Michelle Moulds

• BA(Hons) MPsych(Clinical) PhD
• Professor at UNSW Sydney

Background Repetitive Negative Thinking (RNT) is a key transdiagnostic mechanism underlying anxiety and depressive disorders, and targeting RNT specifically leads to improved treatment outcomes. There is a lack of research however into mechanisms of change in RNT-focused interventions and factors that predict treatment response. The aim of this stu...

There has been a call for innovative, low-cost and simple treatments for people who have experienced trauma. The proposal that targeting intrusive memories could have the downstream effect of reducing other posttrauma symptoms or preventing their emergence has prompted the development of single-symptom interventions for intrusive memories, drawing...

Background Frontline health care staff are frequently exposed to traumatic events as part of their work. Although this study commenced before the emergence of COVID-19, levels of exposure were heightened by the pandemic. Many health care staff members report intrusive memories of such events, which can elicit distress, affect functioning, and be as...

Background Perinatal anxiety is common: up to 40% of pregnant women and new mothers experience high levels of anxiety. Given its prevalence, interventions that are low-intensity, highly accessible and cost-efficient, and target modifiable risk factors for anxiety are needed. Repetitive negative thinking (RNT)—such as worrying about ways things will...

Background Intrusive memories of psychologically traumatic events bring distress both sub-clinically and clinically. This parallel-group, two-arm randomised controlled trial evaluated the effect of a brief behavioural intervention on reducing intrusive memories in frontline healthcare workers exposed to traumatic events during the COVID-19 pandemic...

Objectives Psychological distress is common among university students globally. A culturally relevant internet-based mindfulness intervention could be a potential solution for addressing students’ distress in low- and middle-income countries (LMICs), including Indonesia. However, internet-based mindfulness interventions are new in Indonesia. In thi...

Background There is emerging evidence that a brief cognitive task intervention may reduce the frequency of intrusive memories, even long-standing memories of older trauma. However, evaluations to date have involved in-person researcher contact. We investigated the feasibility and acceptability of remote delivery to women (n = 12) in Iceland who had...

BACKGROUND Frontline healthcare staff are frequently exposed to traumatic events as part of their work. Whilst this study commenced prior to the emergence of COVID-19, levels of exposure were heightened by the pandemic. Many healthcare staff report intrusive memories of such events, which can elicit distress, affect functioning, and be associated w...

Background: Psychological distress is prevalent among university students. However, the availability of evidence-based mental health treatment remains limited in many low- and middle-income countries, including Indonesia. Internet-delivered, mindfulness-based interventions that reduce distress have potential for treating university student distress...

Background: Rumination and worry, forms of repetitive negative thinking (RNT), are implicated in the onset, maintenance, severity, and relapse risk of depression and anxiety disorders. This randomised controlled trial evaluated an internet intervention targeting both rumination and worry in adults compared to treatment-as-usual (TAU) and compared...

Individuals with depression typically remember their past in a generalised manner, at the cost of retrieving specific event memories. This may impair engagement with cognitive behavioural therapy (CBT) tasks that use concrete episodic information to challenge maladaptive beliefs, potentially limiting their therapeutic benefit. Study 1 demonstrated...

During the COVID-19 pandemic, there has been a rise in common mental health problems compared to prepandemic levels, especially in young people. Understanding the factors that place young people at risk is critical to guide the response to increased mental health problems. Here we examine whether age-related differences in mental flexibility and fr...

Individuals vary in their ability to tolerate uncertainty. High intolerance of uncertainty (the tendency to react negatively to uncertain situations) is a known risk factor for mental health problems. In the current study we examined the degree to which intolerance of uncertainty predicted depression and anxiety symptoms and their interrelations ac...

This chapter describes the treatment of a 41-year-old female (Naomi) with major depressive disorder and symptoms of anxiety and stress following a stressful workplace event. Naomi endorsed a range of dysfunctional appraisals which contributed to the maintenance of her symptoms; they centred around themes of her incompetence and inability to cope at...

