Physical Limitations, Health Rumination/Worry, and Depressive Symptoms: Gender Differences among African Americans

Although studies have documented the relationships between physical health, health rumination/worry, and mental health, few investigations have assessed these linkages within African American communities. Using a community-based sample of residents in historically lower-income, African American communities (N = 306), this study assesses the mediating role of health rumination/worry in the physical limitation-depressive symptom relationship, and the moderating effect of gender on the relationship between health rumination/worry-depressive symptoms. Findings demonstrate that health rumination/worry explains half of the physical limitation-depressive symptom relationship, and the relationship between health rumination/worry and depressive symptoms is stronger for African American men than women. The findings underscore the importance of intersectional research for policy efforts aimed at reducing mental health morbidities within African American communities.

Perceived stress moderates emotion regulation success in real-world contexts: an ecologically-valid multilevel investigation

BACKGROUND

Emotion regulation plays a crucial role in well-being in everyday life. Effective emotion regulation depends upon adaptively matching a given strategy to a given situation. Recent research has begun to explore these interactions in the context of daily reports of perceived stress, affect, and emotion regulation strategy usage. To further understand these differences in strategy efficacy in an ecologically valid context, we examined responses to real world stressors in a young adult sample.

METHODS

We surveyed a range of emotion regulation strategies, including two forms of cognitive reappraisal (i.e., reinterpretation, which involves cognitively reframing one's emotional responses, and psychological distancing, which involves adopting an objective, impartial perspective). Participants reported strategy usage, momentary perceived stress, and affect in response to multiple ecological momentary assessments over a period of 7 days.

RESULTS

Analyses of links between strategy usage and affect revealed that rumination was significantly negatively associated with more positive affect ratings. Further, a significant interaction between momentary perceived stress and reinterpretation usage was observed on affect, such that reinterpretation was more adaptive during situations perceived as less stressful.

CONCLUSION

These results provide further insight into the importance of situational context in determining the effectiveness of particular emotion regulation strategies.

Influencing factors of depressive symptoms among undergraduates: A systematic review and meta-analysis

OBJECTIVE

This systematic review aims to examine the influencing factors of undergraduates' depressive symptoms by summarizing the categories and intensity of the factors, to lay a foundation for subsequent research.

METHODS

Two authors independently searched in Medline (Ovid), Embase (Ovid), Scopu, PsycINFO, PsycARTICLES, the Chinese Scientific Journal Database (VIP Database), China National Knowledge database (CNKI), and the WanFang database for cohort studies related to the influencing factors affecting depressive symptoms among undergraduates published prior to September 12, 2022. Adjusted Newcastle-Ottawa scale (NOS) was used to assess the risk of bias. Meta-analyses of regression coefficient estimates were performed to calculate pooled estimates with R 4.0.3 software.

RESULTS

A total of 73 cohort studies were included, involving 46362 participants from 11 countries. Factors affecting depressive symptoms were classified into relational, psychological, predictors of response to trauma, occupational, sociodemographic and lifestyle factors. In Meta-analysis, 4 of 7 influencing factors were revealed to be statistically significant: negative coping (B = 0.98, 95%CI: 0.22-1.74), rumination (B = 0.06, 95%CI: 0.01-0.11), stress (OR = 0.22, 95%CI: 0.16-0.28) and childhood abuse (B = 0.42, 95%CI:0.13-0.71). No significant association was found in positive coping, gender and ethnicity.

LIMITATIONS

The current studies have the problems of inconsistent use of scales and large heterogeneity of research design, making it difficult to summarize, which is expected to be further improved in future research.

CONCLUSION

This review evidences the importance of several influencing factors of depressive symptoms among undergraduates. We advocate for more high-quality studies with more coherent and appropriate study designs and outcome measurement approaches in this field.

TRIAL REGISTRATION

Systematic review registration: PROSPERO registration CRD42021267841.

A systematic review on the potential use of machine learning to classify major depressive disorder from healthy controls using resting state fMRI measures

BACKGROUND

Major Depressive Disorder (MDD) is a psychiatric disorder characterized by functional brain deficits, as documented by resting-state functional magnetic resonance imaging (rs-fMRI) studies.

AIMS

In recent years, some studies used machine learning (ML) approaches, based on rs-fMRI features, for classifying MDD from healthy controls (HC). In this context, this review aims to provide a comprehensive overview of the results of these studies.

DESIGN

The studies research was performed on 3 online databases, examining English-written articles published before August 5, 2022, that performed a two-class ML classification using rs-fMRI features. The search resulted in 20 eligible studies.

RESULTS

The reviewed studies showed good performance metrics, with better performance achieved when the dataset was restricted to a more homogeneous group in terms of disease severity. Regions within the default mode network, salience network, and central executive network were reported as the most important features in the classification algorithms.

LIMITATIONS

The small sample size together with the methodological and clinical heterogeneity limited the generalizability of the findings.

CONCLUSIONS

In conclusion, ML applied to rs-fMRI features can be a valid approach to classify MDD and HC subjects and to discover features that can be used for additional investigation of the pathophysiology of the disease.

Development of an mHealth App-Based Intervention for Depressive Rumination (RuminAid): Mixed Methods Focus Group Evaluation

BACKGROUND

Depression is a common mental health condition that poses a significant public health burden. Effective treatments for depression exist; however, access to evidence-based care remains limited. Mobile health (mHealth) apps offer an avenue for improving access. However, few mHealth apps are informed by evidence-based treatments and even fewer are empirically evaluated before dissemination. To address this gap, we developed RuminAid, an mHealth app that uses evidence-based treatment components to reduce depression by targeting a single key depressogenic process-rumination.

OBJECTIVE

The primary objective of this study was to collect qualitative and quantitative feedback that could be used to improve the design of RuminAid before the software development phase.

METHODS

We reviewed empirically supported interventions for depression and rumination and used the key aspects of each to create a storyboard version of RuminAid. We distributed an audio-guided presentation of the RuminAid storyboard to 22 individuals for viewing and solicited user feedback on app content, design, and perceived functionality across 7 focus group sessions.

RESULTS

The consumer-rated quality of the storyboard version of RuminAid was in the acceptable to good range. Indeed, most participants reported that they thought RuminAid would be an engaging, functional, and informational app. Likewise, they endorsed overwhelming positive beliefs about the perceived impact of RuminAid; specifically, 96% (21/22) believed that RuminAid will help depressed ruminators with depression and rumination. Nevertheless, the results highlighted the need for improved app aesthetics (eg, a more appealing color scheme and modern design).

CONCLUSIONS

Focus group members reported that the quality of information was quite good and had the potential to help adults who struggle with depression and rumination but expressed concern that poor aesthetics would interfere with users' desire to continue using the app. To address these comments, we hired a graphic designer and redesigned each screen to improve visual appeal. We also removed time gating from the app based on participant feedback and findings from related research. These changes helped elevate RuminAid and informed its initial software build for a pilot trial that focused on evaluating its feasibility and acceptability.

