Appraisals and strategies associated with rumination and worry

Hooked on a thought: Associations between rumination and neural responses to social rejection in adolescent girls

Rumination is a significant risk factor for psychopathology in adolescent girls and is associated with heightened and prolonged physiological arousal following social rejection. However, no study has examined how rumination relates to neural responses to social rejection in adolescent girls; thus, the current study aimed to address this gap. Adolescent girls (N = 116; ages 16.95-19.09) self-reported on their rumination tendency and completed a social evaluation fMRI task where they received fictitious feedback (acceptance, rejection) from peers they liked or disliked. Rejection-related neural activity and subgenual anterior cingulate cortex (sgACC) connectivity were regressed on rumination, controlling for rejection sensitivity and depressive symptoms. Rumination was associated with distinctive neural responses following rejection from liked peers including increased neural activity in the precuneus, inferior parietal gyrus, dorsolateral prefrontal cortex, and supplementary motor area (SMA) and reduced sgACC connectivity with multiple regions including medial prefrontal cortex, precuneus and ventrolateral prefrontal cortex. Greater precuneus and SMA activity mediated the effect of rumination on slower response time to report emotional state after receiving rejection from liked peers. These findings provide clues for distinctive cognitive processes (e.g., mentalizing, conflict processing, memory encoding) following the receipt of rejection in girls with high levels of rumination.

Worry, rumination and negative metacognitive beliefs as moderators of outcomes of Transdiagnostic group cognitive-behavioural therapy in emotional disorders

BACKGROUND

Despite the relevance of cognitive processes such as rumination, worry, negative metacognitive beliefs in emotional disorders, the existing literature about how these cognitive processes moderate the effect of treatment in treatment outcomes is limited. The aim of the present study was to explore the potential moderator effect of baseline cognitive processes-worry, rumination and negative metacognitive beliefs-on the relationship between treatment allocation (transdiagnostic cognitive-behavioural therapy -TD-CBT plus treatment as usual-TAU vs. TAU alone) and treatment outcomes (anxiety and depressive symptoms, quality of life [QoL], and functioning) in primary care patients with emotional disorders.

METHODS

A total of 631 participants completed scales to evaluate worry, rumination, negative metacognitive beliefs, QoL, functioning, and anxiety and depressive symptoms.

RESULTS

Worry and rumination acted as moderators on the effect of treatment for anxiety (b = -1.25, p = .003; b = -0.98, p = .048 respectively) and depressive symptoms (b = -1.21, p = .017; b = -1.34, p = .024 respectively). Individuals with higher baseline levels of worry and rumination obtained a greater reduction in emotional symptoms from the addition TD-CBT to TAU. Negative metacognitive beliefs were not a significant moderator of any treatment outcome.

LIMITATIONS

The study assesses cognitive processes over a relatively short period of time and uses self-reported instruments. In addition, it only includes individuals with mild or moderate anxiety or depressive disorders, which limits generalization to other populations.

CONCLUSIONS

These results underscore the generalization of the TD-CBT to individuals with emotional disorders in primary care with different cognitive profiles, especially those with high levels of worry and rumination.

Embedding Research on Emotion Duration in a Network Model

Contrary to early theorizing, emotions often last for longer periods of time. Variability in people's emotion duration contributes to psychopathologies. Therefore, emotion theories need to account for this variability. So far, reviews only list predictors of emotion duration without integrating them in a theoretical framework. Mechanisms explaining why these predictors relate to emotion duration remain unknown. I propose to embed research on emotion duration in a network model of emotions and illustrate the central ideas with simulations using a formal network model. In the network model, the components of an emotion have direct causal effects on each other. According to the model, emotions last longer (a) when the components are more strongly connected or (b) when the components have higher thresholds (i.e., they are more easily activated). High connectivity prolongs emotions because components are constantly reactivated. Higher thresholds prolong emotions because components are more easily reactivated even when connectivity is lower. Indirect evidence from research on emotion coherence and research on the relationship of predictors of emotion duration with components outside of emotional episodes supports the usefulness of the network model. I further argue and show in simulations that a common cause model, in which a latent emotion causes changes in emotion components, cannot account for research on emotion duration. Finally, I describe future directions for research on emotion duration and emotion dynamics from a network perspective.

Supplementary Information

The online version contains supplementary material available at 10.1007/s42761-023-00203-3.

Reflect on emotional events from an observer's perspective: a meta-analysis of experimental studies

Self-distancing has been proposed as an emotion regulation strategy to reduce the duration and intensity of emotions. This meta-analysis synthesised 48 studies and 102 effect sizes examining the effects of self-distancing on emotion regulation. The results showed an overall significant, small effect of self-distancing in attenuating emotional responses (Hedges' g = -0.26, 95%CI: [-0.36, -0.15]). Moderator analyses highlighted the efficacy of one intervention feature: approach. Stronger effect was associated with the visual and verbal approach to process emotional events, in comparison to the visual only approach and the pronouns approach. The effectiveness of self-distancing was consistent across other intervention features (context, stimuli, time, emotional outcome) and individual characteristics (emotional vulnerability, age, culture). These findings suggest that self-distancing is effective in emotion regulation when people externalise and articulate thoughts through writing and talking. Practical implications were discussed in relation to the design of interventions to enhance emotional well-being.

