Repetitive negative thinking (RNT) is a transdiagnostic feature of psychiatric disorders. Women report greater RNT than do men, yet the association between uniquely female characteristics, such as fluctuating sex hormones during the menstrual cycle, and RNT has not been established. Here we examined changes in RNT and anxiety symptoms across the menstrual cycle in women with (n = 40) and without (n = 41) generalized anxiety disorder (GAD). Women with GAD reported an increase in RNT and negative affect from the follicular phase to the luteal phase; unexpectedly, this was not associated with changes in anxiety symptoms, estradiol, or progesterone. Nonanxious women reported no changes in RNT or anxiety symptoms over the menstrual cycle, but higher within-participants progesterone was associated with reduced RNT and negative affect. These results indicate that uniquely female biological processes may influence core cognitive processes that underlie anxiety disorders, but further investigations to determine the implications for symptom severity are required.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: Author.
2.
BenjaminiY.HochbergY. (1995). Controlling the false discovery rate: A practical and powerful approach to multiple testing. Journal of the Royal Statistical Society: Series B (Methodological), 57, 289–300.
3.
BlakeK. R.DixsonB. J.O’DeanS. M.DensonT. F. (2016). Standardized protocols for characterizing women’s fertility: A data-driven approach. Hormones and Behavior, 81, 74–83.
4.
BrownT. A.AntonyM. M.BarlowD. H. (1992). Psychometric properties of the Penn State Worry Questionnaire in a clinical anxiety disorders sample. Behaviour Research and Therapy, 30, 33–37.
5.
BryantR. A.FelminghamK. L.SiloveD.CreamerM.O’DonnellM.McFarlaneA. C. (2011). The association between menstrual cycle and traumatic memories. Journal of Affective Disorders, 131, 398–401.
6.
EhringT.WatkinsE. R. (2008). Repetitive negative thinking as a transdiagnostic process. International Journal of Cognitive Therapy, 1, 192–205.
7.
EppersonC. N.HagaK.MasonG. F.SellersE.GueorguievaR.ZhangW.. . . KrystalJ. H. (2002). Cortical γ-aminobutyric acid levels across the menstrual cycle in healthy women and those with premenstrual dysphoric disorder: A proton magnetic resonance spectroscopy study. Archives of General Psychiatry, 59, 851–858.
8.
FerreeN. K.CahillL. (2009). Post-event spontaneous intrusive recollections and strength of memory for emotional events in men and women. Consciousness and Cognition, 18, 126–134.
9.
FerreeN. K.KamatR.CahillL. (2011). Influences of menstrual cycle position and sex hormone levels on spontaneous intrusive recollections following emotional stimuli. Consciousness and Cognition, 20, 1154–1162.
10.
FirstM.SpitzerR. L.GibbonM.WilliamsJ. B. (2007). Structured clinical interview for DSM-IV-TR axis I disorders-patient edition (SCID-I/P, 1/2007 Revision). New York, NY: Biometrics Research, New York State Psychiatric Institute.
11.
GrahamB. M.DensonT. F.BarnettJ.CalderwoodC.GrishamJ. R. (2018). Sex hormones are associated with rumination and interact with emotion regulation strategy choice to predict negative affect in women following a sad mood induction. Frontiers in Psychology, 9, Article 937. doi:10.3389/fpsyg.2018.00937
12.
HaradaM.KuboH.NoseA.NishitaniH.MatsudaT. (2011). Measurement of variation in the human cerebral GABA level by in vivo MEGA-editing proton MR spectroscopy using a clinical 3 T instrument and its dependence on brain region and the female menstrual cycle. Human Brain Mapping, 32, 828–833.
13.
KaspiS. P.OttoM. W.PollackM. H.EppingerS.RosenbaumJ. F. (1994). Premenstrual exacerbation of symptoms in women with panic disorder. Journal of Anxiety Disorders, 8, 131–138.
14.
KertzS. J.KoranJ.StevensK. T.BjörgvinssonT. (2015). Repetitive negative thinking predicts depression and anxiety symptom improvement during brief cognitive behavioral therapy. Behaviour Research and Therapy, 68, 54–63.
15.
LabadJ.MenchónJ. M.AlonsoP.SegalàsC.JiménezS.VallejoJ. (2005). Female reproductive cycle and obsessive-compulsive disorder. Journal of Clinical Psychiatry, 66, 428–435.
16.
LiS. H.GrahamB. M. (2017). Why are women so vulnerable to anxiety, trauma-related and stress-related disorders? The potential role of sex hormones. The Lancet Psychiatry, 4, 73–82.
17.
MahoneyA. E.HobbsM. J.NewbyJ. M.WilliamsA. D.SunderlandM.AndrewsG. (2016). The Worry Behaviors Inventory: Assessing the behavioral avoidance associated with generalized anxiety disorder. Journal of Affective Disorders, 203, 256–264.
