Perseverative Thinking Research Articles

Co-rumination and intrapersonal cognitive processes predict distress: Longitudinal evidence from the COVID-19 pandemic.

Perseverative thinking and catastrophizing have well established associations with fear and distress. However, less is known about the impact of interpersonal dynamics, such as co-rumination, on these intrapersonal cognitive processes and subsequent stress. The present study addresses this knowledge gap. A sample of 433 adults from across the United States was recruited online and completed measures of co-rumination, perseverative thinking, catastrophizing, and demographic characteristics early in the COVID-19 pandemic, and the COVID Stress Scales (CSS) at six month follow up. Co-rumination, perseverative thinking, catastrophizing, and CSS scores were correlated in the expected direction. Regression analyses revealed all three independently predicted CSS worry about the dangerousness of COVID-19 subscale. Co-rumination was the strongest predictor of CSS worry about the socioeconomic impact and CSS compulsive checking scales. Perseverative thinking and catastrophizing predicted CSS traumatic stress symptoms subscale. Finally, perseverative thinking was the strongest predictor of CSS xenophobia subscale. Structural equation modelling indicated that co-rumination had a significant indirect effect on CSS scores through perseverative thinking and catastrophizing. Interpersonal dynamics, such as co-rumination, are relevant for understanding stress and are promising targets for intervention research to prevent or attenuate fears and distress, in addition to traditional intrapersonal cognitive processes such as perseverative thinking and catastrophizing.

The role of Anupreksha meditation in alleviating negative thinking among adults: a cross-sectional study

Background: Anupreksha-based meditations (AM) involve focusing on objects including images, colors, sounds, and the nature of the body and soul. Similar to Preksha meditation, which has shown positive effects on mental and physical well-being, AM is proposed to have potential benefits. However, the impact of AM on negative thinking, a key factor in various psycho-physiological ailments, has not been thoroughly examined. This study aimed to explore the effectiveness of AM in reducing negative thoughts and improving mental-health and well-being. It hypothesized that practicing AM can positively alter thought patterns and enhance overall well-being. Methods: A total of 462 English-speaking participants aged 19 to 60 years. Among them, 233 were regular AM practitioners with at least 12 months of experience, and 229 were non-meditators. Self-reported scales were used to measure perseverative thinking, mindfulness, self-compassion, and spiritual well-being. Results: Data were checked for normality and the Mann-Whitney U-test was performed. The AM group showed significant lower perseverative thinking scores (p<0.001) and higher mindfulness, self-compassion, and spiritual well-being scores (p<0.001). The scores of perseverative thinking negatively correlated with mindfulness (rho -0.53; p<0.001), self-compassion (rho -0.43; p<0.001), and spiritual well-being (rho -0.22; p<0.001) in meditators. Additionally, mindfulness positively correlated with self-compassion (rho 0.42; p<0.001) and spiritual well-being (rho 0.36; p<0.001). Conclusions: Shreds of evidence indicated that the practice of Anupreksha-based meditations alleviates negative thoughts by promoting mindfulness, self-compassion, and spiritual well-being. Therefore, the AM can be suggested to improve the positive state of mind and also can be practiced to mitigate psychological-related issues.

Effectiveness of an abbreviated version of the automated attention training technique (ATT) for stress reduction in a non-clinical sample—A randomized controlled trial

