Rumination, negative cognition, and their interactive effects on depressed mood

The Association Between Rumination and Craving in Chinese Methamphetamine-Dependent Patients: The Masking Effect of Depression

BACKGROUND

Craving is a core feature of addiction. Rumination and depression play a crucial role in the process of methamphetamine addiction. The aim of this study was to examine the relationship between rumination, depression and craving in methamphetamine patients, which has not been explored yet.

METHODS

A total of 778 patients with methamphetamine user disorder (MUD) at the Xinhua Drug Rehabilitation Center, located in Mianyang City, Sichuan Province, China. We used a set of self-administered questionnaires that included socio-demographic, detailed drug use history, rumination, depression and craving information. The Rumination Response Scale (RRS) was used to measure rumination, the Beck Depression Inventory (BDI) to measure depression and the Visual Analogue Scale (VAS) to measure craving.

RESULTS

There was a significant positive correlation between rumination and craving, or depression, and between depression and craving. Furthermore, depression mediated between rumination and craving, with a mediation effect of 160%.

CONCLUSIONS

Our findings suggest that there is a close interrelationship between rumination, craving and depression in MUD patients, and that depression may play a mediating role between rumination and craving.

Multiple paths to rumination within a network analytical framework

Theories of rumination have proposed different psychological factors to place one at risk for repetitive negative thinking. A comprehensive empirical test that captures the most relevant contributors to rumination is lacking. Building on influential self-regulatory and metacognitive frameworks, we modeled how key constructs in this context relate to ruminative thinking. 498 participants completed online questionnaires including indicators of rumination, metacognition, promotion goal orientation, effortful control, and depression. We estimated regularized partial correlation networks to investigate unique associations between the different constructs and followed these analyses up with directed acyclic graphs to identify potential pathways towards rumination. Results demonstrated that: (1) both self-regulatory and metacognitive factors were directly linked to rumination, amongst these were (2) positive beliefs, negative beliefs about uncontrollability and harm, cognitive self-consciousness, depression, effortful control, perfectionism, and (lack of) cognitive confidence, and (3) we identified multiple directed pathways, suggesting three direct contributors to rumination while controlling for the influence of all other variables: diminished effortful control, positive beliefs, and cognitive self-consciousness. This study is the first to comprehensively assess metacognitive and self-regulatory frameworks of rumination in a data-driven manner. Our findings suggest that there are multiple pathways towards rumination, which should be incorporated in clinical case conceptualization of rumination and related disorders.

The relationship between perceived social support and rumination among parents of children with autism: moderating effect of the degree of intervention received by children

Objective

As the number of children diagnosed with autism rises year by year, the issue of nurturing this particular group becomes increasingly salient. Parents of autistic children, as the nearest and most reliable caregivers for their children, shoulder immense psychological strain and accountability. They are compelled to confront an array of daily life challenges presented by their children, as well as endure multiple pressures such as societal scrutiny and financial burdens. Consequently, the mental health status of the parents is of utmost significance.

Methods

In this study, questionnaire survey combined with literature analysis were applied. The rumination thinking scale and the social support scale were used to investigate the relationship between social support perceived by parents of autistic children and rumination. Meanwhile, the moderating effects of intervention on children with autism were also explored. It hopes that our research would provide a basis for alleviating psychological stress and improving the mental health levels of the parents. A total of 303 parents of children with autism were collected (including 160 females and 143 males). Corresponding data analyses were conducted using SPSS 26.0.

Results

Parents of autistic children generally exhibited high levels of rumination, with significant gender differences. At the same time, the perceived social support by the parents significantly influenced their level of rumination. It showed that the higher the social support received by parents, the lower the level of rumination. More importantly, the extent of intervention received by the children had a regulating effect on rumination of their parents.

Conclusion

The personalized psychological support programs should be developed based on the actual situation of parents, to better manage the challenges presented by raising a child with autism. Our findings would provide important theoretical underpinnings and practical guidance for psychological intervention efforts aimed at families of autistic children. Moreover, these findings offer novel insights for future research, with the potential to advance the field of mental health studies concerning parents of children with autism.

