Pepperdine University Pepperdine Digital Commons Theses and Dissertations 2018 Worry and rumination: a rationale for a transdiagnostic approach to treatment Katya Naman Follow this and additional works at: https://digitalcommons.pepperdine.edu/etd Recommended Citation Naman, Katya, "Worry and rumination: a rationale for a transdiagnostic approach to treatment" (2018). Theses and Dissertations. 957. https://digitalcommons.pepperdine.edu/etd/957 This Dissertation is brought to you for free and open access by Pepperdine Digital Commons. It has been accepted for inclusion in Theses and Dissertations by an authorized administrator of Pepperdine Digital Commons. For more information, please contact [email protected], [email protected], [email protected]. Pepperdine University Graduate School of Education and Psychology WORRY AND RUMINATION: A RATIONALE FOR A TRANSDIAGNOSTIC APPROACH TO TREATMENT A clinical dissertation submitted in partial satisfaction of the requirements for the degree of Doctor of Psychology by Katya Naman, M.A., M.B.A. June, 2018 Judy Ho Gavazza, Ph.D., ABPP – Dissertation Chairperson This clinical dissertation, written by Katya Jean Naman under the guidance of a Faculty Committee and approved by its members, has been submitted to and accepted by the Graduate Faculty in partial fulfillment of the requirements for the degree of DOCTOR OF PSYCHOLOGY Doctoral Committee: Judy Ho Gavazza, Ph.D., ABPP, Chairperson Robert deMayo, Ph.D., ABPP Sarosh Motivala, Ph.D. TABLE OF CONTENTS Page LIST OF TABLES .......................................................................................................................... v DEDICATION ............................................................................................................................... vi ACKNOWLEDGMENTS ............................................................................................................ vii VITA ............................................................................................................................................ viii ABSTRACT .................................................................................................................................... x Chapter I: Introduction .................................................................................................................... 1 Definition of Rumination .................................................................................................... 2 Definition of Worry ............................................................................................................. 3 Worry, Rumination, and Psychopathology ......................................................................... 4 Chapter II: Rumination .................................................................................................................... 7 Function of Rumination ..................................................................................................... 7 Rumination in the Context of Disorders .............................................................................. 8 Rumination and depression. .................................................................................... 9 Rumination and generalized anxiety disorder. ...................................................... 12 Rumination and posttraumatic stress disorder. ...................................................... 13 Rumination and obsessive compulsive disorder. ................................................... 14 Rumination and social anxiety disorder. ............................................................... 16 Summary of Rumination in the Context of Disorders ....................................................... 17 Chapter III: Worry ......................................................................................................................... 18 Function of Worry ............................................................................................................ 18 Worry in the Context of Disorders .................................................................................... 20 Worry and depression. ........................................................................................... 20 Worry and generalized anxiety disorder. ............................................................... 21 Worry and posttraumatic stress disorder. .............................................................. 22 Worry and obsessive compulsive disorder. ........................................................... 23 Worry and social anxiety disorder. ........................................................................ 24 Summary of Worry in the Context of Disorders ............................................................... 24 Chapter IV: Worry and Rumination .............................................................................................. 26 Differences between Worry and Rumination .................................................................... 26 Similarities between Worry and Rumination .................................................................... 27 Moving toward a Transdiagnostic Theory ........................................................................ 29 How Worry and Rumination leads to Psychopathology ................................................... 30 Chapter V: Method ........................................................................................................................ 33 Purpose of the Study .......................................................................................................... 33 Literature Identification ..................................................................................................... 33 iv Page Presentation of Findings .................................................................................................... 34 Chapter VI: Culture and Psychopathology .................................................................................... 35 Thinking a Lot a Cross-Cultural Similarity ....................................................................... 35 Cultural Differences .......................................................................................................... 36 Culture and depression .......................................................................................... 38 Culture and anxiety disorders ................................................................................ 39 Chapter VII: Unified Protocol for Transdiagnostic Treatment of Emotional Disorders ............... 41 Rationale for Transdiagnostic Therapies ........................................................................... 41 Overview of Unified Protocol for Transdiagnostic Treatment of Emotional Disorders ... 44 Module 1: Motivation enhancement for treatment engagement. ........................... 47 Module 2: Psychoeducation and tracking of emotional experiences. ................... 47 Module 3: Emotion awareness training. ................................................................ 48 Module 4: Cognitive appraisal and reappraisal. .................................................... 48 Module 5: Emotion avoidance and emotion driven behaviors (EDBs). ................ 49 Module 6: Awareness and Tolerance of Physical Sensations. ............................. 50 Module 7: Interoceptive and Situation-Based Emotion Exposures. ...................... 50 Module 8: Relapse Prevention. .............................................................................. 50 Unified protocol trials. ........................................................................................... 52 Further investigations. ........................................................................................... 55 Unified protocol group delivery ............................................................................ 58 Cross-Cultural literature. ....................................................................................... 59 Recommendations for Future Research ............................................................................. 60 Conclusion ......................................................................................................................... 61 REFERENCES .............................................................................................................................. 63 APPENDIX A: The Ruminative Response Scale .......................................................................... 83 APPENDIX B: The Penn State Worry Questionnaire ................................................................. 86 APPENDIX C: IRB Non-Human Subjects Determination Notice ............................................... 89 v LIST OF TABLES Page Table 1. Worry and Rumination in OCD, GAD and PTSD…………………………………….5 vi DEDICATION To my mother, Nadia, my father, John, my sister, Carla, my brother-in-law, OJ and my nephews, Alexander and Nicholas, for their unending love, support, and encouragement. Thank you for taking this journey with me and for always believing in me. I love you eternally. vii ACKNOWLEDGMENTS First and foremost, I would like to express the deepest appreciation and gratitude to my dissertation chairperson and academic advisor, Dr. Judy Ho Gavazza, for her mentorship, support, and constant encouragement throughout my academic journey. Without her hard work and commitment this project would not have been possible. She is an inspiration.