The Future-oriented Repetitive Thought (FoRT) scale: Validation in Chinese samples and application in the schizophrenia spectrum.

BACKGROUND: Repetitive thoughts are usually associated with psychopathology. The Future-oriented Repetitive Thought (FoRT) Scale is a measure designed to capture frequency of repetitive thought about positive and negative future events. However, the validity of the scale in Chinese population and its application in the schizophrenia spectrum have not been examined. METHODS: The current study aimed to examine the psychometric properties of the Chinese version of the FoRT scale and to apply it to the schizophrenia spectrum. In Study 1, three samples (total N = 1875) of university students were recruited for exploratory factor analysis, confirmatory factor analysis, and validity test, respectively. In Study 2, we identified subsamples with high schizotypal traits (N = 89) and low schizotypal traits (N = 89), and recruited 36 inpatients with schizophrenia and 41 matched healthy controls. RESULTS: The three-factor (pessimistic repetitive future thinking, repetitive thinking about future goals, and positive indulging about the future) structure of the FoRT scale with one item deleted, fitted the Chinese samples. And the scale could distinguish patients with schizophrenia and individuals with high schizotypal traits from controls. CONCLUSION: These findings support that the Chinese version of the FoRT scale is a valid tool and provide evidence for the potential applications in the schizophrenia spectrum.

Future-oriented repetitive thought, depressive symptoms, and suicide ideation severity: Role of future-event fluency and depressive predictive certainty.

BACKGROUND: Knowing how future-oriented repetitive thought - i.e., repeated consideration of whether positive or negative outcomes will happen in one's future - leads to hopelessness-related cognitions may elucidate the role of anticipating the future in depressive symptoms and suicide ideation. This study examined future-event fluency and depressive predictive certainty - i.e., the tendency to make pessimistic future-event predictions with certainty - as mechanisms explaining the relation between future-oriented repetitive thought, depressive symptoms, and suicide ideation. METHODS: Young adults (N = 354), oversampled for suicide ideation or attempt history, completed baseline measures of pessimistic future-oriented repetitive thought (i.e., the degree to which people consider whether negative outcomes will happen or positive outcomes will not happen in their futures), future-event fluency, depressive predictive certainty, depressive symptoms, and suicide ideation severity and were followed up 6 months later (N = 324). RESULTS: Pessimistic future-oriented repetitive thought predicted depressive predictive certainty at 6-months, partially mediated by lower positive but not increased negative future-event fluency. There was an indirect relationship between pessimistic future-oriented repetitive thought and 6-month suicide ideation severity via 6-month depressive predictive certainty through 6-month depressive symptoms, and also via 6-month depressive symptoms (but not depressive predictive certainty) alone. LIMITATIONS: Lack of an experimental design limits inferences about causality, and a predominantly female sample may limit generalizability by sex. CONCLUSION: Clinical interventions should address pessimistic future-oriented repetitive thought - and its impact on how easily people can think about positive future outcomes - as one potential way to reduce depressive symptoms and, indirectly, suicide ideation.

An intervention to promote concrete thinking style in young adults: Effects on depressive symptoms and its protective factors.

BACKGROUND AND OBJECTIVES: Individuals with low concreteness-experiential thought (CET) tend to have exacerbated depressive symptoms. Interventions aimed at increasing CET have been shown to influence depressive symptoms. The present study examined the effects of increasing CET on depressive symptoms and its protective factors. METHODS: A two-armed experimental intervention was conducted with 86 healthy university students in Japan. They were randomly allocated to the intervention and waitlist groups. Participants in the intervention group engaged in an unguided and web-based (UW) intervention to increase CET (UW-CET). This intervention included a one-off session, to explain the rationale behind increasing CET via a psychoeducation video, and a five-session training on CET over a week. We assessed depressive symptoms, thought styles, and protective factors, such as mindfulness and goal striving, both pre- and-post-assessment and at the one-month follow-up. RESULTS: Participants in the intervention group had marginally increased CET in the follow-up assessments; however, participants in the waitlist group did not. Furthermore, participants in the intervention showed marginally increased mindfulness tendencies and strivings toward their personal goals, but their depressive symptoms were not affected. LIMITATIONS: The present study did not include any active control conditions. Additionally, the sample consisted of only healthy university students. CONCLUSIONS: The findings suggest that the UW-CET can marginally increase adaptive thinking, such as CET, and promote positive psychological aspects in healthy young adults; however, the effect is small. The findings may also help expand clinical implementations to prevent depression in young adults.

