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An experience sampling study of worry and rumination in psychosis

Published online by Cambridge University Press:  19 August 2013

S. Hartley ,
G. Haddock ,
D. Vasconcelos e Sa ,
R. Emsley  and
C. Barrowclough
S. Hartley*
Affiliation:
Division of Clinical Psychology, University of Manchester, UK Greater Manchester West Mental Health NHS Foundation Trust, UK
G. Haddock
Affiliation:
Division of Clinical Psychology, University of Manchester, UK Manchester Mental Health and Social Care Trust, UK
D. Vasconcelos e Sa
Affiliation:
Division of Clinical Psychology, University of Manchester, UK
R. Emsley
Affiliation:
Centre for Biostatistics, University of Manchester and Manchester Academic Health Sciences Centre, UK
C. Barrowclough
Affiliation:
Division of Clinical Psychology, University of Manchester, UK Manchester Mental Health and Social Care Trust, UK
*
*Address for correspondence: S. Hartley, Ph.D., Division of Clinical Psychology, 2nd Floor, Zochonis Building, University of Manchester, Brunswick Street, Manchester M13 9PL, UK. (Email: samantha.hartley@manchester.ac.uk)
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Abstract

Background

Increasing research effort is being dedicated to investigating the links between emotional processes and psychosis, despite the traditional demarcation between the two. Particular focus has alighted upon two specific anxious and depressive processes, worry and rumination, given the potential for links with aspects of delusions and auditory hallucinations. This study rigorously explored the nature of these links in the context of the daily life of people currently experiencing psychosis.

Method

Experience sampling methodology (ESM) was used to assess the momentary links between worry and rumination on the one hand, and persecutory delusional ideation and auditory hallucinations on the other. Twenty-seven participants completed the 6-day experience sampling period, which required repeated self-reports on thought processes and experiences. Multilevel modelling was used to examine the links within the clustered data.

Results

We found that antecedent worry and rumination predicted delusional and hallucinatory experience, and the distress they elicited. Using interaction terms, we have shown that the links with momentary symptom severity were moderated by participants' trait beliefs about worry/rumination, such that they were reduced when negative beliefs about worry/rumination (meta-cognitions) were high.

Conclusions

The current findings offer an ecologically valid insight into the influence of worry and rumination on the experience of psychotic symptoms, and highlight possible avenues for future intervention strategies.

Keywords

Auditory hallucinationdelusionecological momentary assessmentexperience sampling methodologymeta-cognitionpsychosisruminationworry
Type
Original Articles
Information
Psychological Medicine , Volume 44 , Issue 8 , June 2014 , pp. 1605 - 1614
Copyright
Copyright © Cambridge University Press 2013 

