Negative Intrusive Thoughts Research Articles

Age-based stereotype threat effects on dynamic balance in healthy older adults.

Stereotype threat can lead older adults to perceive their experiences in a biased manner, giving rise to interfering thoughts and negative emotions that generate stress and anxiety. Negative beliefs about aging may serve as an additional factor that increases the need for attentional demand, potentially resulting in a performance level below their actual capabilities. In the present study, we asked whether negative aging stereotypes influence a dynamic balance task and explored the means to counteract them in healthy elderly participants. The performance of balance was compared in two groups of participants aged 65 to 75 years (n = 22) under stereotype threat or reduced-threat situation. Balance abilities were tested under dynamic conditions, requiring participants to maintain balance on a moving platform and using a gradient of difficulty (with eyes open or closed, without or with foam). Postural performance was evaluated by means of posturographic evaluation of the center of pressure displacement and motion analysis. Additionally, we investigated the effects of stereotype threat on a preferred walking speed task and on the Timed Up and Go (TUG) test. Participants under stereotype threat showed poorer balance, particularly in challenging conditions (eyes closed, on foam), with less effective body segments stabilization. Their postural stabilization on foam was worse compared to a solid surface. Conversely, those in the reduced threat condition maintained better body segment stabilization across all conditions, indicating consistent postural control regardless of the presence of foam. Stereotype threat did not affect preferred walking speed or the time to complete the "Time Up and Go" test. This study provides the first description of age-based stereotype threat effects on a dynamic balance task and how to counteract them in healthy older adults. We suggest that the decrease in postural performance observed in participants exposed to stereotype threat can be attributed to a split in attentional focus between negative intrusive thoughts and the attention needed for maintaining balance. These findings open new perspectives on how to overcome negative expectations when evaluating and training physical abilities, thereby contributing to fall prevention among older adults.

Do beta-blockers reduce negative intrusive thoughts and anxiety in cancer survivors? – An emulated trial

BackgroundHigh rates of negative intrusive thoughts have been reported among cancer patients. Prevalent users of beta-blocker therapy have reported lower levels of cancer related intrusive thoughts than non-user. The aim of this study is to investigate if initiation of beta-blocker therapy reduces the prevalence and severity of intrusive thoughts (co-primary endpoints) and the prevalence of anxiety, depressed mood, and low quality of life (secondary endpoints) in cancer survivors.MethodsData on patient-reported outcomes from three cohort studies of Swedish patients diagnosed with colon, prostate or rectal cancer were combined with data on beta-blocker prescriptions retrieved from the Swedish Prescribed Drug Register. Two randomized controlled trials were emulated. Trial 1 had follow-up 1 year after diagnosis, trial 2 had follow-up 2 years after diagnosis, baseline in both trials was 12 months before follow-up. Those who initiated beta-blocker therapy between baseline and follow-up was assigned Active group, those who did not was assigned Control group. All endpoints were analysed using Bayesian ordered logistic regression.ResultsTrial 1 consisted of Active group, n = 59, and Control group, n = 3936. Trial 2 consisted of Active group, n = 87, and Control group, n = 3132. The majority of participants were men, 83% in trial 1 and 94% in trial 2. The prevalence and severity of intrusive thoughts were lower in the Active group in trial 1, but no significant differences between groups were found in either trial. The prevalence of depressed mood, worse quality of life and periods of anxiety were higher in the Active group in both trials with significant differences for quality of life in trial 1 and anxiety in trial 2.ConclusionsThe emulated trials demonstrated no evidence of a protective effect of beta-blocker therapy against intrusive thoughts. The Active group had reduced quality of life and elevated anxiety compared to the Control group.Trial registrationThe three cohort studies were registered at isrctn.com/clinicaltrials.gov (ISRCTN06393679, NCT02530593 and NCT01477229).

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).

