Perseverative Negative Thinking Research Articles

Brain mechanisms of rumination and negative self-referential processing in adolescent depression

BackgroundDepression is linked to cognitive biases towards more negative and less positive self-relevant information. Rumination, perseverative negative thinking about the past and the self, may contribute to these biases. Methods159 adolescents (12–18 years), with a range of depression symptoms, completed the SRET during fMRI. Multiple regressions tested associations between conventional self-report and ecological momentary assessment (EMA) measured rumination, and neural and behavioral responses during a self-referent encoding task (SRET). ResultsHigher rumination (conventional self-report and EMA) was associated with more negative and fewer positive words endorsed and recalled. Higher self-reported (but not EMA) rumination was associated with higher accuracy in recognizing negative words and greater insula and dorsal anterior cingulate activity to negative versus positive words. LimitationsThe sample included mostly non-Hispanic White participants with household incomes above the national average, highlighting the need for replication in more diverse samples. Word endorsement discrepancies required fMRI analyses to model neural response to viewing negative versus positive words. ConclusionsAdolescents with higher rumination endorsed and recalled more negative and fewer positive words and recognized more negative words during the SRET. Higher insula reactivity, a key region for modulating externally-oriented attention and internally-oriented self-referential processes, may contribute to links between rumination and negative memory biases. These findings provide insight into neurocognitive mechanisms underlying depression.

Schema therapy versus treatment as usual for outpatients with difficult-to-treat depression: study protocol for a parallel group randomized clinical trial (DEPRE-ST)

BackgroundAbout one third of patients with depression are in a condition that can be termed as “difficult-to-treat”. Some evidence suggests that difficult-to-treat depression is associated with a higher frequency of childhood trauma and comorbid personality disorders or accentuated features. However, the condition is understudied, and the effects of psychotherapy for difficult-to-treat depression are currently uncertain. The aim of this trial is to investigate the beneficial and harmful effects of 30 sessions of individual schema therapy versus treatment as usual for difficult-to-treat depression in the Danish secondary, public mental health sector.MethodsIn this randomized, multi-centre, parallel-group, superiority clinical trial, 129 outpatients with difficult-to-treat depression will be randomized (1:1) to 30 sessions of individual schema therapy or treatment as usual; in this context mainly group-based, short-term cognitive behaviour or psychodynamic therapy. The primary outcome is the change from baseline in depressive symptoms 12 months after randomization, measured on the observer-rated 6-item Hamilton Rating Scale for Depression. The secondary outcomes are health-related quality of life assessed with the European Quality of Life 5 Dimensions 5 Level Version, functional impairment assessed with the Work and Social Adjustment Scale, psychological wellbeing assessed with the WHO-5 Well-being Index, and negative effects of treatment assessed with the Negative Effects Questionnaire. Exploratory outcomes are improvement on patient self-defined outcomes, personal recovery, anxiety symptoms, anger reactions, metacognitive beliefs about anger, and perseverative negative thinking. Outcomes will be assessed at 6, 12, and 24 months after randomization; the 12-month time-point being the primary time-point of interest. Outcome assessors performing the depression-rating, data managers, statisticians, the data safety and monitoring committee, and conclusion makers for the outcome article will be blinded to treatment allocation and results. To assess cost-effectiveness of the intervention, a health economic analysis will be performed.DiscussionThis trial will provide evidence on the beneficial and harmful effects, as well as the cost-effectiveness of schema therapy versus treatment as usual for outpatients with difficult-to-treat depression. The results can potentially improve treatment for a large and understudied patient group.Trial registrationClinicalTrials.gov NCT05833087. Registered on 15th April 2023 (approved without prompts for revision on 27th April 2023).

