Abstract
Background
Repetitive negative thinking (RNT) contributes significantly to anxiety and depression. The Perseverative Thinking Questionnaire (PTQ) was developed as a measure of the content-independent form of RNT. The current study aimed to validate a Chinese version of the PTQ and to examine a transdiagnostic model of anxiety and depression with a focus on the effects of RNT and intolerance of uncertainty (IU).
Methods
We first validated a Chinese version of the PTQ in two Chinese-speaking samples recruited using a web-based data collection method. We then examined the mediating effect of RNT in the relationship between IU and symptoms of anxiety and depression in these two samples.
Results
The results provided evidence of reliability and validity of the Chinese version of the PTQ. A modified second-order model of the PTQ (Chinese version) was supported. Mediation analysis demonstrated that RNT partially mediated the association between IU and symptoms of anxiety and depression.
Conclusions
The validation of the Chinese version of the PTQ enables assessment of content-independent RNT in Chinese-speaking samples. Further, the current findings showed that IU and RNT together contributed to greater severity of anxiety and depression, providing implications for potential treatment avenues for emotional disorders.
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Data Availability
Data of the current study are included in supplementary materials.
Notes
A total of 640 participants completed the test, while 40 participants failed to pass the attention check and thus were excluded.
A total of 415 participants completed the test, while 15 participants failed to pass the attention check and thus were excluded.
References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. American Psychiatric Association
Altan-Atalay, A., & Saritas-Atalar, D. (2018). Psychometric qualities of turkish version of perseverative thinking questionnaire (PTQ). Journal of Rational-Emotive and Cognitive-Behavior Therapy, 36, 252–266. https://doi.org/10.1007/s10942-018-0285-7
Beck, A. T., Epstein, N., Brown, G., & Steer, R. A. (1988). An inventory for measuring clinical anxiety: psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893–897. https://doi.org/10.1037/0022-006X.56.6.893
Borkovec, T. D., Alcaine, O. M., & Behar, E. (2004). Avoidance Theory of Worry and Generalized Anxiety Disorder. In R. G. Heimberg, C. L. Turk, & D. S. Mennin (Eds.), Generalized anxiety disorder: Advances in research and practice (pp. 77–108). The Guilford Press
Borkovec, T. D., Robinson, E., Pruzinsky, T., & DePree, J. A. (1983). Preliminary exploration of worry: Some characteristics and processes. Behaviour Research and Therapy, 21, 9–16. https://doi.org/10.1016/0005-7967(83)90121-3
Brown, T. A., & Naragon-Gainey, K. (2013). Evaluation of the unique and specific contributions of dimensions of the triple vulnerability model to the prediction of DSM-IV anxiety and mood disorder constructs. Behavior Therapy, 44, 277–292. https://doi.org/10.1016/j.beth.2012.11.002
Carleton, R. N. (2016). Into the unknown: A review and synthesis of contemporary models involving uncertainty. Journal of Anxiety Disorders, 39, 30–43. https://doi.org/10.1016/j.janxdis.2016.02.007
Carleton, R. N., Norton, M. P. J., & Asmundson, G. J. (2007). Fearing the unknown: A short version of the Intolerance of Uncertainty Scale. Journal of Anxiety Disorders, 21, 105–117. https://doi.org/10.1016/j.janxdis.2006.03.014
Dai, Q., Feng, Z., Xu, S., Xie, J., Liu, K., Yu, Y. … Han, Z. (2015). The reliability and validity of the Chinese version ruminative response scale (RRS) in undergraduates. China Journal of Health Psychology, 23, 753–758. https://doi.org/10.13342/j.cnki.cjhp.2015.05.031
Dar, K. A., Iqbal, N., & Mushtaq, A. (2017). Intolerance of uncertainty, depression, and anxiety: Examining the indirect and moderating effects of worry. Asian Journal of Psychiatry, 29, 129–133. https://doi.org/10.1016/j.ajp.2017.04.017
