Imbalance between default mode and sensorimotor connectivity is associated with perseverative thinking in obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is highly heterogeneous. Although perseverative negative thinking (PT) is a feature of OCD, little is known about its neural mechanisms or relationship to clinical heterogeneity in the disorder. In a sample of 85 OCD patients, we investigated the relationships between self-reported PT, clinical symptom subtypes, and resting-state functional connectivity measures of local and global connectivity. Results indicated that PT scores were highly variable within the OCD sample, with greater PT relating to higher severity of the “unacceptable thoughts” symptom dimension. PT was positively related to local connectivity in subgenual anterior cingulate cortex (ACC), pregenual ACC, and the temporal poles—areas that are part of, or closely linked to, the default mode network (DMN)—and negatively related to local connectivity in sensorimotor cortex. While the majority of patients showed higher local connectivity strengths in sensorimotor compared to DMN regions, OCD patients with higher PT scores had less of an imbalance between sensorimotor and DMN connectivity than those with lower PT scores, with healthy controls exhibiting an intermediate pattern. Clinically, this imbalance was related to both the “unacceptable thoughts” and “symmetry/not-just-right-experiences” symptom dimensions, but in opposite directions. These effects remained significant after accounting for variance related to psychiatric comorbidity and medication use in the OCD sample, and no significant relationships were found between PT and global connectivity. These data indicate that PT is related to symptom and neural variability in OCD. Future work may wish to target this circuity when developing personalized interventions for patients with these symptoms.

Effect of Mindfulness-Based Cognitive Therapy on Cognitive Emotion Regulation, Perseverative Thinking, and Glycemic Index in Patients with Type 2 Diabetes- A Trial Study

Objective: Type 2 diabetes (T2DM) is a chronic disease associated with many psychological complications, which require psychological interventions. This study aimed to examine the effect of mindfulness-based cognitive therapy (MBCT) on cognitive emotion regulation, perseverative thinking, and glycemic index in patients with T2DM Materials and Methods: This quasi-experimental study was done on T2DM patients visiting Yazd diabetes center in 2019, 30 men and women were randomly divided into experimental (n=15) and control (n=15) groups. The experimental group received 8 sessions (90 minutes) of MBCT and the control group received no interventions. In the pretest and posttest phase, data were collected using the cognitive emotion regulation questionnaire (CERQ), Perseverative Thinking Questionnaire and fasting blood sugar test. Data were analyzed in statistical package (SPSS 21) using multivariate analysis of covariance. Results: Results showed a significant difference in mean scores of cognitive emotion regulation (F= 9.866 & P-value= 0.0001), perseverative thinking (F= 13.745 & P-value= 0.0001), and fasting blood sugar (FBS) (F= 3.679 & P-value= 0.034) in the experimental group before and after the intervention. Conclusion: Based on findings of the study MBCT by specialists in public and private centers can help improve cognitive emotion regulation strategies, perseverative thinking, and ultimately blood sugar control in patients with T2DM.

A Novel Measure of Real-Time Perseverative Thought

Perseverative thinking (PT), or repetitive negative thinking, has historically been measured using global self-report scales. New methods of assessment are needed to advance understanding of this inherently temporal process. We developed an intensive longitudinal method for assessing PT. A mixed sample of 77 individuals ranging widely in trait PT, including persons with PT-related disorders (generalized anxiety disorder, major depression) and persons without psychopathology, used a joystick to provide continuous ratings of thought valence and intensity following exposure to scenarios of differing valence. Joystick responses were robustly predicted by trait PT, clinical status, and stimulus valence. Higher trait perseverators exhibited more extreme joystick values overall, greater stability in values following threatening and ambiguous stimuli, weaker stability in values following positive stimuli, and greater inertia in values following ambiguous stimuli. The joystick method is a promising measure with the potential to shed new light on the dynamics and precipitants of perseverative thinking.