Effects of COVID-19-related worry and rumination on mental health and loneliness during the pandemic: longitudinal analyses of adults in the UK COVID-19 mental health & wellbeing study.

BACKGROUND: The lasting effects of the coronavirus disease 2019 pandemic are likely to be significant. AIMS: This study tracked worry and rumination levels during the pandemic and investigated whether periods with higher COVID-related worry and rumination were associated with more negative mental health and loneliness. METHODS: A quota survey design and a sampling frame that permitted recruitment of a national sample were employed. Findings for waves 1 (March 2020) to 6 (November 2020) are reported (N = 1943). RESULTS: Covid-related worry and rumination levels were highest at the beginning of the first lockdown, then declined but increased when the UK returned to lockdown. Worry levels were higher than rumination levels throughout. High levels of COVID-related worry and rumination were associated with a five- and ten-fold increase in clinically meaningful rates of depression and anxiety (respectively) together with lower well-being and higher loneliness. The effects of COVID-related worry on depression and anxiety levels were most marked and clinically meaningful in individuals living with a pre-existing mental health condition. CONCLUSIONS: Psychological interventions should include components that specifically target COVID-related worry and rumination. Individuals with pre-existing mental health conditions should be prioritised as we emerge from the current pandemic and in any future public health crises.

Repetitive thought, cognition, and systemic inflammation in the midlife in the United States study.

OBJECTIVE: Poor cognition increases risk for negative health outcomes, and this may be explained by associations with systemic inflammation. Previously, amount of repetitive thought (Total RT) interacted with IQ to predict interleukin-6 (IL-6) in older adults. This study continued the investigation of repetitive thought (RT) as an element involved in the effect of cognition on inflammation. DESIGN: Participants (N = 164) came from the Midlife in the United States Refresher project (Mage = 45.33, SD = 11.51, ranges = 25-74; 48.2% female; 85% Caucasian). Cognition was assessed via telephone, inflammatory biomarkers (IL-6, C-reactive protein (CRP), and tumour-necrosis factor-alpha (TNF- α)) analysed after blood draw, and RT derived from daily diary data. RESULTS: Cognition significantly interacted with RT valence (p = .009) to explain CRP after covariate adjustment. Better cognition and more negative RT valence was associated with lower CRP (ß = -0.190 [-.387, .008]). Worse cognition and more negative RT valence was associated with higher CRP (ß = 0.133 [-.031, .297]). No significant effects were found for IL-6 or TNF-α. CONCLUSION: RT may interact with cognition to affect different inflammatory biomarkers. Those with worse cognition may benefit more from skills related to regulating thought than those with better cognition.

Understanding associations between rumination and inflammation: A scoping review.

A growing body of evidence suggests that rumination, or focused attention on mental representations of negative events, may have physiological consequences that adversely affect long term health. We conducted a scoping review on quantitative studies of humans examining associations between rumination and inflammation, which included 13 studies representing 14 samples and 1,102 unique participants. The review included 8 biomarkers measured in plasma, serum and saliva (C reactive protein, and C-C motif chemokine 11, interleukin (IL)- 1ß, IL-4, IL-6, IL-8, IL-10 and tumor necrosis factor alpha). More consistent findings of an association between greater rumination and increased inflammation were found in studies that used experimental designs and manipulated rumination. Emerging research suggests rumination may interact with other factors (e.g., socioeconomic status, anxiety) to predict inflammation. This review offers an up to date synthesis of the emerging research focused on rumination and inflammation. The relationship between inflammation and rumination may be contingent on how rumination is conceptualized and measured, as well as the measure of inflammation (i.e., at rest/ in response to stress).

