Repetitive negative thinking as a transdiagnostic factor in depression and anxiety: A conceptual replication

Adherence to unhealthy diets is associated with altered frontal gamma-aminobutyric acid and glutamate concentrations and grey matter volume: preliminary findings

OBJECTIVES

Common mental disorders (CMD) are associated with impaired frontal excitatory/inhibitory (E/I) balance and reduced grey matter volume (GMV). Larger GMV (in the areas that are implicated in CMD-pathology) and improved CMD-symptomatology have been observed in individuals who adhere to high quality diets. Moreover, preclinical studies have shown altered neurometabolites (primarily gamma-aminobutyric acid: GABA and glutamate: GLU) in relation to diet quality. However, neurochemical correlates of diet quality and how these neurobiological changes are associated with CMD and with its transdiagnostic factor, rumination, is unknown in humans. Therefore, in this study, we examined the associations between diet quality and frontal cortex neuro-chemistry and structure, as well as CMD and rumination in humans.

METHODS

Thirty adults were classified into high and low diet quality groups and underwent 1H-MRS to measure medial prefrontal cortex (mPFC) metabolite concentrations and volumetric imaging to measure GMV.

RESULTS

Low (vs High) diet quality group had reduced mPFC-GABA and elevated mPFC-GLU concentrations, as well as reduced right precentral gyrus (rPCG) GMV. However, CMD and rumination were not associated with diet quality. Notably, we observed a significant negative correlation between rumination and rPCG-GMV and a marginally significant association between rumination and mPFC-GLU concentrations. There was also a marginally significant association between mPFC-GLU concentrations and rPCG-GMV.

DISCUSSION

Adhering to unhealthy dietary patterns may be associated with compromised E/I balance, and this could affect GMV, and subsequently, rumination.

Trajectories and influencing factors of social anxiety in postoperative breast cancer patients

BACKGROUND

Social anxiety among postoperative breast cancer patients is a prevalent concern, with its intensity fluctuating throughout the course of treatment. The study aims to describe the trajectory of social anxiety in postoperative breast cancer patients, explore the influencing factors, and provide theoretical support for the construction of future intervention programs.

METHODS

This study was conducted from June 2022 to January 2023, encompassing 213 breast cancer patients from three first-class hospitals in China. Data collection occurred at four distinct time points. A growth mixture model was employed to identify latent categories representing the trajectories of social anxiety changes among patients. A multiple regression analysis was utilized to explore predictive factors associated with different latent trajectory categories.

RESULTS

The trajectory of social anxiety changes in postoperative breast cancer patients includes five potential categories: maintaining mild social anxiety group, changing from mild to moderate social anxiety group, maintaining moderate social anxiety group, changing from moderate to severe social anxiety group, and maintaining severe social anxiety group. Cluster analysis results indicated three types: positive, negative, and low. Logistic regression analysis revealed that younger age, spouses concerned about postoperative appearance, chemotherapy with taxol-based drugs, opting for modified radical surgery or radical mastectomy surgical approaches, and breast cancer patients with negative rumination were factors that influenced patients' social anxiety (P < 0.05).

CONCLUSION

The trajectory of social anxiety in postoperative breast cancer patients comprises five potential categories. In clinical practice, it is essential to strengthen the management of high-risk populations susceptible to experiencing social anxiety emotions, including younger age, spouses concerned about postoperative appearance, chemotherapy with taxol-based drugs, opting for modified radical surgery or radical mastectomy surgical approaches, and breast cancer patients with negative rumination.

Pre-COVID-19 predictors of low-income women's COVID-19 appraisal, coping, and changes in mental health during the pandemic

Study examined predictors and mental health consequences of appraisal (threat, support satisfaction) and coping (active, avoidant) in a sample of low-income women during coronavirus disease 2019 (COVID-19). Pre-COVID-19 contextual risk and individual resources and COVID-19-specific risk factors were examined as predictors of COVID-19 appraisal and coping, which, in turn, were tested as predictors of changes in depression and anxiety across the pandemic. Pre-COVID-19 resilience predicted more active coping, whereas pre-COVID-19 anxiety and depression predicted more avoidant coping and lower support satisfaction, respectively. Increases in anxiety were predicted by lower pre-COVID-19 self-compassion and higher concurrent threat appraisal and avoidant coping. Increases in depression were related to lower pre-COVID-19 self-compassion, active coping and support satisfaction, and higher COVID-19 hardships and health risk. Findings highlight contextual and individual factors and processes that contribute to mental health problems in a vulnerable population during community-level stressors, with implications for prevention and intervention.

Repetitive negative thinking during ambiguous situations: Interactive roles of looming cognitive style and intolerance of uncertainty

BACKGROUND AND OBJECTIVES

Looming cognitive style (LCS) and intolerance of uncertainty (IUC) are both cognitive risk factors that play an important role in development of anxiety disorders. Even though both are known to be triggered by ambiguous situations, there is inadequate research on how they predict anxiety and repetitive negative thinking (RNT) patterns in response to ambiguity. The current study aimed to examine the interactive association of IUC and LCS with state anxiety and intensity of RNT following exposure to a stressor that involves ambiguity.

METHODS

Data were collected from 292 (153 women) individuals aged between 18 and 63 (M = 20.82, SD = 5.20) who were administered self-report measures of LCS, IUC, and anxiety followed by a vignette describing an ambiguous situation. State RNT and anxiety were assessed following exposure to the vignette.

RESULTS

The results indicated that IUC moderated the association of physical looming with state RNT. Individuals who have elevated levels of both physical looming and IUC reported experiencing more higher frequency of RNT when compared with other individuals.

LIMITATIONS

Although the manipulation check has shown that the scenario is effective it was not pilot tested. Also, since the manipulation was conducted online, the manipulation may not have been presented in a standardized way to all the participants.