Stress is one of the leading risk factors for mental health problems. The attention training technique (ATT), developed in the context of metacognitive therapy, is a method for increasing flexible control of attention and might thus reduce the impact of stressful events on mental health. Developed as a 12-min exercise, ATT is primarily used in a clinical context. To ensure low-threshold implementation by the general population in everyday life, we developed an abbreviated 5-min version of the ATT. The present study examined the effectiveness of this abbreviated ATT in reducing stress in a three-armed randomized controlled trial by comparing the abbreviated version (ATTabbr; n = 74) with the long version (ATTlong; n = 67) and a waitlist control group (WCG; n = 77) in a non-clinical sample. The primary outcome was change on the Depression, Anxiety, and Stress Scale (DASS-21). In the intention-to-treat analysis of changes from baseline to follow-up, both the abbreviated ATT version and the long ATT version were superior to the WCG in the reduction of stress (d = 0.67 for the abbreviated version and d = 0.44 for the long version). From post to follow-up, reductions in stress were greater for the abbreviated version than the long version (d = 0.37). We also observed effects of both ATT versions on depression and anxiety but no effect on attention control, perseverative thinking, or quality of life. For the abbreviated version, we found preliminary evidence of a dose-response relationship. Participants with access to the abbreviated version conducted the training twice as often compared with those with access to the long version. These results suggest that the abbreviated version of the ATT is associated with greater adherence and possibly greater effects on stress than the long version. If these results are confirmed, the abbreviated version could be used to reduce stress and increase mental well-being in the general population.

Metacognitive strategies mediate the association between metacognitive beliefs and perceived quality of life.

Quality of life may be understood as a multidimensional evaluation of life circumstances in relation to values, expectations, and perceived well-being. Quality of life is thus dependent on the subjective perception of the current life situation, not only objective circumstances. According to metacognitive theory, metacognition guides the appraisal of inner experiences (i.e., thoughts and feelings) and influences how one relates to external stressors. Hence, dysfunctional metacognitive beliefs and the cognitive attentional syndrome (CAS), which includes perseverative thinking, threat monitoring and ineffective coping strategies, may negatively influence subjective quality of life. Therefore, we aimed to investigate if metacognitive beliefs and CAS strategies were associated with quality of life. A sample of 503 participants (77.1% women, mean age 41.0, SD = 11.5) completed the metacognitions questionnaire 30 (MCQ-30), the CAS-1 and the quality of life scale (QOLS). We used structural equation modelling (SEM) to estimate associations between the variables founded in metacognitive theory. The results of the SEM showed a significant direct relationship between metacognitive beliefs and quality of life. CAS strategies mediated the effect of metacognitive beliefs on quality of life. Higher level of metacognitive beliefs was associated with greater use of CAS strategies, which in turn was associated with lower quality of life. Further, more CAS strategies were associated with lower quality of life. The results support the generic metacognitive model and suggest that stronger endorsement of dysfunctional metacognitive beliefs and corresponding CAS strategies are associated with lower quality of life. This observation held even when controlling for relevant covariates and suggests that modifying metacognitive beliefs may impact on subjective quality of life.

‘Hidden’ anger as a risk factor for operational health: An exploratory approach among French military personnel

ABSTRACT Military personnel are repeatedly exposed to multiple stressors, and are sometimes characterized by high levels of anger. Evidence suggests that this anger can become dysfunctional, and impact the health status of populations chronically exposed to stress. In particular, rumination (understood as perseverative thoughts about a past event), provides a theoretical framework for investigating how anger may impact stress regulation abilities in military personnel declared fit for deployment. This exploratory study aimed therefore to examine the impact of the anger profile on psychological suffering in terms of burnout and post-traumatic stress disorder (PTSD), along with the reactivity of the autonomic nervous system, measured as cardiac variability. One hundred and seventeen French soldiers were tested before deployment to Operation BARKHANE. Anger rumination, burnout, and PTSD symptoms were assessed using questionnaires, and cardiac variability was measured as the questionnaires were completed. The results revealed two profiles related to anger trait and anger rumination. Burnout and PTSD scores were higher among military personnel with high levels of anger trait and rumination, and this group also had lower parasympathetic activity and flexibility after completing the questionnaires. These results suggest that there may be a link between an angry profile and psychological suffering, notably burnout and PTSD. Rumination could be involved in this link, as it is associated with poor adaptation to stress in a military context. Prospective researches including post-deployment will establish whether this ruminative response can account for the relationship between problematic anger, stress regulatory capacities and psychological health in military populations.

