Attentional bias is commonly associated with emotional disorders. However, potential transdiagnostic mediators of attentional bias, such as repetitive negative thinking (RNT) have been overlooked. The current study examined attentional biases associated with three forms of RNT and tested a proposed mediation model. Participants (N = 249) completed self-report measures, a repetitive thought induction, and an emotional face dot-probe measure of attentional bias. I hypothesized that RNT would be associated with attentional bias to angry, sad, and disgust faces, worry with angry faces, and rumination with sad faces after a negative thought induction. I also hypothesized that attentional bias scores would mediate the association between negative affect and RNT. Overall study hypotheses were not supported. Clinical worry was associated with slower reaction times to sad faces in the negative induction. RNT, worry, and rumination were not associated with attentional bias scores to emotional faces, and the mediation model was not supported.

LITERATURE REVIEW: A systematic review of the associations between effortful control, repetitive negative thinking and depression in adolescence. ABSTRACT: Background: Repetitive negative thinking (RNT) and the self-regulatory temperament, effortful control (EC), have been found to be important risk factors for the development of depressive symptoms. Furthermore, adolescence has been found to be a period of increased risk for developing depressive symptoms. The relationships between these risk pathways are not well understood during this period of development. Objective: This systematic review aimed to evaluate the literature exploring the relationships RNT and EC have in accounting for depressive symptoms in adolescents. In particular, whether RNT and EC are associated with depressive symptoms, and whether EC moderates the effects of RNT on depressive symptoms. Methods: Three databases and key journals were searched for studies measuring EC, RNT and depressive symptoms in 10-20 year olds. Study selection was undertaken by applying inclusion and exclusion criteria. The methodological quality of the included studies was assessed using a validated checklist. Inter-rater reliability was calculated for a random subsample of the search. Results: Thirteen studies were selected for inclusion. There was evidence indicating that RNT was correlated with depressive symptoms both concurrently and prospectively. The evidence for a relationship between lower EC and higher levels of depressive symptoms was mixed. High quality studies concluded that EC and depressive symptoms are associated concurrently, but not over time. There is evidence that lower EC predicts RNT over time, and even spanning over childhood. Some evidence was found for EC as a moderator between RNT and depressive symptoms and this was also found when the relationship was prospective. Conclusions: Whilst the reviewed literature had many strengths, there were large differences in how EC in particular, was measured. This resulted in a challenge synthesising the results and making clear conclusions. Future research would benefit from considering self-report and behavioural measures, and recognising the potential impact of stressful life events. EMPIRICAL PAPER: Investigating associations between repetitive negative thinking, stress, and effortful control, and the development and maintenance of depression in adolescence: A follow-up study. ABSTRACT: Background: Adolescence is a period of increased vulnerability for depressive symptoms (Twenge & Nolen-Hoeksema, 2002). Given the impact of emotional disorders on an individual, it is important to understand risk factors, and conversely, protective factors to inform effective interventions. Repetitive negative thinking (RNT) and the self-regulatory temperament, effortful control (EC), have been found to be important risk factors for the development of depressive symptoms and require further exploration in adolescence. Objective: This study investigated whether RNT predicted changes in later depressive symptoms, and if so, whether this change was moderated by EC. The study examined these associations during emotional reactivity to a stressor (exams), and emotional recovery following the stressor. Methods: Two samples with similar designs and measures were combined in this study. Two-hundred-and-fifty-five females completed Baseline questionnaires measuring life events, RNT, EC, and depressive symptoms. One-hundred-and-ninety-nine participants were followed up prior to their exams (Pre-exam), and 115 participants were followed up after their exams (Post-exam). Results: The study first examined emotional reactivity to stress, finding that contrary to the literature, RNT did not predict depressive symptoms in response to stress, when controlling for Baseline depressive symptoms. EC did not significantly interact with RNT in predicting depressive symptoms. However, RNT was associated with emotional recovery from stress: RNT predicted levels of depressive symptoms following exams, when controlling for Pre-exam depressive symptoms. Furthermore, EC moderated this relationship, however contrary to the literature and predictions, this was not in the expected direction, with high levels of EC associated with high levels of depressive symptoms. Conclusions: These findings suggest that despite the strengths of the study design, including a large sample at Baseline and follow up over a period of stress, hypothesized associations were not found during emotional reactivity to stress, but hypothesized associations were found during emotional recovery from stress. Recommendations are made for future studies, including recruiting sufficient number of males to the study.