Embodying Stressful Events: No Difference in Subjective Arousal and Neural Correlates Related to Immersion, Interoception, and Embodied Mentalization.

Repetitive thought about oneself, including one's emotions, can lead to both adaptive and maladaptive effects. Construal level of repetitive self-referential thought might moderate this. During interoception, which engages areas such as the insula, the anterior and/or posterior cingulate cortex (PCC) and the somatosensory cortex, concrete low level construal self-referential thought is applied, which has been shown to lead to more positive emotions after upsetting events. Contrarily, during immersion, related to neural activity in the default mode network (DMN), abstract high level construal self-referential thought is applied, which is linked to depression. The current study investigated whether the integration of concrete and abstract self-referential thought by means of embodied mentalization leads to less subjective arousal, decreased DMN activity and increased somatosensory activity as compared to immersion, and to more DMN activity as compared to interoception. In the fMRI scanner, participants imagined stressful events while adopting immersion, interoception or embodied mentalization. After each imagined stressful event, participants rated their subjective arousal and how difficult it was to apply the mode of self-referential thought. Results showed that participants felt that immersion was easier to apply than embodied mentalization. However, no differences in subjective arousal or neural activity were found between immersion, interoception and embodied mentalization. Possible reasons for this lack of significant differences are discussed.

Future-Oriented Repetitive Thought: Pessimistic View of Future in Patients With Alzheimer Disease.

OBJECTIVE: In this study, we, for the first time, evaluated future-oriented repetitive thought in patients with Alzheimer disease (AD), that is, how they think and worry about the future. METHODS: We administered the Future-Oriented Repetitive Thought scale to 34 patients with AD and 37 control participants. This scale assessed 3 categories of future-oriented repetitive thought: (1) pessimistic repetitive future thinking (eg, "I think about the possibility of losing people or things that are important to me"), (2) repetitive thinking about future goals (eg, "I make specific plans for how to get things that I want in life"), and (3) positive indulging about the future (eg, "When I picture good things happening in my future, it is as if they were actually happening to me now"). RESULTS: Analysis demonstrated more pessimistic repetitive future thinking, but less repetitive thinking about future goals and positive indulging about the future, in patients with AD than in control participants. CONCLUSION: Our findings demonstrate a pessimistic view of future in patients with AD, which is possibly attributed to hopelessness and depression.

Worry alters speed-accuracy tradeoffs but does not impair sustained attention.

Worry has been experimentally linked to a range of cognitive consequences, including impairments in working memory, inhibition, and cognitive control. However, findings are mixed, and the effects of worry on other phenomenologically-relevant constructs, such as sustained attention, have received less attention. Potential confounds such as speed-accuracy tradeoffs have also received little attention, as have psychometric and related design considerations, and potential moderators beyond trait worry. The present study investigated the effects of experimentally-induced worry versus a neutral control condition on speed-accuracy tradeoff-corrected performance on a validated measure of sustained attention (88 participants; within-subjects). Moderation by trait worry and trait mindfulness was probed in confirmatory and exploratory analyses, respectively. Worry led to faster and less accurate responding relative to the neutral comparison condition. There was no main effect of condition or trait worry on sustained attention after accounting for speed-accuracy tradeoffs. In exploratory analyses, higher trait mindfulness was robustly related to better post-worry performance, including after controlling for trait worry, general distress, and post-neutral performance, and correction for multiple comparisons. Follow-up analyses exploring dissociable mindfulness facets found a robust relationship between present-moment attention and post-worry performance. Future research should experimentally manipulate mindfulness facets to probe causality and inform treatment development.

Exposure and reactivity to repetitive thought in the neuroticism-distress relationship.

