Repetitive negative thinking as a predictor of depression and anxiety: A longitudinal cohort study

Impact of repetitive negative thinking on subjective cognitive decline: insights into cognition and brain structure

Introduction

Individuals with subjective cognitive decline (SCD) express concern about self-perceived cognitive decline despite no objective impairment and are at higher risk of developing Alzheimer's disease. Despite documented links between SCD and repetitive negative thinking (RNT), the specific impact of RNT on brain integrity and cognition in exacerbating the SCD condition remains unclear. We aimed to investigate the influence of RNT on global cognition and brain integrity, and their interrelationships among healthy middle-aged and older adults experiencing SCD.

Methods

Out of 616 individuals with neuroimaging and neuropsychological data available, 89 (mean age = 56.18 years; 68.54% females) met SCD criteria. Eighty-nine non-SCD individuals matched by age, sex, and education were also selected and represented the control group (mean age = 56.09 years; 68.54% females). Global cognition was measured using the preclinical Alzheimer's cognitive composite (PACC5), which includes dementia screening, episodic memory, processing speed, and category fluency tests. RNT was calculated through three questionnaires assessing intrusive thoughts, persistent worry, and rumination. We generated cortical thickness (CTh) maps and quantified the volume of white matter lesions (WML) in the whole brain, as grey and white matter integrity measures, respectively.

Results

SCD individuals exhibited higher RNT scores, and thinner right temporal cortex compared to controls. No differences were observed in PACC5 and WML burden between groups. Only the SCD group demonstrated positive associations in the CTh-PACC5, CTh-RNT, and WML-RNT relationships.

Discussion

In this cross-sectional study, RNT was exclusively associated with brain integrity in SCD. Even though our findings align with the broader importance of investigating treatable psychological factors in SCD, further research may reveal a modulatory effect of RNT on the relationship between cognition and brain integrity in SCD.

Comparing the effectiveness of behavioral activation in group vs. self-help format for reducing depression, repetitive thoughts, and enhancing performance of patients with major depressive disorder: a randomized clinical trial

BACKGROUND

Behavioral activation has gained increasing attention as an effective treatment for depression. However, the effectiveness of Behavioral Activation Group Therapy (BAGT) in controlled conditions compared to its self-help programs requires more investigation. The present study aimed to compare their effectiveness on depressive symptoms, repetitive negative thinking (RNT), and performance in patients with major depressive disorder (MDD).

METHODS

In this randomized clinical trial, 40 patients diagnosed with Major Depressive Disorder (MDD) were recruited based on a structured clinical interview for DSM-5 (SCID-5). Participants were allocated to BAGT (n = 20) and self-help behavioral activation (SBA; n = 20) groups. BAGT received ten weekly sessions (90 min), while the SBA group followed the same protocol as the self-help intervention. Participants were evaluated at pre-treatment, post-treatment, and the 2-month follow-up using the Beck Depression Inventory-II (BDI-II), repetitive thinking questionnaire (RTQ-31), and work and social adjustment scale (WSAS).

RESULTS

The results of a Mixed ANOVA analysis revealed that participants who underwent BAGT showed significant improvement in depression, rumination, work, and social functioning post-treatment and at the 2-month follow-up. However, the SBA group did not show significant changes in any outcome. The study also found that, based on clinical significance, 68% of the BAGT participants were responsive to treatment, and 31% achieved a high final performance status at the 2-month follow-up.

DISCUSSION

BAGT was more effective than SBA in MDD patients. Participants' engagement with self-help treatment is discussed.

TRIAL REGISTRATION

The present trial has been registered in the Iranian Registry of Clinical Trials Center (IRCT ID: IRCT20181128041782N1|| http://www.irct.ir/ ) (Registration Date: 04/03/2019).

Stress, repetitive negative thinking, and mental health in Chilean university students: an ecological momentary assessment study

Background

Mental disorders in university students are a growing attention problem in the international community due to their high prevalence and serious consequences. One possible reason is university students' difficulties in coping with stress. Repetitive negative thinking (RNT) is a transdiagnostic process that, when combined with stress, can lead to the development of various disorders. We aim to determine the effect of stress and RNT on predicting various mental health syndromes in university students across 7 days.

Method

Prospective observational study using Momentary Ecological Assessment (EMA) with the OURMIND Mobile App. On day one, 238 university students responded to the SCL-90R questionnaire for symptoms of depression, anxiety, hostility, obsession, psychoticism, paranoia, somatization, and interpersonal sensitivity; RNT styles questionnaires, RRS for rumination and negative reflection, PSWQ for worry; SISCO-II for term academic stress, and sociodemographic. EMA consisted of five assessments a day for 6 days; each time, the students answered items about academic and non-academic stress (EMA-stress), reactive RNT duration and intrusiveness (EMA-RNT process), and reactive RNT rumination, reflection, and worry (EMA-RNT content). On day eight, symptoms were re-assessed. Seven hierarchical stepwise linear regression models were used to test the predictive power of the study variables in the development of SCL-90R symptoms.

Results

When comparing models, adding baseline symptoms increased the models' predictive power in all symptom groups. In most cases, including EMA-stress generated greater predictive power, except for paranoia and interpersonal sensitivity. Adding the EMA-RNT process increased the prediction of paranoia and obsessive symptoms; for hostility symptoms, RNT styles increased predictive power. For the final regression models, considering the initial symptoms, the EMA-RNT process predicted the progression of symptoms in six out of eight groups, while EMA-non-academic stress predicted the remaining two. Additionally, living with other relatives or friends was a predictor of depressive symptoms.

Discussion

The stress of university life impacts the development of psychiatric symptoms in university students. These results provide evidence of RNT as a transdiagnostic process in several syndromic groups. Universal preventive programs should consider the impact of academic and non-academic stress on university students' mental health. Targeting RNT would also benefit selective preventive interventions.

Can an intervention designed to reduce repetitive negative thinking alter the response to a psychosocial stressor? A randomized controlled study

Prior research suggests that repetitive negative thinking (RNT) negatively impacts mental health by intensifying and prolonging emotional reactivity to stress. This study investigated whether an intervention designed to reduce RNT alters emotional reactivity. Young adults with high trait RNT (N = 79) were randomly allocated to an RNT-focused intervention (smartphone app-based, 10 days) or a waiting list before exposure to a standardized stressor. The pre-registered analysis did not reveal a significant condition * time interaction for negative affect. However, exploratory analyses showed that whilst initial increases in negative affect in response to the stressor did not differ between conditions, participants in the intervention condition reported less negative affect throughout the following recovery phase. Additionally, participants in the intervention condition appraised their ability to cope with the stressor as higher and reported less RNT in the recovery phase. In contrast, the intervention did not affect biological stress responses. The findings indicate that RNT-focused interventions might have positive effects on mental health by breaking the self-reinforcing cycle of RNT, negative affect and maladaptive appraisals in response to stress. However, as findings are partly based on exploratory analyses, further research is needed to confirm whether reduced subjective stress reactivity mediates the effects of RNT-focused interventions on psychopathological symptoms.

