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08-08-2022 | Original Article

Symptom-Level Network Analysis Distinguishes Unique Associations of Repetitive Negative Thinking and Experiential Avoidance with Depression and Anxiety in a Transdiagnostic Clinical Sample

Auteurs: Kean J. Hsu, Michael Mullarkey, Mallory Dobias, Christopher G. Beevers, Thröstur Björgvinsson

Gepubliceerd in: Cognitive Therapy and Research | Uitgave 6/2022

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Abstract

Introduction

Repetitive negative thinking and experiential avoidance have been hypothesized to be related, transdiagnostic maintenance factors for depression and anxiety, yet is unclear how these processes overlap or diverge. Here we use a symptom-level approach to address this question.

Methods

Adults presenting for treatment to an intensive CBT program (n = 492) completed measures of depression and anxiety symptom severity, repetitive negative thinking, and experiential avoidance. Our pre-registered network analysis approach examined the contribution of these transdiagnostic maintenance factors to the predictability of a depression and anxiety symptom network. Exploratory analyses used permutation testing to formally evaluate the predictability of the symptom network.

Results

Permutation testing indicates that repetitive negative thinking significantly improved the predictability of worrying and poor concentration, whereas experiential avoidance improved the predictability of difficulties relaxing, being afraid something bad was going to happen, and feeling like a failure.

Limitations

Our sample was cross-sectional and a predominantly white, educated, industrialized, rich, and democratic (WEIRD) sample.

Conclusions

Repetitive negative thinking and experiential avoidance each were associated with symptoms of depression and anxiety but did not overlap across the comorbid symptom network. More broadly, applying network analysis helps to more precisely identify which symptoms of depression and anxiety are associated with transdiagnostic maintenance factors, thus providing insight into how these factors may contribute to the maintenance of co-occurring disorders.
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To attempt to contextualize the importance of repetitive negative thinking and experiential avoidance, we also permuted each individual symptom using a similar process to examine how overall network predictability and individual symptom predictability are impacted. As it is not possible to compare whether the increase in predictability across these different permuted networks significantly differ, these results are only included in the Supplemental Materials.
 