(039) Challenges in Transgender Care Through a Qualitative Lens: Provisional Results About Sexual Medicine Professionals´ Opinions

Abstract Introduction Transgender people’s health and healthcare have become one of the most important challenges in healthcare settings and policy making. The perspectives of transgender consumers are important to inform policymaking and the development of measures to diminish barriers to accessing and maintaining health care. However, the perspective of healthcare providers, namely clinicians, is less known and is important to take a comprehensive and collaborative stance to deliver the best healthcare. Objective To highlight the perspective of sexual medicine practitioners/sexologists involved in transgender healthcare on the challenges faced in providing transgender healthcare. Methods Following an initiative by the Portuguese Society for Clinical Sexology, we used a participatory research design involving experienced sexual medicine clinicians/sexologists and activists for transgender care to develop a study to collect sexologists' perceptions of the challenges they faced when providing health care to transgender people. After IRB approval, we used a cross-sectional qualitative design and disseminated an online survey among professional associations (e.g., the Portuguese Society of Andrology, Sexual Medicine and Reproduction). A total of 25 complete answers were collected from clinicians who act in transgender healthcare and whose professional background included: Clinical Psychology, Pediatric Psychiatry, Psychiatry, Endocrinology, Urology, Gynecology and Anesthesiology. Participants were, on average, 46 years old (SD = 12.38), had an average of 13 years (SD = 11.25) experience in Sexual Medicine/Clinical sexology and 11 years on average (SD = 10.38) of experience with transgender healthcare. Sociodemographic data was collected between January and June 2023, and four open questions were presented. The current study will report preliminary content analysis concerning the open question: “Which challenges have you encountered in your experience as a health professional acting clinically with transgender people?”. Results The preliminary content analysis revealed 6 main categories, each representing distinct and interrelated subcategories aggregating different codes. The main categories were: 1. Formal Institutional Challenges (e.g., lack of formal education concerning transgender care, lack of specific guidelines for primary care; long waiting lists); 2. Informal Institutional Challenges (e.g., lack of updated knowledge from other clinicians not directly involved in transgender care; non-responsiveness from colleagues, translating policies and international guidelines into practices); 3. Social Challenges (e.g., family stigma; social discrimination); 4. Patient’s Challenges (e.g., lack of compliance; hostility or negative expectations towards health professionals); 5. Personal limits (e.g., perseverative thinking about the timing and patients’ internalisation of information about surgery risks; feelings of strangeness towards non-binary bodies); 6. Clinical Challenges (e.g., presence of emotional disorders/psychopathology; establishing differential diagnosis). Conclusions The current preliminary and provisional results highlight that clinical sexologists involved in transgender healthcare face different challenges regarding their role. The interrelated themes and subthemes reveal that clinical sexologists acting in transgender care have a critical stance towards policy making, service management and the quality of professional education provided to clinicians. Stigmatisation by their colleagues towards transgender people is a focus of concern. Still, they also feel they experience patients’ hostility and clinical and ethical challenges when trying to provide the best standards of care with a lack of resources. Disclosure No.

Impact of Yoga on anxiety, stress and sleep quality among health care professionals during a public health crisis.

Health care professionals (HCPs) working on the frontlines of health care emergencies/pandemics often experience elevated anxiety, stress and reduced quality of sleep. Yoga is a mind-body practice that has been proven to effective in improving physical and mental health. To evaluate the effectiveness of integrated Yoga intervention on mental health measures and sleep quality among HCPs working during the COVID-19 pandemic. This quasi-experimental study was conducted on 110 HCPs, including Doctors and nursing staff, with an age range of 20 to 65 years who were recruited through a convenience sampling method and assigned to a Yoga group (n = 55) or a control group (n = 55). The Yoga group received a weekly one-hour Yoga session followed by a 30-minute self-practice three times a week at home for one month. The control group followed routine activity. Heart rate (HR), Blood Pressure, stress measures (Perceived Stress and visual analogue Scale for Stress), COVID-related anxiety, Sleep Quality, Quality of life and Preservative Thinking were assessed before and after the intervention. A significant decrease in stress measures, COVID-19-related anxiety and fear, and perseverative thinking was noticed in the Yoga group. Sleep quality and quality of life also improved significantly. The control group showed no significant change. At one month, the Yoga group showed significantly greater improvement in stress measures, COVID-19-related anxiety and fear, perseverative thinking, sleep quality and quality of life compared to the control group. Yoga practice during the public health crisis would help reduce anxiety and stress and improve sleep among HCPs. Further randomized controlled trials are warranted.