Depressive symptom trajectory following romantic relationship breakup and effects of rumination, neuroticism and cognitive control

Studying individuals who recently experienced a romantic reltionship breakup allows us to investigate mood disturbances in otherwise healthy individuals. In our study, we aimed to identify distinct depressive symptom trajectories following breakup and investigate whether these trajectories relate to personality traits and cognitive control. Subjects (n = 87) filled out questionnaires (RRS-NL-EXT trait rumination and NEO-FFI neuroticism) and performed cognitive tasks (trail making test, Stroop task) during a period of 30 weeks. To identify distinct depressive symptom trajectories ('trajectory groups'), we performed K-means clustering on the consecutive (assessed every 2 weeks) Major Depression Inventory scores. This resulted in four trajectory groups; 'resilience', 'fast recovery', 'slow recovery' and 'chronic distress'. The 'slow recovery group' and the 'chronic distress group' were found to have higher neuroticism and trait rumination levels compared to the 'resilience group', and the 'chronic distress group' also had higher neuroticism levels than the 'fast recovery group'. Moreover, the 'chronic distress group' showed worse overall trail making test performance than the 'resilience group'. Taken together, our findings show that distinct patterns of depressive symptom severity can be observed following breakup and that personality traits and cognitive flexibility seem to play a role in these depressive symptom patterns.

Not the Master of Your Volitional Mind? The Roles of the Right Medial Prefrontal Cortex and Personality Traits in Unconscious Introjections Versus Self-Chosen Goals

Humans are unconditionally confronted with social expectations and norms, up to a degree that they, or some of them, have a hard time recognizing what they actually want. This renders them susceptible for introjection, that is, to unwittingly or “unconsciously” mistake social expectations for self-chosen goals. Such introjections compromise an individual’s autonomy and mental health and have been shown to be more prevalent in individuals with rumination tendencies and low emotional self-awareness. In this brain imaging study, we draw on a source memory task and found that introjections, as indicated by imposed tasks that are falsely recognized as self-chosen, involved the bilateral medial prefrontal cortex (MPFC) and the dorsal anterior cingulate cortex (ACC). Notably, reduced right MPFC activation within this condition correlated with trait scores of ruminations and reduced emotional self-awareness, but also introversion. Moreover, correct recognition of tasks as self-chosen involved the right MPFC. Accordingly, the right MPFC may play a role in supporting the maintenance of psychological autonomy and counteract introjection, which individuals with certain personality traits seem to be prone to. This research has significant implications for the study of mechanisms underlying autonomous motivation, goal and norm internalization, decision-making, persuasion, education, and clinical conditions such as depression and burnout.

Neuroticism and satisfaction in romantic relationships: A systematic investigation of intra- and interpersonal processes with a longitudinal approach

Relationship satisfaction—the degree to which a close relationship is perceived as rewarding and satisfying by both partners—is reliably predicted by both partners’ neuroticism, but the psychological mechanisms underlying this effect are not sufficiently well understood. By analyzing several cognitive, emotional, and behavioral processes simultaneously, the current longitudinal study looked at how both partners’ neuroticism affects their respective (and mutual) relationship satisfaction both on an intra- and on an interpersonal level. Dyadic data from 2090 heterosexual couples from the “Pairfam” study were analyzed with Actor-Partner Interdependence Mediation Models (APIMeM). Results support the assumption that neuroticism reliably predicts cognitive, emotional, and behavioral variables, which, in turn, predict both partners’ relationship satisfaction. Importantly, cognitive processes play a particularly important role both on an interpersonal as well as on an intrapersonal level. These findings help to shed light on the maladaptive cognitive, emotional, and behavioral processes underlying the effect of neuroticism on relationship satisfaction.

Predictors of health behaviors during a college national championship sports event: A daily diary study

Objective: Few studies have examined relations between college sporting events and maladaptive health behaviors among non-athlete college students. Participants: 97 college students. Methods: Completed nightly surveys (alcohol, eating, physical activity, sexual risk taking, smoking) for 11 days around a National Championship game. Results: Baseline stress and rumination was related to worse health behavior; mindfulness was related to better health behavior. Hierarchical linear modeling showed that all maladaptive health behaviors significantly increased the day of the sporting event compared to individuals' baseline levels. Rumination significantly predicted a spike in alcohol use and sexual risk taking behavior on the day of the Championship game. Conclusions: Risk factors for maladaptive health behaviors include stress and rumination, while mindfulness is protective. Interventions may work to make sports events on campus safer for students (e.g., condoms, reminder emails, mindfulness interventions for at risk groups); more research is needed.

Depression, Rumination, and Impulsive Action: A Latent Variable Approach to Behavioral Impulsivity

Previous research on the relationship between rumination and behavioral impulsivity has been limited because impulsivity was assessed by using individual tasks. This study examined the concurrent associations of a latent variable named impulsive action with rumination and depression to alleviate the task-impurity problem and the low reliability of laboratory tasks assessing impulsivity. This study also examined whether stressors mediated the association between impulsive action and rumination. University students in Japan (N = 176) conducted three laboratory tasks assessing impulsive action: the Go/No-Go Task, the Stop Signal Task, and the Conners Continuous Performance Test 3rd Edition. They also completed self-report measures of rumination, stressors, and depression. Results indicated that the latent variable named impulsive action constructed from the performance in these three tasks was positively associated with rumination. Moreover, stressors mediated this association. Also, impulsive action was positively associated with depression via the increase in stressors and rumination. These findings and those of previous studies examining associations between rumination and self-reported impulsivity suggest that impulsivity might be a determinant of rumination.

Mindfulness and eudaimonic well-being: the mediating roles of rumination and emotion dysregulation

Mindfulness has been widely studied in Western psychology for reducing psychological distress. However, several scholars noted that in the East, where the concept originated, mindfulness may be understood differently. In Eastern cultures such as Thailand, mindfulness is not only employed to deal with suffering but also to promote well-being. To the best of our knowledge, no studies have been undertaken to evaluate the relationship between traditional mindfulness and eudaimonic well-being in Eastern contexts. In the present study, we investigated the relationships between mindfulness and eudaimonic well-being in Thai contexts. We also explored the mediating roles of rumination and emotion dysregulation on this relationship. Data were collected from 312 Thai undergraduates who completed a measure of Eudaimonic Well-Being, the Freiburg Mindfulness Inventory, the Rumination-Reflection Questionnaire, and the Difficulties in Emotion Regulation Scale. Results largely supported our hypotheses. Mindfulness was found to have a positive and direct association with eudaimonic well-being. Rumination and emotion dysregulation partially mediated this association. Additionally, both rumination and emotion dysregulation had negative and direct association with eudaimonic well-being. The findings highlight the positive influences of mindfulness on well-being. The benefits of mindfulness for improvement of eudaimonic well-being through reducing rumination and emotion dysfunction are discussed.