CONCLUSIONS

Overall, the study shows that the two risk factors enhance each other's effect and lead to more intense levels of repetitive, uncontrollable, and distressing thoughts following exposure to ambiguity.

The psychometric properties of positive and negative beliefs about the rumination scale in Chinese undergraduates

BACKGROUND

Rumination, a transdiagnostic factor in different psychopathological conditions, is believed to be activated and sustained by dysfunctional metacognition. The Positive Beliefs about Rumination Scale (PBRS) and the Negative Beliefs about Rumination Scale (NBRS) have been used to measure the metacognitive beliefs of rumination and have been investigated in many cultural contexts. However, it remains unclear whether these scales can work as well for the Chinese population. Therefore, this study aimed to explore the psychometric properties of the Chinese versions of these scales and to test the metacognitive model of rumination for students with different levels of depression.

METHODS

The PBRS and NBRS were forward-backward translated into Mandarin. In total 1,025 college students were recruited to complete a battery of web-based questionnaires. Exploratory factor analysis, confirmatory factor analysis, and correlation analysis were used to test the structure, validity, and reliability of the two scales, as well as their item correlations with rumination.

RESULTS

A new two-factor structure of the PBRS (rather than the original one-factor model) and a new three-factor structure of the NBRS (rather than the original two-factor model) were extracted. The goodness-of-fit indices of these two factor models showed they had a good to very good fit with the data. The internal consistency and construct validity of PBRS and NBRS were also affirmed.

CONCLUSION

The Chinese versions of the PBRS and the NBRS were generally shown to be reliable and valid, but their newly extracted structures fit the Chinese college students better than their original structures. These new models of PBRS and NBRS are of value to be further explored in Chinese population.

Cognitive processes associated with emotional disorders: implications for efficient psychological treatments

BACKGROUND

Emotional disorders (EDs) are the most prevalent worldwide. Despite psychotherapies are their treatment of choice, there are difficulties to apply them properly in mental health services. Since literature shows that cognitive processes are associated with anxiety and depressive symptoms, more information is needed in order to improve psychological treatments.

AIMS

To determine the relation between cognitive factors with specific and non-specific ED symptoms in order to promote the development of accurate psychological treatments.

METHODS

We analyzed the relation between rumination, worry, and metacognition with generalized anxiety, panic, and depression disorder symptoms from a clinical sample of 116 individuals through correlation and linear regression analyses.

RESULTS

Although each specific disorder had a closer link with a particular cognitive process, all general ED symptoms were associated with the three cognitive factors studied.

CONCLUSIONS

For "pure" disorders, targeting a concrete cognitive process might be an optimal therapeutic option. However, due to the high comorbidity among EDs, we support the dissemination of the transdiagnostic treatment approach in which all cognitive factors are taken into account.

The contribution of transdiagnostic vulnerability factors in patients with chronic insomnia

Introduction

Various transdiagnostic factors have been associated with insomnia severity. The current study aimed to predict insomnia severity based on a group of transdiagnostic factors including neuroticism, emotion regulation, perfectionism, psychological inflexibility, anxiety sensitivity, and repetitive negative thinking after controlling for depression/anxiety symptoms and demographic characteristics.

Methods

Two hundred patients with chronic insomnia disorder were recruited from a sleep disorder clinic. Participants completed the Insomnia Severity Index (ISI), Clinical Perfectionism Questionnaire (CPQ), Acceptance and Action Questionnaire-II (AAQ-II), Anxiety Sensitivity Index-3 (ASI-3), Repetitive Thinking Questionnaire (RTQ-10), Big Five Inventory (BFI-10), Emotion Regulation Questionnaire (ERQ), and Depression Anxiety Stress Scale (DASS-21).

Results

After controlling for the confounding variables (depression/anxiety symptoms and demographic characteristics), hierarchical multiple linear regression suggested the significant association of neuroticism (BFI), cognitive reappraisal (ERQ), personal standards (CPQ), evaluative concerns (CPQ), physical concerns (ASI), cognitive concerns (ASI), and repetitive negative thinking (RTQ) with insomnia severity.

Discussion

The findings support the role of transdiagnostic factors, especially physical concerns, repetitive negative thinking, and neuroticism in chronic insomnia. Future research using longitudinal designs is required to verify the causal status of transdiagnostic variables.

Lockdown in Chinese university dormitories: Significant increase in negative feelings and time perception distortion

The COVID-19 pandemic has led to a global crisis resulting in lockdowns worldwide. Studies found that these could amplify negative affects predictive of disturbances in time perception. However, all existing studies on this topic concentrated on the general population during a lockdown at home. There was no research on university students living in dormitories. This study fills a gap in the literature by investigating the affective states and awareness of the passage of time of Chinese university students during an exceptional dormitory lockdown. Using a snowball sampling approach, this web-based study recruited 225 volunteers (136 girls, 17-27 years old) during a dormitory lockdown. The online survey consisted of questions on demographic information, affective states (the Chinese version of the depression anxiety stress scales-21 (DASS-21) on depression, anxiety, and stress), and sense of the passage of time (the translated version of the assessment of passage of time over daily, weekly and yearly periods). The researchers shared the questionnaire link via the social media application WeChat. The study applied descriptive statistics and column charts to represent students' affective states and sense of the passage of time under extreme conditions and Pearson's correlation analysis to examine the impact of affective states on their sense of time. The study's results indicate that the dormitory lockdown caused a significant increase in all depression, anxiety, and stress categories of the DASS-21, as well as a distortion of the sense of time passing. However, the direction of the distortion differed from that in previous studies. Moreover, a Pearson correlation analysis showed that none of the three negative affects could be associated with students' sense of time. The findings of this study indicate an increased vulnerability of students due to the lockdown. Their emotions were strongly affected, requiring particular interventions to preserve their mental well-being. In addition, they showed a different distortion direction of time passage. Finally, they differed in the correlations between negative affect and the sense of passage of time compared to the general population in lockdown at home. This shows a need to investigate the impact of psychological states on students' routines and quality of life in emergencies. This study's scope should be expanded by incorporating additional factors pertaining to the passage of time and by integrating cross-cultural comparisons.

