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Jansson-Fröjmark M, Sunnhed R, Carney CE, Rosendahl I. Conceptual overlap of negative thought processes in insomnia: A focus on catastrophizing, worry, and rumination in a student sample. Behav Sleep Med 2024:1-16. [PMID: 38949088 DOI: 10.1080/15402002.2024.2374264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
OBJECTIVES The association and overlap between different forms of negative thought processes in insomnia is largely unknown. The purpose of the current investigation was to examine conceptual overlap between three insomnia-specific negative thought processes; catastrophizing, worry, and rumination, identify the underlying factors, and explore their associations with insomnia symptoms. METHODS A total of 360 students completed three insomnia-related negative thought process scales (Catastrophic Thoughts about Insomnia Scale, Anxiety and Preoccupation about Sleep Questionnaire, Daytime Insomnia Symptom Response Scale) and two insomnia symptoms measures (the Insomnia Severity Index and Sleep Condition Indicator). RESULTS The three scales and their subscales displayed acceptable reliabilities. Further, confirmatory factor analysis was supportive of the notion of catastrophizing, worry, and rumination measures as distinct. The catastrophizing and worry constructs were significantly associated with insomnia symptoms, but the rumination factor was not. CONCLUSIONS The findings indicate that catastrophizing, worry, and rumination might be viewed as distinct constructs. Although more research is warranted on the topic of conceptual overlap, the current results might have implications for the development of models of insomnia, clinical research, and practice.
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Affiliation(s)
- Markus Jansson-Fröjmark
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Rikard Sunnhed
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Colleen E Carney
- Department of Psychology, Toronto Metropolitan University, Toronto, Canada
| | - Ingvar Rosendahl
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Stockholm, Sweden
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Vancappel A, Chkili R, Eberle DJ, Maercker A, El-Hage W, Bachem R. Exploring Characteristics of Preoccupation and Failure to Adapt Among Patients Suffering From Adjustment Disorder: A Qualitative Study. CLINICAL PSYCHOLOGY IN EUROPE 2024; 6:e11565. [PMID: 39119050 PMCID: PMC11303921 DOI: 10.32872/cpe.11565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 01/15/2024] [Indexed: 08/10/2024] Open
Abstract
Background Adjustment Disorder (AjD) is a frequent diagnosis in psychological and psychiatric consultations. Recently, the ICD-11 has introduced preoccupation and failure to adapt as core symptoms of AjD. However, empirical research that explores the various possible manifestations of preoccupation and failure to adapt in AjD patients is sparse. Therefore, the study aimed to explore patients' experiences of the core symptoms of AjD in a qualitative study. Method We recruited 16 patients suffering from ICD-11 AjD who filled in self-report questionnaires to assess sociodemographic information, adjustment disorder symptoms, anxiety and depression. Then, they participated in a semi-structured interview with a trained psychologist to explore the determinants and characteristics of their preoccupation and failure to adapt symptoms. Thematic analysis was applied to analyze the responses. Results Six themes were identified in our analysis 1) Preoccupation triggers, 2) Preoccupations and negative emotions, 3) Strategies to stop preoccupation, 4) Consequences of preoccupation, 5) Manifestation of difficulties/failure to adapt and 6) Strategies to address difficulties/failure to adapt. Conclusion We found partial congruence between our data and previous conceptualizations of AjD. Preoccupations seem to be time-consuming, center around stressors and their consequences, and be associated with negative emotions. Some preoccupations reported by the patients could also be labeled as ruminations or worries. The failure to adapt symptoms seemed to be broader than the exemplary symptoms highlighted in current measures of AjD.
