Improving Attentional and Cognitive Control in the Psychological Treatment of Intrusive Thoughts

Massachusetts General Hospital87 enrolled

Overview

The investigators are conducting this study to learn more about the cognitive and attentional processes among individuals with three types of repetitive negative thinking (RNT): mental rituals (as seen in obsessive compulsive disorder, OCD), worries (as seen in generalized anxiety disorder, GAD), and ruminations (as seen in major depressive disorder, MDD). Specifically, the investigators are studying whether psychological treatment can help people with RNT who have trouble stopping unwanted thoughts and shifting their attention.

The current study will examine whether enhancing attention regulation skills in a transdiagnostic intervention for repetitive negative thinking (RNT) will significantly improve the target of attentional/cognitive control. Participants will be randomly assigned (like the flip of a coin) to receive eight 60 minute sessions (over 8 weeks) of either: Emotion Regulation Therapy-Attention Regulation (AR-ERT) or Supportive Psychotherapy (SPT). The investigators will use a multi-method approach to measure attentional/cognitive control: (a) behavioral (i.e., eye tracking fixations and reaction time), (b) electrophysiological (i.e., event related potentials), and (c) self-report (i.e., perceived ability to shift and focus attention). They also will examine early signs of treatment efficacy of AR-ERT and SPT and target validation (i.e., whether changes in attentional/cognitive control correlate with changes in RNT and associated symptoms). Participants will receive assessments of these target and outcome measures at baseline (week 0), mid-treatment (week 4), post-treatment (week 8), and 3-month follow-up (week 20). While most of these procedures are conducted virtually (e.g., therapy sessions), some (e.g., eye tracking and electrophysiological assessments) will be performed in-person. Findings could help identify a cross-cutting target that can be engaged to optimize treatment response for individuals with elevated RNT.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

SINGLE

Interventions

Emotion Regulation Therapy - Attention Regulation (AR-ERT)BEHAVIORAL

Participants will receive a total of eight 60 minute sessions (over 8 weeks) of individual, manual-based AR-ERT. This intervention aims to build attention regulation skills (i.e., the ability to flexibly shift and sustain attention) by teaching participants exercises for Orienting their attention and Allowing the presence of negative emotions. Participants are taught to apply these skills to counteract reactive perseverative thinking when negative emotions arise as well as proactively engage with emotion-laden situations that trigger repetitive negative thinking.

Supportive Psychotherapy (SPT)BEHAVIORAL

Participants will receive a total of eight 60 minute sessions (over 8 weeks) of individual, manual-based SPT. This intervention addresses factors that may affect participants' repetitive negative thinking symptoms (for example, relationships, work, stress), and teaches skills for managing challenges by improving self-esteem and positive coping skills.

Eligibility

Sex: ALLMin age: 18 YearsMax age: 60 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Adults ages 18-60 years old * Right-handed * Living in Massachusetts * Repetitive Negative Thinking (RNT) in the form of mental rituals, worries, and/or depressive ruminations is the primary reason for seeking treatment * RNT significant enough to warrant intervention * Fluent in English, willing to provide informed consent, and willing to comply with the study protocol * Access to a device with an internet connection, camera, and microphone (e.g., computer, smart phone, tablet) * Comfortable and capable of using a computer and completing reaction-time tasks Exclusion Criteria: * History of head injury or neurologic disease, mental retardation, or borderline intellectual functioning that would interfere with ability to participate in the study. * Impaired (or uncorrected) vision, medical illness, or medical treatment that would interfere with participation. * Active suicidal or homicidal ideation or any features requiring a higher level of care. * Lifetime psychotic disorder or bipolar disorder * Substance or alcohol use disorder that would interfere with treatment. * Current Attention Deficit Hyperactivity Disorder (ADHD) that would interfere with attentional tasks. * Unstable dose of psychotropic medications or recent discontinuation of psychotropic medication. * Current psychotherapy or plans to initiate such treatment during the study. * Previous course of treatment with cognitive behavioral therapy and/or mindfulness/meditation for obsessive compulsive disorder (OCD), generalized anxiety disorder (GAD), or depression.

Outcomes

Primary Outcomes

Change from baseline in transdiagnostic repetitive negative thinking at 8 weeks (as measured by the Perseverative Thinking Questionnaire)

15-item self-report measure of transdiagnostic repetitive negative thinking that includes items about thoughts as repetitive, intrusive, unproductive, and capturing mental capacity (e.g., "I think about many problems without solving any of them"). Total scores range from 0-60, with higher scores indicating more repetitive negative thinking (i.e., worse outcomes).