Repetitive Negative Thinking (RNT)

At the end of last year, we discussed experiential avoidance including escape strategies and reassurance seeking, situational avoidance, somatic avoidance, cognitive avoidance, emotional avoidance and emotion-driven behaviors.

For the next several weeks, we will shift to another type of response mechanism that creates, maintains, and intensifies psychological suffering: repetitive negative thinking.

Repetitive negative thinking is the broad category of habits of mind that occur when you are stuck in a rigid cognitive loop. It is a behavior, not an automatic process. Those with anxiety and mood disorders are vulnerable to experiencing thinking patterns (that is, vulnerability mechanisms) that make repetitive negative thinking more likely, but the repetitive negative thinking itself is a behavior.

We discussed the thinking patterns that make repetitive negative thinking more likely throughout the fall. Specifically, anxiety sensitivity, intolerance of uncertainty, clinical perfectionism, fear of evaluation, inflated responsibility, and pervasive negative beliefs are thinking patterns that trigger the urge to worry, ruminate, or engage in post-event processing.

In my academic study of ACT and transdiagnostic mechanisms and in my application of these theories in clinical work, I’ve noticed 5 types of RNT that can be understood on 5 dimensions. That is, I’ve noticed that very few people only worry or only rumination, but rather many people have combinations of all of them. As I’ve been thinking through who gets stuck on what types of thoughts, I came up with 5 dimensions that help us understand the similarities and differences between worry, rumination, post-event processing, and mental compulsions. This week I will explain the 5 dimensions by which you can understand a repetitive negative loop. Over the next several weeks, we will practice applying the understanding of the dimensions to the types of RNT. My hope is that if you can see these patterns, you will take your thoughts less personally and get unstuck faster.

Types of RNT
Functional worry
Process-oriented worry
Mental compulsions
Post-event processing

5 Dimensions:
Ego-orientation – how reasonable do the thoughts seem to the thinker? Ego-syntonic thoughts seem reasonable and you are more likely to be fused to the content. Ego-dystonic thoughts do not seem reasonable and you are more likely to feel shame about the content.

Time orientation – Is the content primarily about the past or the future? If the content is about the past, you are more likely to be sensitized by feelings like guilt, shame, and regret. If the content is about the future, you are more likely to be sensitized by anxiety sensitivity and intolerance of uncertainty.

Beliefs – The beliefs you have about why thinking these thoughts is helpful or necessary to you in some ways, even if it is painful. The categories of beliefs that maintain RNT are my thoughts:
1. Reduce painful emotions.
2. Increase my self-esteem.
3. Prevent catastrophe.
4. Help me solve problems.
5. Motivate me.

Workable functions – Cognitive behaviorism assumes that something about every behavior either worked in the past or works in some ways now, even if it is not the ideal solution. Possible workable functions of RNT include:
1. Short-term reduction in painful affect.
2. Short-term reduction in uncertainty.
3. Short-term increase in self-esteem.
4. Short-term increase in self-efficacy.

Unworkable functions – Cognitive behaviorism honors the workable parts of all behaviors, while also seeking to shift the behaviors that create, maintain, and intensify suffering. This is the unworkable part of the behavior. Unworkable functions include:
1. Long-term increase in painful affect.
2. Long-term increase in sensitivity to uncertainty.
3. Long-term reduction in self-esteem.
4. Long-term reduction in self-efficacy.
5. Long-term narrowing of options.

It’s complicated! No wonder you can’t just stop worrying, even if you want to! Each of these dimensions has different interventions and different types of exposures that can help you learn to see what’s happening in your thinking and shift to a more flexible way of thinking. If you’re still frequently getting stuck in thought loops, we might not have a clear picture about what you are stuck on. It will take trial and error and we will figure out what’s happening in your mind over time together!

Questions for reflection: 

  • What types of RNT are most common for you?
  • For the RNT that is most common for you, what dimensions likely maintain that loop?
  • What questions do you have about this framework?

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