A Comparison of Repetitive Negative Thinking and Post-Event Processing in the Prediction of Maladaptive Social-Evaluative Beliefs: A Short-Term Prospective Study

Managing Rumination and worry: A randomised controlled trial of an internet intervention targeting repetitive negative thinking delivered with and without clinician guidance

BACKGROUND

Rumination and worry, forms of repetitive negative thinking (RNT), are implicated in the onset, maintenance, severity, and relapse risk of depression and anxiety disorders. This randomised controlled trial evaluated an internet intervention targeting both rumination and worry in adults compared to treatment-as-usual (TAU) and compared treatment effects and adherence when delivered with and without clinician guidance.

METHODS

Adults (N = 137) with elevated RNT were randomly allocated to a 3-lesson clinician guided (n = 45) or self-help (n = 47) online program delivered over 6 weeks, or a TAU control group which waited 18 weeks to receive the program (n = 45). The clinician guided group received semi-structured phone support after each lesson. All three groups continued any pre-trial TAU. RNT, anxiety, depression, and psychological distress were assessed at baseline, post-treatment (week 7), and 3-month follow-up.

RESULTS

Intention-to-treat linear mixed models showed that participants in the self-help and clinician guided groups had significantly lower RNT, anxiety, depression, and distress at post-treatment and 3-month follow-up compared to TAU. Treatment effects were significantly larger in the clinician guided group compared to self-help (between-group gs = 0.41-0.97). No significant between-group differences were found in adherence/program completion (guided: 76%; self-guided: 79%) or treatment satisfaction (1-5 scale: guided: M = 4.17, SD = 1.20; self-guided: M = 3.89, SD = 0.93). Total time spent on clinician guidance was M = 48.64 min (SD = 21.28).

CONCLUSION

This brief online intervention for RNT is acceptable and efficacious in reducing RNT, anxiety, depression, and distress in both clinician guided and self-help formats. The program appeared most effective when delivered with clinician guidance. Larger definitive trials comparing guided and self-guided programs are needed. Australian and New Zealand Clinical Trials Registration number: ACTRN12620000959976.

Understanding the Dimensions of Post-Event Processing: Applying a Bifactor Modeling Approach to the EPEPQ-15

Social anxiety disorder is maintained in part by rumination about past social experiences, known as post-event processing. The Extended Post-Event Processing Questionnaire (EPEPQ-15) assesses post-event processing as three correlated factors. Competing against this structure is a bifactor model that has not yet been evaluated for the EPEPQ-15. These models were tested for the conventional state version of the EPEPQ-15 and a new trait version in two separate samples (Ns = 327 and 351). In both samples, the fit of the bifactor model was better than that of correlated factor models. Moreover, the results did not support the group factors, indicating that a unidimensional interpretation of the EPEPQ-15 is most appropriate. The general dimension of the EPEPQ-15 was highly correlated with social interaction anxiety, beliefs related to social anxiety, anticipatory processing, and safety behaviors. These results overall suggest post-event processing is best conceptualized as a unitary construct.

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.

Understanding the experience of rumination and worry: A descriptive qualitative survey study

OBJECTIVES

Rumination and worry have been implicated in the onset, severity, maintenance and relapse risk of depression and anxiety disorders. Despite this, little research has examined individuals' personal experiences of these processes. This study investigates how individuals experience these processes, which will provide insight into these common features of mental disorders and inform the development of an online intervention specifically targeting rumination and worry.

DESIGN

An online qualitative survey was conducted to gain insight into people's personal definitions, experiences with and understandings of rumination and worry.

METHODS

Participants answered open- and close-ended questions about their personal understanding of rumination and worry, typical thought content, triggers, frequency, duration and coping strategies. Participant responses were coded into themes. Participants also completed self-report questionnaires of depression, anxiety and stress and repetitive negative thinking.

RESULTS

Two hundred and seven adults completed the online survey (76% female; mean age = 28.2 years, range = 17-71), 51% of whom reported previously experiencing depression and anxiety. All participants were familiar with the concept of worry, whereas 28% of participants indicated they had never heard of rumination. Participants reported most commonly ruminating and/or worrying about personal relationships, past mistakes, negative experiences and conversations/social interactions. The most commonly reported triggers for rumination and/or worry were social situations/interpersonal interactions (25%) and negative events/experiences (24%). Distraction was the most common coping strategy (48%); however, 21% reported being unable to stop themselves from ruminating and/or worrying.