Repetitive negative thinking as a unique transdiagnostic risk factor for suicidal ideation

Repetitive negative thinking (RNT) is a transdiagnostic symptom observed across mood and anxiety disorders and is characterized by frequent, distressing thoughts that are perceived as uncontrollable. Specific forms of RNT have been linked to increased suicide risk. However, most work examining links between RNT and suicide has been conducted within specific disorders and subtypes of RNT (e.g., rumination in individuals with depression). The present study aimed to investigate associations between transdiagnostic RNT and suicidal ideation. We hypothesized RNT would be associated with suicide risk beyond disorder-specific clinical symptoms. Fifty-four participants with mood, anxiety, and/or traumatic stress disorders completed an interview assessing suicidal risk (Columbia-Suicide Severity Rating Scale (C-SSRS)) and self-report questionnaires assessing transdiagnostic RNT, depression, and anxiety. Based on C-SSRS, we divided participants into high or low suicide risk groups. We analyzed the relationship between suicidal risk group and RNT and found that RNT was uniquely associated with suicidal risk group, controlling for depression and anxiety severity. Our results suggest including assessments of RNT may have clinical utility for understanding the degree of suicide risk in individuals and point to the potential utility of including clinical interventions to target this symptom for those at high risk of suicide.

From Tripping and Falling to Ruminating and Worrying: A Meta-Control Account of Repetitive Negative Thinking

Repetitive negative thinking (RNT) is a transdiagnostic construct that encompasses rumination and worry, yet what precisely is shared between rumination and worry is unclear. To clarify this, we develop a meta-control account of RNT. Meta-control refers to the reinforcement and control of mental behavior via similar computations as reinforce and control motor behavior. We propose rumination and worry are coarse terms for failure in meta-control, just as tripping and falling are coarse terms for failure in motor control. We delineate four meta-control stages and risk factors increasing the chance of failure at each, including open-ended thoughts (stage 1), individual differences influencing subgoal execution (stage 2) and switching (stage 3), and challenges inherent to learning adaptive mental behavior (stage 4). Distinguishing these stages therefore elucidates diverse processes that lead to the same behavior of excessive RNT. Our account also subsumes prominent clinical accounts of RNT into a computational cognitive neuroscience framework.

Rumination in dementia and its relationship with depression, anxiety, and attentional biases

Rumination (self-referential and repetitive thinking), attentional biases (AB), and impaired cognitive control are theorized as being integral factors in depression and anxiety. Yet, research examining the relationship between rumination, mood, and AB for populations with reduced cognitive control, e.g., people living with dementia (PwD), is lacking. To explore whether literature-based relationships are demonstrated in dementia, PwD (n = 64) and healthy controls (HC) (n = 75) completed an online self-report survey measuring rumination and mood (twice), and a telephone cognitive status interview (once). Rumination was measured as an emotion-regulation style, thinking style, and response to depression. We examined the test-retest reliability of PwD's (n = 50) ruminative-scale responses, ruminative-scale internal consistency, and correlations between rumination, age, cognitive ability, and mood scores. Also, nine participants (PwD = 6, HC = 3) completed an AB measure via eye-tracking. Participants fixated on a cross, naturally viewed pairs of facial images conveying sad, angry, happy, and neutral emotions, and then fixated on a dot. Exploratory analyses of emotional-face dwell-times versus rumination and mood scores were conducted. Except for the HC group's reflective response to depression measure, rumination measures were reliable, and correlation strengths between rumination and mood scores (.29 to .79) were in line with literature for both groups. For the AB measure subgroup, ruminative thinking style scores and angry-face metrics were negatively correlated. The results of this study show that literature-based relationships between rumination, depression, and anxiety are demonstrated in dementia, but the relationship between rumination and AB requires further investigation.

Psychological distress and self-reported mental disorders: the partially mediating role of coping strategies

BACKGROUND AND OBJECTIVES

Accumulating evidence suggests a substantial prevalence of mental health disorders worldwide and the association between psychological distress and mental disorders. However, the mechanisms underlying this association are underexplored. Using longitudinal data, this study examined coping strategies as a potential mechanism.

METHODS

Participants (N = 2,333) from the Midlife in the United States (MIDUS) completed psychosocial and mental health surveys over 19 years. A parallel mediation model was used to test the direct association between psychological distress (baseline) and self-reported mental disorders (17-19 years follow-up) and the indirect associations via coping strategies (8-11 years follow-up), controlling for demographics and baseline self-reported mental disorders.

RESULTS

Psychological distress predicted an increased likelihood of mental disorders later in life. Emotion-focused coping was a significant mediator of this association, but problem-focused coping was not. Psychological distress was positively associated with emotion-focused coping, and emotion-focused coping was positively associated with mental disorders. Psychological distress was negatively associated with problem-focused coping; however, no association was found between problem-focused coping and mental disorders.

CONCLUSIONS

Findings provide further support for the longitudinal association between psychological distress and mental health disorders and extend prior research by showing the partial mediating role of emotion-focused coping in this association.

Connecting chronic stress and anxiety: a multi-dimensional perspective

Studies show a connection between anxiety and stress, but with little differentiation between different domains of stress. In this article, we utilize a multi-dimensional approach to better understand the relationship between different chronic stress domains and anxiety. This will allow researchers to identify and address those areas of stress that are most relevant with regard to anxiety. We used data from a sub sample of the LIFE-Adult-Study (n = 1085) to analyze the association between nine different areas of chronic stress (Trier Inventory for Chronic Stress, TICS) and anxiety (General Anxiety Disorder 7, GAD-7), controlling for sociodemographic variables, personality, and social support. There was a significant and positive association between Work Overload, Pressure to Perform, Social Tensions, Social Isolation, Chronic Worrying, and anxiety. After including the control variables, only Work Overload and Chronic Worrying remained significant. By focusing on Work Overload and Chronic Worrying researchers, practitioners, and policy makers can help to mitigate anxiety and related health problems in the population in an efficient way.

Cannabis And College Students: Self-Perceived Mental Health Prior to, During, and After the Pandemic

Introduction

College students demonstrated changes in levels of mental wellbeing as they and the world experienced new levels of stress and anxiety due to the COVID-19 pandemic. As access to healthcare became limited, students turned to alternative methods of coping, which included cannabis use.

Objective

To determine if an association between cannabis use and self-perceived mental wellbeing during the pandemic among college students exists.

Method

A paired samples t-Test was used to compare self-reported mental wellbeing at different times during the pandemic, a one-way ANOVA to compare self-reported mental health between respondents' cannabis use status, and a Tukey-Kramer post-hoc analysis was used to determine between group significance. All data collected were from participants at a single time point (retrospective self-report during April 2022).

Results

Of 103 self-reported college students, the most significant differences in mental wellbeing were reported prior to and during the pandemic. Consistent significant differences were observed between each of the college student groups derived from those students who entirely avoided cannabis use or cessation of use (highest rating), p = .018, as compared to those who initiated cannabis use prior to and during the pandemic (lowest rating) p = .045. Post pandemic mental wellbeing demonstrated a higher level of mental wellbeing among those who had some exposure to cannabis compared to those who avoided cannabis entirely.

Conclusions

It cannot be concluded that mental wellbeing was lower due to cannabis use. However, it is possible those with lower self-perceived mental wellbeing turned to cannabis use.