Daily worry, rumination, and sleep in late life

ObjectivePerseverative thinking (e.g., worry/rumination) is a common response to stress, and can be detrimental to well-being. Sleep may represent an important mechanism by which perseverative thinking is disrupted or amplified from day to day. This study examined the associations between older adults' everyday worry, rumination, and sleep. MethodsOlder adults (N = 270) aged 65–89 completed a baseline interview and morning and evening assessments each day for 5–6 days. Every morning, they indicated their worry toward the day and their sleep duration and disturbances the prior night. Every evening, they rated worry and rumination experienced that day. ResultsMultilevel models showed that perseverative thinking predicted worse sleep (i.e., fewer hours of sleep) at the between-person level (B = −0.29, p = .004) but better sleep (i.e., fewer sleep disturbances) at the within-person level (Bs < −0.18, ps < .003). At the within-person level, more hours of sleep (B = −0.06, p = .04) and fewer sleep disturbances (B = 0.10, p < .001) predicted less worry the next morning. Prior night's worry predicted greater next morning's worry, but this association was significant only when older adults reported fewer-than-usual hours of sleep (B = 0.24, p < .001), not when they reported more-than-usual hours of sleep (B = 0.04, p = .61). ConclusionFindings suggest that worry and rumination are intimately linked with sleep and highlight the protective role that better sleep may play in reducing older adults' everyday perseverative thinking.

What to think or how to think – is symptom reduction in posttraumatic symptomatology associated with change in posttraumatic cognitions or perseverative thinking? A latent change score model approach

Objective Patients with posttraumatic stress disorder (PTSD) report changes in what they think of the world and themselves, referred to as posttraumatic cognitions, and changes in how they think, reflected in increased perseverative thinking. We investigated whether pre–post therapy changes in the two aspects of thinking were associated with pre–post therapy changes in posttraumatic symptom severity. Method 219 d clinic patients with posttraumatic stress symptoms received trauma-focused psychotherapy with cognitive behavioral and metacognitive elements. The posttraumatic cognitions inventory (PTCI), the perseverative thinking questionnaire (PTQ), and the Davidson trauma scale (DTS) were applied at two occasions, pre- and post-therapy. Using latent change score models, we investigated whether change in PTCI and change in PTQ were associated with change in DTS and its subscales. We then compared the predictive value of PTQ and PTCI in joint models. Results When jointly modeled, change in overall DTS score was associated with change in both PTCI and PTQ. Concerning DTS subscales, reexperiencing and avoidance were significantly associated with change in PTCI, but not in PTQ. Conclusion Results indicate that both aspects of cognition may be valuable targets of psychotherapy. A focus on posttraumatic cognitions might be called for in patients with severe reexperiencing and avoidance.

'I felt like I'd lost control of everything': An exploration of metacognition and masculinity in men experiencing suicidality.

Seventy-five per cent of UK suicides are completed by men, and associated masculinity beliefs are well researched. The self-regulatory executive functioning (S-REF) model of distress is governed by metacognitive beliefs about mental processes, such as worry and rumination. Little is known about metacognition in male suicidality and how these processes interact with masculinity beliefs, suicidal ideation and behaviour. To identify which aspects of the S-REF model were present in a sample of men experiencing suicidality, and to consider how these processes interact with masculinity beliefs, suicidal ideation and behaviour. Fifteen men experiencing suicidal ideation or behaviour were recruited from a home-based treatment team. Semi-structured interviews and self-report measures were administered to identify metacognitive processes and masculinity beliefs. Interviews were analysed using the framework approach. The S-REF model was identified across three super-ordinate themes; 'the cognitive attentional syndrome (CAS) and maladaptive coping', 'metacognitive beliefs about worry, uncontrollability and danger' and 'consequences'. Thirteen sub-ordinate themes included processes such as 'worry' and 'rumination', metacognitive beliefs such as 'worrying helps me avoid problems' and 'worry is dangerous for me' and emotional consequences such as 'overwhelm', 'emasculation' and 'escape'. Perseverative thinking and erroneous metacognitive beliefs were associated with reduced functioning, which was incompatible with masculinity beliefs about leadership and strength, and suicide was considered as re-establishing control. Further research into metacognitive processes in male suicidality would enhance theoretical understanding.

