Validity and reliability of the perseverative thinking questionnaire in patients with fibromyalgia.

Measuring repetitive thinking in Iran: Psychometric properties of Persian version of Perseverative Thinking Questionnaire

The Revised Fibromyalgia Impact Questionnaire (FIQR) attempts to address the limitations of the Fibromyalgia Impact Questionnaire (FIQ). As there is no Turkish version of the FIQR available, we aimed to investigate the validity and reliability of a Turkish translation of the FIQR in Turkish female fibromyalgia (FM) patients. After translating the FIQR into Turkish, it was administered to 87 female patients with FM. All of the patients filled out the questionnaire together with a Turkish version of the FIQ, hospital anxiety and depression scales (HADS), short form-36 (SF-36). The tender-point count (TPC) was also calculated from tender points identified by thumb palpation. One week later, FM patients filled out the Turkish FIQR at their second visit. The test-retest reliability of the Turkish FIQR questions ranged from 0.714 to 0.898. The test and retest reliability of total FIQR score was 0.835. Cronbach's alpha was 0.89 for FIQR visit 1 (the first assessment) and 0.91 for FIQR visit 2 (the second assessment), indicating acceptable levels of internal consistency for both assessments. The total scores of the FIQR and FIQ were significantly correlated (r = 0.87, P < 0.01). Significant correlations for construct validity were also obtained between the FIQR total and domain scores and the FIQ, the HADS and the subscales of the SF-36 (FIQR total versus SF-36 physical component score and mental component score were r = -0.63, P < 0.01 and r = -0.51, P < 0.01, respectively). The Turkish FIQR is a reliable and valid instrument for measuring health status in FM, showing sufficient reliability and construct validity. It may be utilized for both clinical practice and research use in the Turkish-speaking population in place of FIQ, since its Turkish version has problems in the wording, omissions, concepts, and scoring from the original FIQ.

Insomnia is highly prevalent and associated with anxiety and depression in patients with coronary heart disease patients. The development of effective psychological interventions is needed. Worry and rumination are potential risk factors for the maintenance of insomnia, anxiety, and depression that may be modified by psychological treatment grounded in the Self-Regulatory Executive Function model. However, the relationships between worry, rumination, anxiety and depression, and insomnia are not known. Therefore, we investigated these relationships both cross-sectionally and longitudinally among patients with coronary heart disease. A cross-sectional study consecutively included 1,082 patients in 2014-2015, and 686 were followed up after mean of 4.7 years. Data were gathered from hospital records and self-report questionnaires comprising assessment of worry (Penn State Worry Questionnaire), rumination (Ruminative Responses Scale), anxiety and depression (Hospital Anxiety and Depression Scale), and insomnia (Bergen Insomnia Scale). Insomnia correlated moderately with all other psychological variables (R 0.18-0.50, all P values < .001). After adjustments for anxiety and depression, odds ratios for insomnia at baseline were 1.27 (95% confidence interval 1.08-1.50) and 1.60 (95% confidence interval 1.31-1.94) per 10 points increase of worry and rumination, respectively. Corresponding odds ratios for insomnia at follow-up were 1.28 (95% confidence interval 1.05-1.55) and 1.38 (95% confidence interval 1.09-1.75). Depression was no longer significantly associated with insomnia after adjustments for worry and rumination, but anxiety remained significant. Worry and rumination predicted insomnia both cross-sectionally and prospectively, even after controlling for anxiety and depression, although anxiety remained significant. Future studies may test psychological interventions targeting these factors in patients with coronary heart disease and insomnia. Frøjd LA, Papageorgiou C, Munkhaugen J, etal. Worry and rumination predict insomnia in patients with coronary heart disease: a cross-sectional study with long-term follow-up. J Clin Sleep Med. 2022;18(3):779-787.

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.

Abstract: Introduction: The Perseverative Thinking Questionnaire (PTQ) measures repetitive negative thinking and has been translated and validated in several countries. However, the PTQ has not been translated and validated in a Danish clinical sample. The aim of this paper was to evaluate the psychometric properties of the PTQ in a Danish clinical population and to introduce a shorter, 9-item version of the PTQ, the PTQ-9. Methods: Participants were recruited from a multicenter randomized clinical trial ( N = 251). They all completed the PTQ and World Health Organization 5-item Wellbeing Index (WHO-5). Participants were further assessed with the 6-item Hamilton Anxiety Rating Scale (HAM-A6) and the 6-item Hamilton Depression Rating Scale (HAM-D6). Results: The 2nd order factor model with one higher order general factor and three lower order factors showed the best model fit for the PTQ and the PTQ-9. Both versions showed good internal consistency and the expected correlations with the constructs used for validation. Furthermore, using WHO-5 as primary outcome, both the PTQ and PTQ-9 versions were able to discriminate between treatment responders and nonresponders. Conclusion: The PTQ and the PTQ-9 showed satisfying psychometric properties in a Danish clinical sample, including sensitivity to change, and could be used to evaluate psychotherapeutic treatment. To minimize the burden for the patients, the PTQ-9 may be recommended for clinical use over the PTQ.