Effectiveness of an Internet-Based Self-Help Intervention versus Public Mental Health Advice to Reduce Worry during the COVID-19 Pandemic: A Pragmatic, Parallel-Group, Randomized Controlled Trial

INTRODUCTION

The mental health burden for the general population due to the COVID-19 pandemic has been highlighted. Evidence on effective, easily accessible public health interventions to reduce worry, a major transdiagnostic risk-factor for, e.g., anxiety and depression, is scarce.

OBJECTIVE

In a pragmatic randomized controlled trial, we aimed to assess whether an internet cognitive-behavioral self-help intervention could reduce worry more than public mental health advice in the general population.

METHODS

Eligible internet users above the age of 18 were recruited from the German general population and randomly assigned, to either get.calm-move.on (GCMO), a 10-day unguided, internet-based self-help intervention, or mental health advice waiting group (MHA-W, receiving officially endorsed mental health recommendations). The primary outcome was level of worry, using the Penn State Worry Questionnaire (PSWQ), 2 weeks after randomization. Baseline assessment and 2-month and 6-month follow-ups were conducted. The trial was registered at the German Clinical Trials Registry (DRKS00021153).

RESULTS

Between April 7, 2020 and December 11, 2020, we randomly assigned 351 individuals to receive either GCMO (n = 175) or MHA-W (n = 176). Participants receiving GCMO (PSWQ = 46.6; change -10.3) reported significantly less worrying at post-intervention (F1,219 = 12.9; p < 0.001; d = 0.38) than MHA-W controls (PSWQ = 51.6; change -5.1). Improvements were also seen on most secondary outcomes, including symptoms of anxiety and depression, general well-being, resiliency, and emotion regulation skills. Improvements made from baseline were stable until the 6-month follow-up.

CONCLUSIONS

This internet-based self-help intervention providing cognitive-behavioral techniques to cope with the threatening pandemic situation is effective in reducing worry in the general population and should complement existing and potentially effective mental health recommendations.

Sleep to Internalizing Pathway in Young Adolescents (SIPYA): A proposed neurodevelopmental model

The prevalence of internalizing disorders, i.e., anxiety and depressive disorders, spikes in adolescence and has been increasing amongst adolescents despite the existence of evidence-based treatments, highlighting the need for advancing theories on how internalizing disorders emerge. The current review presents a theoretical model, called the Sleep to Internalizing Pathway in Young Adolescents (SIPYA) Model, to explain how risk factors, namely sleep-related problems (SRPs), are prospectively associated with internalizing disorders in adolescence. Specifically, SRPs during late childhood and early adolescence, around the initiation of pubertal development, contribute to the interruption of intrinsic brain networks dynamics, both within the default mode network and between the default mode network and other networks in the brain. This interruption leaves adolescents vulnerable to repetitive negative thought, such as worry or rumination, which then increases vulnerability to internalizing symptoms and disorders later in adolescence. Sleep-related behaviors are observable, modifiable, low-stigma, and beneficial beyond treating internalizing psychopathology, highlighting the intervention potential associated with understanding the neurodevelopmental impact of SRPs around the transition to adolescence. This review details support for the SIPYA Model, as well as gaps in the literature and future directions.

Nonproductive thoughts, somatic symptoms and well-being in adolescence: testing the moderator role of age and gender in a representative study

Background

Previous findings suggest a female preponderance in nonproductive thoughts -rumination and worry-, but studies on gender differences in the strength of the relationship between nonproductive thoughts, somatic symptoms and subjective well-being are scarce. Our aim was to test whether gender and age would moderate these associations.

Methods

1572 adolescents were involved in this representative cross-sectional study (770 boys; mean age = 15.39; SD = 2.26 years). Nonproductive thoughts were measured by Nonproductive Thoughts Questionnaire for Children (NPTQ-C), somatic symptoms were assessed by Somatic Complaint List (SCL), while Mental Health Continuum-Short Form (MHC-SF) was used to measure subjective well-being. To assess the moderation effects of age and gender on the relationship between nonproductive thoughts, somatic symptoms and well-being, four multiple indicator multiple causes (MIMIC) models were defined.

Results

Our results suggested that higher rates of nonproductive thoughts predicted a higher level of somatic symptoms and a lower level of subjective well-being. The analyses revealed that although nonproductive thoughts were strongly and equally associated with somatic symptoms among boys and girls, age was a significant moderator. Gender also moderated the relationship between nonproductive thoughts and subjective well-being.

Conclusions

Our results support the importance of nonproductive thoughts in somatic symptoms and highlight that the strength of the relationship is similar across both genders but could be dependent upon age. The findings also shed light on the decreased well-being of girls, especially with elevated level of nonproductive thoughts.

Is it magic? An exploratory randomized controlled trial comparing imagery rescripting and cognitive restructuring in the treatment of depression

BACKGROUND AND OBJECTIVES

To investigate whether working with intrusive images and the use of imagery processes would be beneficial to treating depression, an imagery-based intervention (imagery rescripting, IR) was compared with a more commonly used verbal-based technique (cognitive restructuring, CR). The study aimed not only to test the efficacy of IR as a brief modular treatment for depression, but to explore whether such experiential use of imagery would alleviate the abstract-evaluative, verbal processes of rumination and worry.

