Perseverative Cognitions Research Articles

Treatment as a moderator and executive function as a mediator of the effect of a mindfulness ecological momentary intervention for generalized anxiety disorder.

Theory and research indicated that executive functioning (EF) correlated with, preceded, and stemmed from worry in generalized anxiety disorder (GAD). The present secondary analysis (Zainal & Newman, 2023b) thus determined whether EF domains mediated the effect of a 14-day (5 prompts/day) mindfulness ecological momentary intervention (MEMI) against a self-monitoring control (SM) for GAD. Participants (N = 110) diagnosed with GAD completed self-reported (Attentional Control Scale, GAD Questionnaire, Perseverative Cognitions Questionnaire) and performance-based tests (Letter-Number Sequencing, Stroop, Trail Making Test-B, Verbal Fluency) at baseline, post-treatment, and one-month follow-up (1MFU). Causal mediation analyses determined if pre-post changes in EF domains preceded and mediated the effect of MEMI against SM on pre-1MFU changes in GAD severity and trait repetitive negative thinking (RNT). MEMI was more efficacious than SM in improving pre-post inhibition (β = -2.075, 95% [-3.388, -0.762], p = .002), working memory (β = 0.512, 95% [0.012, 1.011], p = .045), and set-shifting (β = -2.916, 95% [-5.142, -0.691], p = .010) but not verbal fluency and attentional control. Within groups, MEMI but not SM produced improvements in all examined pre-post EF outcomes except attentional control. Only pre-post improvements in inhibition mediated the effect of MEMI against SM on pre-1MFU reductions in GAD severity (β = -0.605, 95% [-1.357, -0.044], p = .030; proportion mediated = 7.1%) and trait RNT (β = -0.024, 95% [-0.054, -0.001], p = .040; proportion mediated = 7.4%). These patterns remained after conducting sensitivity analyses with non-linear mediator-outcome relations. Optimizing MEMI for GAD might entail specifically boosting inhibition plausibly by augmenting it with dialectical behavioral therapy, encouraging high-intensity physical exercises, and targeting negative emotional contrast avoidance.

The relationship between children’s rumination and parental rumination, worry and depressive symptoms

IntroductionRumination is a transdiagnostic phenomenon that is linked to psychological and physical symptoms not only in adulthood but also in childhood. Several distal and proximal factors are believed to underlie the development of ruminative tendencies, with parental characteristics and modelling being among those with a potential association with the increased levels of children’s rumination.ObjectivesThe primary aim of the study was to investigate the link between rumination in children and parental functioning, including rumination, worry and depressive symptoms. Additionally, we aimed to test the association between rumination and psychological and somatic health in a sample of healthy children and early adolescents.Methods153 children (87 girls, mean age = 10.74; SD = 0.91 years) and their parents (130 females, mean age = 42.65; SD = 4.08 years) participated in the study. For children, Kid Rumination Interview (KRI; Baiocco et al., 2017) was used, alongside the assessment of nine subjective health complaints. KRI employes 4 images to measure the frequency of rumination. Self-reported questionnaires were also completed by parents to report on worry, rumination, and depressive symptoms.ResultsContrary to our expectations, there was no significant association between children’s rumination and parental rumination (r = .06, p = .506), worry (r = -.02, p = .850) and depressive symptoms (r = -.01, p = .979). Psychosomatic complaints in children exhibited a positive albeit weak association with parental depressive symptoms (r = .17, p = .046). Regression analysis revealed that the frequency of rumination occurring in the four situations associated significantly with psychosomatic symptoms (β = .266; t = 3.321; p = .001) after controlling for sex and age.Conclusions Our findings are in line with previous studies demonstrating the relationship between rumination and psychosomatic symptoms in older adolescent samples. However, parental perseverative cognitions and depression were unrelated to ruminative tendencies in children. Nevertheless, the modest sample size and the employment of a different assessment approach compared to self-report questionnaires may have influenced our findings.Disclosure of InterestNone Declared

