Rumination, also referred to as repetitive thought, is extended and recurrent detrimental desirous about emotions and upsetting previous experiences (Watkins, 2008). In distinction, fear refers to a sequence of ideas and detrimental emotions about anticipated future occasions (Borkovec, 1983). Carefully aligned, rumination and fear are thought of transdiagnostic, which implies they’re elements related to quite a few psychological well being difficulties (McEvoy et al., 2013; Zagaria et al., 2023).
One of many detrimental results of repetitive detrimental considering is that it additionally magnifies and prolongs detrimental temper states, interferes with drawback fixing and the flexibility to make optimistic behaviour modifications (Watkins & Roberts, 2020). As such, it is smart that some psychological well being interventions deal with transdiagnostic elements like repetitive detrimental considering, as a result of concentrating on this might have a widespread influence.
The last Mental Elf blog that focused on repetitive negative thinking in young people was published in 2017 – so what has modified since? For this weblog, I’ve checked out a scientific assessment and meta-analysis by Egan and colleagues (2024) which targeted on fear and rumination because the goal for interventions for younger folks experiencing a spread of psychological well being difficulties.
Rumination and fear can have a detrimental influence throughout a spread of psychological well being difficulties, making them a possible goal for transdiagnostic intervention.
Strategies
One of many highlights of this systematic assessment and meta-analysis was that it was co-produced with a global group of younger folks with lived expertise of hysteria, melancholy, and psychosis. The younger folks, who have been supported by lived expertise leads, guided all facets of the analysis, together with the event of the search methods, the protocol, synthesising insights, reviewing papers, and writing the publication.
The authors searched 4 databases in April 2023 for research that:
- Included members with a imply age between 10- 24 years
- Had been a managed trial of a fear/rumination/repetitive detrimental considering intervention evaluating to any type of management situation, together with internet-delivered and face-to-face codecs
- Used validated psychometric measures of fear/rumination/repetitive detrimental considering and nervousness, melancholy, suicide, self-harm or psychosis
- Had been printed in a peer-reviewed journal in English or German.
Research have been excluded if the interventions have been too normal or weren’t a focused remedy for fear/rumination/repetitive considering, and if the trial was nonetheless ongoing.
One researcher screened all articles, with a random 30% of articles double-screened. Twelve articles have been additionally included within the assessment based mostly on the reference checklist of a earlier systematic assessment (Bell et al., 2023).
Danger of bias was assessed utilizing the Cochrane Danger of Bias Software V.2 (Sterne et al., 2019), with most articles rated as having some considerations concerning threat of bias.
For the meta-analysis, a random results mannequin was used to pool impact sizes (Hunter-Schmidt g) of between-group results for fear, rumination, repetitive detrimental considering, nervousness and melancholy outcomes. A Sturdy Bayesian meta-analysis was additionally run (RoBMA g) to help the random results mannequin, which higher accounts for publication bias.
Outcomes
Sixteen articles have been included within the assessment. Most research have been carried out within the UK and Europe (38%). Individuals have been primarily feminine (79%) and have been primarily younger adults (81%). Twenty interventions have been included within the research, and the most typical (25%) was Rumination Targeted Cognitive Behaviour Remedy (RFCBT). Different interventions included:
- Repetitive detrimental thinking-specific CBT
- Meta-cognitive remedy
- Working reminiscence coaching
- Repetitive detrimental thinking-specific Acceptance and Dedication Remedy.
Results on fear, rumination and repetitive detrimental considering
There was robust proof, and a small to average impact for the efficacy of repetitive detrimental considering interventions (g(Hunter-Schmidt) = −0.51; g(RoBMA) = −0.50) and CBT (g(Hunter-Schmidt) = −0.42 to −0.44; g(RoBMA) = −0.34 to −0.41) respectively on decreasing repetitive detrimental considering.
Therapist-led interventions produced a bigger impact than self-help methods. The authors famous that there was additionally robust proof indicating that some therapist-led interventions may be simpler than others however couldn’t state which varieties attributable to a scarcity of proof and heterogeneity between the included therapist-led interventions.
Results on nervousness
Robust help was discovered for the efficacy of particular repetitive detrimental considering interventions on nervousness. It was steered that meta-cognitive remedy had a very robust influence on decreasing repetitive detrimental considering (g(Hunter-Schmidt) = −1.34; g(RoBMA) = -0.42). Nevertheless, the authors famous that one research was skewing the outcomes, so additional exploration is required. Therapist-led interventions additionally produced a bigger impact than self-help methods.