Devynck, F., Kornacka, M., Baeyens, C., Serra, das, Neves, J. F., Gaudrat, B. … Romo, L. (2017). Perseverative thinking questionnaire (PTQ): French validation of a transdiagnostic measure of repetitive negative thinking. Frontiers in Psychology, 8, 2159–2159. https://doi.org/10.3389/fpsyg.2017.02159
Ehring, T., Raes, F., Weidacker, K., & Emmelkamp, P. M. G. (2012). Validation of the Dutch Version of the Perseverative Thinking Questionnaire (PTQ-NL). European Journal of Psychological Assessment, 28, 102–108. https://doi.org/10.1027/1015-5759/a000097
Ehring, T., & Watkins, E. R. (2008). Repetitive negative thinking as a transdiagnostic process. International Journal of Cognitive Therapy, 1, 192–205. https://doi.org/10.1680/ijct.2008.1.3.192
Ehring, T., Zetsche, U., Weidacker, K., Wahl, K., Schönfeld, S., & Ehlers, A. (2011). The Perseverative Thinking Questionnaire (PTQ): Validation of a content-independent measure of repetitive negative thinking. Journal of Behavior Therapy and Experimental Psychiatry, 42, 225–232. https://doi.org/10.1016/j.jbtep.2010.12.003
Einstein, D. A. (2014). Extension of the transdiagnostic model to focus on intolerance of uncertainty: A review of the literature and implications for treatment. Clinical Psychology, 21(3), 280–300. https://doi.org/10.1111/cpsp.12077
Groves, D., Clark, L. H., & Clark, G. I. (2020). The relationship between worry and intolerance of uncertainty subtypes. Australian Psychologist, 55, 132–142. https://doi.org/10.1111/ap.12421
Harvey, A., Watkins, E., Mansell, W., & Shafran, R. (2004). Cognitive Behavioural Processes Across Psychological Disorders: A Transdiagnostic Approach to Research And Treatment. Oxford: Oxford University Press
Huang, V., Yu, M., Carleton, R. N., & Beshai, S. (2019). Intolerance of uncertainty fuels depressive symptoms through rumination: Cross-sectional and longitudinal studies. PLOS ONE, 14, e0224865. https://doi.org/10.1371/journal.pone.0224865
Jaso, B. A., Hudiburgh, S. E., Heller, A. S., & Timpano, K. R. (2019). ;2020;). The relationship between affect intolerance, maladaptive emotion regulation, and psychological symptoms. International Journal of Cognitive Therapy, 13(1), 67–82. https://doi.org/10.1007/s41811-019-00061-7
Kertz, S. J., Bigda-Peyton, J. S., Rosmarin, D. H., & Björgvinsson, T. (2012). The importance of worry across diagnostic presentations: Prevalence, severity and associated symptoms in a partial hospital setting. Journal of Anxiety Disorder, 26, 126–133. https://doi.org/10.1016/j.janxdis.2011.10.005
Kornacka, M., Buczny, J., & Layton, R. L. (2016). Assessing repetitive negative thinking using categorical and transdiagnostic approaches: A comparison and validation of three Polish language adaptations of self-report questionnaires. Frontiers in Psychology, 7, 322–322. https://doi.org/10.3389/fpsyg.2016.00322
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9: validity of a brief depression severity measure. Journal of General Internal Medicine, 16, 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
Liao, K. Y., & Wei, M. (2011). Intolerance of uncertainty, depression, and anxiety: The moderating and mediating roles of rumination. Journal of Clinical Psychology, 67, 1220–1239. https://doi.org/10.1002/jclp.20846
Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the Depression Anxiety Stress Scales. Sydney, New South Wales, Australia: Psychology Foundation
McEvoy, P. M., Hyett, M. P., Shihata, S., Price, J. E., & Strachan, L. (2019). The impact of methodological and measurement factors on transdiagnostic associations with intolerance of uncertainty: A meta-analysis. Clinical Psychology Review, 73, 101778. https://doi.org/10.1016/j.cpr.2019.101778
McEvoy, P. M., Watson, H., Watkins, E. R., & Nathan, P. (2013). The relationship between worry, rumination, and comorbidity: evidence for repetitive negative thinking as a transdiagnostic construct. Journal of Affective Disorders, 151(1), 313–320. https://doi.org/10.1016/j.jad.2013.06.014