Validation of the Child-version of the Perseverative Thinking Questionnaire of repetitive negative thinking in young people with diagnosed depressive and anxiety disorders

This paper sought to provide the first validation of a transdiagnostic measure of repetitive negative thinking – the Perseverative Thinking Questionnaire- Child version (PTQ-C) – in young people diagnosed with anxiety and depressive disorders. Participants (N=114) were 11-17 year-olds with complex and comorbid presentations seeking treatment through Child and Adolescent Mental Health Services. Confirmatory factor analyses best supported a three-factor model for the PTQ-C, however, hypotheses of both perfect and close fit were rejected. Results demonstrated good internal consistency, convergent validity and divergent validity for the three PTQ-S subscales; core characteristics, perceived unproductiveness and consumed mental capacity of negative repetitive thinking. PTQ-C scores did not account for additional variance in anxiety symptoms once worry was considered, indicating that retention of a content specific measure may be warranted in clinical samples. Findings suggest that PTQ-C subscales not total scores should be used with clinical samples, and emphasise the importance of validating clinically relevant measures which were developed with subclinical populations in samples with diagnosed mental health disorders.

747 Suicidal Ideation Associated with Cognitive Hyperarousal, Rumination and Insomnia in Depressed Perinatal Women

Introduction This prospective study explored associations among clinical insomnia, nocturnal cognitive hyperarousal, and nocturnal perinatal-focused rumination with suicidal ideation (SI) in perinatal women with mild-to-moderate depression. Methods From late pregnancy through early postpartum, 39 women with depression completed 17 weekly surveys assessing insomnia, depression, suicidal ideation, perceived stress, and three cognitive arousal indices. Results Women with nocturnal cognitive hyperarousal at baseline, relative to those with low nocturnal cognitive arousal, were at greater risk for developing new onset SI in late pregnancy or early postpartum (33% vs 1%). Moreover, nocturnal perinatal-focused rumination was independently associated with SI. SI-risk was highest when women reported clinical insomnia combined with nocturnal cognitive hyperarousal (OR=5.66, p=.037) or perinatal-focused rumination (OR=11.63, p=.018). Daytime perseverative thinking was not uniquely associated with SI. Conclusion Cognitive hyperarousal and perinatal-focused rumination at night are uniquely associated with SI among perinatal women with depression. Moreover, insomnia augments the suicidogenicity of nighttime cognitive activity. Future research should determine whether alleviating nocturnal cognitive arousal, pregnancy- and fetal/infant-related concerns, and insomnia with psychotherapy reduces SI for women with perinatal depression. Support (if any) This study was funded by the American Academy of Sleep Medicine (198-FP-18, PI: Kalmbach). Dr. Cheng’s effort was supported by the National Heart, Lung, and Blood Institute (K23-HL13866, PI: Cheng).

740 Insomnia, cognitive arousal, and perinatal-focused rumination fuel perinatal depression

Introduction Depression is among the most prevalent perinatal complications, yet modifiable risk factors remain elusive. Over half of perinatal women endorse clinical insomnia symptoms, which are etiologically implicated in depression in non-perinatal samples. Yet, prospective data on perinatal insomnia and depression are mixed. We sought to clarify temporal associations of insomnia and depression during peripartum, and to investigate cognitive arousal as a potential mechanism facilitating this relationship. Methods Seventy pregnant women completed sociodemographic information and baseline sleep and mood symptoms between gestational weeks 25–30. Beginning at gestational week 30, participants completed 17 weekly online surveys assessing insomnia, depression, and three cognitive arousal indices (nocturnal cognitive arousal, perseverative thinking, perinatal-focused rumination). Mixed effects models were conducted to test hypotheses. Results Women were at elevated risk of screening positive for depression when experiencing high levels of insomnia (OR=2.36, 95%CI=1.28, 4.35), nocturnal cognitive arousal (OR=3.05, 95%CI=1.60, 5.79), perinatal-focused rumination (OR=2.05, 95%CI=1.11, 3.79), and perseverative thinking (OR=7.48, 95%CI=3.90, 14.32). Prospective analyses revealed bidirectional effects between insomnia and cognitive arousal, and both predicted future depression. Nocturnal cognitive arousal mediated 23–43% of the effect of insomnia on depression. Insomnia mediated 12–18% of the effect of nocturnal cognitive arousal on depression. A similar pattern was observed with perinatal-focused rumination. Depression did not predict insomnia. Conclusion Perseverating at night, particularly on perinatal concerns, fuels insomnia. In turn, lying awake at night provides ample opportunity for perseverating. This cycle feeds perinatal depression. Daytime cognitive arousal may indirectly disrupt sleep as perseverating during the day persists into the night. Support (if any):