Results on melancholy
There was a medium to robust impact general for the repetitive detrimental considering interventions on melancholy. There was stronger proof for an impact of CBT on melancholy (g(Hunter-Schmidt) = −0.43; g(RoBMA) = −0.41). Once more, therapist-led interventions produced a bigger impact than self-help methods. Nevertheless, longer interventions (e.g., greater than 2 hours in whole) have been additionally discovered to be simpler than medium and quick interventions. There weren’t sufficient research to find out any variations between the intervention varieties.
This meta-analysis discovered robust help for the effectiveness of repetitive detrimental considering interventions on nervousness, melancholy and repetitive detrimental considering, indicating its potential use as a transdiagnostic goal.
Conclusions
The authors concluded that the proof suggests that interventions particularly concentrating on detrimental considering are efficient in decreasing nervousness and melancholy in younger folks. Longer interventions versus interventions that have been lower than 2 hours in whole, are steered as being most useful. Whereas the findings counsel that therapist-led interventions produced a bigger impact than self-help methods, extra analysis is required to additional discover this.
Based mostly on the findings, the younger folks with lived expertise who co-produced the assessment emphasised that the interventions concentrating on repetitive detrimental considering appear to be useful. It was famous, nevertheless, that cultural context must be thought of, as they stated it’s probably that totally different interventions may be suited to folks in some international locations greater than others.
Proof means that therapist-led interventions concentrating on repetitive detrimental considering are simpler than self-help methods for nervousness and melancholy in younger folks, however extra analysis is required.
Strengths and limitations
An amazing power of this analysis is that it was co-produced with younger folks with lived expertise, and that the younger folks have been a) from a spread of nations, and b) concerned in all levels of the analysis. That is vital as a result of younger folks have a proper to take part in selections which could have an effect on them (Lundy, 2007).
This analysis constructed on a earlier assessment (Bell et al., 2023) by increasing some key components, resembling decreasing the age vary of curiosity, together with self-harm, suicide and psychosis in addition to nervousness and melancholy, and together with younger individuals who wouldn’t meet medical ranges of signs. This locations an vital emphasis on early intervention and prevention work, that are vital in serving to to make sure higher outcomes, and constructing abilities that help good future psychological well being and wellbeing (McCorry & Mei, 2018).
Pre-registration of the research protocol with PROSPERO, and adherence to PRISMA tips and Cochrane Danger-of-Bias Software, point out that the research was carried out and reported in keeping with greatest observe, rising the transparency and rigour of the analysis.
There was additionally no limitation on publication date, resulting in an intensive assessment of present literature and a lowered threat of publication-date bias. Nevertheless, the exclusion of gray literature, dissertations, and unpublished research could have lowered the pool of accessible analysis and will enhance the probability of publication bias. But, unpublished analysis normally contains a small proportion of critiques, and sometimes could have little influence on the findings (Hartling et al., 2017).
The authors acknowledge some limitations within the proof on this assessment, together with:
- The low variety of research assembly the inclusion standards, that means the causal mechanisms underlying the efficacy of the interventions couldn’t be examined as deliberate.
- Most research specializing in nervousness and melancholy, with restricted analysis obtainable analysis on self-harm, suicide and psychosis, which have been within the scope of the assessment.
- Limitations to the generalisability of the findings, given the inhabitants of the included research was primarily college aged, and there was an over-representation of research populations from the World North. As round 90% of younger folks globally stay within the World South (UNICEF, 2025), this implies that there’s a substantial quantity of data lacking concerning the effectiveness of those interventions for younger folks.
Whereas these are limitations of the analysis and proof, they aren’t limitations of the methodology of this particular assessment, which was typically sound. Nevertheless, the authors famous that they excluded CBT interventions that included elements targeted on repetitive detrimental considering, which can imply that some proof was missed on this assessment.
This can be a robust systematic assessment and meta-analysis, co-produced with younger folks with related lived expertise who have been from 4 international locations, and concerned in all levels of the analysis
Implications for observe
The findings of this assessment reinforce the significance of early intervention and prevention work for younger folks’s psychological well being, in addition to the significance of specializing in transdiagnostic elements resembling repetitive detrimental considering. If supported by potential proof that may examine the causal mechanisms underlying the efficacy of the interventions, bettering repetitive detrimental considering has the potential to enhance outcomes for younger folks experiencing a spread of psychological well being difficulties. This will have a wide-reaching influence on younger folks’s psychological well being itself which, if taking a prevention and early intervention stance, would cut back the burden on specialist companies later down the road.
