Repetitive Negative Thinking in Adolescents Who Stutter
Publication: Journal of Speech, Language, and Hearing Research
Volume 66, Number 9
Pages 3290-3306
Abstract
Purpose:
Repetitive negative thinking (RNT) is the process of engaging in negatively valenced and habitual thought patterns. RNT is strongly associated with mental health conditions and often affects quality of life. This study explored RNT in older school-age children and adolescents who stutter to quantify the relationship between RNT and self-reported anxiety characteristics. An additional aim was to describe how individual differences in an adolescent's goal when speaking influences the frequency they engage in RNT.
Method:
Ninety-nine children and adolescents who stutter aged 9–18 years completed a measurement of the frequency/severity of RNT, a screener of anxiety characteristics, and a measure of adverse impact related to stuttering. Children aged 10 years and above also answered questions about their goal when speaking.
Results:
Individual differences in RNT significantly predicted Overall Assessment of the Speaker's Experience of Stuttering (OASES) Total Scores more so than a child or adolescent's age. Higher generalized or social anxiety scores were significantly correlated with more frequent RNT and higher OASES Total Scores. Individual differences in goal when speaking (i.e., whether or not to stutter openly) were found to predict RNT. Finally, 22 children and adolescents (22.2%) also screened positive for generalized anxiety disorder and 32 (32.3%) screened positive for social anxiety disorder.
Discussion:
These data provide strong evidence that (a) many children and adolescents who stutter engage in RNT; (b) children and adolescents who engage more frequently in RNT or who have higher OASES Total Scores may be at increased risk for more characteristics of generalized or social anxiety; and (c) individual differences in goal when speaking can predict the degree to which an adolescent engages in RNT.
Supplemental Material:
Get full access to this article
View all available purchase options and get full access to this article.
References
Abela, J. R. Z., & Hankin, B. L. (2011). Rumination as a vulnerability factor to depression during the transition from early to middle adolescence: A multiwave longitudinal study. Journal of Abnormal Psychology, 120(2), 259–271.
Allison, P. D. (1999). Logistic regression using the SAS system: Theory and application. SAS Institute.
Altemus, M., Sarvaiya, N., & Neill Epperson, C. (2014). Sex differences in anxiety and depression clinical perspectives. Frontiers in Neuroendocrinology, 35(3), 320–330.
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). American Psychiatric Association.
Beck, J. S. (2021). Cognitive behavior therapy, third edition: Basics and beyond. The Guildford Press.
Behrens, B., Swetlitz, C., Pine, D. S., & Pagliaccio, D. (2019). The Screen for Child Anxiety Related Disorders (SCARED): Informant discrepancy, measurement invariance, and test–retest reliability. Child Psychiatry & Human Development, 50(3), 473–482.
Beilby, J. M., & Byrnes, M. L. (2012). Acceptance and commitment therapy for people who stutter. SIG 4 Perspectives on Fluency and Fluency Disorders, 22(1), 34–46.
Bell, I. H., Marx, W., Nguyen, K., Grace, S., Gleeson, J., & Alvarez-Jimenez, M. (2022). The effect of psychological treatment on repetitive negative thinking in youth depression and anxiety: A meta-analysis and meta-regression. Psychological Medicine, 53(1), 6–16.
Bernard, R., Hofslundsengen, H., & Norbury, C. F. (2022). Anxiety and depression symptoms in children and adolescents who stutter: A systematic review and meta-analysis. Journal of Speech, Language, and Hearing Research, 65(2), 624–644.
Bijttebier, P., Raes, F., Vasey, M. W., Bastin, M., & Ehring, T. W. (2015). Assessment of repetitive negative thinking in children: The Perseverative Thinking Questionnaire – Child version (PTQ-C). Journal of Psychopathology and Behavioral Assessment, 37(1), 164–170.
Birmaher, B., Brent, D. A., Chiappetta, L., Bridge, J., Monga, S., & Baugher, M. (1999). Psychometric properties of the Screen for Child Anxiety Related Disorders (SCARED): A replication study. Journal of the American Academy of Child and Adolescent Psychiatry, 38(10), 1230–1236.
