predicted lower post-treatment symptoms and distress.

Conclusions

The CBT-SUITS represents a psychometrically sound measure of CBT-mindedness. Results amongst this large sample of adults accessing iCBT in a community service indicate that CBT-mindedness (or CBT-mindedness change) is an important predictor of therapy response.

Worry and insomnia as risk factors for depression during initial stages of COVID-19 pandemic in India

The biggest nationwide COVID-19 pandemic lockdown worldwide was enforced in India for an initial period of 21-days. Emerging evidence suggests that pandemic situations and associated lockdowns have an adverse impact on sleep and mental health. However, prediction of sleep health from sociodemographic characteristics and the public’s worry during the initial stages of the COVID-19 pandemic has not been extensively explored so far. It’s also unclear whether sleep outcomes mediate the association between worry and mental health during pandemic situations. A web-survey (N = 391) on sociodemographic characteristics, COVID-19 related worry, sleep health (insomnia and daytime sleepiness), and depression was conducted during the initial 21-days of the COVID-19 stringent lockdown in India. Multiple regression analyses showed that variables, including sex, age, income level, and worry score, contributed to the significant regression equation for insomnia but not for daytime sleepiness. Specifically, the female, younger, lower income, and highly worried populations contributed significantly more than the male, elderly, higher income, and less worried populations, respectively, to the prediction of insomnia. Mediation analyses showed that insomnia, but not daytime sleepiness, fully mediated the relationship between worry score and severity of depressive symptoms. We provide evidence that the female, younger, lower income, and worried populations may be at higher risk for insomnia during pandemic situations. Current evidence gives hope that improving sleep may reduce depressive symptoms during a pandemic situation. This underscores the importance of the implementation of effective public health policies in conjunction with strategical responses to the COVID-19 pandemic.

My Mind is Working Overtime-Towards an Integrative Perspective of Psychological Detachment, Work-Related Rumination, and Work Reflection

In the literature on occupational stress and recovery from work, several facets of thinking about work during off-job time have been conceptualized. However, research on the focal concepts is currently rather diffuse. In this study we take a closer look at the five most well-established concepts: (1) psychological detachment, (2) affective rumination, (3) problem-solving pondering, (4) positive work reflection, and (5) negative work reflection. More specifically, we scrutinized (1) whether the five facets of work-related rumination are empirically distinct, (2) whether they yield differential associations with different facets of employee well-being (burnout, work engagement, thriving, satisfaction with life, and flourishing), and (3) to what extent the five facets can be distinguished from and relate to conceptually similar constructs, such as irritation, worry, and neuroticism. We applied structural equation modeling techniques to cross-sectional survey data from 474 employees. Our results provide evidence for (1) five correlated, yet empirically distinct facets of work-related rumination. (2) Each facet yields a unique pattern of association with the eight aspects of employee well-being. For instance, detachment is strongly linked to satisfaction with life and flourishing. Affective rumination is linked particularly to burnout. Problem-solving pondering and positive work reflection yield the strongest links to work engagement. (3) The five facets of work-related rumination are distinct from related concepts, although there is a high overlap between (lower levels of) psychological detachment and cognitive irritation. Our study contributes to clarifying the structure of work-related rumination and extends the nomological network around different types of thinking about work during off-job time and employee well-being.

Cognitive and Metacognitive Mechanisms of Change in Metacognitive Training for Depression

Metacognitive Training for Depression (D-MCT), a low-threshold group intervention, has been shown to improve depressive symptoms. It aims at the reduction of depression by changing dysfunctional cognitive as well as metacognitive beliefs. The purpose of the present study was to investigate whether the mechanisms of change in D-MCT are cognitive (and thus primarily concern the content of cognition) or metacognitive in nature. Eighty-four outpatients with depression were included in a randomized controlled trial comparing D-MCT to an active control intervention. Level of depression, dysfunctional cognitive beliefs (DAS), and metacognitive beliefs (MCQ subscales: Positive Beliefs, Negative Beliefs, Need for Control) were assessed before (t0) and after treatment (t1). Severity of depression was also assessed 6 months later (t2). Linear regression analyses were used to determine whether change in depression from t0 to t2 was mediated by change in cognitive vs. metacognitive beliefs from t0 to t1. D-MCT's effect on change in depression was mediated by a decrease in dysfunctional metacognitive beliefs, particularly 'need for control'. Our findings underline that one of the key mechanisms of improvement in D-MCT is the change in metacognitive beliefs. The current study provides further support for the importance of metacognition in the treatment of depression.