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.

Experience sampling methodology study of anxiety and depression in adolescents with epilepsy: The role of metacognitive beliefs and perseverative thinking

Emotional distress is common in young people with epilepsy (YPwE). According to the Self-Regulatory Executive Function (S-REF) model, maladaptive metacognitive beliefs and perseverative thinking are fundamental in the development and maintenance of emotional distress. As emotional distress and perseverative thinking can highly fluctuate over short intervals in YPwE, it is important to account for this variability when testing the utility of psychological models. Experience sampling methodology (ESM) was therefore used to explore the momentary relationship between metacognitive beliefs, perseverative thinking, and emotional distress in YPwE. Eighteen participants diagnosed with epilepsy (aged 12–17 years) completed the 10-day ESM period. Participants were prompted to complete the ESM assessment five times daily. The ESM assessment assessed participant’s momentary levels of metacognitive beliefs, perseverative thinking (i.e., worry and rumination), and emotional distress (i.e., anxiety and depression). A series of multilevel regression analyses indicated that metacognitive beliefs were significantly positively associated with worry, rumination, anxiety and depression. After controlling for worry and rumination, respectively, metacognitive beliefs did not account for additional variance in anxiety or depression. Findings provide preliminary support for the utility of the S-REF model for emotional distress in YPwE. Metacognitive therapy, which is underpinned by the S-REF model, may be an appropriate intervention for emotional distress in YPwE. Future studies should assess the mediational relationship between metacognitive beliefs, perseverative thinking, and emotional distress using time-lagged models.

DAILY WORRY, RUMINATION, AND SLEEP IN LATE LIFE

Abstract Perseverative thinking, including worry and rumination, is a common response induced by stress, and can be detrimental to well-being and health especially for older adults. Sleep may represent an important mechanism by which preservative thoughts affect health. Yet, limited research has investigated links between worry and rumination and their implications for sleep in late life. This study examines the associations between older adults’ everyday worry, rumination, and sleep. We leveraged the daily diary data over 5 to 6 days from the Daily Experiences and Well-being Study (N = 271, Mage = 73.62). Every evening, older adults reported worry and rumination they experienced that day. Every morning, they indicated how worried they were about something that might happen that day, and sleep the prior night (e.g., duration, quality, disturbances). Multilevel models showed that greater evening rumination was associated with fewer sleep disturbances. More hours of sleep, higher sleep quality, and fewer sleep disturbances were associated with less worry the next morning. Greater evening worry and rumination were both associated with greater next morning’s worry, but more hours of sleep buffered the lingering of worry over the night. These results suggest that worry and rumination may tend to persist in older adults’ daily life, and highlight the protective role that better sleep may play in reducing older adults’ everyday perseverative thinking.

The relationship between perseverative thinking, proactive control, and inhibition in psychological distress: a study in a women’s cohort

Cognitive control is a core feature of several mental disorders. A recent account poses that health problems may derive from proactive forms of cognitive control that maintain stress representation over time. The working hypothesis of the present study is that psychological distress is caused by the tendency to select a particular maladaptive self-regulation strategy over time, namely perseverative thinking, rather than by transient stimulus–response patterns. To test this hypothesis, we asked 84 women to carry out a battery of standardized questionnaires regarding their tendency to undertake perseverative thinking and their level of psychological distress, followed by cognitive tasks measuring the tendency to use proactive versus reactive control modality and disinhibition. Through a series of mediation analyses, we demonstrate that the tendency to use proactive control correlates with psychological distress and that this relation is mediated by perseverative thinking. Moreover, we show that the relation between low inhibitory control and psychological stress is more strongly mediated by perseverative thinking than impulsiveness, a classical construct that focuses on more transient reactions to stimuli. The present results underline the importance of considering psychological distress as the consequence of a maladaptive way of applying control over time, rather than the result of a general deficit in cognitive control abilities.