Gastric myoelectrical associations with autonomic and central nervous system activity during state negative emotionality and perseverative negative thinking: A two-study investigation

BackgroundDistress is known to set off a variety of physiological dysfunctions. There have been previous investigations of central and peripheral (e.g., cardiac) correlates of distress and a burgeoning field examining immunological and inflammatory relationships to distress. However, despite a connection between gastrointestinal symptoms and distress at the clinical level, little research has connected this activity to other biological correlates of distress. Heightened negative emotions and dysregulation of emotions in the form of perseverative negative thinking (PNT, e.g., worry, rumination) are two components that underlie distress. Investigating the effect that these components have on gastric and related biological measures is crucial to better understanding the relationship between distress and health outcomes. We present results from two studies, which examined the impact of experimentally induced negative emotionality and PNT on gastric, autonomic nervous system, central nervous system, and inflammatory processes. MethodIn Study 1 (N = 95), we examined changes in electrogastrogram (EGG), respiratory sinus arrythmia (RSA), and alpha- and beta-band electroencephalogram (EEG) power at baseline and during experimental inductions of fear and sadness in a diverse sample of undergraduate students. In Study 2 (N = 30), we examined changes in EGG, RSA, and EEG at baseline and during worry and rumination inductions. We also collected inflammatory markers post-inductions in Study 2. ResultsIn Study 1, normal gastric activity, vagal tone, and alpha- and beta-band power decreased, whereas EGG cycle length and variability increased during fear and sadness compared to baseline. We also observed significant relationships among EGG, RSA, and EEG during fear and sadness. In Study 2, normal gastric activity and RSA decreased, whereas EGG cycle length and variability increased during rumination compared to baseline. We also observed increases in frontal alpha-band power during worry and rumination compared to baseline. Regarding relationships among EGG, RSA, EEG, and inflammation, greater EGG cycle variability was associated with higher vagal tone during worry; additionally, EGG cycle length and variability during rumination were positively related to CRP and TNF-α inflammation composite scores post-inductions. ConclusionsThese findings offer insight into how negative emotionality and PNT might relate to gastric, ANS, CNS, and inflammatory processes.

EXPLORATORY ROLE OF COGNITIVE BEHAVIORAL FACTORS ON PSYCHOLOGICAL EMPOWERMENT AMONG YOUTH

An individual is said to be psychologically empowered when the individual has control and can make his/her own life choices, which is essential in present times. In this context, cognitive flexibility and self-control act as effective tools to regulate one’s urges, be motivated and regulate the available resources in the most effective way, so that the individual can make successful life decisions and achieve the goals, while on other hand perseverative negative thinking hampers an individual’s decision making and goal achievement, which is especially true in current times. Considering this aspect the purpose of the current study was to look at the connection between psychological empowerment, cognitive flexibility, perseverative thinking and self-control and to study the interaction of cognitive flexibility, perseverative thinking, and self-control concerning psychological empowerment in present times. Purposive sampling technique was used to select the sample. The study sample was university students of upper-middle and higher socioeconomic backgrounds aged between 18 and 25 years, from urban domicile. Product Moment Correlation and Regression analysis was administered to test the hypothesis. The result showed that the dimensions of psychological empowerment were significantly correlated with cognitive flexibility, self-control and perseverance, also the three variables of the study (cognitive flexibility, perseverative thinking, and self-control) significantly contributed variance in predicting psychological empowerment. This research implicates that there are clear potential benefits to delivering effective intervention for youth so that they can be taught ego depletion strategies which in turn leads to long term goal satisfaction.

A randomized controlled trial comparing two doses of emotion regulation therapy: Preliminary evidence that gains in attentional and metacognitive regulation reduce worry, rumination, and distress

BackgroundEmotion regulation therapy (ERT) promotes resilience in distress disorders by strengthening attentional and metacognitive capacities. Regulation skills are presented with the goal of ameliorating the perseverative negative thinking (PNT) that characterizes these disorders. This study tested ERT in a randomized controlled trial comparing the effectiveness of 16-session (ERT16) versus 8-session (ERT8) doses. MethodPatients (N = 72) endorsing elevated worry and/or rumination and meeting diagnostic criteria for a distress disorder were randomized to ERT8 or ERT16. PNT, anxiety/depressive symptoms, functioning/quality of life, and treatment mechanisms (attention shifting, attention focusing, decentering, reappraisal) were measured at pre, mid, and post treatment. Clinical symptom severity was also assigned via diagnostic interview at each timepoint. ResultsERT produced significant improvements across outcomes. ERT16 showed an advantage over ERT8 for distress disorder severity, worry, rumination, and attention shifting from pre-post treatment. Changes in ERT treatment mechanisms mediated changes in clinical improvement. ConclusionThese findings provide evidence of the effectiveness of two doses of ERT in reducing PNT and distress through improvements in regulation skills. Clinicaltrials.gov identifierNCT04060940.

