Document Type : Research Paper

Authors

kharazmi university

Abstract

The aim of the present study was to investigate transdiagnostic role of repetitive negative thoughts, emotional dysregulation, intolerance of uncertainty, cognitive fusion and distress intolerance in depression and anxiety disorders. This study was causal-comparative. 149 patients with depression and anxiety disorders (included 37 patients with Major Depressive Disorder, 35 patients with Obsessive-Compulsive Disorder, 40 patients with Generalized Anxiety Disorder, 37 patients with Social Anxiety Disorder) selected by convenience sampling from eight psychiatric and psychological centers in Tehran. Then they compared with normal group (N=40) through Repetitive Negative Thoughts Questionnaire (RNTQ), Cognitive Fusion Questionnaire (CFQ), Difficulties in Emotion Regulation Scale (DERS), Intolerance Uncertainty Scale (IUS) and Distress Tolerance Scale (DTS). Data was analyzed using multivariate analysis of variance (MANOVA), ANOVA and Bonferroni tests. The results showed that participants in clinical groups weren’t together significant differences of repetitive negative thoughts, cognitive fusion and intolerance distress, but with normal groups were different. In addition, despite the fact that scores of intolerance of uncertainty in group of major depressive disorder was higher than normal group, but lower than anxiety disorders groups. In connection with the emotional dysregulation, results showed that only participants of group of major depressive disorder and generalized anxiety disorder were not different. Repetitive negative thoughts, cognitive fusion and intolerance distress are common transdiagnostic processes and play important role in development and maintenance in different depression and anxiety disorders.

Keywords

اکبری، مهدی؛ حمیدپور، حسن و اندوز، زهرا (1389). بررسی عوامل پیش‌بینی کننده نگرانی پاتولوژیک در دانشجویان. پنجمین سمینار سراسری بهداشت روانی دانشجویان، 22-24 اردیبهشت، دانشگاه علوم پزشکی تهران.
اکبری، مهدی؛ محمدخانی، شهرام؛ ضرغامی، فیروزه (1395). نقش واسطه‌ای آمیختگی شناختی در تبیین ارتباط بین بی‌نظمی هیجانی با اضطراب و افسردگی: یک عامل فراتشخیصی. مجله روان‌پزشکی و روان‌شناسی بالینی ایران، 84، صص 17-29.
سلیمانی، سمیرا (1393). نقش خودآگاهی و تنظیم هیجان در کنترل اضطراب دانشجویان. فرهنگ مشاوره و روان‌درمانی، 5 (20)، 65-51.
عزیزی، علیرضا؛ میرزایی، آزاده؛ شمس، جمال (1389). بررسی رابطه تحمل آشفتگی و تنظییم هیجانی با میزان وابستگی دانشجویان به سیگار. مجله پژوهشی حکیم، 13(1)، صص. 18-11.
عسگری، پرویز؛ پاشا، غلامرضا؛ امینیان، مریم (1388). رابطه تنظیم هیجانی، فشارزاهای روانی زندگی و تصویر بدن با اختلالات خوردن در زنان. اندیشه و رفتار (روان‌شناسی کاربردی). 4(13)، صص. 65-78.
مژدهی، رضا؛ اعتمادی، احمد؛ فلسفی­نژاد، محمدرضا (1390). بررسی میانجی‌های درمانی و اثربخشی درمان پذیرش و تعهد در کاهش علائم اختلال اضطراب فراگیر. فرهنگ مشاوره و روان‌درمانی، 2 (7)، 30-1.
Abbott, M.J., Rapee, R.M. (2004). Post–event rumination and negative self–appraisal in social phobia before and after treatment. Journal of Abnormal Psychology; 113:136–44.
Abramowitz, J.S., Whiteside, S., Kalsy, S.A., Tolin, D.F. (2003). Thought control strategies in obsessive–compulsive disorder: A replication and extension. Behaviour Research and Therapy; 41:529–40.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Washington, DC:Author;.
Anestis, M.D., Tull, M.T., Bagge, C.L, Gratz, K.L. (2012). The Moderating Role of Distress Tolerance in the Relationship between Posttraumatic Stress Disorder Symptom Clusters and Suicidal Behavior among Trauma Exposed Substance Users in Residential Treatment. Archives of Suicide Research; 16(3); 198-211.
Barlow, D.H. (1991).Disorders of emotion. Psychological Inquiry; 2:58–71.