Feasibility and Efficacy of Addiction-Focused Eye Movement Desensitization Reprocessing in Adults with Substance Use Disorder

ABSTRACT Purpose Addiction-focused eye movement desensitization reprocessing (AF-EMDR) is a viable add-on therapy to treat memories that drive addiction cravings. However, little research has explored AF-EMDR and its effects in people with substance abuse disorder (SUD). The purposes of this study were to determine the feasibility of conducting AF-EMDR and to test the preliminary efficacy of AF-EMDR on overall cravings experienced by persons with SUD, craving, perseverations associated with addiction, and irrational cognitions related to addiction. Methods This pilot study used a two-arm randomized controlled trial (RCT) design with an experimental group (AF-EMDR + cognitive behavioral therapy [CBT]) and a control group (CBT Only). Thirty participants were recruited from a residential program or a partial hospitalization program in a recovery center in Florida, from October 2021 through January 2022 and randomly assigned to the experimental group (n = 15) or the control group (n = 15). Results All participants adhered to the four-session 60-min AF-EMDR intervention and post-intervention data collection; 98.33% completed all four sessions. Results indicated significant reductions in cravings, perseverative thoughts about substance of choice, and irrational cognitions among participants in both the experimental (AF-EMDR + CBT) and control (CBT Only) groups during the intervention; however, there was no significant difference between groups. Conclusions The results showed positive trends in decreasing craving. However, more clinical trials with a larger sample are necessary to assess the efficacy and sustainability of such effects in persons with SUD.

Ruminative response scale for eating disorders: bifactor model and measurement invariance in a Portuguese community sample

ABSTRACT The Ruminative Response Scale for Eating Disorders (RRS-ED) measures ruminative thought content specifically related to eating disordered themes, assessing two domains of rumination, brooding and reflection. This study aims to examine the factor structure of the RRS-ED in a Portuguese community sample, using correlated two-factor models, unifactorial and bifactor models and test for invariance across sex. A sample of 535 adults (179 male; 356 female) filled out the RRS-ED. A subsample (n=347) answered additional measures of repetitive negative thinking and eating psychopathology. The bifactor model of the RRS-ED provided the best fit, demonstrating a reliable general rumination factor. Also, the bifactor model of the RRS-ED was invariant across sex. RRS-ED showed moderate to strong correlations with negative perseverative thinking and eating psychopathology. Both domain-specific factors of RRS-ED were associated with higher levels of eating psychopathology. Findings indicate that RRS-ED is a reliable and valid measure to assess the ruminative response from the general population in Portugal, showing initial evidence that supports the use of a total score of RRS-ED as an overall measure of rumination, while specific factor scores should be reported with caution. Future studies are needed to replicate the findings and further corroborate the unidimensionality of the RRS-ED.

Behavioral and neurocognitive factors distinguishing post-traumatic stress comorbidity in substance use disorders