Birmaher, B., Khetarpal, S., Brent, D., Cully, M., Balach, L., Kaufman, J., & Neer, S. M. K. (1997). The Screen for Child Anxiety Related Disorders (SCARED): Scale construction and psychometric characteristics. Journal of the American Academy of Child and Adolescent Psychiatry, 36(4), 545–553.
Blood, G. W. (1995). A behavioral-cognitive therapy program for adults who stutter: Computers and counseling. Journal of Communication Disorders, 28(2), 165–180.
Blood, G. W., Blood, I. M., Maloney, K., Meyer, C., & Qualls, C. D. (2007). Anxiety levels in adolescents who stutter. Journal of Communication Disorders, 40(6), 452–469.
Bloodstein, O. (1995). A handbook on stuttering. Singular.
Boey, R. A., Van de Heyning, P. H., Wuyts, F. L., Heylen, L., Stoop, R., & De Bodt, M. S. (2009). Awareness and reactions of young stuttering children aged 2-7 years old towards their speech disfluency. Journal of Communication Disorders, 42(5), 334–346.
Boyle, M. P. (2011). Mindfulness training in stuttering therapy: A tutorial for speech-language pathologists. Journal of Fluency Disorders, 36(2), 122–129.
Cheasman, C. (2013). A mindful approach to stammering. In C. Cheasman, R. Everard, & S. Simpson (Eds.), Stammering therapy from the inside: New perspectives on working with young people and adults (pp. 227–265). J & R Press.
Christensen, R. H. B. (2019). Ordinal regression models for ordinal data (R package version 2019.12-10). https://cran.r-project.org/package=ordinal
Cicchetti, D., & Rogosch, F. A. (2002). A developmental psychopathology perspective on adolescence. Journal of Consulting and Clinical Psychology, 70(1), 6–20.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Erlbaum.
Constantino, C. D., Eichorn, N., Buder, E. H., Gayle Beck, J., & Manning, W. H. (2020). The speaker's experience of stuttering: Measuring spontaneity. Journal of Speech, Language, and Hearing Research, 63(4), 983–1001.
Constantino, C. D., Manning, W. H., & Nordstrom, S. N. (2017). Rethinking covert stuttering. Journal of Fluency Disorders, 53, 26–40.
Cook, R. D. (1979). Influential observations in linear regression. Journal of the American Statistical Association, 74(365), 169–174.
Craig, A., & Hancock, K. (1996). Anxiety in children and young adolescents who stutter. Australian Journal of Human Communication Disorders, 24(1), 28–38.
Craig, A., Hancock, K., Chang, E., McCready, C., Shepley, A., McCaul, A., Costello, D., Harding, S., Kehren, R., Masel, C., & Reilly, K. (1996). A controlled clinical trial for stuttering in persons aged 9 to 14 years. Journal of Speech and Hearing Research, 39(4), 808–826.
Dawson, G. C., Adrian, M., Chu, P., McCauley, E., & Vander Stoep, A. (2022). Associations between sex, rumination, and depressive symptoms in late adolescence: A four-year longitudinal investigation. Journal of Clinical Child and Adolescent Psychology. Advance online publication.
De Nil, L. F., & Brutten, G. J. (1991). Speech-associated attitudes of stuttering and nonstuttering children. Journal of Speech and Hearing Research, 34(1), 60–66.
Dowle, M., & Srinivasan, A. (2021). data.table: Extension of `data.frame` (R package version 1.14.0.) . https://cran.r-project.org/package=data.table
Ehrenreich-May, J., & Chu, B. C. (2014). Overview of transdiagnostic mechanisms and treatments for youth psychopathology. In J. Ehrenreich-May & B. C. Chu (Eds.), Transdiagnostic treatments for children and adolescents: Principles and practice (pp. 2–14). Guilford Press.
Ehring, T., Raes, F., Weidacker, K., & Emmelkamp, P. M. G. (2012). Validation of the Dutch version of the Perseverative Thinking Questionnaire (PTQ-NL). European Journal of Psychological Assessment, 28(2), 102–108.
Ehring, T., & Watkins, E. R. (2008). Repetitive negative thinking as a transdiagnostic process. International Journal of Cognitive Therapy, 1(3), 192–205.
