Mini-internet training in positive reappraisal and concrete thinking for adolescents

Rumination (or depressive worrying), can be defined as repeatedly and
persistently thinking about the causes, consequences, and implications of
stressful experiences. Characteristic to rumination is the abstract-analytical
style and the experience of difficulties in stopping the process
(Nolen-Hoeksema, 1991; Watkins, 2008). Rumination has a detrimental influence
on the course of, and recovery from depressive disorder. Furthermore,
rumination is strongly related to depressive symptoms in adults and youth from
the age of 10 (Lyubomirsky, Wisco, & Nolen-Hoeksema, 1999; Rood et al., 2009).
The detrimental effects of rumination can predominantly be explained by the
abstract-evaluative way of thinking (verbal, generalising, general, analytical,
vague, ambiguous-interpretative, with regard to personality; Watkins, 2008).
From research it van be concluded thsat the way of thinking about stressful
events is a crucial factor is when it comes to ameliorating or worsening of
mood. The hypothesized advantages that a concrete thinking style (detailed,
experience-focused, situation-specific, visual; with regard to the situation;
Watkins, 2008) has on mood has led to the development of concreteness training
for prevention and treatment of depressive symptoms. This training has its
roots in mindfulness, and can be seen as a cognitive intervention aimed at the
reduction of ruminative and worrisome thinking leading to a reduction of
depressive symptoms (Watkins, Baeyens, & Read, 2009). This training teaches to
adopt a concrete thinking style when thinking about (for the participant)
worrisome questions. As expected, this training has a beneficial effect on
mood: a significant reduction in depressive symptoms and level of rumination
was found (Watkins et al., 2009).
Besides a concrete thinking style, other thinking styles have been examined as
counterparts of rumination with regard to their effects on mood. Helgeson,
Reynolds and Tomich (2006) have examined the effects of another verbal and
abstract-analytical thinking style (like rumination), positive reappraisal, on
general well-being. Positive reappraisal is a thinking style, whereby a
positive meaning is given to a negative stressful event. Studies (Helgeson et
al., 2006; Rood, Roelofs, Bögels, & Arntz, 2012) have shown that positive
reappraisal significantly is related to general wellbeing and that positive
reappraisal can ameliorate mood in school-attending youth on the short-term.
Positive reappraisal is just like rumination, an abstract and verbal thinking
style. Rood et al. (2012) therefore suggest based on their research that
positive reappraisal may be a fruitful alternative to a ruminative thinking
style, specifically for individuals who have the tendency to think more in
words than in images.
The effectiveness of a concreteness training, just as the effect of a training
in positive reappraisal, has not yet been examined before in youth. Only the
short-term effects of positive reappraisal have been examined in youth, in a
brief experiment which showed that positive reappraisal causes an increase in
positive effect and de decrease in negative affect when thinking about a
stressful experience compared to rumination (Rood et al., 2009). Also, these
two thinking styles as counterparts of rumination have not been compared to
each other as yet.
*

This study aims to compare the effects of a training in concrete thinking and a
training in positive reappraisal with a control conditions (no specific
training instructions) on indices of psychological wellbeing in youth aged 15
to 18. Participants are asked to complete writing tasks via internet, by means
of which a concrete thinking style or positive reappraisal is trained using
their personal experiences of that particular day, with the focus on negative
events or experiences, during one week. The researchers expect both training
programs will significantly positively affect mood and that mood will be better
in the trainings groups compared to the control group. Furthermore, it is
expected that the effect of the training programs is dependent on the natural
tendency to ruminate, in that mood significantly ameliorates more strongly in
the training groups compared to the control group as participants have a
stronger tendency to ruminate.
The results of the current study can contribute to the prevention and treatment
of mood disorder symptoms and stress in youth. The advantage of a brief,
minimal intervention training to prevent stress and mood disorder symptoms as
the current one, is that it is easily accessible for school-attending youth and
that it is low-budget. The intervention is currently primarily designed as a
preventive intervention.

