Feasibility of implementing a group intervention for transdiagnostic repetitive negative thinking in primary care

Theoretical conceptualizations of psychopathology have shifted from categorical toward dimensional models, prompting a parallel shift toward transdiagnostic approaches to treatment. Repetitive negative thinking (RNT) is a transdiagnostic construct defined as cognitive perseveration on negative themes (e.g., worry and rumination) and has been implicated in the etiology and maintenance of several disorders including depression, generalized anxiety, and social anxiety. Group metacognitive therapy (MCT) has been shown to be effective in treating RNT across diagnoses in specialty mental health settings. Research is limited regarding the implementation of transdiagnostic group treatments in settings outside of specialty mental healthcare settings. The current study sought to explore the feasibility and effectiveness of implementing a group MCT program to address RNT in a primary care setting. Despite active recruitment attempts, the study enrolled only two participants in a family medicine practice with complaints related to RNT. Participants completed six 1.5 hour MCT group sessions and completed outcome measures at pre-treatment, post-treatment, and 4-week follow-up. Primary outcomes were engagement with RNT, anxiety, and depression. Results suggested that group metacognitive therapy delivered in primary care may be effective at decreasing engagement with RNT and improving symptoms of anxiety and depression, as evidenced by the two participants’ improvements on all outcome measures; however, there were significant difficulties with participant recruitment, calling into question the validity of the findings and the feasibility of such a treatment program. Limitations and future directions are discussed, emphasizing specific recommendations for improving recruitment procedures.Psy.D.Includes bibliographical referencesby Angelo N. Alag