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Affiliation(s)
- Alexis Vancappel
- CHRU de Tours, Pôle de Psychiatrie-Addictologie, Centre Régional de Psychotraumatologie CVL, Tours, France
- Département de Psychologie, QualiPsy, Qualité de Vie et santé Psychologique,Université de Tours, Tours, France
| | - Rania Chkili
- Département de Psychologie, QualiPsy, Qualité de Vie et santé Psychologique,Université de Tours, Tours, France
| | - David J. Eberle
- Department of Psychology, Universität Zürich, Zurich, Switzerland
| | - Andreas Maercker
- Department of Psychology, Universität Zürich, Zurich, Switzerland
| | - Wissam El-Hage
- CHRU de Tours, Pôle de Psychiatrie-Addictologie, Centre Régional de Psychotraumatologie CVL, Tours, France
- UMR 1253, iBrain, Université de Tours, Inserm, Tours, France
| | - Rahel Bachem
- Department of Psychology, Universität Zürich, Zurich, Switzerland
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Xu J, Wang Y, Peng Y. Psychodynamic profiles of major depressive disorder and generalized anxiety disorder in China. Front Psychiatry 2024; 15:1312980. [PMID: 38322139 PMCID: PMC10844481 DOI: 10.3389/fpsyt.2024.1312980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 01/08/2024] [Indexed: 02/08/2024] Open
Abstract
Traditional clinical diagnoses relying on symptoms may overlook latent factors that illuminate mechanisms and potentially guide treatment. The Operationalized Psychodynamic Diagnosis (OPD) system may compensate for symptom-based diagnosis by measuring psychodynamic profiles underlying mental disorders through conflicts and structure axes. However, OPD has not been widely adopted in China, and it remains unclear whether OPD can be used as an effective approach to distinguish between depression and anxiety. The current study aims to adopt the OPD system to investigate the psychodynamic profiles of major depressive disorder (MDD) and generalized anxiety disorder (GAD) in China, targeting patients with "pure" symptoms without comorbidity. We recruited 42 MDD patients, 32 GAD patients, and 31 healthy controls (HC), and assessed their self-report depression and anxiety symptoms, along with their underlying psychodynamic profiles through OPD interviews. Overall, both MDD and GAD patients showed more prominent conflict issues and lower levels of structure than HC. The MDD and GAD groups yielded different conflict profiles and conflict processing modes when processing their second conflicts. Importantly, the multi-dimensional psychodynamic profiles achieved machine learning classification of clinical groups with an accuracy of 0.84, supporting successful distinction of MDD and GAD patients. In conclusion, the OPD demonstrated sensitivity in revealing distinct psychodynamic profiles underlying "pure" depression and anxiety clinical populations in China. This work calls for future incorporation of OPD as a tool to investigate psychodynamic formulations underlying mental disorders, compensating for traditional symptom-based diagnostic approaches to guide precise individualized interventions.
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Affiliation(s)
- Jia Xu
- Peking University Institute of Mental Health, Key Laboratory of Ministry of Health (Peking University), Beijing, China
| | - Yuxi Wang
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
| | - Yujia Peng
- School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China
- Institute for Artificial Intelligence, Peking University, Beijing, China
- National Key Laboratory of General Artificial Intelligence, Beijing Institute for General Aritificial Intelligence, Beijing, China
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Hitchcock C, Brown RL, Cobham VE. Validation of the Child version of the Perseverative Thinking Questionnaire of repetitive negative thinking in young people with diagnosed depressive and anxiety disorders. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 61:242-254. [PMID: 34617301 PMCID: PMC9292182 DOI: 10.1111/bjc.12336] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 09/28/2021] [Indexed: 12/02/2022]
Abstract
This paper sought to provide the first validation of a transdiagnostic measure of repetitive negative thinking – the Perseverative Thinking Questionnaire‐Child version (PTQ‐C) – in young people diagnosed with anxiety and depressive disorders. Participants (N = 114) were 11‐ to 17‐year‐olds with complex and comorbid presentations seeking treatment through Child and Adolescent Mental Health Services. Confirmatory factor analyses best supported a three‐factor model for the PTQ‐C; however, hypotheses of both perfect and close fit were rejected, and a subsequent bifactor model suggested minimal unique variance for each subscale. Results demonstrated good internal consistency, convergent validity and divergent validity for the total score and three PTQ‐S subscales: core characteristics, perceived unproductiveness, and consumed mental capacity of negative repetitive thinking. PTQ‐C scores did not account for additional variance in anxiety symptoms once worry was considered, indicating that retention of a content‐specific measure may be warranted in clinical samples. Findings emphasize the importance of validating clinically relevant measures which were developed with subclinical populations in samples with diagnosed mental health disorders.