There was a current name for built-in fashions of care that concentrate on transdiagnostic signs and elements to help younger folks’s psychological well being (Colizzi et al., 2020). Such transdiagnostic interventions that lower throughout conventional diagnostic boundaries of help could ease a few of the rising burden on statutory companies. By additional exploring after which concentrating on underlying processes and signs that embody a number of psychological well being difficulties, the onus on ‘treating’ one analysis at a time can be lifted. Afterall, transdiagnostic approaches replicate “the complexity, dimensionality and comorbidity that’s the norm in medical observe” (Dalgleish et al., 2020, p.179).
It’s value noting that smaller impact sizes, as proven on this analysis, are anticipated within the context of prevention and early intervention with non-clinical samples. It is because much less change is normally noticed in these samples, when younger folks have fewer reported, or much less extreme difficulties, in comparison with medical samples. The authors of this research counsel a spread of analysis gaps and areas for future focus, together with proof from international locations within the World South, a wider vary of psychological outcomes, and a deal with which repetitive detrimental thinking-specific interventions are simplest for whom. This may be within the type of longitudinal blended strategies research, notably in prevention and early intervention settings, and will likely be essential for this creating space of focus, to greatest help younger folks.
Transdiagnostic interventions that lower throughout conventional diagnostic boundaries of help could ease a few of the rising burden on statutory companies, which in flip could enhance immediate entry to psychological healthcare.
Assertion of pursuits
None.
Hyperlinks
Main paper
Egan, S. J., Greene, D., Callaghan, T., Raghav, S., Funk, J., Badenbach, T., … & Kopf-Beck, J. (2025). Worry and rumination as a transdiagnostic target in young people: a co-produced systematic review and meta-analysis. Cognitive Behaviour Remedy, 54(1), 17-40.
Different references
Bell, I. H., Marx, W., Nguyen, Ok., Grace, S., Gleeson, J., & Alvarez-Jimenez, M. (2023). The effect of psychological treatment on repetitive negative thinking in youth depression and anxiety: A meta-analysis and meta-regression. Psychological Medication, 53(1), 6-16.
Borkovec, T. D., Robinson, E., Pruzinsky, T., & DePree, J. A. (1983). Preliminary exploration of worry: Some characteristics and processes. Behaviour analysis and remedy, 21(1), 9-16.
Colizzi, M., Lasalvia, A., & Ruggeri, M. (2020). Prevention and early intervention in youth mental health: is it time for a multidisciplinary and trans-diagnostic model for care?. Worldwide Journal of Psychological Well being Techniques, 14, 1-14.
Dalgleish, T., Black, M., Johnston, D., & Bevan, A. (2020). Transdiagnostic approaches to mental health problems: Current status and future directions. Journal of Consulting and Scientific Psychology, 88(3), 179.
Hartling, L., Featherstone, R., Nuspl, M., Shave, Ok., Dryden, D. M., & Vandermeer, B. (2017). Grey literature in systematic reviews: a cross-sectional study of the contribution of non-English reports, unpublished studies and dissertations to the results of meta-analyses in child-relevant reviews. BMC Medical Analysis Methodology, 17, 1-11.
Lundy, L. (2007). ‘Voice’ is not enough: conceptualising Article 12 of the United Nations Convention on the Rights of the Child. British Academic Analysis Journal, 33(6), 927-942.
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 Issues, 151(1), 313-320.
Moulds, M. (2017). Targeting unhelpful repetitive negative thinking in young people to prevent anxiety and depression. The Psychological Elf.
Sterne, J. A., Savović, J., Web page, M. J., Elbers, R. G., Blencowe, N. S., Boutron, I., … & Higgins, J. P. (2019). RoB 2: a revised tool for assessing risk of bias in randomised trials. bmj, 366.
UNICEF. Adolescent demographics. [Online]. Obtainable https://data.unicef.org/topic/adolescents/overview/, Accessed 28 Jan 2025.
Watkins, E. R. (2008). Constructive and unconstructive repetitive thought. Psychological Bulletin, 134(2), 163.
Watkins, E. R., & Roberts, H. (2020). Reflecting on rumination: Consequences, causes, mechanisms and treatment of rumination. Behaviour Analysis and Remedy, 127, 103573.
Zagaria, A., Ballesio, A., Vacca, M., & Lombardo, C. (2023). Repetitive negative thinking as a central node between psychopathological domains: A network analysis. Worldwide Journal of Cognitive Remedy, 16(2), 143-160.
