Assessing Repetitive Negative Thinking Using Categorical and Transdiagnostic Approaches: A Comparison and Validation of Three Polish Language Adaptations of Self-Report Questionnaires

Repetitive negative thinking (RNT) is a transdiagnostic process involved in the risk, maintenance, and relapse of serious conditions including mood disorders, anxiety, eating disorders, and addictions. Processing mode theory provides a theoretical model to assess, research, and treat RNT using a transdiagnostic approach. Clinical researchers also often employ categorical approaches to RNT, including a focus on depressive rumination or worry, for similar purposes. Three widely used self-report questionnaires have been developed to assess these related constructs: the Ruminative Response Scale (RRS), the Perseverative Thinking Questionnaire (PTQ), and the Mini-Cambridge Exeter Repetitive Thought Scale (Mini-CERTS). Yet these scales have not previously been used in conjunction, despite useful theoretical distinctions only available in Mini-CERTS. The present validation of the methods in a Polish speaking population provides psychometric parameters estimates that contribute to current efforts to increase reliable replication of theoretical outcomes. Moreover, the following study aims to present particular characteristics and a comparison of the three methods. Although there has been some exploration of a categorical approach, the comparison of transdiagnostic methods is still lacking. These methods are particularly relevant for developing and evaluating theoretically based interventions like concreteness training, an emerging field of increasing interest, which can be used to address the maladaptive processing mode in RNT that can lead to depression and other disorders. Furthermore, the translation of these measures enables the examination of possible cross-cultural structural differences that may lead to important theoretical progress in the measurement and classification of RNT. The results support the theoretical hypothesis. As expected, the dimensions of brooding, general repetitive negative thinking, as well as abstract analytical thinking, can all be classified as unconstructive repetitive thinking. The particular characteristics of each scale and potential practical applications in clinical and research are discussed.

Duration of Perseverative Thinking as Related to Perceived Stress and Blood Pressure: An Ambulatory Monitoring Study

OBJECTIVE

Psychological distress may be intensified and prolonged by perseverative thinking (e.g., rumination, worry). The tendency to engage frequently in perseverative thinking has been linked to increased blood pressure (BP). Research is needed to investigate the physiological consequences of time spent perseverating by testing the momentary association between the duration of perseverative thinking and BP. The present study examines the extent to which the duration of perseverative thinking is associated with momentary perceived stress and ambulatory BP elevations during daily life.

METHODS

Participants (N = 373) drawn from a larger project on BP and cardiovascular health completed 24-hour ambulatory BP monitoring accompanied by ecological momentary assessments of their perseverative thoughts and feelings. Multilevel models tested associations among perseveration duration, momentary perceived stress, and systolic and diastolic BP, adjusting for person-level and momentary covariates.

RESULTS

Higher within-subject perseveration duration was associated with higher stress (B = 0.29; 95% confidence interval [CI] = 0.24-0.33; p < .001). Although higher perseveration duration was not associated with substantially higher systolic (B = 0.16 mm Hg; 95% CI = 0.00-0.33 mm Hg; p = .056) or diastolic (B = 0.07 mm Hg; 95% CI = -0.05 to 0.19 mm Hg; p = .25) BP, the associations between higher perseveration duration and higher systolic (p = .032) and diastolic (p = .036) BP were significantly mediated by a higher intensity of momentary perceived stress.

CONCLUSIONS

Findings support the clinically important notion that physiological consequences of perceived stress can be maintained and even heightened by maladaptively prolonged mental activity.

Perseverative thinking in depression and anxiety

The current study investigated the impact of worry and brooding as moderators of the tripartite model of depression and anxiety (TMDA). We hypothesized that both types of perseverative thinking would moderate the association between negative affectivity (NA) and both anxiety and depression. Complete data sets for this questionnaire survey were obtained from 537 students. Participants' ages ranged from 16 to 49 years with a mean age of 21.1 years (SD = 3.6). Overall, results from path analyses supported the assumptions of the TMDA, in that NA was a non-specific predictor for both depression and anxiety whilst lack of positive affectivity (PA) was related to depression only. Unexpectedly, perseverative thinking had an effect on the dependency of negative and positive affectivity. Worry was a significant moderator for the path NA-anxiety. All other hypothesized associations were only marginally significant. Alternative pathways as well as methodological implications regarding similarities and differences of the two types of perseverative thinking are discussed.

What to think or how to think - is symptom reduction in posttraumatic symptomatology associated with change in posttraumatic cognitions or perseverative thinking? A latent change score model approach

OBJECTIVE

Patients with posttraumatic stress disorder (PTSD) report changes in what they think of the world and themselves, referred to as posttraumatic cognitions, and changes in how they think, reflected in increased perseverative thinking. We investigated whether pre-post therapy changes in the two aspects of thinking were associated with pre-post therapy changes in posttraumatic symptom severity.