Perceived Parenting Stress Is Related to Cardiac Flexibility in Mothers: Data from the NorBaby Study

Heart rate variability (HRV) is an indicator of autonomic nervous system activity, and high levels of stress and/or depressive symptoms may reduce HRV. Here, we assessed whether (a) parental stress affected HRV in mothers during the perinatal period and whether this is mediated by bonding and (b) whether antenatal maternal mental states, specifically repetitive negative thinking, depressive symptoms, and pregnancy-related anxiety, have an impact on infant HRV, and lastly, we investigated (c) the relationship between maternal HRV and infant HRV. Data are from the Northern Babies Longitudinal Study (NorBaby). In 111 parent-infant pairs, cardiac data were collected 6 months after birth. In the antenatal period, we used the Pregnancy-Related Anxiety Questionnaire-Revised, the Edinburgh Postnatal Depression Scale, and the Perseverative Thinking Questionnaire; in the postnatal period, we used the Parenting Stress Index and the Maternal Postnatal Attachment Scale. Higher levels of perceived parenting stress but not depressive symptoms were associated with lower HRV in mothers (τ = -0.146), and this relationship was not mediated by maternal bonding. Antenatal maternal mental states were not associated with infant HRV. There was no significant correlation between maternal HRV and infant HRV. Our observational data suggest that perceived stress reduces cardiac flexibility. Future studies should measure HRV and parenting stress repeatedly during the perinatal period.

Psychological and attentional outcomes following acute mindfulness induction among high anxiety individuals: A systematic review and meta-analysis

BACKGROUND

Training outcomes of mindfulness interventions for anxiety have been extensively researched. Less is known about the acute effects of mindfulness induction and associated mechanisms. This systematic review aimed to identify 1) the effect of mindfulness induction on pre-post measures of state anxiety and attention among adults experiencing high levels of anxiety; and 2) the impact of predictors, mediators and moderators on post-induction changes in anxiety and attention. State distress and mindfulness were included as secondary outcomes.

METHODS

A systematic search was conducted in November 2021 in electronic databases using relevant search terms. Five studies (four randomised controlled trials and one non-randomised controlled trial) were included, comprising a total of 277 participants with elevated trait/generalised anxiety. Each study used a brief audio-based mindfulness induction exercise.

RESULTS

The meta-analysis indicated mindfulness induction had medium and large effects on state anxiety (k = 3, n = 100, g = -0.60, 95%CI [-1.04, -0.16]; p = .008) and state mindfulness (k = 2, n = 110, g = 0.91, 95%CI [0.52, 1.30], p < .001), respectively, when compared with non-therapeutic control conditions. Furthermore, two studies showed small and moderate effects of mindfulness on state anxiety when compared to therapeutic active controls, but were not pooled in a meta-analysis. While results could not be pooled for attention, there was limited evidence of behavioural improvements on tasks measuring aspects of attention following mindfulness induction. However, one study found an increase in Low Beta to High Beta ratio and a reduction in Beta activity in the Anterior Cingulate Cortex following mindfulness induction. Moreover, another study found aspects of state mindfulness mediated reductions in state anxiety.

LIMITATIONS

A small number of studies were included in the review, with high risk of bias and low certainty of evidence present.

CONCLUSION

The findings support the use of mindfulness induction to reduce state anxiety in anxious individuals but suggest gains in state mindfulness may be a more realistic expected outcome. Further controlled trials are needed to delineate the relative effects of objectively assessed anxiety outcomes from mindfulness induction in clinically defined samples.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

TRIAL REGISTRATION

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

The Management of Chronic Pain: Re-Centring Person-Centred Care

The drive for a more person-centred approach in the broader field of clinical medicine is also gaining traction in chronic pain treatment. Despite current advances, a further departure from 'business as usual' is required to ensure that the care offered or received is not only effective but also considers personal values, goals, abilities, and day-to-day realities. Existing work typically focuses on explaining pain symptoms and the development of standardised interventions, at the risk of overlooking the broader consequences of pain in individuals' lives and individual differences in pain responses. This review underscores the importance of considering additional factors, such as the influence of chronic pain on an individual's sense of self. It explores innovative approaches to chronic pain management that have the potential to optimise effectiveness and offer person-centred care. Furthermore, it delves into research applying hybrid and individual formulations, along with self-monitoring technologies, to enhance pain assessment and the tailoring of management strategies. In conclusion, this review advocates for chronic pain management approaches that align with an individual's priorities and realities while fostering their active involvement in self-monitoring and self-management.

Developing a Theory of Change for a Digital Youth Mental Health Service (Moderated Online Social Therapy): Mixed Methods Knowledge Synthesis Study

BACKGROUND

Common challenges in the youth mental health system include low access, poor uptake, poor adherence, and limited overall effectiveness. Digital technologies offer promise, yet challenges in real-world integration and uptake persist. Moderated Online Social Therapy (MOST) aims to overcome these problems by integrating a comprehensive digital platform into existing youth mental health services. Theory of change (ToC) frameworks can help articulate how and why complex interventions work and what conditions are required for success.

OBJECTIVE

The objective of this study is to create a ToC for MOST to explain how it works, why it works, who benefits and how, and what conditions are required for its success.

METHODS

We used a multimethod approach to construct a ToC for MOST. The synthesis aimed to assess the real-world impact of MOST, a digital platform designed to enhance face-to-face youth mental health services, and to guide its iterative refinement. Data were gathered from 2 completed and 4 ongoing randomized controlled trials, 11 pilot studies, and over 1000 co-design sessions using MOST. Additionally, published qualitative findings from diverse clinical contexts and a review of related digital mental health literature were included. The study culminated in an updated ToC framework informed by expert feedback. The final ToC was produced in both narrative and table form and captured components common in program logic and ToC frameworks.

RESULTS

The MOST ToC captured several assumptions about digital mental health adoption, including factors such as the readiness of young people and service providers to embrace digital platforms. External considerations included high service demand and a potential lack of infrastructure to support integration. Young people and service providers face several challenges and pain points MOST seeks to address, such as limited accessibility, high demand, poor engagement, and a lack of personalized support. Self-determination theory, transdiagnostic psychological treatment approaches, and evidence-based implementation theories and their associated mechanisms are drawn upon to frame the intervention components that make up the platform. Platform usage data are captured and linked to short-, medium-, and long-term intended outcomes, such as reductions in mental health symptoms, improvements in functioning and quality of life, reductions in hospital visits, and reduced overall mental health care costs.

CONCLUSIONS

The MOST ToC serves as a strategic framework for refining MOST over time. The creation of the ToC helped guide the development of therapeutic content personalization, user engagement enhancement, and clinician adoption through specialized implementation frameworks. While powerful, the ToC approach has its limitations, such as a lack of standardized methodology and the amount of resourcing required for its development. Nonetheless, it provides an invaluable roadmap for iterative development, evaluation, and scaling of MOST and offers a replicable model for other digital health interventions aiming for targeted, evidence-based impact.

A replication and extension of bifactor modelling of perseverative thought in an at-risk community sample: Exploring sex differences in the structure of PT

BACKGROUND

Perseverative thought (PT) is a transdiagnostic construct associated with internalizing disorders. Bifactor models have shown that PT can be split into a general PT factor and lower-order factors for specific forms of PT, such as rumination and worry. No bifactor study to date has investigated if the structure of PT differs across sexes.

METHODS

The study consisted of 280 individuals recruited for a larger study targeting risk factors for suicidal ideation and behaviours. Participants completed a diagnostic interview and self-report questionnaires.