Write and Let Go: An Online Writing Program for University Students

Background

There are a plethora of studies on expressive writing and positive writing interventions, but few have addressed the combination of both paradigms. Additionally, research on the role of ambivalence toward change in the context of writing-based interventions is lacking. Ambivalence toward change is a natural movement of approaching and avoiding change that may occur in various situations. In psychotherapy, its resolution is associated with successful outcomes.

Aim

This study tested the efficacy of a combination of expressive and positive writing paradigms in an internet-based intervention to improve university students' mental health. Additionally, focusing participants on a current, unresolved problem allowed us to explore the possible role of ambivalence toward change as a mediator of the intervention's results.

Methods

We recruited 172 participants who were randomly divided into experimental (n = 85) and control (n = 87) groups. The intervention consisted of the identification of a current problem and four writing tasks on consecutive days. Assessment was conducted at baseline and posttest in both groups and at follow-up in the experimental group. Participants in the experimental condition were also assessed after each task. Measures of anxiety, depression, rumination, ambivalence toward change, distress, and wellbeing (optimism, affect, and satisfaction with life) were collected.

Results

Multivariate analysis of variance (MANOVA) showed that participants in the experimental group had a significant decrease from baseline to posttest in ambivalence toward change and rumination when compared with the control group. These results were maintained at follow-up. No differences were found in the remaining measures. Within the experimental group, ambivalence toward change, rumination, and distress significantly decreased throughout the intervention and the exploratory mediation analysis indicated that ambivalence toward change partially mediated the improvements in rumination and distress.

Discussion

Considering different perspectives about a current problem and using a combination of expressive and positive writing fostered the reduction of ambivalence toward change and rumination. Ambivalence toward change reduction after the second writing task may have created optimal conditions for the subsequent decrease in rumination and distress. Future studies should replicate this finding and dismantle the components that are more adequate in changing these variables.

In the here and now: Future thinking and social problem-solving in depression

This research investigates whether thinking about the consequences of a problem being resolved can improve social problem-solving in clinical depression. We also explore whether impaired social problem solving is related to inhibitory control. Thirty-six depressed and 43 non-depressed participants were presented with six social problems and were asked to generate consequences for the problems being resolved or remaining unresolved. Participants were then asked to solve the problems and recall all the consequences initially generated. Participants also completed the Emotional Stroop and Flanker tasks. We found that whilst depressed participants were impaired at social problem-solving after generating unresolved consequences, they were successful at generating solutions for problems for which they previously generated resolved consequences. Depressed participants were also impaired on the Stroop task, providing support for an impaired inhibitory control account of social problem-solving. These findings advance our understanding of the mechanisms underpinning social problem-solving in depression and may contribute to the development of new therapeutic interventions to improve social-problem solving in depression.

How do mindfulness-based programmes improve anxiety, depression and psychological distress? A systematic review

This study aimed to systematically review studies which conducted a controlled mediation analysis in order to examine the potential mechanisms which underlie mindfulness-based programme’s (MBPs) effects on anxiety, depression and psychological distress in any health or mental health population. Searches of six databases (Medline (Ovid), PsycINFO, Cochrane Central Register of Controlled Trials, EMBASE, Cinahal Plus and Cochrane Reviews) were undertaken in September 2020. After removing duplicates, 2052 records were screened, of these 1822 were excluded based on the abstract and 230 were further assessed for eligibility against the full study inclusion criteria. Full texts were acquired for the 11 studies which met the inclusion criteria. The quality of the methodologies of each of these 11 studies were assessed using the Cochrane risk of bias tool (Higgins et al., 2011). The quality of the findings from each study relating to the hypothesised mechanisms of action of the MBP reviewed were evaluated using Alsubaie et al. (2017)’s framework for abstracting and interpreting mechanistic study quality, derived from recommendations made by Kazdin (2007, 2009). We found preliminary evidence that MBCT/MBSR treatment effects on anxiety and depression may be mediated by hypothesised mechanisms, such as mindfulness, rumination, worry, self-compassion, cognitive reactivity, aversion, attention regulation skills and positive affect. An overall lack of methodological rigour does preclude us from making any definitive conclusions on causality. The results from this study do however provide some insights into what the potential causal pathways connecting MBPs with improved anxiety and depression might be.

Repetitive Negative Thinking and Eating Disorders: A Meta-Analysis of the Role of Worry and Rumination

The role of worry and rumination in eating disorders (EDs) is controversial. This meta-analysis of the literature is aimed at clarifying the relationship between repetitive negative thinking (RNT) and EDs. In accordance with the PRISMA criteria, a comprehensive search of the literature was conducted on PubMed and PsycInfo from inception to March 2021. Search terms: “eating disorder/anorexia/bulimia/binge eating disorder” AND “worry/rumination/brooding/repetitive thinking”. A manual search of reference lists was also run. Forty-three studies were included. RNT was found to be associated with anorexia, bulimia, and binge eating disorder. A moderating effect was found for “presence/absence ED diagnosis” and “subtype of ED symptom”. ED patients showed higher RNT than the general population. No differences were observed for age or between worry and rumination in the magnitude of their association with EDs.