Response inhibition deficits are positively associated with trait rumination, but attentional inhibition deficits are not: aggressive behaviors and interpersonal stressors as mediators

Previous findings on relationships between inhibition that is a core executive function, and trait rumination have been inconsistent. This inconsistency could be overcome by investigating the association between rumination and the two subcomponents of inhibition: response inhibition and attentional inhibition. This study examined whether and how response inhibition and attentional inhibition were related to rumination as well as worry. University students in Japan (N = 213) conducted the Go/No-Go Task and the Modified Stroop Task. They also completed self-report measures of depression, trait rumination, trait worry, stressors, and aggressive behaviors. Results indicated that response inhibition deficits were positively associated with trait rumination, and this association was mediated by increases in aggressive behaviors and interpersonal stressors. The associations between these variables remained significant even after controlling for depression level. There were no significant direct or indirect associations between attentional inhibition deficits and rumination. These results suggest that response inhibition deficits, among the subcomponents of inhibition, have an indirect positive association with rumination through interpersonal processes. Results also showed nonsignificant differences between rumination and worry in the magnitude of correlation coefficients with the two subcomponents of inhibition. Therefore, it remains unclear whether the positive association with response inhibition is unique to rumination.

Relationship of Internalized Transnegativity and Protective Factors With Depression, Anxiety, Non-suicidal Self-Injury and Suicidal Tendency in Trans Populations: A Systematic Review

Discrimination heavily impacts the lives of trans populations and causes adverse mental health outcomes. As stated by the Gender Minority Stress Model self-stigmatization could play an important role in this process. The aim of this systematic review is to investigate whether there is a positive association between self-stigmatization and mental health and to identify mediation factors. Studies which quantitatively investigated the association between internalized transnegativity and selected mental health outcomes (depression, anxiety, non-suicidal self-injury, suicidal tendency) in self-identified trans populations were included. Comprehensive search of 5 large databases in June 2020 and the following screening and selection procedure, performed by two researchers separately, identified 14 studies which met criteria. The relationship to be studied was reported with correlation and/or mediation analysis of cross-sectional data. IT was directly positively associated with depression, anxiety and suicidal tendency in most of the reviewed studies. Data indicates links between self-stigmatization and other general mental health stressors such as rumination and thwarted belongingness. Community connectedness showed to be the strongest protective factor for mental health impairments. These results should be considered in transition counseling. More research is needed to better understand the underlying mechanisms of the GMSM and to address unsolved operationalization and measurement issues.

Comparing the effects of emotional disclosure and peer helping writing on psychological distress among Chinese international students: The moderating role of rumination

OBJECTIVES

This study tested the effects of emotional disclosure writing and peer helping writing in reducing psychological distress among Chinese international students. This study also examined whether rumination and ambivalence over emotion expression moderated the effects of emotional disclosure and peer helping writing.

METHOD

One hundred forty-four Chinese international students were randomly assigned to one of three conditions: emotional disclosure, peer helping, or neutral control writing. Participants completed two 20-min writing sessions and questionnaires at baseline, 2-month follow-up, and 4-month follow-up.

RESULTS

We found no significant differences across the three writing conditions in levels of psychological distress over time. However, rumination emerged as a significant moderator in both emotional disclosure and peer helping intervention conditions. High ruminators generally experienced significant reductions in depressive symptoms, whereas low ruminators experienced increased depressive symptoms.

CONCLUSIONS

These findings demonstrate that the benefits of writing interventions may vary as a function of rumination.

Electrophysiological scarring in remitted depressed patients: Elevated EEG functional connectivity between the posterior cingulate cortex and the subgenual prefrontal cortex as a neural marker for rumination

INTRODUCTION

Prior resting state fMRI studies have revealed that elevated connectivity between the default mode network (DMN) and subgenual prefrontal cortex (sgPFC) connectivity may underly maladaptive rumination, which is a major risk factor for depression. To further evaluate such relationship, we investigated whether posterior regions of the DMN, showed elevated connectivity with the sgPFC in remitted depressed patients (rMDD) and whether this connectivity was related to maladaptive rumination.

METHODS

We examined whether rMDD (N = 20) had elevated EEG posterior DMN - sgPFC functional connectivity when compared to age and sex matched healthy controls (N = 17), and whether this posterior DMN - sgPFC connectivity positively correlated with rumination. Using minimum norm as the source estimation method, we extracted current density maps from six regions of interest (ROIs) within the posterior DMN. EEG source-space functional connectivity was calculated using the Amplitude Envelope Correlation method.

RESULTS

Relative to controls, rMDD showed increased posterior cingulate cortex (PCC) - sgPFC connectivity in the beta-3 (25-30 Hz) band. As hypothesized, PCC - sgPFC connectivity was positively associated with rumination for rMDD, even after controlling for depression and anxiety.

LIMITATIONS

The absence of an MDD patient group and the relatively small sample size can limit the generalizability of the results.

CONCLUSIONS

EEG resting state PCC - sgPFC functional connectivity is significantly elevated in rMDD and is associated with rumination, suggesting that EEG PCC - sgPFC connectivity may be useful as a neural marker to identify individuals at risk for depression.

Prevent breaking bad: A proof of concept study of rebalancing the brain's rumination circuit with real-time fMRI functional connectivity neurofeedback

Rumination, repetitively thinking about the causes, consequences, and one's negative affect, has been considered as an important factor of depression. The intrusion of ruminative thoughts is not easily controlled, and it may be useful to visualize one's neural activity related to rumination and to use that information to facilitate one's self‐control. Real‐time fMRI neurofeedback (rtfMRI‐nf) enables one to see and regulate the fMRI signal from their own brain. This proof‐of concept study utilized connectivity‐based rtfMRI‐nf (cnf) to normalize brain functional connectivity (FC) associated with rumination. Healthy participants were instructed to brake or decrease FC between the precuneus and the right temporoparietal junction (rTPJ), associated with high levels of rumination, while engaging in a self‐referential task. The cnf group (n = 14) showed a linear decrease in the precuneus‐rTPJ FC across neurofeedback training (trend [112] = −0.180, 95% confidence interval [CI] −0.330 to −0.031, while the sham group (n = 14) showed a linear increase in the target FC (trend [112] = 0.151, 95% CI 0.017 to 0.299). Although the cnf group showed a greater reduction in state‐rumination compared to the sham group after neurofeedback training (p < .05), decoupled precuneus‐rTPJ FC did not predict attenuated state‐rumination. We did not find any significant aversive effects of rtfMRI‐nf in all study participants. These results suggest that cnf has the capacity to influence FC among precuneus and rTPJ of a ruminative brain circuit. This approach can be applied to mood and anxiety patients to determine the clinical benefits of reduction in maladaptive rumination.

