Clara Krzikalla

Background: Previous research has reported associations between various forms of repetitive negative thinking (RNT; e.g., rumination, worry, and the content-independent process of RNT) and the onset and maintenance of psychological disorders. Additionally, reductions in RNT are linked to improved treatment outcomes, primarily based on findings from randomized controlled trials. This study examined RNT in the context of outpatient cognitive behavioral therapy (CBT) in routine clinical care. Methods: We investigated the predictive value of RNT in a sample of 506 patients from an outpatient clinic and postgraduate training center for CBT, all of whom received CBT for various mental health conditions. Of these, 256 (50.6%) presented with depressive disorder, and we repeated our analyses using only this subsample. We assessed content-independent RNT, brooding, and worrying at pre- and post-assessment. General psychopathology and depression were assessed at pre- and post-assessment as well as at 6- and 12-month follow-up. Results: There were significant reductions in general psychopathology and depression between pre-assessment and all subsequent assessments. All forms of RNT showed significant reductions from pre- to post-assessment. These reductions predicted general psychopathology and depression at post-assessment. At follow-up, findings were mixed, with only some forms of RNT being significantly associated with treatment outcome. Conclusions: Naturalistic CBT reduced general psychopathology and depression, as well as content-independent RNT, rumination, and worrying. Change in all forms of RNT predicted reductions in general psychopathology and depression at post-assessment. This study highlights the relevance of addressing different forms of RNT in therapeutic interventions.

Background: Pathological worry is associated with appraisals of worrying as uncontrollable. Worry postponement (WP) with a stimulus control rationale appears to be effective in non-clinical samples. However, preliminary research in participants with generalized anxiety disorder (GAD) does not support its efficacy in reducing negative metacognitions or worry. The aim of this study was to investigate the efficacy of WP with a metacognitive rationale. Method: Participants with GAD (n = 47) or hypochondriasis (HYP; n = 35) were randomly assigned to either an intervention group (IG) or waitlist (WL). The IG received a two-session long WP intervention aiming at mainly reducing negative metacognitions concerning uncontrollability of worrying. Participants were instructed to postpone their worry process to a predetermined later time during the six days between the two sessions. Participants completed questionnaires of negative metacognitions and worry at pre-assessment, post-assessment, and follow-up. Results: We observed a significant Time*Group interaction for negative metacognitions and worry. Post-hoc analyses on the total sample and separately for GAD and HYP revealed significantly lower worry scores in the treated GAD sample compared to the WL, representing the only significant effect. In the GAD group, pre-post-effect sizes were small for negative metacognitions and large for worry. Effects persisted to a four-week follow-up. Conclusion: WP with a metacognitive rationale seems to be effective in reducing worry in participants with GAD. The effectiveness for HYP seems limited, possibly due to the small sample size.

Objective: Numerous randomized controlled trials (RCTs) demonstrate the efficacy of cognitive behavioral therapy (CBT), metacognitive therapy (MCT), and methods to reduce intolerance of uncertainty (IU-CBT) in the treatment of generalized anxiety disorder (GAD). However, few studies have investigated these treatments under conditions of routine clinical care. The main objective of this study was to investigate the effectiveness of psychotherapy for GAD in an outpatient setting and to identify factors influencing treatment outcome. Methods: Fifty-nine GAD patients received naturalistic CBT (including MCT and IU-CBT) in an outpatient clinic and postgraduate training center for psychotherapy. Patients completed self-report questionnaires at the beginning and end of therapy regarding the main outcome worry as well as metacognitions, intolerance of uncertainty, depression, and general psychopathology. Results: Worry, negative metacognitions, intolerance of uncertainty, depression, and general psychopathology decreased significantly (p’s < .001) with large effect sizes for all symptoms (d = 0.83–1.49). A reliable change in the main outcome worry was observed in 80% of patients, and recovery occurred in 23%. Higher worry scores at posttreatment were predicted by higher pretreatment scores, female sex, and less change in negative metacognitive beliefs during treatment. Conclusions: Naturalistic CBT for GAD appears to be effective in routine clinical care for worry as well as depressive symptoms, with particular benefits associated with altering negative metacognitions. However, a recovery rate of only 23% is lower than the rates reported in RCTs. Treatment needs to be improved, especially for patients with more severe GAD and for women.

Although women predominantly report negative premenstrual changes, a substantial portion of women also reports positive changes. Little is known about factors related to report of positive and negative premenstrual changes. The aim of this experimental study at the Philipps-University of Marburg from January and February 2015 was to investigate the effect of manipulated information about premenstrual changes on the retrospective report of premenstrual changes. A total of 241 healthy women were randomly assigned either to an experimental group (EG) reading: (1) text focusing on negative and positive premenstrual changes (EG1 (+/−)); (2) text focusing on negative changes (EG2 (−)); or (3) control group (CG) text. At least one positive premenstrual change was reported by the majority of the participating women. The results of the MANOVA and discriminant analysis showed that, after having read the text, EG2 (−) reported more negative and fewer positive premenstrual changes in a retrospective screening compared to EG1 (+/−) and CG. No significant difference was observed between EG1 (+/−) and CG. The results show the negative influence of information focusing on negative premenstrual changes on the retrospective report of both negative and positive premenstrual changes.