Literatuur
go back to reference Beevers, C. G., Mullarkey, M. C., Dainer-Best, J., Stewart, R. A., Labrada, J., Allen, J. J., McGeary, J. E. & Shumake, J. (2019). Association between negative cognitive bias and depression: A symptom-level approach. Journal of Abnormal Psychology, 128(3), 212. Beevers, C. G., Mullarkey, M. C., Dainer-Best, J., Stewart, R. A., Labrada, J., Allen, J. J., McGeary, J. E. & Shumake, J. (2019). Association between negative cognitive bias and depression: A symptom-level approach. Journal of Abnormal Psychology, 128(3), 212.
go back to reference Brockmeyer, T., Holtforth, M. G., Krieger, T., Altenstein, D., Doerig, N., Zimmermann, J., Backenstrass, M., Friederich, H. C., & Bents, H. (2015). Preliminary evidence for a nexus between rumination, behavioural avoidance, motive satisfaction and depression. Clinical Psychology & Psychotherapy, 22(3), 232–239. Brockmeyer, T., Holtforth, M. G., Krieger, T., Altenstein, D., Doerig, N., Zimmermann, J., Backenstrass, M., Friederich, H. C., & Bents, H. (2015). Preliminary evidence for a nexus between rumination, behavioural avoidance, motive satisfaction and depression. Clinical Psychology & Psychotherapy, 22(3), 232–239.
go back to reference Cernvall, M., Skogseid, E., Carlbring, P., Ljungman, L., Ljungman, G., & von Essen, L. (2016). Experiential avoidance and rumination in parents of children on cancer treatment: Relationships with posttraumatic stress symptoms and symptoms of depression. Journal of Clinical Psychology in Medical Settings, 23(1), 67–76. https://doi.org/10.1007/s10880-015-9437-4CrossRefPubMed Cernvall, M., Skogseid, E., Carlbring, P., Ljungman, L., Ljungman, G., & von Essen, L. (2016). Experiential avoidance and rumination in parents of children on cancer treatment: Relationships with posttraumatic stress symptoms and symptoms of depression. Journal of Clinical Psychology in Medical Settings, 23(1), 67–76. https://​doi.​org/​10.​1007/​s10880-015-9437-4CrossRefPubMed
go back to reference Coussement, C., & Heeren, A. (2022). Sleep problems as a transdiagnostic hub bridging impaired attention control, generalized anxiety, and depression. Journal of Affective Disorders, 296, 305–308.CrossRefPubMed Coussement, C., & Heeren, A. (2022). Sleep problems as a transdiagnostic hub bridging impaired attention control, generalized anxiety, and depression. Journal of Affective Disorders, 296, 305–308.CrossRefPubMed
go back to reference Epskamp, S., Cramer, A. O. J., Waldorp, L. J., Schmittmann, V. D., & Borsboom, D. (2012). Qgraph: Network visualizations of relationships in psychometric data. Journal of Statistical Software, 48(4), 1–18.CrossRef Epskamp, S., Cramer, A. O. J., Waldorp, L. J., Schmittmann, V. D., & Borsboom, D. (2012). Qgraph: Network visualizations of relationships in psychometric data. Journal of Statistical Software, 48(4), 1–18.CrossRef
go back to reference Forgeard, M. J. C., Beard, C., Kirakosian, N., & Björgvinsson, T. (2018). Research in partial hospital settings. In R. T. Codd III. (Ed.), Practice-based research: A guide for clinicians. Routledge. Forgeard, M. J. C., Beard, C., Kirakosian, N., & Björgvinsson, T. (2018). Research in partial hospital settings. In R. T. Codd III. (Ed.), Practice-based research: A guide for clinicians. Routledge.
go back to reference Fried, E. I., & Haslbeck, J. (2018). Using network analysis to examine links between individual depression symptoms, inflammatory markers, and covariates. Psychological Medicine, 50, 2682–2690.CrossRef Fried, E. I., & Haslbeck, J. (2018). Using network analysis to examine links between individual depression symptoms, inflammatory markers, and covariates. Psychological Medicine, 50, 2682–2690.CrossRef
go back to reference Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experimental avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64(6), 1152–1168.CrossRefPubMed Hayes, S. C., Wilson, K. G., Gifford, E. V., Follette, V. M., & Strosahl, K. (1996). Experimental avoidance and behavioral disorders: A functional dimensional approach to diagnosis and treatment. Journal of Consulting and Clinical Psychology, 64(6), 1152–1168.CrossRefPubMed
go back to reference Hayes, S. C., Strosahl, K., Wilson, K. G., Bissett, R. T., Pistorello, J., Toarmino, D., Polusny, M. A., Dykstra, T. A., Batten, S. V., Bergan, J., Stewart, S. H., et al. (2004). Measuring experiential avoidance: A preliminary test of a working model. The Psychological Record, 54(4), 553–578. https://doi.org/10.1007/BF03395492CrossRef Hayes, S. C., Strosahl, K., Wilson, K. G., Bissett, R. T., Pistorello, J., Toarmino, D., Polusny, M. A., Dykstra, T. A., Batten, S. V., Bergan, J., Stewart, S. H., et al. (2004). Measuring experiential avoidance: A preliminary test of a working model. The Psychological Record, 54(4), 553–578. https://​doi.​org/​10.​1007/​BF03395492CrossRef
go back to reference Holm, S. (1979). A simple sequentially rejective multiple test procedure. Scandinavian Journal of Statistics, 6(2), 65–70. Holm, S. (1979). A simple sequentially rejective multiple test procedure. Scandinavian Journal of Statistics, 6(2), 65–70.
go back to reference Hsu, K. J., Beard, C., Rifkin, L., Dillon, D. G., Pizzagalli, D. A., & Björgvinsson, T. (2015). Transdiagnostic mechanisms in depression and anxiety: The role of rumination and attentional control. Journal of Affective Disorders, 188, 22–27.CrossRefPubMedPubMedCentral Hsu, K. J., Beard, C., Rifkin, L., Dillon, D. G., Pizzagalli, D. A., & Björgvinsson, T. (2015). Transdiagnostic mechanisms in depression and anxiety: The role of rumination and attentional control. Journal of Affective Disorders, 188, 22–27.CrossRefPubMedPubMedCentral