Adverse childhood experiences and repetitive negative thinking in adulthood: A systematic review

BACKGROUND

It has been proposed that repetitive negative thinking (worry and rumination) may be more common among adults who have been exposed to childhood adverse experiences, leading to emotional disorders and other adverse outcomes. The current study aims to present a comprehensive evaluation of the literature examining the relationship between the exposure to childhood adversities, repetitive negative thinking and clinical outcomes in adulthood.

METHODS

In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, a search was conducted on PubMed and Ebsco. A manual search of reference lists was also run. Search terms were 'childhood adversity/childhood abuse/childhood neglect/early loss event AND worry or rumination'.

RESULTS

A total of 18 studies met the inclusion criteria. In both non-clinical and clinical populations, worry and rumination seem to be common among adults exposed to childhood abuse or childhood neglect. Among adults who have been exposed to childhood adversities, rumination seems to be associated with worse clinical outcomes such as severe psychiatric symptoms, depression, dysphoria, suicidal ideation, cognitive complaints, post-traumatic stress symptoms and aggression.

CONCLUSION

Early experiences of abuse and neglect may be associated with a tendency to engage in repetitive negative thinking, such as worry and rumination, in adulthood. Among adults, with a history of childhood adversities, tailored treatment to reduce repetitive negative thinking should be considered.

A General Model of Dissonance Reduction: Unifying Past Accounts via an Emotion Regulation Perspective

Cognitive dissonance has been studied for more than 60 years and many insightful findings have come from this research. However, some important theoretical and methodological issues are yet to be resolved, particularly regarding dissonance reduction. In this paper, we place dissonance theory in the larger framework of appraisal theories of emotion, emotion regulation, and coping. The basic premise of dissonance theory is that people experience negative affect (to varying degrees) following the detection of cognitive conflict. The individual will be motivated to alleviate these emotional reactions and could do so by reducing dissonance in some manner. We argue that detection of dissonance will follow the same principles as when people interpret any other stimuli as emotionally significant. Thus, appraisal theory of emotion, which argues that emotions are generated via the cognitive evaluation of surrounding stimuli, should be applicable to the dissonance-detection process. In short, we argue that dissonance-reduction strategies (attitude change, trivialization, denial of responsibility, etc.) can be understood as emotion-regulation strategies. We further argue that this perspective contributes to reconciling fragmented (and sometimes contrary) viewpoints present in the literature on dissonance reduction. In addition to proposing the general model of dissonance reduction, we illustrate at the hand of empirical data how research on dissonance reduction can be performed without relying on experimental paradigms that focus on a specific reduction strategy.

Evaluating the empirical evidence for three transdiagnostic mechanisms in anxiety and mood disorders

High co-morbidity among mental disorders indicates that common transdiagnostic mechanisms underlie various psychopathology, yet there has been little research effort to empirically explicate transdiagnostic processes. A few existing studies are limited in the number of transdiagnostic mechanisms and mental disorder categories explored. The current study addresses these limitations by examining the relationship between three transdiagnostic processes (experiential avoidance, rumination, and emotion dysregulation) and symptom severity of five mental disorders (generalized anxiety disorder, panic disorder, social anxiety disorder, specific phobia, and depression) in a college sample (N = 266). Applying Structural Equation Modeling (SEM), three transdiagnostic models were evaluated, with the five latent variables of mental disorder regressed onto each transdiagnostic process. The results showed that all transdiagnostic models-except the emotion dysregulation model-generally fit the data well. Among the tested models, the strongest evidence was found for experiential avoidance as a transdiagnostic mechanism underlying multiple disorders, suggesting the need for further research effort to reduce experiential avoidance in diverse clinical populations.

Goal-directed rumination and its antagonistic effects on problem solving: a two-week diary study

BACKGROUND

The tendency to repetitively and intrusively think about a particular negative event, goal failure, or problem (i.e., goal-directed rumination) is generally associated with impairments in well-being, thus decreasing performance in solving this failure. However, rumination is also associated with higher levels of resources invested in problem solving, likely leading to an improvement in performance.

OBJECTIVES

The current study thus examines the indirect effect of rumination via various mediators on subjective problem-solving performance in the everyday context.

DESIGN

Over a period of two weeks, 147 students completed a brief survey each evening (i.e., diary study).

METHODS

Data were analyzed by means of a multiple mediation model in the multilevel structural equation modeling (MSEM) framework.

RESULTS

The analyses revealed that perceived stress and negative mood negatively mediated the relationship between rumination and problem solving, while attention and effort positively mediated this relationship. Finally, both a negative direct and total effect of rumination on problem solving was observed.

CONCLUSIONS

Conclusively, goal-directed rumination exerted a negative indirect effect on subjective problem solving via perceived stress and negative mood, whereas it positively affected problem solving via attention and effort. Possible limitations and implications are discussed.

