Subjective Experience of Thought Overactivation in Mood Disorders: Beyond Racing and Crowded Thoughts

Abstract

Background: Racing thoughts, crowded thoughts and flight of ideas are frequent symptoms in mood disorders, but the underlying subjective experience of overactivation of thought processes remains poorly documented. Methods: Qualitative analysis of audiotaped interviews explored subjective experience of thought overactivation in patients with mood disorders (sample 1, n = 45). Quantitative analysis considered the properties of a newly developed rating scale in sample 1, in an additional sample of patients with mood disorders (sample 2, n = 37) and in healthy subjects (sample 3, n = 38). Results: Qualitative analysis of individual interviews revealed that 5 conceptual categories characterized thought overactivation: sequential thought flow, overstimulation, competition for resource allocation, unexpected/unexplained onset, and association with mood and emotions. A principal component analysis of the initial 16-item rating scale indicated that a single component explained 55.9% of the variance, with major and exclusive contributions from 9 items, which were retained in the final 9-item Subjective Thought Overactivation Questionnaire (STOQ; Cronbach's α = 0.95). Total score correlated significantly with activation, depression and perceived conflict subscales of the Internal State Scale (ISS; r_s = 0.57-0.66, p < 0.001). It was associated with decreased well-being (ISS; r_s = -0.48, p = 0.001) and increased state anxiety (State-Trait Anxiety Inventory; r_s = 0.60, p < 0.001). The STOQ score was significantly higher in patients than in healthy subjects. It allowed distinguishing between ISS mood states, with the highest median score in mixed states. Limitations: Sample size, representativeness, possible bias in qualitative analysis, and quality of expert consensus. Conclusions: Qualitative analysis of clinical interviews, together with a new short rating scale, contributed to a documentation of subjective thought overactivation, an important but often undetected feature in mood disorders.

Racing thoughts revisited: A key dimension of activation in bipolar disorder

“…CFA assists in the reduction of measurement error and allows the comparison of a priori models at the latent factor level (Jackson et al, 2009;Atkinson et al, 2011). In the present study, there were three a priori models regarding the construct validity of the RCTQ: (i) the single-factor model yielded by the STOQ-9 results (Keizer et al, 2014), (ii) the bifactorial model, referring to the racing vs. crowded thoughts theoretical distinction (Piguet et al, 2010), and (iii) the three-factor model, based on the results obtained in healthy individuals (Weiner et al, 2018). For the single-factor model, the 34 items of the RCTQ were included in the analysis (model 1); for the bifactorial model (model 2), 17 items belonging to the 'racing' a priori factor, i.e., items 2, 5, 7, 8, 11, 12, 14, 17, 20, 21, 22, 25, 28, 30, 31, 32 & 34, and 17 items belonging to the 'crowded' a priori factor, i.e., items 1, 3,4,6,9,10,13,15,16,18,19,23,24,26,27,29,33, were included; for the three-factor model (model 3), factor 1 consisted of items 1, 2, 4, 5, 7, 8 & 9, factor 2 consisted of items 10, 13, 14, 15, 18, 23, 29 & 30, and factor 3 consisted of items 12, 17, 20, 21, 22, 25, 31 & 32 (Weiner et al, 2018).…”

“…The RCTQ is a 34-item self-report questionnaire that assesses racing thoughts during the past 24 h. Nine items of the RCTQ belong to the Subjective Thought Overactivation Questionnaire (STOQ; Keizer et al, 2014), of which 4 underwent very minor wording adaptations, whereas the remaining 25 items were developed by three experienced clinicians (GB, IK and LW) based on the six themes that emerged in the qualitative reports of patients (Keizer et al, 2014). Initially 17 items were con-ceived to refer to racing thoughts; they convey the notion of an accel-eration and an increased amount of thoughts that are linked to each other in a sequential manner (e.g., my thoughts race at 200 km/h); these thoughts are usually associated with positive emotions and are not perceived as being emotionally overwhelming.…”

“…To our knowledge, there is only one questionnaire, the 9-item Subjective Thought Overactivation Questionnaire (STOQ; Keizer et al,2014), designed to specifically assess racing and crowded thoughts in patients with mood disorder. The initial STOQ contained items that were developed by two of the authors (GB and IK).…”

“…However, its dis-criminant power was modest, as scores were equivalent in the manic and depression groups, and they did not allow the distinction between mania and euthymia. Moreover, the single-factor STOQ-9 did not ad-dress the numerous features found in the qualitative analysis of patient reports (Keizer et al, 2014). Hence to address the multi-faceted nature of racing and crowded thoughts in different episodes of mood disorders, we developed a new questionnaire, the 34-item RCTQ (Weiner et al, 2018).…”

Alterations in neural systems mediating cognitive flexibility and inhibition in mood disorders

“…Further, our task design also allowed us to examine whether these switching components are differentially modulated when processing positive or negative emotional information [Hare et al, ; Piguet et al, ; Sagaspe et al, ]. Because these deficits might represent a common and specific trait across the mood disorder spectrum, underlying cognitive dysfunction in these patients independent of mood anomalies, we took a dimensional approach combining patients with different clinical symptoms, as recently recommended in order to extract valid research domain criteria surpassing diagnostic boundaries (http://www.nimh.nih.gov/research-priorities/rdoc/nimh-research-domain-criteria-rdoc.shtml, Narrow and Kuhl, ; Keizer et al, ; Vieta and Valentí, ).…”