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References

Barrett, DJ, Feldman Barrett, L (2000). The Experience-Sampling Program (ESP) (http://www.experience-sampling.org/). Accessed January 2011.Google Scholar
Becker, ES, Rinck, M, Roth, WT, Margraf, J (1998). Don't worry and beware of white bears: thought suppression in anxiety patients. Journal of Anxiety Disorders 12, 39–55.CrossRefGoogle ScholarPubMed
Belzer, KD, D'Zurilla, TJ, Maydeu-Olivares, A (2002). Social problem solving and trait anxiety as predictors of worry in a college student population. Personality and Individual Differences 33, 573–585.Google Scholar
Ben-Zeev, D, Ellington, K, Swendsen, J, Granholm, E (2011). Examining a cognitive model of persecutory ideation in the daily life of people with schizophrenia: a computerized experience sampling study. Schizophrenia Bulletin 37, 1248–1256.CrossRefGoogle ScholarPubMed
Chadwick, P, Taylor, KN, Abba, N (2005). Mindfulness groups for people with psychosis. Behavioural and Cognitive Psychotherapy 33, 351–359.Google Scholar
Cribb, G, Moulds, ML, Carter, S (2006). Rumination and experiential avoidance in depression. Behaviour Change 23, 165–176.Google Scholar
Csikszentmihalyi, M, Larson, R (1987). Validity and reliability of the experience-sampling method. Journal of Nervous and Mental Disease 175, 526–536.Google Scholar
Delespaul, P, deVries, M, van Os, J (2002). Determinants of occurrence and recovery from hallucinations in daily life. Social Psychiatry and Psychiatric Epidemiology 37, 97–104.CrossRefGoogle ScholarPubMed
deVries, M, Delespaul, P (1989). Time, context, and subjective experience in schizophrenia. Schizophrenia Bulletin 15, 233–244.Google Scholar
Donaldson, C, Lam, D (2004). Rumination, mood and social problem-solving in major depression. Psychological medicine 34, 1309–1318.Google Scholar
Donaldson, C, Lam, D, Mathews, A (2007). Rumination and attention in major depression. Behaviour Research and Therapy 45, 2664–2678.Google Scholar
Field, AP (2009). Discovering Statistics Using SPSS. SAGE Publications: London.Google Scholar
Flavell, JH (1979). Metacognition and cognitive monitoring: a new area of cognitive-developmental inquiry. American Psychologist 34, 906–911.CrossRefGoogle Scholar
Foster, C, Startup, H, Potts, L, Freeman, D (2010). A randomised controlled trial of a worry intervention for individuals with persistent persecutory delusions. Journal of Behavior Therapy and Experimental Psychiatry 41, 45–51.Google Scholar
Foulds, GA, Bedford, A (1976). Classification of depressive illness: a re-evaluation. Psychological Medicine 6, 15–19.Google Scholar
Freeman, D, Garety, PA (1999). Worry, worry processes and dimensions of delusions: an exploratory investigation of a role for anxiety processes in the maintenance of delusional distress. Behavioural and Cognitive Psychotherapy 27, 47–62.Google Scholar
Freeman, D, Garety, PA (2003). Connecting neurosis and psychosis: the direct influence of emotion on delusions and hallucinations. Behaviour Research and Therapy 41, 923–947.Google Scholar
Freeman, D, Pugh, K, Antley, A, Slater, M, Bebbington, P, Gittins, M, Dunn, G, Kuipers, E, Fowler, D, Garety, P (2008). Virtual reality study of paranoid thinking in the general population. British Journal of Psychiatry 192, 258–263.Google Scholar
Freeman, D, Stahl, D, McManus, S, Meltzer, H, Brugha, T, Wiles, N, Bebbington, P (2012). Insomnia, worry, anxiety and depression as predictors of the occurrence and persistence of paranoid thinking. Social Psychiatry and Psychiatric Epidemiology 47, 1195–1203.Google Scholar
Gana, K, Martin, B, Canouet, MD (2001). Worry and anxiety: is there a causal relationship? Psychopathology 34, 221–229.Google Scholar
Granholm, E, Ben-Zeev, D, Link, PC, Bradshaw, KR, Holden, JL (2012). Mobile Assessment and Treatment for Schizophrenia (MATS): a pilot trial of an interactive text-messaging intervention for medication adherence, socialization, and auditory hallucinations. Schizophrenia Bulletin 38, 414–425.Google Scholar
Haddock, G, McCarron, J, Tarrier, N, Faragher, EB (1999). Scales to measure dimensions of hallucinations and delusions: the Psychotic Symptom Rating Scales (PSYRATS). Psychological Medicine 29, 879–889.Google Scholar
Hartley, S, Haddock, G, Barrowclough, C (2012). Anxiety and depression and their links with delusions and hallucinations in people with a dual diagnosis of psychosis and substance misuse: a study using data from a randomised controlled trial. Behaviour Research and Therapy 50, 65–71.Google Scholar
Hepworth, C, Startup, H, Freeman, D (2011). Developing treatments of persistent persecutory delusions: the impact of an emotional processing and metacognitive awareness intervention. Journal of Nervous and Mental Disease 199, 653–658.Google Scholar
Jones, SR, Fernyhough, C (2009). Rumination, reflection, intrusive thoughts, and hallucination-proneness: towards a new model. Behaviour Research and Therapy 47, 54–59.CrossRefGoogle ScholarPubMed
Kay, SR, Opler, LA, Fiszbein, A (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin 13, 261–276.CrossRefGoogle ScholarPubMed
Kelly, J, Gooding, P, Pratt, D, Ainsworth, J, Welford, M, Tarrier, N (2012). Intelligent real-time therapy: harnessing the power of machine learning to optimise the delivery of momentary cognitive-behavioural interventions. Journal of Mental Health 21, 404–414.Google Scholar