Barlow, D.H., Farchione, T.J., Fairholme, C.P., Ellard, K.K., Boisseau, C.L., Allen, L.B., et al. (2011). The unified protocol for transdiagnostic treatment of emotional disorders: Therapist guide. New York: Oxford University Press
Boelen, P.A., Reijntjes, A. (2009). Intolerance of uncertainty and social anxiety. J Anxiety Disord. 2009; 23(1):130–35.
Buher, K., Dugas, M.J. (2006). Investigation the construct validity of intolerance of uncertainly and its unique relationship with worry. J Anxiety Disord; 20:223-34.
Buhr, K., Dugas, M.J. (2002). The intolerance of uncertainty scale: Psychometric properties of the English version. Behav Res Ther. 2002; 40(8):931–45.
Calmes, C.A., & Roberts, J.E. (2007). Repetitive thought and emotional distress: Rumination and worry as prospective predictors of depressive and anxious symptomatology. Cognit Ther Res. 2007; 31 (3):343–56.
Carleton, R.N., Gosselin, P., Asmundsen, G.J. (2010). The Intolerance of Uncertainty Index: Replication and extension with an English sample. Psychol Assess; 22(2):396–406.
Carleton, R.N., Mulvogue, M.K., Thibodeau, M.A., McCabe, R.E., Antony, M.M., Asmundson, G.J.G. (2012). Increasingly certain about uncertainty: intolerance of uncertainty across anxiety and depression. J Anxiety Disord; 26 (3):468–79.
Chen, C.Y., Hong, R.Y. (2010). Intolerance of uncertainty moderates the relation between negative life events and anxiety. Pers Individ Dif. 2010; 49(1):49–53.
Cougle, J.R., Timpano, K.R., Fitch, K.E., Hawkins, K.A. (2011). Distress tolerance and obsessions: an integrative analysis. Depression and Anxiety; 28:906–14.
Dalrymple, K.L., Herbert, J.D. (2007). Acceptance and commitment therapy for generalized social anxiety disorder: A pilot study. Behav Modif; 31(5):543–68.
De Jong-Meyer, R., Beck, B., Riede, K. (2009). Relationships between rumination, worry, intolerance of uncertainty and metacognitive beliefs. Pers Individ Dif; 46(4):547–51.
Dugas, M.J., Robichaud, M. (2007). Cognitive-behavioral treatment for generalized anxiety disorder: From science to practice. New York: Rutledge.
Ehring, T., &Watkins, E.R. (2008). Repetitive negative thinking as a transdiagnostic process. Int J Cogn Ther; 1(3):192-205.
Ehring, T., Welboren, R., Morina, N., Wicherts, J.M., Freitag, J., Emmelkamp, P.M.G. (2014). Meta-analysis of psychological treatments for posttraumatic stress disorder in adult survivors of childhood abuse. Clinical Psychology Review; 34: 645-57.
Ehring, T., Zetsche, U., Weidacker, K., Wahl, K., Schönfeld, S., & Ehlers, A. (2011). The Pereservative Thinking Questionnaire: Validation of a content-independent measure of repetitive negative thinking. J Behav Ther Exp Psychiatry; 42(2):225-32.
Ellis, A.J., Vanderlind, W.M., Beevers, C.G. (2013). Enhanced anger reactivity and reduced distress tolerance in major depressive disorder. Cognitive Therapy and Research; 37(3): 498-509.
 Gadermann, A. M., Alonso, J., Vilagut, G., Zaslavsky, A.M., & Kessler, R.C. (2012). Comorbidity and disease burden in the National Comorbidity Survey Replication (NCS-R). Depression & Anxiety, 29(9): 797-806.
Garnefski, N., Kraaij, V. (2006). Relationships between cognitive emotion regulation strategies and depressive symptoms: A comparative study of five specific samples. Pers Individ Dif; 40 (8):1659–69.
Gaudiano, B.A, Herbert, J.D. (2006). Believability of hallucinations as a potential mediator of their frequency and associated distress in psychotic inpatients. Behav Cogn Psychother; 34(4):497–502.
Gentes, E.L., Ruscio, A.M. (2011). A meta-analysis of the relation of intolerance of uncertainty to symptoms of generalized anxiety disorder, major depressive disorder, and obsessive–compulsive disorder. Clin Psychol Rev; 31 (6):923–33.