The effect of mindfulness-based cognitive therapy on rumination and a task-based measure of intrusive thoughts in patients with bipolar disorder

BackgroundPreliminary evidence suggests that Mindfulness-Based Cognitive Therapy (MBCT) is a promising treatment for bipolar disorder (BD). A proposed working mechanism of MBCT in attenuating depressive symptoms is reducing depressive rumination. The primary aim of this study was to investigate the effect of MBCT on self-reported trait depressive rumination and an experimental state measure of negative intrusive thoughts in BD patients. Exploratively, we investigated the effect of MBCT on positive rumination and positive intrusive thoughts.MethodsThe study population consisted of a subsample of bipolar type I or II patients participating in a multicenter randomized controlled trial comparing MBCT + treatment as usual (TAU) (N = 25) to TAU alone (N = 24). Trait depressive rumination (RRS brooding subscale) and intrusive thoughts (breathing focus task (BFT)) were assessed at baseline (full subsample) and post-treatment (MBCT + TAU; n = 15, TAU; n = 15). During the BFT, participants were asked to report negative, positive and neutral intrusive thoughts while focusing on their breathing.ResultsCompared to TAU alone, MBCT + TAU resulted in a significant pre- to post-treatment reduction of trait depressive rumination (R2 = .16, F(1, 27) = 5.15, p = 0.031; medium effect size (f2 = 0.19)) and negative intrusive thoughts on the BFT (R2 = .15, F(1, 28) = 4.88, p = 0.036; medium effect size (f2 = 0.17)). MBCT did not significantly change positive rumination or positive intrusive thoughts.ConclusionsMBCT might be a helpful additional intervention to reduce depressive rumination in BD which might reduce risk of depressive relapse or recurrence. Considering the preliminary nature of our findings, future research should replicate our findings and explore whether this reduction in rumination following MBCT indeed mediates a reduction in depressive symptoms and relapse or recurrence in BD.

Affective and somatic symptom clusters in depression and their relationship to treatment outcomes in the STAR*D sample

BackgroundThe heterogenous nature of depression continues to stymie efforts to identify biomarkers or predict treatment response. Efforts leveraging large datasets to define more uniform subtypes of depression or subgroups of depressed patients have considered only small subsets of symptoms. We aimed to understand how inclusion of more diverse complaints would impact data-emergent symptom and patient clusters. MethodsWe applied principal components analysis to baselineInventory of Depressive Symptomatology data from 1491 patients with major depressive disorder to derive naturally co-occurring symptom subsets before utilizing k-means clustering to divide patients into groups based on standardized residuals of each symptom subset score. We evaluated the clinical utility of our approach by comparing how cluster membership impacted response to citalopram. ResultsPrinicpal components analysis identified nine naturally co-occurring symptom subsets: core affective symptoms, appetite/weight loss, anxiety, somatic symptoms, insomnia, negative intrusive thoughts, leaden paralysis/mood quality, diurnal mood variation, and irritability. Cluster analysis identified two patient groups, differing significantly in 7 of 9 c symptom subsets. Patients distinguished by the prominence of somatic versus core affective symptoms exhibited less reduction in depression severity with citalopram treatment. LimitationsResults depend not only on raw data, but also parameter selection, and interpretation. Replication is indicated. ConclusionsFindings are consistent with previous reports linking somatic symptoms to treatment resistance and demonstrating that SSRIs are most effective in treating affective symptoms. A novel distinction between physical somatic symptoms and psychic anxiety highlights the utility of assessing a broad spectrum of symptoms when exploring heterogeneity in depression and the need for treatments targeting physical somatic symptoms specifically.

