Repetitive negative thinking: transdiagnostic correlate and risk factor for mental disorders? A proof-of-concept study in German soldiers before and after deployment to Afghanistan.

BACKGROUND AND OBJECTIVES: Disorder-specific forms of Repetitive Negative Thinking (RNT) are associated with multiple diagnostic categories, indicating a transdiagnostic nature. Few studies examined content-independent RNT processes across groups of diagnosed mental disorders. Moreover, theory describes RNT processes as critically involved in the etiology of mental disorders, empirical evidence however is scarce. We first tested the transdiagnostic nature by examining levels of RNT across groups of internalizing and externalizing mental disorders compared to healthy individuals and explored RNT levels in a comorbid disorder-group. Second, we examined whether RNT predicts incident psychopathology. METHODS: In a sample of German soldiers (n = 425) scheduled for deployment in Afghanistan, we compared RNT levels between diagnosed groups with alcohol use disorders, anxiety disorders and healthy individuals cross-sectionally. Exploratory analyses were conducted comparing a comorbid disorder-group to healthy individuals and to both single-disorder-groups. Longitudinally, we examined the predictive value of pre-deployment RNT levels for incident psychopathology after deployment (n = 167). RNT was measured using the Perseverative Thinking Questionnaire (PTQ), DSM-IV diagnoses were assessed using the standardized Composite International Diagnostic Interview (CIDI). RESULTS: Cross-sectional comparisons revealed that soldiers with alcohol use disorders and anxiety disorders showed significantly higher degrees of RNT compared to healthy soldiers. RNT levels in those with comorbid disorders were significantly higher compared to healthy soldiers but also compared to both single-disorder-groups. Longitudinal analyses revealed that higher levels of RNT prior to deployment were associated with a higher risk to have any incidental mental disorder after deployment. This however is only attributable to individuals with a PTQ score above a cut-off of 15. CONCLUSIONS: Findings provide evidence for RNT as a transdiagnostic correlate and a vulnerability factor for the development of mental disorders.

The predictive role of hair cortisol concentrations for treatment outcome in PTSD inpatients.

Psychological treatments of posttraumatic stress disorder (PTSD) are associated with non-response rates of up to 50%. This fact highlights the need to identify characteristics of poorer treatment outcome. Among others, previous evidence focused on the role of dysfunctional cortisol secretion which has been related to the development, maintenance and treatment of PTSD. Particularly, promising evidence stems from research using hair cortisol analysis which allows for a reliable assessment of cortisol secretion over several months. Another variable that has been linked to both HCC and non-response to treatment is childhood maltreatment (CM). In order to examine the predictive value of pre-treatment hair cortisol concentrations (HCC), treatment-related changes in HCC as well as CM for changes in PTSD symptomatology, we set up a prospective study in which we followed 52 female PTSD patients over the course of a trauma-focused inpatient treatment. Specifically, 3-month integrated HCC were assessed at treatment entry, at discharge and on average five months later accompanied by assessments of PTSD, overall and depressive symptomatology. CM was measured at treatment entry. Self-report indices improved following inpatient treatment. No evidence for pre-treatment HCC to be associated with changes in PTSD symptoms was revealed. However, attenuated pre-treatment HCC predicted less improvement in overall symptomatology from treatment entry to discharge. This effect lost significance after adjusting for baseline dissociative symptoms. Neither changes in HCC nor CM were predictive of treatment response. Pre-treatment cross-sectional analyses revealed no association between HCC and CM. The current hair cortisol data provided little evidence for a predictive role of lower long-term integrated cortisol secretion for poorer inpatient treatment outcome. If corroborated by further research in larger PTSD samples with much more methodological rigor, these data might be a valuable basis for future tailored research projects.

Assessing psychological flexibility: what does it add above and beyond existing constructs?

The construct of psychological flexibility (PF) is a central concept in acceptance and commitment therapy. It is defined as the process of contacting the present moment fully as a conscious human being and persisting in or changing behavior in the service of chosen values. PF is hypothesized to be an important aspect of healthy psychological functioning. Despite its potential importance, the distinctness of PF from other constructs has not been adequately demonstrated, and psychometric evaluations of measures designed to assess it are limited. This study aimed at extending current knowledge about PF by examining the construct in 2 help-seeking samples, including panic disorder with agoraphobia (n = 368), clinically relevant social phobia (n = 209), and 2 nonclinical samples including students (n = 495) and individuals visiting an employment office (n = 95). Results across all samples indicate that PF, as measured by the Acceptance and Action Questionnaire (2nd version; AAQ-II), is a unitary construct with a 1 factor model. PF correlated with other variables largely consistent with predictions, differentiated patients from healthy controls, and showed preliminary indications of treatment sensitivity. Incremental validity was partially demonstrated, especially for indices of functioning. Surprisingly, PF also explained unique variance above more established measures for some indices of symptomatology. Results suggest that PF adds some incremental clinical validity, yet further and more stringent tests are required to fully elucidate its strengths and limitations.