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Training Protocol 'Drop it'. The Impact of a Training Protocol Focused on Coping With Negative Repetitive Thinking on Cognitive and Behavioural Functioning of People Suffering From GAD or Minor or Moderate Depressive Disorder or Depressive Disorder in Rem

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Last updated:6th Nov 2013
Repetitive negative thinking (RNT) plays an important role in different psychiatric disorders, such as depressive and anxiety disorders, complicated grief, anorexia nervosa. RNT is seen as a vulnerability factor in the onset, duration, severity and relapse of those disorders. Although there is a lot of theoretical research, it is un- known if a training program addressing RNT has a surplus effect on Treatment as Usual (TAU). Our hypothesis is that a training intervention will show a significant effect on declined RNT activity, reduced identification with worrying/rumination, and reduced scores on metacognitions questionnaires, when compared to TAU (medication, psychotherapy or a combination of both treatments). Further we expect that this effect on RNT will not be temporary and the beneficial effects will remain present over a longer time (6 months). Our third hypothesis claims that reduced RNT will have an effect on Quality of Life, self-esteem and depressive and anxiety scores ( as measured by BDI-II and STAI). Fourth hypothesis concerns the effect of the training in the functioning on a neurobiological level. Here we expect that in ruminative patients beneficial effects of RNT will increase top-down prefrontal (dorsolateral) cortical control over an overactive bottom-up limbic system. To examine these neurobiological effects, we apply a multimodal approach where we combine resting state fMRI, structural MRI such as diffuse tensor imaging (DTI), anterior spin labelling (ASL). Further, in our department we developed an audio critique task where participants hear different kinds of critique amongst some of negative valence which will be especially problematic for ruminative patients reflecting difficulties and differences these top-down/bottom-up processes when compared to a healthy control group at baseline. Further, we hypothesize that only when RNT is successful these neuronal processes will normalize. We do not expect changes in the waiting list group. To examine these clinical and neuronal effects, people suffering from GAD and/or minor or moderate depression will be allocated by randomisation to an active treatment condition (ATC) and a waiting list control group WLC). All the participants will be patients treated by general practitioner, psychologist or psychiatrist. Training exists of 8 sessions in group (max 12 participants) on a weekly basis, except for the last session, which takes place after one month). During the training people will get information on RNT, they will be trained in focusing their attention, will receive some basic ideas about becoming aware of dysfunctional thinking and learn coping strategies such as stimulus control and engaging in activity. Measurement will take place before and after treatment for the ATC. The WLC will be measured at the start of the ATC and after 12 weeks. Measurement takes place by means of questionnaires and fMRI. During the fMRI people will undergo a resting state paradigm and some tasks triggering RNT. After three and 6 months, at the time interval of 3 and 6 months, participants will be evaluated again on RNT by means of questionnaires. At the end of the training, after 8th session, two participants per run will be asked to cooperate in a qualitative in-depth interview. We are interested in linking results with the training with some factors such as quantity of sessions, degree of active participation in between sessions. We are also interested in defining which interventions are perceived as most useful and if there is a link between disorder and the usefulness of some interventions.
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Study start date 2013-11-06

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