Maternal attachment security modulates the relationship between vulnerability to anxiety and attentional bias to threat in healthy children

This study aimed to investigate whether attentional bias to threat, commonly observed in clinically anxious children, also manifests in healthy children, potentially aiding the early detection of at-risk individuals. Additionally, it sought to explore the moderating role of parent–child attachment security on the association between vulnerability factors (anxiety sensitivity, intolerance of uncertainty, perseverative cognitions) as indicators of vulnerability to anxiety, and attentional bias towards threat in healthy children. A total of 95 children aged 8 to 12 years completed the Visual Search Task to assess attentional bias. Vulnerability to anxiety was measured using a composite score derived from the Childhood Anxiety Sensitivity Index, Intolerance of Uncertainty Scale for Children, and Perseverative Thinking Questionnaire. Parent–child attachment security was assessed using the Security Scale-Child Self-Report. Analyses revealed that higher vulnerability to anxiety was associated with faster detection of anger-related stimuli compared to neutral ones, and this association was further influenced by high maternal security. These findings in healthy children suggest an interaction between specific factors related to anxiety vulnerability and the security of the mother–child relationship, leading to cognitive patterns resembling those seen in clinically anxious individuals. These results hold promise for early identification of children at risk of developing anxiety disorders.

Which client with generalized anxiety disorder benefits from a mindfulness ecological momentary intervention versus a self-monitoring app? Developing a multivariable machine learning predictive model

Precision medicine methods (machine learning; ML) can identify which clients with generalized anxiety disorder (GAD) benefit from mindfulness ecological momentary intervention (MEMI) vs. self-monitoring app (SM). We used randomized controlled trial data of MEMI vs. SM for GAD (N = 110) and tested three ML models to predict one-month follow-up reliable improvement in GAD severity, perseverative cognitions (PC), trait mindfulness (TM), and executive function (EF). Eleven baseline predictors were tested regarding differential reliable change from MEMI vs. SM (age, sex, race, EF errors, inhibitory dyscontrol, set-shifting deficits, verbal fluency, working memory, GAD severity, TM, PC). The final top five prescriptive predictor models of all outcomes performed well (AUC = .752 .886). The following variables predicted better outcome from MEMI vs. SM: Higher GAD severity predicted more GAD improvement but less EF improvement. Elevated PC, inhibitory dyscontrol, and verbal dysfluency predicted better improvement in most outcomes. Greater set-shifting and TM predicted stronger improvements in GAD symptoms and TM. Older age predicted more alleviation of GAD and PC symptoms. Women exhibited more enhancements in trait mindfulness and EF than men. White individuals benefitted more than non-White. PC, TM, EF, and sociodemographic data might help predictive models optimize intervention selection for GAD.

Cortisol reactivity and emotional cognitive processes in healthy youth presenting elevated vulnerability to anxiety

Children diagnosed with anxiety disorders show altered reactive cortisol levels and emotional cognitive processes. To date, it remains unclear whether anxiety pathologies lead to these dysregulations or whether they are detectable in healthy children. If the latter is true, this may provide insight into their vulnerability to developing anxiety disorders. Various personality factors (anxiety sensitivity, intolerance of uncertainty, perseverative cognitions) have been found to increase one’s vulnerability to developing clinical anxiety. The purpose of this study was to examine whether vulnerability to anxiety was associated with cortisol reactivity, attentional biases towards threat, and perceptual information needed to identify emotional faces in healthy youth. In total, 114 children (8-12 y/o) were exposed to the Trier Social Stress Test for Children while saliva samples were collected for later cortisol quantification. Children completed two cognitive tasks to assess attentional biases and visual perception of emotional information. Vulnerability to anxiety was assessed using a composite score of the Childhood Anxiety Sensitivity Index, Intolerance of Uncertainty Scale for Children, and the Perseverative Thinking Questionnaire. Results showed that higher vulnerability to anxiety was associated with enhanced cortisol reactivity for boys, as well as faster reaction times to anger-related stimuli and less perceptual information needed to identify angry faces for boys and girls. These results indicate that endocrine and cognitive patterns characterizing anxiety disorders are detectable in healthy children who exhibit a high level of self-reported vulnerability to anxiety. These results could aid in the early identification of children at risk of developing an anxiety disorder.

