Improving Attentional and Cognitive Control in the Psychological Treatment of Intrusive Thoughts

The current study will examine whether enhancing attention regulation skills in a transdiagnostic intervention for repetitive negative thinking (RNT) will significantly improve the target of attentional/cognitive control. Phase 1 is an open pilot trial in which participants will be assigned to eight 60 minute sessions (over 8 weeks) of Emotion Regulation Therapy-Attention Regulation (AR-ERT). In Phase 2, participants will be randomly assigned (like the flip of a coin) to receive eight 60 minute sessions (over 8 weeks) of either: AR-ERT or Supportive Psychotherapy (SPT). The investigators will use a multi-method approach to measure attentional/cognitive control: (a) behavioral (i.e., eye tracking fixations and reaction time), (b) electrophysiological (i.e., event related potentials), and (c) self-report (i.e., perceived ability to shift and focus attention). They also will examine early signs of treatment efficacy of AR-ERT and SPT and target validation (i.e., whether changes in attentional/cognitive control correlate with changes in RNT and associated symptoms). Participants will receive assessments of these target and outcome measures at baseline (week 0), mid-treatment (week 4), post-treatment (week 8), and 3-month follow-up (week 20 - Phase 2 only). While most of these procedures are conducted virtually (e.g., therapy sessions), some (e.g., eye tracking and electrophysiological assessments) will be performed in-person. Findings could help identify a cross-cutting target that can be engaged to optimize treatment response for individuals with elevated RNT.

Inclusion criteria

• Adults ages 18-60 years old
• Right-handed
• Living in Massachusetts
• Repetitive Negative Thinking (RNT) in the form of mental rituals, worries, and/or depressive ruminations is the primary reason for seeking treatment
• RNT significant enough to warrant intervention
• Fluent in English, willing to provide informed consent, and willing to comply with the study protocol
• Access to a device with an internet connection, camera, and microphone (e.g., computer, smart phone, tablet)
• Comfortable and capable of using a computer and completing reaction-time tasks

Exclusion criteria

• History of head injury or neurologic disease, mental retardation, or borderline intellectual functioning that would interfere with ability to participate in the study.
• Impaired (or uncorrected) vision, medical illness, or medical treatment that would interfere with participation.
• Active suicidal or homicidal ideation or any features requiring a higher level of care.
• Lifetime psychotic disorder or bipolar disorder
• Substance or alcohol use disorder that would interfere with treatment.
• Current Attention Deficit Hyperactivity Disorder (ADHD) that would interfere with attentional tasks.
• Unstable dose of psychotropic medications or recent discontinuation of psychotropic medication.
• Current psychotherapy or plans to initiate such treatment during the study.
• Previous course of treatment with cognitive behavioral therapy and/or mindfulness/meditation for obsessive compulsive disorder (OCD), generalized anxiety disorder (GAD), or depression.