Repetitive negative thinking (RNT) is an umbrella term that refers to an individual’s tendency to have negative thoughts in an uncontrollable and repetitive manner regardless of their content and temporal focus. RNT is suggested to be a transdiagnostic factor that may be associated with vulnerability for many different psychological disorders. The aim of the present study is to examine the psychometric qualities of Perseverative Thinking Questionnaire (PTQ), which is a scale that assesses non-disorder-specific form of RNT. The data was gathered from 446 Turkish individuals between the ages of 18 and 58 years through a web based data collection method. In addition to PTQ, the participants also completed questionnaires that measure worry, rumination, anxiety, depression, and thought suppression. Two models were tested, and CFA revealed a better fit for the 3-factor model. Results indicated that the scale has satisfactory levels of internal consistency, split-half reliability, and test–retest reliability. Further, correlation analyses showed moderate correlations with measures of worry, rumination, anxiety, and depression; which is indicative of satisfactory levels of both convergent and concurrent validity. In sum, Turkish version of PTQ is a psychometrically sound measure that researchers can utilize in research focusing on transdiagnostic processes.

Background and objectivesDisorder-specific forms of Repetitive Negative Thinking (RNT) are associated with multiple diagnostic categories, indicating a transdiagnostic nature. Few studies examined content-independent RNT processes across groups of diagnosed mental disorders. Moreover, theory describes RNT processes as critically involved in the etiology of mental disorders, empirical evidence however is scarce. We first tested the transdiagnostic nature by examining levels of RNT across groups of internalizing and externalizing mental disorders compared to healthy individuals and explored RNT levels in a comorbid disorder-group. Second, we examined whether RNT predicts incident psychopathology.MethodsIn a sample of German soldiers (n = 425) scheduled for deployment in Afghanistan, we compared RNT levels between diagnosed groups with alcohol use disorders, anxiety disorders and healthy individuals cross-sectionally. Exploratory analyses were conducted comparing a comorbid disorder-group to healthy individuals and to both single-disorder-groups. Longitudinally, we examined the predictive value of pre-deployment RNT levels for incident psychopathology after deployment (n = 167). RNT was measured using the Perseverative Thinking Questionnaire (PTQ), DSM-IV diagnoses were assessed using the standardized Composite International Diagnostic Interview (CIDI).ResultsCross-sectional comparisons revealed that soldiers with alcohol use disorders and anxiety disorders showed significantly higher degrees of RNT compared to healthy soldiers. RNT levels in those with comorbid disorders were significantly higher compared to healthy soldiers but also compared to both single-disorder-groups. Longitudinal analyses revealed that higher levels of RNT prior to deployment were associated with a higher risk to have any incidental mental disorder after deployment. This however is only attributable to individuals with a PTQ score above a cut-off of 15.ConclusionsFindings provide evidence for RNT as a transdiagnostic correlate and a vulnerability factor for the development of mental disorders.

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.

Repetitive negative thinking (RNT) has been found to be involved in the maintenance of several types of emotional problems and has therefore been suggested to be a transdiagnostic process. However, existing measures of RNT typically focus on a particular disorder-specific content. In this article, the preliminary validation of a content-independent self-report questionnaire of RNT is presented. The 15-item Perseverative Thinking Questionnaire was evaluated in two studies (total N = 1832), comprising non-clinical as well as clinical participants. Results of confirmatory factor analyses across samples supported a second-order model with one higher-order factor representing RNT in general and three lower-order factors representing (1) the core characteristics of RNT (repetitiveness, intrusiveness, difficulties with disengagement), (2) perceived unproductiveness of RNT and (3) RNT capturing mental capacity. High internal consistencies and high re-test reliability were found for the total scale and all three subscales. The validity of the Perseverative Thinking Questionnaire was supported by substantial correlations with existing measures of RNT and associations with symptom levels and clinical diagnoses of depression and anxiety. Results suggest the usefulness of the new measure for research into RNT as a transdiagnostic process.