Do negative intrusive thoughts at diagnosis predict impaired quality of life, depressed mood and waking up with anxiety 3, 12 and 24 months after radical prostatectomy? – a longitudinal study

Objective: To evaluate the effect of intrusive thoughts at diagnosis on quality of life, depressed mood and waking up with anxiety up to two years after radical prostatectomy.Method: The Laparoscopic Prostatectomy Robot Open (LAPPRO) trial was a prospective, longitudinal multicenter study of 4003 patients undergoing radical prostatectomy. Questionnaire data were collected preoperatively, at 3, 12 and 24 months after surgery.Results: The group of patients with intrusive thoughts at diagnosis had a statistically significant higher postoperative prevalence of impaired quality of life, depressed mood and waking up with anxiety as compared with the group of patients with no or minor intrusive thoughts. The highest risk increase for impaired QoL, depressed mood and waking up with anxiety ≥1/week was at 12, 3 and 3 months, respectively, where the three outcomes increased by 38% (RR: 1.38; 95%CI: 1.27–1.49)), 136% (RR: 2.36; 95%CI: 1.74–3.19)) and 165% (RR: 2.65; 95%CI: 2.22–3.17)), respectively.Conclusions: The demonstrated link between intrusive thoughts and quality of life, depressed mood and waking up with anxiety deliver is further evidence to the idea that intrusive thoughts has potential as an endpoint for assessing and predicting psychological distress among men with prostate cancer diagnosis.Trial registration number: ISRCTN06393679 (www.isrctn.com). Date of registration: 07/02/2008. Retrospectively registered.

TDCS increases anxiety reactivity to intentional worry

While considerable experimental research has examined the impact of transcranial direct current stimulation (tDCS) on a range of cognitive processes associated with emotional pathology, the impact of tDCS on worry has been comparatively neglected. Given that anxiety pathology is characterised by motivated engagement in worry, and that frontal tDCS has the capacity to enhance goal-oriented cognition, it is important to examine whether tDCS would increase or ameliorate the cognitive and emotional effects of worry. In the current study we examined how tDCS influenced the anxiety response to worry, and the frequency of negative intrusive thoughts. We additionally examined whether stimulation delivered in isolation, or in combination with a mindful-focus task would augment the effects of tDCS. Ninety-seven (75 female) healthy participants received either active or sham anodal tDCS to the left dorsolateral prefrontal cortex, delivered either in isolation or concurrently with a mindful task (four conditions). The frequency of negative thought intrusions was assessed before and after a period of instructed worry, and state anxiety was assessed across the study. Active tDCS was associated with significantly greater elevation in anxiety in response to the worry induction. No effects were observed on the frequency of negative thought intrusions, and the combined delivery of tDCS with the concurrent mindful task did not alter the pattern of observed effects. While inviting replication in a high anxious sample, the present results highlight the possibility that tDCS may interact with motivated engagement in negative patterns of cognition, such as worry, to produce greater emotional reactivity.

Comparison of the Effectiveness of Mindfulness-Based Cognitive Therapy and a Quality of Life-Based Therapy on Rumination in Patients With Migraine

Introduction: The effects of mindfulness-based cognitive therapy and quality of life-based therapy on rumination were compared in patient with migraine. The present study also investigated the effectiveness of quality of life-based therapy and mindfulness-based cognitive therapy.Methods: This quasi-experimental study with 3 (2 experimental and one control) groups was carried out with pretest-post test design. The study population consisted of all patients with migraine headache referring to Torbat Heidarie hospitals and clinics from June to July 2018. The samples were 45 patients who were selected by random sampling and then randomly allocated to 2 experimental groups and one control group each with 15 members. One experimental group underwent mindfulness-based cognitive therapy and the other received quality of life based therapy. The control group received no intervention. Research instruments were Ahvaz Migraine Questionnaire and Huksema and Maro’s Ruminative Response Scale. The tools were filled out by the participants before and after the interventions. The data was analyzed in SPSS version 22.Results: The mindfulness-based cognitive therapy and quality of life-based therapy significantly improved rumination in patients with migraine. In addition, the effectiveness of the 2 interventions was not significantly different.Conclusion: The educational interventions based on modifying basic cognitions, replacing negative intrusive thoughts with positive thoughts, and avoiding and neutralizing intrusive thoughts through mindfulness-based cognitive methods and interventions based on improving quality of life resulted in a substantial improvement of rumination and frequent intrusive thoughts. Indeed, changes in cognitive reactions to pain and altering beliefs and expectations are the main mechanisms for improving headache.