RESULTS

A two-factor model of PT fit best in males, whereas a bifactor model fit best in females. In a structural equation model, worry was associated with generalized anxiety disorder diagnoses in females, but not males. Rumination was associated with depressive disorder diagnoses in females, but not males.

CONCLUSIONS

The present study contributes to a growing literature on PT; we found that dimensionality of PT varied by sex. We also found that relations between PT factors and generalized anxiety disorder differed by sex. Sex differences in the internalizing spectrum and related risk factors need to be considered when examining the structure and function of risk factors.

Associations between rumination, depression, and distress tolerance during CBT treatment for depression in a tertiary care setting

BACKGROUND

Rumination is strongly associated with depressive symptom severity and course. However, changes in rumination during outpatient cognitive behavioral therapy (CBT), and their links to baseline features such as distress tolerance and clinical outcomes, have received limited attention.

METHODS

278 outpatients with depression received group or individual CBT. Measures of rumination, distress tolerance, and depression symptom severity were assessed at baseline and periodically during treatment. Mixed effect and regression-based models evaluated changes over time, and associations between rumination, distress tolerance and depression severity.

RESULTS

Depression and rumination decreased throughout acute treatment. Rumination reduction was concurrently associated with depressive symptom reduction. Lower levels of rumination at each time point prospectively predicted lower depressive symptoms at the next time point. Distress tolerance measured at baseline was positively associated with depression symptom severity; the indirect effect on post-treatment depression symptoms via rumination measured mid-treatment was nonsignificant when rumination at baseline was accounted for. Changes in and associations between depression and rumination were replicated in sensitivity analyses; although changes in depression and rumination were smaller in magnitude in patients receiving treatment during COVID-19.

LIMITATIONS

Additional assessment points would permit a more nuanced assessment of the role rumination may play in mediating the associations between distress tolerance and depression severity. Additional investigation of treatments in community settings may also further our understanding of variability in rumination during depression treatment.

CONCLUSIONS

The current study provides unique real-world support for variability in rumination as a key indicator of change over the course of CBT for depression.

Trait- and state-like co-activation pattern dynamics in current and remitted major depressive disorder

BACKGROUND

Distinguishing between trait- and state-like neural alternations in major depressive disorder (MDD) may advance our understanding of this recurring disorder. We aimed to investigate dynamic functional connectivity alternations in unmedicated individuals with current or past MDD using co-activation pattern analyses.

METHODS

Resting-state functional magnetic resonance imaging data were acquired from individuals with first-episode current MDD (cMDD, n = 50), remitted MDD (rMDD, n = 44), and healthy controls (HCs, n = 64). Using a data-driven consensus clustering technique, four whole-brain states of spatial co-activation were identified and associated metrics (dominance, entries, transition frequency) were analyzed with respect to clinical characteristics.

RESULTS

Relative to rMDD and HC, cMDD showed increased dominance and entries of state 1 (primarily involving default mode network (DMN)), and decreased dominance of state 4 (mostly involving frontal-parietal network (FPN)). Among cMDD, state 1 entries correlated positively with trait rumination. Conversely, relative to cMDD and HC, individuals with rMDD were characterized by increased state 4 entries. Relative to HC, both MDD groups showed increased state 4-to-1 (FPN to DMN) transition frequency but reduction in state 3 (spanning visual attention, somatosensory, limbic networks), with the former metric specifically related to trait rumination.

LIMITATIONS

Further confirmation with longitudinal studies are required.

CONCLUSIONS

Regardless of symptoms, MDD was characterized by increased FPN-to-DMN transitions and reduced dominance of a hybrid network. State-related effect emerged in regions critically implicated in repetitive introspection and cognitive control. Asymptomatic individuals with past MDD were uniquely linked to increased FPN entries. Our findings identify trait-like brain network dynamics that might increase vulnerability to future MDD.

A randomized trial on differential changes in thought and affect after mindfulness versus dyadic practice indicates phenomenological fingerprints of app-based interventions

Contemplative practice has demonstrated benefits for mental health and well-being. Most previous studies, however, implemented in-person trainings containing a mix of different, mostly solitary, practices and focused on pre- to post-training outcomes. In this randomized trial, we explore the immediate differential efficacy of two daily app-delivered practices in shifting emotional (valence, arousal) and thinking patterns (thought content on future-past, self-other, positive-negative dimensions). For 10 weeks of daily training, 212 participants (18-65 years) performed either a novel 12-min partner-based socio-emotional practice (Affect Dyad) or a 12-min attention-focused solitary mindfulness-based practice. Using ordinal Bayesian multilevel modeling, we found that both practice types led to more positive affect and higher arousal. However, whereas mindfulness-based practice partly led to a decrease in active thoughts, particularly in future-, other-related and negative thoughts, the Dyad in contrast led to increases in other-related, and positive thoughts. This shift towards more social and positive thoughts may specifically support overcoming ruminative thinking patterns associated with self-related and negative thought content. Overall, these differential findings may help inform the adaptation of scalable app-based mental trainings in different segments of the population with the goal to improve mental health and well-being.

Psychological Momentum

Our mental experience is largely continuous on the scale of seconds and minutes. However, this continuity does not always arise from a volitional carrying forward of ideas. Instead, recent actions, thoughts, dispositions, and emotions can persist in mind, continually shaping our later experience. Aspects of this fundamental property of human cognition - psychological momentum - have been studied under the rubrics of memory, task set, mood, mind-wandering, and mindset. Reviewing these largely independent threads of research, we argue that psychological momentum is best understood from an integrated perspective, as an adaptation that helps us meet the current demands of our environment and to form lasting memories.

Linking repetitive negative thinking and insomnia symptoms: A longitudinal trait-state model

Sleep disturbance is highly debilitating, and an abundance of research suggests that repetitive negative thinking (i.e., rumination, worry) may contribute to the development and maintenance of maladaptive sleep patterns, such as insomnia symptoms. Although repetitive negative thinking is often conceptualized as a 'trait' risk factor for anxiety-related disorders, it is unclear if it consists of time-varying (TV) or state-like features versus time-invariant (TI) or trait-like characteristics. Furthermore, it is unclear if it is the TV or TI components of repetitive negative thinking that contribute to insomnia symptoms that is commonly observed in anxiety-related disorders. In a 6-wave, 5-month longitudinal study, community participants (N = 1219) completed measures of rumination, worry, transdiagnostic repetitive negative thinking, and insomnia symptoms. A latent variable (trait-state-occasion) model was applied to the measures of repetitive negative thinking. The results showed that although estimates of TI factor variance and TV factor variance were both significant for latent repetitive negative thinking, worry, and rumination, the proportion of TI factor variance (0.82-0.89) was greater than the amount of TV factor variance (0.11-0.19). Although TV factor stability was statistically significant for latent repetitive negative thinking, rumination, and worry, the magnitude of the coefficients was small. Furthermore, regression weights for the latent repetitive negative thinking, rumination, and worry TI factor were significant and larger than those for the TV factor in predicting insomnia symptoms at each of the six time points. These findings suggest that repetitive negative thinking is largely TI, and it is this TI component that contributes to insomnia symptoms. Implications for conceptualizations of repetitive negative thinking as a predisposing and perpetuating factor in insomnia for anxiety and related disorders are discussed.

