Michelle L. Moulds

Distinct modes of ruminative self-focus: Impact of abstract versus concrete rumination on problem solving in depression.

One account for the negative effects of rumination on social problem solving (SPS) is the symptom-focus hypothesis, which proposes that focus on symptoms amplifies the vicious cycle between depressed mood and negative cognition. The authors tested a contrasting account, the reduced concreteness hypothesis, which postulates that the abstract thinking typical of rumination impairs SPS. In 40 depressed patients and 40 never-depressed controls, SPS was assessed before and after versions of symptom-focused rumination known to differentially induce abstract versus concrete self-focus (E. Watkins & J. D. Teasdale, 2001). As predicted by reduced concreteness theory, relative to abstract self-focus, concrete self-focus improved SPS in depressed patients, suggesting that the particular mode of symptom-focus, rather than symptom-focus per se, determines the effects of rumination on problem solving.

Acute Stress Disorder Scale: a self-report measure of acute stress disorder.

The Acute Stress Disorder Scale (ASDS) is a self-report inventory that (a) indexes acute stress disorder (ASD) and (b) predicts posttraumatic stress disorder (PTSD). The ASDS is a 19-item inventory that is based on Diagnostic and Statistical Manual of Mental Disorders (4th ed.; DSM-IV, American Psychiatric Association, 1994) criteria. The ASDS possessed good sensitivity (95%) and specificity (83%) for identifying ASD against the ASD Interview on 99 civilian trauma survivors. Test-retest reliability of the ASDS scores between 2 and 7 days was strong (r = .94). The ASDS predicted 91% of bushfire survivors who developed PTSD and 93% of those who did not; one third of those identified by the ASDS as being at risk did not develop PTSD, however. The ASDS shows promise as a screening instrument to identify acutely traumatized individuals who warrant more thorough assessment for risk of PTSD.

Imaginal exposure alone and imaginal exposure with cognitive restructuring in treatment of posttraumatic stress disorder.

This study investigated the extent to which providing cognitive restructuring (CR) with prolonged imaginal exposure (IE) would lead to greater symptom reduction than providing IE alone for participants with posttraumatic stress disorder (PTSD). Fifty-eight civilian survivors of trauma with PTSD were randomly allocated to IE/CR, IE, or supportive counseling (SC). Treatment involved 8 individual weekly sessions with considerable homework. Independent assessments were conducted pretreatment, posttreatment, and at 6-month follow-up. IE/CR and IE resulted in reduced PTSD and depression compared with SC at posttreatment and follow-up. Further, IE/CR participants had greater reductions in PTSD and maladaptive cognitive styles than IE participants at follow-up. These findings suggest that providing CR in combination with IE may enhance treatment gains.

Processing Mode Causally Influences Emotional Reactivity : Distinct Effects of Abstract Versus Concrete Construal on Emotional Response

Three studies are reported showing that emotional responses to stress can be modified by systematic prior practice in adopting particular processing modes. Participants were induced to think about positive and negative scenarios in a mode either characteristic of or inconsistent with the abstract-evaluative mind-set observed in depressive rumination, via explicit instructions (Experiments 1 and 2) and via implicit induction of interpretative biases (Experiment 3), before being exposed to a failure experience. In all three studies, participants trained into the mode antithetical to depressive rumination demonstrated less emotional reactivity following failure than participants trained into the mode consistent with depressive rumination. These findings provide evidence consistent with the hypothesis that processing mode modifies emotional reactivity and support the processing-mode theory of rumination.

The Additive Benefit of Hypnosis and Cognitive-Behavioral Therapy in Treating Acute Stress Disorder.

This research represents the first controlled treatment study of hypnosis and cognitive- behavioral therapy (CBT) of acute stress disorder (ASD). Civilian trauma survivors (N=87) who met criteria for ASD were randomly allocated to 6 sessions of CBT, CBT combined with hypnosis (CBT-hypnosis), or supportive counseling (SC). CBT comprised exposure, cognitive restructuring, and anxiety management. CBT-hypnosis comprised the CBT components with each imaginal exposure preceded by a hypnotic induction and suggestions to engage fully in the exposure. In terms of treatment completers (n=69), fewer participants in the CBT and CBT-hypnosis groups met criteria for posttraumatic stress disorder at posttreatment and 6-month follow-up than those in the SC group. CBT-hypnosis resulted in greater reduction in reexperiencing symptoms at posttreatment than CBT. These findings suggest that hypnosis may have use in facilitating the treatment effects of CBT for posttraumatic stress.