Association between operative technique and intrusive thoughts on health-related Quality of Life 3years after APE/ELAPE for rectal cancer: results from a national Swedish cohort with comparison with normative Swedish data.

The aim of this prospective registry‐based population study was to investigate the association between QoL 3 years after surgery for rectal cancer and intrusive thoughts and to assess the association with the type of surgery (i.e., APE or ELAPE) in a population‐based national cohort. ELAPE has been proposed as a superior surgical technique for distal rectal cancer, but long‐term effects on QoL are not known. There are also no studies on the association of negative intrusive thoughts on patients′ self‐reported Quality of Life following surgery for distal rectal cancer. Negative intrusive thoughts are regarded as a marker of incomplete cognitive processing of the psychological trauma caused by, for example, a cancer diagnosis. Intrusive thoughts have been recognized as an important factor associated Quality of Life outcome following surgery for other malignancies. All Swedish patients operated with any kind of abdominoperineal resection in the years 2007–2009 were identified through the Swedish ColoRectal Cancer Registry (SCRCR)—the APER population. All patients alive 3 years after surgery and willing to participate were included. Data were collected from three different sources: the registry, the original operative notes, and a study‐specific questionnaire regarding health‐related QoL answered by the patients. Questions on QoL from a normative reference population were also collected for comparison. Fifty‐six percent of the APER population reported a low overall Quality of Life. There was no significant difference between the sexes. Among men, there was a difference in overall QoL, with a higher level in the normative population (48%) compared with the male APER population (39%). Overall QoL was compared to a normative Swedish population. Almost half of the patients experienced negative intrusive thoughts, which was associated with a lower overall Quality of Life. The frequency and severity of negative intrusive thoughts were significantly associated with a low overall QoL. There was no difference in overall QoL after standard, compared with extralevator abdominoperineal excision. A large proportion of survivors after abdominoperineal excision for rectal cancer has a Quality of Life compared with a normative population, but many suffer from negative intrusive thoughts, a symptom of stress, which significantly decrease overall Quality of Life.

Timely access to care in the treatment of rectal cancer and the effect on quality of life.

The aim of this study was to investigate if a delay in a patient's first contact with a healthcare professional, and any subsequent delay in diagnosis, affected self-assessed quality of life prior to start of treatment for rectal cancer. Questionnaires were administered when patients had been informed of the diagnosis and planned treatment. The primary end-point was self-assessed quality of life according to a seven-point Likert scale. The response variables were dichotomized and analysed by unadjusted and adjusted binary logistic regression. A reported duration of symptoms longer than 4months was found to be associated with a lower quality of life than a reported duration of symptoms of less than 3months. Furthermore, a reported period of longer than 2months from first contact with a healthcare professional to a diagnosis was found to correlate with lower quality of life compared with a period shorter than 2months. However, when adjusting for possible confounding variables the duration of symptoms and time to diagnosis were not found to affect self-assessed quality of life. Several variables were found to have significant influence in the statistical model, including sense of coherence, the presence of negative intrusive thoughts, comorbidity, depressed mood, male sex and comorbidity. One conclusion of our study is that further efforts to shorten delay in rectal cancer care withthe aim of improving quality of life may be futile. To improve the patient's quality of life at diagnosis other interventions should be considered, such as screening for depression and/or negative intrusive thoughts.