A multimethod assessment to study the relationship between rumination and gender differences

Rumination is described as the propensity of responding to distress by repetitively and passively focusing on one's negative emotions, and failures, and their consequences (Nolen-Hoeksema, 1991, 1998). Therefore, given that rumination is characterized especially by difficulties in managing and controlling negative emotional states, it is considered as the most common (impaired) emotional regulation strategy, and can be defined as an emotional process related to a repetitive, undesired, and past-oriented negatively inclined thought (Compare, Zarbo, Shonin, Van Gordon, & Marconi, 2014; Smith & Alloy, 2009). Recent evidence suggested that because of problems related to monitoring of negative states, rumination may be associated with exaggerated physiological reactivity relative to demands from the environment, and to some difficulties in attentional control abilities. The current study aimed at deepening our understanding of the role that a maladaptive emotional regulation strategy - such as rumination - might play in physiological response changes and in engaging dysfunctional attentional strategies. We used a multimethod assessment including self-reports (i.e., Rumination and Reflection Questionnaire, and Difficulties in Emotion Regulation Scale), physiological measures, (i.e., Heart Rate Variability recording), and attention tasks (i.e., Stroop Task) in order to examine the multiple aspects of rumination across genders. Sixty-eight individuals (30 males and 38 females) were administered DERS -16, RRQ and, soon after them, the Stroop task. Immediately after completing the Stroop task (T1), participants were exposed to a three-phase, baseline-stress-recovery experimental paradigm while their heart rate variability (HRV) was recorded. After completing the experimental paradigm, Stroop stimuli were presented for the second time (T2), in order to examine possible intra-individual differences between the two performances in the Stroop task. Our findings showed that rumination was higher in females than in males, but in men it appeared to be strongly associated with an overall impaired emotional regulation. However, no gender differences in rumination and emotion dysregulation were found when inspecting physiological data. The current study aims to contribute towards a better understanding which emotion regulation strategies and which physiological mechanisms are associated with rumination.

Intolerance of uncertainty fuels depressive symptoms through rumination: Cross-sectional and longitudinal studies

The current study replicated and extended previous studies by examining the mediating and moderating role of rumination in the relationship between intolerance of uncertainty (IU) and depression in a community sample using both cross-sectional (n = 494; 56.9% female) and a two-months longitudinal (n = 321; 48.4% female) designs. Participants in each study were recruited through online crowdsourcing websites and completed study questionnaires. Results from Study 1 suggested that, while rumination did not appear to moderate the relationship between IU and depression, rumination appeared to partially mediates such relationship. Results from Study 2 supported rumination as fully mediating the relationship between IU and depression over two months. The brooding and reflection rumination subtypes exerted a significant indirect, but not moderating, effect on the relationship between IU and depression. Brooding exhibited a stronger mediation effect than did reflection. Overall, current results suggest that high levels of IU fuel the development of depression symptoms over time through engagement in heightened rumination. The IU-depression association appeared fully explained through rumination as it is a passive and contextually-dependent coping response that may enhance individuals’ emotion and facilitate the development of depressive symptoms.

Rumination and the default mode network: Meta-analysis of brain imaging studies and implications for depression

Rumination is strongly and consistently correlated with depression. Although multiple studies have explored the neural correlates of rumination, findings have been inconsistent and the mechanisms underlying rumination remain elusive. Functional brain imaging studies have identified areas in the default mode network (DMN) that appear to be critically involved in ruminative processes. However, a meta-analysis to synthesize the findings of brain regions underlying rumination is currently lacking. Here, we conducted a meta-analysis consisting of experimental tasks that investigate rumination by using Signed Differential Mapping of 14 fMRI studies comprising 286 healthy participants. Furthermore, rather than treat the DMN as a unitary network, we examined the contribution of three DMN subsystems to rumination. Results confirm the suspected association between rumination and DMN activation, specifically implicating the DMN core regions and the dorsal medial prefrontal cortex subsystem. Based on these findings, we suggest a hypothesis of how DMN regions support rumination and present the implications of this model for treating major depressive disorder characterized by rumination.

Differences in clinical intrusive thoughts between obsessive-compulsive disorder, generalized anxiety disorder, and hypochondria

Differences and similarities between intrusive thoughts typical of obsessive-compulsive disorder, generalized anxiety disorder, and hypochondriasis are relevant for their differential diagnosis, formulation, and psychological treatment. Previous research in non-clinical samples pointed out the relevance of some process variables, such as responsibility, guilt, or neutralization strategies. This research is aimed to investigate the differences and similarities between clinical obsessions, worries, and illness intrusions in some of these process variables. A second aim is to identify models based on these variables that could reliably differentiate between them. Three groups of patients with obsessive-compulsive disorder (n = 35; 60% women, mean age 38.57), generalized anxiety disorder (n = 36; 61.1% women, mean age 41.50), and hypochondriasis (n = 34; 70.6% women, mean age 31.59) were evaluated using the Cognitive Intrusions Questionnaire-Transdiagnostic Version (Romero-Sanchiz, Nogueira-Arjona, Godoy-Ávila, Gavino-Lázaro, & Freeston, ). The results showed that some appraisals (e.g., responsibility or egodystonicity), emotions (e.g., guilt or insecurity), neutralization strategies, and other variables (e.g., verbal content or trigger from body sensation) are relevant for the discrimination between obsessions, worries, and illness intrusions. The results also showed 3 stable models based on these variables for the discrimination between these thoughts. The implication of these results in the diagnosis, formulation, and psychological treatment of obsessive-compulsive disorder, generalized anxiety disorder, and hypochondriasis is discussed.

