Rumination, automatic thoughts, dysfunctional attitudes, and thought suppression as transdiagnostic factors in depression and anxiety

Rumination, but not mood, predicts prospective memory performance: novel insights from a derived measure of trait rumination

Prospective memory (PM) is the accurate execution of an intention in the future. PM may be negatively impacted by negative affect, but the underlying mechanisms remain unclear. Rumination may increase the frequency of task-irrelevant thoughts, which deplete attentional capacity and reduce performance. To date, no studies have examined state and trait rumination on an online measure of PM. The present study examined the effects of state and trait rumination on an event-based, focal PM task embedded within a one-back task over multiple sessions. 95 non-depressed adults (18-53 years) completed measures of state/trait rumination, mood, and PM on at least two occasions. Using multi-level modelling, we found that a derived measure of trait rumination, but not an established trait rumination survey, nor negative mood, predicted poorer PM accuracy. These novel findings demonstrate that trait rumination may partially underlie the association between negative affect & PM in a non-clinical sample, and highlight the potential of online methods to study PM.

Internalizing psychopathology and its links to suicidal ideation, dysfunctional attitudes, and help-seeking readiness in a national sample of college students

BACKGROUND

Recent evidence suggests that multiple emotional disorders may be better assessed using dimensional models of psychopathology. The current study utilized a cross-sectional population survey of college students (N = 8613 participants) to examine the extent to which broad psychopathology factors accounted for specific associations between emotional problems and clinical and behavioral validators: suicidality, dysfunctional attitudes, and treatment seeking.

METHODS

Confirmatory factor models were estimated to identify the best structure of psychopathology. Models were then estimated to examine the broad and specific associations between each psychopathology indicator and the clinical and behavioral validators.

RESULTS

The hierarchical model of psychopathology with internalizing problems at the top, fear, and distress at the second level, and five specific symptom dimensions at the third level evidenced the best fit. The associations between symptom indicators of psychopathology and clinical and behavioral validators were relatively small and inconsistent. Instead, much of the association between clinical and behavioral validators and emotional problems operated at a higher-order level.

LIMITATIONS

The cross-sectional nature of the survey precludes the ability to make conclusions regarding causality.

CONCLUSIONS

Researchers should focus on investigating the shared or common components across emotional disorders, particularly concerning individuals presenting with higher rates of suicidal ideation dysfunctional attitudes, and help-seeking behavior. Using higher-order dimensions of psychopathology could simplify the complex presentation of multiple co-occurring disorders and suggest valid constructs for future investigations.

Investigation of Cognitive Distortions in Panic Disorder, Generalized Anxiety Disorder and Social Anxiety Disorder

The aim of this study was to determine the main cognitive distortions observed in panic disorder (PD), generalized anxiety disorder (GAD) and social anxiety disorder (SAD) and to investigate the impact of cognitive distortions on diagnoses, depression levels, disorder type and severity of anxiety. This study consisted of 150 clinical (50 PD, 50 GAD, 50 SAD) and 91 healthy control participants. A sociodemographic data form, the Beck Depression Inventory (BDI), the Dysfunctional Attitudes Scale (DAS), the Cognitive Distortions Scale (CDS) and the State-Trait Anxiety Inventory (STAI) scales were administered to all participants. It was found that cognitive distortions were higher in individuals with PD, GAD and SAD. The PD, SAD and GAD groups were similar for "catastrophizing", "mindreading", "all or nothing thinking", "overgeneralization", "should statements" and "emotional reasoning". "Personalization", "labeling" and "minimizing or disqualifying the positive" were observed at a higher severity in the SAD group compared to the PD group, and "mental filter" was observed at a higher severity in the GAD group compared to the PD group. Our findings emphasize the need to address cognitive distortions in PD, GAD and SAD treatment. The evaluation of cognitive distortions specific to anxiety disorders is significant in guiding therapy goals and pioneering new research.

Measuring dysfunctional interpersonal beliefs: validation of the Interpersonal Cognitive Distortions Scale among a heterogeneous German-speaking sample

BACKROUND

Dysfunctional interpersonal beliefs (DIBs) are a key symptom domain in numerous mental disorders. Because DIBs exert a strong influence on social experience and behavior, they play an important role in a mental disorder's development and progression. To date, only the Interpersonal Cognitive Distortions Scale (ICDS) captures DIBs independently of specific disorders, populations, or contexts. The present study's aim was to psychometrically evaluate and validate a German translation of the ICDS.

METHODS

The ICDS was administered along with indicators of convergent (rejection sensitivity, depressive expectations, interpersonal trust, interpersonal problems, perceived social support), discriminant (self-efficacy, perseverative negative thinking, optimism), and clinical validity (psychopathology, perceived stress, well-being) to a pooled sample incorporating non-clinical (N = 114) and clinical (N = 94) participants.