Habits and self-assessed quality of life, negative intrusive thoughts and depressed mood in patients with prostate cancer: a longitudinal study

Objective: The aim of this study was to evaluate the association of self-assessed preoperative physical activity, alcohol consumption and smoking with self-assessed quality of life, negative intrusive thoughts and depressed mood after radical prostatectomy.Materials and methods: The Laparoscopic Prostatectomy Robot Open (LAPPRO) trial was a prospective, controlled, non-randomized longitudinal trial of patients (n = 4003) undergoing radical prostatectomy at 14 centers in Sweden. Validated patient questionnaires were collected at baseline, and 3, 12 and 24 months after surgery.Results: Preoperative medium or high physical activity or low alcohol consumption or non-smoking was associated with a lower risk of depressed mood. High alcohol consumption was associated with increased risk of negative intrusive thoughts. Postoperatively, quality of life and negative intrusive thoughts improved gradually in all groups. Depressed mood appeared to be relatively unaffected.Conclusions: Evaluation of preoperative physical activity, tobacco and alcohol consumption habits can be used to identify patients with a depressed mood in need of psychological support before and immediately after surgery. Quality of life and intrusive thoughts improved postoperatively.

Care-related predictors for negative intrusive thoughts after prostate cancer diagnosis-data from the prospective LAPPRO trial.

Negative intrusive thoughts about one's prostate cancer have been associated with depressive mood and impaired quality of life among prostate cancer patients. However, little is known about possible predictors for negative intrusive thoughts among this group. We aimed to identify health- and care-related predictors for such thoughts among a population of men newly diagnosed with prostate cancer and undergoing radical prostatectomy. In the LAPPRO-trial, 3154 men (80%) answered study-specific questionnaires at admission and 3months after surgery. Questions concerned socio-demographics, health, uncertainty, preparedness for symptoms, and the outcome-negative intrusive thoughts. Associations between variables were analyzed by log-binominal and multivariable approach. The strongest predictor of negative intrusive thoughts at admission to surgery was uncertainty of cure, followed by binge drinking, poor physical health, antidepressant medication, not being prepared for urinary symptoms, age under 55, and physical pain. Reporting it not probable to obtain urinary symptoms after surgery lowered the odds. Negative intrusive thoughts before surgery were the strongest predictor for such thoughts 3months later followed by uncertainty of cure, physical pain, younger age, living alone, and poor self-reported physical health. Our findings showed an association of preoperative uncertainty of cure as well as low preparedness for well-known surgery-induced symptoms with higher occurrence of negative intrusive thoughts about prostate cancer. Future studies should examine if interventions designed to have healthcare professionals inform patients about their upcoming prostatectomy reduce patients' negative intrusive thoughts and thereby, improve their psychological well-being.

Testing the differential effects of acceptance and attention-based psychological interventions on intrusive thoughts and worry

BackgroundWorry is a key component of anxiety and may be an effective target for therapeutic intervention. We compared two psychological processes (attention and acceptance) on the frequency of intrusive worrying thoughts in an experimental worry task. Method77 participants were randomised across three groups and completed either a 10 min attention or acceptance-based psychological exercise, or progressive muscle relaxation control. We subsequently measured anxiety, and the content and frequency of intrusive thoughts before and after a ‘worry induction task’. ResultsGroups did not differ in baseline worry, anxiety or thought intrusions. Both attention and acceptance-based groups experienced fewer negative thought intrusions (post-worry) compared to the relaxation control group. The acceptance exercise had the largest effect, preventing ‘worry induction’. Increases in negative intrusive thoughts predicted subjective anxiety. DiscussionWe provide evidence that acceptance and attention psychological exercises may reduce anxiety by reducing the negative thought intrusions that characterise worry.

The efficacy of expressive writing intervention: the role of optimism and alexithymia

The beneficial effects on the health of the re-experimentation of traumatic experiences are well-established. The effectiveness of using reexperimentation seems to be affected by certain conditions. Among personal variables that have been shown to influence the recovery of such experiences it has highlighted the optimism and alexithymia. The aim of this study was to evaluate the effects on mental health of an intervention based on re-experimentation. The sample consisted in a total of 60 participants, of which 40 carried out a process of emotional re-experimentation through three sessions of expressive writing. The rest formed the control group. All participants were evaluated before and after the emotional disclosure in positive and negative affect, anxiety, depression, intrusive thoughts and cognitive avoidance. Furthermore, the level of optimism and alexithymia were controlled. The results showed the effectiveness of expressive writing on the positive and negative affect and on depression. Among the covariables, only optimism affected significantly to effect emotional variables. The contextual and personal conditions that can be ameliorated the clinical use of emotional disclosure were discussed.