INTRODUCTION: Distress has been assumed to result from exposure to repetitive thought (RT). However, if RT is viewed as internally generated stressors, both exposure and affective reactivity to RT could play roles in generating distress. METHODS: Three studies (young adults, N=99; midlife women, N=111; older adults, N=159) assessed exposure and reactivity to daily RT and tested whether neuroticism was related to individual differences in both exposure and affective reactivity. RESULTS: Across all 3 studies, reactivity effects on depressive symptoms exceeded those of exposure to RT, and neuroticism was associated with more exposure and greater affective reactivity. Furthermore, RT exposure and reactivity accounted for most when not all of the relationship between neuroticism and depressive symptoms. DISCUSSION AND CONCLUSIONS: Further consideration of both exposure and affective reactivity to RT can not only increase the explanatory power of this construct but also suggest effective targets for intervention.

Psychometric evaluation of the Chinese version of the Utrecht Grief Rumination Scale.

Given the severe mental health consequences that may ensue after bereavement, it is crucial to better understand malleable cognitive factors that are associated with poorer bereavement outcomes. Grief rumination (i.e., repetitive thinking about the causes and consequences of a loss) is a malleable cognitive process that is concurrently and longitudinally associated with postloss mental health problems. To assess grief rumination, the English and Dutch Utrecht Grief Rumination Scale (UGRS) were recently developed. The current study examined the reliability and validity of a Chinese version of the UGRS. Three hundred and ninety-three Chinese adults (56% women) bereaved on average 16.88 months ago filled out online questionnaires assessing demographic and loss-related characteristics, grief rumination (UGRS), trait rumination, trait mindfulness, and anxiety, depressive, and prolonged grief symptoms. Confirmatory factor analyses showed that a second-order five-factor hierarchical model provided the most optimal factor structure for the Chinese UGRS. UGRS total scale and subscale scores demonstrated acceptable internal consistency. Grief rumination had a moderate positive association with trait rumination and a low negative association with trait mindfulness, providing convergent and discriminant validity evidence. Test-criterion validity evidence was also provided. UGRS scores could distinguish bereaved groups with different relationships with the deceased. Moreover, grief rumination was associated with symptoms of anxiety, depression, and prolonged grief even after controlling for demographic and loss-related variables, trait rumination, and trait mindfulness. The Chinese UGRS appears a valid and reliable instrument to assess grief rumination in Chinese bereaved individuals.

Repetitive thought is associated with both subjectively and objectively recorded polysomnographic indices of disrupted sleep in insomnia disorder.

BACKGROUND: Repetitive thought is a hallmark of several psychopathological conditions and in particular a perpetuating and maintaining factor in Insomnia Disorder. Accordingly, one of the primary complaints reported by Insomnia patients is the inability to shut-off or control thoughts. Worry and rumination are the two best-known styles of repetitive thought leading to sleep disturbances. The aim of this study was to investigate the relationship of these two cognitive processes on nocturnal sleep indices objectively recorded by polysomnography. METHODS: 27 Insomnia patients and 20 healthy controls matched for sex and age were recruited and completed a comprehensive assessment aimed to evaluate sleep quality, excessive daytime sleepiness, insomnia severity, worry, rumination, depressive and anxious symptomatology, and the ability to produce reasonable cognitive estimates. Sleep diaries indices and polysomnographic recordings were evaluated. RESULTS: Insomnia patients showed increased levels of worry and rumination in comparison to controls. Our polysomnographic study revealed that these two different types of repetitive thoughts were significantly associated with objective sleep variables. In particular, heightened worry levels were related to an augmented wake after sleep onset and diminished total sleep time, sleep efficiency and percentage of REM sleep, whereas rumination was associated with an increase of sleep latency and a decrement of sleep efficiency. However, after controlling for anxiety and depressive symptoms only worry maintained a significant relationship with polysomnographic variables. Remarkably, repetitive thoughts did not correlate with microstructural REM sleep features and quantitative EEG analysis. CONCLUSION: Our study indicates the existence of a significant relationship between daytime levels of repetitive thought and sleep, thus corroborating the hypothesis of an interplay between cognitive and nocturnal electrophysiological activity in insomniacs.

Maladaptive repetitive thought as a transdiagnostic phenomenon and treatment target: An integrative review.