Longitudinal associations between rumination and depressive symptoms in a probability sample of adults

BACKGROUND

According to the Response Styles Theory, rumination maintains and exacerbates depression. This study was conducted to examine the bidirectional longitudinal associations between rumination and depressive symptoms in a probability sample of Australian adults, evaluate the degree to which the strength of these longitudinal associations was moderated by gender, and test whether these longitudinal associations remained statistically significant when adjusting for the influence of demographic characteristics and neuroticism.

METHODS

A probability sample of Australian adults (N = 5891) completed self-report measures of rumination, neuroticism, and depressive symptoms at baseline and rumination and depressive symptoms at a four-year follow-up.

RESULTS

Results from regression analyses indicated that rumination predicted residual change in depressive symptoms and depressive symptoms predicted residual change in rumination, suggesting that rumination and depressive symptoms influence one another in a bidirectional, recursive fashion. Gender was not a significant moderator of the longitudinal associations between rumination and depressive symptoms. Analyses including the covariates of age, gender, and neuroticism, a personality trait characterized by heightened negative emotionality, indicated that the bidirectional longitudinal associations between rumination and depressive symptoms were not explained by their shared association with demographic characteristics or neuroticism.

LIMITATIONS

Within-person analyses involving repeated assessments, shorter time intervals, and assessment of brooding rumination would provide a stronger test of the potential causal association between rumination and depressive symptoms.

CONCLUSIONS

Study findings suggest that rumination may be both a potential risk factor for and a consequence of depressive symptoms in adults.

Cognitive factors related to distress in patients recently diagnosed with cancer

OBJECTIVE

This study aims to analyse the association between rumination and thought suppression and the intensity of psychological distress in a sample of patients with recently diagnosed cancer.

METHODS

A total of 131 patients with a recent diagnosis of cancer were assessed within 4 months of diagnosis. All participants completed standardized questionnaires to assess psychological distress, rumination, and thought suppression. Multiple regression and logistic regression models were conducted to determine the associations between these variables.

RESULTS

The multiple regression model explained 50% of variance in psychological distress, with rumination independently explaining more than 16% of the variance. Thought suppression, however, was not significantly associated with distress. The logistic model for caseness of depression and anxiety explained, respectively, 33% and 48% of the variance. Anxiety caseness was also associated with social support and self-efficacy.

CONCLUSIONS

The findings of this study indicate that rumination is an important explanatory variable of psychological distress in patients with recently diagnosed cancer. Statistical models that include rumination could explain a significant proportion of variance of clinical caseness for both anxiety and depression. These findings suggest that assessing rumination in recently diagnosed patients could improve clinical practice by detecting individuals at greater risk of developing more severe psychological distress. These findings suggest that treating rumination as a key component of the therapeutic objectives of psychological interventions could improve clinical outcomes.

Topologically state-independent and dependent functional connectivity patterns in current and remitted depression

OBJECTIVE

Identification of state-independent and -dependent neural biomarkers may provide insight into the pathophysiology and effective treatment of major depressive disorder (MDD), therefore we aimed to investigate the state-independent and -dependent topological alterations of MDD.

METHOD

Brain resting-state functional magnetic resonance imaging (fMRI) data were acquired from 59 patients with unmedicated first episode current MDD (cMDD), 48 patients with remitted MDD (rMDD) and 60 demographically matched healthy controls (HCs). Using graph theory, we systematically studied the topological organization of their whole-brain functional networks at the global and nodal level.

RESULTS

At a global level, both patient groups showed decreased normalized clustering coefficient in relative to HCs. On a nodal level, both patient groups showed decreased nodal centrality, predominantly in cortex-mood-regulation brain regions including the dorsolateral prefrontal cortex, posterior parietal cortex and posterior cingulate cortex. By comparison to cMDD patients, rMDD group had a higher nodal centrality in right parahippocampal gyrus.

LIMITATIONS

The present study, an exploratory analysis, may require further confirmation with task-based and experimental studies.

CONCLUSIONS

Deficits in the topological organization of the whole brain and cortex-mood-regulation brain regions in both rMDD and cMDD represent state-independent biomarkers.

Cleansing the Attentional Palate: A Preliminary Test of a Novel Approach to Facilitate Disengagement From Rumination

Resource allocation theory suggests that rumination depletes cognitive resources that could be directed toward task-relevant processes. We propose a new approach to the treatment of rumination that specifically targets this misappropriation of cognitive resources, wherein individuals engage in an attentionally demanding task in order to interrupt the ruminative cycle. We argue that this strategy would serve to free cognitive resources from rumination and facilitate performance on other tasks. Thus, the present study served as an initial test of this novel approach. This study employed a within-subjects design, in which participants were 30 college students who completed self-report measures of baseline mood state, anxiety, depression, and trait rumination. Subsequently, they underwent sad mood and rumination inductions followed by random assignment to either a low attentional demand disengagement strategy (DS) followed by a high attentional demand DS or vice versa. Reading comprehension was assessed at baseline and following each of the two DSs. The high attentional demand DS condition was associated with better performance on the reading comprehension task compared to the low attentional demand DS condition. These results provide initial support for our novel approach to targeting rumination and demonstrate that attentionally demanding DSs may successfully free cognitive resources that might otherwise be consumed by rumination. Thus, future research into attentionally demanding DSs that interrupt ruminative cycles is warranted. This approach could be a useful adjunct for interventions targeting disorders driven by rumination, such as depression.

Anxiety and Depression Predict the Paths Through Which Rumination Acts on Behavior: A Daily Diary Study

Introduction: Rumination—thinking passively, negatively, and repetitively—is a common cognitive process that is associated with poor health behaviors. Rumination impacts health behaviors through two distinct behavioral pathways: acting too quickly (impulsivity) or not acting at all (amotivation), though no research to date has examined the conditions under which rumination may manifest in these two disparate behavioral paths. The presence of anxiety and depression may lead to the behavioral manifestations of rumination, which may then differentially impact health behavior patterns. In this study, we tested whether individuals reporting anxiety who ruminate will then act impulsively and individuals reporting depression who ruminate will then not act in the context of their daily health behaviors.

Methods: We recruited 285 college students (mean age = 19.3; 76.8% female; 79.4% Caucasian) and had them complete a baseline survey and an 11-day online daily diary to assess associations among anxiety, depression, rumination, and health behaviors.

Results: Rumination predicted health behaviors through both impulsivity and amotivation as expected. Moderation models revealed that rumination in the context of anxiety leads to impulsivity and rumination in the context of depression leads to amotivation. Limitations: The undergraduate sample limits the generalizability of this data.