METHODS

Forty-one participants diagnosed with clinical depression and who also reported intrusive images underwent one assessment session of imagery properties before they were randomly assigned to an IR group or to an active control group of CR. They then received three weekly sessions of treatment, and outcomes were measured before and after treatment, as well as at two-month follow-up.

RESULTS

The results showed that IR was equally if not more effective than CR in alleviating depression. Significant differential reductions in rumination, worry and experiential avoidance between treatments added support to the technique's experiential nature, and possibly, a defusing out of an abstract-evaluative mode of processing.

LIMITATIONS

Only self-report measures were used, with a small number of treatment sessions by one clinician.

CONCLUSIONS

The findings support the therapeutic potential of imagery modalities in the treatment of depression, which compared to cognitive restructuring, appear to bring about more significant emotional change with time (clinical trial registered at the Joint CUHK-NTEC CREC Ref. No. 2015.458).

The association between repetitive negative thinking and distress across mental disorders: Preliminary findings from an outpatient treatment-seeking sample

Distress is a characteristic of various mental disorders. The transdiagnostic construct repetitive negative thinking (RNT) has been suggested to contribute to distress. However, there is little evidence that this association can actually be found across diagnostic categories. We analyzed this association for phobias, other anxiety disorders, stress disorders, depressive disorders and substance use disorders in 194 treatment-seeking individuals. RNT was associated with distress across all diagnostic categories with high effect sizes. Except for phobias, these associations were not attributable to general emotion regulation abilities. RNT might contribute to distress in several mental disorders which underlines its potential for transdiagnostic interventions.

Amygdala functional connectivity mediates the association between catastrophizing and threat-safety learning in youth with chronic pain

ABSTRACT

There is a need to identify brain connectivity alterations predictive of transdiagnostic processes that may confer vulnerability for affective symptomology. Here, we tested whether amygdala resting-state functional connectivity (rsFC) mediated the relationship between catastrophizing (negative threat appraisals and predicting poorer functioning) and altered threat-safety discrimination learning (critical to flexibly adapt to new and changing environments) in adolescents with persistent pain. We examined amygdala rsFC in 46 youth with chronic pain and 29 healthy peers (age M = 15.8, SD = 2.9; 64 females) and its relationship with catastrophizing and threat-safety learning. We used a developmentally appropriate threat-safety learning paradigm and performed amygdala seed-based rsFC and whole-brain mediation analyses. Patients exhibited enhanced connectivity between the left amygdala and right supramarginal gyrus (SMG) (cluster-level P-FDR < 0.05), whereas right amygdala rsFC showed no group differences. Only in patients, elevated catastrophizing was associated with facilitated threat-safety learning (CS+>CS-; rp = 0.49, P = 0.001). Furthermore, in patients, elevated catastrophizing was associated with reduced left amygdala connectivity with SMG / parietal operculum, and increased left amygdala connectivity with hippocampus, dorsal striatum, paracingulate, and motor regions (P < 0.001). In addition, blunted left amygdala rsFC with right SMG/parietal operculum mediated the association between catastrophizing and threat-safety learning (P < 0.001). To conclude, rsFC between the left amygdala (a core emotion hub) and inferior parietal lobe (involved in appraisal and integration of bodily signals and attentional reorienting) explains associations between daily-life relevant catastrophizing and threat-safety learning. Findings provide a putative model for understanding pathophysiology involved in core psychological processes that cut across diagnoses, including disabling pain, and are relevant for their etiology.

Investigating the structural model of procrastination based on transdiagnostic factors

Background: Procrastination is a common and widespread phenomenon that affects 15-20% of the general population and 50% of students. Since developing and providing beneficial and effective interventions for procrastination needs a strong, comprehensive theoretical background explanation, the aim of the study was to assess the underlying transdiagnostic factors of procrastination and presenting a causal model.

Methods: In this cross-sectional study, 390 college students were asked to fill out a packet of self-report measures, which included the Pure procrastination scale, Difficulties in emotion regulation scale, Depression-anxiety-stress scales, Frost multidimensional perfectionism scale, Rumination response scale, Penn state worry questionnaire, Acceptance and action questionnaire. The causal model was tested using structural equation modeling (SEM).

Results: Results of the SEM indicate that perfectionism was significantly associated with increasing emotion dysregulation (β=0.446, P<0.001) and emotion dysregulation was significantly associated with increasing anxiety (β=0.499, P<0.001) and depression (β=0.478, P<0.001), and then anxiety and depression with other variables, such as worry (β=0.245, P<0.001; β=0.004, P=0.935), rumination (β=0.046, P=0.424; β=0.418, P<0.001) and experiential avoidance (β=0.277, P<0.001; β=0.319, P<0.001) related to procrastination. Finally, worry has the most significant increasing effect on procrastination. The very small root mean square error of approximation (RMSEA=0.038), together with large values of comparative fit index (CFI=0.985), relative fit index (RFI=0.917), and normed fit index (NFI=0.979) indicated that the model was well fit.

Conclusion: Perfectionism, emotion dysregulation, negative affects, worry, rumination, and experiential avoidance, known as transdiagnostic factors, had a causal relationship with procrastination, and reducing each transdiagnostic factor will improve procrastination. This study could be considered as a cornerstone for further studies on procrastination from a transdiagnostic approach.

Repetitive negative thinking: transdiagnostic correlate and risk factor for mental disorders? A proof-of-concept study in German soldiers before and after deployment to Afghanistan

BACKGROUND AND OBJECTIVES

Disorder-specific forms of Repetitive Negative Thinking (RNT) are associated with multiple diagnostic categories, indicating a transdiagnostic nature. Few studies examined content-independent RNT processes across groups of diagnosed mental disorders. Moreover, theory describes RNT processes as critically involved in the etiology of mental disorders, empirical evidence however is scarce. We first tested the transdiagnostic nature by examining levels of RNT across groups of internalizing and externalizing mental disorders compared to healthy individuals and explored RNT levels in a comorbid disorder-group. Second, we examined whether RNT predicts incident psychopathology.