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Affiliation(s)
- Caitlin Hitchcock
- MRC Cognition and Brain Sciences Unit, University of Cambridge, UK.,Melbourne School of Psychological Sciences, University of Melbourne, UK
| | - Renee L Brown
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Vanessa E Cobham
- School of Psychology, The University of Queensland, Brisbane, Queensland, Australia.,Children's Health Queensland, Child and Youth Mental Health Service, Brisbane, Queensland, Australia
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Heinzel CV, Kollárik M, Miché M, Clamor A, Ertle A, Lieb R, Wahl K. Is a Ruminative Thinking Style Related to Obsessive-Compulsive Symptom Severity Beyond Its Associations with Depressive and Anxiety Symptom Severity? Int J Cogn Ther 2021. [DOI: 10.1007/s41811-021-00112-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
AbstractPrevious studies suggest that a ruminative thinking style (RTS) is positively associated with the severity of obsessive-compulsive symptoms and might be involved in the maintenance of obsessive-compulsive disorder (OCD). We sought to replicate this association in a sample of individuals with OCD, controlling for depressive and anxiety symptom severity, and to extend previous studies by including an interview measure of obsessive-compulsive symptom severity. A sample of 140 individuals diagnosed with OCD participated in a cross-sectional observational study. Participants completed questionnaire measures of an RTS as well as obsessive-compulsive, depressive, and anxiety symptom severity. Obsessive-compulsive symptom severity was additionally assessed with an interview. When statistically controlling for depressive and anxiety symptom severity, an RTS continued to predict the questionnaire, but not the interview measure of obsessive-compulsive symptom severity. We discuss possible explanations for these mixed findings, emphasizing the unique aspects of each measure, and consider implications for further research on OCD.
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Abasi I, Pourshahbaz A, Mohammadkhani P, Dolatshahi B, Moradveisi L, Mennin DS. Emotion regulation therapy for social anxiety disorder: a single case series study. Behav Cogn Psychother 2021; 49:1-15. [PMID: 33952371 DOI: 10.1017/s1352465821000175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Despite the vast majority of evidence indicating the efficacy of traditional and recent cognitive behaviour therapy (CBT) therapies in treating social anxiety disorder (SAD), some individuals with SAD do not improve by these interventions, particularly when co-morbidity is present. AIMS It is not clear how emotion regulation therapy (ERT) can improve SAD co-morbid with symptoms of generalized anxiety disorder (GAD) and depression. This study investigated this gap. METHOD Treatment efficacy was assessed using a single case series methodology. Four clients with SAD co-occurring with GAD and depression symptoms received a 16-session version of ERT in weekly individual sessions. During the treatment, self-report measures and clinician ratings were used to assess the symptom intensity, model-related variables, and quality of life, work and social adjustment of participants every other week throughout the treatment. Follow-up was also conducted at 1, 2 and 3 months after treatment. Data were analysed using visual analysis, effect size (Cohen's d) and percentage of improvement. RESULTS SAD clients with depression and GAD symptoms demonstrated statistically and clinically significant improvements in symptom severity, quality of life, work, social adjustment and model-related measures (i.e. negative emotionality/safety motivation, emotion regulation strategies). The improvements were largely maintained during the follow-up period and increased for some variables. CONCLUSION These findings showed preliminary evidence for the role of emotion dysregulation and motivational factors in the aetiology and maintenance of SAD and the efficacy of ERT in the treatment of co-morbid SAD.