Gillanders, D., Bolderston, H., Bond, F.W., Dempster, M., Flaxman, P., Campbell, L., Kerr, S., Tansey, L., Noel, P., Ferenbach, C., Masley, S., Roach, L., Lloyd, J., May, L., Clarke, S., Remington, B. (2014). The Development and Initial Validation of the Cognitive Fusion Questionnaire. Behav Ther. 2014. 45(1):83–101.
Gratz, K.L., Roemer, L. (2004). Multidimensional assessment of emotion regulation a dysregulation: development, factor structure, and initial validation of the difficulties in emotion regulation scale. J Psychopathol Behav Assess; 26 (1):41–54.
Gross, J.J., Thompson, R.A. (2007). Emotion regulation: Conceptual foundations. In: Gross JJ, editor. Handbook of emotion regulation. New York: Guilford Press; p.115-45.
Harvey, A.G., Watkins, E., Mansell, W., & Shafran, R. (2004). Cognitive behavioural processes across psychological disorders. Oxford, UK: Oxford University Press.
Hayes, S.C. (2004). Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies. Behav Ther; 35(4):639-65.
Hayes, S.C., Pankey, J. (2002). Experiential avoidance, cognitive fusion, and an ACT approach to anorexia nervosa. Cogn Behav Pract; 9(3):243–47.
Hayes, S.C., Strosahl, K.D., Wilson, K.G. (2012). Acceptance and commitment therapy: the process and practice of mindful change (2nd Ed). New York: Guilford.
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. J Consult Clin Psychol; 64 (6):1152-68.
Herbert, J.D., Cardaciotto, L. (2005). An acceptance and mindfulness-based perspective on social anxiety disorder. In: S. M. Orsillo, & L. Roemer (Eds.), Acceptance and mindfulness-based approaches to anxiety: conceptualization and treatment (pp. 189–212). New York, NY: Springer Science þ Business Media.
Herbert, J.D., Forman, E.M. (2011).The evolution of cognitive behavior therapy: the rise of psychological acceptance and mindfulness. In: J. D. Herbert, & E. M. Forman (Eds.), Acceptance and mindfulness in cognitive behavior therapy: understanding and applying the new therapies (pp. 3–25). Hoboken, NJ: Wiley.
Johnston, M., Foster, M., Shennan, J., Starkey, N.J., Johnson, A. (2010). The effectiveness of an acceptance and commitment therapy self-help intervention for chronic pain. Clin J Pain; 26(5):393–402.
Joormann, J., Gotlib, I.H. (2010). Emotion regulation in depression: relation to cognitive inhibition. Cogn Emot; 24(2):281-98.
Kaiser, A.J., Milich, R., Lynam, DR., Charnigo, R.J. (2012). Negative Urgency, Distress Tolerance, and substance
abuse among college students. Addictive Behaviors; 37:1075-83.
Kessler, R C., & Bromet, E. J. (2013). The epidemiology of depression across cultures. Annual Review of Public Health, 34:119-38.
Khaleghi, S., Liaghat, R., Ganjdanesh, Y. (2011). The Repetitive Thinking Questionnaire: Psychometric properties in Iranian Students and Relationship with depression, Anxiety and Social Anxiety. 2nd International Conference on Psychiatry and Psychotherapy-PSYCHO 2011. University of Cambridge, Cambridge, UK, February 23-25.
Koerner N, Dugas MJ. (2008). An investigation of appraisals in individuals vulnerable to excessive worry: the role of intolerance of uncertainty. Cognit Ther Res; 32 (5):619-38.
Kring, A.M., Sloan, D.M. (2010). Emotion regulation in psychopathology: A transdiagnostic approach to etiology and treatment. New York: Guilford.
Ladouceur, R., Gosselin, P., Dugas, M.J. (2000). Experimental manipulation of intolerance of uncertainty: a study of a theoretical model of worry. Behav Res Ther; 38 (9):933-41.
Laposa, J.M., Collimore, K.C., Hawley, L.L., Rector, N.A. (2015). Distress tolerance in OCD and anxiety disorders, and its relationship with anxiety sensitivity and intolerance of uncertainty. Journal of Anxiety Disorders; 33:8-14.
Larsson, A., Hooper, N., Osborne, L.A., Bennett, P., McHugh, L. (2016). Using Brief Cognitive Restructuring and Cognitive Defusion Techniques to Cope With Negative Thoughts. Behav Modif.; 40(3):452-82.