METHODS

In a sample of German soldiers (n = 425) scheduled for deployment in Afghanistan, we compared RNT levels between diagnosed groups with alcohol use disorders, anxiety disorders and healthy individuals cross-sectionally. Exploratory analyses were conducted comparing a comorbid disorder-group to healthy individuals and to both single-disorder-groups. Longitudinally, we examined the predictive value of pre-deployment RNT levels for incident psychopathology after deployment (n = 167). RNT was measured using the Perseverative Thinking Questionnaire (PTQ), DSM-IV diagnoses were assessed using the standardized Composite International Diagnostic Interview (CIDI).

RESULTS

Cross-sectional comparisons revealed that soldiers with alcohol use disorders and anxiety disorders showed significantly higher degrees of RNT compared to healthy soldiers. RNT levels in those with comorbid disorders were significantly higher compared to healthy soldiers but also compared to both single-disorder-groups. Longitudinal analyses revealed that higher levels of RNT prior to deployment were associated with a higher risk to have any incidental mental disorder after deployment. This however is only attributable to individuals with a PTQ score above a cut-off of 15.

CONCLUSIONS

Findings provide evidence for RNT as a transdiagnostic correlate and a vulnerability factor for the development of mental disorders.

Mind wandering and depression: A status report

While many clinical studies and overviews on the contribution of rumination to depression exist, relatively little information regarding the role of mind wandering (MW) in general is available. Therefore, it remains an open question whether patterns of MW are altered in depression and, if so, how these alterations are related to rumination. Here, we review and discuss studies investigating MW in cohorts, showing either a clinically significant depression or with clinically significant disorders accompanied by depressive symptoms. These studies yield first tentative insights into major issues. However, further investigations are required, specifically studies which: i) compare patients with a primary diagnosis of major depression with healthy and appropriately matched controls, ii) implement measures of both MW and rumination, iii) are based on experience sampling (in combination with other key approaches), iv) compare experience sampling during daily life, resting state and attentional tasks, v) explore possible biases in the assessment of MW, vi) acquire data not only related to the propensity and contents of MW, but also regarding meta-awareness and intentionality.

Psychological risk factors and the course of depression and anxiety disorders: A review of 15 years NESDA research

BACKGROUND

The Netherlands Study of Depression and Anxiety (NESDA; N_baseline=2981) is an ongoing longitudinal, multi-site, naturalistic, cohort study examining the etiology, course, and consequences of depression and anxiety. In this article we synthesize and evaluate fifteen years of NESDA research on prominent psychological risk factors for the onset, persistence, recurrence, and comorbidity of affective disorders.

METHODS

A narrative review of 62 NESDA articles examining the specificity and predictive value of neuroticism, behavioral inhibition, repetitive negative thinking, experiential avoidance, cognitive reactivity, locus of control, (implicit) self-esteem, (implicit) disorder-specific self-associations, and attentional bias for the course of affective disorders.

RESULTS

All self-reported risk factors showed cross-sectional relationships with singular and comorbid affective disorders, and prospective relationships with the development and chronicity of depression and anxiety disorders. High neuroticism, low self-esteem, and negative repetitive thinking showed most prominent transdiagnostic relationships, whereas cognitive reactivity showed most pronounced depression-specific associations. Implicit self-esteem showed predictive validity for the persistence and recurrence of anxiety and depression over and above self-reported risk factors. Automatic approach-avoidance behavior and attentional bias for negative, positive, or threat words showed no relationship with affective disorders.

CONCLUSION

NESDA identified both (a) transdiagnostic factors (e.g., neuroticism, low implicit self-esteem, repetitive negative thinking) that may help explain the comorbidity between affective disorders and overlap in symptoms, and (b) indications for disorder-specific risk factors (e.g., cognitive responsivity) which support the relevance of distinct disorder categories and disorder-specific mechanisms. Thus, the results point to the relevance of both transdiagnostic and disorder-specific targets for therapeutic interventions.

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.

Cognitive behavioral based group psychotherapy focusing on repetitive negative thinking: Decreased uncontrollability of rumination is related to brain perfusion increases in the left dorsolateral prefrontal cortex

Repetitive negative thinking (RNT) is a core process underlying various psychiatric disorders. 'Uncontrollability of rumination (UOR)' is one the most maladaptive factors of rumination, but little is known on how cognitive behavioral focused RNT psychotherapy may alter brain activity. In a subsample of 47 patients suffering from RNT who also underwent brain imaging (registered RCT trial NCT01983033), we evaluated the effect of cognitive behavioral based group psychotherapy (CBGP) (n = 25) as compared to a delayed treatment control group (DTCG) (n = 22) on frontolimbic brain perfusion with a focus on UOR. This RNT construct was measured using the subscale 'uncontrollability' of the Dutch version of the Rumination on Sadness Scale (LARSS-U). Brain perfusion was assessed with arterial spin labeling (ASL)-fMRI. LARSS-U scale scores significantly decreased in the CBGP cohort whereas no significant changes emerged in the DTCG group. Compared to the DTCG, this decrease on UOR in the CBGP group was related to significant perfusion increases in the left (dorsolateral) prefrontal cortex, part of the executive network. Besides the fact that CBGP significantly reduced RNT, this attenuation of uncontrollable ruminative thoughts was related to brain perfusion increases areas documented to be involved in the top down control of adaptive emotion regulation and the inhibition of ruminative processes.