Vulnerability to anxiety differently predicts cortisol reactivity and state anxiety during a laboratory stressor in healthy girls and boys

BackgroundChildren diagnosed with anxiety disorders show altered cortisol and state anxiety reactivity to stressful situations. To date, it remains unclear whether these dysregulations emerge after the pathology or whether they are also detectable in healthy children. If the latter is true, this may provide insight into children's vulnerability to develop clinical anxiety. Various personality factors (anxiety sensitivity, intolerance of uncertainty, perseverative cognitions) increase youth's vulnerability to develop anxiety disorders. This study aimed to examine whether vulnerability to anxiety was associated with cortisol reactivity and state anxiety in healthy youth. Methods114 children (8–12 y/o) were exposed to the Trier Social Stress Test for Children (TSST-C), where saliva samples were collected for cortisol quantification. State anxiety was assessed 20 min before and 10 min after the TSST-C using the state form of the State-Trait Anxiety Inventory for Children. Vulnerability to anxiety was assessed using a composite score of the Childhood Anxiety Sensitivity Index, Intolerance of Uncertainty Scale for Children, and Perseverative Thinking Questionnaire. ResultsHigher vulnerability to anxiety was associated with enhanced cortisol reactivity in boys. Irrespective of vulnerability level, girls reported greater changes in state anxiety in response to the TSST. LimitationsGiven the correlational nature of this study, the directionality of the results remains to be elucidated. ConclusionsThese results indicate that endocrine patterns characterizing anxiety disorders are detectable in healthy boys who exhibit a high level of self-reported vulnerability to anxiety. These results could aid in the early identification of children at risk of developing anxiety disorders.

Effects of non-invasive vagus nerve stimulation on cognitive and autonomic correlates of perseverative cognition.

Perseverative cognitions can provoke psychophysiological stress in the absence of an actual stressor and are considered important transdiagnostic vulnerability factors for several (mental) health issues. These stress-related cognitive processes are reflected by both cognitive (assessed by self-reports) and autonomic inflexibility (assessed by heart rate variability; HRV), with a key role attributed to the vagus nerve. Interestingly, modulation of the afferent branches of the vagus can be achieved with transcutaneous auricular vagus nerve stimulation (taVNS), a non-invasive technique that employs a low-intensity electrical current applied to the ear. In a sample of healthy individuals, we investigated the effects of taVNS of the left concha, compared to sham (earlobe) stimulation, on the cognitive and autonomic correlates of perseverative cognition following a psychosocial stress task. Interestingly, taVNS significantly reduced cognitive rigidity, reflected by reduced subjective perseverative thinking after psychosocial stress. Although there were no direct effects on autonomic correlates of perseverative cognition, individual differences in perseverative thinking after the stressor significantly affected the effects of taVNS on HRV. Specifically, more autonomic inflexibility during the stress task (i.e., reduced HRV) was associated with increases in perseverative thinking afterward for the sham condition, but not the active taVNS condition. Additional exploratory analyses revealed no significant moderation of stimulation intensity. Overall, the study findings endorse the association between perseverative cognitions and vagus nerve functioning.

Stressor anticipation and subsequent affective well-being: A link potentially explained by perseverative cognitions.