Gender Invariance and Psychometric Properties of the Nonproductive Thoughts Questionnaire for Children

Perseverative cognitions—rumination and worry—can contribute to mental and somatic health problems in adolescence. Girls usually report stronger rumination or worry than boys even in earlier years across the development age spectrum. Our aim was to test the gender invariance and psychometric properties of the Nonproductive Thoughts Questionnaire for Children (NPTQ-C). Study 1 involved 1,572 students (mean age = 15.39 years, SD = 2.26; 49% boy) recruited representatively from local schools. We applied confirmatory factor analysis (CFA) to test the measurement model of perseverative cognitions. The gender invariance of the measurement model and the convergent validity were analyzed as well with CFA with covariates model. The original one-factor structure of NPTQ-C was supported in our adolescent sample. Gender invariance was also confirmed. The NPTQ-C indicated high convergent validity: showing positive correlations with emotional instability and emotional symptoms. In Study 2 (385 students; mean age = 16.05; SD = 1.23; 34% boy), we tested the construct validity of NPTQ-C. The applied CFA with covariates model supported the construct validity. In summary, NPTQ-C proved to be a good instrument for measuring ruminative and worrying thoughts of adolescents, which reliably measures perseverative cognitions across genders.

Delineating Characteristics of Maladaptive Repetitive Thought: Development and Preliminary Validation of the Perseverative Cognitions Questionnaire

Worry, rumination, and obsessive thinking are theorized to differ on temporal orientation, positive perceived function, degree of intrusiveness, and discordance with one's self-concept. However, prior findings with respect to such differences may be due to method variance of the measures used and/or inclusion of items confounded by diagnostic symptoms. Accurately capturing differences between types of perseverative thought linked to psychopathology and understanding whether such aspects are common across disorders or specific to some may be important to designing effective treatments for them. Two studies are presented detailing the development and validation of the Perseverative Cognitions Questionnaire (PCQ). The PCQ is a 45-item self-report measure that assesses six dimensional characteristics of worry, rumination, and obsessive thinking previously found to discriminate these thought styles: Lack of Controllability, Preparing for the Future, Expecting the Worst, Searching for Causes/Meaning, Dwelling on the Past, and Thinking Discordant with Ideal Self. Factor structure of the PCQ was established using principal components, exploratory factor, and confirmatory factor analyses. PCQ scales exhibited differential convergence with measures of perseverative thought and psychopathology. The PCQ also demonstrated acceptable retest correlations across 1- and 2-week periods, and incremental validity when predicting symptoms of anxiety, depression, and obsessive compulsive disorder.

Identity Processes and Statuses in Patients with and without Eating Disorders

Problems with identity formation are associated with a range of psychiatric disorders. Yet, the mechanisms underlying such problems and how they are refined into specific diagnostic presentations require further investigation. The present study investigated identity processes among 123 women with eating disorders (ED) and age-matched community controls via a newly developed identity model. Several clinical outcome variables were assessed. Patients with ED scored lower on committing to and identifying with identity-related choices and scored higher on maladaptive or ruminative exploration, identity diffusion and identity disorder. They also experienced less identity achievement as compared with controls. The identity disorder status was associated with the highest scores on anxiety, depression, borderline personality disorder symptoms, and non-suicidal self-injury and the lowest scores on need satisfaction. Results indicate that patients with ED experience more identity problems than community controls and those captured by an identity disorder status experience the most problematic psychosocial functioning. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.

A Comprehensive Review of the Cognitive Determinants of Anxiety and Rumination in Social Anxiety Disorder

Social anxiety disorder (SAD) is characterised by an intense fear of social situations in which the individual believes they may be negatively evaluated (American Psychiatric Association, 2013). A number of cognitive models (Clark & Wells, 1995; Hofmann, 2007; Rapee & Heimberg, 1997) have been proposed that provide frameworks for understanding the key cognitive processes involved in SAD. Negative rumination, which can be divided into pre- and post-event rumination, appears to be a key maintaining factor in the cycle of social anxiety. However, there are mixed findings regarding the cognitive predictors of post-event rumination and a lack of research regarding the consequences and predictors of pre-event rumination. Furthermore, there has been little empirical research investigating the effects of targeting negative rumination and state anxiety in social anxiety treatment. If the cognitive predictors of negative rumination can be determined then they can be targeted when designing interventions that aim to break the vicious cycle of social anxiety. The state of research investigating the cognitive determinants of state anxiety and negative rumination is reviewed and suggestions are made for continuing research.

Emotions and Emotion Regulation in Breast Cancer Survivorship

Emotional distress in cancer patients is an important outcome; however, emotional experience does not begin and end with emotion generation. Attempts to regulate emotions may lessen their potentially negative effects on physical and psychological well-being. Researchers have called for the study of emotion regulation (ER) in health psychology and psycho-oncology. Thus, this review has three aims. First, we discuss current understandings of emotion and ER across the cancer trajectory, including the principles of ER and methods for its assessment. Second, we present a model for examining the mediating effects of ER on psychosocial outcomes. Third, we “round out” the discussion with an example: new data on the role of ER in recurrent breast cancer. Taken together, these aims illustrate the impact of affective regulatory processes on cancer patients’ long-term outcomes. As survival rates increase, long-term follow-up studies are needed to characterize the dynamic, reciprocal effects of emotion and ER for cancer survivors. Further research on ER may help women with breast cancer better manage the challenges associated with diagnosis and treatment.