Sooner than you think: A very early affective reaction to the COVID-19 pandemic and quarantine in Argentina

The unique circumstances created by the COVID-19 pandemic pose serious challenges to mood stability and emotional regulation at all ages. Although many people tend to react resiliently to stress, others appear to display emotional anxiety and depression-related symptoms. In this study, we carried out a survey (N = 10,053) during the first week of the general lockdown (quarantine) in Argentina to measure early affective reactions in Argentine adults. Respondents showed substantial anxious and depressive symptoms, with 33% and 23% of participants reporting possible depressive and anxious syndromes, respectively, with the youngest group (18 to 25 y.o.) showing the highest prevalence of symptoms. Even if prior mental health problems predisposed or aggravated the reaction, participants without prior complaints showed signs of psychological impact. Using linear regression, the most important independent variables related to depressive symptoms were the feeling of loneliness followed by daily stress. In the case of anxious states, the strongest variables were negative repetitive thinking and feeling of loneliness. Other psychological, economic, and social factors are discussed. This study is in line with previous literature that highlight the importance of the psychological impact of pandemics, but additionally demonstrates that these reactions are present at a large scale immediately after the start of quarantine with very low infectious rates as an early anticipatory adaptive reaction leading to potential negative outcomes from adjustment disorders to major disorders. In addition, the present results provide potentially relevant information about sudden environmental impacts on affective states and specific pathways for anxiety and depression to be expressed. We end by discussing implications for public policy based on considering the most vulnerable groups.

Chinese adolescents' mindfulness and internalizing symptoms: The mediating role of rumination and acceptance

BACKGROUND

Internalizing problems during adolescence are common psychiatric symptoms. Previous research has demonstrated that mindfulness was significantly and negatively associated with and mindfulness-based interventions would be efficacious for aiming at adolescents' internalizing problems. However, research about how mindfulness could improve internalizing symptoms among Chinese adolescents is sparse and its potential mechanism is still unclear. The present study adopted rumination and acceptance to examine their mediation effects between Chinese adolescents' mindfulness and internalizing symptoms.

METHODS

A final sample of 1,554 adolescents (aged from 10 to 18 years old, M = 15.58, SD =1.25) were recruited from schools in South China. Participants were asked to complete a package of questionnaires measuring mindfulness, internalizing problems (indicated by generalized anxiety and depression), rumination, and acceptance.

RESULTS

Structural equation model confirmed our hypothesis and showed that rumination, as well as acceptance, significantly mediated the relationship between Chinese adolescents' mindfulness level and internalizing symptoms (generalized anxiety and depression).

LIMITATIONS

a) only cross-sectional design was employed in the study; b) most of participants were normal adolescent students, without a diagnosis of any psychiatric disorder; c) all the measures were self-reported by adolescents.

CONCLUSIONS

Mindfulness not only directly impacted on adolescents' internalizing problems, but also indirectly improved their anxious and depression emotions via the reduction of rumination and the increase of acceptance. Hence, mindfulness training as well as the application of emotion regulation skills may be useful for adolescents exposed to the likelihood of suffering from internalizing problems.

Emotional working memory training reduces rumination and alters the EEG microstate in anxious individuals

Rumination is an important etiological factor of anxiety pathology, with its mechanism related to the deficit of working memory. The current study examined whether working memory training (WM-T) and emotional working memory training (EWM-T) could reduce rumination in anxious individuals. The participants with high trait anxiety underwent 21 days of mobile applications-based WM-T (n = 34), EWM-T (n = 36) or placebo control (n = 36), with questionnaires, cognitive tasks, and resting electroencephalogram (EEG) as the pre-post-test indicators. The results revealed that two training groups obtained comparable operation span increases (WM-T: d = 0.53; EWM-T: d = 0.65), updating improvement (WM-T: d = 0.43; EWM-T: d = 0.60) and shifting improvement (WM-T: d = 0.49; EWM-T: d = 0.72). Furthermore, compared to the control group, the EWM-T showed significant self-reported rumination reduction (d = 0.69), increased inhibition ability (d = 0.72), as well as modification of resting EEG microstate C parameters (Duration C: d = 0.42, Coverage C: d = 0.39), which were closely related to rumination level (r ~ 0.4). The WM-T group also showed the potential to reduced self-reported rumination (d = 0.45), but with the absence of the observable inhibition improvement and resting EEG changes. The correlation analysis suggested that the emotional benefits of WM-T depending more on improved updating and shifting, and that of EWM-T depending more on improved inhibition ability. The advantage to add emotional distractions into general working memory training for targeting rumination related anxiety has been discussed.

Better Safe Than Sorry: A Common Signature of General Vulnerability for Psychopathology

Several labels, such as neuroticism, negative emotionality, and dispositional negativity, indicate a broad dimension of psychopathology. However, largely separate, often disorder-specific research lines have developed that focus on different cognitive and affective characteristics that are associated with this dimension, such as perseverative cognition (worry, rumination), reduced autobiographical memory specificity, compromised fear learning, and enhanced somatic-symptom reporting. In this article, we present a theoretical perspective within a predictive-processing framework in which we trace these phenotypically different characteristics back to a common underlying “better-safe-than-sorry” processing strategy. This implies information processing that tends to be low in sensory-perceptual detail, which allows threat-related categorical priors to dominate conscious experience and for chronic uncertainty/surprise because of a stagnated error-reduction process. This common information-processing strategy has beneficial effects in the short term but important costs in the long term. From this perspective, we suggest that the phenomenally distinct cognitive and affective psychopathological characteristics mentioned above represent the same basic processing heuristic of the brain and are only different in relation to the particular type of information involved (e.g., in working memory, in autobiographical memory, in the external and internal world). Clinical implications of this view are discussed.

