Transcript Maladaptive Repetitive Thought and Physical Disease

Immune-Spectrum Disease
and Repetitive Thought in
Female Veterans
Elizabeth A. Mullen-Houser, Ph.D.,
Susan K. Lutgendorf, Ph.D., Michelle A. Mengeling,
Ph.D., James C. Torner, Ph.D., Brian L. Cook, D.O.,
Brenda M. Booth, Ph.D. , Anne G. Sadler, Ph.D.
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ACBS June 19th, 2014
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THE CENTER FOR
Comprehensive Access &
Delivery Research and Evaluation
Background Overview
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1. Stress and Health
Stress and health overview
1.2 Stress and health in female veterans
1.1
2. Repetitive Thought
Perseverative Cognition Hypothesis
2.2 Dimensions of repetitive thought
2.1
3. Inflammatory disorders
4. Maladaptive repetitive thought and
inflammatory disorders
1.1 Stress and Health (Background)
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


Poorer health with chronic stress
 Prolonged presence of threat or perception of
threat (Miller et al., 2007)
Immune dysregulation in stressors lasting more than
one month (Kiecolt-Glaser et al., 2002)
 time to wound healing in caregivers (Kiecolt-Glaser et al.,1995)
1.2 Stress and Health in Female
Veterans (Background)

17% of Reserve and National Guard
(Department of Veteran Affairs, 2007)

Military sexual trauma (Sadler et al., 2001)
 79%
harassed, 36% assaulted
 60% with PTSD
 Perpetrated by coworkers

75% of inflammatory disorders occur in women,
often during childbearing years (NIH, 2005)
2.1 Repetitive Thought(Background)
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Perseverative Cognition Hypothesis
(Brosschot, Gerin & Thayer, 2006)
Stressor
Short
Stress
Response
Coping & Appraisal
Prolonged
Stress
Response
Pathogenic
state
Perseverative Cognition
about Stressor
Organic
Disease
2.2 Repetitive Thought: Dimensions
(Background)
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

Self-absorption paradox (Trapnell & Campbell, 1999)
Maladaptive
 Rumination, worry
 Brooding about implications of mistakes, passive,
evaluative (Coarocco, Vohs & Baumeister, 2010; Segerstrom et al., 2003)
 Form

of avoidant coping
(Dickson et al., 2012; Walser & Hayes, 2006)
Adaptive
 Reflective pondering
 Error correction or goal attainment, non-evaluative
(Coarocco, Vohs & Baumeister, 2010 ; Watkins & Teasdale, 2004)
3. Inflammatory Disorders (Background)
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
Immune Mediated Inflammatory Disorder
 Immune
system attacks own tissues
  cortisol,  proinflammatory cytokines
(Calcagni & Elenkov, 2006)

80+ inflammatory-related diseases (NIH, 2005)
 Rheumatoid
arthritis, Lupus, Crohn’s Disease,
Multiple sclerosis, Ulceritive Colitis
 Newer: Chronic fatigue, fibromyalgia
(Robinson et al., 2006)
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4. Maladaptive Repetitive Thought and
Inflammatory Disorders (Background)

Elevated trait maladaptive repetitive thought predicts:
  biological dysregulation
  cortisol stress response (Zoccola et al., 2008)
  inflammatory response (Segerstrom et al., 2008)
 Worse
physical functioning, treatment response
  maladaptive repetitive thought prevalence in
lupus (Siegle, 2008)
  mobility, grip in arthritis (Evers et al., 2008)
 Psoriasis treatment (Fortune et al., 2008)
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Objective
Determine if maladaptive repetitive
thought is associated with greater
immune-spectrum disease and
disease-related disability
Measures
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

Maladaptive repetitive thought operationalized as
brooding rumination (RSQ; Nolen-Hoeksema & Morrow, 1991)
Physical disease
 number of inflammatory diseases reported
 physical functioning subscale of SF-12
Ruminative Responses Scale (RRS):
Brooding Rumination Subscale
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Treynor, Gonzalez and Nolen-Hoeksema (2003)
People say and do many different things when they feel
distressed. Please indicate whether you never, sometimes,
often, or always think or do each one when you feel
distressed. Please indicate what you generally do, not what
you think you should do.
1. Think “What am I doing to deserve this?”
2. Think “Why do I always react this way?”
3. Think about a recent situation, wishing it had gone better.
4. Think “Why do I have problems other people don’t have?”
5. Think “Why can’t I handle things better?”
Sample
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N=665


OEF/OIF-era Reserve and National
Guard (RNG) women
Five Midwestern states (IA, IL, MO,
KS, NE)

