Could repetitive negative thinking interfere with corrective learning? The example of anorexia nervosa

Abstract

Identifying processes that may interfere with corrective learning during treatments for anorexia nervosa (AN) may help to improve the effectiveness of existing interventions. We propose that certain cognitive processes characteristic of the AN temperament may help explain previous findings in AN suggesting difficulty updating previously learned associations and learning from feedback. Specifically, we hypothesize that engagement in repetitive negative thinking (RNT), including worry and rumination, could interfere with corrective learning that is critical to the success of behavioral treatments. In doing so, we draw from existing work in anxiety and mood disorders linking RNT to the maintenance of symptoms and poorer response to cognitivebehavioral treatments. Next, we outline hypothesized mechanisms through which engagement in RNT before, during, and after exposure to aversive stimuli could interfere with learning in AN. We then provide recommendations for how these hypothesized associations could be tested in future research. Although prior work has suggested that RNT processes are common among individuals with AN, this work has been primarily descriptive in nature. We propose that extending this work through direct examination of the impact of active engagement in RNT on corrective learning could aid in identifying AN maintenance processes that could be explicitly targeted in treatment.

Reflecting on rumination: Consequences, causes, mechanisms and treatment of rumination

“…Such abstract and internal preoccupation could prevent ruminators from adaptively responding to changes in the environment or from benefiting from corrective learning that disconfirms negative beliefs (Reilly et al, 2019).…”

Rumination Derails Reinforcement Learning with Possible Implications for Ineffective Behavior

“…Disrupted RL is possibly more insidious than inhibited action; it not only affects the ability to take effective action during ongoing experience but also has prolonged effects on subsequent experiences that would have benefited from learning had it taken place (cf. Reilly et al, 2019). Thus, the results of this study demonstrate that rumination may disrupt RL, suggesting it may impair effective action in the moment (due to failure to adapt to errors during ongoing experience) and lower the chance of adaptive actions in similar situations in the future.…”

Rumination Derails Reinforcement Learning With Possible Implications for Ineffective Behavior

“…Disrupted RL is possibly more insidious than inhibited action; it not only affects the ability to take effective action during ongoing experience but also has prolonged effects on subsequent experiences that would have benefited from learning had it taken place (cf. Reilly et al, 2019). Thus, the results of this study demonstrate that state rumination may disrupt RL, which suggests that it may impair effective action in the moment (because of failure to adapt to errors during ongoing experience) and lower the chance of adaptive actions in similar situations in the future.…”

“…Thus, ACT, BA, and other psychotherapies emphasize that repetitive negative thinking such as rumination can disrupt experiences that might otherwise pave the way to mental-health recovery. Yet the field lacks a unifying basic science framework for understanding the effects of these techniques across psychotherapies (see also, Reilly et al, 2019).…”