Estrutura Interna da Escala Cognitiva de Ansiedade (ECOGA)

Resumo Este estudo objetivou investigar evidências de validade de estrutura interna para a Escala Cognitiva de Ansiedade (ECOGA) por análise fatorial exploratória (AFE). A amostra foi formada por 874 participantes, sendo 656 da população geral, 179 de instituições de saúde e 39 de consultórios particulares com hipótese diagnóstica de transtornos de ansiedade. A maioria da amostra foi masculina (55%), solteiros (61,1%) com ensino superior incompleto (46%). A análise paralela da ECOGA, contendo inicialmente 73 itens, demonstrou a existência de até quatro fatores, a MAP com três e a Hull com um. Análises com três e quatro fatores (teoricamente aceitáveis) foram realizadas, utilizando cargas fatoriais acima de 0,40 e 0,50. O modelo teórico e psicométrico mais adequado compreendeu 31 itens e três fatores, com cargas fatoriais mínimas de 0,50. Os índices de ajuste (CFI, GFI, RMSEA) unidimensionalidade (ÚNICO e MIREAL) e confiabilidade (Orion e Cronbach) complementaram as adequadas propriedades psicométricas desta versão.

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.

Cognitive behavioral therapy for perinatal anxiety: A randomized controlled trial

BACKGROUND

Up to one in five women meet diagnostic criteria for an anxiety disorder during the perinatal period (i.e. pregnancy and up to 1 year postpartum). While psychotropic medications are effective, they are associated with risks for mothers and babies. There is a growing demand for evidence-based non-pharmacological treatments for perinatal anxiety.

OBJECTIVE

To evaluate the effectiveness of a cognitive behavioral group therapy protocol for perinatal anxiety.

METHODS

In total, 96 women were randomized to cognitive behavioral group therapy or waitlist at a clinic specializing in women's mental health. Participants were 22-41 years of age, pregnant or up to 6 months postpartum and had an anxiety disorder with or without comorbid depression.

RESULTS

Compared to waitlist, participants in cognitive behavioral group therapy reported significantly greater reductions in the primary outcome of anxiety (State-Trait Inventory of Cognitive and Somatic Anxiety, η²_p = .19; Hamilton Anxiety Rating Scale, η²_p = .16), as well as in secondary outcomes including worry (Penn State Worry Questionnaire, η²_p = .29), perceived stress (Perceived Stress Scale, η²_p = .33) and depressive symptoms (Edinburgh Postnatal Depression Scale, η²_p = .27; Montgomery-Åsberg Depression Rating Scale, η²_p = .11). Maternal status (pregnant, postpartum) and medication use were unrelated to treatment outcomes. All gains were maintained, or continued to improve, at 3-month follow-up.

CONCLUSION

Cognitive behavioral group therapy was effective in improving anxiety and related symptoms among women with anxiety disorders in the perinatal period.

Group rumination-focused cognitive-behavioural therapy (CBT) v. group CBT for depression: phase II trial

BACKGROUND

Although cognitive-behavioural therapy (CBT) is an effective treatment for depression, less than half of patients achieve satisfactory symptom reduction during treatment. Targeting known psychopathological processes such as rumination may increase treatment efficacy. The aim of this study was to test whether adding group rumination-focused CBT (RFCBT) that explicitly targets rumination to routine medical management is superior to adding group CBT to routine medical management in treating major depression.

METHODS

A total of 131 outpatients with major depression were randomly allocated to 12 sessions group RFCBT v. group CBT, each in addition to routine medical management. The primary outcome was observer-rated symptoms of depression at the end of treatment measured on the Hamilton Rating Scale for Depression. Secondary outcomes were rumination at post-treatment and depressive symptoms at 6 months follow-up (Trial registered: NCT02278224).

RESULTS

RFCBT significantly improved observer-rated depressive symptoms (Cohen's d 0.38; 95% CI 0.03-0.73) relative to group CBT at post-treatment on the primary outcome. No post-treatment differences were found in rumination or in depressive symptoms at 6 months follow-up, although these secondary analyses may have been underpowered.

CONCLUSIONS

This is the first randomized controlled trial providing evidence of benefits of RFCBT in major depression compared with CBT. Group RFCBT may be a beneficial alternative to group CBT for major depression.

A Comparison of Metacognitive Therapy in Current Versus Persistent Depressive Disorder - A Pilot Outpatient Study

Background: Metacognitive therapy (MCT) is a modern approach with demonstrated efficacy in current major depressive disorder (MDD). The treatment aims to modify thinking styles of rumination and worry and their underlying metacognitions, which have been shown to be involved in the initiation and perpetuation of MDD. We hypothesized that metacognitive therapy may also be effective in treating persistent depressive disorder (PDD). Methods: Thirty depressed patients (15 with MDD; 15 with PDD) were included. Patients in both groups were comparable on depression severity and sociodemographic characteristics, but PDD was associated with more former treatments. Metacognitive therapy was applied by trained psychotherapists for a mean of 16 weeks. Results: We observed a significant improvement of depressive symptoms in both groups, and comparable remission rates at the end of treatment and after 6 months follow-up. Furthermore, we observed significant and similar levels of improvement in rumination, dysfunctional metacognitions, and anxiety symptoms in both groups. Limitations: The study is limited by the small sample size and a missing independent control group. The effect of the therapeutic alliance was not controlled. The quality of depression rating could have been higher. Conclusions: We demonstrated that metacognitive therapy can successfully be applied to patients with PDD. The observed results were comparable to those obtained for patients with current major depressive disorder. Further studies with larger groups and a randomized design are needed to confirm these promising initial findings.