BACKGROUND Psychological distress (depression, anxiety, and stress) is prevalent among university students. However, the availability of evidence-based mental health treatment remains limited in many low-middle income countries (LMICs), including Indonesia. Internet-delivered mindfulness-based interventions that reduce distress have potential for t...

Emerging evidence shows that compared to pre-pandemic norms pregnant women report significant increases in clinical levels of depressive and anxiety symptoms during COVID-19. This pre-registered study examined cognitive and social vulnerability factors for poor mental health in pregnancy during COVID-19. Understanding vulnerability profiles is key...

Emerging evidence shows that compared to pre-pandemic norms pregnant women report significant increases in clinical levels of depressive and anxiety symptoms during COVID-19. This pre-registered study examined cognitive and social vulnerability factors for poor mental health in pregnancy during COVID-19. Understanding vulnerability profiles is key...

Global restrictions imposed during the COVID-19 pandemic significantly limited the capacity to plan for the future. Little is known about young people’s future self-images and the impact the COVID-19 pandemic may have had upon them. Given evidence that the ability to imagine a positive future can be protective for mental health, research into the i...

Individuals with depression typically remember their past in a generalised manner, at the cost of retrieving specific event memories. This may impair engagement with cognitive behavioural therapy (CBT) tasks that use concrete episodic information to challenge maladaptive beliefs, potentially limiting their therapeutic benefit. Study 1 demonstrated...

Background: During the COVID-19 pandemic there has been a rise in common mental health problems compared to pre-pandemic levels, especially in young people. Understanding the factors that place young people at risk is critical to guide the response to increased mental health problems. Here we examine whether age-related differences in emotion regul...

Psychological distress is a common mental health problem among university students, including students from Low and Middle-income countries (LMICs), such as Indonesia. Mindfulness interventions that can reduce psychological distress have been growing in popularity and are being increasingly delivered through the Internet. The present study examined...

Objective Intrusive memories are a core feature of posttraumatic stress disorder and have transdiagnostic relevance across mental disorders. Establishing flexible methods to monitor intrusions, including patterns and characteristics, is a key challenge. A daily diary has been developed in experimental settings to provide symptom count data, without...

Background Rates of perinatal mental health difficulties (experienced during pregnancy and the 12-months postpartum) increased worldwide during the COVID-19 pandemic. In the UK, anxiety and depression were estimated to affect more than half of perinatal women during the first national lockdown. However, little is known about women’s qualitative exp...

Belonging is a basic human need, with social isolation signaling a threat to biological fitness. Sensitivity to ostracism varies across individuals and the lifespan, peaking in adolescence. Government-imposed restrictions upon social interactions during COVID-19 may therefore be particularly detrimental to young people and those most sensitive to o...

Social anxiety disorder (SAD) is associated with marked physiological reactivity in social-evaluative situations. However, objective measurement of biomarkers is rarely evaluated in treatment trials, despite potential utility in clarifying disorder-specific physiological correlates. This randomized controlled trial sought to examine the differentia...

Background Rumination and worry represent two types of repetitive negative thinking (RNT), and their predictive and maintaining roles are well-established in depression and anxiety, respectively. Furthermore, there is an emerging literature on the link between RNT and psychological wellbeing in the perinatal period. Methods We conducted a scoping...

Objectives Rumination and worry have been implicated in the onset, severity, maintenance and relapse risk of depression and anxiety disorders. Despite this, little research has examined individuals' personal experiences of these processes. This study investigates how individuals experience these processes, which will provide insight into these comm...

Intrusive memories of trauma (memories that enter consciousness involuntarily) highjack cognitive processing, cause emotional distress, and represent a core symptom of posttraumatic stress disorder. Intrusive memories often contain the worst moment/s (‘hotspots’) of the trauma memory. Little is known about hotspots shortly after they are formed, i....

Background Repetitive thinking (RT) has been defined as prolonged, recurrent thought about oneself and one’s experiences. Recent studies have shown that various measures of RT load onto a common factor and predict symptoms of depression and anxiety. The relationship with mania symptoms, however, remains underexplored. The current study examined the...