RESULTS

An exploratory factor analysis (EFA) suggested a five-factor solution (factor loadings: .44 to .85). Correlational analyses demonstrated acceptable convergent (ρ = -.29 to -.35, ρ = .27 to .59), suboptimal discriminant (ρ = -.27 to -.38, ρ = .52), and acceptable clinical validity (ρ = -.21, ρ = .36 to .44) at the total-scale level. However, results at the subscale level were mixed and required nuanced interpretation. Likewise, internal consistency was acceptable at the total-scale level (α = .76), but ranged from good to poor at the subscale level (α = .61 to .80). DIBs mediated the negative relationship between mental disorder onset and psychopathology levels.

DISCUSSION

Our results imply DIBs' relevance to mental health and related outcomes. When working with the ICDS's German version, we recommend employing only the "insecurity" subscale, as this was the only scale revealing acceptable psychometric properties. Future studies should improve the construct validity of the ICDS (and its subscales), e.g., by adding more items to the respective subscales and further classes of DIBs.

Variables Associated with Emotional Symptom Severity in Primary Care Patients: The Usefulness of a Logistic Regression Equation to Help Clinical Assessment and Treatment Decisions

The aim of this study is to contribute to the evidence regarding variables related to emotional symptom severity and to use them to exemplify the potential usefulness of logistic regression for clinical assessment at primary care, where most of these disorders are treated. Cross-sectional data related to depression and anxiety symptoms, sociodemographic characteristics, quality of life (QoL), and emotion-regulation processes were collected from 1,704 primary care patients. Correlation and analysis of variance (ANOVA) tests were conducted to identify those variables associated with both depression and anxiety. Participants were then divided into severe and nonsevere emotional symptoms, and binomial logistic regression was used to identify the variables that contributed the most to classify the severity. The final adjusted model included psychological QoL (p < .001, odds ratio [OR] = .426, 95% CI [.318, .569]), negative metacognitions (p < .001, OR = 1.083, 95% CI [1.045, 1.122]), physical QoL (p < .001, OR = .870, 95% CI [.841, .900]), brooding rumination (p < .001, OR = 1.087, 95% CI [1.042, 1.133]), worry (p < .001, OR = 1.047, 95% CI [1.025, 1.070]), and employment status (p = .022, OR [.397, 2.039]) as independent variables, ρ2 = .326, area under the curve (AUC) = .857. Moreover, rumination and psychological QoL emerged as the best predictors to form a simplified equation to determine the emotional symptom severity (ρ2 = .259, AUC = .822). The use of statistical models like this could accelerate the assessment and treatment-decision process, depending less on the subjective point of view of clinicians and optimizing health care resources.

Forgive, Let Go, and Stay Well! The Relationship between Forgiveness and Physical and Mental Health in Women and Men: The Mediating Role of Self-Consciousness

BACKGROUND

The current study assessed forgiveness (positive forgiveness and reduced unforgiveness), self-consciousness (rumination and reflection), and physical and mental health. The aim of the study was to check if self-consciousness mediates the relationship between dispositional forgiveness and health.

METHODS

To address this link, we conducted 2 studies (N = 484 in Study 1 and N = 249 in Study 2). Data were collected separately for Study 1, as well as Study 2. We used in both studies the Heartland Forgiveness Scale and the Rumination-Reflection Questionnaire, and additionally, the General Health Questionnaire-28 in Study 1 and the Scales of Psychological Well-Being in Study 2.

RESULTS

The results indicated that rumination was an effective mediator between positive forgiveness and mental health (B = 0.14, CI95% = [0.064, 0.234]), reduced unforgiveness and physical health (B = -0.13, CI95% = [-0.182, -0.088]), and both rumination and reflection between reduced unforgiveness and mental health (B = 0.13 CI95% = [0.051, 0.226]), positive forgiveness (B = -0.09 CI95% = [-0.135, -0.052]), and physical health.

CONCLUSION

The mediating role of ruminations was more frequently observed in females. The study highlighted the indirect effect between forgiveness and health. Rumination and reflection are mediators between forgiveness and health.

Family cohesion and adaptability reduces mobile phone addiction: the mediating and moderating roles of automatic thoughts and peer attachment

With the popularity of mobile Internet devices, the incidence of mobile phone addiction has been increasing, which has aroused the concern of all sectors of society. Due to the difficulty of eliminating the risk factors of mobile phone addiction, it's significant for researchers to examine the function and underlying mechanisms of positive environmental factors in reducing individuals' mobile phone addiction. Thus, the current study aimed to examine the relationship between family cohesion and adaptability and mobile phone addiction among university students and analyzed the mediating role of automatic thoughts as well as the moderating role of peer attachment in this link. The sample consisted of 958 Chinese university students. Participants completed self-report questionnaires assessing family cohesion and adaptability, mobile phone addiction, automatic thoughts, and peer attachment. PROCESS model 8 was significant (the total effect model (F (5, 952) = 19.64, R² = 0.09, p < 0.001)). Results indicated that family cohesion and adaptability could not only negatively predict mobile phone addiction directly, but also indirectly through the mediating effect of automatic thoughts. Moreover, both the direct association between family cohesion and adaptability and mobile phone addiction as well as the indirect effect of automatic thoughts were moderated by peer attachment. Findings emphasized the beneficial role of peer attachment on the effect of family cohesion and adaptability on automatic thoughts and mobile phone addiction.