Repetitive negative thinking as a unique transdiagnostic risk factor for suicidal ideation

Repetitive negative thinking (RNT) is a transdiagnostic symptom observed across mood and anxiety disorders and is characterized by frequent, distressing thoughts that are perceived as uncontrollable. Specific forms of RNT have been linked to increased suicide risk. However, most work examining links between RNT and suicide has been conducted within specific disorders and subtypes of RNT (e.g., rumination in individuals with depression). The present study aimed to investigate associations between transdiagnostic RNT and suicidal ideation. We hypothesized RNT would be associated with suicide risk beyond disorder-specific clinical symptoms. Fifty-four participants with mood, anxiety, and/or traumatic stress disorders completed an interview assessing suicidal risk (Columbia-Suicide Severity Rating Scale (C-SSRS)) and self-report questionnaires assessing transdiagnostic RNT, depression, and anxiety. Based on C-SSRS, we divided participants into high or low suicide risk groups. We analyzed the relationship between suicidal risk group and RNT and found that RNT was uniquely associated with suicidal risk group, controlling for depression and anxiety severity. Our results suggest including assessments of RNT may have clinical utility for understanding the degree of suicide risk in individuals and point to the potential utility of including clinical interventions to target this symptom for those at high risk of suicide.

Parental criticism affects adolescents' mood and ruminative state: Self-perception appears to influence their mood response

Feeling and/or being criticized is a known risk factor for various psychiatric disorders in adolescents. However, the link between the experience of social stressors and the development of psychopathological symptoms is not yet fully understood. Identifying which adolescent subgroups are more vulnerable to parental criticism could be of great clinical relevance. In this study, 90 nondepressed 14- to 17-year-old adolescents were exposed to a sequence of auditory segments with a positive, neutral, and finally negative valence, mirroring parental criticism. Their mood and ruminative states were assessed before and after exposure to criticism. We observed an overall increase in mood disturbance and ruminative thoughts. Self-perception appeared to influence these mood changes, whereas no significant influence by perceived criticism, self-worth, or the general tendency to ruminate was found. Emotional awareness seemed to account for some of the variance in positive mood state changes. These findings point to the importance of adolescent self-perception (and emotional awareness) in dealing with parental criticism.

tDCS efficacy and utility of anhedonia and rumination as clinical predictors of response to tDCS in major depressive disorder (MDD)

BACKGROUND

Anhedonia and rumination are mental disorders' transdiagnostic features but remain difficult to treat. Transcranial direct current stimulation (tDCS) is a proven treatment for depression, but its effects on anhedonia and rumination and whether anhedonia and rumination can be used as a predictive biomarker of treatment response is not well known. This study aimed to investigate the tDCS efficacy and identify the predictive role of anhedonia and rumination in response to tDCS in patients with MDD.

METHODS

182 patients received 10 tDCS sessions delivered at 2 mA to left (anode) dorsolateral prefrontal cortex (DLPFC). Hamilton Rating Scale for Depression (HRSD-17), Snaith-Hamilton Pleasure Scale (SHAPS), and the 10-item Ruminative Response Scale (RRS-10) was administered to patients with MDD before treatment, following it, and after two weeks of tDCS.

RESULTS

There was an overall significant improvement in anhedonia from pre- to post-treatment. Regression analyses revealed that responders had higher baseline anhedonia and rumination (reflective pondering) scores. We found that the reduction in HRSD scores after tDCS was significantly associated with anhedonia's baseline values while no relation was found between baseline rumination and tDCS treatment response.

CONCLUSION

These results provide new evidence that pronounced anhedonia may be a significant clinical predictor of response to tDCS. Patients with severe or low baseline rumination had an equal chance of achieving clinical response. Prospective tDCS studies are necessary to validate the predictive value of the derived model.

Effects of a video game intervention on symptoms, training motivation, and visuo-spatial memory in depression

Background

People with Major Depressive Disorder (MDD) often experience reduced affect, mood, and cognitive impairments such as memory problems. Although there are various treatments for MDD, many of them do not address the cognitive deficits associated with the disorder. Playing 3D video games has been found to improve cognitive functioning in healthy people, but it is not clear how they may affect depressed mood and motivation in people with MDD. The aim of this study was to investigate whether a six-week video game intervention leads to improvements in depressed mood, training motivation, and visuo-spatial (working) memory functions in patients with MDD.