Addressing the mental health needs of healthcare staff exposed to psychologically traumatic events at work during the COVID-19 pandemic is a pressing global priority. We need to swiftly develop interventions to target the psychological consequences (e.g., persistent intrusive memories of trauma). Interventions for healthcare staff must be brief, fl...

Individuals vary in their ability to tolerate uncertainty. High intolerance of uncertainty is a known risk factor for mental health problems. In the current study we examined the degree to which intolerance of uncertainty predicted depression and anxiety symptoms and their interrelations across the first year of the COVID-19 pandemic. We examined t...

Objective This randomised controlled trial (RCT) aimed to investigate the effects of a simple cognitive task intervention on intrusive memories ("flashbacks") and associated symptoms following a traumatic event. Patients presenting to a Swedish emergency department (ED) soon after a traumatic event were randomly allocated (1:1) to the simple cognit...

Belonging is a basic human need, with social isolation signaling a threat to biological fitness. Sensitivity to ostracism varies across individuals and the lifespan, peaking in adolescence. Government-imposed restrictions upon social interactions during COVID-19 may therefore be particularly detrimental to young people and those most sensitive to o...

Please note, this early pre-print has been replaced by the final published version available at https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-022-04876-9 or https://www.researchgate.net/publication/362082633_A_qualitative_analysis_of_feelings_and_experiences_associated_with_perinatal_distress_during_the_COVID-19_pandemic....

Background Despite the well-established role of repetitive negative thinking (RNT) in the prediction and maintenance of depression and anxiety, only minimal research to date has investigated RNT in the context of postnatal psychological adjustment. Objective We examined the relationships between RNT, associated maladaptive cognitive processes, inf...

Background Rumination and worry, both forms of repetitive negative thinking (RNT), have been implicated in the onset, maintenance, severity, and relapse risk of depression and anxiety disorders. Despite promising initial findings for internet-delivered interventions targeting both rumination and worry simultaneously, no studies have investigated tr...

Background Recent evidence suggests that anxiety is more common than depression in the perinatal period, however there are few interventions available to treat perinatal anxiety. Targeting specific processes that maintain anxiety, such as worry, may be one potentially promising way to reduce anxiety in this period. Given evidence that negative inte...

Background: Increasing evidence has linked repetitive negative thinking (RNT) to postnatal depression and anxiety, yet the factors moderating this relationship have been minimally investigated. During the COVID-19 pandemic of 2020, social restrictions imposed to reduce viral transmission limited access to social support, which is critical to postna...

Repetitive thinking (RT) predicts and maintains depression and anxiety, yet the role of RT in the perinatal context has been under-researched. Further, the content and themes that emerge during RT in the perinatal period have been minimally investigated. We recruited an online community sample of women who had their first baby within the past 12 mo...

Intrusive memories are common after trauma, and can cause significant distress. Interventions to prevent/reduce the occurrence of this core clinical feature of posttraumatic stress disorder are needed; they should be easy to deliver, readily disseminated and scalable. A novel one-session intervention by Iyadurai et al. 2018, Molecular Psychiatry, r...

Problem Prenatal depression and anxiety are linked to poor maternal and infant outcomes. We need to understand predictors of poor mental health to identify at-risk women, and targets for support. Background Previous research has demonstrated a relationship between low levels of perceived social support, and depression and anxiety in pregnant women...

Background Repetitive negative thinking (RNT; e.g., worry about the future, rumination about the past) and the tendency to interpret ambiguous information in negative ways (interpretation bias) are cognitive processes that play a maintaining role in anxiety and depression, and recent evidence has demonstrated that interpretation bias maintains RNT....

Background: Cognitive behavior therapy (CBT) is effective for most patients with a social anxiety disorder (SAD) but a substantial proportion fails to remit. Experimental and clinical research suggests that enhancing CBT using imagery-based techniques could improve outcomes. It was hypothesized that imagery-enhanced CBT (IE-CBT) would be superior...

Initial models and empirical investigations of rumination in the clinical literature were predominantly in the domain of depression. However, rumination is now well-established as a transdiagnostic cognitive process, including in the context of posttraumatic stress. To clarify the current understanding of rumination in posttraumatic stress, we cond...