Perseverative thinking is associated with features of spoken language

Perseverative thinking (PT), such as rumination or worry, is a transdiagnostic process implicated in the onset and maintenance of emotional disorders. Existing measures of PT are limited by demand and expectancy effects, cognitive biases, and reflexivity, leading to calls for unobtrusive, behavioral measures. In response, we developed a behavioral measure of PT based on language. A mixed sample of 188 participants with major depressive disorder, generalized anxiety disorder, or no psychopathology completed self-report PT measures. Participants were also interviewed, providing a natural language sample. We examined language features associated with PT, then built a language-based PT model and examined its predictive power. PT was associated with multiple language features, most notably I-usage (e.g., "I", "me"; β = 0.25) and negative emotion language (e.g., "anxiety", "difficult"; β = 0.19). In machine learning analyses, language features accounted for 14% of the variance in self-reported PT. Language-based PT predicted the presence and severity of depression and anxiety, psychiatric comorbidity, and treatment seeking, with effects in the r = 0.15-0.41 range. PT has face-valid linguistic correlates and our language-based measure holds promise for assessing PT unobtrusively. With further development, this measure could be used to passively detect PT for deployment of "just-in-time" interventions.

Does an app designed to reduce repetitive negative thinking decrease depression and anxiety in young people? (RETHINK): a randomized controlled prevention trial

BACKGROUND

The first onset of common mental health disorders, such as mood and anxiety disorders, mostly lies in adolescence or young adulthood. Hence, effective and scalable prevention programs for this age group are urgently needed. Interventions focusing on repetitive negative thinking (RNT) appear especially promising as RNT is an important transdiagnostic process involved in the development of depression and anxiety disorders. First clinical trials indeed show positive effects of preventative interventions targeting RNT on adult as well as adolescent mental health. Self-help interventions that can be delivered via a mobile phone app may have the advantage of being highly scalable, thus facilitating prevention on a large scale. This trial aims to investigate whether an app-based RNT-focused intervention can reduce depressive and anxiety symptoms in young people at risk for mental health disorders.

METHODS

The trial will be conducted in a sample (planned N = 351) of individuals aged 16-22 years with elevated levels of RNT but no current depression or anxiety disorder. In a randomized controlled between-subjects design, two versions of the app-based self-help intervention will be compared to a waiting list control condition. The full RNT-focused intervention encompasses a variety of RNT-reducing strategies, whereas the concreteness training intervention focuses on only one of these strategies, i.e., concrete thinking. The primary outcome (depressive symptoms) and secondary outcomes (anxiety symptoms and RNT) will be measured at pre-intervention, post-intervention (6 weeks after pre-intervention), and follow-up (18 weeks after pre-intervention).

DISCUSSION

This trial aims to find out whether targeting RNT via an app is an effective and feasible way of preventing depression and anxiety disorders in adolescents. Since app-based interventions are highly scalable, this trial might contribute to tackling challenges related to the increasing rates of mental health disorders among young people.

TRIAL REGISTRATION

https://www.drks.de , DRKS00027384. Registered on 21 February 2022-prospectively registered.

Repetitive Negative Thinking as a Central Node Between Psychopathological Domains: a Network Analysis

Repetitive negative thinking (RNT) may be defined as a reiterative, passive and uncontrollable thinking process. RNT has been recognized as a transdiagnostic phenomenon associated with the onset and maintenance of several clinical conditions including depression, generalised anxiety, psychosis and insomnia. We aimed to estimate a network model of mutual associations between RNT and the aforementioned indicators whilst controlling for other well-established transdiagnostic factors (i.e. perceived stress, loneliness). A total of 324 participants (Mage = 25.26 years, SD = 6.89; 69.3% females) completed a cross-sectional survey of self-report questionnaires. A Gaussian graphical model was estimated using the graphical LASSO in combination with the extended Bayesian information criterion. We found a dense network in which RNT exhibited substantial connections with the majority of the psychopathological domains. The centrality indices confirmed that RNT was one of the most important nodes in the network. Moreover, the estimated network showed satisfactory accuracy and stability. Findings emphasized RNT as a potentially good therapeutic target for psychopathology prevention and treatment protocols.

Factors influencing attitudes toward vaccine safety and vaccine effectiveness amongst UK healthcare professionals prior to and at the time of COVID-19 vaccine rollout: Insights from the CoPE-HCP cohort study

Given the potential for nosocomial outbreaks, we must understand factors associated with negative vaccine attitudes amongst healthcare professionals (HCPs) before the rollout of a newly developed vaccine in a pandemic setting. The aim of this prospective cohort study was to study the impact of preexisting and prevailing mental health on United Kingdom HCPs' attitudes towards a newly developed COVID-19 vaccine. Two online surveys were distributed: first during vaccine development (July-September, 2020) and second during nationwide vaccine rollout (December 2020-March 2021). Mental health (PHQ-9 for depression; GAD-7 for anxiety) was assessed in both surveys. Negative attitude regarding vaccine safety and vaccine effectiveness was assessed at vaccine rollout. A series of logistic regression models were developed relating mental health (preexisting during vaccine development, ongoing and new-onset during rollout, and changes in symptom severity) to negative vaccine attitudes. In 634 HCPs, the presence of depression and/or anxiety during vaccine development was associated with elevated negative attitude towards vaccine safety (adj. OR 1.74 [95% CI 1.10-2.75], p = .02), but not vaccine effectiveness (1.13 [0.77-1.66], p = .53) at rollout. This was independent of other characteristics: age, ethnicity, professional role, and history of contracting COVID-19. Ongoing depression and/or anxiety (1.72 [1.10-2.69], p = .02) was associated with elevated negative attitude regarding vaccine effectiveness, but not vaccine safety. Worsened combined symptom scores over time were associated with elevated negative vaccine effectiveness attitudes (1.03 [1.00-1.05], p < .05), but not vaccine safety. Overall, adverse mental health can impact on HCPs' attitudes towards a newly developed vaccine. Further work is required to understand how this translates to vaccine uptake.

Do perfectionists show negative, repetitive thoughts facing uncertain situations?

Perfectionism, intolerance of uncertainty and repetitive negative thinking are all psychological traits, which are treated as transdiagnostic phenomena for the development and the maintenance of psychopathology. The aim of the current work was to investigate the associations between repetitive negative thinking and the multidimensional aspects of perfectionism (perfectionistic strivings and perfectionistic concerns) and intolerance of uncertainty (prospective and inhibitory) in one model. Two studies were conducted in which participants (N1 = 227; N2 = 148) completed questionnaires in an online survey. The first study measured rumination and worry separately as repetitive negative thinking processes. The second study measured repetitive negative thinking as an underlying construct of rumination and worry using a single questionnaire. We applied hierarchical regression analyses and mediation analyses in both studies. The mediation analyses in both studies showed that inhibitory intolerance of uncertainty significantly partially mediated the relationship between perfectionistic concerns and repetitive negative thinking (as well as worry and rumination). Perfectionistic concerns seem to be the more crucial perfectionism aspect for transdiagnostic considerations, particularly in association with a heighten inhibitory intolerance of uncertainty and repetitive negative thinking. Both studies strongly affirm the necessity to use the multidimensional aspects of perfectionism and intolerance of uncertainty in psychological research.