Inhibition Versus Switching Deficits in Different Forms of Rumination

Individuals who depressively ruminate about their current dysphoria tend to perseverate more than nonruminators. The goal of the current study was to determine whether such perseverative tendencies are associated with an inability to switch attention away from old to new information or with an inability to effectively inhibit the processing of previously relevant information. We used a task-switching paradigm that can distinguish between these two processes. Two experiments showed that depressive rumination is associated with a deficit in inhibiting prior mental sets. The second experiment also demonstrated that, in contrast to depressive rumination, angry and intellectual rumination are associated with difficulties in switching to a new task set, but not with inhibition of a prior task set. This study suggests that different forms of rumination are associated with different cognitive mechanisms and that both deficits may contribute to the perseveration that is associated with ruminative tendencies.

Trait reflection predicts interleukin-6 response to a social-evaluative stressor

Past work has linked negative repetitive thought (worry, rumination) about stressors to sustained stress responses. Less is known about the effects of neutral types of repetitive thought (e.g., reflection) on physiological stress responses. The present study examined whether greater trait reflection was associated with a lower inflammatory response to an acute psychosocial stressor. Thirty-four healthy undergraduate women completed a speech stressor, and plasma interleukin-6 (IL-6), C-reactive protein, and tumor necrosis factor-α levels were assessed before and after the stressor. Higher levels of reflection predicted lower IL-6 responses 1h after the stressor. Stressor appraisal was not a significant mediator. These preliminary findings stand in contrast to existing evidence that other forms of repetitive thought like worry and rumination may exacerbate or prolong the inflammatory stress response and indicate that reflection is a notable factor worth considering when examining the relationship between stress, inflammation, and health.

Rumination and self-reflection in stress narratives and relations to psychological functioning

The longitudinal study aims to expand what is known about the costs and benefits of narrating stressful experiences by exploring changes in rumination within the narrative process and comparing it to changes in self-reflection. Rumination (e.g., brooding, self-criticism, and negative emotions) and self-reflection were measured in stress narratives of 56 college students. There were several goals: (1) examine changes in narrative rumination and narrative self-reflection over 3 days of writing, (2) examine the relations among the changes in narrative rumination variables and narrative self-reflection and (3) examine how changes in narrative rumination and narrative self-reflection relate to multiple measures of psychological functioning. Overall, individuals increased self-reflection over the 3-day writing task. Individuals who increased ruminative brooding across the 3 days of writing showed lower ego identity development (short term and long term) and self-esteem (short term), while increased self-criticism was positively correlated with identity distress (short term). Implications of the different aspects of narrative rumination, specifically in the context of stressful experiences, are discussed.

Rethinking Rumination

The response styles theory (Nolen-Hoeksema, 1991) was proposed to explain the insidious relationship between rumination and depression. We review the aspects of the response styles theory that have been well-supported, including evidence that rumination exacerbates depression, enhances negative thinking, impairs problem solving, interferes with instrumental behavior, and erodes social support. Next, we address contradictory and new findings. Specifically, rumination appears to more consistently predict the onset of depression rather than the duration, but rumination interacts with negative cognitive styles to predict the duration of depressive symptoms. Contrary to original predictions, the use of positive distractions has not consistently been correlated with lower levels of depressive symptoms in correlational studies, although dozens of experimental studies show positive distractions relieve depressed mood. Further, evidence now suggests that rumination is associated with psychopathologies in addition to depression, including anxiety, binge eating, binge drinking, and self-harm. We discuss the relationships between rumination and worry and between rumination and other coping or emotion-regulation strategies. Finally, we highlight recent research on the distinction between rumination and more adaptive forms of self-reflection, on basic cognitive deficits or biases in rumination, on its neural and genetic correlates, and on possible interventions to combat rumination.

Thinking about rumination: the scholarly contributions and intellectual legacy of Susan Nolen-Hoeksema

Our article reviews and celebrates Susan Nolen-Hoeksema's remarkable contributions to psychological and clinical science, focusing on her vast body of theoretical and empirical work and her influence on colleagues and students. Susan spent her career trying to understand how and why a style of regulating emotions called rumination increases vulnerability to depression and exacerbates and perpetuates negative moods. More broadly, we describe research by Susan and her colleagues on the predictors of depression in childhood and adolescence; gender differences in depression and rumination in adolescence and adulthood; roots, correlates, and adverse consequences of ruminative response styles; and rumination as a transdiagnostic risk factor for not only depression but also a host of psychological disorders, including anxiety, substance abuse, and eating disorders. Susan's intellectual legacy is evident in her impressive publication and citation record, the clinical applications of her work, and the flourishing careers of the students she mentored.

Diagnostic utility of worry and rumination: a comparison between generalized anxiety disorder and major depressive disorder

AIM

Although previous reports have addressed worry and rumination as prominent cognitive processes in generalized anxiety disorder (GAD) and major depressive disorder (MDD) and their distinct correlation with anxious and depressive symptoms, the differential association of worry and rumination with the diagnosis of GAD and MDD remains unclear. The purpose of this study was to investigate the distinct features of worry and rumination in factor structure and their predictive validity for the diagnosis of GAD and MDD.

METHODS

Four hundred and sixty-eight patients with GAD (n = 148) and MDD (n = 320) were enrolled and the diagnoses were confirmed with the Structured Clinical Interview for DSM-IV. Participants completed the Penn State Worry Questionnaire and Ruminative Response Scale and the severity of anxiety and depressive symptoms was assessed via clinician ratings.