Significant trauma histories and post-traumatic stress disorder (PTSD) are common in persons with substance use disorders (SUD) and often associate with increased SUD severity and poorer response to SUD treatment. As such, this sub-population has been associated with unique risk factors and treatment needs. Understanding the distinct etiological profile of persons with co-occurring SUD and PTSD is therefore crucial for advancing our knowledge of underlying mechanisms and the development of precision treatments. To this end, we employed supervised machine learning algorithms to interrogate the responses of 160 participants with SUD on the multidimensional NIDA Phenotyping Assessment Battery. Significant PTSD symptomatology was correctly predicted in 75% of participants (sensitivity: 80%; specificity: 72.22%) using a classification-based model based on anxiety and depressive symptoms, perseverative thinking styles, and interoceptive awareness. A regression-based machine learning model also utilized similar predictors, but failed to accurately predict severity of PTSD symptoms. These data indicate that even in a population already characterized by elevated negative affect (individuals with SUD), especially severe negative affect was predictive of PTSD symptomatology. In a follow-up analysis of a subset of 102 participants who also completed neurocognitive tasks, comorbidity status was correctly predicted in 86.67% of participants (sensitivity: 91.67%; specificity: 66.67%) based on depressive symptoms and fear-related attentional bias. However, a regression-based analysis did not identify fear-related attentional bias as a splitting factor, but instead split and categorized the sample based on indices of aggression, metacognition, distress tolerance, and interoceptive awareness. These data indicate that within a population of individuals with SUD, aberrations in tolerating and regulating aversive internal experiences may also characterize those with significant trauma histories, akin to findings in persons with anxiety without SUD. The results also highlight the need for further research on PTSD-SUD comorbidity that includes additional comparison groups (i.e., persons with only PTSD), captures additional comorbid diagnoses that may influence the PTSD-SUD relationship, examines additional types of SUDs (e.g., alcohol use disorder), and differentiates between subtypes of PTSD.

Preliminary evidence of psychological improvements and increased maternal-fetal attachment associated with a mindfulness sleep programme: secondary analysis of uncontrolled data in 11 pregnant women with insomnia disorder.

Treating insomnia during pregnancy improves sleep and depressed mood. However, given well-established links between poor sleep and a broad spectrum of adverse maternal outcomes, the benefits of insomnia care may reach beyond sleep and depression. The present study evaluated the preliminary efficacy of 'Perinatal Understanding of Mindful Awareness for Sleep' (PUMAS)-a mindfulness sleep programme tailored to pregnancy that combines behavioural sleep strategies and meditation-for enhancing everyday mindfulness and maternal-fetal attachment, as well as for alleviating anxiety, repetitive thinking, and sleep-related daytime impairment. We conducted a secondary analysis of a single-arm proof-of-concept trial of 11 pregnant women with fifth edition of the Diagnostic and Statistical Manual of Mental Disorders diagnosed insomnia disorder who completed PUMAS (six sessions), which was delivered in an individual format via telemedicine video. Pre- and post-treatment outcomes included the Cognitive and Affective Mindfulness Scale-Revised (CAMS-R), Maternal-Fetal Attachment Scale (MFAS), Generalised Anxiety Disorder seven-item survey (GAD-7), Perseverative Thinking Questionnaire (PTQ), Daytime Insomnia Symptoms Response Scale (DISRS), and the Patient-Reported Outcomes Measurement Information System Sleep-Related Impairment Scale (PROMIS-SRI). Symptom changes were evaluated with paired-samples t tests. Results showed PUMAS patients reported large increases in CAMS-R (Cohen's dz = 1.81) and medium-large increases in MFAS scores (Cohen's dz = 0.73). Moreover, PUMAS patients reported large reductions in scores on the GAD-7 (Cohen's dz = 1.09), PTQ (Cohen's dz = 1.26), DISRS (Cohen's dz = 1.38), and PROMIS-SRI (Cohen's dz = 1.53). Preliminary evidence suggests that a mindfulness-based perinatal sleep programme may benefit several domains of maternal wellbeing beyond sleep and depression. PUMAS substantially enhanced patient ratings of everyday mindfulness and maternal-fetal attachment, while reporting alleviations in anxiety, perseverative thinking, insomnia-focused rumination, and sleep-related daytime impairment.

0325 Reducing nocturnal cognitive arousal and rumination mediate treatment effects of digital cognitive behavioral therapy for insomnia

