Repetitive negative thinking as a transdiagnostic cognitive process

Repetitive negative thinking processes such as rumination and worry — also referred to as ‘perseverative thinking’ or ‘perseverative cognition’ — have traditionally been conceptualized as distinct processes defined, measured and studied in the clinical literature from a disorder-specific stance (for example, rumination in relation to depression, worry in relation to anxiety). However, rumination and worry are highly correlated, share phenomenological features, load onto a common factor, and predict and maintain multiple psychopathologies. In this Review, we overview the evidence base that conceptualizes repetitive negative thinking as an overarching cognitive process unconstrained by disorder-related content or temporal focus. The related theories and the empirical literature covering measurement, treatment and prevention support repetitive negative thinking as a transdiagnostic process. Adopting a transdiagnostic approach can help advance a more nuanced understanding of the role of repetitive negative thinking in clinical presentations and their treatment. Transdiagnostic approaches to psychopathology are expected to overcome the assessment and treatment limitations of categorical diagnoses. In this Review, Moulds and McEvoy conceptualize repetitive negative thinking as a transdiagnostic process and advance a nuanced understanding of its diverse clinical presentations.