Meng, X., Rosenthal, R., & Rubin, D. B. (1992). Comparing correlated correlation coefficients. Psychological Bulletin, 111, 172–175. https://doi.org/10.1037/0033-2909.111.1.172
Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and validation of the penn state worry questionnaire. Behaviour Research and Therapy, 28, 487–495. https://doi.org/10.1016/0005-7967(90)90135-6
Muris, P., Roelofs, J., Meesters, C., & Boomsma, P. (2004). Rumination and Worry in Nonclinical Adolescents. Cognitive Therapy and Research, 28, 539–554. https://doi.org/10.1023/B:COTR.0000045563.66060.3e
Nolen-Hoeksema, S. (2004). The response styles theory. In C. Papageorgiou, & A. Wells (Eds.), Depressive rumination: Nature, theory and treatment (pp. 107–123). Chichester, UK: Wiley
Olatunji, B. O., Naragon-Gainey, K., & Wolitzky-Taylor, K. B. (2013). Specificity of rumination in anxiety and depression: A multimodal meta-analysis. Clinical Psychology: Science and Practice, 20(3), 225–257. https://doi.org/10.1111/cpsp.12037
Shihata, S., McEvoy, P., Mullan, B., & Carleton, R. (2016). Intolerance of uncertainty in emotional disorders: What uncertainties remain? Journal of Anxiety Disorders, 41, 115–124. https://doi.org/10.1016/j.janxdis.2016.05.001
Spitzer, R., Kroenke, K., Williams, J., & Lowe, B. (2006). A Brief Measure for Assessing Generalized Anxiety Disorder: The GAD-7. Journal Of The American Medical Association, 166, 1092–1097. https://doi.org/10.1001/archinte.166.10.1092
Sugiura, T., & Sugiura, Y. (2016). Relationships Between Refraining From Catastrophic Thinking, Repetitive Negative Thinking, and Psychological Distress. Psychological Reports, 119(2), 374–394. https://doi.org/10.1177/0033294116663511
Swee, M. B., Olino, T. M., & Heimberg, R. G. (2019). Worry and anxiety account for unique variance in the relationship between intolerance of uncertainty and depression. Cognitive Behaviour Therapy, 48, 253–264. https://doi.org/10.1080/16506073.2018.1533579
Treynor, W., Gonzalez, R., & Nolen-Hoeksema, S. (2003). Rumination reconsidered: A psychometric analysis. Cognitive Therapy and Research, 27, 247–259. https://doi.org/10.1023/A:1023910315561
Wang, K., Shi, H. S., Geng, F. L., Zou, L. Q., Tan, S. P., Wang, Y. … Chan, R. C. K. (2016). Cross-cultural validation of the Depression Anxiety Stress Scale-21 in China. Psychological Assessment, 28, e88–e100. https://doi.org/10.1037/pas0000207
Wang, X. D., Wang, X. L., & Ma, H. (1999). Rating scales for mental health. Beijing: Chinese Mental Health Journal Press
Watkins, E. R. (2008). Constructive and unconstructive repetitive thought. Psychological Bulletin, 134, 163–206. https://doi.org/10.1037/0033-2909.134.2.163
Yang, Z. (2013). Psychometric properties of the intolerance of uncertainty scale (IUS) in a Chinese-speaking population. Behavioural and Cognitive Psychotherapy, 41(4), 500–504. https://doi.org/10.1017/S1352465812000975
Yao, N., Qian, M., Jiang, Y., & Elhai, J. D. (2021). The Influence of Intolerance of Uncertainty on Anxiety and Depression Symptoms in Chinese-speaking Samples: Structure and Validity of The Chinese Translation of The Intolerance of Uncertainty Scale. Journal of Personality Assessment, 103, 406–415. https://doi.org/10.1080/00223891.2020.1739058
Zhang, M. Y., & He, Y. L. (2015). Manual of psychiatric rating scales. Changsha: Hunan Science & Technology Press
Zhong, J., Wang, C., Li, J., & Liu, J. (2009). Penn State Worry Questionnaire: structure and psychometric properties of the Chinese version. Journal of Zhejiang University Science B, 10, 211–218. https://doi.org/10.1631/jzus.B0820189
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We thank Dong., H. and Kishimoto., T. for their assistance.
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Yao, N., Yang, Y. & Huang, S. Validation of the Chinese Version of the Perseverative Thinking Questionnaire. J Rat-Emo Cognitive-Behav Ther 41, 552–567 (2023). https://doi.org/10.1007/s10942-022-00470-2
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DOI: https://doi.org/10.1007/s10942-022-00470-2