Transdiagnostic mechanisms in depression and anxiety: The role of rumination and attentional control.
BACKGROUND
Deficits in attentional control have been hypothesized to cause rumination, suggesting that the relationships between attentional control and clinical symptoms may be mediated in part by rumination. However, to date, no clinical study has examined these constructs transdiagnostically in a path analysis model.


METHODS
Fifty-one adults presenting for treatment completed measures of self-reported attentional control, rumination, and depression and anxiety symptoms. A bias-corrected path analysis-based approach was employed to test whether indirect (i.e., mediating) effects of rumination were significantly associated with the direct effects of attentional control on depression and anxiety symptoms. Separate models for depression and anxiety symptoms were tested along with reverse models using attentional control as a proposed mediator.


RESULTS
The relationship between attentional control and clinical symptomatology (i.e., both depression and anxiety symptoms) was mediated by rumination. Poor attentional control was associated with more rumination and consequently more severe symptoms of depression and anxiety. The reverse relationship (i.e., attentional control mediating the relationship between rumination and depression or anxiety symptoms) was not significant.


CONCLUSIONS
Study design did not allow testing of temporal precedence for the mediation models. All constructs were assessed via self-report.


CONCLUSIONS
Attentional control appears to impact depression and anxiety symptoms through rumination. The pathway between poor attentional control and emotion dysregulation via rumination suggests that interventions targeting attentional control may decrease maladaptive ruminative processes, leading to improved emotion regulation and reduced clinical symptomatology. Future studies should examine the stability of this mediational relationship over time (and in the face of targeted interventions).
Behavioral Health Partial Program, McLean Hospital, Belmont, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States. Electronic address: khsu@mclean.harvard.edu.
Kean J
KJ
Hsu
Behavioral Health Partial Program, McLean Hospital, Belmont, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States.
Courtney
C
Beard
Behavioral Health Partial Program, McLean Hospital, Belmont, MA, United States.
Lara
L
Rifkin
Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, United States.
Daniel G
DG
Dillon
Department of Psychiatry, Harvard Medical School, Boston, MA, United States; Center for Depression, Anxiety and Stress Research, McLean Hospital, Belmont, MA, United States.
Diego A
DA
Pizzagalli
Behavioral Health Partial Program, McLean Hospital, Belmont, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States.
Thröstur
T
Björgvinsson
D000328:Adult; D001007:Anxiety / Q000175:diagnosis* / Q000523:psychology*; D001288:Attention; D003863:Depression / Q000175:diagnosis* / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008960:Models, Psychological; D011569:Psychiatric Status Rating Scales; D057566:Self Report; D063189:Symptom Assessment; D055815:Young Adult
Anxiety; Attentional control; Depression; Mediation; Rumination