Cognitive behaviour therapy of acute stress disorder: a four-year follow-up

The aim of this study was to index the long-term benefits of early provision of cognitive behavior therapy to trauma survivors with acute stress disorder. Civilian trauma survivors (n = 80) with acute stress disorder were randomly allocated to either cognitive behavior therapy (CBT) or supportive counseling (SC) - 69 completed treatment, and 41 were assessed four years post-treatment for post-traumatic stress disorder (PTSD) with the Clinician Administered PTSD Scale. Two CBT patients (8%) and four SC patients (25%) met PTSD criteria at four-year follow-up. Patients who received CBT reported less intense PTSD symptoms, and particularly less frequent and less avoidance symptoms, than patients who received SC. These findings suggest that early provision of CBT in the initial month after trauma has long-term benefits for people who are at risk of developing PTSD.

Are worry, rumination, and post-event processing one and the same? Development of the repetitive thinking questionnaire

Accumulating evidence suggests that repetitive negative thinking (RNT) is a transdiagnostic phenomenon. However, various forms of RNT such as worry, rumination, and post-event processing have been assessed using separate measures and have almost exclusively been examined within the anxiety, depression, and social phobia literatures, respectively. A single transdiagnostic measure of RNT would facilitate the identification of transdiagnostic maintaining factors of RNT, and would be more efficient than administering separate measures for each disorder. Items from three existing measures of RNT were modified to remove diagnosis-specific content and administered to a sample of undergraduate students (N=284). Exploratory factor analysis yielded two factors labeled Repetitive Negative Thinking and Absence of Repetitive Thinking (ART). The RNT scale demonstrated high internal reliability and was associated with anxiety, depression, anger, shame, and general distress. Moreover, the RNT scale was associated with constructs that are theoretically related to engagement in RNT, including positive and negative metacognitions, cognitive avoidance, thought suppression, and thought control strategies. The ART scale had little predictive utility. Theoretical and clinical implications are discussed.

A Randomized Controlled Trial of Exposure Therapy and Cognitive Restructuring for Posttraumatic Stress Disorder

Previous studies have reported that adding cognitive restructuring (CR) to exposure therapy does not enhance treatment gains in posttraumatic stress disorder (PTSD). This study investigated the extent to which CR would augment treatment response when provided with exposure therapy. The authors randomly allocated 118 civilian trauma survivors with PTSD to receive 8 individually administered sessions of either (a) imaginal exposure (IE), (b) in vivo exposure (IVE), (c) IE combined with IVE (IE/IVE), or (d) IE/IVE combined with CR (IE/IVE/CR). There were fewer patients with PTSD in the IE/IVE/CR (31%) condition than the IE (75%), IVE (69%), and IE/IVE (63%) conditions at a 6-month follow-up assessment. The IE/IVE/CR condition resulted in larger effect sizes than each of the other conditions in terms of PTSD and depressive symptoms. These findings suggest that optimal treatment outcome may be achieved by combining CR with exposure therapy in treating PTSD patients.

Prospective and positive mental imagery deficits in dysphoria.

We know less about positive mental imagery than we do about negative mental imagery in depression. This study examined the relationship between depressed mood and the subjective experience of emotion in imagined events; specifically, prospective imagery, and imagery in response to emotionally ambiguous stimuli. One hundred and twenty-six undergraduates completed measures of depression, imagery vividness for future events, and a homograph interpretation task in which they generated images and subsequently rated image pleasantness and vividness. As predicted, compared to low dysphoria, high dysphoria was associated with poorer ability to vividly imagine positive (but not negative) future events. These findings were augmented by the observation that high dysphorics provided lower pleasantness ratings of images generated in response to homographs they interpreted as positive. We suggest that an imbalance in the inability to vividly imagine positive but not negative future events may curtail the ability of high dysphorics to be optimistic. High dysphoric individuals are further disadvantaged: even when they interpret ambiguity positively, the resulting images they generate are associated with less positive affect. Therapeutic strategies that address both such positive-specific imagery biases hold promise for depression treatment innovation.

Impact of rumination versus distraction on anxiety and maladaptive self-beliefs in socially anxious individuals.

A large body of experimental evidence has demonstrated the adverse effects of rumination on depressive mood and cognitions. In contrast, while prominent models of social phobia (Clark & Wells, 1995; Rapee & Heimberg, 1997) have proposed rumination as a key maintaining factor, the effects of rumination in social anxiety have not been extensively explored. In a sample of (N = 93) undergraduates, this study investigated the impact of rumination versus distraction following a social-evaluative task on anxiety and another key component of social phobia: maladaptive self-beliefs. Relative to distraction, rumination maintained anxiety in both high and low socially anxious individuals, and maintained unconditional beliefs in high socially anxious individuals. The results support models of social phobia and also suggest important theoretical extensions. Implications for the treatment of social anxiety are discussed.