Discussion: These results show that those who report depression or anxiety are likely to experience more daily rumination and the deleterious behavioral manifestations of that rumination, which then affects health behavior engagement or avoidance. Future behavioral health interventions can perhaps specifically target impulsivity among individuals reporting anxiety and amotivation among individuals reporting depression in order to promote more healthy behaviors.

Relations between trait anxiety and depression: A mediated moderation model

BACKGROUND

This study proposed a mediated moderation model based on the cognitive theory and susceptibility phenotype theory for depression to explore the moderating role of cognitive flexibility in the relationship between trait anxiety and depression and the mediating role of rumination in this interactive effect.

METHODS

The subjects were selected via the cluster sampling method. A cross-sectional survey of 1619 Chinese adults of Han nationality was recruited from three cities in central and western China. The trait anxiety subscale of the State-Trait Anxiety Inventory (STAI-Trait scale), Short Ruminative Response Scale (SRRS), Cognitive Flexibility Inventory (CFI) and Beck Depression Inventory (BDI-II) were used for a paper-and-pencil evaluation. The data were statistically processed using correlation analysis, multiple linear regression analysis, and a test of mediated moderation.

RESULTS

(1) Trait anxiety was significantly positively correlated with rumination and depression. There was a significant negative correlation between cognitive flexibility and trait anxiety, rumination, and depression. (2) The moderating effect of cognition flexibility on the relationship between trait anxiety and depression was mediated by rumination, and the indirect moderating effect accounted for 79.25% of the total variance.

LIMITATIONS

Cross-sectional studies do not reveal the causal relationships between observed variables well. Self-report questionnaires lack objective indicators. The applicability of the current results in the clinical depression population requires further experimental tests.

CONCLUSIONS

The results support the important role of trait anxiety in the development of depression. Cognitive flexibility moderates the relationship between trait anxiety and depression and has a risk-buffering effect on this relationship. Rumination plays a mediating role in the moderating effects of cognitive flexibility on the relationship between trait anxiety and depression. The findings enrich the research on the relationship between trait anxiety and depression and have important practical implications for the early prevention and intervention of depression, which can increase individual cognitive flexibility and address rumination to regulate depression.

Hardiness, Perseverative Cognition, Anxiety, and Health-Related Outcomes: A Case for and Against Psychological Hardiness

The present study investigates the utility of psychological hardiness as well as the differences between rumination and worry. Undergraduate students completed questionnaires assessing hardiness, worry, rumination, mindfulness, neuroticism, anxiety, somatization, coping, and health. Correlations and partial correlations controlling for neuroticism were examined. Hardiness was negatively correlated with neuroticism, rumination, worry, and anxiety and positively correlated with mindfulness, coping, and health. When neuroticism was statistically controlled, the relationships between hardiness and rumination, health, and coping became nonsignificant, and the relationships between hardiness and worry, mindfulness, and anxiety, although attenuated, remained significant. Rumination and worry were positively correlated, but when neuroticism was statistically controlled, this relationship became nonsignificant. The results suggest that hardiness is better conceptualized as a personality style that contributes to psychological well-being. Furthermore, our findings suggest that rumination and worry are distinct cognitive processes.

Aberrant working memory processing in major depression: evidence from multivoxel pattern classification

Major depressive disorder (MDD) is often accompanied by severe impairments in working memory (WM). Neuroimaging studies investigating the mechanisms underlying these impairments have produced conflicting results. It remains unclear whether MDD patients show hyper- or hypoactivity in WM-related brain regions and how potential aberrations in WM processing may contribute to the characteristic dysregulation of cognition-emotion interactions implicated in the maintenance of the disorder. In order to shed light on these questions and to overcome limitations of previous studies, we applied a multivoxel pattern classification approach to investigate brain activity in large samples of MDD patients (N = 57) and matched healthy controls (N = 61) during a WM task that incorporated positive, negative, and neutral stimuli. Results showed that patients can be distinguished from healthy controls with good classification accuracy based on functional activation patterns. ROI analyses based on the classification weight maps showed that during WM, patients had higher activity in the left DLPFC and the dorsal ACC. Furthermore, regions of the default-mode network (DMN) were less deactivated in patients. As no performance differences were observed, we conclude that patients required more effort, indexed by more activity in WM-related regions, to successfully perform the task. This increased effort might be related to difficulties in suppressing task-irrelevant information reflected by reduced deactivation of regions within the DMN. Effects were most pronounced for negative and neutral stimuli, thus pointing toward important implications of aberrations in WM processes in cognition-emotion interactions in MDD.

Reward learning impairment and avoidance and rumination responses at the end of Engage therapy of late-life depression

OBJECTIVES

This study examined the association between reward processing, as measured by performance on the probabilistic reversal learning (PRL) task and avoidance/rumination in depressed older adults treated with Engage, a psychotherapy that uses "reward exposure" to increase behavioral activation.

METHODS

Thirty older adults with major depression received 9 weeks of Engage treatment. At baseline and treatment end, the 24-item Hamilton Depression Rating Scale (HAM-D) was used to assess depression severity and the Behavioral Activation for Depression Scale (BADS) to assess behavioral activation and avoidance/rumination. Participants completed the PRL task at baseline and at treatment end. The PRL requires participants to learn stimulus-reward contingencies through trial and error, and switch strategies when the contingencies unexpectedly change.

RESULTS

At the end of Engage treatment, the severity of depression was lower (HAM-D: t(19) = -7.67, P < .001) and behavioral activation was higher (BADS: t(19) = 2.23, P = .02) compared to baseline. Response time following all switches (r(19) = -0.63, P = .003) and error switches (r(19) = -0.57, P = .01) at baseline was negatively associated with the BADS avoidance/rumination subscale score at the end of Engage treatment.

CONCLUSIONS

Impaired reward learning, evidenced by slower response following all switches and error switches, contributes to avoidant, ruminative behavior at the end of Engage therapy even when depression improves. Understanding reward processing abnormalities of avoidance and rumination may improve the timing and targeting of interventions for these symptoms, whose persistence compromises quality of life and increases the risk of depression relapse.

Posture-Motor and Posture-Ideomotor Dual-Tasking: A Putative Marker of Psychomotor Retardation and Depressive Rumination in Patients With Major Depressive Disorder

Background: Recent studies have demonstrated that the assessment of postural performance may be a potentially reliable and objective marker of the psychomotor retardation (PMR) in the major depressive disorder (MDD). One of the important facets of MDD-related PMR is reflected in disrupted central mechanisms of psychomotor control, heavily influenced by compelling maladaptive depressive rumination. In view of this we designed a research paradigm that included sequential execution of simple single-posture task followed by more challenging divided attention posture tasks, involving concurring motor and ideomotor workloads. Another difficulty dimension assumed executing of all the tasks with eyes open (EO) (easy) and closed (EC) (difficult) conditions. We aimed at investigating the interplay between the severity of MDD, depressive rumination, and efficiency of postural performance.

