Repetitive Negative Thinking Longitudinally Predicts the Psychological Adjustment of Clinical Psychology Trainees

Context and objectives

Clinical training represents a demanding stage in the formation of psychologists that may result in significant emotional symptoms. Previous research has identified repetitive negative thinking (RNT) as a transdiagnostic factor associated with various emotional disorders. However, a gap exists in the literature regarding how repetitive negative thinking specifically related to clinical practice training (PTQ-CPT) longitudinally predicts changes in psychological adjustment during clinical training.

The primary objective of this study was to examine whether repetitive negative thinking specific to the clinical practice context, measured at the beginning of the semester, longitudinally predicts subsequent emotional symptoms in clinical psychology students. The study sought to differentiate the predictive power of general repetitive negative thinking (PTQ) and psychological acceptance (AAQ-II) in relation to clinical practice-specific repetitive negative thinking (PTQ-CPT).

Method: Participants, Design, Instruments, Analysis

Participants: A sample of 236 undergraduate clinical psychology students (9th semester of 10) from a Colombian university were recruited during their mandatory clinical practice at the university's Center of Clinical Psychology. The participation rate was 98.33%. The sample had a mean age of 22.91 years (SD = 3.80, range 19-40 years) and was predominantly female (83.1%). At follow-up (T2), 164 students participated (retention rate of 69.5%), with no significant differences between completers and non-completers according to Bayesian tests.

Design: A longitudinal design was employed with two assessment timepoints:

• T1: Before beginning mandatory clinical practice
• T2: Approximately 2 months later (mid-semester)

Instruments:

1. DASS-21 (Depression, Anxiety and Stress Scale-21): Measures depressive, anxious, and stress symptoms. Reliability: α_T1 = .92, α_T2 = .92. Means at T1: M = 15.22 (SD = 9.93); at T2: M = 20.50 (SD = 11.5).

2. GHQ-12 (General Health Questionnaire-12): Assesses general mental health. Reliability: α_T1 = .87, α_T2 = .87. Means at T1: M = 11.01 (SD = 5.85); at T2: M = 13.6 (SD = 6.9).

3. PTQ (Perseverative Thinking Questionnaire): Measures general repetitive negative thinking. Reliability: α_T1 = .96. Mean at T1: M = 21.04 (SD = 12.66).

4. AAQ-II (Acceptance and Action Questionnaire-II): Evaluates experiential avoidance and psychological acceptance. Reliability: α_T1 = .91. Mean at T1: M = 21.60 (SD = 8.88).

5. PTQ-CPT (PTQ adapted for Clinical Practice Training): An adapted 9-item version of the PTQ specifically designed for the clinical practice training context. Reliability: α_T1 = .93, α_T2 = .93. Mean at T1: M = 14.29 (SD = 8.16).

Analysis: Bayesian regression analyses were conducted with five separate models, using the following as dependent variables measured at T2: DASS-Total, DASS-Depression, DASS-Anxiety, DASS-Stress, and GHQ-12. Predictor variables included T1 scores of the dependent variable, PTQ-CPT at T1, PTQ at T1, and AAQ-II at T1. Bayes factors (BF) were calculated to evaluate the inclusion of each predictor. Additionally, sensitivity analyses were conducted controlling for gender, age, and past and current psychological treatment.

Results

Emotional symptoms: A significant increase in emotional symptoms from T1 to T2 was observed, with moderate correlations ranging from .37 to .56.

Bayesian regression analysis: In all five Bayesian regression models, the best models consistently included:

1. T1 scores of the dependent variable
2. T1 scores of PTQ-CPT

General PTQ and AAQ-II did NOT enter the best regression models, with Bayes factors < 1 in all cases.

Bayes factors for PTQ-CPT (BF_inclusion):

• DASS-Total: BF = 236.896
• DASS-Depression: BF = 431,664.465 (extremely strong evidence)
• DASS-Anxiety: BF = 43.798
• DASS-Stress: BF = 7,338.009
• GHQ-12: BF = 1.558 (weaker evidence)

R² values: The R² values for the best models ranged from .247 (GHQ-12) to .327 (DASS-Depression).

Model comparison (Table 4): The model including PTQ-CPT + baseline DASS score was confirmed as the best model for DASS-Total (BF = 12.775, R² = .306).

Additional analyses: When controlling for gender, age, and past/current psychological treatment, the same results were obtained. Past psychological treatment was the third-best predictor in the additional analyses.

Discussion and conclusions

The study provides longitudinal evidence that repetitive negative thinking specific to the clinical practice context (PTQ-CPT) is a robust predictor of psychological adjustment in clinical psychology students during their mandatory clinical training period.

Key findings:

1. Construct specificity: PTQ-CPT demonstrated superior predictive power compared to general repetitive negative thinking (PTQ), suggesting that repetitive negative thinking specific to the clinical practice context captures particular aspects of emotional distress during this training stage.

2. Limited role of psychological acceptance: The AAQ-II did not enter the best predictive models, contrary to what might be expected from acceptance and commitment therapy-based perspectives. This suggests that during this specific period, repetitive negative thinking may be more relevant than general acceptance.

3. Symptom increase: The increase in symptoms from T1 to T2 is consistent with the notion that initial clinical practice represents a period of elevated stress and emotional demand.

4. Baseline effect: The consistent inclusion of the baseline score of the dependent variable in all best models suggests that symptom trajectories are partially determined by prior levels, although PTQ-CPT adds significant predictive power.

Significance and contribution

This study makes significant contributions to the field:

1. Validation of context-specific measurement: Provides empirical evidence for the value of adapting general repetitive negative thinking measures for specific contexts (in this case, clinical practice training).

2. Clinical implications: Identifies repetitive negative thinking related to clinical practice as a malleable risk factor during training, suggesting potential intervention points.

3. Relevance to clinical training: The findings have direct implications for clinical training programs, indicating the need to monitor and address repetitive negative thinking specific to practice as part of student support.

4. Bayesian methodology: The use of Bayesian analyses provides a more robust approach than traditional frequentist analyses, offering explicit Bayes factors for model comparison.

5. Specific population: The focus on clinical psychology students, a population with direct relevance to the profession, provides valuable information about factors affecting adjustment during clinical training.

Verification checklist

• ✓ Clear longitudinal design with two assessment timepoints (T1 pre-practice, T2 mid-semester)
• ✓ Defined sample (n = 236 at T1, n = 164 at T2) with reported retention rate (69.5%)
• ✓ Attrition analysis: no significant differences between completers and non-completers
• ✓ Instruments with reported reliabilities at both timepoints
• ✓ Means and standard deviations reported for key variables
• ✓ Statistical analyses specified (Bayesian regressions)
• ✓ Bayes factors reported for evaluation of predictor inclusion
• ✓ R² values reported to evaluate explained variance
• ✓ Model comparison with appropriate statistics
• ✓ Sensitivity analyses (controlling for demographic variables)
• ✓ Discussion of findings in theoretical context
• ✓ Limitations considered in presentation of results