Ehring, T., Zetsche, U., Weidacker, K., Wahl, K., Schönfeld, S., & Ehlers, A. (2011). The Perseverative Thinking Questionnaire (PTQ): Validation of a content-independent measure of repetitive negative thinking. Journal of Behavior Therapy and Experimental Psychiatry, 42(2), 225–232.
Emerick, L. L. (1988). Counseling adults who stutter: A cognitive approach. Seminars in Speech and Language, 9(3), 257–267.
Esbjørn, B. H., Falch, A., Walczak, M. A., Normann, N., & Breinholst, S. (2021). Social anxiety disorder in children: Investigating the relative contribution of automatic thoughts, repetitive negative thinking and metacognitions. Behavioural and Cognitive Psychotherapy, 49(2), 159–171.
Fox, J., & Weisberg, S. (2019). An {R} companion to applied regression (3rd ed.). SAGE. https://socialsciences.mcmaster.ca/jfox/Books/Companion/
Franken, M. C. J. P., Koenraads, S. P. C., Holtmaat, C. E. M., & Van der Schroeff, M. P. (2018). Recovery from stuttering in preschool-age children: 9 year outcomes in a clinical population. Journal of Fluency Disorders, 58, 35–46.
Gerlach, H., Chaudoir, S. R., & Zebrowski, P. M. (2021). Relationships between stigma-identity constructs and psychological health outcomes among adults who stutter. Journal of Fluency Disorders, 70, 11–12.
Gerlach-Houck, H., Kubart, K., & Cage, E. (2023). Concealing stuttering at school: “When you Can't fix it…the only alternative is to hide it.” Language, Speech, and Hearing Services in Schools, 54(1), 96–113.
Goodman, L. A. (1961). Snowball sampling. The Annals of Mathematical Statistics, 32(1), 148–170.
Gunn, A., Menzies, R. G., O'Brian, S., Onslow, M., Packman, A., Lowe, R., Iverach, L., Heard, R., & Block, S. (2014). Axis I anxiety and mental health disorders among stuttering adolescents. Journal of Fluency Disorders, 40, 58–68.
Helgadóttir, F. D., Menzies, R. G., Onslow, M., Packman, A., & O'Brian, S. (2014). A standalone Internet cognitive behavior therapy treatment for social anxiety in adults who stutter: CBTpsych. Journal of Fluency Disorders, 41, 47–54.
Hirsch, C. R., Mathews, A., Lequertier, B., Perman, G., & Hayes, S. (2013). Characteristics of worry in generalized anxiety disorder. Journal of Behavior Therapy and Experimental Psychiatry, 44(4), 388–395.
Iverach, L., Jones, M., Lowe, R., O'Brian, S., Menzies, R. G., Packman, A., & Onslow, M. (2018). Comparison of adults who stutter with and without social anxiety disorder. Journal of Fluency Disorders, 56, 55–68.
Iverach, L., & Rapee, R. M. (2014). Social anxiety disorder and stuttering: Current status and future directions. Journal of Fluency Disorders, 40, 69–82.
Iverach, L., Rapee, R. M., Wong, Q. J. J., & Lowe, R. (2017). Maintenance of social anxiety in stuttering: A cognitive-behavioral model. American Journal of Speech-Language Pathology, 26(2), 540–556.
Jackson, E. S., Miller, L. R., Warner, H. J., & Yaruss, J. S. (2021). Adults who stutter do not stutter during private speech. Journal of Fluency Disorders, 70, Article 105878.
Jose, P. E., & Brown, I. (2008). When does the gender difference in rumination begin? Gender and age differences in the use of rumination by adolescents. Journal of Youth and Adolescence, 37(2), 180–192.
Kelman, E., & Wheeler, S. (2015). Cognitive behaviour therapy with children who stutter. Procedia - Social and Behavioral Sciences, 193, 165–174.
Kennedy, P. (2003). A guide to econometrics (5th ed.). MIT Press.
Kessler, R. C., Chiu, W. T., Demler, O., & Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 617–627.
Kuehner, C., & Weber, I. (1999). Responses to depression in unipolar depressed patients: An investigation of Nolen-Hoeksema's response styles theory. Psychological Medicine, 29(6), 1323–1333.