Anxiety is prevalent among 13 % of young adult college students and is associated with emotional and behavioral consequences that adversely affect their mental and physical well-being. The major challenge for implementing evidence-based interventions is the lack of a multidimensional approach for evaluating anxiety in this population. The purpose of this dissertation was to develop an evidence-based theoretical framework for studying the phenomenon of anxiety in young adult college students. Three studies were conducted to achieve this purpose. First, the psychometric properties of the 21-item shortened version of the Depression Anxiety and Stress Scale (DASS-21) were evaluated in a sample of young adult college students. The results indicated that the DASS-21 is a valid and reliable instrument for distinguishing between depression and anxiety in this population. Second, the relative contributions of students’ demographics, life-satisfaction, and coping style to their anxiety levels were evaluated. Maladaptive coping style was identified as the main predictor of students’ anxiety. Particularly, coping strategies related to negative thoughts, such as self-blaming, and cognitive avoidance, such as denial, were significant predictors of anxiety. Other strategies that are related to behavioral coping such as venting and substance use were not significant predictors of anxiety. Thus, further investigation of the cognitive aspect of anxiety was necessary in the third study. In the third study, an integrated hypothetical model of the psychosocial, behavioral, and cognitive dimensions of anxiety was proposed and evaluated in this population. Using a web-based survey, 257 undergraduate students were assessed for anxiety, coping style, negative thinking, social support, life-satisfaction and demographics. Path analysis was used to examine the proposed model. Maladaptive coping and negative thinking were directly related to anxiety with negative thinking being the primary predictor of anxiety in this model. The findings from these studies suggest that the DASS-21 is a valid measure of anxiety and that interventions’ that address negative thinking and maladaptive coping should be considered in future research and practice with young adult college students.

Sleep problems are common among college students and are associated with numerous negative outcomes including anxiety, depression, executive dysfunction, and poor academic performance. When sleep is limited, individuals may suffer impaired cognitive capacities, such as reduced memory and difficulty focusing attention. Difficulty with these cognitive functions can result in difficulty disengaging from negative thoughts, thereby contributing to negative mood. Poor sleep contributes to negative mood states, but few studies have examined in what way poor sleep may exacerbate negative mood. The purpose of this study was to examine cognitive factors as explanatory variables between sleep and state affect. Participants were undergraduate students from a university in the Midwest. Participants (N = 150, completed baseline questionnaires and wore an actigraphy watch for one night. They returned to the lab the following day to complete additional self-report measures and a computerized cognitive control task. Participants were primarily female (66.67%, n = 100) and white (67.33%, n = 101). To test the hypothesis that the relationship between sleep and affect is explained by cognitive factors, a path analytic model was fit to the data. It was hypothesized that cognitive factors (i.e., Posner task performance, repetitive negative thinking, and self-report attention control) would explain the relationship between sleep (as measured by objective total sleep time and self-report sleepiness) and state affect. The hypothesized model yielded poor global and local fit to the data. While several direct effects emerged in the model, no indirect effects were statistically significant. The model was re-specified, adding paths where large magnitude correlational residual statistics coincided with statistically significant standardized residual statistics. The final model yielded good global and local fit to the data, with primary modifications being added covariances among control variables (e.g., GAD-7 and PHQ-8 scores) with cognitive factors. Overall, the results of this study indicate that the relationship between sleep and next-day affect is complex and cannot be simply explained by cognitive factors. However, the current study found several significant relationships among study variables, suggesting that sleep, cognitive functioning, and emotion are highly related constructs that warrant further study. Future research should examine alternative models incorporating these constructs to find a comprehensive model with utility that can explain the relationships among these constructs.