Skill Improvement Through Learning in Therapy (SKILT): A Study Protocol for a Randomized Trial Testing the Direct Effects of Cognitive Behavioral Therapy Skill Acquisition and Role of Learning Capacity in Depression

Background

To improve psychological treatments for major depressive disorder (MDD), a better understanding on how symptoms ameliorate during treatment is essential. In cognitive behavioral therapy (CBT), it is unclear whether procedures focused on the acquisition of CBT skills play a causal role in the improvement of CBT skills. In this randomized trial, we isolate a single CBT Skill Acquisition Procedure (CBTSAP) and test its direct effects on CBT skills and related therapy processes (i.e., change in (idiosyncratic) dysfunctional thinking and reward processing). We hypothesize that the CBTSAP causes improvements in CBT skills and related therapy processes compared to an active control condition. In addition, we hypothesize that individual differences in attentional bias and memory functioning (defined as learning capacity) moderate the effects of CBTSAP on outcomes and that using mental imagery as a cognitive support strategy to strengthen the effects of the CBTSAP will be most beneficial for patients with low learning capacity.

Method

150 patients with MDD will be randomized to one of three conditions: 1. an active control condition, 2. CBTSAP, 2. CBTSAP plus mental imagery, all consisting of three sessions. Primary outcomes will be change in CBT skills, changes in (idiosyncratic) dysfunctional thoughts and behaviors, reward processing. Depressive symptoms are a secondary outcome. Measures of learning capacity will be conducted at baseline and tested as a potential moderator.

Discussion

Knowing whether and for whom the acquisition of CBT skills leads to change in therapy processes and a subsequent reduction of depressive symptoms will inform on how to personalize and optimize psychotherapy outcomes for depression.

Trial registration

The trial is registered at the German Clinical Trial Register (DKTR; registration number: DRKS00024116).

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.

Effects of non-invasive vagus nerve stimulation on cognitive and autonomic correlates of perseverative cognition

Perseverative cognitions can provoke psychophysiological stress in the absence of an actual stressor and are considered important transdiagnostic vulnerability factors for several (mental) health issues. These stress-related cognitive processes are reflected by both cognitive (assessed by self-reports) and autonomic inflexibility (assessed by heart rate variability; HRV), with a key role attributed to the vagus nerve. Interestingly, modulation of the afferent branches of the vagus can be achieved with transcutaneous auricular vagus nerve stimulation (taVNS), a non-invasive technique that employs a low-intensity electrical current applied to the ear. In a sample of healthy individuals, we investigated the effects of taVNS of the left concha, compared to sham (earlobe) stimulation, on the cognitive and autonomic correlates of perseverative cognition following a psychosocial stress task. Interestingly, taVNS significantly reduced cognitive rigidity, reflected by reduced subjective perseverative thinking after psychosocial stress. Although there were no direct effects on autonomic correlates of perseverative cognition, individual differences in perseverative thinking after the stressor significantly affected the effects of taVNS on HRV. Specifically, more autonomic inflexibility during the stress task (i.e., reduced HRV) was associated with increases in perseverative thinking afterward for the sham condition, but not the active taVNS condition. Additional exploratory analyses revealed no significant moderation of stimulation intensity. Overall, the study findings endorse the association between perseverative cognitions and vagus nerve functioning.

Specific Pandemic-Related Worries Predict Higher Attention-Related Errors and Negative Affect Independent of Trait Anxiety in UK-Based Students

Background

The COVID-19 pandemic has resulted in many individuals experiencing increased symptoms of anxiety. We predict that this increase may be underpinned by pandemic-related worry (PRW), characterised by repetitive negative thinking about pandemic-specific outcomes; and that this relationship is mediated through reduced attentional capacity required to regulate negative affect.

Methods

We developed a novel scale to measure the contents of PRW in an initial sample of 255 participants, and explored its relationship with cognitive functioning and negative affect in a sample of 382 UK-based university students, whilst controlling for recalled pre-pandemic trait anxiety.

Results

A five-factor model of PRW was identified, with factors reflecting worry about decline in quality of life (QoL) and probability of infection correlating with attention and memory-related errors. Importantly, attention-related errors partially mediated the positive relationship between PRW and negative affect, even when controlling for pre-pandemic trait anxiety.

Conclusion

PRW's relationship with negative affect was partially mediated through attentional function, consistent with models of anxiety and attentional control. In UK-based students PRW may be predominantly focused on the decline in QoL; therefore, interventions targeting worry about the decline in QoL caused by COVID-19 are especially important in this population in the wake of the pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10608-022-10336-7.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Repetitive negative thinking during pregnancy and postpartum: Associations with mental health, inflammation, and breastfeeding

INTRODUCTION

Repetitive negative thinking (RNT) is a transdiagnostic feature that predicts increased mental health risks, inflammation, and reduced engagement in health promoting behaviors. Depression, anxiety, stress, inflammation, higher body mass index (BMI), and low engagement in health behaviors are associated with adverse outcomes during pregnancy as well as postpartum. However, there is limited literature on the associations between RNT and these contributing factors in the perinatal period, an at-risk time during which women may benefit from clinical interventions directed at RNT.

METHODS

This study examined the contribution of RNT to inflammation [interleukin (IL)-6] and breastfeeding duration through mediating indicators of mental health and BMI. Behavioral and biological assessments occurred during late pregnancy as well as at 4-6 weeks, 4 months, 8 months, and 12 months postpartum.

RESULTS

RNT was positively associated with depressive symptoms, anxiety, and perceived stress (ps ≤ .001) at each assessment timepoint, with the strongest associations observed at the pregnancy assessment and significant, but attenuated, associations during postpartum (ps < .01). In modeling of the association between RNT and IL-6, the indirect effect of BMI was significant at each timepoint (95%CIs 0.0013, 0.0052). Women with lower RNT exhibited longer breastfeeding duration (p = .02). These effects were not significantly mediated by mental health indicators.

CONCLUSIONS

Clinically meaningful relationships, in which RNT predicts mental health, inflammation, and health behavior engagement during pregnancy and postpartum were observed. Clinical interventions to reduce RNT may have unique benefits this time.

LIMITATIONS

Further research is warranted to determine if therapies to reduce RNT confer unique benefits for maternal and child health.

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

Background

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

Methods

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

Results

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

Conclusion

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

Working memory function in patients with major depression disorder: A narrative review

Working memory (WM) deficits are recognized as serious cognitive impairment in patients with major depressive disorder (MDD). This review aims to clarify the effects of impaired WM function in patients with MDD and explore non-invasive and effective treatments that can be adopted in clinical practice. This review (1) synthesizes extant literature examining brain function and brain areas in terms of WM in individuals with depression, (2) utilizes the outcomes of the studies presented in this review to discuss the effects of impaired WM function on cognitive processing in individuals with depression, (3) integrates the treatments explored in current studies and (4) provides some suggestions for future research. We found that (1) central executive (CE) components affect the processing of WM, and this might be one of the factors influencing cognitive biases, as it is implicated in repetitive negative thinking and rumination; (2) the left dorsal anterior cingulate cortex (dACC), the left dorsolateral prefrontal cortex (DLPFC) and the regions of the default mode network (DMN) play a vital role in CE functioning; and (3) psychotherapy, cognitive training, exercise and physical therapy can be used as complementary treatments for MDD.

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.