Langevin, M., Packman, A., & Onslow, M. (2010). Parent perceptions of the impact of stuttering on their preschoolers and themselves. Journal of Communication Disorders, 43(5), 407–423.
MacIntyre, S. (2012). Passing as fluent. In P. Reitzes & D. Reitzes (Eds.), Stuttering (Vol. 1, pp. 25–38). StutterTalk, Inc.
Manning, W., & Beck, J. G. (2011). Comments concerning Iverach, et al., screening for personality disorders among adults seeking speech treatment for stuttering [J. Fluency Disorders 34 (2009) 173–186]. Journal of Fluency Disorders, 36(1), 61–65.
Martin, L. L., & Tesser, A. (1996). Some ruminative thoughts. In R. S. Wyer, Jr. (Ed.), Ruminative thoughts. Advances in social cognition (Vol. 9, pp. 1–47). Erlbaum.
Matthews, G., & Wells, A. (2000). Attention, automaticity, and affective disorder. Behavior Modification, 24(1), 69–93.
McAllister, J. (2016). Behavioural, emotional and social development of children who stutter. Journal of Fluency Disorders, 50, 23–32.
McEvoy, P. M., Mahoney, A. E. J., & Moulds, M. L. (2010). Are worry, rumination, and post-event processing one and the same? Development of the repetitive thinking questionnaire. Journal of Anxiety Disorders, 24(5), 509–519.
McEvoy, P. M., Salmon, K., Hyett, M. P., Jose, P. E., Gutenbrunner, C., Bryson, K., & Dewhirst, M. (2019). Repetitive negative thinking as a transdiagnostic predictor of depression and anxiety symptoms in adolescents. Assessment, 26(2), 324–335.
McEvoy, P. M., Watson, H., Watkins, E. R., & Nathan, P. (2013). The relationship between worry, rumination, and comorbidity: Evidence for repetitive negative thinking as a transdiagnostic construct. Journal of Affective Disorders, 151(1), 313–320.
McLaughlin, K. A., & Nolen-Hoeksema, S. (2012). Interpersonal stress generation as a mechanism linking rumination to internalizing symptoms in early adolescents. Journal of Clinical Child and Adolescent Psychology, 41(5), 584–597.
Menzies, R. G., O'Brian, S., Onslow, M., & Packman, A., St Clare, T., & Block, S. (2008). An experimental clinical trial of a cognitive-behavior therapy package for chronic stuttering. Journal of Speech, Language, and Hearing Research, 51(6), 1451–1464.
Menzies, R. G., Onslow, M., Packman, A., & O'Brian, S. (2009). Cognitive behavior therapy for adults who stutter: A tutorial for speech-language pathologists. Journal of Fluency Disorders, 34(3), 187–200.
Messenger, M., Onslow, M., Packman, A., & Menzies, R. (2004). Social anxiety in stuttering: Measuring negative social expectancies. Journal of Fluency Disorders, 29(3), 201–212.
Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy, 28(6), 487–495.
Monteregge, S., Tsagkalidou, A., Cuijpers, P., & Spinhoven, P. (2020). The effects of different types of treatment for anxiety on repetitive negative thinking: A meta-analysis. Clinical Psychology: Science and Practice, 27(2), Article e12316.
Mpundu-Kaambwa, C., Bulamu, N., Lines, L., Chen, G., Dalziel, K., Devlin, N., & Ratcliffe, J. (2022). A systematic review of international guidance for self-report and proxy completion of child-specific utility instruments. Value in Health, 25(10), 1791–1804.
Mulcahy, K., Hennessey, N., Beilby, J., & Byrnes, M. (2008). Social anxiety and the severity and typography of stuttering in adolescents. Journal of Fluency Disorders, 33(4), 306–319.
Neter, J., Wasserman, W., & Kutner, M. H. (1985). Applied linear statistical models (2nd ed.). Richard D. Irwin.
Nolen-Hoeksema, S. (1987). Sex differences in unipolar depression: Evidence and theory. Psychological Bulletin, 101(2), 259–282.