RESULTS

In joint factor analysis using the Penn State Worry Questionnaire and Ruminative Response Scale items, worry and rumination emerged as distinct factors. In logistic regression analyses, worry contributed to a higher probability of the diagnosis of GAD than rumination, as rumination did in MDD than worry.

CONCLUSION

This is the first comprehensive study investigating the diagnostic utility of worry and rumination in a well-defined clinical sample of both GAD and MDD. Our results suggest that worry and rumination are distinct cognitive processes and play a differential role in the diagnosis of GAD and MDD, distinguishing them at the cognitive level.

Risk factors associated with depressive symptoms among undergraduate students

The purpose of the present study was to examine the relationship of several cognitive and emotional variables including perfectionism, rumination, and attachment quality with depressive symptoms in a sample of Iranian undergraduate students. Two hundred and ninety nine undergraduate students (144 males, 156 females) from Urmia University of Technology, Urmia University, and Urmia University of Medical Sciences participated in this study. Participants were asked to complete Tehran Multidimensional Perfectionism Scale (TMPS), Ruminative Responses Scale (RRS), Revised Adult Attachment Scale (RAAS), and Center for Epidemiologic Studies Depression Scale (CES-D). The results demonstrated that insecurity of attachment, socially prescribed perfectionism, and rumination could significantly predict the depressive symptoms in undergraduate students. Confirming predictive risk factors of depressive symptoms, results of the present study can produce an empirical basis for designing educational and health programs for people at risk. Accordingly, proper assessment of the risk factors of depressive symptoms in health care settings may provide invaluable information for prevention and management programs.

Worry and Rumination in Anorexia Nervosa

Background: Difficulties with comprehending and managing emotions are core features of the pathology of anorexia nervosa (AN). Advancements in understanding aetiology and treatment have been made within other clinical domains by targeting worry and rumination. However, worry and rumination have been given minimal consideration in AN. Aims: This study is the largest to date of worry and rumination in AN. Method: Sixty-two outpatients with a diagnosis of AN took part. Measures of worry, rumination, core AN pathology and neuropsychological correlates were administered. Results: Findings suggest that worry and rumination are elevated in AN patients compared with both healthy controls and anxiety disorder comparison groups. Regression analyses indicated that worry and rumination were significant predictors of eating disorder symptomatology, over and above the effects of anxiety and depression. Worry and rumination were not associated with neuropsychological measures of set-shifting and focus on detail. Conclusions: The data suggest that worry and rumination are major concerns for this group and warrant further study.

Dispositional mindfulness moderates the effects of stress among adolescents: rumination as a mediator

Recent research has demonstrated that higher levels of mindfulness are associated with greater psychological and physical health. However, the majority of this research has been conducted with adults; research is only beginning to examine the effects of mindfulness among adolescents. Further, research into adolescent mindfulness has typically conceptualized mindfulness as a unidimensional phenomenon and has not yet examined multidimensional models of mindfulness that have emerged in the adult literature. Further, the mechanisms through which mindfulness influences these outcomes are presently unclear. The present study examined the effects of three facets of mindfulness among adolescents. Seventy-eight adolescents (61% female, 94% Caucasian, M age = 16) completed a measure of dispositional mindfulness at baseline. Participants then completed measures of daily stress, dysphoric affect, and state rumination over a 7-day period. Multilevel modeling analyses revealed that facets of mindfulness (i.e., nonreactivity and nonjudgment) were associated with lower levels of dysphoric mood. Mindfulness interacted with daily stress to predict later dysphoria; less mindful individuals were particularly vulnerable to the negative effects of stress. Finally, analyses demonstrated that the effect of the Mindfulness × Stress Moderation was significantly mediated by increases in daily rumination. These findings support the importance of mindfulness among adolescents and help to elucidate the mechanisms through which mindfulness influences psychological health.

Psychometric properties of the Repetitive Thinking Questionnaire in a clinical sample

Repetitive negative thinking (RNT) is thought to contribute to the maintenance of many emotional disorders. Although several measures of RNT are available, the items of most of these instruments index RNT that is specific to particular diagnostic groups (e.g., RNT about depression symptoms). This has limited our ability to examine the relevance of RNT across diagnostic groups and advance our understanding of RNT as a transdiagnostic process. This study evaluated the psychometric properties of the Repetitive Thinking Questionnaire (RTQ), a transdiagnostic measure of RNT. In a clinical sample of individuals with anxiety and depressive disorders (N = 186), the RTQ demonstrated good internal consistency, convergent, and divergent validity. Supporting the transdiagnostic nature of the measure, the Repetitive Negative Thinking subscale of the RTQ was associated with a variety of negative emotions and metacognitive beliefs, and significantly predicted symptoms of multiple disorders when controlling for neuroticism. Our findings support the use of the RTQ as a transdiagnostic, trans-emotional measure of maladaptive repetitive thought following distressing events, with scope to increase efficiency and reduce burden on patients by assessing RNT in clinical settings with one short measure. Experimental and longitudinal research identifying mechanisms driving RNT using the RTQ would be informative for theory and treatment developments.

