Interpretation training to target repetitive negative thinking in generalized anxiety disorder and depression.

Abstract

Objective: Repetitive negative thinking (RNT) e.g., worry in generalized anxiety disorder (GAD) and rumination in depression, is often targeted during psychological treatments. To test the hypothesis that negative interpretation bias contributes to worry and rumination, we assessed the effects of inducing more positive interpretations in reducing RNT. Method: Volunteers diagnosed with GAD (66) or Depression (65) were randomly allocated to one of two versions of Cognitive Bias Modification (CBM-I), either with or without RNT priming prior to training), or a control condition, each involving 10 internet-delivered sessions. Outcome measures of interpretation bias, a behavioral RNT task and self-reported worry, rumination, anxiety and depression were obtained at baseline, after home-based training and at 1-month follow up (self-report questionnaires only). Results: CBM-I training, across diagnostic groups, promoted a more positive interpretation bias and led to reductions in worry, rumination, and depressive symptoms, which were maintained at follow up. Anxiety symptoms were reduced only in the GAD group at follow up. There were no differences between CBM-I versions; brief priming of RNT did not influence CBM-I effectiveness. Level of interpretation bias post training partially mediated the effects of CBM-I on follow-up questionnaire scores. Conclusions: In contrast to some recent failures to demonstrate improvements following internet-delivered CBM, we found that self-reported RNT and negative mood were reduced by CBM-I. This is consistent with a causal role for negative interpretation bias in both worry and rumination, suggesting a useful role for CBM-I within treatments for anxiety and depression.

A Hot-Cold Cognitive Model of Depression: Integrating the Neuropsychological Approach Into the Cognitive Theory Framework

“…Nevertheless, such findings suggest that the hot cognitive interpretation bias prompts the hot regulatory process of rumination to promote the maintenance of depressive symptoms. Consideration of longitudinal research by Hirsch et al (2018), examining the effect of multi-session cognitive bias modification strategies to target interpretation biases, further corroborates this mechanism. This training involved participants listening to scenarios that were emotionally ambiguous but were resolved positively (76% of trials), negatively (12%), or remained unresolved (12%).…”

Are Different Forms of Repetitive Negative Thinking Associated With Interpretation Bias in Generalized Anxiety Disorder and Depression?

“…Participants were included from two sources: Participants with a diagnosis of GAD or depression (n = 151) were drawn from a larger multi-session study, described in Hirsch et al (2018). We included all participants who completed the larger study, as well as those who attended at least the first session (thus, the n is greater here than that included in Hirsch et al, 2018). Hirsch et al (2018) excluded participants without a diagnosis of GAD or depression.…”

“…We included all participants who completed the larger study, as well as those who attended at least the first session (thus, the n is greater here than that included in Hirsch et al, 2018). Hirsch et al (2018) excluded participants without a diagnosis of GAD or depression.…”

“…However, as these participants still had elevated levels of anxiety and depression symptoms (a pre-requisite for diagnostic screening in that study, see Hirsch et al, 2018), we recruited a separate group of participants for the healthy comparison group 1 . To ensure consistency between samples, exclusion criteria stipulated in Hirsch et al (2018) applied to all participants included and recruited for the present study. In particular, prior to inviting participants to the SCID screening, we excluded individuals with severe depression (>23 PHQ-9 total score), past or current risk to self (self-harm in past 12 months/suicide attempt in last five years/PHQ-9 suicidal ideation item 9 scored >1), comorbid psychosis, bipolar disorder, borderline personality disorder or substance abuse, non-normal/not corrected to normal hearing as well as current or recent (past six months) psychological treatment or changes to psychotropic medication in the last three months.…”

Training to Inhibit Negative Content Affects Memory and Rumination

“…In CBM, a putative cognitive bias is targeted with the aim of affecting emotional symptoms. CBM procedures have been fruitful in elucidating the role of cognitive biases in emotional disorders (e.g., Beevers, Clasen, Enock, & Schnyer, 2015), and in delineating causal pathways between these biases and rumination (e.g., Hirsch et al, 2018;Vermeulen, Brown, Raes, & Krans, 2018).…”