Infraslow closed-loop brain training for anxiety and depression (ISAD): a protocol for a randomized, double-blind, sham-controlled pilot trial in adult females with internalizing disorders

Background

The core intrinsic connectivity networks (core-ICNs), encompassing the default-mode network (DMN), salience network (SN) and central executive network (CEN), have been shown to be dysfunctional in individuals with internalizing disorders (IDs, e.g. major depressive disorder, MDD; generalized anxiety disorder, GAD; social anxiety disorder, SOC). As such, source-localized, closed-loop brain training of electrophysiological signals, also known as standardized low-resolution electromagnetic tomography (sLORETA) neurofeedback (NFB), targeting key cortical nodes within these networks has the potential to reduce symptoms associated with IDs and restore normal core ICN function. We intend to conduct a randomized, double-blind (participant and assessor), sham-controlled, parallel-group (3-arm) trial of sLORETA infraslow (<0.1 Hz) fluctuation neurofeedback (sLORETA ISF-NFB) 3 times per week over 4 weeks in participants (n=60) with IDs. Our primary objectives will be to examine patient-reported outcomes (PROs) and neurophysiological measures to (1) compare the potential effects of sham ISF-NFB to either genuine 1-region ISF-NFB or genuine 2-region ISF-NFB, and (2) assess for potential associations between changes in PRO scores and modifications of electroencephalographic (EEG) activity/connectivity within/between the trained regions of interest (ROIs). As part of an exploratory analysis, we will investigate the effects of additional training sessions and the potential for the potentiation of the effects over time.

Methods

We will randomly assign participants who meet the criteria for MDD, GAD, and/or SOC per the MINI (Mini International Neuropsychiatric Interview for DSM-5) to one of three groups: (1) 12 sessions of posterior cingulate cortex (PCC) ISF-NFB up-training (n=15), (2) 12 sessions of concurrent PCC ISF up-training and dorsal anterior cingulate cortex (dACC) ISF-NFB down-training (n=15), or (3) 6 sessions of yoked-sham training followed by 6 sessions genuine ISF-NFB (n=30). Transdiagnostic PROs (Hospital Anxiety and Depression Scale, HADS; Inventory of Depression and Anxiety Symptoms – Second Version, IDAS-II; Multidimensional Emotional Disorder Inventory, MEDI; Intolerance of Uncertainty Scale – Short Form, IUS-12; Repetitive Thinking Questionnaire, RTQ-10) as well as resting-state neurophysiological measures (full-band EEG and ECG) will be collected from all subjects during two baseline sessions (approximately 1 week apart) then at post 6 sessions, post 12 sessions, and follow-up (1 month later). We will employ Bayesian methods in R and advanced source-localisation software (i.e. exact low-resolution brain electromagnetic tomography; eLORETA) in our analysis.

Discussion

This protocol will outline the rationale and research methodology for a clinical pilot trial of sLORETA ISF-NFB targeting key nodes within the core-ICNs in a female ID population with the primary aims being to assess its potential efficacy via transdiagnostic PROs and relevant neurophysiological measures.

Trial registration

Our study was prospectively registered with the Australia New Zealand Clinical Trials Registry (ANZCTR; Trial ID: ACTRN12619001428156). Registered on October 15, 2019.

How the Brain Becomes the Mind: Can Thermodynamics Explain the Emergence and Nature of Emotions?

The neural systems' electric activities are fundamental for the phenomenology of consciousness. Sensory perception triggers an information/energy exchange with the environment, but the brain's recurrent activations maintain a resting state with constant parameters. Therefore, perception forms a closed thermodynamic cycle. In physics, the Carnot engine is an ideal thermodynamic cycle that converts heat from a hot reservoir into work, or inversely, requires work to transfer heat from a low- to a high-temperature reservoir (the reversed Carnot cycle). We analyze the high entropy brain by the endothermic reversed Carnot cycle. Its irreversible activations provide temporal directionality for future orientation. A flexible transfer between neural states inspires openness and creativity. In contrast, the low entropy resting state parallels reversible activations, which impose past focus via repetitive thinking, remorse, and regret. The exothermic Carnot cycle degrades mental energy. Therefore, the brain's energy/information balance formulates motivation, sensed as position or negative emotions. Our work provides an analytical perspective of positive and negative emotions and spontaneous behavior from the free energy principle. Furthermore, electrical activities, thoughts, and beliefs lend themselves to a temporal organization, an orthogonal condition to physical systems. Here, we suggest that an experimental validation of the thermodynamic origin of emotions might inspire better treatment options for mental diseases.

The reciprocal relationships between Chinese children’s perception of interparental conflict, negative thinking, and depression symptoms: A cross-lagged study

The present longitudinal study used the traditional cross-lagged panel model (CLPM) and autoregressive latent trajectory model with structured residuals (ALT-SR) to examine the relationships between perceived interparental conflict (IPC), negative thinking (NT), and depression symptoms in Chinese children. Changes in these three variables over time were also examined, as well as the trait and state aspects of the relationships between them. A sample of 516 third-grade primary students completed questionnaires about IPC, NT, and depression three times over a period of 1 year, at 6-month intervals. The CLPM findings indicated that, assuming that stability of each variable across time was controlled, Chinese children’s perception of IPC significantly affected their level of depression through the mediating path of NT. After taking trait factors into account, among all the significant autoregressive and cross-lagged paths originally found in the CLPM, only one third remained significant in the ALT-SR model. More specifically, the ALT-SR model, revealed a driving effect of children’s NT on perceived IPC and depression symptoms. The CLPM model although elucidated the interplay among three variables, the ALT-SR model showed little evidence of their interrelated growth across time. Taken together, these results indicate that children’s perceived IPC in the long term are a stable trait, with few state-level fluctuations, and is not a significant within-person predictor of subsequent children’s internalization problems. These perceptions appear to contribute more to children’s general psychological tendency than do changes over time. The research is the first to test the reciprocal relationships between Chinese children’s perceived IPC, NT, and depression symptoms. The findings demonstrate that previously proposed theories about the bidirectional relation between IPC and children’s social adjustment, to some extent, may reflect a correlation at a trait level. Put another way, it is IPC’s central tendency to be sensitive in the long term as a stable trait that is associated with their children’s general tendency to show well adjustment. The study contributes to our understanding of that extend previous results and have implications for complementary theoretical and practical interventions. The complementary techniques of CLPM and ALT-SR models offer different insights into children’s internalization problems, and hold promise for supporting the building of more comprehensive children’s developmental theories that acknowledge the interconnectedness of different domains of mental health.

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.

Associations Between Repetitive Negative Thinking and Habituation of Defensive Responding Within and Between Sessions

Repetitive negative thinking (RNT) is a transdiagnostic risk factor for internalizing psychopathology, and theoretical models suggest that RNT may maintain symptoms by interfering with psychophysiological habituation. The present study therefore examined associations between RNT and habituation within and between study sessions. Community members (N=86) completed a habituation task involving exposure to acoustic probes at up to five sessions spaced 7 days apart on average. Eyeblink startle response was measured using the electromyography startle magnitude. Self-reported anxiety was assessed before and after the habituation task at each session. Multilevel growth curve modeling indicated that RNT was associated with a higher "floor" (i.e., asymptote) of startle responding as evidenced by reduced within-session startle habituation at later sessions. Results suggest that RNT may disrupt startle habituation and are consistent with theoretical models proposing that RNT sustains physiological activation to support avoidance of negative emotional contrasts or perceived future threats.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42761-022-00121-w.