Methods

A total of 46 clinically depressed individuals were randomly assigned to one of three groups: an experimental "3D video gaming" group (n = 14) which played a video game, an active control group (n = 16) which trained with a computer program "CogPack," and a treatment-as-usual group (n = 16) which received a standard clinical treatment including psychotherapy and/or pharmacotherapy. Participants performed a neuropsychological assessment, including self-report questionnaires asking for depressive symptoms, training motivation, and visuo-spatial (working) memory functions before and after the training intervention.

Results

Regarding depressive symptoms, a significant decrease in the proportion of participants who showed clinical levels of depressive symptoms as measured by the Beck Depression Inventory was only found in the 3D video gaming group. Additionally, mean motivational levels of performing the training were significantly higher in the 3D video gaming group when compared with the active control group. Moreover, whereas the 3D Video Gaming group only significantly improved on one visuo-spatial memory test, the active control group improved in all visuo-spatial memory functions. The 3D video gaming group did not perform significantly better than the CogPack group, and the TAU group.

Conclusion

Besides a standalone cognitive training, the current findings suggest that cognitive trainings using a video game have potential to increase subjective well-being, show higher levels of training motivation, and lead to improvements in visuo-spatial (working) memory functions in MDD. However, given the mixed and unblinded nature of this study, the results should be interpreted with caution. Further research with larger samples and follow-up measurements is needed.

Minority stress, repetitive negative thinking, and internalizing symptoms in sexual minorites: Does cognitive content matter?

BACKGROUND

The Psychological Mediation Framework theorizes that repetitive negative thinking (RNT) mediates the relationship between minority stress and mental health, and this theory has been consistently supported by previous research. Yet, it is unclear whether the process or content of RNT is more important in the development of internalizing symptoms in sexual minorities. Consequently, the goal of the current study was to use structural equation modeling to determine whether there are significant indirect effects of repetitive negative thought content in the relationship between minority stress and internalizing psychopathology.

METHODS

Measures of RNT, internalizing symptoms, and proximal minority stress were completed online by 205 cisgender sexual minority adults. Structural equation modeling was used to examine indirect effects of proximal stress on internalizing symptoms through content-independent RNT, depressive rumination, and sexual orientation-related rumination.

RESULTS

Significant direct effects of proximal minority stress on internalizing symptoms were observed. Indirect effects of proximal stress on internalizing symptoms were observed for content-independent RNT and depressive rumination, but not sexual orientation-related rumination.

CONCLUSIONS

The current study provides evidence that the process and affective valence of RNT contributes more to internalizing symptoms in sexual minorities when compared with sexual orientation-related content. Theoretical and clinical implications are discussed.

Temporal dynamic patterns of the ventromedial prefrontal cortex underlie the association between rumination and depression

As a major contributor to the development of depression, rumination has proven linked with aberrant default-mode network (DMN) activity. However, it remains unclear how the spontaneous spatial and temporal activity of DMN underlie the association between rumination and depression. To illustrate this issue, behavioral measures and resting-state functional magnetic resonance images were connected in 2 independent samples (NSample1 = 100, NSample2 = 95). Fractional amplitude of low-frequency fluctuations (fALFF) and regional homogeneity (ReHo) were used to assess spatial characteristic patterns, while voxel-wise functional concordance (across time windows) (VC) and Hurst exponent (HE) were used to assess temporal dynamic patterns of brain activity. Results from both samples consistently show that temporal dynamics but not spatial patterns of DMN are associated with rumination. Specifically, rumination is positively correlated with HE and VC (but not fALFF and ReHo) values, reflecting more consistent and regular temporal dynamic patterns in DMN. Moreover, subregion analyses indicate that temporal dynamics of the ventromedial prefrontal cortex (VMPFC) reliably predict rumination scores. Furthermore, mediation analyses show that HE and VC of VMPFC mediate the association between rumination and depression. These findings shed light on neural mechanisms of individual differences in rumination and corresponding risk for depression.

