Repetitive negative thinking and visual perspective: A special relationship? A meta-analysis

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Therapies targeting mental imagery

The use of mental imagery has a long tradition in cognitive and behavior therapies, such as techniques for fear-based imagery including the systematic desensitization (Wolpe, 1958; cited by Hackmann, Bennett-Levy, & Holmes, 2011) or the imaginal exposure (Foa & Kozak, 1986). Aaron Beck (Beck, Emery, & Greenberg, 1958; cited by Hackmann et al., 2011) also developed the use of mental imagery in cognitive restructuring.
In recent years, the use of imagery or the focus on mental images in therapy has increased (Holmes, Arntz, & Smucker, 2007). Emily Holmes has conceptualized mental imagery as an emotional amplifier representing an interesting way for therapy (Holmes & Mathews, 2010). She has developed therapies aiming at encouraging positive mental imagery (Holmes, Lang, & Shah, 2009; Holmes, Mathews, Dalgleish, & Mackintosh, 2006). Another recent form of therapy is imagery rescripting, which aims at transforming negative mental images into a more benign form (for a review, see Arntz, 2012; Smucker, 2005).
Interventions targeting mental imagery have in common the consideration either that the actor perspective is in important prerequisite when working with mental imagery (Hackmann et al., 2011) or that the visual perspective can be used to distance or put into perspective vivid mental images.


In summary, mental imagery is an important transdiagnostic process implicated in psychological disorders such as depression or PTSD. The visual perspective adopted seems to be an important feature of mental images, with clinical or subclinical populations adopting greater observer perspective than non-clinical populations. Visual perspective is underpinned by an abstraction process: The observer perspective is determined by an abstract level of construal and the actor perspective by a concrete level of construal. The observer perspective could have both adaptive and maladaptive consequences, depending on the subjective meaning derived from the integration of the event within broader self-knowledge. Depending on the subjective meaning, the observer perspective can serve an avoidance function and have negative cognitive and emotional consequences.

Synthesis and overview of the empirical section

Repetitive negative thinking and visual perspective: A special relationship?

The first two chapters of this dissertation have outlined the role of verbal maladaptive RNT and mental images from an observer perspective, conceptualized as two important transdiagnostic processes in several psychological disorders, such as depressed and anxious disorders (Holmes & Mathews, 2010; Watkins, 2008). Based on the literature, we have developed the idea that RNT and visual perspective can be determined by the level of construal adopted. The adoption of an abstract level of construal –focused on the analysis of causes, consequences, and implications of events or actions– would lead to an abstract RNT and an observer perspective, which are predominant in vulnerable populations, i.e., clinical and subclinical populations (e.g., Coles et al., 2002; Kuyken & Howell, 2006; Lemogne et al., 2006; Watkins, 2008, 2011). However, this abstract level would have negative consequences in these populations, possibly through generalization. Indeed, vulnerable populations differ from non-clinical populations on their tendency to generalize from a single negative event (Carver, 1998; Carver & Ganellen, 1983; Fulford et al., 2012). The adoption of an abstract level of construal would promote generalization in vulnerable individuals and lead to negative consequences.
Even if RNT and visual perspective have often been studied independently, one hypothesis on which the present dissertation has been based is that they can be considered as the product of other processes. This idea of processes that can be defined at different levels is somewhat recent (Philippot, 2016). In the present case, the central process is abstraction, i.e., the adoption of an abstract level of construal. Furthermore, RNT and visual perspective seem to serve an avoidance function: Avoiding focusing on concrete features would be associated with fewer feelings, even if this also has negative consequences through abstraction (Sibrava & Borkovec, 2006 for RNT; Williams & Moulds, 2007 for visual perspective, but also see Libby & Eibach, 2011).
Given processual and functional similarities between RNT and visual perspective, one could make the hypothesis that RNT, more specifically abstract RNT, and the observer perspective are positively correlated. Indeed, cognitive behavioral models of psychopathology often postulate that several psychological processes operate in interaction and contribute to the onset and maintenance of the disorder (e.g., combined cognitive biases hypothesis, Hirsch et al., 2006). It would be therefore necessary to study the role of RNT and visual perspective in mental disorders in a more integrative manner. Despite the fundamental and clinical relevance of this proposition, only a few studies have explored the relationship between RNT and the visual perspective adopted. In the following sections, we will review these studies.