CONCLUSIONS

The results provide a unique insight into the personal experiences and understandings of rumination and worry of potential end users of treatment programs targeting these processes.

Managing rumination and worry: A pilot study of an internet intervention targeting repetitive negative thinking in Australian adults

BACKGROUND

Rumination and worry, both forms of repetitive negative thinking (RNT), have been implicated in the onset, maintenance, severity, and relapse risk of depression and anxiety disorders. Despite promising initial findings for internet-delivered interventions targeting both rumination and worry simultaneously, no studies have investigated treatment effects in an adult population or when delivered in a brief, unguided format. We developed a 3-lesson unguided online treatment program targeting both rumination and worry and evaluated the adherence and effectiveness in Australian adults using an open pilot trial.

METHODS

Adult participants (N=26) experiencing elevated levels of RNT completed the online program over 6-weeks. Outcomes were assessed at baseline, post-treatment, and 1-month follow-up. Intention-to-treat linear mixed models were used to examine effects on RNT, anxiety, depression, and general psychological distress.

RESULTS

Of the 26 participants who started the program, 18 completed all three lessons (69.2% completion rate). Large within-subject effect sizes were found between pre- and post-treatment for RNT (Hedges' g= 2.26) and symptoms of depression (g = 1.04), generalised anxiety (g = 1.82) and distress (g = 0.93). Treatment effects were maintained at 1-month follow-up.

LIMITATIONS

No long-term follow-up, exclusion of severely depressed individuals.

CONCLUSIONS

This is the first study to evaluate a brief, unguided internet intervention targeting both rumination and worry in adults. The results provide promising preliminary evidence for the feasibility and acceptability of the online program. Randomised controlled trials are needed to evaluate treatment efficacy compared to a control group and to investigate long-term outcomes.

A Short-Term Longitudinal Investigation of Hookups and Holistic Outcomes Among College Students

Majority of college students hook up at least once during their time in school. The literature on casual sex encounters among college students is growing, though most studies are cross-sectional and individual studies focus on few outcomes at a time, leaving piecemeal and mixed results. The current longitudinal study clarifies prior work by analyzing how post-event process (PEP), an understudied construct within the hookup literature, and emotional (i.e., positive or negative) hookup reactions interact to predict a breadth of outcomes, representing holistic student well-being. The inclusion of PEP reframes the current literature to consider PEP as a predictor variable of hookup outcomes, as moderated by emotional hookup reactions. This is consistent with literature indicating emotional experiences affect PEP across a variety of incidents. Participants (N = 377, 87.6% female) completed self-report measures at 2-month intervals. We tested relationships between the main and interaction effects of PEP and emotional hookup reactions as a moderation regression analyses on anxiety, academic engagement, religious coping, and psychological flourishing. The main effect of PEP predicted more anxiety and less negative religious coping, negative hookup reactions predicted more anxiety, and positive hookup reactions predicted more flourishing. Regarding interaction effects, high levels of positive hookup reactions and PEP were associated with less anxiety, less academic engagement, more negative religious coping, and less psychological flourishing; high levels of negative hookup reactions and PEP were associated with less anxiety and more negative religious coping and were unrelated to academic engagement or flourishing over two months.

Changes in post-event processing during cognitive behavioural therapy for social anxiety disorder: A longitudinal analysis using post-session measurement and experience sampling methodology

PURPOSE

Post-event processing (PEP) is posited to be an important factor in the maintenance of social anxiety symptoms. Previous research has demonstrated that general PEP tendencies are sensitive to treatment. However, it remains unclear how momentary PEP following social interactions changes over the course of treatment for social anxiety disorder. The purpose of the present study was to examine how both momentary and general PEP change over the course of treatment, and how such changes predict treatment outcome.

METHOD

Participants (N = 60) with social anxiety disorder were enrolled in group cognitive behavioural therapy. All participants completed measures of PEP and social anxiety symptom severity at five time points over treatment. A subset (N = 33) also completed repeated experience sampling measurements of PEP following social interactions across the course of treatment.

RESULTS

Both general and momentary PEP decreased over the course of treatment. Decreases in both types of PEP predicted lower social anxiety symptom severity following treatment.

