What, Me Worry and Ruminate About DSM-5 and RDoC? The Importance of Targeting Negative Self-Referential Processing

Clinical Psychology Science and Practice (Impact Factor: 2.92). 02/2013; 20:259-268. DOI: 10.1111/cpsp.12038

ABSTRACT Rumination, worry, and other forms of negative self-referential processing are familiar to everyone, as reflecting on the self is perhaps our most human characteristic. However, for a substantial subgroup of patients, negative self-referential processing (NSRP) arises in response to intense emotionality, worsening the clinical presentation and diminishing the treatment response. The combination of emotionality and NSRP likely reflects the endophenotype of complicated and treatment refractory patients who fail to achieve a satisfactory treatment response in our trials and our clinics. An important next step is to personalize treatments by deliberately targeting NSRPs within established treatment protocols or in as yet novel treatments. Enriching treatments with mindfulness meditation is one possible avenue for personalized care of patients with this hypothesized endophenotype.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: 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. Copyright © 2015 Elsevier Ltd. All rights reserved.
    Behaviour Research and Therapy 03/2015; DOI:10.1016/j.brat.2015.03.006 · 3.85 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The immediate outcomes of mindfulness meditation (MM) and loving-kindness meditation (LKM) on experimental measures of explicit and implicit self- and other-referential processing (SRP-ORP) have not been investigated previously. In this study, undergraduate students (n = 104) were randomized to a single-session practice of MM, LKM, or reading control and completed self-report measures of decentering and positive affect directed toward self and other. Participants also completed an experimental measure of valenced SRP-ORP. Practice of both meditations was associated with increased decentering and positive affect relative to reading control, although self-reported response to MM and LKM did not significantly differ. Following the meditation, whereas participants randomized to MM evidenced an expected self-positivity bias in positive affective response and reaction time during an experimental SRP-ORP task, participants randomized to LKM did not. LKM, as uniquely involving the intentional cultivation of positive emotion toward both self and other, may be associated with a relative normalization of the self-positivity bias. Individual differences in response to SRP-ORP were also examined as a function of traits related to mindfulness and loving-kindness, in addition to as a function of variability in experiential response to MM and LKM. Study limitations and future research directions are also discussed.
    Mindfulness 01/2014; DOI:10.1007/s12671-014-0317-z
  • [Show abstract] [Hide abstract]
    ABSTRACT: Generalized anxiety disorder (GAD) is a psychological disorder characterized by chronic and severe worry. The past thirty years have seen a surge in the understanding of GAD, and specific advances have been made in how the disorder is conceptualized and treated within the field of psychology. However, despite these advances, GAD remains the most treatment refractory anxiety disorder. The current chapter, therefore, provides an overview of the current conceptualization of GAD, including its key symptoms and features. In addition, this chapter highlights many of the specific theoretical and treatment advances of the past several decades. Finally, this chapter will explore future directions that the field may be able to take in an attempt to better understand and treat this disorder.
    Primer on Anxiety Disorders: Translational Perspectives on Diagnosis and Treatment, 1 edited by Daniel Pine, Barbara Olasov Rothbaum, Kerry Ressler, 03/2015: chapter 22: pages 315-328; Oxford University Press.


Available from
May 20, 2014