Measuring dysfunctional interpersonal beliefs: validation of the Interpersonal Cognitive Distortions Scale among a heterogeneous German-speaking sample

BackroundDysfunctional interpersonal beliefs (DIBs) are a key symptom domain in numerous mental disorders. Because DIBs exert a strong influence on social experience and behavior, they play an important role in a mental disorder's development and progression. To date, only the Interpersonal Cognitive Distortions Scale (ICDS) captures DIBs independently of specific disorders, populations, or contexts. The present study's aim was to psychometrically evaluate and validate a German translation of the ICDS.MethodsThe ICDS was administered along with indicators of convergent (rejection sensitivity, depressive expectations, interpersonal trust, interpersonal problems, perceived social support), discriminant (self-efficacy, perseverative negative thinking, optimism), and clinical validity (psychopathology, perceived stress, well-being) to a pooled sample incorporating non-clinical (N = 114) and clinical (N = 94) participants.ResultsAn exploratory factor analysis (EFA) suggested a five-factor solution (factor loadings: .44 to .85). Correlational analyses demonstrated acceptable convergent (ρ = -.29 to -.35, ρ = .27 to .59), suboptimal discriminant (ρ = -.27 to -.38, ρ = .52), and acceptable clinical validity (ρ = -.21, ρ = .36 to .44) at the total-scale level. However, results at the subscale level were mixed and required nuanced interpretation. Likewise, internal consistency was acceptable at the total-scale level (α = .76), but ranged from good to poor at the subscale level (α = .61 to .80). DIBs mediated the negative relationship between mental disorder onset and psychopathology levels.DiscussionOur results imply DIBs' relevance to mental health and related outcomes. When working with the ICDS’s German version, we recommend employing only the “insecurity” subscale, as this was the only scale revealing acceptable psychometric properties. Future studies should improve the construct validity of the ICDS (and its subscales), e.g., by adding more items to the respective subscales and further classes of DIBs.

A-195 The Indirect Effects of Repetitive Negative Thinking and Emotion Dysregulation on the Association Between Attentional Control and Anxiety Symptoms

Abstract Objective: Attentional control has been found to influence the ability to effectively down-regulate negative emotional states and attenuate intrusive negative thinking. The present study aims to clarify the unique effects of attentional control on anxiety symptoms through perseverative negative thinking and emotional dysregulation. Method: A sample of undergraduate psychology students (n=741) completed the Attentional Control Scale-Straightforward (ACS), the Perseverative Thinking Questionnaire (PTQ), the Difficulties with Emotion Regulation Scale-Short Form (DERS-SF), Positive and Negative Affect Schedule (PANAS), and the Generalized Anxiety Disorder-7 (GAD-7). A parallel mediation model was tested in the PROCESS macro in SPSS using 10,000 sample bias-corrected bootstrapping. Results: Attentional control was negatively associated with emotional dysregulation, B=-.30, [-.41, -.18], repetitive negative thinking, B=-.37, [-.50, -.24], and anxiety symptoms, B=-.07, [-.11, -.02]. Repetitive negative thinking, B=.13, [.11, .16], and emotional dysregulation, B=.06, [.03, .09], were both positively associated with anxiety symptoms. There was an indirect effect of attentional control on anxiety symptoms through both repetitive negative thinking, B=-.05, [-.07, -.03], and emotional dysregulation, B=-.02, [-.03, -.01]. The direct effect was no longer significant after accounting for repetitive negative thinking and emotional dysregulation in the model, B=.00, [-.04, .04]. Conclusions: These findings indicate that the relationship between attentional control and anxiety symptoms can be explained by emotion dysregulation and repetitive negative thinking. Future research focusing on whether the use of attentional and cognitive resources can prospectively predict emotion regulation and perseverative negative thinking may assist with better understanding the mechanism of attentional and cognitive intervention techniques.

The metacognitive model of rumination and depression in postpartum women.

