Insistence on sameness and repetitive negative thinking in autistic and non-autistic adults

Sep 16, 2026

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Autistic adults experience elevated mental health difficulties, with repetitive cognitive and behavioral processes contributing to risk. The study examines whether insistence on sameness relates to depression and anxiety through repetitive negative thinking measured as rumination and obsessing. Three adult groups completed standardized assessments: autistic clinical, autistic community, and non-autistic community participants. Results show higher insistence, rumination, and obsessing in autistic participants and mediation across all groups.

LanguageEnglish

CategoryGeneral

FormatPDF

Pages22

Reading Time8 min

AccessFree to download

Abstract

Study aims

Participants and measures

Findings and implications

Insistence on sameness, repetitive negative thinking and mental health in autistic and non autistic adults Kate Cooper1,2 & Ailsa Russell2 1. Department of Clinical, Educational and Health Psychology, University College London 2. Centre for Applied Autism Research, University of Bath Keywords: Autism spectrum disorders, Anxiety, Depression, Quality of life, Psychiatric comorbidity, Interventions – psychosocial/behavioral, Repetitive behaviors and interests Abstract Autistic people experience high rates of mental health problems. A tendency towards behavioural repetition in autistic individuals could contribute to repetitive negative thinking, which is atransdiagnostic risk factor for mental health problems. Our research aimed to add to the literature by using transdiagnostic measures of both mental health symptoms and repetitive negative thinking. We explored the relationships between insistence on sameness and depression-anxiety, via the mediating role of repetitive negative thinking, operationalised as rumination and obsessing. Three groups of adults were recruited; autistic clinical cohort participants (n=67); autistic community participants (n=54) and non-autistic community participants (n=66) . All participants completed measures of: Insistence on sameness; Anxiety and Depression; Obsessing; Rumination. Autistic community participants had significantly higher insistence on sameness, rumination and obsessing scores than non-autistic community participants. The mediation analysis found support for the hypothesis that the relationship between insistence on sameness and depression-anxiety would be mediated by rumination and obsessing in all participants. The higher rates of repetitive negative thinking found in autistic individuals may contribute to elevated rates of mental health problems in this group. Mental health assessments and interventions for autistic people should consider transdiagnostic factors including multiple forms of repetitive negative cognition and behaviour. Autism, a neurodevelopmental condition characterised by difference in social communication and a restricted, repetitive pattern of behaviours, interests and activities is present in approximately 1% of people (Zeidan et al., 2022) . Autistic people are at significant risk of experiencing mental health problems, with a lifetime prevalence of 42% for anxiety conditions and 37% for depression (Hollockset al., 2019) and high rates of obsessive-compulsive disorder (e.g., Lai et al., 2019) . Multiple genetic and psychosocial factors contribute to the elevated rates of anxiety and depression in this group (Nord & Garfinkel, 2022; Rydzewska et al., 2019; Han et al., 2022) . In terms of psychological factors, high rates of repetitive cognitive processes such as worry and rumination have been found to be associated with anxiety and depression in autistic people (DeLong, 2004; Gotham et al., 2014; van Heijst et al., 2020; Smith & Alloy, 2020) . Repetitive cognitive processes have typically been investigated in respect to specific mental health problems and are under-investigated as a transdiagnostic process in mental health problems in autistic people. Repetitive negative thinking (RNT), prevalent across several emotional disorders, is considered a transdiagnostic factor. Repetitive negative thinking describes a thinking process that is repetitive, negative in content and difficult to disengage from (Ehring and Watkins, 2008) . RNT is associated with multiple mental disorders including depression, generalised anxiety disorder and obsessive-compulsive disorder (OCD) . As a transdiagnostic factor, there are similarities in the process of RNT across different conditions, but some disorder specific differences in the content or form of RNT (e.g. Wahl et al, 2019) . For example, rumination or repetitive negative thinking about the self which is past-orientated (Trapnell & Campbell, 1999) has links with depression in typically developing popul

FAQs

What relationship does the study test between insistence on sameness and mental health?

The study tests whether insistence on sameness is associated with depression-anxiety, and whether that link operates through repetitive negative thinking.

How is repetitive negative thinking measured in the study?

Repetitive negative thinking is operationalised as rumination and obsessing, assessed alongside depression-anxiety measures.

Do autistic and non-autistic participants differ on insistence on sameness and repetitive negative thinking?

Yes. Autistic community participants show significantly higher insistence on sameness, rumination, and obsessing than non-autistic community participants.

Sep 16, 2026

Upload by Quinn