The perseverative worry bout: A review of cognitive, affective and motivational factors that contribute to worry perseveration

This paper reviews the cognitive, affective and attentional factors that contribute to individual perseverative worry bouts. We describe how automatic biases in attentional and interpretational processes contribute to threat detection and to the inclusion of negative intrusive thoughts into the worry stream typical of the “what if …?” thinking style of pathological worriers. The review also describes processes occurring downstream from these perceptual biases that also facilitate perseveration, including cognitive biases in beliefs about the nature of the worry process, the automatic deployment of strict goal-directed responses for dealing with the threat, the role of negative mood in facilitating effortful forms of information processing (i.e. systematic information processing styles), and in providing negative information for evaluating the success of the worry bout. We also consider the clinical implications of this model for an integrated intervention programme for pathological worrying.

Unresolved grief and its consequences. A nationwide follow-up of teenage loss of a parent to cancer 6-9years earlier.

The early loss of a parent is a tragedy and a serious life event. This study investigated grief resolution and morbidity in cancer-bereaved teenagers 6 to 9years after the loss of a parent to cancer. In a nationwide population-based study of 622 of 851 (73%) youths who as teenagers 6 to 9years earlier had lost a parent to cancer, we explored the magnitude of unresolved grief and its association with psychological and physiological morbidity. Participants answered a study-specific anonymous questionnaire including questions about if they had worked through their grief and about their current health. Six to nine years post-loss 49% reported unresolved grief (8% no and 41% a little grief resolution). They had, in comparison with youths reporting resolved grief, statistically significantly elevated risks, e.g. for insomnia (sons' relative risk (RR) 2.3, 95% CI 1.3-4.0; daughters' RR 1.7, 95% CI 1.1-2.7), fatigue (sons' RR 1.8, 95% CI 1.3-2.5; daughters' RR 1.4, 95% CI 1.1-1.7) and moderate to severe depression, i.e. score >9, PHQ-9 (sons' RR 3.6, 95% CI 1.4-8.8; daughters' RR 1.8, 95% CI 1.1-3.1). Associations remained for insomnia in sons, exhaustion in daughters and fatigue in both sons and daughters when depression, negative intrusive thoughts and avoiding reminders of the parents' disease or death were included in a model. Approximately half of cancer-bereaved youth report no or little grief resolution 6 to 9years post-loss, which is associated with fatigue, sleeping problems and depressive symptoms.

Of passions and positive spontaneous thoughts.

Despite the abundance of research on negative intrusive thoughts, far less is known about their positive counterparts. In two studies, we explored how positive spontaneous thoughts are related to people's favorite activities (i.e., their passions, Vallerand et al., 2003), and how passions and associated thoughts contribute to mental health. In Study 1, 170 participants reported on the valence and frequency of the spontaneous thoughts they tend to have about several activities. Harmonious and obsessive passion both predicted more frequent spontaneous thoughts, but only harmonious passion predicted thought positivity. In Study 2, 232 participants completed measures pertaining to physical activity, spontaneous thoughts, and mental health. As predicted, positivity of spontaneous thoughts about physical activity predicted frequency of physical activity. Further, positivity of spontaneous thoughts about physical activity mediated the relationship between harmonious passion and indices of mental well-being.

Delineating the Role of Negative Verbal Thinking in Promoting Worry, Perceived Threat, and Anxiety.