Nolen-Hoeksema, S. (1991). Responses to depression and their effects on the duration of depressive episodes. Journal of Abnormal Psychology, 100(4), 569–582.
Nolen-Hoeksema, S., Larson, J., & Grayson, C. (1999). Explaining the gender difference in depressive symptoms. Journal of Personality and Social Psychology, 77(5), 1061–1072.
Nolen-Hoeksema, S., & Morrow, J. (1991). A prospective study of depression and posttraumatic stress symptoms after a natural disaster: The 1989 Loma Prieta earthquake. Journal of Personality and Social Psychology, 61(1), 115–121.
Nolen-Hoeksema, S., Stice, E., Wade, E., & Bohon, C. (2007). Reciprocal relations between rumination and bulimic, substance abuse, and depressive symptoms in female adolescents. Journal of Abnormal Psychology, 116(1), 198–207.
Nolen-Hoeksema, S., Wisco, B., & Lyubomirsky, S. (2008). Rethinking rumination. Perspectives on Psychological Science, 3(5), 400–424.
Nordahl, H. M., Borkovec, T. D., Hagen, R., Kennair, L. E. O., Hjemdal, O., Solem, S., Hansen, B., Haseth, S., & Wells, A. (2018). Metacognitive therapy versus cognitive–behavioural therapy in adults with generalised anxiety disorder. BJPsych Open, 4(5), 393–400.
Palasik, S., & Hannan, J. (2013). The clinical applications of acceptance and commitment therapy with clients who stutter. SIG 4 Perspectives on Fluency and Fluency Disorders, 23(2), 54–69.
Perkins, W. H. (1990). What is stuttering? Journal of Speech and Hearing Disorders, 55(3), 370–382.
Plexico, L. W., & Sandage, M. J. (2011). A mindful approach to stuttering intervention. SIG 4 Perspectives on Fluency and Fluency Disorders, 21(2), 43–49.
Qualtrics. (2021). Qualtrics (February, 2019). https://www.qualtrics.com/
R Core Team. (2022). R: A language and environment for statistical computing (Version 4.2.1). The R Foundation for Statistical Computing.
Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35(8), 741–756.
Reilly, E. E., Gordis, E. B., Boswell, J. F., Donahue, J. M., Emhoff, S. M., & Anderson, D. A. (2018). Evaluating the role of repetitive negative thinking in the maintenance of social appearance anxiety: An experimental manipulation. Behaviour Research and Therapy, 102, 36–41.
Revelle, W. (2022). psych: Psychological, psychometric, and personality research (Version 2.2.5). Northwestern University. https://cran.r-project.org/package=psych
Riediger, M., Wrzus, C., & Wagner, G. G. (2014). Happiness is pleasant, or is it? Implicit representations of affect valence are associated with contrahedonic motivation and mixed affect in daily life. Emotion, 14(5), 950–961.
Rodgers, N. H., Lau, J. Y. F., & Zebrowski, P. M. (2020). Attentional bias among adolescents who stutter: Evidence for a vigilance–avoidance effect. Journal of Speech, Language, and Hearing Research, 63(10), 3349–3363.
Samson, I., Schalling, E., Herlitz, A., Lindström, E., & Sand, A. (2022). A cross-sectional investigation of the impact of stuttering on Swedish females and males in childhood, adolescence, and young adulthood. Journal of Speech, Language, and Hearing Research, 65(12), 4608–4622.
Smith, K. A., Iverach, L., O'Brian, S., Kefalianos, E., & Reilly, S. (2014). Anxiety of children and adolescents who stutter: A review. Journal of Fluency Disorders, 40, 22–34.
Spinhoven, P., Klein, N., Kennis, M., Cramer, A. O. J., Siegle, G., Cuijpers, P., Ormel, J., Hollon, S. D., & Bockting, C. L. (2018). The effects of cognitive-behavior therapy for depression on repetitive negative thinking: A meta-analysis. Behaviour Research and Therapy, 106, 71–85.
Stroud, L. R., Foster, E., Papandonatos, G. D., Handwerger, K., Granger, D. A., Kivlighan, K. T., & Niaura, R. (2009). Stress response and the adolescent transition: Performance versus peer rejection stressors. Development and Psychopathology, 21(1), 47–68.