The metacognitive model of rumination and depression (Papageorgiou & Wells, 2003, Cognitive Therapy and Research, 27, 261) postulates that beliefs that perseverative negative thinking, i.e. rumination, will help solve problems contributing to rumination. However, this activates negative beliefs about the uncontrollability and social consequences of ruminations, which exacerbate depression. The metacognitive model has been well-supported but with some inconsistencies in specific pathways. It has also not yet been tested for postpartum depression (PPD). Therefore, this study aimed to examine the relations between the metacognitive model of rumination and depression when applied to PPD symptoms and to compare it with the cognitive model of depression. This is a cross-sectional study. Postpartum mothers (N= 603) participated in an online study in their first postpartum year. They completed the Edinburgh Postnatal Depression Scale (EPDS), Postnatal Negative Thoughts Questionnaire (PNTQ), Ruminative Responses Scale (RRS), Positive Beliefs about Rumination Scale (PBRS) and Negative Beliefs about Rumination Scale (NBRS). A path analysis revealed that the model had an excellent fit to the data. Specifically, positive beliefs about rumination predicted engagement in rumination that, in turn, predicted PPD, both directly and indirectly, through negative beliefs about uncontrollability and the social consequences of rumination. A cognitive model with ruminations as a partial mediator between negative postpartum thoughts and PPD symptoms also had a good fit. The findings of this study contribute to the understanding of the cognitive and metacognitive mechanisms underlying postpartum depression, which might be similar to depression in general and have important implications for treatment strategies.

Imbalance between default mode and sensorimotor connectivity is associated with perseverative thinking in obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is highly heterogeneous. Although perseverative negative thinking (PT) is a feature of OCD, little is known about its neural mechanisms or relationship to clinical heterogeneity in the disorder. In a sample of 85 OCD patients, we investigated the relationships between self-reported PT, clinical symptom subtypes, and resting-state functional connectivity measures of local and global connectivity. Results indicated that PT scores were highly variable within the OCD sample, with greater PT relating to higher severity of the “unacceptable thoughts” symptom dimension. PT was positively related to local connectivity in subgenual anterior cingulate cortex (ACC), pregenual ACC, and the temporal poles—areas that are part of, or closely linked to, the default mode network (DMN)—and negatively related to local connectivity in sensorimotor cortex. While the majority of patients showed higher local connectivity strengths in sensorimotor compared to DMN regions, OCD patients with higher PT scores had less of an imbalance between sensorimotor and DMN connectivity than those with lower PT scores, with healthy controls exhibiting an intermediate pattern. Clinically, this imbalance was related to both the “unacceptable thoughts” and “symmetry/not-just-right-experiences” symptom dimensions, but in opposite directions. These effects remained significant after accounting for variance related to psychiatric comorbidity and medication use in the OCD sample, and no significant relationships were found between PT and global connectivity. These data indicate that PT is related to symptom and neural variability in OCD. Future work may wish to target this circuity when developing personalized interventions for patients with these symptoms.

Biology of Perseverative Negative Thinking: The Role of Timing and Folate Intake.

Past-oriented rumination and future-oriented worry are two aspects of perseverative negative thinking related to the neuroticism endophenotype and associated with depression and anxiety. Our present aim was to investigate the genomic background of these two aspects of perseverative negative thinking within separate groups of individuals with suboptimal versus optimal folate intake. We conducted a genome-wide association study in the UK Biobank database (n = 72,621) on the “rumination” and “worry” items of the Eysenck Personality Inventory Neuroticism scale in these separate groups. Optimal folate intake was related to lower worry, but unrelated to rumination. In contrast, genetic associations for worry did not implicate specific biological processes, while past-oriented rumination had a more specific genetic background, emphasizing its endophenotypic nature. Furthermore, biological pathways leading to rumination appeared to differ according to folate intake: purinergic signaling and circadian regulator gene ARNTL emerged in the whole sample, blastocyst development, DNA replication, and C-C chemokines in the suboptimal folate group, and prostaglandin response and K+ channel subunit gene KCNH3 in the optimal folate group. Our results point to possible benefits of folate in anxiety disorders, and to the importance of simultaneously taking into account genetic and environmental factors to determine personalized intervention in polygenic and multifactorial disorders.

Catenin Alpha 2 May Be a Biomarker or Potential Drug Target in Psychiatric Disorders with Perseverative Negative Thinking.