Repetitive negative thinking (RNT) has been shown to be an important vulnerability factor for a variety of emotional problems. Recently, the Perseverative Thinking Questionnaire (PTQ) was developed as a content-independent measure of RNT in adults, which allows research into this process from a transdiagnostic perspective. The current study describes the construction of a child-appropriate version of the instrument and provides initial evidence for its reliability and validity. Both a one-factor model and a three-factor higher-order model were found to adequately fit with the data but the more parsimonious one-factor model was retained for further analyses. The unidimensional PTQ-C scale showed excellent internal consistency and its validity was supported by substantial correlations with other measures of repetitive thinking as well as with symptom levels of depression and anxiety. Finally, as expected, regression analyses suggested that the PTQ-C scale captures the general repetitive negative thinking associated with anxiety and depression, whereas measures of worry and brooding tap additional content-related aspects of these symptom dimensions.

Introduction Repetitive negative thinking (RNT), a perpetuating factor of insomnia, is often associated with adverse outcomes (e.g., depression). According to the Attentional scope model of rumination, RNT is associated with a narrowed attentional scope. As such, individuals with more RNT tend to exhibit stable attention toward task-relevant information. Previous research has also shown that RNT is linked to better set-shifting ability in adolescents. However, the evidence was mainly based on the research on mood disorders and remained limited and inconclusive in the context of insomnia. The study aimed to examine the relationship between set-shifting ability and RNT and explore the role of depression in this relationship among adolescents with insomnia. Methods Adolescents diagnosed with DSM-5 insomnia disorder were recruited. Participants completed self-reported questionnaires, including the Perseverative Thinking Questionnaire (PTQ) for the measure of RNT, the Insomnia Severity Index (ISI) and the Beck’s Depression Inventory-Short Form (BDI-SF) and were administered Wisconsin Card Sorting Test (WCST). A score ≥ 10 on BDI-SF indicated the presence of depression. The number of Perseverative Responses (PR) and Perseverative Error (PE) on WCST were used to reflect set-shifting ability. Results Of 115 recruited participants with insomnia (Age: 18.34 ± 1.56, 14-20, female: 65.22%), the prevalence of depression was 51.30%. PTQ scores were significantly associated with PR and PE. The effect of PTQ on PR, but not PE, was moderated by the presence of depression. Among the participants with depression, lower PTQ scores were associated with greater PR, but such association was not observed in those without depression. Insomnia symptoms, presence of depression, age, and gender were not found to be associated with PR and PE, respectively. Conclusion RNT is associated with better performance in set-shifting among adolescents with insomnia. The result may be explained by the attentional scope model, which suggests that RNT enhances the ability to ignore irrelevant information to the tasks, thus exerting greater set-shifting ability. Further exploration with neuroimaging is needed to understand the relationship between RNT and set-shifting ability in the context of insomnia and psychopathology. Support (if any) This work was funded by General Research Fund (Ref. 17613820), Research Grants Council, University Grants Committee, Hong Kong SAR, China.

Thinking too much: rumination and psychopathology.

Transdiagnostic assessment of repetitive negative thinking and responses to positive affect: Structure and predictive utility for depression, anxiety, and mania symptoms

Background: The Perseverative Thinking Questionnaire (PTQ) is a global measure of repetitive negative thinking, a core transdiagnostic dimension of mental health. Objectives: This study sought to examine the factor structure, reliability, and evidence of associative validity of the PTQ in Peruvian undergraduates. Method: Data from 240 undergraduates (Mage = 20.33, 59% female) were evaluated with confirmatory factor analysis. After finding the best factor structure, reliability was estimated with coefficient omega. The correlation between the PTQ’s latent variable and cognitive fusion was examined as evidence of associative validity. Results: the PTQ proved to be essentially unidimensional since acceptable fit was obtained by the one-factor model with three correlations between errors (CFI = .945; RMSEA = .079). Reliability was high (ω = .927). The correlation between the PTQ and cognitive fusion was very large (ϕ = .876). Conclusion: The PTQ is an essentially unidimensional measure, thus only a global score should be computed. Associative validity should be further examined in future studies.

Repetitive negative thinking (RNT) is a transdiagnostic process involved in the onset and maintenance of many psychological disorders. The Perseverative Thinking Questionnaire (Ehring et al., 2011) is a content-independent scale composed of 15 items that assesses RNT from a transdiagnostic perspective in both clinical and general populations. The aim of the current research was to translate and validate the French version of the PTQ through two studies (total N = 1016) following the steps for the trans-cultural validation of psychometric instruments (Hambleton et al., 2006). An exploratory factor analysis conducted on a first community sample revealed a latent structure composed of 10 items distributed on one common factor, labeled RNT, and three subfactors that evaluated the repetitive characteristic of RNT, the intrusiveness of RNT and the effect of RNT on mental resources. This factorial structure was confirmed in two confirmatory factor analyses in community and clinical samples. Scale score reliability indices were good and confirmed the validity of the instrument. The French version of the PTQ is a good content-independent instrument to assess RNT in general and clinical populations of French speakers.