METHOD

219 d clinic patients with posttraumatic stress symptoms received trauma-focused psychotherapy with cognitive behavioral and metacognitive elements. The posttraumatic cognitions inventory (PTCI), the perseverative thinking questionnaire (PTQ), and the Davidson trauma scale (DTS) were applied at two occasions, pre- and post-therapy. Using latent change score models, we investigated whether change in PTCI and change in PTQ were associated with change in DTS and its subscales. We then compared the predictive value of PTQ and PTCI in joint models.

RESULTS

When jointly modeled, change in overall DTS score was associated with change in both PTCI and PTQ. Concerning DTS subscales, reexperiencing and avoidance were significantly associated with change in PTCI, but not in PTQ.

CONCLUSION

Results indicate that both aspects of cognition may be valuable targets of psychotherapy. A focus on posttraumatic cognitions might be called for in patients with severe reexperiencing and avoidance.

The challenge of learning adaptive mental behavior

Many psychotherapies aim to help people replace maladaptive mental behaviors (such as those leading to unproductive worry) with more adaptive ones (such as those leading to active problem solving). Yet, little is known empirically about how challenging it is to learn adaptive mental behaviors. Mental behaviors entail taking mental operations and thus may be more challenging to perform than motor actions; this challenge may enhance or impair learning. In particular, challenge when learning is often desirable because it improves retention. Yet, it is also plausible that the necessity of carrying out mental operations interferes with learning the expected values of mental actions by impeding credit assignment: the process of updating an action's value after reinforcement. Then, it may be more challenging not only to perform-but also to learn the consequences of-mental (vs. motor) behaviors. We designed a task to assess learning to take adaptive mental versus motor actions via matched probabilistic feedback. In two experiments (N = 300), most participants found it more difficult to learn to select optimal mental (vs. motor) actions, as evident in worse accuracy not only in a learning but also test (retention) phase. Computational modeling traced this impairment to an indicator of worse credit assignment (impaired construction and maintenance of expected values) when learning mental actions, accounting for worse accuracy in the learning and retention phases. The results suggest that people have particular difficulty learning adaptive mental behavior and pave the way for novel interventions to scaffold credit assignment and promote adaptive thinking. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

10-Week Trajectories of Candidate Psychological Processes Differentially Predict Mental Health Gains from Online Dyadic versus Mindfulness Interventions: A Randomized Clinical Trial

Background: App-based contemplative interventions, such as mindfulness-based interventions, have gained popularity for the promotion of mental health; however, the understanding of underlying intervention-specific mechanisms remains limited, especially related to novel inter-relational dyadic practices. Methods: We tested (n = 253) seven putative mechanisms underlying two brief (daily 12-min) online mental interventions: attention-focused mindfulness and socio-emotional partner-based, both supported by weekly online coaching. Weekly self-reports of rumination, worry, psychological flexibility, affective control, social support, acceptance, and mindfulness were obtained over 10 weeks of intervention, and depression, anxiety, and resilience were assessed as pre- and post-intervention outcomes. Results: Significant week-to-week reductions in rumination and increases in psychological flexibility were observed in both interventions. Only attention-based practice led to temporal reductions in worry, and only socio-emotional dyadic practice led to temporal increases in affective control. Mediation analyses with slopes of weekly variables as mediators detected no significant indirect effects. However, exploratory moderation analyses revealed that intervention-related reductions in depressive symptomatology and anxiety vulnerability and increases in resilience were predicted by weekly increases in acceptance and affective control in the socio-emotional dyadic group, and by weekly reductions in rumination and worry in the mindfulness group. Limitations of the study include reliance on brief self-report measures, relatively small sample size, and absence of long-term follow-up assessments indicating the need for future well-powered longitudinal studies comparing intervention modalities. Conclusions: We present preliminary evidence for practice-specific active ingredients of contemplative interventions, which can be leveraged to enhance their efficiency for mental health.

Feasibility and Efficacy of Addiction-Focused Eye Movement Desensitization Reprocessing in Adults with Substance Use Disorder

PURPOSE

Addiction-focused eye movement desensitization reprocessing (AF-EMDR) is a viable add-on therapy to treat memories that drive addiction cravings. However, little research has explored AF-EMDR and its effects in people with substance abuse disorder (SUD). The purposes of this study were to determine the feasibility of conducting AF-EMDR and to test the preliminary efficacy of AF-EMDR on overall cravings experienced by persons with SUD, craving, perseverations associated with addiction, and irrational cognitions related to addiction.