Anticipatory stress can prospectively and negatively influence diverse outcomes, including cognitive performance and emotional well-being. It has been suggested that perseverative cognitions (e.g., worry, rumination) during the anticipation period constitute a key mechanism driving these effects. The present study investigated the temporal dynamics among stressor anticipation, perseverative cognitions, and affective well-being. To accurately test the suggested mechanism, we focused on how these dynamics unfold within individuals over time. To that end, we analyzed data from an ecological momentary assessment study in an ethnically diverse sample (N = 243, 25-65 year olds, 68.7% Hispanic or non-Hispanic Black; 14 days, 5 measurement occasions per day) using dynamic structural equation modeling. Anticipating an upcoming stressor was linked to higher levels of perseverative cognitions approximately 3 hours later. At times when individuals reported higher levels of recent perseverative cognitions than typical for them, they also reported higher levels of negative affect and lower levels of positive affect. Mediational modeling indicated that perseverative cognitions accounted for the persistent effects of previous stressor anticipation on negative as well as positive affect several hours later. These findings suggest that perseverative cognitions may play an important role in explaining the detrimental effects of anticipatory stress on subsequent emotional well-being. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Efficacy and acceptability of digital stress management micro-interventions

Tremendous interest exists in the use of brief digital “micro-interventions” for online and mobile intervention. Most digital micro-interventions, however, lack a strong theoretical or empirical basis and have not demonstrated efficacy and acceptability. We developed a suite of brief digital stress management micro-interventions based on theory and empirical evidence and tested the efficacy and acceptability of these micro-interventions in managing stress, mood, and perseverative cognition. Participants were 1,050 US adults (ages 35-65) in good health who received digital micro-intervention content (or comparison content) and then completed post-intervention measures and acceptability ratings. We created 16 brief (<2 min) micro-interventions across four therapeutic domains (relaxation, response modulation, positive experiences, and resource buffers) and a brief active comparison activity. We also created one multi-component micro-intervention (∼20 min) that contained elements of all four domains, and a time-matched active comparison activity. A subset (n=850) of participants received one of the 16 brief micro-interventions or a brief comparator; the remainder (n=200) received either the longer multi-component micro-intervention or the time-matched active comparator task. All micro-intervention stress management content reduced acute stress, negative mood, and perseverative cognitions. For all outcomes, the multi-component intervention showed the strongest effects. Active comparator tasks were more weakly associated with outcomes (except that brief distraction was highly effective at reducing perseverative cognitions). Micro-intervention acceptability was generally high across multiple dimensions. These data demonstrate that a diverse set of 16 brief digital micro-interventions comparison activity were efficacious, and an integrative multi-component micro-intervention was more efficacious. Such micro-interventions hold great potential for scalable digital implementation, including “just-in-time” intervention in response to acute risk states.

Anterior cingulate cortex activity during attentional control corresponds with rumination in depression and social anxiety

Rumination and worry are transdiagnostic perseverative cognitions that have overlapping and distinct characteristics. While the mechanisms of perseverative cognitions remain incomplete, limited data indicate anterior cingulate cortex (ACC) as it relates to top-down functions contributes to perseverative cognitions in internalizing conditions. The current study extends this work in patients with major depression (n = 39) or social anxiety (n = 42). During fMRI, participants viewed images comprising letter strings superimposed on task-irrelevant threatening or neutral faces. To moderate task difficulty, there was a low perceptual load condition where the target letter was in a string of identical letters and high load condition with the target letter in a mixed letter string increasing task difficulty. Regions of interest (ROI) comprised dorsal ACC and rostral ACC. Bilateral amygdala was also examined. Results showed diagnostic groups had similar levels of rumination and worry. Exploratory hierarchical regression analysis comprising clinical measures, task performance, and the 4 ROIs revealed significantly less dorsal ACC engagement during low (vs. high) load to task-irrelevant faces corresponded with more rumination, but not worry, regardless of diagnostic status. However, the ACC finding did not survive Bonferroni correction. Preliminary results suggest dorsal ACC response during attentional control may serve as a transdiagnostic mechanism of rumination.

Ambulatory assessment of rumination and worry: Capturing perseverative cognitions in children's daily life.