go back to reference Lamers, F., van Oppen, P., Comijs, H. C., Smit, J. H., Spinhoven, P., van Balkom, A. J., Nolen, W. A., Zitman, F. G., Beekman, A. T., & Penninx, B. W. J. H. (2011). Comorbidity patterns of anxiety and depressive disorders in a large cohort study: The Netherlands Study of Depression and Anxiety (NESDA). The Journal of Clinical Psychiatry, 72(3), 341–348. https://doi.org/10.4088/JCP.10m06176bluCrossRefPubMed Lamers, F., van Oppen, P., Comijs, H. C., Smit, J. H., Spinhoven, P., van Balkom, A. J., Nolen, W. A., Zitman, F. G., Beekman, A. T., & Penninx, B. W. J. H. (2011). Comorbidity patterns of anxiety and depressive disorders in a large cohort study: The Netherlands Study of Depression and Anxiety (NESDA). The Journal of Clinical Psychiatry, 72(3), 341–348. https://​doi.​org/​10.​4088/​JCP.​10m06176bluCrossRefPubMed
go back to reference McEvoy, P. M., Hyett, M. P., Ehring, T., Johnson, S. L., Samtani, S., Anderson, R., & Moulds, M. L. (2018). Transdiagnostic assessment of repetitive negative thinking and responses to positive affect: Structure and predictive utility for depression, anxiety, and mania symptoms. Journal of Affective Disorders, 232, 375–384. https://doi.org/10.1016/j.jad.2018.02.072CrossRefPubMed McEvoy, P. M., Hyett, M. P., Ehring, T., Johnson, S. L., Samtani, S., Anderson, R., & Moulds, M. L. (2018). Transdiagnostic assessment of repetitive negative thinking and responses to positive affect: Structure and predictive utility for depression, anxiety, and mania symptoms. Journal of Affective Disorders, 232, 375–384. https://​doi.​org/​10.​1016/​j.​jad.​2018.​02.​072CrossRefPubMed
go back to reference O’Mahen, H. A., Karl, A., Moberly, N., & Fedock, G. (2015). The association between childhood maltreatment and emotion regulation: two different mechanisms contributing to depression? Journal of Affective Disorders, 174, 287–295. O’Mahen, H. A., Karl, A., Moberly, N., & Fedock, G. (2015). The association between childhood maltreatment and emotion regulation: two different mechanisms contributing to depression? Journal of Affective Disorders, 174, 287–295.
go back to reference Redlich, R., Opel, N., Bürger, C., Dohm, K., Grotegerd, D., Förster, K., Zaremba, D., Meinert, S., Repple, J., Enneking, V., Leehr, E., et al. (2018). The limbic system in youth depression: Brain structural and functional alterations in adolescent in-patients with severe depression. Neuropsychopharmacology, 43(3), 546–554. https://doi.org/10.1038/npp.2017.246CrossRefPubMed Redlich, R., Opel, N., Bürger, C., Dohm, K., Grotegerd, D., Förster, K., Zaremba, D., Meinert, S., Repple, J., Enneking, V., Leehr, E., et al. (2018). The limbic system in youth depression: Brain structural and functional alterations in adolescent in-patients with severe depression. Neuropsychopharmacology, 43(3), 546–554. https://​doi.​org/​10.​1038/​npp.​2017.​246CrossRefPubMed
go back to reference Ron de, J., Fried, E. I., & Epskamp, S. (2019). Psychological networks in clinical populations: A tutorial on the consequences of Berkson’s Bias. Psychological Medicine, 51(1), 168–176. Ron de, J., Fried, E. I., & Epskamp, S. (2019). Psychological networks in clinical populations: A tutorial on the consequences of Berkson’s Bias. Psychological Medicine, 51(1), 168–176.
go back to reference Spinhoven, P., Drost, J., de Rooij, M., van Hemert, A. M., & Penninx, B. W. J. H. (2016). Is experiential avoidance a mediating, moderating, independent, overlapping, or proxy risk factor in the onset, relapse and maintenance of depressive disorders? Cognitive Therapy and Research, 40(2), 150–163.CrossRefPubMed Spinhoven, P., Drost, J., de Rooij, M., van Hemert, A. M., & Penninx, B. W. J. H. (2016). Is experiential avoidance a mediating, moderating, independent, overlapping, or proxy risk factor in the onset, relapse and maintenance of depressive disorders? Cognitive Therapy and Research, 40(2), 150–163.CrossRefPubMed
go back to reference Tibshirani, R. (1996). Regression shrinkage and selection via the lasso. Journal of the Royal Statistical Society: Series B (methodological), 58(1), 267–288. Tibshirani, R. (1996). Regression shrinkage and selection via the lasso. Journal of the Royal Statistical Society: Series B (methodological), 58(1), 267–288.
go back to reference van Borkulo, C. D., Borsboom, D., Epskamp, S., Blanken, T. F., Boschloo, L., Schoevers, R. A., & Waldorp, L. J. (2014). A new method for constructing networks from binary data. Scientific Reports, 4, 5918.CrossRefPubMedPubMedCentral van Borkulo, C. D., Borsboom, D., Epskamp, S., Blanken, T. F., Boschloo, L., Schoevers, R. A., & Waldorp, L. J. (2014). A new method for constructing networks from binary data. Scientific Reports, 4, 5918.CrossRefPubMedPubMedCentral
go back to reference van Borkulo, C., Boschloo, L., Borsboom, D., Penninx, B. W., Waldorp, L. J., & Schoevers, R. A. (2015). Association of symptom network structure with the course of depression. JAMA Psychiatry, 72(12), 1219–1226.CrossRefPubMed van Borkulo, C., Boschloo, L., Borsboom, D., Penninx, B. W., Waldorp, L. J., & Schoevers, R. A. (2015). Association of symptom network structure with the course of depression. JAMA Psychiatry, 72(12), 1219–1226.CrossRefPubMed
Metagegevens
Titel
Symptom-Level Network Analysis Distinguishes Unique Associations of Repetitive Negative Thinking and Experiential Avoidance with Depression and Anxiety in a Transdiagnostic Clinical Sample
Auteurs
Kean J. Hsu
Michael Mullarkey
Mallory Dobias
Christopher G. Beevers
Thröstur Björgvinsson
Publicatiedatum
08-08-2022
Uitgeverij
Springer US
Gepubliceerd in
Cognitive Therapy and Research / Uitgave 6/2022
Print ISSN: 0147-5916
Elektronisch ISSN: 1573-2819
DOI
https://doi.org/10.1007/s10608-022-10323-y