The impact of rumination on life satisfaction of hotel employees during the COVID-19 pandemic: the mediating role of fear of COVID-19 and the moderating role of sedentary lifestyle

BACKGROUND

It is important to determine the individual factors that cause the differentiation of negative reactions of individuals due to epidemics. The purpose of this study is to investigate the moderating role of a sedentary lifestyle and the mediating role of fear of COVID-19 on the relationship between rumination and life satisfaction. Intense rumination is known to have a negative impact on individuals' life satisfaction levels. Very little is known about variables that may mediate and moderate this relationship.

PARTICIPANTS AND PROCEDURE

The study was conducted with staff members of five-star accommodation establishments in Turkey. Data were collected with a quantitative research method via questionnaires, completed by 386 full-time employees.

RESULTS

The results show that rumination negatively affects life satisfaction, and fear of COVID-19 has a mediating role between rumination and life satisfaction. In addition, the study concluded that a sedentary lifestyle moderated the indirect effect of rumination on life satisfaction through fear of COVID-19. This finding indicates that the negative impact of rumination on life satisfaction, mediated by fear of COVID-19, decreased, as the active lifestyle level of employees increased.

CONCLUSIONS

The results indicate the importance of active lifestyles in reducing negative impacts of the fear of being infected with a disease during times of crisis such as outbreaks and ruminative thoughts on lifestyle. The findings of this study provide substantial contributions with respect to how outbreak-related negative reactions occur and differ.

Longitudinal relationships between guilt and suicide risk among adolescents in a postdisaster context: Mediating roles of rumination and posttraumatic stress disorder

OBJECTIVE

To analyze the pathways and mechanisms underlying the impact of guilt on suicide risk using a well-controlled longitudinal study, we examined the mediating roles of intrusive rumination, deliberate rumination, and posttraumatic stress disorder (PTSD) in this association.

METHOD

Four hundred and eight adolescent survivors (M_age  = 14.05 years) were assessed using self-report questionnaires three and a half years and four and a half years after the Ya'an earthquake. The self-report questionnaires included the Trauma Exposures Questionnaire, the Interpersonal Guilt Questionnaire, the Event-Related Rumination Inventory, the PTSD Checklist for the DSM-5, and the Child Behavior Problems Questionnaire.

RESULTS

The results indicated that guilt had a direct and positive effect on suicide risk. Intrusive rumination and PTSD mediated the relationship between guilt and suicide risk. Guilt could increase deliberate rumination, but deliberate rumination did not significantly predict PTSD and suicide risk.

CONCLUSION

Negative postdisaster emotions, such as guilt, can enhance the combined effects of cognition and psychological disorders on suicide risk. Guilt affects suicide risk indirectly through intrusive rumination and PTSD but not through deliberate rumination.

Network analysis on the relationship between posttraumatic stress disorder, psychiatric co-morbidity and posttraumatic growth among Chinese adolescents

BACKGROUND

This study investigated the association between posttraumatic stress disorder (PTSD), psychiatric co-morbidity and posttraumatic growth (PTG) among Chinese adolescents using network analysis.

METHODS

867 Chinese adolescents (male = 424, female = 443) were recruited from three secondary schools. They completed the Posttraumatic Stress Disorder Checklist for DSM-5, the Posttraumatic Growth Inventory, and the General Health Questionnaire-28.

RESULTS

Domains of each construct mainly clustered within their respective communities with several bridging edges identified. The prominent roles of bridging nodes and edges (positive and negative) were highlighted. Key bridging nodes were negative alterations in cognitions and mood for PTSD, anxiety and insomnia for psychiatric co-morbidity and appreciation of life for PTG.

LIMITATIONS

The cross-sectional nature of the present study may preclude the identification of real causal relationships between nodes.

CONCLUSIONS

Following a trauma, adolescents displayed posttraumatic stress along with general psychological disorder symptoms. These distress reactions could affect the way they appreciated life and their motivation to seek future life possibilities. Findings from the current study may provide some clue for the facilitation of posttraumatic growth among clinical patients.