Efficacy of an internet and app-based gratitude intervention in reducing repetitive negative thinking and mechanisms of change in the intervention's effect on anxiety and depression: Results from a randomized controlled trial

Repetitive negative thinking (RNT) has been identified as a transdiagnostic process that is involved in various forms of psychopathology, including anxiety and depression. This randomized controlled trial compared a 5-week internet and app-based gratitude intervention (intervention group; IG) with adherence-focused guidance against a wait list control group (WLG) in reducing RNT in a sample with elevated RNT.

METHOD

A total of 260 individuals were randomized to either the IG or the WLG. Data were collected at baseline (T1), within one week post intervention (T2), and at three (3-MFU) and six-months of follow-up (6-MFU; for IG only). The primary outcome was RNT. Secondary outcomes included other mental health outcomes and resilience factors.

RESULTS

Participants of the IG reported significantly less RNT at T2 (d = 0.61) and 3-MFU (d = 0.75) as compared to WLG. Improvements were sustained until 6-MFU. Significant, small to moderate effect sizes were identified for most secondary outcomes at T2 and 3-MFU. Furthermore, results of mediation analyses revealed that the gratitude intervention exerts its effect on anxiety and depression by reducing the risk factor of RNT, while the mediating role of resilience was less clear.

CONCLUSIONS

The gratitude intervention investigated in this study was found to be effective in reducing RNT. Gratitude interventions might affect mental health by two parallel pathways: increasing resources and reducing risk factors.

REFERENCE NUMBER ETHICS COMMITTEE OF THE UNIVERSITY OF LUENEBURG

EB 201701-03-Lehr.

CLINICAL TRIAL REGISTRATION NUMBER

DRKS00011862. The trial protocol can be assessed at: https://www.drks.de/.

Repetitive negative thinking as a mediator in prospective cross-disorder associations between anxiety and depression disorders and their symptoms

BACKGROUND AND OBJECTIVES

Comorbidity among anxiety and depression disorders and their symptoms is high. Rumination and worry have been found to mediate prospective cross-disorder relations between anxiety and depression disorders and their symptoms in adolescents and adults. We examined whether generic repetitive negative thinking (RNT), that is content- and disorder-independent, also mediates prospective cross-disorder associations between anxiety and depressions disorders and their symptoms.

METHODS

This was studied using a 5-year prospective cohort study. In a mixed sample of 1859 adults (persons with a prior history of or a current affective disorder and healthy individuals), we assessed DSM-IV affective disorders (Composite Interview Diagnostic Instrument), anxiety (Beck Anxiety Inventory) and depression symptoms (Inventory of Depressive Symptomatology) and RNT (Perseverative Thinking Questionnaire).

RESULTS

We found that baseline depression disorders and symptom severity have predictive value for anxiety disorders and symptom severity five years later (and vice versa) and that these associations were significantly mediated by level of RNT as assessed two years after baseline. The significant and rather large mediation effects seemed mainly due to the mental capacity captured by RNT, especially in the prospective relation of anxiety with future depression.

LIMITATIONS

The mediation effects were greatly attenuated or even nullified after rigorously controlling for concomitant psychopathology at two years after baseline.

CONCLUSIONS

From these results it can be concluded that repetitive negative thinking could be an important transdiagnostic factor, that may constitute a suitable target for treatment.

Validation of the Geriatric Anxiety Inventory in Chilean older people

OBJECTIVE

Currently in Chile there is a lack of validated tools for measuring anxiety in the elderly population. Considering this, the purpose of this study was to validate the Geriatric Anxiety Inventory (GAI) in the country.

METHOD

An analysis of the psychometric properties of the GAI was carried out, using a non-clinical sample of 301 older adults in the Metropolitan and Valparaíso regions of Chile. Older people were asked about anxiety, rumination, depression, well-being and sociodemographic data.

RESULTS

An excellent internal reliability was obtained with a Cronbach score of 0.931. An adequate convergent validity was observed with the Depression scales (CES-D) (Rho = 0.549, p < .01), Rumination (RSS) (Rho = 0.618; p < 0.01) and Experiential avoiding (Rho = 0.485; p < 0.01). On the other hand, the discriminant validity of the psychological well-being scale presented a negative correlation of Rho = -0.699 (p < 0.01). Finally, and Exploratory Factor Analysis was made, revealing a one-dimensional model of the instrument.

CONCLUSION

The Geriatric Anxiety Inventory has very good psychometric properties measuring anxiety in elderly people, being an adequate instrument for the screening of anxiety on this population.

Moderating effects of the valence of social interaction on the dysfunctional consequences of perseverative cognition: an ecological study in major depression and social anxiety disorder

BACKGROUND AND OBJECTIVES

Major depression disorder (MDD) and social anxiety disorder (SAD) are characterized by the use of perseverative cognition (PC) as a dysfunctional coping strategy. We sought to investigate the dysfunctional physiological and psychological consequences of PC and how the valence of social interactions moderates such consequences in these psychopathological conditions.

DESIGN/METHODS

The study combined 24-hour heart rate variability (HRV) and ecological momentary assessments in 48 individuals with MDD, SAD, and sex-matched controls.

RESULTS

In all participants, PC was associated with mood worsening and reduced ability of the parasympathetic nervous system, mainly the vagus, to inhibit sympathetic arousal (i.e., reduced HRV). Individuals with SAD had the highest frequency of daily PC, while those with MDD reported that PC interfered more with their ongoing activities. In SAD, daily PC was associated with significantly lower HRV after negative social interactions. Individuals with MDD reported higher levels of sadness during PC irrespective of the valence of the preceding social interaction but higher levels of anxiety and efforts to inhibit PC following positive interactions.

CONCLUSIONS

Results highlight the need to account for important moderators like the valence of social interaction when looking at the physiological consequences of maladaptive emotion regulation strategies.