OBJECTIVE: Maladaptive repetitive thought (RT), the frequent and repetitive revisiting of thoughts or internal experiences, is associated with a range of psychopathological processes and disorders. We present a synthesis of prior research on maladaptive RT and develop a framework for elucidating and distinguishing between five forms of maladaptive RT. METHOD: In addition to the previously studied maladaptive RT (worry, rumination, and obsession), this framework is used to identify two additional forms of maladaptive RT (yearning and interoceptive RT). We then present a review of extant psychotherapy intervention research targeting maladaptive RT, focusing both on specific empirically based treatment strategies, and also constructs within treatments that impact maladaptive RT. CONCLUSION: The paper concludes with recommendations for future basic and intervention research on maladaptive RT and related psychopathologies.

Characteristics of Repetitive Thought Associated with Borderline Personality Features: A Multimodal Investigation of Ruminative Content and Style.

Increased ruminative style of thought has been well documented in borderline personality disorder (BPD); however, less is known about how the content of rumination relates to domains of BPD features. Relationships between forms of rumination and BPD features were examined in an undergraduate sample with a wide range of BPD features. Participants completed self-report measures of rumination and a free-writing task about their repetitive thought. Rumination on specific themes, including anger rumination, depressive brooding, rumination on interpersonal situations, anxious rumination, and stress-reactive rumination were significantly associated with most BPD features after controlling for general rumination. Coded writing samples suggested that BPD features are associated with repetitive thought that is negative in valence, difficult to control, prolonged, unhelpful, and unresolved. Although rumination is often described as a form of self-focused attention, BPD relationship difficulties were correlated with greater other-focus in the writing samples, which may reflect more interpersonal themes. Across both self-reports and the writing task, the BPD feature of self-destructive behavior was associated specifically with anger and hostility, suggesting this content may play a particularly important role in fueling impulsive behavior. These findings suggest that both the style and the content of repetitive thought may play a role in BPD features.

Assessing maladaptive repetitive thought in clinical disorders: A critical review of existing measures.

Rumination and worry have recently been grouped under the broader transdiagnostic construct of repetitive thought (Watkins, 2008). The purpose of this review is to provide an overview of scales used to assess repetitive thinking across a broad range of contexts: depression, anxiety, trauma, stress, illness, interpersonal difficulties, positive affect, and so forth. We also include scales developed or adapted for children and adolescents. In the extant literature, measures of repetitive thinking generally show small-to-moderate correlations with measures of psychopathology. This review highlights problems with the content validity of existing instruments; for example, confounds between repetitive thought and symptomatology, metacognitive beliefs, and affect. This review also builds on previous reviews by including newer transdiagnostic measures of repetitive thinking. We hope that this review will help to expand our understanding of repetitive thinking beyond the mood and anxiety disorders, and suggest ways forward in the measurement of repetitive thinking in individuals with comorbid conditions.

Investigating the work-family conflict and health link: Repetitive thought as a mechanism.

Research is needed to investigate mechanisms linking work-family conflict to poor health in working adults. We took a novel approach to build on extant studies by testing a potential mechanism in these associations - repetitive thought. Data came from a sample of 203 partnered working adults. There were significant direct effects of work-family conflict with lower life satisfaction, positive affect, and perceived health as well as greater fatigue. As for total effects, work-family conflict was significantly associated with all health outcomes - life satisfaction, positive affect, negative affect, fatigue, perceived health, and chronic health conditions - in the expected directions through repetitive thought. This study provides support that repetitive thought is one potential mechanism of how work-family conflict can take a toll on psychological and physical health. Findings are discussed in relation to improving workplace policies to improve the health of working adults managing work-family conflict.

The future-oriented repetitive thought (FoRT) scale: A measure of repetitive thinking about the future.