Social Undermining and Interpersonal Rumination among Employees: The Mediating Role of Being the Subject of Envy and the Moderating Role of Social Support

Rumination is a common problem and is associated with reduced psychological well-being. However, little is known about how rumination in the workplace is affected by interpersonal relationships. We propose that negative workplace behavior could serve as a potential influencing factor for rumination. Therefore, the current study constructed a multilevel moderated mediation model to investigate the relationship between workplace unit social undermining and interpersonal rumination. We also examined whether unit social support moderated that relationship and whether being the subject of envy mediated that relationship. Survey data were collected from 630 employees in China. The results indicate that: (1) a high level of unit social undermining by either a supervisor or co-workers has a significant positive influence on interpersonal rumination; (2) being the subject of envy exerts a mediating effect between unit supervisor social undermining and interpersonal rumination, as well as between unit co-worker social undermining and interpersonal rumination; and (3) unit social support moderates the associations between unit supervisor/co-worker social undermining and interpersonal rumination. These findings extend the research on rumination to the field of management and interpersonal relationships and emphasize the potential mechanisms of rumination, providing significant guidance for reducing staff rumination and improving psychological well-being.

Rumination Derails Reinforcement Learning with Possible Implications for Ineffective Behavior

How does rumination affect reinforcement learning-the ubiquitous process by which we adjust behavior after error in order to behave more effectively in the future? In a within-subject design (n=49), we tested whether experimentally manipulated rumination disrupts reinforcement learning in a multidimensional learning task previously shown to rely on selective attention. Rumination impaired performance, yet unexpectedly this impairment could not be attributed to decreased attentional breadth (quantified using a "decay" parameter in a computational model). Instead, trait rumination (between subjects) was associated with higher decay rates (implying narrower attention), yet not with impaired performance. Our task-performance results accord with the possibility that state rumination promotes stress-generating behavior in part by disrupting reinforcement learning. The trait-rumination finding accords with the predictions of a prominent model of trait rumination (the attentional-scope model). More work is needed to understand the specific mechanisms by which state rumination disrupts reinforcement learning.

Decentering predicts attenuated perseverative thought and internalizing symptoms following stress exposure: A multi-level, multi-wave study

While research identifies a growing list of risk factors for anxiety and depression, it is equally important to identify potential protective factors that may prevent or reduce vulnerability to developing internalizing psychopathology. We hypothesized that forms of perseverative thinking, such as rumination and worry, act as mechanisms linking negative life experiences and prospective symptoms of anxiety and depression. More specifically, we investigated whether decentering, the meta-cognitive capacity to adopt a distanced perspective toward one's thoughts and feelings, serves as a protective factor at various points along this mediational pathway. A sample of 181 undergraduate students were recruited and assessed at five time points over a 12-week period. Multilevel modeling indicated that decentering was associated with an attenuated impact of (1) negative events on prospective depressive symptoms; (2) negative events on prospective brooding, and (3) brooding, pondering and worry on prospective internalizing symptoms. Multilevel moderated mediation analyses provided partial support for the hypothesis that perseverative thinking would mediate the longitudinal associations between negative life events and internalizing symptoms, with decentering attenuating risk at several connections of the indirect pathways. The strongest support was provided for moderated mediation models in which decentering was associated with attenuated relationships between negative events, brooding, and symptoms of depression. This study is the first to elucidate the role of decentering as a protective factor against anxiety and depressive symptoms at different points in the path from stress to perseverative thought to internalizing symptoms. Decentering therefore may be a critical target for clinical intervention to promote resilience against anxiety and depression.

The Impact of Intrusive Rumination on College Students’ Creativity During the COVID-19 Pandemic: The Mediating Effect of Post-traumatic Growth and the Moderating Role of Psychological Resilience

Purpose

College students in the pandemic area are experiencing the problems caused by COVID-19 by themselves or people around them, how to cope with the sudden changes and adjust the psychological stress response, and get experience and grow in the fight against the pandemic is a question worth in-depth discussion. The researchers constructed a mediated regulation model to examine the effects of intrusive rumination on the creativity of college students during the COVID-19 pandemic, as well as the mediating effect of post-traumatic growth and the moderating role of psychological resilience.

