A systematic review and meta-analysis published in Psychology Medicine found that among adolescents and young adults, reducing repetitive negative thinking with psychological interventions was associated with improvements in symptoms of depression and anxiety.

Investigators from the University of Melbourne in Australia searched the Orygen Evidence Finder for relevant articles from publication databases published through June 2020. A total of 28 articles that evaluated psychological treatments for repetitive negative thinking, depression, and anxiety among adolescents were included.

The pooled study sample comprised 2498 patients with a mean age of 19.70 (SD, 3.71) years, and 76% were girls or women. The studies included patients with repetitive negative thinking (n=24), anxiety (n=20), and depression (n=17).

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The overall effect sizes of treatment on the conditions were similar, in which the greatest effect size was observed for depression (g, -0.47; 95% CI, -0.77 to -0.17; I2, 88.82%; P <.001), followed by repetitive negative thinking (g, -0.45; 95% CI, -0.067 to -0.23; I2, 84.81%; P <.001) and anxiety (g, -0.42; 95% CI, -0.65 to -0.20; I2, 81.67%; P <.001).

In subgroup analyses, significant interactions were observed for content versus process interventions (P =.01) and intervention format (P =.02). Overall, a significant effect on repetitive negative thinking outcomes were observed for process-focused interventions (g, -0.85; 95% CI, -1.29 to -0.41; I2, 89.45%) but not content-focused interventions (g, -0.13; 95% CI, -0.28 to 0.01; I2, 38.28%). All intervention formats had significant effects on repetitive negative thinking outcomes, with the highest observed for group interventions (g, -1.35; 95% CI, -2.29 to -0.41; I2, 95.16%), followed by individual (g, -0.56; 95% CI, -1.11 to -0.01; I2, 81.08%) and digital or self-guided (g, -0.24; 95% CI, -0.44 to -0.04; I2, 72.12%) interventions.

In general, significant positive relationships between repetitive negative thinking and depression outcomes were observed (Z, 2.01; P =.04). In interventions that focused on repetitive negative thinking outcomes, both depression (Z, 2.32; P =.02) and anxiety (Z, 2.15; P =.03) outcomes were positively related with repetitive negative thinking outcomes.

The limitation of this review was the small number of studies and the high level of interstudy heterogeneity.

Study authors concluded, “The current findings suggest that reducing RNT using a variety of psychological treatment approaches may help improve depression and anxiety in youth. The significant relationship between reductions in RNT and improvements in depression and anxiety highlights the clinical significance of RNT as a transdiagnostic target in psychological treatment for youth, although further research is needed to determine whether this relationship is causal.”


Bell IH, Marx W, Nguyen K, Grace S, Gleeson J, Alvarez-Jimenez M. The effect of psychological treatment on repetitive negative thinking in youth depression and anxiety: a meta-analysis and meta-regression. Psychol Med. 2022;1-11. doi:10.1017/S0033291722003373

This article originally appeared on Psychiatry Advisor