BACKGROUND AND OBJECTIVES: Repetitive thinking about the future has been suggested as one way in which individuals may become hopeless about the future. We report on a new scale assessing future-oriented repetitive thinking, termed the Future-Oriented Repetitive Thought (FoRT) Scale. METHODS: In Study 1, an exploratory factor analysis was conducted with data from 1071 individuals who completed the scale. Study 2 describes a confirmatory factor analysis with a revised version of the scale on a sample of 612 individuals, a subsample of whom (N=99) also completed measures of repetitive thought (rumination, worry), hopelessness-related cognitions, and symptoms of depression and generalized anxiety disorder in order to examine evidence for the measure's convergent, discriminant, and concurrent validity. Study 3 examined the scale's concurrent validity in distinguishing between individuals with and without a history of suicidal ideation and attempts. RESULTS: A three-factor solution emerged in Study 1, and this solution was confirmed in Study 2. In addition, the FoRT scale demonstrated moderate associations with other measures of repetitive thought (rumination, worry), with hopelessness-related cognitions, and with symptoms of depression and generalized anxiety. Finally, the FoRT scale distinguished between individuals with and without a history of suicidal ideation and attempts. LIMITATIONS: Cross-sectional data limit conclusions that can be drawn about directionality. CONCLUSIONS: These findings suggest that the newly developed FoRT scale is a reliable and valid measure of future-oriented repetitive thought.

Trait reflection predicts interleukin-6 response to a social-evaluative stressor.

Past work has linked negative repetitive thought (worry, rumination) about stressors to sustained stress responses. Less is known about the effects of neutral types of repetitive thought (e.g., reflection) on physiological stress responses. The present study examined whether greater trait reflection was associated with a lower inflammatory response to an acute psychosocial stressor. Thirty-four healthy undergraduate women completed a speech stressor, and plasma interleukin-6 (IL-6), C-reactive protein, and tumor necrosis factor-α levels were assessed before and after the stressor. Higher levels of reflection predicted lower IL-6 responses 1h after the stressor. Stressor appraisal was not a significant mediator. These preliminary findings stand in contrast to existing evidence that other forms of repetitive thought like worry and rumination may exacerbate or prolong the inflammatory stress response and indicate that reflection is a notable factor worth considering when examining the relationship between stress, inflammation, and health.

Processing coping methods in expressive essays about stressful experiences: Predictors of health benefit.

This study distinguished constructive (e.g. planning/problem-solving) and unconstructive (e.g. worry) processing in expressive essays and their impact on depressive symptoms, healthcare visits, and physical symptoms. Affect labeling, achievement orientation, and insight utilization were examined as mediators. Essays from 43 medical students were coded; mediators were identified through linguistic text analysis. Outcomes were assessed at baseline and 3 months. Constructive processing predicted declining depressive symptoms (ß = -.33, p < .05) and healthcare visits (ß = -.61, p < .01). Unconstructive processing predicted increasing healthcare visits (ß = .42, p < .05). Higher affect labeling mediated the effect of constructive processing, and lower achievement orientation mediated the effect of unconstructive processing.

The role of repetitive thought in determining posttraumatic growth and distress following interpersonal trauma.

BACKGROUND AND OBJECTIVES: Repetitive thought (RT) strategies have been linked to a range of negative outcomes following traumatic interpersonal events but are proposed to serve an adaptive function under particular circumstances. This study examined outcomes following RT within a transdiagnostic framework, and explored the potentially adaptive nature of trait-like and event-related RT. DESIGN: The centrality of a traumatic event to one's identity was explored as a context under which the adaptive nature of RT might change. Young adults with interpersonal violence experiences (N = 163) reported use of trait-like and event-related RT, centrality of the event, depressive, anxious, and posttraumatic stress symptoms (PTSS), posttraumatic depreciation and posttraumatic growth. METHODS: Hierarchical multiple regression analyses were used to examine main and moderating effects of four types of RT and event centrality on outcome variables. RESULTS: Centrality positively predicted depressive symptoms and PTSS, depreciation, and growth. Brooding RT positively predicted all negative outcomes. Reflecting RT positively predicted anxious symptoms and PTSS and depreciation. Only deliberate RT positively predicted growth. Centrality did not moderate any examined relationships. CONCLUSIONS: Findings highlight the importance of addressing specific types of RT in interventions with survivors and of considering centrality as a robust contributor to outcomes following interpersonal violence.