Methods: Compared with 24 age- and body mass index-matched healthy controls (HCs), 26 patients with MDD sequentially executed three experimental tasks: (1) single-posture task of maintaining a quiet stance (ST), (2) actual posture-motor dual task (AMT); and (3) mental/imaginary posture-motor dual task (MMT). All the tasks were performed in the EO and the EC conditions. The primary dependent variable was the amount of kinetic energy (E) expended for the center of pressure deviations (CoPDs), whereas the absolute divided attention cost index showed energy cost to the dual-tasking vs. the single-posture task according to the formula: ΔE = (E_Dual-task - E_Single-task).

Results: The signs of PMR in the MDD group were objectively indexed by deficient posture control in the EC condition along with overall slowness of fine motor and ideomotor activity. Another important and probably more challenging feature of the findings was that the posture deficit manifested in the ST condition was substantially and significantly attenuated in the MMT and AMT performance dual-tasking activity. A multiple linear regression analysis evidenced further that the dual-tasking energy cost (i.e., ΔE) significantly predicted clinical scores of severity of MDD and depressive rumination.

Conclusion: The findings allow to suggest that execution of concurrent actual or imaginary fine motor task with closed visual input deallocates attentional resources from compelling maladaptive depressive rumination thereby attenuating severity of absolute dual-tasking energy costs for balance maintenance in patients with MDD.

Significance: Quantitative assessment of PMR through measures of the postural performance in dual-tasking may be useful to capture the negative impact of past depressive episodes, optimize the personalized treatment selection, and improve the understanding of the pathophysiological mechanisms underlying MDD.

Cognitive-behavioural therapy and short-term psychoanalytic psychotherapy versus brief psychosocial intervention in adolescents with unipolar major depression (IMPACT): a multicentre, pragmatic, observer-blind, randomised controlled trial

BACKGROUND

Although there are effective psychological treatments for unipolar major depression in adolescents, whether or not one or more of the available therapies maintain reduced depressive symptoms 1 year after the end of treatment is not known. This is a non-trivial issue because maintaining lowered depressive symptoms below a clinical threshold level reduces the risk for diagnostic relapse into the adult years.

OBJECTIVE

To determine whether or not either of two specialist psychological treatments, cognitive-behavioural therapy (CBT) or short-term psychoanalytic psychotherapy (STPP), is more effective than a reference brief psychosocial intervention (BPI) in maintaining reduction of depression symptoms in the year after treatment.

DESIGN

Observer-blind, parallel-group, pragmatic superiority randomised controlled trial.

SETTING

A total of 15 outpatient NHS clinics in the UK from East Anglia, north-west England and North London.

PARTICIPANTS

Adolescents aged 11-17 years with Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition major depression including those with suicidality, depressive psychosis and conduct disorder. Patients were randomised using stochastic minimisation controlling for age, sex and self-reported depression sum score; 470 patients were randomised and 465 were included in the analyses.

INTERVENTIONS

In total, 154 adolescents received CBT, 156 received STPP and 155 received BPI. The trial lasted 86 weeks and study treatments were delivered in the first 36 weeks, with 52 weeks of follow-up.

MAIN OUTCOME MEASURES

Mean sum score on self-reported depressive symptoms (primary outcome) at final study assessment (nominally 86 weeks, at least 52 weeks after end of treatment). Secondary measures were change in mean sum scores on self-reported anxiety symptoms and researcher-rated Health of the Nation scales for children and adolescents measuring psychosocial function. Following baseline assessment, there were a further five planned follow-up reassessments at nominal time points of 6, 12, 52 and 86 weeks post randomisation.

RESULTS

There were non-inferiority effects of CBT compared with STPP [treatment effect by final follow-up = -0.578, 95% confidence interval (CI) -2.948 to 4.104; p = 0.748]. There were no superiority effects for the two specialist treatments (CBT + STPP) compared with BPI (treatment effect by final follow-up = -1.898, 95% CI -4.922 to 1.126; p = 0.219). At final assessment there was no significant difference in the mean depressive symptom score between treatment groups. There was an average 49-52% reduction in depression symptoms by the end of the study. There were no differences in total costs or quality-of-life scores between treatment groups and prescribing a selective serotonin reuptake inhibitor (SSRI) during treatment or follow-up did not differ between the therapy arms and, therefore, did not mediate the outcome.

CONCLUSIONS

The three psychological treatments differed markedly in theoretical and clinical approach and are associated with a similar degree of clinical improvement, cost-effectiveness and subsequent maintenance of lowered depressive symptoms. Both STPP and BPI offer an additional patient treatment choice, alongside CBT, for depressed adolescents attending specialist Child and Adolescent Mental Health Services. Further research should focus on psychological mechanisms that are associated with treatment response, the maintenance of positive effects, determinants of non-response and whether or not brief psychotherapies are of use in primary care and community settings.

LIMITATIONS

Neither reason for SSRI prescribing or monitoring of medication compliance was controlled for over the course of the study, and the economic results were limited by missing data.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN83033550.

FUNDING

This project was funded by the National Institute for Heath Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 21, No. 12. See the National Institute for Heath Research Journals Library website for further project information. Funding was also provided by the Department of Health. The funders had no role in the study design, patient recruitment, data collection, analysis or writing of the study, any aspect pertinent to the study or the decision to submit to The Lancet.

Regulating Rumination by Anger: Evidence for the Mutual Promotion and Counteraction (MPMC) Theory of Emotionality

Unlike the strategy of cognitive regulation that relies heavily on the top-down control function of the prefrontal cortex (PFC), which was recently found may be critically impaired in stressful situations, traditional Chinese philosophy and medicine views different types of emotionality as having mutual promotion and counteraction (MPMC) relationships, implying a novel approach that requires less cognition to emotional regulation. Actually, our previous studies have indicated that anger responses could be successfully regulated via the induction of sadness, and this efficiency could not be influenced by stress, thus providing evidences for the hypothesis of "sadness counteracts anger" (SCA) proposed by the MPMC theory of emotionality (Zhan et al., 2015, 2017). In this study, we experimentally examined the MPMC hypothesis that "anger counteracts rumination" (ACR) which postulates that rumination may be alleviated by the anger emotion. In Study 1, all participants were initially caused state rumination and then induced anger, joy or neutral mood, the results showed that the rumination-related affect was alleviated after anger induction relative to that after joy or neutral mood induction. In Study 2, female participants with high trait rumination were recruited and divided into two groups for exposure to an anger or neutral emotion intervention, the result indicated that the anger intervention group exhibited a greater decline in trait rumination than the neutral emotion intervention group. These findings provided preliminary evidence supporting the hypothesis of ACR, which suggested a new strategy that employs less cognitive resources to regulating state and trait rumination by inducing anger.