541 Cognitive Hyperarousal, Sleep Problems and Temperament Linked to Impaired Maternal-Infant Bonding

Introduction Emerging evidence links maternal and infant sleep problems to impairments in the mother-to-infant bond, but the independence and directionality of these associations remain unclear. The present study characterized concurrent and prospective effects of maternal sleep disturbances and poor infant sleep on the mother-infant relationship. As common sequalae of problematic sleep, nocturnal cognitive hyperarousal and daytime sleepiness were investigated as facilitating mechanisms. Methods Sociodemographic information and clinical symptoms were measured prenatally then weekly across the first two postpartum months in 67 women. Participants reported insomnia symptoms, sleep duration, snoring, daytime sleepiness, nocturnal cognitive arousal (broadly focused and perinatal-specific), perseverative thinking, depression, infant colic, infant sleep quality, and mother-infant relationship quality. Mixed effects models were conducted to test hypotheses. Results Prenatal snoring and weak maternal-fetal attachment augured poorer postpartum bonding. Poor infant sleep was associated with increased odds for maternal insomnia and short sleep. Impairments in the mother-to-infant bond were linked to maternal insomnia, nocturnal perinatal-focused rumination, daytime sleepiness, depression, and poor infant sleep. Postnatal insomnia predicted future decreases in mother-infant relationship quality, and nocturnal cognitive hyperarousal partially mediated this association. Conclusion Both maternal and infant sleep problems were associated with impairments in mother-to-infant bonding, independent of the effects of maternal depression and difficult infant temperament. Perseverative thinking at night, particularly on infant-related concerns, was linked to impaired bonding, rejection and anger, and infant-focused anxiety. Improving maternal and infant sleep, as well as maternal cognitive-emotional regulation, may improve the maternal-to-infant bond. Support (if any) This work was funded by the American Academy of Sleep Medicine (198-FP-18, PI: Kalmbach). Dr. Cheng’s effort was supported by the National Heart, Lung, and Blood Institute (K23 HL138166, PI: Cheng).

A pathogenic cycle between insomnia and cognitive arousal fuels perinatal depression: exploring the roles of nocturnal cognitive arousal and perinatal-focused rumination

Study Objectives Depression is among the most prevalent perinatal complications, yet modifiable risk factors remain elusive. Over half of perinatal women endorse clinical insomnia symptoms, which are etiologically implicated in depression in nonperinatal samples. Yet, prospective data on perinatal insomnia and depression are mixed. We sought to clarify temporal associations of insomnia and depression during peripartum, and to investigate cognitive arousal as a potential mechanism facilitating this relationship. Methods Seventy pregnant women completed sociodemographic information and baseline sleep and mood symptoms between gestational weeks 25 and 30. Beginning at gestational week 30, participants completed 17 weekly online surveys assessing insomnia, depression, and three cognitive arousal indices (nocturnal cognitive arousal, perseverative thinking, and perinatal-focused rumination). Mixed effects models were conducted to test hypotheses. Results Women were at risk for depression when experiencing insomnia (odds ratio [OR] = 2.36, 95% confidence interval [CI] = 1.28 to 4.35), nocturnal cognitive arousal (OR = 3.05, 95% CI = 1.60 to 5.79), perinatal-focused rumination (OR = 2.05, 95% CI = 1.11 to 3.79), and perseverative thinking (OR = 7.48, 95% CI = 3.90 to 14.32). Prospective analyses revealed bidirectional effects between insomnia and cognitive arousal, and both predicted future depression. Nocturnal cognitive arousal mediated 23–43% of the effect of insomnia on depression. Insomnia mediated 12%–18% of the effect of nocturnal cognitive arousal on depression. A similar pattern was observed with perinatal-focused rumination. Depression did not predict insomnia. Conclusion Nocturnal cognitive arousal, including ruminating on perinatal concerns while trying to fall asleep, fuels insomnia. In turn, lying awake at night provides an opportunity for nocturnal cognitive arousal. This cycle feeds perinatal depression. Daytime cognitive arousal may indirectly disrupt sleep as perseverating during the day persists into the night.