Mood-as-input hypothesis and perseverative psychopathologies

Mood-as-input hypothesis is a theory of task perseveration that has been applied to the understanding of perseveration across psychopathologies such as pathological worrying, compulsive checking, depressive rumination, and chronic pain. We review 10 years of published evidence from laboratory-based analogue studies and describe their relevance for perseveration in clinical populations. In particular, mood-as-input hypothesis predicts that perseveration at a task will be influenced by interactions between the individual's stop rules for the task and their concurrent mood, and that the valency of an individual's concurrent mood is used as information about whether the stop rule-defined goals for the task have been met. The majority of the published research is consistent with this hypothesis, and we provide evidence that clinical populations possess characteristics that would facilitate perseveration through mood-as-input processes. We argue that mood-as-input research on clinical populations is long overdue because (1) it has potential as a transdiagnostic mechanism helping to explain the development of perseveration and its comorbidity across a range of different psychopathologies, (2) it is potentially applicable to any psychopathology where perseveration is a defining feature of the symptoms, and (3) it has treatment implications for dealing with clinical perseveration.

The Perseverative Thinking Questionnaire (PTQ): validation of a content-independent measure of repetitive negative thinking

Repetitive negative thinking (RNT) has been found to be involved in the maintenance of several types of emotional problems and has therefore been suggested to be a transdiagnostic process. However, existing measures of RNT typically focus on a particular disorder-specific content. In this article, the preliminary validation of a content-independent self-report questionnaire of RNT is presented. The 15-item Perseverative Thinking Questionnaire was evaluated in two studies (total N = 1832), comprising non-clinical as well as clinical participants. Results of confirmatory factor analyses across samples supported a second-order model with one higher-order factor representing RNT in general and three lower-order factors representing (1) the core characteristics of RNT (repetitiveness, intrusiveness, difficulties with disengagement), (2) perceived unproductiveness of RNT and (3) RNT capturing mental capacity. High internal consistencies and high re-test reliability were found for the total scale and all three subscales. The validity of the Perseverative Thinking Questionnaire was supported by substantial correlations with existing measures of RNT and associations with symptom levels and clinical diagnoses of depression and anxiety. Results suggest the usefulness of the new measure for research into RNT as a transdiagnostic process.

Rumination in PTSD as well as in traumatized and non-traumatized depressed patients: a cross-sectional clinical study

BACKGROUND

Although rumination is a key process in the onset and maintenance of depressive symptoms and a powerful predictor of persistent posttraumatic stress disorder (PTSD), little is known about the differences and similarities of rumination in these conditions. Previous research has not always differentiated between rumination and intrusive images.

AIMS

We sought to systematically evaluate rumination and to gather more information about the content and associated emotions in three patient groups (PTSD, and depressed with and without trauma; n = 65). Furthermore, we examined the interaction between rumination and another predominant intrusive cognition, intrusive image.

METHOD

A multi-method assessment for rumination, including a rumination questionnaire and a rumination log (kept for one week), was employed.

RESULTS

Rumination was found to be complex and composed of subcomponents that are similar across the diagnostic groups. Rumination rarely stopped intrusive images and it made the participants feel worse. There were, however, also important differences: in PTSD, rumination always or often triggered intrusive images and the traumatized individuals (PTSD and depressed with trauma) ruminated more than non-traumatized depressed patients.

CONCLUSIONS

The results corroborate the assumption of rumination being a transdiagnostic process, with similarities but also with important differences across diagnostic groups. Moreover, the findings support recent research on the intricate relationship between different types of intrusive cognitions.

Knowledge about and preoccupation with reading disabilities: a delicate balance

This study investigated the extent to which children's knowledge about reading disabilities, preoccupation with their own reading disability, and anxiety predicted reading comprehension in fifth and sixth grade children with reading disabilities (N=85). Participants provided rich and accurate information about reading disabilities and the academic and emotional implications of having a reading disability. Children's knowledge about the characteristics of reading disabilities was positively associated with reading comprehension, and preoccupation with their own disability was negatively associated with reading comprehension. Girls reported higher levels of preoccupation and anxiety than boys did. In addition to gender, children's reading comprehension, trait anxiety, and perceptions of their mothers' worry about their reading disabilities predicted their preoccupation with their own disability. Children with the most adaptive profile in terms of reading comprehension and anxiety were those who had high levels of knowledge and low levels of preoccupation with their disability.

Worry and rumination in older adults: Differentiating the processes

OBJECTIVES

This study examined the factor structure of the adapted Ruminative Response Scale in a large Australian older adult sample. Previously, the factor structure has only been explored in small UK sample and thus remains tentative. A further objective was to explore overlapping and distinct characteristics of worry, brooding and reflection in relation to coping behaviour which has not previously been examined in older adults.

METHOD

A total of 138 older adults aged between 65 and 97 years (M = 77, SD = 7.9) completed a number of instruments to measure worry, rumination, anxiety and coping behaviour.

RESULTS

A three-factor structure comprised of worry, brooding and reflection emerged. However, no unique relationship was found between the rumination components (brooding and reflection) and worry and coping pathways.

CONCLUSION

The factor structure supports the idea that worry, brooding and reflection are distinguishable constructs in the elderly. However, the lack of differential associations between the rumination components and worry in relation to coping strategies provided evidence that rumination and worry are part of the same theoretical construct of repetitive thought. The implications of these findings for the management of anxiety and depression in the elderly are discussed.