Mindfulness-based cognitive group therapy for treatment-refractory anxiety disorder: A pragmatic randomized controlled trial

BACKGROUND

This study aimed: (a) to examine the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) for patients with a treatment-refractory anxiety disorders compared to Relapse Prevention-Cognitive Behavioral Therapy (CBT-RP); and (b) to explore candidate mediating variables.

METHODS

We conducted a pragmatic randomized controlled trial comparing MBCT with CBT-RP in a group format for 136 outpatients with treatment-refractory DSM-IV defined anxiety disorder, who insufficiently responded to first-line psychological treatment.

RESULTS

At post-treatment, the MBCT group showed a significantly larger decrease in self-reported anxiety (Beck Anxiety Inventory), avoidance (Fear Questionnaire), difficulties in emotion regulation (Difficulties in Emotion Regulation Strategies), and worry (Penn State Worry Questionnaire), as well as a significantly larger increase in mindfulness skills (Five Facet Mindfulness Questionnaire). After a 6-month follow-up treatment gains were somewhat diminished. Effects of MBCT on anxiety at post-treatment did not prove to be mediated by mindfulness skills, difficulties in emotion regulation strategies, worry, or rumination (Rumination on Sadness Scales) at mid-treatment.

CONCLUSIONS

MBCT seems to be a promising intervention in routine clinical care for persons with an anxiety disorder who insufficiently responded to first-line psychological treatment. Future research in larger samples assessing long-term effects and using intensive longitudinal designs to identify possible working mechanisms is called for.

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

OBJECTIVES

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

DESIGN

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The 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.

Focus on and venting of negative emotion mediates the 18-year bi-directional relations between major depressive disorder and generalized anxiety disorder diagnoses

BACKGROUND

Myriad emotion regulation and coping theories have proposed that avoidant/emotion-oriented coping is a cause and consequence of anxiety and depression. However, few studies have investigated potential mechanisms underlying the prospective anxiety-depression disorder relation. The current study examined various coping strategies (i.e., denial, focus on and venting of emotion (FOAVE), and behavioral disengagement) as potential longitudinal mediators between generalized anxiety disorder (GAD) and major depressive disorder (MDD).

METHODS

In a nationally representative sample of adults (N = 3,294), MDD and GAD were assessed at Time 1 (T1) and Time 3 (T3) (Composite International Diagnostic Interview - Short-Form), and avoidant coping strategies (denial, behavioral disengagement, and FOAVE) were measured at Time 2 (T2) (Coping Questionnaire). Assessments occurred over 18 years, each spaced approximately 9 years apart. Structural equation modeling mediation analyses examined whether T1 MDD predicted T3 GAD (and vice versa), and if T2 avoidant coping mediated these relations, above and beyond baseline comorbidity.

RESULTS

FOAVE mediated the T1 MDD-T3 GAD association, and vice versa. Presence of T1 MDD and GAD predicted more T2 FOAVE, and greater T2 FOAVE forecasted T3 MDD and GAD, accounting for 16-21% of the longitudinal MDD-GAD relations. However, behavioral disengagement and denial did not mediate the prospective MDD-GAD relations. Also, T1 MDD and GAD forecasted greater T2 behavioral disengagement.

CONCLUSIONS

The use of FOAVE, may be a mechanism by which MDD earlier in life may lead to GAD 18 years later, and vice versa. Theoretical and potential clinical implications are discussed.

Repetitive Negative Thinking Processes Account for Gender Differences in Depression and Anxiety During Adolescence

Rumination and worry are vulnerability factors involved in the early development of depression and anxiety during adolescence, particularly in girls. Current views conceptualize rumination and worry as transdiagnostic forms of repetitive negative thinking (RNT). However, most of research has analyzed them separately, without considering gender differences. We analyzed common and specific roles of rumination and worry in accounting for depressive and anxiety symptom levels overall and as a function of gender in adolescents (N = 159). Rumination and worry items were loaded into separate RNT factors. Girls showed a higher use of rumination and worry and higher levels of depression and anxiety than boys. Structural equation modeling supported that both RNT factors accounted for gender differences in symptom levels: rumination was the strongest mediator for depression and worry the strongest mediator for anxiety. Our findings support both general and specific contributions of RNT to account for affective symptomatology during adolescence, particularly in girls.

Perseverative Thinking about Suicide Questionnaire (PTSQ): Validation of a new measure to assess suicide-specific rumination

BACKGROUND

Suicide-specific rumination has been shown to be associated with lifetime suicide attempts as well as suicide intent and might be an important risk factor for the transition from suicidal ideation to suicidal behavior. Based on this background, the wording of the items of an often-used self-report measure assessing core characteristics of rumination was adapted to assess specifically suicide-specific rumination.

METHODS

The entire study sample comprised N = 1689 participants from the German healthcare sector. A total of 721 participants with a history of suicidal ideation (68% female; M_age = 30.63, SD_age = 8.41, range: 18-81 years) who had completed five measures assessing suicide-specific rumination, suicidal ideation, depression, hopelessness, and resilience were included for the present examination. Factorial validity (Exploratory [EFA] to determine the appropriate number of factors and confirmatory factor analyses [CFA] after randomly splitting of the sample to validate the EFA solution), construct validity, and reliability were evaluated.

RESULTS

The EFA revealed a one-factor solution consisting of four items, which could be confirmed within a CFA (RMSR = 0.006; RMSEA = 0.039; CFI = 0.999; TLI = 0.998). Internal consistency was excellent with Cronbachs α = 0.93. Construct validity was given with moderate to high positive correlations with suicidal ideation (0.76), depression (0.55), and hopelessness (0.38) and negative correlation with resilience (-0.31). Participants with recent suicidal ideation and/or lifetime suicide attempt reported significantly more suicide-specific rumination than those with only lifetime suicidal ideation.

CONCLUSION

A new 4-item measure for suicide-specific rumination was developed and could be shown to be a reliable and valid instrument in a large German sample. Results emphasize the potential importance of suicide-specific rumination for the understanding of trajectories of suicidal ideation and suicide risk assessments.

From low sense of control to problematic smartphone use severity during Covid-19 outbreak: The mediating role of fear of missing out and the moderating role of repetitive negative thinking

Since the outbreak of Covid-19, the use of digital devices, especially smartphones, remarkably increased. Smartphone use belongs to one's daily routine, but can negatively impact physical and mental health, performance, and relationships if used excessively. The present study aimed to investigate potential correlates of problematic smartphone use (PSU) severity and the mechanisms underlying its development. Data of 516 smartphone users from Germany (Mage = 31.91, SDage = 12.96) were assessed via online surveys in April and May 2021. PSU severity was significantly negatively associated with sense of control. In contrast, it was significantly positively linked to fear of missing out (FoMO), repetitive negative thinking (RNT), and daily time spent on smartphone use. In a moderated mediation analysis, the negative relationship between sense of control and PSU severity was significantly mediated by FoMO. RNT significantly moderated the positive association between FoMO and PSU severity. Specifically, the higher the RNT, the stronger the relationship between FoMO and PSU. The present findings disclose potential mechanisms that could contribute to PSU. Potential ways of how to reduce PSU severity are discussed.