Diagnostic utility of worry and rumination: a comparison between generalized anxiety disorder and major depressive disorder

AIM

Although previous reports have addressed worry and rumination as prominent cognitive processes in generalized anxiety disorder (GAD) and major depressive disorder (MDD) and their distinct correlation with anxious and depressive symptoms, the differential association of worry and rumination with the diagnosis of GAD and MDD remains unclear. The purpose of this study was to investigate the distinct features of worry and rumination in factor structure and their predictive validity for the diagnosis of GAD and MDD.

METHODS

Four hundred and sixty-eight patients with GAD (n = 148) and MDD (n = 320) were enrolled and the diagnoses were confirmed with the Structured Clinical Interview for DSM-IV. Participants completed the Penn State Worry Questionnaire and Ruminative Response Scale and the severity of anxiety and depressive symptoms was assessed via clinician ratings.

RESULTS

In joint factor analysis using the Penn State Worry Questionnaire and Ruminative Response Scale items, worry and rumination emerged as distinct factors. In logistic regression analyses, worry contributed to a higher probability of the diagnosis of GAD than rumination, as rumination did in MDD than worry.

CONCLUSION

This is the first comprehensive study investigating the diagnostic utility of worry and rumination in a well-defined clinical sample of both GAD and MDD. Our results suggest that worry and rumination are distinct cognitive processes and play a differential role in the diagnosis of GAD and MDD, distinguishing them at the cognitive level.

A seven day actigraphy-based study of rumination and sleep disturbance among young adults with depressive symptoms

OBJECTIVES

Trait ruminators exhibit significantly higher levels of sleep disturbance than those without this cognitive vulnerability. However, support for the sleep disruptive effects of state rumination, especially in the pre-sleep period, is rare, and hindered by methodological drawbacks such as self-report and single night assays of sleep. Finally, despite the pervasiveness of the ruminative response style among individuals with depression, the association between rumination and sleep disturbance has not been explored in this population. The present study employed a week-long daily sampling approach to examine the effects of naturally occurring pre-sleep rumination on self-reported and actigraphy-based sleep among individuals with high depressive symptomatology.

METHODS

Forty-two university students (19.6±3.2 yo;73.8% female), all of whom reported at least moderate levels of depressive symptoms, completed a short questionnaire after waking each morning for seven days. On this questionnaire, they self-reported sleep indices from the previous night and levels of engagement in pre-sleep rumination. Sleep was also monitored throughout this period via wrist actigraphy. Hierarchical-linear-modeling was used to examine the association between nightly rumination and sleep.

RESULTS

Nightly variations in pre-sleep rumination were predictive of significantly longer actigraphy- and diary-based sleep onset latency (SOL). Notably, a 1 SD increase on the pre-sleep rumination scale was associated with an approximately 7 minute increase in actigraphy-based SOL, even after controlling for baseline sleep disturbance and depressive symptoms.

CONCLUSIONS

These data offer compelling evidence for the impact of pre-sleep rumination on sleep onset, providing insight into one potential mechanism that triggers sleep disturbance among individuals with depressive symptoms.

Depressive Rumination and Past Depression in Japanese University Students: Comparison of Brooding and Reflection

The Ruminative Responses Scale, a measure of depressive rumination, contains two subscales: Brooding and Reflection. Treynor, Gonzalez, and Nolen-Hoeksema (2003) proposed that Brooding is maladaptive and Reflection is adaptive. This article examined the relationships among Brooding, Reflection, and previous depression in two samples of Japanese undergraduates, who were non-depressed at the time of their participation. Based on answers to a self-report measure, participants were divided into a formerly depressed group, who had experienced an episode that met the criteria for major depression, and a never-depressed group. Logistic regression analyses were conducted with Brooding, Reflection, and current depression as the independent variables and past depression as the dependent variable. Brooding had consistent positive associations with past depression. The relationship between Reflection and past depression was not significant for one sample, but was statistically significant and positive in the second sample. In the second sample, Brooding and Reflection both were related with past depression after controlling for worry.

Metacognitive beliefs in unipolar and bipolar depression: a comparative study

AIMS

The purpose of this study was to perform a comparative investigation of metacognitive beliefs regarding pathological worry in patients with unipolar and bipolar depressive disorder.