Mansell, W., Harvey, A., Watkins, E., &Shafran, R. (2009). Cognitive Behavioral Processes across Psychological Disorders: A Review of the Utility and Validity of the Transdiagnostic Approach. Int J Cogn Ther; 1(3):181–91.
Masuda, A., Hayes, S.C., Twohig, M.P., Drossel, C., Lillis, J., Washio, Y. (2009). A parametric study of cognitive defusion and the believability and discomfort of negative self-relevant thoughts. Behavior Modification; 33(2):250-62.
Masuda, A., Twohig, M.P., Stormo, A.R., Feinstein, A.B., Chou, Y.Y., Wendell, J.W. (2010). The effects of cognitive defusion and thought distraction on emotional discomfort and believability of negative self-referential thoughts. Journal of Behavior Therapy and Experimental Psychiatry; 41(1):11–7.
McEvoy, P.M., Mahoney, A., Perini, S.J., & Kingsep, P. (2009). Changes in post-event processing and metacognitions during cognitive behavioural group therapy for social phobia. J Anxiety Disord; 23(5):617-23.
McEvoy, P.M., Mahoney, A.E.J. (2013). Intolerance of uncertainty and negative metacognitive beliefs as transdiagnostic mediators of repetitive negative thinking in a clinical sample with anxiety disorders. J Anxiety Disord; 27(2):216–24.
McEvoy, P.M., Mahoney, A.E.J. (2013). Intolerance of uncertainty and negative metacognitive beliefs as transdiagnostic mediators of repetitive negative thinking in a clinical sample with anxiety disorders. J Anxiety Disord; 27(2):216–24.
McEvoy, P.M., Mahoney, A.E.J., Moulds, M.L. (2010). Are worry, rumination, and post-event processing one and the same? Development of the repetitive thinking questionnaire. J Anxiety Disord; 24 (5):509-19.
Nolen-Hoeksema, S., Wisco, B.E., & Lyubomirsky, S. (2008). Rethinking rumination. Perspect Psychol Sci; 3(5):400-24.
Raes F. (2012). Repetitive Negative Thinking Predicts Depressed Mood at 3-Year Follow-up in Students. J Psychopathol Behav Assess; 34(4):497–501.
Reinholt, N., Krogh, J. (2014). Efficacy of Transdiagnostic Cognitive Behavior Therapy for Anxiety Disorders: A Systematic Review and Meta-Analysis of Published Outcome Studies. Journal of Cognitive Behaviour Therapy; 35:453-63.
Ruscio, A.M., Seitchik, A.E., Gentes, E.L., Jones, J.D., Hallion, L.S. (2011). Preservative thought: a robust predictor of response to emotional challenge in generalized anxiety disorder and major depressive disorder. Behav Res Ther; 49(12):867-74.
Simons, J.S., Gaher, R.M. (2005). The Distress Tolerance Scale: development and validation of a self-report measure. Motivation and Emotion; 29:83–102.
Spasojevic, J., &Alloy, L.B. (2001). Rumination as a common mechanism relating depressive risk factors to depression. Emotion; 1 (1):25–37.
Tabachnick, B.G., Fidell, L.S. (2007). Using multivariate statistics (5th ed). Boston: Allyn and Bacon.
Twohig, M.P. (2009). Acceptance and commitment therapy for treatment-resistant posttraumatic stress disorder: A case study. Cognitive and Behavioral Practice; 16:243–52.
Twohig, M.P., Hayes, S.C., Masuda, A. (2006). Increasing willingness to experience obsessions: Acceptance and commitment therapy as a treatment for obsessive–compulsive disorder. Behav Ther; 37(1):3–13.
Twohig, M.P., Shoenberger, D., Hayes, S.C. (2007). A preliminary investigation of acceptance and commitment therapy as a treatment for marijuana dependence in adults. J Appl Behav Anal; 40(4):619–32.
Wells, A. (2009). Metacognitive therapy for anxiety and depression. New York: Guilford press.
Zettle, R.D, Rains, J.C. (1989). Group cognitive and contextual therapies in treatment of depression. J Clin Psychol; 45(3):438–45.
Zvolensky, M.J., Bernstein, A., Vujanovic, A.A. (2011). Distress tolerance: Theory, Research, and Clinical Application, New York: Guilford Press.