Repetitive negative thinking predicts depression and anxiety symptom improvement during brief cognitive behavioral therapy

Behav Res Ther. 2015 May:68:54-63. doi: 10.1016/j.brat.2015.03.006. Epub 2015 Mar 14.


Repetitive negative thinking (RNT) is a common symptom across depression and anxiety disorders and preliminary evidence suggests that decreases in rumination and worry are related to improvement in depression and anxiety symptoms. However, despite its prevalence, relatively little is known about transdiagnostic RNT and its temporal associations with symptom improvement during treatment. The current study was designed to examine the influence of RNT on subsequent depression and anxiety symptoms during treatment. Participants (n = 131; 52% female; 93% White; M = 34.76 years) were patients presenting for treatment in a brief, cognitive behavior therapy based, partial hospitalization program. Participants completed multiple assessments of depression (Center for the Epidemiological Studies of Depression-10 scale), anxiety (the 7-item Generalized Anxiety Disorder Scale), and repetitive negative thinking (Perseverative Thinking Questionnaire) over the course of treatment. Results indicated statistically significant between and within person effects of RNT on depression and anxiety, even after controlling for the effect of time, previous symptom levels, referral source, and treatment length. RNT explained 22% of the unexplained variability in depression scores and 15% of the unexplained variability in anxiety scores beyond that explained by the control variables. RNT may be an important transdiagnostic treatment target for anxiety and depression.

Keywords: Anxiety; Depression; Repetitive negative thinking; Treatment outcome.

MeSH terms

  • Adult
  • Anxiety / psychology*
  • Anxiety / therapy
  • Anxiety Disorders / therapy
  • Cognitive Behavioral Therapy
  • Depression / psychology*
  • Depression / therapy
  • Depressive Disorder / psychology
  • Female
  • Forecasting
  • Humans
  • Male
  • Middle Aged
  • Negativism*
  • Psychiatric Status Rating Scales
  • Surveys and Questionnaires
  • Thinking
  • Treatment Outcome