Background and objectives: Comorbidity among anxiety and depression disorders and their symptoms is high. Rumination and worry have been found to mediate prospective cross-disorder relations... Show moreBackground and objectives: Comorbidity among anxiety and depression disorders and their symptoms is high. Rumination and worry have been found to mediate prospective cross-disorder relations between anxiety and depression disorders and their symptoms in adolescents and adults. We examined whether generic repetitive negative thinking (RNT), that is content- and disorder-independent, also mediates prospective cross-disorder associations between anxiety and depressions disorders and their symptoms.Methods: This was studied using a 5-year prospective cohort study. In a mixed sample of 1859 adults (persons with a prior history of or a current affective disorder and healthy individuals), we assessed DSM-IV affective disorders (Composite Interview Diagnostic Instrument), anxiety (Beck Anxiety Inventory) and depression symptoms (Inventory of Depressive Symptomatology) and RNT (Perseverative Thinking Questionnaire).Results: We found that baseline depression disorders and symptom severity have predictive value for anxiety disorders and symptom severity five years later (and vice versa) and that these associations were significantly mediated by level of RNT as assessed two years after baseline. The significant and rather large mediation effects seemed mainly due to the mental capacity captured by RNT, especially in the prospective relation of anxiety with future depression.Limitations: The mediation effects were greatly attenuated or even nullified after rigorously controlling for concomitant psychopathology at two years after baseline.Conclusions: From these results it can be concluded that repetitive negative thinking could be an important transdiagnostic factor, that may constitute a suitable target for treatment. Show less
It is not clear if treatments for depression targeting repetitive negative thinking (RNT: rumination, worry and content-independent perseverative thinking) have a specific effect on RNT resulting... Show moreIt is not clear if treatments for depression targeting repetitive negative thinking (RNT: rumination, worry and content-independent perseverative thinking) have a specific effect on RNT resulting in better outcomes than treatments that do not specifically target rumination. We conducted a systematic search of PsycINFO, PubMed, Embase and the Cochrane library for randomized trials in adolescents, adults and older adults comparing CBT treatments for (previous) depression with control groups or with other treatments and reporting outcomes on RNT. Inclusion criteria were met by 36 studies with a total of 3307 participants. At post-test we found a medium-sized effect of any treatment compared to control groups on RNT (g = 0.48; 95% CI: 0.37–0.59). Rumination-focused CBT: g = 0.76, <0.01; Cognitive Control Training: g = 0.62, p < .01; CBT: g = 0.57, p < .01; Concreteness training: g = 0.53, p < .05; and Mindfulness-based Cognitive Therapy: g = 0.42, p < .05 had medium sized and significantly larger effect sizes than other types of treatment (i.e., anti-depressant medication, light therapy, engagement counseling, life review, expressive writing, yoga) (g = 0.14) compared to control groups. Effects on RNT at post-test were strongly associated with the effects on depression severity and this association was only significant in RNT-focused CBT. Our results suggest that in particular RNT-focused CBT may have a more pronounced effect on RNT than other types of interventions. Further mediation and mechanistic studies to test the predictive value of reductions in RNT following RNT-focused CBT for subsequent depression outcomes are called for. Show less
Spinhoven, P.; Drost, J.; Van Hemert, B.; Penninx, B.W. 2015
Worry and rumination are cognitive processes that have been proposed to constitute a driving force across many psychological disorders, emotional disorders in particular. The two concepts are often... Show moreWorry and rumination are cognitive processes that have been proposed to constitute a driving force across many psychological disorders, emotional disorders in particular. The two concepts are often referred to by the overarching term repetitive negative thinking (RNT), however whether they are indeed representations of the same process is debated. The main aim of the present thesis is to contribute to the ongoing worry-rumination debate by investigating whether worry and rumination are indeed transdiagnostic processes and whether they represent a shared underlying process. In accordance with this aim several studies were designed covering two lines of research; i) epidemiological studies comparing worry and rumination in their relationship with each other and with emotional disorders; ii) experimental studies examining worry at a more functional/process level. Overall the studies presented in this thesis yield support for both accounts: worry and rumination are highly related, are present across emotional disorders and show both similarities and differences at process level. Especially at a general, abstract, level similarities between worry and rumination seem to predominate. However, at a more concrete and specific level both similarities and differences are observed. Such differences can be relevant for research as well as therapeutic interventions. Depending on the questions in a certain research or clinical context emphasis on a more general-abstract or concrete-specific perspective on worry and rumination seems warranted. Show less