18.
MahoneyA. E. J.McEvoyP. M.MouldsM. L. (2012). Psychometric properties of the Repetitive Thinking Questionnaire in a clinical sample. Journal of Anxiety Disorders, 26, 359–367.
19.
McEvoyP. M.MahoneyA. E.MouldsM. L. (2010). Are worry, rumination, and post-event processing one and the same? Development of the Repetitive Thinking Questionnaire. Journal of Anxiety Disorders, 24, 509-519.
20.
McEvoyP. M.WatsonH.WatkinsE. R.NathanP. (2013). The relationship between worry, rumination, and comorbidity: Evidence for repetitive negative thinking as a transdiagnostic construct. Journal of Affective Disorders, 151, 313–320.
21.
McLeanC. P.AndersonE. R. (2009). Brave men and timid women? A review of the gender differences in fear and anxiety. Clinical Psychology Review, 29, 496–505.
22.
MortbergE.AnderssonG. (2014). Predictors of response to individual and group cognitive behaviour therapy of social phobia. Psychology and Psychotherapy, 87, 32–43.
23.
NillniY. I.PinelesS. L.PattonS. C.RouseM. H.SawyerA. T.RasmussonA. M. (2015). Menstrual cycle effects on psychological symptoms in women with PTSD. Journal of Traumatic Stress, 28, 1–7.
24.
Nolen-HoeksemaS.JacksonB. (2001). Mediators of the gender difference in rumination. Psychology of Women Quarterly, 25, 37–47.
25.
PausT.KeshavanM.GieddJ. N. (2008). Why do many psychiatric disorders emerge during adolescence?Nature Reviews Neuroscience, 9, 947–957.
26.
PinelesS.NillniY.PinnaG.IrvineJ.WebbA.HallK. A.. . . OrrS. (2018). PTSD in women is associated with a block in conversion of progesterone to the GABAergic neurosteroids allopregnanolone and pregnanolone measured in plasma. Psychoneuroendocrinology, 93, 133–141.
27.
QuerstretD.CropleyM. (2013). Assessing treatments used to reduce rumination and/or worry: A systematic review. Clinical Psychology Review, 33, 996–1009.
28.
RasmussonA. M.PinnaG.PaliwalP.WeismanD.GottschalkC.CharneyD.. . . GuidottiA. (2006). Decreased cerebrospinal fluid allopregnanolone levels in women with posttraumatic stress disorder. Biological Psychiatry, 60, 704–713.
29.
ReynoldsM.BrewinC. R. (1999). Intrusive memories in depression and posttraumatic stress disorder. Behaviour Research and Therapy, 37, 201–215.
30.
RoodL.RoelofsJ.BögelsS. M.Nolen-HoeksemaS.SchoutenE. (2009). The influence of emotion-focused rumination and distraction on depressive symptoms in non-clinical youth: A meta-analytic review. Clinical Psychology Review, 29, 607–616.
31.
ShirtcliffE. A.GrangerD. A.SchwartzE. B.CurranM. J.BoothA.OvermanW. H. (2000). Assessing estradiol in biobehavioral studies using saliva and blood spots: Simple radioimmunoassay protocols, reliability, and comparative validity. Hormones and Behavior, 38, 137–147.
32.
SigmonS. T.DorhoferD. M.RohanK. J.HotovyL. A.BoulardN. E.FinkC. M. (2000). Psychophysiological, somatic, and affective changes across the menstrual cycle in women with panic disorder. Journal of Consulting and Clinical Psychology, 68, 425–431.
33.
SpitzerR. L.KroenkeK.WilliamsJ. B.LöweB. (2006). A brief measure for assessing generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166, 1092–1097.
34.
Van VeenJ. F.JonkerB. W.Van VlietI. M.ZitmanF. G. (2009). The effects of female reproductive hormones in generalized social anxiety disorder. The International Journal of Psychiatry in Medicine, 39, 283–295.
35.
ViningR. F.McGinleyR. A. (1987). The measurement of hormones in saliva: Possibilities and pitfalls. Journal of Steroid Biochemistry, 27, 81–94.
36.
WatkinsE.MouldsM.MackintoshB. (2005). Comparisons between rumination and worry in a non-clinical population. Behaviour Research and Therapy, 43, 1577–1585.
37.
WatkinsE.ScottJ.WingroveJ.RimesK.BathurstN.SteinerH.. . . MalliarisY. (2007). Rumination-focused cognitive behaviour therapy for residual depression: A case series. Behaviour Research and Therapy, 45, 2144–2154.
38.
WoodP. (2009). Salivary steroid assays—Research or routine?Annals of Clinical Biochemistry, 46, 183–196.
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