Methods

A sample of 475 university students from Guangdong Province, China, were surveyed with the Runco Ideational Behavior Scale, the Event Related Rumination Inventory, the Posttraumatic Growth Inventory, and the Psychological Resilience Scale. SPSS (version 23) and PROCESS (version 3.3) were used for correlation analysis, mediation analysis, and mediated moderation analysis.

Results

(1) Intrusive rumination was positively correlated with post-traumatic growth and creativity but negatively correlated with psychological resilience. Psychological resilience was positively correlated with post-traumatic growth and creativity. Post-traumatic growth and creativity were positively correlated. (2) Post-traumatic growth played a mediating role in the relationship between intrusive rumination and creativity. (3) Psychological resilience moderated the first half of the pathway “intrusive rumination → post-traumatic growth → creativity.”

Conclusion

Intrusive rumination affected creativity directly and also indirectly through post-traumatic growth. At the same time, psychological resilience played a moderating role between intrusive rumination and creativity. The correlation between intrusive rumination and post-traumatic growth was stronger when levels of psychological resilience levels were higher.

The inter-relationships of the neural basis of rumination and inhibitory control: neuroimaging-based meta-analyses

Rumination, as a clinical manifestation and pathogenic factor of depression, has long been the focus of psychological research regarding its causes and ameliorating approaches. Behavioral studies have shown that rumination is related to inhibitory control deficits, which provides ideas for reducing it. However, the neural relationship between them has not been clearly discussed. In this study, we first used multi-level kernel density analysis to conduct two meta-analyses of published functional magnetic resonance imaging studies: one was rumination comprising 17 studies with 180 foci, and the other was inhibitory control comprising 205 studies with 3791 foci. Conjunction analysis was then performed to explore the common brain regions and further decode them through Neurosynth to confirm the cognitive specificity. Results showed that rumination was mainly related to the default mode network (DMN), while inhibitory control was associated with the frontoparietal network (FPN). In addition, the common activation areas were mainly concentrated in the bilateral precuneus, right superior frontal gyrus, bilateral median cingulate, paracingulate gyri, and the left triangular part of inferior frontal gyrus (IFG). Decoding results also revealed they were involved in inhibition, memory retrieval, and self-related processes. Our findings support that rumination is associated with inhibitory control and can be explained neurologically by an antagonistic relationship between the DMN and FPN. In sum, inhibitory control may be related to rumination via inhibiting task-unrelated attention and controlling self-related processing. This research will help us understand and predict rumination from the perspective of inhibitory control and reduce rumination through behavioral training of inhibitory control or the application of neuromodulation techniques to common activation regions.

A transdiagnostic model of low self-esteem: pathway analysis in a heterogeneous clinical sample

BACKGROUND

Low self-esteem (LSE) has been associated with several psychiatric disorders, and is presumably influenced by transdiagnostic factors. Our study was based both on investigations of the relationship between depression and LSE (vulnerability, scar, reciprocal models) and on theories of cognitive factors contributing to the development and maintenance of LSE, such as Melanie Fennell's model, the catalyst model and the Self-Regulatory Executive Function model.

AIMS

Based on the theories above, in our cross-sectional study we aimed at understanding more specifically the transdiagnostic factors that can maintain LSE in a heterogeneous clinical sample.

METHOD

Six hundred and eleven out-patients were assessed by SCID-I and self-report questionnaires. The model was tested by structural equation modelling.

RESULTS

Based on the fit indices, the hypothesis model did not fit the data; therefore, a modified transdiagnostic model was emerged. This model made a good fit to the data [χ2 (12, n=611)=76.471, p<.001; RMSEA=.080, CFI=.950, TLI=.913] with a strong explanatory power (adj R2=.636). Severe stressful life events and depressive symptoms lead to LSE indirectly. Self-blame, perfectionism, seeking love and hopelessness have been identified as mediating factors in the relationship between depressive symptoms and LSE. Although there was a significant correlation between state-anxiety and LSE, as well as LSE and rumination, these two factors did not fit into the model.

CONCLUSIONS

The new transdiagnostic model of LSE has great potential in the treatment of various mental conditions and may serve as a guide to developing more focused and more effective therapeutic interventions.