Introduction: One route to advancing psychological treatments is to harness mental health science, a multidisciplinary approach including individuals with lived experience and end users (e.g., Holmes, E. A., Craske, M. G., & Graybiel, A. M. (2014). Psychological treatments: A call for mental-health science. Nature, 511(7509), 287–289. doi:10.1038/5...

The current worldwide refugee crisis has led to an unprecedented increase in migration globally. Due to stigma and language barriers, mental healthcare for refugees is limited. There is a need for novel, scalable psychological interventions. We investigated whether a brief behavioural intervention involving a memory reminder cue and Tetris gameplay...

Emergency services are under enormous pressure to offer programmes that could protect their staff from the psychological impact of stressors encountered in their roles. There has been a surge in the number of pre-incident training programmes aimed at first responders to maintain their psychological wellbeing after critical incidents. These include...

ruminative processing and recalling memories from an observer perspective represent two cognitive processes with adverse consequences in depression. However, no study to date has investigated the interrelationship of abstract processing, observer perspective and depression symptoms in the context of recalling personal emotional (positive, negative)...

The ability to regulate anger facilitates harmonious interactions with strangers, colleagues, friends, and romantic partners. We review the influence of four emotion regulation strategies (i.e., cognitive reappraisal, suppression, angry rumination, and mindfulness) on subjective anger experience, cardiovascular reactivity, and aggressive behavior....

Background While existing psychological treatments for depression are effective for many, a significant proportion of depressed individuals do not respond to current approaches and few remain well over the long-term. Anhedonia (a loss of interest or pleasure) is a core symptom of depression which predicts a poor prognosis but has been neglected by...

In two studies we tested the hypothesis that abstract thinking is linked to decision-making problems in depression. In Study 1, we compared the extent to which high dysphoric (n = 24) and low dysphoric (n = 26) individuals engaged in abstract thinking while completing a decision-making task. As predicted, high dysphoric participants demonstrated mo...

The depressive-realism effect refers to a phenomenon in which depressed individuals are more realistic at assessing the relationship between two events than non-depressed individuals. Recent evidence suggests that the depressive realism hypothesis is weaker than first thought. Thus, we sought evidence for depressive-realism under conditions that we...

Low levels of proactivity are characteristic of individuals with depression. Two studies were conducted to compare the relative effects of abstract versus concrete processing on proactivity in high dysphoric individuals. In Study 1, participants read information about an upcoming research study and were then randomly allocated to a writing task tha...

rumination is characteristic of depressed individuals, as is the tendency to experience post-decisional regret. We conducted two studies to test whether (i) abstract rumination is associated with post-decisional regret, and (ii) inducing the converse style of thinking, namely concrete rumination, would reduce post-decisional regret. In Study 1, par...

Abstract processing and observer vantage perspective have been associated with negative consequences in depression. We investigated the relationship between mode of processing and vantage perspective bidirectionally in high and low dysphoric individuals, using abstract and concrete descriptions of experimenter-provided everyday actions. When vantag...

Background and objectives: Emerging evidence suggests that the effectiveness of cognitive reappraisal (CR) depends on different factors, including the individual's psychological wellbeing (e.g., level of anxiety) and the context in which the strategy is used (e.g., stressor controllability). The present study aimed to investigate the emotional (ne...

Background: There is evidence that anxiety is common, perhaps even more prevalent than depression, in the postpartum period. In this review we propose adopting a transdiagnostic approach to perinatal mental health: to delineate psychopathology, and identify potential underlying cognitive mechanisms such as repetitive negative thinking (RNT). Sampli...

Background: Psychological treatments occupy an important place in evidence-based mental health treatments. Now is an exciting time to fuel treatment research: a pressing demand for improvements is poised alongside new opportunities from closer links with sister scientific and clinical disciplines. The need to improve mental health treatment is grea...

Background: Repetitive negative thinking (RNT) is a cognitive process that is repetitive, passive, relatively uncontrollable, and focused on negative content, and is elevated in emotional disorders including depression and anxiety disorders. Repetitive positive thinking is associated with bipolar disorder symptoms. The unique contributions of posi...