AlphaN-catenin gene CTNNA2 has been implicated in intrauterine brain development, as well as in several psychiatric disorders and cardiovascular diseases. Our present aim was to investigate CTNNA2 gene-wide associations of single-nucleotide polymorphisms (SNPs) with psychiatric and cardiovascular risk factors to test the potential mediating role of rumination, a perseverative negative thinking phenotype in these associations. Linear mixed regression models were run by FaST-LMM within a sample of 795 individuals from the Budakalasz Health Examination Survey. The psychiatric outcome variables were rumination and its subtypes, and ten Brief Symptom Inventory (BSI) scores including, e.g., obsessive-compulsive, depression, anxiety, hostility, phobic anxiety, and paranoid ideation. Cardiovascular outcome variables were BMI and the Framingham risk scores for cardiovascular disease, coronary heart disease, myocardial infarction, and stroke. We found nominally significant CTNNA2 associations for every phenotype. Rumination totally mediated the associations of CTNNA2 rs17019243 with eight out of ten BSI scores, but none with Framingham scores or BMI. Our results suggest that CTNNA2 genetics may serve as biomarkers, and increasing the expression or function of CTNNA2 protein may be a potential new therapeutic approach in psychiatric disorders with perseverative negative thinking including, e.g., depression. Generally, an antiruminative agent could be a transdiagnostic and preventive psychopharmacon.

Measuring the Cognitive Attentional Syndrome Associated with Emotional Distress: Psychometric Properties of the CAS-1

The self-regulatory executive function model is the basis of metacognitive therapy and proposes that psychological disorders are caused by maladaptive beliefs about thinking (metacognitive beliefs) and a perseverative negative thinking style associated with them, named the cognitive attentional syndrome (CAS). The CAS-1 was devised and has been used as a clinical tool for assessment and monitoring of the cognitive attentional syndrome and underlying positive and negative metacognitive beliefs during the course of treatment. The aim of this study is to assess the psychometric properties of the CAS-1. Seven hundred and seventy-three participants completed a battery of self-report questionnaires at the cross-sectional level, and 431 individuals also completed the same measures 6 and 12 weeks later. Confirmatory factor analysis supported the proposed three-factor solution of the measure, and the factors demonstrated good internal consistency (α ranging from .77 to .89), convergent validity, incremental validity, stability and discriminative validity were satisfactory. Our findings support the continued use of the CAS-1 in clinical and research settings.

Perseverative negative thinking predicts depression in people with acute coronary syndrome

ObjectiveDepression is common in people who have experienced recent Acute Coronary Syndrome (ACS), and predicts worse medical outcomes. Mechanisms underpinning the development of depression and its association with poor medical outcomes are unclear however. The aim of this study was to investigate the role of perseverative negative thinking (e.g. worry and rumination) in predicting depression in people with recent ACS. MethodsAdults attending specialist inpatient and outpatient cardiology services who had recently experienced ACS were invited to participate in this observational prospective cohort study. Questionnaire assessments were completed within 6months of index ACS (baseline), then 2months and 6months later. Results169 participants (131 male (78%), median age 68 (±16) years) completed baseline questionnaires, and 111 completed follow-ups. After controlling for the effects of key covariates, baseline rumination was a significant predictor of depression at 6months, accounting for 2% of the variance in depression. This association was partially mediated by poor problem-solving ability and lack of social support. Neither worry nor rumination at baseline were significant predictors of quality of life at 6months. ConclusionsRumination is a significant independent predictor of depression, and this association may be partially explained by deficits in problem-solving ability and reduced social support. Both rumination and problem solving may provide useful targets for the development of evidence-based interventions to reduce depression among people with coronary heart disease.

Emotion regulation therapy for cancer caregivers-an open trial of a mechanism-targeted approach to addressing caregiver distress.

Informal caregivers (ICs) are integral to care provided to patients facing life-threatening or incurable illnesses. This responsibility causes considerable burden, as approximately one half of ICs report clinically significant symptoms of depression and/or anxiety that persist when left untreated. Psychosocial interventions containing efficacious treatment principles (e.g., cognitive behavior therapy [CBT]) show disappointing results in reducing anxiety and depression in ICs. This may reflect failure of these interventions to specifically target crucial mechanisms underlying the central feature of distress caused by the patient's illness-notably, perseverative negative thinking (PNT). Emotion Regulation Therapy (ERT) is an efficacious CBT developed to explicitly target mechanisms underlying PNT and the emotional concomitants that arise in response to stressful situations. This open trial was conducted to evaluate the acceptability and initial efficacy of ERT adapted to the experience of cancer ICs (ERT-C). Thirty-one ICs provided informed consent and completed eight weekly individual sessions of ERT-C. Participants completed self-report measures of depression and anxiety symptoms, PNT, emotion regulation deficits, and caregiver burden before and after treatment. ERT-C was well tolerated as indicated by 22 treatment completers and feedback provided in exit interviews. ICs demonstrated reduced depression and anxiety symptoms, PNT, and emotion regulation deficits with moderate to large effect sizes (Hedge's g range: 0.36-0.92). Notably, caregiver burden was not reduced but ICs expressed more ability to confront caregiving-related challenges. Findings offer promising but preliminary support for ERT-C as a conceptual model and treatment modality for distressed cancer ICs.