Evaluation mini-training, online intervention study (carried out at home),
parallel-group randomised controlled trial; 3 conditions: positive reappraisal
training, concreteness training, control group

Design of study over the period of 14 days:

Day 1 Pre-measurement* and Writing task (mini-internet training)**
Day 2 to 6 Writing task
Day 7 Writing task and Post-measurement***
Day 14 Follow-up measurement****

*Pre-measurement: demographic data, mood disorder symptoms (Beck Depression
Inventory; BDI-II-NL), worry/rumination (Perseverative Thinking Questionnaire;
PTQ-NL), positive and negative mood states (Positive Affect Negative Affect
Schedule; PANAS)
***Post-measurement: PANAS, PTQ, Manipulation check and evaluation
****Follow-up measurement: PANAS, PTQ

**Writing task
1. Pre-measurement affect state VAS (time 1)
2. General instruction writing task (for all conditions) "Think about a
stressful experience..."
3. Post-measurement VAS (time 2)
4. Specific instructions per condition
a. Positive reappraisal condition
b. Concreteness training condition
c. Control condition
5. Post-measurement VAS (time 3)

Part 1

Now we want you to think about a stressful event or situation that is bothering
you at this moment, today, or that you experienced today and that is bothering
you now. You may think for example about a fight with your parents or with a
friend, problems at school, being bullied, being in love with someone, etc. It
can also be something small, as long as it occupies you. (If you really cannot
think of something, think about something stressful that happened some time
longer ago and which occupies you still from time to time.)
Try to play the event in your head as a movie, and to experience all thoughts
and feelings accompanying the event again now, until you see the event again
lively before you and as if you are in the middle of it again. Freeze the
screen at the most stressful moment.

Now describe very briefly (in max. 10 words) which stressful event or situation
you are thinking of (e.g., *fight with teacher*. There may be more than one
event.

How bad is this event to you? 1= not bad....2=a bit bad*3=pretty bad*4=very bad*
5= the worst thing I've ever experienced

Part 2 Specific instructions per condition

Positive reappraisal condition
You just thought about the stressful experience. Now we want you to think about
that experience again, but now in a specific way.
Now try to think about the positive sides of the stressful event. Use the
following support questions to think about the stressful event. You may decide
for yourself how much time you spend on one question, as long as you try to
answer the question for yourself. Try to keep to the instructions!
1. Think about what you learned from this experience
2. Think about the positive things that this stressful event has brought to you
3. Think about the things you do still have
4. Think about how this event has finally made you stronger

Some people think in words, other see images before them. You may decide
yourself whether you think in words or images.
Now we want you to write down what goes through your mind, when you try to
answer the questions. What kind of thoughts and/or images come up? Try to
describe what goes through your mind as accurately as possible and to be as
completely as possible in your description. (We don*t want you to go thinking
again at this moment, just write down what you thought about during the task.)
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Concreteness training condition
You just thought about the stressful experience. Now we want you to think about
that experience again, but now in a specific way. Try to think as lively and
concretely as possible to think about the stressful experience. Use the
following support questions to think about the stressful event. You may decide
for yourself how much time you spend on one question, as long as you try to
answer the question for yourself. Try to keep to the instructions!
1. Think about how it happened (What happened first? What followed? And
consequently?)
2. Try to play the stressful event in your thoughts (see it before you) as a
movie
3. Try to remember as much details and facts of the event as possible (think
about where you was, with whom, what you were wearing, what time it was, which
day, how did the environment look like? etc.)
4. What did you exactly feel in your body? What did it smell like? What colours
did you see? What kind of sounds did you hear around you? What went through
your mind regarding thoughts and feelings?

Some people think in words, other see images before them. You may decide
yourself whether you think in words or images.
Now we want you to write down what goes through your mind, when you try to
answer the questions. What kind of thoughts and/or images come up? Try to
describe what goes through your mind as accurately as possible and to be as
completely as possible in your description. (We don*t want you to go thinking
again at this moment, just write down what you thought about during the task.)
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Control condition
You just thought about the stressful experience. Now we want you to think about
that experience again. Describe the stressful situation in your own words. Try
not to wander off and think about anything else, even if that can be difficult.

Some people think in words, other see images before them. You may decide
yourself whether you think in words or images.
Now we want you to write down what goes through your mind, when you try to
answer the questions. What kind of thoughts and/or images come up? Try to
describe what goes through your mind as accurately as possible and to be as
completely as possible in your description. (We don*t want you to go thinking
again at this moment, just write down what you thought about during the task.)
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The participants are trained to adopt a certain thinking strategy when thinking
of personal, negative or stressful experiences. This can be confronting for
some participants and cause a negative mood.
Youth diagnosed with a mood disorder are excluded from the study. Most youth
think about stressful experiences every day, and especially when they have a
tendency to worry (indicating vulnerability to stress) the trained thinking
strategies could have beneficial effects.
No specific instructions are given in the control condition, just the
instruction to take a moment to think about the experience and to write down
their thoughts (like in a diary).
In general, the participants keep control of how much time they spend on the
task, there is no pressure regarding time. Adverse effects of thinking about
something stressful that happened that day, are most likely of a temporary
nature and under the participant's control.

Burden filling out questionnaires:

Pre-measurement: 15 minutes
Post-measurement: 10 minutes
Follow-up measurement: 10 minutes