METHODS

This pilot study used a two-arm randomized controlled trial (RCT) design with an experimental group (AF-EMDR + cognitive behavioral therapy [CBT]) and a control group (CBT Only). Thirty participants were recruited from a residential program or a partial hospitalization program in a recovery center in Florida, from October 2021 through January 2022 and randomly assigned to the experimental group (n = 15) or the control group (n = 15).

RESULTS

All participants adhered to the four-session 60-min AF-EMDR intervention and post-intervention data collection; 98.33% completed all four sessions. Results indicated significant reductions in cravings, perseverative thoughts about substance of choice, and irrational cognitions among participants in both the experimental (AF-EMDR + CBT) and control (CBT Only) groups during the intervention; however, there was no significant difference between groups.

CONCLUSIONS

The results showed positive trends in decreasing craving. However, more clinical trials with a larger sample are necessary to assess the efficacy and sustainability of such effects in persons with SUD.

Rumination and Self-Compassion Moderate Mindfulness-Based Cognitive Therapy for Patients With Recurrent and Persistent Major Depressive Disorder: A Controlled Trial

Background: Mindfulness-based cognitive therapy (MBCT) is effective in reducing depressive symptoms in patients with major depressive disorder (MDD). Understanding for whom and how MBCT works may allow for improvements in treatment allocation and effectiveness. In this study, our aim was to investigate depressive rumination, content-independent perseverative thinking, mindfulness skills, and self-compassion as potential moderators and mediators of MBCT. Methods: In this non-randomized controlled trial, patients with persistent (n = 53) or recurrent MDD with (n = 31) or without (n = 51) a current depressive episode were assigned to an intervention (MBCT plus treatment as usual [TAU], n = 94) or control group (TAU only, n = 40) based on the time between the date of inclusion and the start of MBCT. Assessments were carried out before, halfway, and after 8 weeks of MBCT + TAU or TAU. Latent growth models were employed to examine moderation, while cross-lagged structural equation models were used to assess the mediating effects of several possible mediators of MBCT-induced change in depressive symptoms and overall functional impairment. Results: MBCT + TAU was more effective in reducing depressive symptoms (and overall functional impairment than TAU with a medium [d = -0.54] and small [d = 0.44] effect size, respectively). Higher baseline levels of rumination and perseverative thinking and lower levels of self-compassion moderated the effect of MBCT on depressive symptoms and overall functional impairment. Task-based negative intrusive thoughts moderated the effects of MBCT on overall functional impairment. No mediators were established, particularly due to a lack of effect of MBCT on all assessed mediators at mid-treatment. For interpretative purposes, a sample split (based on Johnson-Newman values) showed moderate-to-large effects in depressive symptom reduction for those with high rumination, high perseverative thinking, and low self-compassion, while negative-to-small nonsignificant effects were found for the opposite traits. Conclusion: In the future, MBCT allocation based on levels of rumination and self-compassion might lead to a more efficient reduction in depressive symptoms. Directions for mediation analysis within the context of MBCT for depression are discussed. Preregistration: This study was initially preregistered in the Dutch National Trial Register (NL7842). However, due to the NTR no longer being available since June 2022, the trial was reregistered at ClinicalTrials.gov (NCT05802966, dd 09-Apr-2023). The statistical analysis plan was adjusted after the start of the trial but before the finalization of data collection (NCT05802966; ClinicalTrials.gov).

Co-rumination and intrapersonal cognitive processes predict distress: Longitudinal evidence from the COVID-19 pandemic

Perseverative thinking and catastrophizing have well established associations with fear and distress. However, less is known about the impact of interpersonal dynamics, such as co-rumination, on these intrapersonal cognitive processes and subsequent stress. The present study addresses this knowledge gap. A sample of 433 adults from across the United States was recruited online and completed measures of co-rumination, perseverative thinking, catastrophizing, and demographic characteristics early in the COVID-19 pandemic, and the COVID Stress Scales (CSS) at six month follow up. Co-rumination, perseverative thinking, catastrophizing, and CSS scores were correlated in the expected direction. Regression analyses revealed all three independently predicted CSS worry about the dangerousness of COVID-19 subscale. Co-rumination was the strongest predictor of CSS worry about the socioeconomic impact and CSS compulsive checking scales. Perseverative thinking and catastrophizing predicted CSS traumatic stress symptoms subscale. Finally, perseverative thinking was the strongest predictor of CSS xenophobia subscale. Structural equation modelling indicated that co-rumination had a significant indirect effect on CSS scores through perseverative thinking and catastrophizing. Interpersonal dynamics, such as co-rumination, are relevant for understanding stress and are promising targets for intervention research to prevent or attenuate fears and distress, in addition to traditional intrapersonal cognitive processes such as perseverative thinking and catastrophizing.