Understanding the relationship between suicidality, current depressed mood, personality, and cognitive factors

OBJECTIVES

Links between suicidality and depressed mood are well established. There is, however, little information about the emotional regulation processes that underlie the relationship between suicidality and current low mood, and how these processes differ between groups of never-suicidal (NS), suicidal ideators, and suicide attempters. As suicidality and depression are heterogeneous constructs, this study aimed to conduct within- and between-group comparisons of known suicide risk factors that are associated with emotion regulation (neuroticism, trait aggression, brooding, impulsivity, and overgeneral autobiographical memories).

DESIGN

Correlational design using between- and within-group comparisons from self-report measures.

METHODS

Inter- and intragroup differences were identified using Pearson's correlation coefficients and tests of difference. An analysis of indirect effects was used to investigate whether the relationship between suicidality and current low mood was mediated by neuroticism, trait aggression, brooding, impulsivity, and overgeneral autobiographical memories, and if this relationship varied according to group type.

RESULTS

Brooding appeared to be a consistent feature of all three groups and was closely related to current low mood. Compared to the NS group, the relationship between suicide attempts and current low mood showed greater associations with brooding, trait aggression, and overgeneral autobiographical memories. Compared to the NS group, the suicidal ideation group showed stronger associations with neuroticism and impulsivity, but these factors did not correlate with low mood.

CONCLUSION

These results suggest a need for larger studies to focus on heterogeneity within suicidal populations and consider how different combinations of risk factors may heighten or reduce suicide risk.

PRACTITIONER POINTS

It is well known that the severity and intensity of suicide and depressed presentations vary because of underlying dispositional and contextual factors (Fried & Nesse, ) which, in turn, affect how events are interpreted and responded to. Despite this, there is little research about how these mechanisms operate in different types of suicide groups, and their influence on the relationship between suicidality and current low mood. Understanding interrelationships that affect current low mood is of clinical significance because past suicidal history and deteriorations in already negative mood are linked to repeated suicide attempts and completion. Our findings show that ruminative brooding, defined as a tendency to repeatedly think about emotional aspects of an event, consistently correlates with current low mood across different types of suicidal groups (NS, suicidal ideators, and suicide attempters), and across analyses. Findings also show that suicidal ideation and attempt groups were associated with specific personality characteristics that increased the propensity of emotional responding and interpretation compared to the NS group. The relationship between suicide attempt and current low mood had a higher propensity to be influenced by trait aggression, brooding, and overgenerality compared to the NS group. In contrast, although the suicidal ideation group correlated more strongly with neuroticism and impulsivity, these factors did not influence current low mood. In terms of clinical practice, these findings imply that specific styles of interpretation and thinking may maintain the relationship between suicidality and current low mood. Given the cross-sectional nature of the study, however, it is not possible to imply causality. Nevertheless, the findings obtained provide some support for transdiagnostic models of cognitive-behavioural processes that could be developed further.

Heart rate variability mediates the link between rumination and depressive symptoms: A longitudinal study

Ruminative thinking about negative feelings has been prospectively associated with increases in depressive symptoms and heightened risk for new onsets of major depression. One putative pathophysiological mechanism underlying this link might be represented by autonomic nervous system dysfunction. The objective of this longitudinal study was to evaluate the interplay between rumination, autonomic function (as revealed by heart rate variability (HRV) analysis), and depressive symptoms in healthy young subjects, over a three-year period. Rumination and depressive symptoms were evaluated in twenty-two women and twenty men at three assessment points (Time 0, 1 and 2) by the score on the Ruminative Response Scale, and the Center for Epidemiological Studies Depression Scale, respectively. Vagally-mediated HRV was assessed in a laboratory session (Time 0) and in two ambulatory sessions at Time 1 and Time 2 (~13 and 34months after Time 0, respectively). Ruminative thinking was found to be (i) a stable trait characteristic, (ii) more prevalent in women than men, and (iii) positively correlated with depressive symptoms. Moreover, resting HRV was negatively correlated with both rumination and depressive symptoms. Finally, HRV at Time 1 mediated the relationship between rumination at Time 0 and depressive symptoms at Time 2. We conclude that autonomic dysfunction, specifically low vagal tone, may be prospectively implicated in the generation of depressive symptoms in a non-clinical setting.

"When my Moods Drive Upward There Is Nothing I Can Do about It": A Review of Extreme Appraisals of Internal States and the Bipolar Spectrum

The integrative cognitive model provides a comprehensive account of bipolar disorder (BD) that, if empirically supported, has important potential implications for psychological therapies. This article is the first to review the evidence for this model. We evaluate the evidence (up to 2017) for four hypotheses derived uniquely from the model: extreme positive and negative appraisals of internal states are associated with (1) risk of developing BD; (2) BD diagnosis; (3) relevant clinical and functional outcomes including hypomanic and depressive mood symptoms; and (4) outcomes over time. Research involving individuals with diagnosed mood disorders as well as non-clinical populations is reviewed. The hypotheses were broadly supported and several consistent findings were not accounted for by alternative psychological models of BD. The evidence base is limited by a relative paucity of prospective studies; only 6 of the 31 studies identified. Implications for theory, research and clinical practice are discussed.

Do Overgeneral Memories Make us feel better? An experimental examination

A critical assumption of the CaR-FA-X model, that overgeneral memory is partly attributable to the "functional avoidance" of specific details about one's past experiences, has not been experimentally tested. Further, while it is assumed that the reinforcing properties of said avoidance leads to the emergence of an overgeneral recall style over time, this question has not been addressed developmentally. To explore these issues, two studies were conducted. In Study 1, 41 children and adolescents (M_age = 12 years) were randomly assigned to recall overgeneral or specific negative memories on the Autobiographical Memory Test; participants later listened to their memories and provided pre- and post-tests of their emotional states at four time points: before and after memory generation and before and after memory exposure. In Study 2, 52 college-aged participants (M_age = 19 years) completed the same protocol. Results indicated that children and adolescents in the overgeneral condition reported higher levels of positive affect relative to those in the specific condition, while recall condition did not impact adults' emotional states. These findings were not explained by differences in emotion regulation strategies or psychopathological symptoms. Implications for developmental models of autobiographical memory and emotion regulation are discussed.

Stuck in Limbo: Motivational Antecedents and Consequences of Experiencing Action Crises in Personal Goal Pursuit

OBJECTIVE

Action crises describe the intrapsychic conflicts individuals experience when they feel torn between further goal pursuit and goal disengagement. The present investigation introduces autonomous and controlled motivation as independent predictors of action crisis severity, beyond known personality-level predictors (action orientation) and novel personality-level predictors (Neuroticism and Conscientiousness).