Objective: Recent research has supported the construction of a model of depression and anxiety in older adults ( > 60years), in which the decline in working memory with age is implicated in increasing propensity to engage in repetitive negative thinking, thereby predisposing older adults to anxiety and depression. The study detailed here intended to extend these research findings by exploring the efficacy and acceptability of a working memory intervention in older adults. Methods: The study employed a randomised multiple-baseline single case research design, in which six older adults participated in baseline assessment of mood, repetitive negative thinking and working memory. Participants then tracked their repetitive negative thinking daily throughout a baseline phase, the length of which was defined by the randomisation procedure. Following phase change, participants continued to rate their repetitive thinking daily, as well as engaging in a daily working memory training intervention. On completion of the intervention phase, outcome measures of mood, repetitive negative thinking and working memory were repeated. Full visual and statistical analysis of all data was undertaken to support exploration of the findings. Results: Results of the study indicated that that the working memory training program was unlikely to have elicited a significant impact upon participants’ working memory. However, two participants demonstrated reliable improvement in both repetitive thinking and mood. Analysis of relevant variables to predict the selective impact of the intervention was not fruitful, but may indicate that improvements in working memory underscore the improvements in thinking and mood, lending support to the proposed model. There appeared to be a small, non-significant decrease in daily repetitive negative thinking across five of the six participants. Conclusion: Further research is needed to identify factors that may predict response to working memory training within older adult populations. The research supports the on-going investigation of innovative working memory interventions within an older adult population, although results are not sufficiently robust to indicate wider adoption of these models within health services or as routine treatments for this population.

Depressive symptoms are common in patients with heart failure (HF) and adversely affect mortality, morbidity, and health-related quality of life. Cognitive therapy (CT) has been proposed as a non-pharmacological treatment for depressive symptoms in patients with HF. However, there is currently little evidence to support use of CT in patients with HF. The purpose of this dissertation was to develop and test a brief, nurse-delivered CT intervention for the treatment of depressive symptoms in patients with HF. Prior to testing the intervention, preliminary work was conducted resulting in four manuscripts: 1) a review of the evidence for CT in treating depressive symptoms in patients with cardiovascular conditions, 2) a description of living with depressive symptoms in patients with HF and strategies that could be used to manage these symptoms, 3) a review of measures of negative thinking and the identification of a measure of negative thinking that can be used in patients with HF, and 4) an evaluation of the psychometric properties of this measure. Based on information from these manuscripts, a randomized, controlled pilot study was conducted to test the effects of a brief CT intervention on outcomes of hospitalized patients with HF who report depressive symptoms. Forty-two hospitalized patients with HF with mild-moderate depressive symptoms were randomized to a brief CT intervention focused on reducing negative thoughts with thought-stopping and affirmations, or to usual care control. Both groups experienced improvements in depressive symptoms, health-related quality of life, and negative thinking at one week and three months. However, the intervention group experienced longer cardiac event-free survival and fewer cardiovascular hospitalizations and emergency department visits at three months when compared to the control group. This dissertation has fulfilled an important gap in the evidence base for depression treatment in patients with HF by demonstrating that a nurse-delivered, brief CT intervention may improve cardiac event-free survival in patients with HF. This brief CT intervention is replicable, practical, can be delivered by acute care nurses, and may improve clinical outcomes in patients with HF. Additional research is needed to determine the effects of the intervention on long-term outcomes in patients with HF.

Research suggests rumination and worry, which have typically been considered as strongly linked to depression and anxiety, respectively, may be better conceptualized through a transdiagnostic construct. According to Ehring and colleagues (2011), a construct broader than worry or rumination might be considered as Repetitive Negative Thinking. Ehring notes three key characteristics of repetitive negative thinking: the thinking is repetitive; it is at least partly intrusive; and it is difficult to disengage from. Two additional features include: individuals perceive it as unproductive and it captures mental capacity. This working definition of these five features formed the basis for the initial development and validation of the Perseverative Thinking Questionnaire (Ehring, Zetsche, Weidacker, Wahl, Schönfeld, & Anke, 2011) which is intended to be a content-independent measure of RNT. The Perseverative Thinking Questionnaire includes 15 total items with three items for each of the assumed characteristics of repetitive negative thinking (repetitive, intrusive, difficult to disengage from, unproductive, and capturing mental capacity). The PTQ is designed to assess for a common process found not only in individuals with prominent worry (as seen in GAD) or rumination (as seen in depression) but also in other diagnoses such as obsessive compulsive disorder and post-traumatic stress disorder. In its current state, the PTQ remains largely untested, leaving its utility in the changing field questionable. The current study intended to assess the psychometric quality of the PTQ to ensure its usefulness as a potential diagnostic tool and as a reflection of Ehring’s model of RNT. The current study administered the PTQ to a large and diverse group of college students located at a Midwestern university. Additional measures were administered to assess the psychometric properties of the measure. Construct and convergent reliability were demonstrated through comparison between the PTQ and the other measures. Unexpectedly, the PTQ and Cognitive Avoidance Questionnaire demonstrated a positive correlation, suggesting the measures are tapping into similar constructs. The factor structure of the PTQ was of particular interest in the current study. Further assessment of the factors reportedly contained in the PTQ was valuable, not just to assess the quality of the measure, but also because doing so would provide support for or undermine the proposed definition and key characteristics believed to underlie the construct of repetitive negative thinking. In this study, a two factor model was best supported for the current data, through Exploratory and Confirmatory Factor Analysis. This finding prompts further consideration and research for the construct of repetitive negative thinking.