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Affiliation(s)
- Imaneh Abasi
- Former Affiliation: Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
- Current Affiliation: Department of Clinical Psychology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Pourshahbaz
- Former Affiliation: Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Parvaneh Mohammadkhani
- Former Affiliation: Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Behrouz Dolatshahi
- Former Affiliation: Department of Clinical Psychology, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Latif Moradveisi
- Research Center for Behavioral Disorders and Substance Abuse, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Douglas S Mennin
- Department of Counseling and Clinical Psychology, Teachers College, Columbia University, New York, United States of America
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Farber R, Wedell E, Herchenroeder L, Dickter CL, Pearson MR, Bravo AJ. Microaggressions and Psychological Health Among College Students: A Moderated Mediation Model of Rumination and Social Structure Beliefs. J Racial Ethn Health Disparities 2021; 8:245-255. [PMID: 32514783 PMCID: PMC7722011 DOI: 10.1007/s40615-020-00778-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Revised: 05/05/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
Abstract
Racial microaggressions are common experiences for students of color on college campuses. Given prior research connecting microaggressions to negative mental health outcomes, it is important to better understand the social context and process through which microaggressions are associated with poorer mental health. In addition, we put forth a psycho-sociological approach to microaggressions, integrating an attention to both individual psychology and broader social structure. Specifically, the present study investigated whether the indirect association of school/workplace microaggressions and internalizing symptoms (i.e., depression, anxiety, and stress) through problem-focused thoughts (a subset of ruminative thinking) differed as a function of horizontal and vertical dimensions of individualism and collectivism among a racially diverse sample of non-White college students (n = 549) from two universities in the USA. As hypothesized, problem-focused thoughts mediated the associations between school/workplace microaggressions and all three negative mental health symptoms. Furthermore, the indirect effect of school/workplace microaggressions on psychological health through problem-focused thoughts was stronger in students with high levels of vertical individualism (i.e., autonomous but recognize/accept inequality among individuals), compared to students with low or average levels. Our findings suggest that students of color who endorse vertical individualism are at a relatively greater risk of negative mental health outcomes related to school/workplace microaggressions via problem-focused thoughts. Future research is needed to examine additional factors that may buffer or strengthen the pathways between microaggressions and negative mental health in students of color.
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Affiliation(s)
- Reya Farber
- Department of Sociology, William & Mary, Williamsburg, VA, USA
| | - Emma Wedell
- Department of Psychological Sciences, William & Mary, Williamsburg, VA, USA
| | - Luke Herchenroeder
- Department of Psychological Sciences, William & Mary, Williamsburg, VA, USA
| | - Cheryl L Dickter
- Department of Psychological Sciences, William & Mary, Williamsburg, VA, USA
| | - Matthew R Pearson
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico, Albuquerque, NM, USA
| | - Adrian J Bravo
- Department of Psychological Sciences, William & Mary, Williamsburg, VA, USA.
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Abstract
Recent research suggests that the stress-sleep relationship is mediated by pre-sleep arousal (PSA) and that cognitive arousal has a stronger mediating effect than somatic arousal; however, this has not been directly tested. Using multilevel moderated mediation, we compared the effects of cognitive arousal and somatic arousal within the stress-sleep relationship. We also assessed whether two forms of repetitive negative thought-rumination and worry-are similarly involved in the stress-sleep relationship. Data was collected from 178 participants across the United States via an online platform. Participants completed baseline self-report surveys examining rumination tendencies and worry tendencies. Over the course of 2 weeks, participants completed daily questionnaires assessing daily stress, PSA, and sleep quality. Results indicated that indirect effects from stress to sleep quality via PSA were statistically significant at low and high levels of rumination and worry, and people at high levels of rumination and worry had stronger relationships between stress and PSA. Across all models, cognitive arousal consistently accounted for more of the variance in the stress-sleep relationship as compared to somatic arousal. Implications for the cognitive behavioral treatment of insomnia are discussed.
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Neuroticism and Somatic Complaints: Concomitant Effects of Rumination and Worry. Behav Cogn Psychother 2018; 47:431-445. [DOI: 10.1017/s1352465818000619] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background: Neuroticism is associated with inflated somatic symptom reporting. Worry and rumination are a cognitive concomitant of neuroticism and potentially mediate the neuroticism–somatic complaint relationship. Aims: The present study examined the degree to which worry and rumination mediated the relationship between neuroticism and somatic complaints. Method: A sample of 170 volunteers, recruited via convenience sampling, took part. Participants completed a series of self-report measures: the Eysenck Personality Questionnaire Revised-Short Form, Penn State Worry Questionnaire, the Ruminative Response Scale and the Somatic Symptom Scale-8. Results: Analysis revealed significant positive correlations between neuroticism, rumination and worry. Neuroticism, rumination and worry also correlated positively with somatic complaints. Using structural equation modelling, a mediational model indicated that rumination fully mediated the relationship between neuroticism and somatic complaints. Conclusions: Findings are consistent with the symptom perception hypothesis and have implications for healthcare in terms of managing individuals who present with multiple somatic complaints. Future research would benefit from adopting a longitudinal approach to test how rumination interacts with neuroticism and somatic complaints over time.
