Interventions Targeting Repetitive Negative Thinking Affect Depression, Anxiety

A systematic review and meta-analysis published in Psychology Medicine found that among adolescents and young adults, reducing repetitive negative thinking (RNT) with psychological interventions associated with improvements to symptoms of depression and anxiety.

Investigators from the University of Melbourne in Australia searched the Orygen Evidence Finder which populated relevant articles from publication databases published through June 2020. A total of 28 articles that evaluated psychological treatments for RNT, depression, and anxiety among adolescents were included.

The pooled study sample comprised 2498 patients with a mean age of 19.70 (SD, 3.71) years and 76% were girls or women. The studies included patients with RNT (n=24), anxiety (n=20), and depression (n=17).

The overall effect sizes of treatment on the conditions were similar, in which the greatest effect size was observed for depression (g, -0.47; 95% CI, -0.77 to -0.17; I², 88.82%; P <.001), followed by RNT (g, -0.45; 95% CI, -0.067 to -0.23; I², 84.81%; P <.001) and anxiety (g, -0.42; 95% CI, -0.65 to -0.20; I², 81.67%; P <.001).

In subgroup analyses, significant interactions were observed for content versus process interventions (P =.01) and intervention format (P =.02). Overall, a significant effect on RNT outcomes were observed for process-focused interventions (g, -0.85; 95% CI, -1.29 to -0.41; I², 89.45%) but not content-focused interventions (g, -0.13; 95% CI, -0.28 to 0.01; I², 38.28%). All intervention formats had significant effects on RNT outcomes, with the highest observed for group interventions (g, -1.35; 95% CI, -2.29 to -0.41; I², 95.16%), followed by individual (g, -0.56; 95% CI, -1.11 to -0.01; I², 81.08%) and digital or self-guided (g, -0.24; 95% CI, -0.44 to -0.04; I², 72.12%) interventions.

In general, significant positive relationships between RNT and depression outcomes were observed (Z, 2.01; P =.04). In interventions that focused on RNT outcomes, both depression (Z, 2.32; P =.02) and anxiety (Z, 2.15; P =.03) outcomes were positively related with RNT outcomes.

The limitation of this review was the small number of studies and the high level of interstudy heterogeneity.

Study authors concluded, “The current findings suggest that reducing RNT using a variety of psychological treatment approaches may help improve depression and anxiety in youth. The significant relationship between reductions in RNT and improvements in depression and anxiety highlights the clinical significance of RNT as a transdiagnostic target in psychological treatment for youth, although further research is needed to determine whether this relationship is causal.”