Acute aerobic exercise hastens emotional recovery from a subsequent stressor.

Despite findings that regular exercise is broadly associated with emotional well-being, more basic research is needed to deepen our understanding of the exercise and emotion connection. This paper examines how acute aerobic exercise in particular influences subjective emotional recovery from a subsequent stressor. Potential mediators and moderators, including level of physical fitness, attentional control, and perseverative negative thinking were explored. All of the participants (n = 95) completed 3 laboratory visits, each including 1 of 3 activities (i.e., cycling, resting, stretching), tests of working memory and attentional control, and an experimental stressor. Self-reported rumination after the stressor and the experience of positive and negative emotions throughout the study were recorded. In this within-subjects paradigm, as expected, higher rumination in response to the stressor predicted more persistent negative emotion afterward; this effect was attenuated only by prior acute aerobic exercise, in this case, cycling, both 5 min and 15 min poststressor. This effect was unrelated to physical fitness or cognitive performance. Physical fitness level did predict greater attentional control and the capacity to update working memory. Acute aerobic exercise may facilitate subjective emotional recovery from a subsequent stressor and improve emotional flexibility. (PsycINFO Database Record

The association of perseverative negative thinking with depression, anxiety and emotional distress in people with long term conditions: A systematic review

ObjectiveDepression is common in people with long term conditions, and is associated with worse medical outcomes. Previous research shows perseverative negative thinking (e.g. worry, rumination) predicts subsequent depression and worse medical outcomes, suggesting interventions targeting perseverative negative thinking could improve depression and medical outcomes. Previous studies recruited healthy individuals, however. This review aimed to determine the temporal relationship and strength of prospective association of perseverative negative thinking with depression, anxiety and emotional distress in people with long term conditions. MethodFour electronic databases were searched for studies including standardised measures of perseverative negative thinking and depression, anxiety or emotional distress, and which presented prospective associations. Findings were narratively synthesized. ResultsThirty studies were identified in a range of long term conditions. Perseverative negative thinking and subsequent depression, anxiety or emotional distress were significantly correlated in the majority of studies (bivariate r=0.23 to r=0.73). 25 studies controlled for confounders, and in 15 perseverative negative thinking predicted subsequent depression, anxiety or emotional distress. Results varied according to condition and study quality. Six of 7 studies found bivariate associations between depression, anxiety or emotional distress and subsequent perseverative negative thinking, though 2 studies controlling for key covariates found no association. Few studies assessed the impact of perseverative negative thinking on medical outcomes. ConclusionStrongest evidence supported perseverative negative thinking predicting subsequent depression, anxiety and emotional distress in people with long term conditions. Further prospective research is warranted to clarify the association of perseverative negative thinking with subsequent poor medical outcomes.

The role of perseverative negative thinking in predicting depression in people with coronary heart disease: Preliminary findings of a prospective cohort study

The role of perseverative negative thinking in predicting depression in people with coronary heart disease: Preliminary findings of a prospective cohort study

Unraveling pathways to depression in fibromyalgia, the role of perseverative negative thinking and negative affect