Worry is characterized by streams of verbal thoughts about potential negative outcomes. Individuals with high levels of worry (and particularly those with generalized anxiety disorder) find it very difficult to control worry once it has started. What is not clear is the extent to which verbal negative thinking style maintains worry. Our study aimed to disentangle the effects of verbal versus imagery based thinking, and negative versus positive worry-related content on subsequent negative intrusive thoughts. High worriers were trained to engage in imagery or verbal processing, focusing on either negative or positive outcomes of their current main worry. Both thinking style and valence of worry content influenced later negative intrusive thoughts that play a role in initiating worry episodes. In contrast, only valence influenced subjective ratings of worry outcomes (i.e., cost, concern, and ability to cope, although not probability), with positive valence leading to lower ratings, irrespective of thinking style.

Prayer in Response to Negative Intrusive Thoughts: Closer Examination of a Religious Neutralizing Strategy.

Few studies have systematically examined the covert neutralizing strategies that serve to maintain and exacerbate the frequency and distress related to intrusive thoughts. Given the lack of research in this area, this study aimed to highlight development and maintenance factors for one such strategy, compensatory prayer, to inform assessment and treatment of related obsessional phenomena. We used a multimethod approach to examine the predictors and function of prayer when it is used in response to negative intrusive thoughts. Participants were 85 undergraduate students (ages 18-55 years) who self-identified with a branch of Christianity. In addition to self-report measures, participants were administered an in vivo negative thought induction and were subsequently asked about their use of compensatory prayer behaviors. Results indicated that religiosity, intrinsic religious motivation, and moral thought-action fusion (TAF) positively predicted the use of prayer, with moral TAF emerging as a unique predictor and a complete mediator between religiosity and the use of prayer. Regarding the function of prayer, results indicated that when prayer is used maladaptively (i.e., negative coping style), it is associated with higher scores on religious measures and moral TAF, as well as more frequent engagement in prayer, and a greater reduction in anxiety postprayer. Surprisingly, likelihood TAF was not found to be related to the use or function of prayer. Results are discussed in terms of certain religious teachings and TAF-related beliefs, neurobiological explanations for our pattern of findings, and clinical implications for religious-related intrusive thoughts. Future directions and limitations are also discussed.

Intrusive thoughts and quality of life among men with prostate cancer before and three months after surgery

BackgroundSudden, unwelcome and repetitive thoughts about a traumatic event – intrusive thoughts – could relate to how men assess their quality of life after prostate-cancer diagnosis. We aimed to study the prevalence of intrusive thoughts about prostate cancer and their association with quality-of-life outcomes before and after radical prostatectomy.MethodsDuring the first year of the LAPPRO-trial, 971 men scheduled for radical prostatectomy were prospectively included from 14 urological centers in Sweden. Of those, 833 men responded to two consecutive study-specific questionnaires before and three months after surgery (participation rate 86%). The association of intrusive thoughts with three quality-of-life outcomes, i.e. self-assessed quality of life, depressive mood and waking up with anxiety was estimated by prevalence ratios that were calculated, together with a 95% confidence interval, at the same time-point as well as over time. Fisher’s exact-test was used to analyze differences between respondents and non-respondents. Wilcoxon signed-ranks and Cochran-Armitage trend tests were used for analysis of change over time. To validate new questions on intrusive thoughts, written answers to open-ended questions were read and analyzed by qualitative content analysis.ResultsBefore surgery, 603 men (73%) reported negative intrusive thoughts about their cancer at some time in the past month and 593 men (59%) reported such thoughts three months after surgery. Comparing those reporting intrusive thoughts at least weekly or once a week before surgery with those who did not, the prevalence ratio (95% confidence interval), three months after surgery, for waking up in the middle of the night with anxiety was 3.9 (2.7 to 5.5), for depressed mood 1.8 (1.6 to 2.1) and for impaired self-assessed quality of life 1.3 (1.2 to 1.5).ConclusionThe prevalence of negative intrusive thoughts about prostate cancer at the time of surgery associates with studied quality-of-life outcomes three months later.Trial registrationCurrent Controlled Trials, ISRCTN06393679