Rumination and worry are common forms of perseverative cognition in children. Research has started to target perseverative cognitions in the everyday life of children, however, valid measurement instruments reliably capturing rumination and worry in children's daily life are still missing. We conducted two ambulatory assessment studies validating short scales suitable for the measurement of rumination and worry in children's daily life. Results of the first study (N = 110, 8-11 year-olds, 31 days, up to 4 daily measurements) supported a unidimensional structure of the rumination scale. Rumination was associated with negative affect (but not positive affect) on the within- and on the between-person level. On the between-person level, children who ruminated more showed poorer working memory performance. In the second study (N = 84, 8-10 year-olds, 21 days, up to 3 daily measurements), findings of Study 1 were largely replicated. Moreover, we established a unidimensional worry scale in Study 2 reliably capturing worry in children's daily life. Importantly, Study 2 showed that worry and rumination share common variance but can be differentiated in children. On the within-person level, higher levels of worry were associated with higher levels of negative affect and lower levels of positive affect. On the between-person level, worry was associated with higher levels of negative affect and lower working memory performance. Altogether, findings of both studies demonstrated that the short scales had excellent psychometric properties suggesting that they are helpful tools for the assessment of rumination and worry in children's daily life.person level, worry was associated with higher levels of negative affect and lower working memory performance. Altogether, findings of both studies demonstrated that the short scales had excellent psychometric properties suggesting that they are helpful tools for the assessment of rumination and worry in children's daily life (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Supplemental Material for Stressor Anticipation and Subsequent Affective Well-Being: A Link Potentially Explained by Perseverative Cognitions

Supplemental Material for Stressor Anticipation and Subsequent Affective Well-Being: A Link Potentially Explained by Perseverative Cognitions

Supplemental Material for Ambulatory Assessment of Rumination and Worry: Capturing Perseverative Cognitions in Children’s Daily Life

Supplemental Material for Ambulatory Assessment of Rumination and Worry: Capturing Perseverative Cognitions in Children’s Daily Life

Cross-Cultural and Gender Invariance of Transdiagnostic Processes in the United States and Singapore.

The Research Domain Criteria define cognitive and emotional processes (e.g., rumination, intolerance of uncertainty, anxiety sensitivity, emotion dysregulation) as key transdiagnostic elements of psychopathology. However, there is currently a dearth of construct equivalence studies on measures of these processes. We thus aimed to validate the latent structures of five transdiagnostic constructs using established and newer measures: two-factor Rumination-Reflection Questionnaire, six-factor Perseverative Cognitions Questionnaire, two-factor Intolerance of Uncertainty Scale, three-factor Anxiety Sensitivity Index-3, two-factor Cognitive and Behavioral Processes Questionnaire (CBPQ). Measurement equivalence was examined across 292 American and 144 Singaporean undergraduates. Cross-cultural confirmatory factor analyses revealed strict invariance for all measures, with interfactor association differences on the Perseverative Cognitions Questionnaire and CBPQ. Across gender, full invariance was found on all measures except the CBPQ. Theoretical and clinical implications are discussed.

The association between perseverative cognition and resting heart rate variability: A focus on state ruminative thoughts

ObjectiveTwo studies were conducted to shed light on the associations between trait and state rumination and worry and a time-domain metric of heart rate variability, the root mean square of successive differences (RMSSD) of cardiac interbeat-interval (IBI). MethodStudy 1 involved 130 healthy adults (118 females; mean age = 23.4 ± 3.59 years), while 72 healthy participants (58 females; mean age = 22.2 ± 1.79 years) were involved in Study 2. RMSSD was calculated from a 5-min baseline recording and state ruminative thoughts were assessed during measurement. Trait perseverative cognitions were measured using self-reported questionnaires. ResultsIn Study 1, we found that a higher level of state but not trait ruminative thoughts showed weak negative association with lnRMSSD. In Study 2, we replicated the results of Study 1 and we found that trait reflection moderated the relationship between state rumination and lnRMSSD. ConclusionState rumination may reflect actual cardiovascular activity better than trait preservative cognitions, although trait reflection could be a protective factor.