IntroductionSeveral studies have demonstrated a strong link between fibromyalgia, negative affect (NA) and depression. However, it remains unclear why some fibromyalgia patients get depressed while others do not and, primarily, which mechanisms account for this difference. We hypothesize that, besides clinical features, the engagement in dysfunctional strategies like perseverative negative thinking (PNT) followed by an amplification of NA levels may increase the risk of fibromyalgia patients experiencing depressive symptoms.Objective/AimsTo explore the serial mediator effect of PNT and NA on the relationship between fibromyalgia symptoms and depressive symptoms.MethodsHundred and three women with fibromyalgia (mean age 47.32 ± 10.63) completed the Portuguese version of the Revised-Fibromyalgia Impact Questionnaire, Perseverative Thinking Questionnaire, Profile of Mood States and Beck Depression Inventory-II. The association between the variables was investigated via Pearson correlations and serial multiple mediation.ResultsThe estimated model was significant [F (3.86) = 57.318, P < .001] explaining 66.66% of depressive symptoms variance. The total effect of fibromyalgia symptoms on depressive symptoms was of .4998 (SE = 0.0795, P < 0.001; CI > 0.3417 and < 0.6578), with a significant direct effect of 0.1911 (SE = 0.0653; CI > 0.0614 and < 0.3209). The total indirect effects were of 0.3086 (SE = 0.0619; CI > 0.2033 < 0.4458). Three significant specific indirect effects were found.ConclusionThe effect of fibromyalgia symptoms on depressive symptoms is partially operated through cognitive interference/unproductiveness, which in turn influences NA levels. Such findings highlight the crucial role of these constructs in the relationship between fibromyalgia symptoms and depressive symptoms and the urge to address them when treating individuals reporting greater fibromyalgia symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Disordered eating behaviors, perfectionism and perseverative negative thinking–Study in a clinical sample

IntroductionIn a recent study developed with a community sample, we have found that although PNT mediated the relationship between perfectionist cognitions and bulimic behavior, the effect of perfectionism on other disordered eating dimensions, such as diet, was independent of the PNT levels (Monteiro et al., 2015).ObjectiveTo investigate if PNT mediates the relationship between perfectionism and disordered eating behaviors in a clinical sample.MethodsFifty-two patients with eating disorders/ED (mean age = 22.54 ± 7.637; mean BMI = 20.07 ± 4.192; 14.5% Anorexia Nervosa cases; 7.8% Bulimia Nervosa and 9.0% EDNOS) were assessed with the ED section of the Diagnostic Interview for Genetic Studies and fill in the Portuguese validated versions of Eating Attitudes Test/EAT-25 (to evaluate Bulimic behaviors/BB, Diet and Social pressure to eat), Multidimensional Perfectionism Scales (to evaluate perfectionism composite dimensions Evaluative Concerns/EC and Perfectionistic Strivings/PS) and Perseverative Thinking Questionnaire/PTQ-15 (to evaluate Repetitive Thought/RT, Cognitive interference and unproductiveness/CIU). Only variables significantly correlated with the outcomes (EAT-25_Total and its dimensions) were entered in the regression models. Mediation analyses using Preacher and Hayes bootstrapping methodology were performed.ResultsEC, PS, CIU and RT were significant predictors of EAT_Total. PA, CIU and PR were significant predictors of BB. EC and PS were significant predictors of Diet. CIU partially mediated the relationship between EC and EAT_Total (95% CI = 0.0025–0.3296) and between EC and BB (95% CI = 0.0037–0.1877).ConclusionAlso in a clinical sample, CII, the most pernicious dimension of PNT, mediates the relationship between perfectionism and disordered eating behavior, particularly bulimic behavior; diet is predicted by perfectionism independently of PNT.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Stress, Perseverative Negative Thinking, and Sleep in University Students

Introduction The perception of stress does not automatically lead to prolonged activation. The cognitive representations of stressors need to be prolonged in order to extend their physiological concomitants (Brosschot, Gerin, & Trayer, 2006). It is shown that elevated levels of repetitive negative thinking appear to be causally involved in the maintenance of emotional problems (Ehring & Watkins, 2008). Aims To analyze the associations between Perceived Stress (PS), Perseverative NegativeThinking (PNT) and Sleep difficulties. Methods 549 students from two Portuguese Universities filled in the Portuguese version of Perceived Stress Scale (Cohen et al., 1983; Amaral et al., 2014), PerseverativeThinking Questionnaire (Ehring et al., 2011; Chaves et al., 2013), and three questions were used to access sleep difficulties (initiating sleep, sleepmaintenance, and early morning awakening). Results In the present sample the prevalence on difficulty initiating sleep was 29,8%, of maintaining sleep was 27,9% and of early morning awakening was 30,9%. The strongest correlations were observed between PS and PNT (from r=.338 to r=.520; p Conclusions The PS was strongly associated with PNT and both of these variables were associated with sleep difficulties (particularly initiating and maintaining sleep).