Computer-based telephone interview

Response rate 70%
Sample
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Mean age=37.9 (SD=10.4)
 16.4% report inflammatory disease diagnosis
 Ethnicity %:

 American
 Asian
Indian 0.3
1.5
 African American or Black 15.9
 Native Hawaiian or Pacific Islander 0.5
 Caucasian 79.5
 More than One Race 0.8
 Other 1.5
Sample: Trauma
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
97% reported a lifetime history of trauma
exposure
 Higher than previous reports in female
veterans and civilians

14.8% met criteria for PTSD
 Similar to other reports in female veterans (1019%) Bean-Mayberry et al., 2011
Maladaptive Repetitive Thought and
Physical Disease: Hypothesized Model
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Physical
Disease
Inflamatory
Disorder
Prevalence
Functional
Disability
Maladaptive
RT
Maladaptive Repetitive Thought and
Physical Disease: Hypothesized Model
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Reexperiencing
Avoidance
Posttraumatic
Stress
Symptoms
Functional
Disability
Arousal
MRT
x
Posttraumatic Stress
Symptoms
Physical
Disease
Inflammatory
Disorder
Prevalence
Maladaptive
RT
Maladaptive Repetitive Thought and
Physical Disease: Hypothesized Model
Smoking
Alcohol Use
Sleep
Reexperiencing
Avoidance
Posttraumatic
Stress
Symptoms
Functional
Disability
Arousal
MRT
x
Posttraumatic Stress
Symptoms
Physical
Disease
Inflammatory
Disorder
Prevalence
Maladaptive
RT
Maladaptive Repetitive Thought and
Physical Disease: Hypothesized Model
Smoking
Alcohol Use
Sleep
Reexperiencing
Avoidance
Posttraumatic
Stress
Symptoms
Physical
Disease
Functional
Disability
Arousal
MRT
x
Posttraumatic Stress
Symptoms
Inflammatory
Disorder
Prevalence
Maladaptive
RT
Depression
Childhood
Trauma
Greater Maladaptive Repetitive Thought
Related to Less Physical Disease
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Smoking
Alcohol Use
.07
Reexperiencing
Sleep
-.22**
-.06
.72**
Avoidance
.80** Posttraumatic
Stress
Symptoms
.89**
.06
Physical
Disease
Inflammatory
.40**
Disorder
Prevalence
.82**
Functional
Disability
Arousal
.03
χ2= .07- 39.48
(p = .02 -.99)
Maladaptive
2
χ /df=.02-1.65
Repetitive Thought
CFI= .99-1.00
x
RMSEA= .00-.03 Posttraumatic Stress
Symptoms
SRMR= .00-.02
Maladaptive
Repetitive
Thought
-.16** .33**
Depression
.10**
Childhood
Trauma
Maladaptive Repetitive Thought Unrelated to
Disease When Depression Not Included in Model
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Smoking
Alcohol Use
Sleep
Posttraumatic
Stress
Symptoms
.04
χ2=
26.04 (p = .21)
χ 2/df=1.24
CFI= 1.00
RMSEA= .02
SRMR= .02
Physical
Disease
Maladaptive
Repetitive Thought
x
Posttraumatic Stress
Symptoms
Maladaptive
Repetitive
Thought
-.12
Childhood
Trauma
Maladaptive Repetitive Thought Unrelated to
Disease When Depression Not Included in Model
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Smoking
Alcohol Use
.07
Posttraumatic
Stress
Symptoms
26.04 (p = .21)
χ 2/df=1.24
CFI= 1.00
RMSEA= .02
SRMR= .02
-.17**
.32**
Maladaptive
Repetitive Thought
x
Posttraumatic Stress
Symptoms
-.13**
Physical
Disease
.04
χ2=
Sleep
MRT
-.12
.14**
Childhood
Trauma
Greater Maladaptive Repetitive Thought
Related to Less Physical Disease
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Smoking
Alcohol Use
.07
Reexperiencing
Sleep
-.22**
-.06
.72**
Avoidance
.80** Posttraumatic
Stress
Symptoms
.89**
.06
Physical
Disease
Inflammatory
.40**
Disorder
Prevalence
.82**
Functional
Disability
Arousal
.03
χ2= .07- 39.48
(p = .02 -.99)
MRT
2
χ /df=.02-1.65
x
CFI= .99-1.00
Posttraumatic Stress
RMSEA= .00-.03
Symptoms
SRMR= .00-.02
Maladaptive
Repetitive
Thought
-.16** .33**
Depression
.10**
Childhood
Trauma
Repetitive Thought, Depression and
Disease
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

Maladaptive repetitive thought unrelated to disease
when depression not included as covariate
When depression was included, higher repetitive
thought was associated with reduced physical
disease