Background: Evidence that repetitive negative thinking (RNT) is a shared feature of a number of disorders has prompted the need for transdiagnostic self-report instruments; that is, measures of RNT that can be administered to individuals irrespective of their diagnosis. The Repetitive Thinking Questionnaire (RTQ; McEvoy et al., 2010) was developed...

Background and objectives: Research has shown a link between self-efficacy appraisals and PTSD symptoms. Less is known about the relation between perceived self-efficacy and specific PTSD symptoms such as intrusions. These two experiments tested the causal relationship between perceived self-efficacy and intrusions from a trauma film. Methods: I...

Cognitive behavior group therapy (CBGT) is effective for social anxiety disorder (SAD), but a substantial proportion of patients do not typically achieve normative functioning. Cognitive behavioral models of SAD emphasize negative self-imagery as an important maintaining factor, and evidence suggests that imagery is a powerful cognitive mode for fa...

The vantage perspective from which a memory is retrieved influences the memory's emotional impact, intrusiveness, and phenomenological characteristics. This study tested whether similar effects are observed when participants were instructed to imagine the events from a specific perspective. Fifty student participants listened to a verbal report of...

Emotional reasoning refers to the use of subjective emotions, rather than objective evidence, to form conclusions about oneself and the world. It is a key interpretative bias in cognitive models of anxiety disorders and appears to be especially evident in individuals with anxiety disorders. However, the amenability of emotional reasoning to change...

Generalizing from a single failure or success to future performances and their self-concept could have an important impact on sport participants. This study examined the impact of the way sport participants think about success on positive generalization. Sport participants (N = 222) completed an online experimental study in which they were induced...

Psychological research into spontaneous or intrusive cognitions has typically focused on cognitions in one predefined domain, such as obsessional thoughts in OCD, intrusive memories in posttraumatic stress disorder and depression, or involuntary autobiographical memories and daydreaming in everyday life. Such studies have resulted in a wealth of kn...

A body of research has demonstrated that individuals with Asian ethnicity endorse higher levels of fear of negative evaluation compared with individuals with European ethnicity. To date, no study has examined whether this Asian-European difference may be confounded by the differential interpretation of the measures of fear of negative evaluation by...

Since the publication of Susan Nolen-Hoeksema's (1991) seminal Response Style Theory of depressive rumination, a wealth of research has demonstrated that rumination plays an important role in the onset and maintenance of depression. More recently, rumination has been examined within the context of anger, and findings have suggested that ruminating...

The capacity to repair sad mood through the deliberate recall of happy memories has been found to be impaired in dysphoric individuals. Rumination, or adopting an abstract processing mode, has been proposed as a possible mechanism underpinning this effect. In low and high dysphoric participants, we examined the relative consequences of adopting an...

The importance of self-beliefs in prominent models of social phobia has led to the development of measures that tap this cognitive construct. The Self-Beliefs Related to Social Anxiety (SBSA) Scale is one such measure and taps the three maladaptive belief types proposed in Clark and Wells’s model of social phobia. This study aimed to replicate and...

Repetitive negative thinking (RNT) has been confirmed as a transdiagnostic phenomenon, but most measures of RNT are contaminated with diagnosis-specific content. The first aim of this study was to examine the structure of an anticipatory version of the Repetitive Thinking Questionnaire (RTQ-Ant) as a trans-emotional measure of anticipatory RNT. The...

Collaborative inhibition refers to the phenomenon that when several people work together to produce a single memory report, they typically produce fewer items than when the unique items in the individual reports of the same number of participants are combined (i.e., nominal recall). Yet, apart from this negative effect, collaboration may be benefic...

Negative appraisals maintain intrusive memories and intrusion-distress in depression, but treatment is underdeveloped. This study compared the efficacy of computerised bias modification positive appraisal training (CBM) versus a therapist-delivered cognitive behavioural therapy session (CB-Education) that both aimed to target and alter negative app...