METHODS

Those subjects with acute depressive episodes among patients diagnosed with major depressive disorder (unipolar) or bipolar disorder on the basis of DSM-IV diagnostic criteria (unipolar n = 51, bipolar n = 45), and healthy controls (n = 60), were included in the study. Participants were administered the Meta-Cognitions Questionnaire (MCQ-30) in order to determine metacognitive beliefs. The relationship between metacognitive beliefs and anxiety severity, depression severity and self-esteem in the unipolar and bipolar patients groups was then examined.

RESULTS

Scores for negative beliefs about worry concerning uncontrollability and danger and for beliefs about the need to control thoughts were higher in both the unipolar and bipolar depression groups than in the healthy controls (P < 0.05). Lack of cognitive confidence scores were higher in the bipolar group than in the healthy controls (P < 0.05). Metacognitive beliefs (to a greater extent in parameters in the bipolar group) were correlated with anxiety level, depression level and self-esteem in both patient groups.

CONCLUSION

In addition to metacognitive beliefs known to be associated with ruminations in unipolar and bipolar depression, metacognitive beliefs can also be seen in association with worry. Worry-associated metacognitive beliefs should be the subject of focus in the identification of metacognitive beliefs in depression patients and in metacognitive therapy in these patients.

Repetitive Negative Thinking in Anticipation of a Stressor

Repetitive negative thinking (RNT) has been confirmed as a transdiagnostic phenomenon, but most measures of RNT are contaminated with diagnosis-specific content. The first aim of this study was to examine the structure of an anticipatory version of the Repetitive Thinking Questionnaire (RTQ-Ant) as a trans-emotional measure of anticipatory RNT. The original RTQ was completed with reference to a past stressor, whereas the RTQ-Ant instructs respondents to link their responses to a future stressor. The second aim was to test if the associations between a range of emotions (anxiety, depression, shame, anger, general distress) and the original post-stressor version of the RTQ would be replicated. Undergraduates (N = 175, 61% women) completed the RTQ-Ant, along with measures of various emotions, with reference to upcoming university exams. Principal axis factor analysis yielded many similarities between the original post-event RTQ and the RTQ-Ant, and some differences. The RTQ-Ant was comprised of two subscales: the RNT subscale measures engagement in repetitive thinking, negative thoughts about oneself, and ‘why’ questions; and the Isolated Contemplation (IC) subscale included items referring to isolating oneself and reflecting on negative thoughts, feelings, loneliness, and listening to sad music. RNT was more strongly related to negative emotions than IC. The RTQ-Ant appears to be a reliable measure of anticipatory RNT that is associated with a broad array of emotions.

Mechanisms driving pre- and post-stressor repetitive negative thinking: metacognitions, cognitive avoidance, and thought control

BACKGROUND AND OBJECTIVES

Repetitive negative thinking (RNT) is common to multiple emotional disorders and occurs before, during, and following a stressor. One replicated difference between common forms of RNT such as worry and rumination is temporal orientation towards a stressor, with worry being more future-oriented and rumination more past-oriented. Different mechanisms may drive RNT at these different time points. The aim of Study 1 was to examine whether previously demonstrated relationships between post-stressor RNT and mechanisms theorized to drive engagement in RNT, including metacognitive beliefs, cognitive avoidance strategies, and thought control strategies, would be replicated with anticipatory (pre-stressor) RNT. The aim of Study 2 was to replicate these associations in a new sample that completed measures of both pre- and post-stressor RNT.

METHOD

Participants in Study 1 (N = 175) completed the RNT-L in anticipation of a stressor, along with measures of metacognitive beliefs, cognitive avoidance strategies, and thought control strategies. Participants in Study 2 (N = 91) completed the measures both before and after a stressor.

RESULTS

Pre- and post-stressor RNT were significantly correlated with all three mechanism measures. Metacognitive beliefs that RNT is uncontrollable and dangerous, and the thought control strategy of punishment, were most consistently and uniquely associated with RNT at both time-points.

LIMITATIONS

Replication with clinical samples and with reference to a broader array of stressors is required. The correlational design precluded causal conclusions.

CONCLUSIONS

Common and possibly some distinct mechanisms drive RNT before and after a stressor.

Preliminary validation of the Nepean Dysphoria Scale

OBJECTIVE

To present the psychometric properties of the Nepean Dysphoria Scale (NDS), the first instrument developed to measure the severity of dysphoria.

