Counter-conditioning habitual rumination with a concrete-thinking exercise
Thesis or dissertation
University of Exeter
Reason for embargo
To pursue publication of the research
Abstract (Systematic Review) Objective: Anxiety and depression have been conceptualised as being associated with “an abundance of habit and a dearth of control” (Hertel, 2015, p. 1). There has been a recent and burgeoning interest toward understanding the role of habits in health psychology and in the psychological disorders of obsessive-compulsive disorder and addiction in particular. To the author’s knowledge, there has been no previous systematic review that aimed to summarise the research investigating the involvement of mental habits in anxiety and depression in clinical and non-clinical populations. Method: The term habit was operationalized and inclusion criteria were specified in the domains of habit measurement, research paradigms, and manipulation tasks. A search across four databases was conducted: Web of Science, EBSCOhost, PubMed and OVID (PsycARTICLES and Journals@OVID). A progressive screening procedure yielded 8 relevant studies related to mental habits in anxiety (n = 1), depression (n = 4) and both anxiety and depression (n = 3). Results: Self-report habit measures correlate with the presence of symptoms. Computational modelling reinforcement learning and goal-devaluation paradigms demonstrate that anxiety and depression are associated with deficits in goal-directed learning and decision-making in favour of habitual learning strategies. Cognitive bias modification meets the criteria for enabling habit change and can strengthen or weaken interpretative habits in response to training. Conclusions: Despite considerable variability and limitations in the design of the studies appraised in this review, overall findings indicate support for habitual thought processes being implicated in anxiety and depression. Treating problematic thought processes in anxiety and depression as habitual – cued automatically by contextual cues, not goal-dependent and resistant to change – may be beneficial for future research and clinical applications. Abstract (Experimental Study) This study investigated predictions from the habit-goal framework for depressive rumination (Watkins & Nolen-Hoeksema, 2014) using a simultaneous replication single case experimental design in a multiple baseline case series. Seven high ruminators were recruited from community and university settings (with one participant’s data later excluded due to insufficient baseline rumination). Following a baseline monitoring period, participants received an intervention that included (i) spotting personal triggers for rumination and (ii) the practice of a scripted concrete thinking exercise (CTE) in response to these triggers, utilising an implementation intention (If-Then plan). It was predicted that practice of the IF-THEN CTE, linked to warning signs, would result in a significant reduction in both frequency and automaticity of rumination in the intervention phase compared to baseline. At the group level, using randomization tests (Onghena & Edgington, 2005), reductions in automaticity of rumination were trending toward statistical significance whilst the impact of the intervention on rumination frequency was not statistically significant. Effect size calculations, using nonoverlap of all pairs, demonstrated a medium effect of the intervention on automaticity (NAP = .76) and weak to medium effect on frequency of rumination (NAP = .66). Visual and statistical analysis of individual data demonstrated that two participants experienced statistically significant benefits (p < .05) for a reduction in automaticity of rumination and one participant’s frequency of rumination was significantly reduced. These two participants also showed the greatest levels of automaticity for the IF-THEN-CTE intervention during the intervention phase. Five participants demonstrated a strong or medium effect of the intervention on automaticity and two participants demonstrated a medium effect on frequency. Taken together, the data is broadly consistent with the predictions made by the habit-goal framework. Pre and post measures indicate reductions for all participants in rumination as habit using the self-report habit index (SRHI) and overall rumination levels rated on the ruminative responses scale (RRS). At post intervention three participants no longer met criteria for inclusion to the study on the RRS. Despite mixed results, feedback at debrief indicated that the intervention was acceptable to participants who reported that they would carry on using it after the study ended.