Abstract Introduction High cognitive arousal—i.e., heightened cognitive activity often in the form of perseverative thinking—is a central feature insomnia. Emerging evidence from randomized controlled trials (RCTs) support alleviating cognitive arousal as a mechanism by which cognitive behavioral therapy for insomnia (CBTI) reduces symptoms of insomnia and depression. However, few RCTs have published CBTI data on cognitive arousal outcomes. The present study tested whether CBTI alleviates cognitive arousal symptoms, and whether reducing cognitive arousal symptoms mediate CBTI effects on insomnia and depression. Methods 434 patients with clinical insomnia symptoms (Insomnia Severity Index [ISI] ≥ 15) were randomized to digital CBTI or digital sleep education control. Study outcomes included insomnia (ISI), depression (quick inventory of depressive symptomatology self-report 16-item survey, QIDS-SR16), and two indices of cognitive arousal (pre-sleep arousal scale’s cognitive factor [PSASC] and daytime insomnia symptoms response scale [DISRS]). Treatment effects and mediation analyses were conducted using multivariate linear regression. Results While controlling for baseline symptoms, CBTI patients, relative to controls, reported lower levels of insomnia (b=-2.45, p&amp;lt;.001), depression (b=-1.13, p&amp;lt;.001), nocturnal cognitive arousal (b=-2.37, p&amp;lt;.001) and insomnia-focused rumination (b=-3.43, p&amp;lt;.001) after treatment. Posthoc independent samples t-tests showed that CBTI produced small-medium effects on nocturnal cognitive arousal (Cohen’s d=.40) and insomnia-focused rumination (Cohen’s d=.31). Mediation analyses showed that reducing nocturnal cognitive arousal (PSASCT2-T1) mediated 29.0% of CBTI effects on insomnia (αβ=-.709, 95%CI=-1.09, -0.38), and 35.1% of CBTI effects on depression (αβ=-.397, 95%CI=-0.65, -0.19). Mediation analyses showed that reducing insomnia-focused rumination (DISRST2-T1) mediated 10.6% of CBTI on insomnia (αβ=-.261, 95%CI=-0.50, -0.08), but did not mediate antidepressant effects (αβ=-.300, 95%CI=-1.46, 0.72). Conclusion Digital CBTI effectively alleviated nocturnal cognitive arousal and insomnia-focused rumination. Moreover, alleviating nocturnal cognitive arousal was a mechanism by which CBTI reduced symptoms of insomnia and depression. By comparison, reducing insomnia-focused rumination mediated a small proportion of CBTI effects on insomnia and was uninvolved in depression effects. Although reducing cognitive arousal facilitated insomnia and depression outcomes, CBTI is likely limited by its modest effects on cognitive arousal symptoms. Improving insomnia therapy benefits for cognitive arousal may enhance patient outcomes. Support (if any) This RCT (NCT03322774) was supported by NIMH R01-MH122636.

Dysfunction of default mode network characterizes generalized anxiety disorder relative to social anxiety disorder and post-traumatic stress disorder

BackgroundThe perseverative cognition of generalized anxiety disorder (GAD) is distinctive compared to other anxiety disorders. However, the disease-specific and shared neuropathophysiological mechanisms of GAD remain unclear. MethodsWe recruited medication-free patients of GAD (N = 33), social anxiety disorder (SAD; N = 36), post-traumatic stress disorder (PTSD; N = 59), and healthy controls (HC; N = 50). All subjects underwent clinical assessments and resting-state functional magnetic resonance imaging. We compared both the amplitude low-frequency fluctuation (ALFF) and seed-based functional connectivity across the whole brain, using the significantly different regions from the ALFF analyses as seed regions, followed by post-hoc tests. ResultsWe found that ALFF of the left angular gyrus (AG), left inferior parietal lobule (IPL), left precentral gyrus, left middle temporal gyrus, and left cerebellum were higher in GAD compared with SAD, PTSD and HC. This trend was further corroborated by the higher functional connectivity between left AG and bilateral IPL, left inferior temporal gyrus, and left medial prefrontal cortex (mPFC) in GAD. In addition, GAD and SAD both showed abnormally higher left AG-right insula connectivity. Significant correlations were found between anxiety symptom severity and the left AG regional activity and left AG-left mPFC connectivity. LimitationsWe did not compare the differences in neuroimaging between GAD and other anxiety disorders, such as panic disorder. ConclusionsThe default mode network dysfunction may underlie the distinctive perseverative thoughts of GAD relative to other anxiety disorders, and left AG-right insula connectivity may reflect somatic anxiety of anxiety disorder spectrum.