CONCLUSION

The results of the study demonstrate that momentary experiences of PEP can be influenced by treatment, and can in turn impact treatment outcome. The findings have significant clinical and theoretical implications.

Transdiagnostic assessment of repetitive negative thinking and responses to positive affect: Structure and predictive utility for depression, anxiety, and mania symptoms

BACKGROUND

Repetitive negative thinking (RNT) is a cognitive process that is repetitive, passive, relatively uncontrollable, and focused on negative content, and is elevated in emotional disorders including depression and anxiety disorders. Repetitive positive thinking is associated with bipolar disorder symptoms. The unique contributions of positive versus negative repetitive thinking to emotional symptoms are unknown. The first aim of this study was to use confirmatory factor analyses to evaluate the psychometrics of two transdiagnostic measures of RNT, the Repetitive Thinking Questionnaire (RTQ-10) and Perseverative Thinking Questionnaire (PTQ), and a measure of repetitive positive thinking, the Responses to Positive Affect (RPA) Questionnaire. The second aim was to determine incremental predictive utility of these measures.

METHOD

All measures were administered to a sample of 2088 undergraduate students from the Netherlands (n = 992), Australia (n = 698), and America (n = 398).

RESULTS

Unidimensional, bifactor, and three-factor models were supported for the RTQ-10, PTQ, and RPA, respectively. A common factor measured by all PTQ items explained most variance in PTQ scores suggesting that this measure is essentially unidimensional. The RNT factor of the RTQ-10 demonstrated the strongest predictive utility, although the PTQ was also uniquely although weakly associated with anxiety, depression, and mania symptoms. The RPA dampening factor uniquely predicted anxiety and depression symptoms, suggesting that this scale is a separable process to RNT as measured by the RTQ-10 and PTQ.

LIMITATIONS

Findings were cross-sectional and need to be replicated in clinical samples.

CONCLUSIONS

Transdiagnostic measures of RNT are essentially unidimensional, whereas RPA is multidimensional. RNT and RPA have unique predictive utility.

Social cognition and metacognition in social anxiety: A systematic review

Cognitive-behavioural and metacognitive approaches to emotional disorder implicate beliefs in social anxiety, but the types of beliefs differ across these perspectives. Cognitive models suggest that social beliefs about the self (i.e., high standards and conditional and unconditional beliefs) are central. In contrast, the metacognitive model gives centre stage to metacognitive beliefs (i.e., positive and negative beliefs about thinking) as main contributors to the maintenance of the disorder. Despite an expanding research interest in this area, the evidence for such contributions has not yet been reviewed. This study set out to systematically review relevant cross-sectional, longitudinal, and experimental investigations of the direct and indirect (through cognitive processes, such as anticipatory processing, self-focused attention, the post-mortem, and avoidance) relationships of social and metacognitive beliefs with social anxiety. Clinical and nonclinical samples were included, and correlation and regression coefficients as well as results from group comparisons (e.g., t tests and analyses of variance) were extracted. Overall, 23 papers were located, through PsycINFO, PubMed, and Web of Science, and reviewed using narrative synthesis. The results showed a robust positive relationship between social beliefs and social anxiety that appeared to be mediated by cognitive processes. Specific metacognitive beliefs were found to positively contribute to social anxiety both directly and indirectly, through cognitive processes. The study's findings are limited to 2 models of social anxiety and other minor limitations (e.g., grey literature was excluded). With these accounted for, the results are discussed in terms of the conceptualization and treatment of social anxiety and suggestions for future research are made.

Examination of the Contribution of Ruminative Thinking and Maladaptive Self-Beliefs to Social Anxiety

The purpose of this study was to examine the relative contribution of 3 components of the Clark and Wells (1995) model to social anxiety symptoms. In particular, based on theory and previous research, it was hypothesized that the association between post-event processing and social anxiety and between anticipatory anxiety and social anxiety would be mediated by maladaptive self-beliefs. To test this hypothesis, a large, nonclinical sample of young adults completed a measure of anticipatory processing, post-event processing, maladaptive self-beliefs, and social anxiety. Based on a structural equation modeling approach, full mediation was found between post-event processing and social anxiety, and partial mediation was found between anticipatory processing and social anxiety. Overall, the results contribute to the literature by elucidating cognitive processes that may lead to the development and maintenance of social anxiety symptoms.