Tichenor, S. E., Constantino, C. D., & Yaruss, J. S. (2022). A point of view about fluency. Journal of Speech, Language, and Hearing Research, 65(2), 645–652.
Tichenor, S. E., Walsh, B. M., Gerwin, K. L., & Yaruss, J. S. (2022). Emotional regulation and its influence on the experience of stuttering across the life span. Journal of Speech, Language, and Hearing Research, 65(7), 2412–2430.
Tichenor, S. E., & Yaruss, J. S. (2018). A phenomenological analysis of the experience of stuttering. American Journal of Speech-Language Pathology, 27(3S), 1180–1194.
Tichenor, S. E., & Yaruss, J. S. (2019). Group experiences and individual differences in stuttering. Journal of Speech, Language, and Hearing Research, 62(12), 4335–4350.
Tichenor, S. E., & Yaruss, J. S. (2020). Repetitive negative thinking, temperament, and adverse impact in adults who stutter. American Journal of Speech-Language Pathology, 29(1), 201–215.
Treynor, W., Gonzalez, R., & Nolen-Hoeksema, S. (2003). Rumination reconsidered: A psychometric analysis. Cognitive Therapy and Research, 27(3), 247–259.
Van Riper, C. (1973). The treatment of stuttering. Prentice Hall.
Vanryckeghem, M., Brutten, G. J., & Hernandez, L. M. (2005). A comparative investigation of the speech-associated attitude of preschool and kindergarten children who do and do not stutter. Journal of Fluency Disorders, 30(4), 307–318.
Venables, W. N., & Ripley, B. D. (2002). Modern applied statistics with S (4th ed.). Springer.
Wells, A. (2009). Metacognitive therapy for anxiety and depression. Guilford Press.
Wells, A., & Papageorgiou, C. (2004). Metacognitive therapy for depressive rumination. In C. Papageorgiou & A. Wells (Eds.), Depressive rumination nature, theory and treatment (pp. 259–273). Wiley.
Wickham, H., Averick, M., Bryan, J., Chang, W., McGowan, L., François, R., Grolemund, G., Hayes, A., Henry, L., Hester, J., Kuhn, M., Pedersen, T., Miller, E., Bache, S., Müller, K., Ooms, J., Robinson, D., Seidel, D., Spinu, V., … Yutani, H. (2019). Welcome to the Tidyverse. Journal of Open Source Software, 4(43), 1686.
Williams, R. (2006). Generalized ordered logit/partial proportional odds models for ordinal dependent variables. Stata Journal, 6(1), 58–82.
Williams, R. (2016). Understanding and interpreting generalized ordered logit models. The Journal of Mathematical Sociology, 40(1), 7–20.
World Health Organization. (2001). International Classification of Functioning, Disability and Health (ICF).
Wrosch, C., & Scheier, M. F. (2003). Personality and quality of life: The importance of optimism and goal adjustment. Quality of Life Research, 12(Suppl. 1), 59–72.
Yaruss, J. S., & Quesal, R. W. (2006). Overall Assessment of the Speaker's Experience of Stuttering (OASES): Documenting multiple outcomes in stuttering treatment. Journal of Fluency Disorders, 31(2), 90–115.
Yaruss, J. S., & Quesal, R. W. (2016). Overall Assessment of the Speaker's Experience of Stuttering (OASES). Pearson.
Information & Authors
Information
Published In
Journal of Speech, Language, and Hearing Research
Volume 66 • Number 9 • September 2023
Pages: 3290-3306
PubMed: 37494925
Copyright
Copyright © 2023 American Speech-Language-Hearing Association.
History
- Received: Mar 2, 2023
- Revised: May 8, 2023
- Accepted: May 10, 2023
- Published online: Jul 26, 2023
- Published in issue: Sep 13, 2023
Authors
Metrics & Citations
Metrics
Article Metrics
View all metricsCitations
If you have the appropriate software installed, you can download article citation data to the citation manager of your choice. Simply select your manager software from the list below and click Download.
For more information or tips please see 'Downloading to a citation manager' in the Help menu.
View Options
Sign In Options
ASHA member? If so, log in with your ASHA website credentials for full access.
Member Login