Negative affect: Predisposition to experience negative
mood states (Thomsen, 2006; Watson & Clark, 1984)
Inclusion of depression may have statistically
removed negative affect from maladaptive repetitive
thought, leaving adaptive repetitive thought
Perseverative Cognition Hypothesis
(Brosschot, Gerin & Thayer, 2006)
Stressor
Short
Stress
Response
Prolonged
Stress
Response
Pathogenic
state
Perseverative Cognition
Coping & Appraisal
about Stressor
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Organic
Disease
Perseverative Cognition Hypothesis
(Brosschot, Gerin & Thayer, 2006)
Stressor
Short
Stress
Response
Coping & Appraisal
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Prolonged
Stress
Response
Pathogenic
state
Adaptive Cognition
about Stressor
Organic
Disease
Clinical Implications: Adaptive
Repetitive Thought Intervention
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

Maladaptive Repetitive Thought
 Rumination, worry
 Brooding about implications of mistakes, passive,
evaluative (Coarocco, Vohs & Baumeister, 2010; Segerstrom et al., 2003)
 Form of avoidant coping (Dickson et al., 2012; Walser & Hayes, 2006)
Adaptive Repetitive Thought
 Reflective pondering
 Error correction or goal attainment, non-evaluative
(Coarocco, Vohs & Baumeister, 2010 ; Watkins & Teasdale, 2004)
Clinical Implications: Adaptive
Repetitive Thought Intervention
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
Error correction or goal attainment

Non-evaluative
Clinical Implications: Adaptive
Repetitive Thought Intervention
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


Error correction or goal attainment
ACT values clarification and increasing valueguided behavior
Values interventions and physical health
 Improved
cortisol response to stress after a value
affirmation exercise (Creswell et al., 2005)
 Seizure improvements with an ACT intervention
mediated by value attainment (Lundgren, Dahl & Hayes, 2008)
 Physical functioning improvements in chronic pain
with greater values-based action (McCracken & Vellemen, 2010)
Clinical Implications: Adaptive
Repetitive Thought Intervention
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
Non-evaluative (Coarocco, Vohs & Baumeister, 2010 ; Watkins & Teasdale, 2004)
 Mindfulness skills: Observing with awareness, nonjudging attention
 Mindfulness and repetitive thought (Segerstrom et al., 2011)
 Observing
by itself associated with less adaptive
repetitive thought and more general repetitive thought
 Non-judging observing associated with more adaptive
repetitive thought, less general repetitive thought
Clinical Implications: Repetitive
Thought Intervention
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
Mindfulness and Health
 Physical
health improvements with MBSR
interventions (Meta-analysis; Grossman et al., 2004)
 medical symptoms, physical pain, physical
impairment, and physical quality of life
 Improved immune function and regulation with
mindfulness interventions (Davidson et al., 2003; Jacobs et al., 2010)
 Joint tenderness reduction after a mindfulness
intervention in rheumatoid arthritis patients with
chronic depression (Zautra et al., 2008)
 Multiple practice sessions needed (Evans et al., 2014)
Limitations and Future Directions
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


Counterintuitive repetitive thought results needs
replication
Operationalize repetitive thought with a greater
number of measures (Evans & Segerstrom, 2011)
Replicate with a more ethnically diverse
participant sample
Acknowledgements
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

VA HSR&D Grant DHI 05-059 to Dr. Sadler
University of Iowa Graduate College research
fellowship
2.3 Maladaptive Repetitive Thought vs.
PTSD Intrusions (Background)
Dimension
Content
Type of
Cognition
Duration
Intrusions
Memory
Sensory
Seconds
Maladaptive
Repetitive
Thought
Evaluative
Verbal
Thoughts
Minutes/
Hours
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IMIDs and PTSD in Veterans
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
IMID prevalence in veterans (Dominick et al., 2006), including
those without PTSD (Frayne, 2004)

PTSD severity
  presence of one IMID and overall number of IMIDs
(Boscarino, 2004; O’Toole & Catts, 2008)
 IMID risk (Seng et al., 2006)
  risk in female veterans (Frayne, 2004)
 Dose-response
Maladaptive Repetitive Thought and
Negative Affect
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
Negative affect
 Predisposition to experience negative mood states
(Thomsen, 2006; Watson & Clark, 1984)
 Spurious

relationship between maladaptive
repetitive thought and physical health?
MRT contributes to morbidity independent of negative
affect
 Health anxiety (Marcus, Hughes and Arnau, 2008)
 Cortisol dysregulation (Roger & Najarian, 1998)
 Physiologic emotional arousal (Feldner et al., 2006)
Deployment
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