Standard CBT versus integrative and multimodal CBT assisted by virtual-reality for generalized anxiety disorder

Introduction

Generalized Anxiety Disorder (GAD) is a prevalent emotional disorder associated with increased dysfunctionality, which has a lasting impact on the individual’s quality of life. Besides medication, Cognitive-Behavioral Therapy (CBT) represents the golden standard psychotherapeutic approach for GAD, integrating multilevel techniques and various delivery formats that enable the development of tailored treatment protocols. The objective of this study was to compare the efficiency of a standard CBT protocol targeting worries, dysfunctional beliefs, and intolerance of uncertainty with an integrative and multimodal CBT intervention augmented with Virtual Reality (VR).

Materials and methods

This study included 66 participants (M_age = 22.53 years; SD = 2.21) with moderate GAD symptoms that were randomized to the standard CBT group (CBTs; N = 32) and the Integrative and Multimodal CBT augmented with VR (IM-VRCBT; N = 34) group. The interventions comprised 10 weekly sessions conducted by trained CBT therapists, including cognitive restructuring, problem-solving, behavioral exposure, and relaxation techniques. Baseline and post-assessments were conducted with both groups. Primary outcome measures included the Hamilton Anxiety Rating Scale (HARS) and Penn-State Worry Questionnaire (PSWQ) to evaluate the severity of GAD symptoms and worries, respectively. Secondary outcomes involved the administration of Automatic Thoughts Questionnaire (ATQ), Dysfunctional Attitudes Scale (DAS) and Unconditional Self-Acceptance Questionnaire (USAQ).

Results

Both interventions determined statistically significant effects on both primary and secondary outcomes (ps < 0.001) in the expected direction. However, CBTs was associated with higher effect sizes for anxiety (Cohen’s d = 2.76) and worries (Cohen’s d = 1.85), in contrast to IM-VRCBT. Also, secondary analyses revealed positive correlations between changes in anxiety and worries level and the reduction of dysfunctional cognitive processes.

Conclusion

This research emphasized the effectiveness of CBT interventions for treating adults with moderate GAD symptomatology. Specifically, both interventions were efficient for reducing anxiety symptomatology present at individuals with GAD. However, regarding cognitive dysfunctions like worries, the standard CBT protocol performed better, as compared to the IM-VRCBT. In addition, we conclude that VR could be integrated within CBT interventions in a single protocol for GAD treatment.

Oversampled and undersolved: Depressive rumination from an active inference perspective

Rumination is a widely recognized cognitive deviation in depression. Despite the recognition, researchers have struggled to explain why patients cannot disengage from the process, although it depresses their mood and fails to lead to effective problem-solving. We rethink rumination as repetitive but unsuccessful problem-solving attempts. Appealing to an active inference account, we suggest that adaptive problem-solving is based on the generation, evaluation, and performance of candidate policies that increase an organism's knowledge of its environment. We argue that the problem-solving process is distorted during rumination. Specifically, rumination is understood as engaging in excessive yet unsuccessful oversampling of policy candidates that do not resolve uncertainty. Because candidates are sampled from policies that were selected in states resembling one's current state, "bad" starting points (e.g., depressed mood, physical inactivity) make the problem-solving process vulnerable for generating a ruminative "halting problem". This problem leads to high opportunity costs, learned helplessness and diminished overt behavior. Besides reviewing evidence for the conceptual paths of this model, we discuss its neurophysiological correlates and point towards clinical implications.

Examining Indirect Effects of Anxiety on Glycated Hemoglobin via Automatic Negative Thinking and Diabetes-Specific Distress in Adolescents With Type 1 Diabetes

OBJECTIVES

In this study, we examined the indirect effects of anxiety on glycated hemoglobin (A1C) via automatic negative thinking and diabetes distress among adolescents with type 1 diabetes (T1D) during the follow-up interval of a randomized controlled trial of an intervention targeting resilience promotion/depression prevention.

METHODS

Adolescents (N=264) participating in the Supporting Teen Problem Solving clinical trial were included and assessed at 8, 12, 16 and 28 months postbaseline. A serial, double-mediation model was used to examine path effects from anxiety to A1C through automatic negative thinking, through diabetes distress and through both automatic negative thinking and diabetes distress. Relevant demographic and clinical covariates were included.

RESULTS

Anxiety significantly predicted increases in both automatic negative thinking and diabetes distress. Automatic negative thinking was not found to mediate the association between anxiety and A1C, but diabetes distress did mediate the association. The double-mediation path through automatic negative thinking and diabetes distress together was significant. The indirect effect of anxiety on A1C through diabetes distress was significant and greater than the indirect effect of the double-mediator path. Anxiety did not predict A1C independent of its effects on automatic negative thinking and diabetes distress. Inclusion of demographic covariates did not substantively change the results.

CONCLUSIONS

Analyses suggest that automatic negative thinking and diabetes distress mediate the relationship between anxiety and A1C among adolescents with T1D. Diabetes distress appears to be a robust factor linking anxiety to A1C. Diabetes distress should be further examined as a mediator of glycemic variability in anxious youth with T1D.