METHOD

Using a multi-wave prospective longitudinal design and multilevel modeling (MLM), we followed students pursuing three personal goals across an academic semester (N = 425 undergraduates; 76% female; 57% Caucasian; M_age  = 20.2, SD = 2.3). In two follow-up surveys, participants reported on the severity of their action crises, goal progress, and symptoms of depression.

RESULTS

Results suggest that autonomous motivation shields individuals from experiencing action crises, whereas controlled motivation represents a risk factor for developing action crises beyond personality-level predictors. Furthermore, MLM revealed that autonomous motivation is a significant predictor of action crisis severity at both the within- and between-person levels of analysis. Action crises mediate both the relationship between autonomous motivation and goal progress, and the relationship between controlled motivation and symptoms of depression.

CONCLUSIONS

The implications of these findings for the prevention of action crises and motivation research are discussed.

Depressive rumination and the emotional control circuit: An EEG localization and effective connectivity study

Ruminations are repetitive thoughts associated with symptoms, causes, and consequences of one's negative feelings. The objective of this study was to explore the neuronal basis of depressive rumination in a non-clinical population within the context of emotional control. Participants scoring high or low on the tendency to ruminate scale took part in the EEG experiment. Their EEG data were collected during a state of induced depressive ruminations and compared with positive and neutral conditions. We hypothesized that both groups would differ according to the level of activation and effective connectivity among the structures involved in the emotional control circuit. Clustering of independent components, together with effective connectivity (Directed Transfer Function), was performed using the EEG signal. The main findings involved decreased activation of the left dorsolateral prefrontal cortex (DLPFC) and increased activation of the left temporal lobe structures in the highly ruminating group. The latter result was most pronounced during the ruminative condition. Decreased information from the left DLPFC to the left temporal lobe structures was also found, leading to the conclusion that hypoactivation of the left DLPFC and its inability to modulate the activation of the left temporal lobe structures is crucial for the ruminative tendencies.

Increased Default Mode Network Connectivity in Individuals at High Familial Risk for Depression

Research into the pathophysiology of major depressive disorder (MDD) has focused largely on individuals already affected by MDD. Studies have thus been limited in their ability to disentangle effects that arise as a result of MDD from precursors of the disorder. By studying individuals at high familial risk for MDD, we aimed to identify potential biomarkers indexing risk for developing MDD, a critical step toward advancing prevention and early intervention. Using resting-state functional connectivity MRI (rs-fcMRI) and diffusion MRI (tractography), we examined connectivity within the default mode network (DMN) and between the DMN and the central executive network (CEN) in 111 individuals, aged 11-60 years, at high and low familial risk for depression. Study participants were part of a three-generation longitudinal, cohort study of familial depression. Based on rs-fcMRI, individuals at high vs low familial risk for depression showed increased DMN connectivity, as well as decreased DMN-CEN-negative connectivity. These findings remained significant after excluding individuals with a current or lifetime history of depression. Diffusion MRI measures based on tractography supported the findings of decreased DMN-CEN-negative connectivity. Path analyses indicated that decreased DMN-CEN-negative connectivity mediated a relationship between familial risk and a neuropsychological measure of impulsivity. Our findings suggest that DMN and DMN-CEN connectivity differ in those at high vs low risk for depression and thus suggest potential biomarkers for identifying individuals at risk for developing MDD.

Differential effects of rumination and distraction on ketamine induced modulation of resting state functional connectivity and reactivity of regions within the default-mode network

Distraction and rumination are distinct response styles that determine how an individual deals with negative thoughts and feelings. Rumination is accompanied by an elevated self-focus, which is associated with increased resting state functional connectivity and decreased reactivity within the default mode network. Interestingly, the NMDA receptor antagonist ketamine reduces functional connectivity in this network, while its effects on blood oxygenation level-dependent (BOLD) responses during stimulus perception are not known. Ketamine might lead to a more variable processing of the external world with an attenuated self-focus by reducing the resting state connectivity. Here, we used an emotional picture-viewing task in combination with functional magnetic resonance imaging to test the hypothesis that a single ketamine administration to healthy subjects increases BOLD reactivity to negative stimuli. We found a region specific increase in BOLD reactivity in the pregenual anterior cingulate cortex and not in a posterior control region after ketamine compared with placebo administration. Moreover, a linear regression revealed that the increase in BOLD reactivity was more pronounced for subjects with a low ability to apply distraction during negative experiences. Our results implicate that ketamine attenuates a potentially pathological increased self-focus during negative experiences.

The influence of self-relevant materials on working memory in dysphoric undergraduates

Difficulties in updating working memory (WM) may underlie problems with regulating emotions that contribute to depression. To examine the ability of updating affective materials in WM, 33 dysphoric and 34 non-dysphoric participants were asked to evaluate the self-descriptiveness of emotional adjectives and provide answers to self-relevant questions. Within 3-7 days, they completed a two-back task with a series of self-irrelevant or self-relevant emotional words (they had generated previously) and four conditions (match-set, break-set, perseveration-set, and no-set). After the WM task, an unexpected recall task was administered; controls recalled more positive self-relevant words and intrusions while dysphoric participants recalled more negative self-relevant words and intrusions. In break-set trials of the two-back task, dysphoric individuals showed slower response to self-relevant words regardless of valence. In the match-set and perseveration-set trials, dysphoric participants showed delayed response to self-related negative words. Moreover, longer reaction times for self-relevant negative words were correlated with higher rumination and worse depression. The results suggest that dysphoric undergraduates are interfered more by and have a better memory of self-relevant negative stimuli in WM, which is closely correlated with rumination. This study is among the first to confirm the potential mechanism that could underwrite the involvement of self-schema in effectively regulating negative affect.

A Validation Study of the Korean-Ruminative Response Scale in Korean Adolescents

OBJECTIVE

We aimed to evaluate the psychometric properties of Korean version of Ruminative Response Scale (K-RRS) for Korean adolescents.

METHODS

A community sample of 1220 adolescents was recruited from middle schools and high schools. Exploratory factor analyses and confirmatory factor analyses were conducted, and additional analyses were performed to assess the reliability and validity of the K-RRS.

RESULTS

An exploratory factor analysis of a sample of adolescents (n=550) yielded a three factor structure: 'depressive rumination', 'reflective pondering', and 'brooding'. Confirmatory factor analyses of another sample of adolescents (n=530) supported the three-factor model for the K-RRS. The K-RRS was found to have good internal consistency and construct validity.

CONCLUSION

Our results suggest that K-RRS is a valid measurement to assess rumination in adolescents, as well as in adults.