Evidence of a strong causal relationship between mental imagery and emotion has informed psychological conceptualisations of disordered positive mood states (i.e., mania). Holmes et al.'s cognitive model of bipolar disorder asserts a prominent role for intrusive and affect-laden positive imagery of the past and the future in the amplification and m...

Clark and Wells' (1995) model of social phobia proposes that there are 3 types of maladaptive self-beliefs responsible for social anxiety (high standard, conditional, and unconditional beliefs). Wong and Moulds (2009) recently developed the 15-item Self-Beliefs Social Anxiety (SBSA) scale that measures the strength of the self-belief types proposed...

Intrusion-based reasoning refers to the tendency to form interpretations about oneself or a situation based on the occurrence of a negative intrusive autobiographical memory. Intrusion-based reasoning characterises post-traumatic stress disorder, but has not yet been investigated in depression. We report two studies that aimed to investigate this....

Cognitive models of depression emphasize how distorted thoughts and interpretations contribute to low mood. Emotional reasoning is considered to be one such interpretative style. We used an experimental procedure to determine whether elevated levels of emotional reasoning characterize depression. Participants who were currently experiencing a major...

Emotional reasoning refers to the use of subjective emotions, rather than objective evidence, to form conclusions about oneself and the world [1]. Emotional reasoning appears to characterise anxiety disorders. We aimed to determine whether elevated levels of emotional reasoning also characterise dysphoria. In Study 1, low dysphoric (BDI-II≤4; n = 2...

Example of emotional reasoning script used in Study 1. (DOCX)

Recalling positive memories is a powerful and effective way to improve mood. However, unlike never-depressed individuals, those with current or past depression do not benefit emotionally from positive memory recall. To examine whether rumination is involved in this difficulty, 80 participants (26 currently depressed, 29 recovered depressed, and 25...

We examined the role of focus of attention and reappraisal in maintaining the adverse effects of ostracism. In Study 1, participants were included or ostracized and then completed questionnaires immediately and after a delay to measure need-threat. During the delay, participants answered questions that directed their focus of attention either towar...

The vantage perspective from which memories are recalled influences their emotional impact. To date, however, the impact of vantage perspective on the emotions elicited by positive memories and images of positive future events has been minimally explored. We experimentally manipulated the vantage perspective from which a sample of undergraduate stu...

Background Emotional and interpersonal impairments associated with alcohol-dependence have been recently explored, but the distorted cognitive representations underlying these deficits remain poorly understood. The present study aims at exploring the presence of maladaptive social self-beliefs among alcohol-dependent individuals, as these biased se...

There is preliminary evidence that dysphoric symptoms are associated with maladaptive regulation of positive emotion. We investigated to what extent this pattern is unique to depression symptoms, persists in recovery, and extends to apprehension of intense emotion experience. In Study 1, in a sample of undergraduates (N = 112), dysphoria was associ...

Background and objectives: Rumination about negative material (e.g., depression symptoms, current problems) contributes to the course and maintenance of depression. More recently, studies have shown that it is not rumination per se, but rather the mode of processing (i.e., abstract/analytical versus concrete/experiential) adopted during rumination...

There has been a growing recognition of the role of memory processes in depressive vulnerability, as has been suggested by influential cognitive models of depressive disorders (Teasdale, 1988). In this study recovered depressed (n = 35) and never-depressed (n=49) participants recalled self-defining memories following either a sad or neutral mood in...

Background and objectives: Repetitive negative thinking (RNT) is common to multiple emotional disorders and occurs before, during, and following a stressor. One replicated difference between common forms of RNT such as worry and rumination is temporal orientation towards a stressor, with worry being more future-oriented and rumination more past-or...

The manner in which individuals recall negative life events has important affective consequences. The present experiment investigated the effects of emotion regulation strategies on anger experience. One hundred and twenty-one undergraduates recalled an anger-inducing memory and were instructed to engage in either analytical rumination, cognitive r...

We compared the content/themes and features of intrusive memories versus rumination about such intrusions in a depressed sample. Participants with major depressive disorder (MDD) (N= 38) completed self-report measures about a negative intrusive memory, and rumination in response to their memory. Both rumination and intrusive memories were highly se...