Kimhy, D, Myin-Germeys, I, Palmier-Claus, J, Swendsen, J (2012). Mobile assessment guide for research in schizophrenia and severe mental disorders. Schizophrenia Bulletin 38, 386–395.CrossRefGoogle ScholarPubMed
Kraepelin, E (1919). Manic-Depressive Insanity and Paranoia (trans. R. M. Barclay) . Livingstone: Edinburgh.Google Scholar
Larøi, F, Van der Linden, M (2005). Metacognitions in proneness towards hallucinations and delusions. Behaviour Research and Therapy 43, 1425–1441.Google Scholar
Lobban, F, Haddock, G, Kinderman, P, Wells, A (2002). The role of metacognitive beliefs in auditory hallucinations. Personality and Individual Differences 32, 1351–1363.CrossRefGoogle Scholar
Lyubomirsky, S, Kasri, F, Zehm, K (2003). Dysphoric rumination impairs concentration on academic tasks. Cognitive Therapy and Research 27, 309–330.CrossRefGoogle Scholar
Mellings, TMB, Alden, LE (2000). Cognitive processes in social anxiety: the effects of self-focus, rumination and anticipatory processing. Behaviour Research and Therapy 38, 243–257.Google Scholar
Moberly, NJ, Watkins, ER (2008). Ruminative self-focus and negative affect: an experience sampling study. Journal of Abnormal Psychology 117, 314–323.Google Scholar
Morrison, AP, Wells, A (2007). Relationships between worry, psychotic experiences and emotional distress in patients with schizophrenia spectrum diagnoses and comparisons with anxious and non-patient groups. Behaviour Research and Therapy 45, 1593–1600.Google Scholar
Moulds, ML, Kandris, E, Starr, S, Wong, ACM (2007). The relationship between rumination, avoidance and depression in a non-clinical sample. Behaviour Research and Therapy 45, 251–261.Google Scholar
Myin-Germeys, I, Delespaul, P, van Os, J (2003 a). The experience sampling method in psychosis research. Current Opinion in Psychiatry 16, S33–S38.CrossRefGoogle Scholar
Myin-Germeys, I, Oorschot, M, Collip, D, Lataster, J, Delespaul, P, van Os, J (2009). Experience sampling research in psychopathology: opening the black box of daily life. Psychological Medicine 39, 1533–1547.Google Scholar
Myin-Germeys, I, Peeters, F, Havermans, R, Nicolson, NA, deVries, MW, Delespaul, P, van Os, J (2003 b). Emotional reactivity to daily life stress in psychosis and affective disorder: an experience sampling study. Acta Psychiatrica Scandinavica 107, 124–131.CrossRefGoogle ScholarPubMed
Nolen-hoeksema, S, Morrow, J (1993). Effects of rumination and distraction on naturally occurring depressed mood. Cognition and Emotion 7, 561–570.Google Scholar
Oorschot, M, Lataster, T, Viviane, T, Wichers, M, Myin-Germeys, I (2012). Mobile assessment in schizophrenia: a data-driven momentary approach. Schizophrenia Bulletin 38, 405–413.Google Scholar
Palmier-Claus, JE, Myin-Germeys, I, Barkus, E, Bentley, L, Udachina, A, Delespaul, PAEG, Lewis, SW, Dunn, G (2010). Experience sampling research in individuals with mental illness: reflections and guidance. Acta Psychiatrica Scandinavica 123, 12–20.Google Scholar
Papageorgiou, C, Wells, A (2001). Metacognitive beliefs about rumination in recurrent major depression. Cognitive and Behavioural Practice 8, 160–164.Google Scholar
Papageorgiou, C, Wells, A (2003). An empirical test of a clinical metacognitive model of rumination and depression. Cognitive Therapy and Research 27, 261–273.Google Scholar
Peters, ER, Williams, SL, Cooke, MA, Kuipers, E (2012). It's not what you hear, it's the way you think about it: appraisals as determinants of affect and behaviour in voice hearers. Psychological Medicine 42, 1013–1023.CrossRefGoogle Scholar
Smith, B, Fowler, D, Freeman, D, Bebbington, PE, Bashworth, H, Garety, PA, Dunn, G, Kuipers, E (2006). Emotion and psychosis: links between depression, self-esteem, negative schematic beliefs and delusions and hallucinations. Schizophrenia Research 86, 181–188.Google Scholar
Soppitt, RW, Birchwood, M (1997). Depression, beliefs, voice content and topography: a cross-sectional study of schizophrenic patients with auditory verbal hallucinations. Journal of Mental Health 6, 525–532.Google Scholar
Stapinski, LA, Abbott, MJ, Rapee, RM (2010). Evaluating the cognitive avoidance model of generalised anxiety disorder: impact of worry on threat appraisal, perceived control and anxious arousal. Behaviour Research and Therapy 48, 1032–1040.Google Scholar
Startup, H, Freeman, D, Garety, PA (2007). Persecutory delusions and catastrophic worry in psychosis: developing the understanding of delusion distress and persistence. Behaviour Research and Therapy 45, 523–537.Google Scholar
Treynor, W, Gonzalez, R, Nolen-Hoeksema, S (2003). Rumination reconsidered: a psychometric analysis. Cognitive Therapy and Research 27, 247–259.Google Scholar
Verkuil, B, Brosschot, JF, Putman, P, Thayer, JF (2009). Interacting effects of worry and anxiety on attentional disengagement from threat. Behaviour Research and Therapy 47, 146–152.CrossRefGoogle ScholarPubMed
Watkins, E (2004). Adaptive and maladaptive ruminative self-focus during emotional processing. Behaviour Research and Therapy 42, 1037–1052.CrossRefGoogle ScholarPubMed
Wells, A (2005). The metacognitive model of GAD: assessment of meta-worry and relationship with DSM-IV generalized anxiety disorder. Cognitive Therapy and Research 29, 107–121.CrossRefGoogle Scholar
Wells, A, Papageorgiou, C (1995). Worry and the incubation of intrusive images following stress. Behaviour Research and Therapy 33, 579–583.Google Scholar