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Les Pensées Répétitives Négatives (PRN) font référence à des pensées récurrentes, prolongées et relativement incontrôlables au sujet de nos expériences négatives passées, actuelles ou anticipées. Ce processus transdiagnostique serait impliqué dans de nombreux troubles psychologiques, dont les troubles de l’usage de l’alcool (TUA). Cette thèse s’inscrit dans une démarche processuelle afin d’étudier l’impact des PRN sur la consommation d’alcool chez des patients souffrant d’un TUA. La recension systématique des travaux concernant la relation entre PRN et consommation d’alcool a souligné des interrogations concernant l’influence du sexe et de la symptomatologie anxio-dépressive sur ce lien. Afin de répondre à ces questions laissées sans réponses par la littérature, nous avons menées une étude écologique en temps réel via l’utilisation d’une application électronique qui enregistraient les PRN, les émotions et la consommation d’alcool chez des patients souffrant d’un TUA, suivis en ambulatoire. Pour mener à bien cette étude, deux outils transdiagnostiques d’évaluation des PRN ont d’abord été validés. Le Perseverative Thinking Questionnaire a permis l’évaluation transdiagnostique des PRN-traits, soit la tendance habituelle à utiliser des PRN et le Momentary Ruminative Self-Focus Inventory, a permis d’examiner les PRN-états, soient le recours aux PRN au moment de la passation. Les résultats de la thèse démontrent que les PRN expliquent la consommation d’alcool. Ils sont discutés en lien avec la formulation métacognitive triphasique des problèmes d’alcool. L’intérêt de valider la prise en charge transdiagnostique des PRN dans le cadre des TUA est également développée. / Repetitive Negative Thinking (RNT) refers to a style of recurring, relatively uncontrollable and prolonged thoughts about one’s current, past or anticipated negative experiences. This transdiagnostic mental process is shared across a wide range of psychological disorders, including alcohol use disorders (AUD). The current thesis examined the link between RNT and alcohol use among patients suffering from an AUD in a processual perspective. The systematic review of the literature on the relationship between RNT and alcohol use highlighted some questions about the impact of sex and anxious or depressed symptoms. To address these unanswered questions, we conducted an ecological study in real time through the use of an electronical application assessing RNT, mood and alcohol consumption among AUD patients. To accomplish this aim, two transdiagnostic scales evaluating RNT were validated. The Perseverative Thinking Questionnaire assessed RNT-traits which is the habitual tendency to have RNT, and the Momentary Ruminative Self-Focus Inventory examined RNT-state which is the use of RNT at the time of the assessment. Results of this thesis demonstrated that the link between RNT and alcohol use was direct. They are discussed according to the triphasic metacognitive formulation of problem drinking. The interest of validating the Rumination-focused Cognitive and Behavioural Therapy for AUD patients is developed.Repetitive Negative Thinking (RNT) refers to a style of recurring, relatively uncontrollable and prolonged thoughts about one’s current, past or anticipated negative experiences. This transdiagnostic mental process is shared across a wide range of psychological disorders, including alcohol use disorders (AUD). The current thesis examined the link between RNT and alcohol use among patients suffering from an AUD in a processual perspective. The systematic review of the literature on the relationship between RNT and alcohol use highlighted some questions about the impact of sex and anxious or depressed symptoms. To address these unanswered questions, we conducted an ecological study in real time through the use of an electronical application assessing RNT, mood and alcohol consumption among AUD patients. To accomplish this aim, two transdiagnostic scales evaluating RNT were validated. The Perseverative Thinking Questionnaire assessed RNT-traits which is the habitual tendency to have RNT, and the Momentary Ruminative Self-Focus Inventory examined RNT-state which is the use of RNT at the time of the assessment. Results of this thesis demonstrated that the link between RNT and alcohol use was direct. They are discussed according to the triphasic metacognitive formulation of problem drinking. The interest of validating the Rumination-focused Cognitive and Behavioural Therapy for AUD patients is developed.