Cardiovascular and affective responses to speech and anger: Proactive benefits of a single brief session of mindfulness meditation

AbstractPurposeThis pilot study evaluated whether a brief, 5‐min single‐session of mindfulness meditation (MM) training could lessen cardiovascular and affective reactivity to speech and anger recall. Moreover, we tested if trait levels of perseverative cognitions (PCs) moderated these relationships.MethodsParticipants completed online survey measures including PCs; thereafter, they completed a 5‐min resting baseline, 2‐min speech task, and 5‐min anger recall task while measures of BP were collected. The experimental group received a 5‐min MM training session before the resting baseline period.ResultsRepeated measures ANOVA were conducted for condition (MM vs. control) and period (repeated: baseline, speech, anger recall) on blood pressure (BP). The MM group showed less systolic and diastolic BP reactivity during speech and anger recall than the control group. There were no effects observed for negative affect nor did PCs moderate the BP findings.ConclusionThus, even 5 min of MM training can have momentary cardiovascular benefits, having important implications for the training and implementation of MM programs.

0135 Stress, Mindfulness, Perseverative Cognitions, and Sleep Quality: A Moderated Mediation Analysis

0135 Stress, Mindfulness, Perseverative Cognitions, and Sleep Quality: A Moderated Mediation Analysis

The relationship between perseverative cognitions and mental health and physical health complaints among college students

College students often experience health problems, but approaches are needed to determine those that are most vulnerable. This study examined whether perseverative cognitions (PCs) represent a comm...

Perseverative Cognitions and Stress Exposure: Comparing Relationships With Psychological Health Across a Diverse Adult Sample.

Both exposure to stress and perseverative cognitions (PCs)-repetitive cognitive representations of real or imagined stressors-are linked with poor psychological health. Yet, stress exposure and PCs are correlated, thus potentially obscuring any unique effects. The purpose of this paper is to concurrently test associations between stress exposure and PCs and psychological health to examine the independent relationship of each with psychological health. Moreover, we examined whether these relationships are similar across sex, age, and race. An adult community sample (n = 302) completed a measure of stress exposure, three PCs scales, and questionnaires assessing self-reported psychological health, including emotional well-being, vitality, social functioning, role limitations due to personal problems, subjective well-being, depressive symptoms, and poor sleep quality. Structural equation modeling was used to test a model in which both stress exposure and PCs predict psychological health. PCs consistently predicted all the psychological health outcomes, but stress was largely unrelated to the outcomes despite bivariate correlations suggesting a relationship. A follow-up model identified indirect effects of stress exposure on psychological health via PCs. Results were fairly consistent regardless of one's sex, age, or race. PCs robustly predicted all of the psychological health outcomes, intimating PCs as a common pathway to poor psychological health. Results have implications for stress interventions, including the need to address PCs after experiencing stress.

The verbal nature of worry in generalized anxiety: Insights from the brain.

BackgroundThe Cognitive Avoidance Theory of Worry argues that worry is a cognitive strategy adopted to control the physiological arousal associated with anxiety. According to this theory, pathological worry, as in Generalized Anxiety Disorder (GAD), is verbal in nature, negative and abstract, rather than concrete. Neuroimaging studies link the expression of worry to characteristic modes of brain functional connectivity, especially in relation to the amygdala. However, the distinctive features of worry (verbal, abstract, negative), and their relationship to physiological arousal, have not so far been mapped to brain function.MethodsWe addressed this omission by undertaking a resting-state functional magnetic resonance neuroimaging study of 19 patients with GAD and 21 controls, before and after induction of perseverative cognitions, while measuring emotional bodily arousal from heart rate (HR). Seed-based analyses quantified brain changes in whole brain functional connectivity from the amygdala.ResultsIn GAD, the induction increased negative thoughts and their verbal content. In line with predictions, the verbal expression of worry in GAD was associated with higher HR at baseline and attenuated HR increases after induction of perseverative cognitions. Within brain, the increased use of words during worry, and the associated dampening of HR after induction were mediated by the strength of functional connectivity between the amygdala and default mode network ‘hubs’ and the opercular cortex. The negative content of worry was further related to functional communication between amygdala and cingulo-opercular and temporal cortices.ConclusionsFindings provide a neurobiological basis for the impact of verbal worry on HR in GAD.