METHOD

The NDS was administered to 134 university students and its characteristics were examined. The structure of the scale was investigated using exploratory factor analysis. Convergent and divergent validity were examined by investigating the associations between the NDS and its subscales with other conceptually similar (Beck Depression Inventory II, Dysfunctional Attitude Scale-Form A and Toronto Alexithymia Scale) and conceptually distinct (Anxiety Sensitivity Index) instruments.

RESULTS

The 24-item NDS demonstrated excellent internal consistency. A four-factor solution was derived, with factors pertaining to irritability, discontent, surrender and interpersonal resentment. There were medium to strong correlations between the NDS and its subscales and depressive symptoms as measured by the Beck Depression Inventory II. The NDS and its subscales showed weaker, but still significant, correlations with Dysfunctional Attitude Scale-Form A, Toronto Alexithymia Scale and Anxiety Sensitivity Index.

CONCLUSIONS

The study suggests that the NDS has good psychometric properties. Further research would more firmly establish the NDS as a valid measure of the complex emotional state of dysphoria.

Trait Rumination Is Associated with Enhanced Recollection of Negative Words

Rumination is associated with Major Depressive Disorder (MDD). To better understand this association, researchers have begun to investigate the relationship between rumination and cognitive biases that are linked to MDD. To date, several studies have found that rumination is related to negatively biased memory, but it is not clear whether this relationship is independent of depressive symptoms. To address this question, the present study examined 97 healthy Caucasian women between the ages of 18 and 25. Participants performed an encoding task of self-referent adjectives, followed by a recognition task. The recognition task utilized a remember/know paradigm to separately examine recollection-based memory and familiarity-based memory. Trait rumination was assessed using the ruminative response scale (RRS). Results indicate that high trait rumination is associated with selective enhancement of recollection for negative words compared to neutral words and a trend toward selective enhancement for recollection for negative words compared to positive words. Trait rumination does not affect biases in overall recognition sensitivity or familiarity.

Are worry, rumination, and post-event processing one and the same? Development of the repetitive thinking questionnaire

Accumulating evidence suggests that repetitive negative thinking (RNT) is a transdiagnostic phenomenon. However, various forms of RNT such as worry, rumination, and post-event processing have been assessed using separate measures and have almost exclusively been examined within the anxiety, depression, and social phobia literatures, respectively. A single transdiagnostic measure of RNT would facilitate the identification of transdiagnostic maintaining factors of RNT, and would be more efficient than administering separate measures for each disorder. Items from three existing measures of RNT were modified to remove diagnosis-specific content and administered to a sample of undergraduate students (N=284). Exploratory factor analysis yielded two factors labeled Repetitive Negative Thinking and Absence of Repetitive Thinking (ART). The RNT scale demonstrated high internal reliability and was associated with anxiety, depression, anger, shame, and general distress. Moreover, the RNT scale was associated with constructs that are theoretically related to engagement in RNT, including positive and negative metacognitions, cognitive avoidance, thought suppression, and thought control strategies. The ART scale had little predictive utility. Theoretical and clinical implications are discussed.

Is worry different from rumination? Yes, it is more predictive of psychopathology!

OBJECTIVE

Although worry and rumination are everyday phenomena as well as common symptoms across numerous psychopathological disorders, the theoretical and clinical delineations of both concepts need more clarification. This study explored the degree of overlap between worry and rumination on the levels of standardized questionnaires and a priori lay concepts.

METHOD

The subjective conceptualization of worry and of rumination of 221 undergraduate and graduate students was assessed with the semantic differential technique, together with the frequency and intensity with which they experienced worry and rumination (based on their lay concepts). Standardized self-report measures for worry, rumination, depression, and anxiety were also administered.

RESULTS

Worry was viewed as more negative than rumination and was more predictive of anxiety as well as of depression than rumination, especially when the assessment was based on the subjective lay concepts. The different measures of worry and rumination were only moderately correlated with each other.

CONCLUSION

It is concluded that the lay concepts worry and rumination and the hypothetical constructs worry and rumination should not be confused in personality and clinical research.

Psychotherapy for generalized anxiety disorder: don't worry, it works!

Generalized anxiety disorder (GAD) differs from other anxiety disorders. Patients do not fear a specific external object or situation; there is no distinct symptomatic reaction pattern; and the feared scenarios are not bizarre, improbable, or inflexible. Avoidance, although central, is less obvious and often is prominent only on the cognitive-emotional level. The key component of GAD, uncontrollable and persistent worrying, is easily confused with the lay concept of worry, and comorbid disorders often make the recognition of GAD difficult. This article discusses the challenges and the innovative, promising, and specific new developments in treating GAD.