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Madian N, Bredemeier K, Heller W, Miller GA, Warren SL. Repetitive Negative Thought and Executive Dysfunction: An Interactive Pathway to Emotional Distress. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9966-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Slavin-Mulford J, Clements A, Hilsenroth M, Charnas J, Zodan J. An examination of generalized anxiety disorder and dysthymia utilizing the Rorschach inkblot method. Psychiatry Res 2016; 240:137-143. [PMID: 27107389 DOI: 10.1016/j.psychres.2016.04.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 12/15/2015] [Accepted: 04/08/2016] [Indexed: 11/16/2022]
Abstract
This study examined transdiagnostic features of generalized anxiety disorder (GAD) and dysthymia in an outpatient clinical sample. Fifteen patients who met DSM-IV criteria for GAD and twenty-one patients who met DSM-IV criteria for dysthymia but who did not have comorbid anxiety disorder were evaluated utilizing the Rorschach. Salient clinical variables were then compared. Results showed that patients with GAD scored significantly higher on variables related to cognitive agitation and a desire/need for external soothing. In addition, there was a trend for patients with GAD to produce higher scores on a measure of ruminative focus on negative aspects of the self. Thus, not surprisingly, GAD patients' experienced more distress than the dysthymic patients. The implications of these findings are discussed with regards to better understanding the shared and distinct features of GAD and dysthymia.
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Affiliation(s)
- Jenelle Slavin-Mulford
- Department of Psychological Sciences, Augusta University, 2500 Walton Way, Augusta, GA 30904, USA.
| | - Alyssa Clements
- Department of Psychological Sciences, Augusta University, 2500 Walton Way, Augusta, GA 30904, USA
| | - Mark Hilsenroth
- Department of Clinical Psychology, Gordon F. Derner Institute of Advanced Psychological Studies, Adelphi University, 158 Cambridge Avenue, Garden City, NY 11530, USA
| | - Jocelyn Charnas
- Department of Clinical Psychology, Gordon F. Derner Institute of Advanced Psychological Studies, Adelphi University, 158 Cambridge Avenue, Garden City, NY 11530, USA
| | - Jennifer Zodan
- Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY 11554, USA
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Merino H, Senra C, Ferreiro F. Are Worry and Rumination Specific Pathways Linking Neuroticism and Symptoms of Anxiety and Depression in Patients with Generalized Anxiety Disorder, Major Depressive Disorder and Mixed Anxiety-Depressive Disorder? PLoS One 2016; 11:e0156169. [PMID: 27243462 PMCID: PMC4886972 DOI: 10.1371/journal.pone.0156169] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 05/10/2016] [Indexed: 11/21/2022] Open
Abstract
This study examines the relationships between neuroticism (higher-order vulnerability factor), the cognitive styles of worry, brooding and reflection (second-order vulnerability factors) and symptoms of anxiety and depression in three groups of patients: patients with Generalized Anxiety Disorder (GAD), with Major Depressive Disorder (MDD) and with Mixed Anxiety-Depressive Disorder (MADD). One hundred and thirty four patients completed a battery of questionnaires including measures of neuroticism, worry, rumination (brooding and reflection), anxiety and depression. Multiple mediation analyses indicate that worry may act as a mediating mechanism linking neuroticism and anxiety symptoms in the three diagnostic groups, whereas brooding-rumination may play a mediating role between neuroticism and depressive symptoms in patients with MDD and MADD and, with less certainty, in patients with GAD. Overall, our findings suggest that neuroticism may increase the risk of anxious and depressive symptoms via specific links involving either worry or brooding, respectively, and that both worry and brooding may operate in the three groups examined, irrespectively of whether anxiety or depression are the main emotions or whether they coexist without any clear predominance; consequently, we hypothesize the existence of "specific transdiagnostic" mechanisms.
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Affiliation(s)
- Hipólito Merino
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - Carmen Senra
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
- * E-mail:
| | - Fátima Ferreiro
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
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