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Previous studies on the relationship between repetitive negative thinking and visual perspective

Several studies have been conducted on the frequency of verbal thoughts and mental images during RNT (e.g., Behar et al., 2012; Borkovec & Inz, 1990; Hirsch et al., 2012). In this section, we will review studies which specifically explored the association between verbal thoughts and the visual perspective adopted during mental images.
Only few correlational studies explored this relationship. Some of them evidenced a positive association between the adoption of an observer perspective and the trait tendency to ruminate or worry (Finnbogadóttir & Berntsen, 2014; Williams & Moulds, 2007)3 or between the adoption of an observer perspective to visualize an event and the state rumination on this event (Kuyken & Moulds, 2009). However, other studies did not find a correlation between the observer perspective and trait (Finnbogadóttir & Berntsen, 2011; Kuyken & Moulds, 2009) or state RNT (Williams & Moulds, 2007).
More precisely, Williams and Moulds (2007) asked dysphoric and non-dysphoric participants to recall a spontaneous intrusive memory occurring during the past week and to indicate its visual perspective, using a complementary measure. Participants also completed the RRS measuring their trait tendency to ruminate and rated their state rumination on the memory. The results showed that, overall, a greater trait tendency to ruminate was associated with more observer perspective when picturing the intrusive memory. When selecting extreme participants on the depression measure (i.e., higher and lower scores), results indicated that this association was only present in the dysphoric subsample compared to the non-dysphoric subsample. However, state rumination did not correlate with the visual perspective adopted.
Similarly, in a first study conducted by Finnbogadóttir and Berntsen (2014), high and low worriers (i.e., selected on their trait tendency to worry using the PSWQ) recalled or imagined events following neutral word cues, positive and negative emotion cues, or personally important events, and rated their visual perspective using complementary measures. The results indicated that high worriers adopted greater observer perspective to visualize the events compared with low worriers. In a second study, Finnbogadóttir and Berntsen (2014) asked a student sample to report the visual perspective adopted to picture past events following positive and negative emotion cues, using complementary measures, and to rate its trait tendency to worry and to ruminate using the PSWQ and the RRQ. Again, higher levels of trait worry or rumination were associated with greater use of an observer perspective.
Kuyken and Moulds (2009) asked patients with a history of recurrent depression to retrieve memories following positive or negative emotion cues and to rate the visual perspective adopted using mutually exclusive measures. They also rated their state rumination on these events and completed a trait measure of rumination using the RRQ. Results showed that participants who pictured memories from an observer perspective had higher levels of state rumination on the event compared to participants who pictured memories from an actor perspective. However, trait rumination was not associated with the visual perspective adopted.

Table of contents :

CHAPTER 1. Repetitive negative thinking
1. Definition of repetitive negative thinking
2. Repetitive negative thinking as a transdiagnostic process
3. Processes implicated in the development and the maintenance of repetitive negative thinking
4. Predominance of verbal thoughts over images
4.1. Worry
4.2. Rumination
5. An underlying process of abstraction
5.1. Worry
5.2. Rumination
6. Therapies targeting repetitive negative thinking
7. Conclusion
CHAPTER 2. Visual perspective in mental imagery
1. Definition of mental imagery
2. Visual perspective in mental imagery as a transdiagnostic process
3. An avoidance function
4. An underlying process of abstraction
5. Therapies targeting mental imagery
6. Conclusion
Synthesis and overview of the empirical section
1. Repetitive negative thinking and visual perspective: A special relationship?
2. Previous studies on the relationship between repetitive negative thinking and visual perspective
3. Overview of the empirical section
CHAPTER 3. Mental rumination and visual perspective: Common function and process?
General discussion
CHAPTER 4. Manipulation of the abstraction process during rumination
Study 2a
Study 2b
General discussion
CHAPTER 5. Manipulation of the abstraction process
CHAPTER 6. Repetitive negative thinking and visual perspective: A special relationship? A meta-analysis


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