Associations between goal orientation and suicidal thoughts and behaviors at one-month follow-up: Indirect effects through ruminative flooding

Previous research has identified both goal orientation and ruminative flooding as potential risk factors for suicidal thoughts and behaviors, as well as positive associations between goal orientation and rumination. The present study examined whether the association between goal orientation and suicidal thoughts and behaviors, assessed one month later, was accounted for by ruminative flooding. A sample of 924 psychiatric outpatients (M_age = 39.09 years, SD = 14.82, range = 18 to 84; 61.7% female; 37.0% White) completed self-report and interview measures at baseline and provided information about suicide-related outcomes at one-month follow-up. Goal orientation was positively associated with ruminative flooding, and both goal orientation and ruminative flooding were associated with suicidal thoughts and behaviors at one-month follow-up. Controlling for lifetime suicidal thoughts and behaviors, as well as patient age and sexual orientation, ruminative flooding accounted for the relationship between goal orientation and suicidal thoughts and behaviors at one-month follow-up. These findings were especially relevant for individuals with a history of multiple suicide attempts. Overall, this study provided evidence that difficulties with goal orientation may relate to suicidal thoughts and behaviors through intense ruminations perceived as a loss of cognitive control. Interventions that address ruminative thinking and cognitive flexibility may, in turn, assist in reducing emotion dysregulation and managing suicidality among those who struggle with goal orientation.

Rumination and worry as putative mediators explaining the association between emotional disorders and alcohol use disorder in a longitudinal study

INTRODUCTION

The high rate of comorbidity between alcohol use and emotional disorders is well demonstrated, but the mechanisms underlying their relationship remain largely unidentified. One possibility is maladaptive responding to negative affect, such as worry and rumination. The present study sought to examine worry and rumination as putative mediators explaining the link between emotional disorders and alcohol use disorders. Methods Mediational analyses were conducted using a sample (n = 232) derived from a larger late adolescence/early adulthood longitudinal dataset (Youth Emotion Project; Zinbarg et al., 2010). Results A significant indirect effect was observed for emotional disorder severity on alcohol use disorder severity via rumination, but not via worry or the shared variance between worry and rumination. Conclusions These findings suggest that rumination may specifically confer risk for the development of alcohol use disorder for individuals with emotional disorders. Further, ruminative thinking may serve as a specific treatment target to reduce vulnerability to alcohol use disorder.

Testing Whether Suicide Capability Has a Dynamic Propensity: The Role of Affect and Arousal on Momentary Fluctuations in Suicide Capability

To prevent suicidal behaviors, it is crucial to understand the mechanisms and processes that enable an individual to act on suicidal thoughts. Suicide capability, which involves an increased pain tolerance and fearlessness of death, is a critical factor that enables an individual to endure the physical pain necessary to make a lethal suicide attempt. Extant research has largely conceptualized suicide capability as developing linearly in response to painful and provocative experiences, but the emerging literature on the temporal dynamics of suicide has been challenging the notion of linearity in suicide risk. Few studies have directly measured and compared changes in suicide capability in response to rumination on different affective states. We sought to experimentally test if rumination in the context of low vs. high arousal emotions will prompt distinct changes in two core components of suicide capability: pain tolerance and fearlessness of death on two undergraduate student samples. In both studies, participants provided measures of subjective emotional state as well as pain threshold, tolerance, and persistence before and after completing experimental manipulations which included both emotion and rumination induction procedures. In the second study, measures of fearlessness about death and physiological arousal (heart rate) were added to the experimental procedures. We found significant decreases in pain threshold, tolerance, and persistence following the experimental manipulations but found no main effects of rumination or suicide risk. These findings suggest that suicide capability can fluctuate but these changes may occur through a different mechanism and/or differ between individuals at varying levels of suicide risk.

How and when abusive supervision influences knowledge hiding behavior: evidence from India

Purpose

This study aims to investigate the differential roles of self-esteem and co-rumination in the mediated relationship between abusive supervision and knowledge hiding via psychological safety.

Design/methodology/approach

The study used a three-wave time-lagged design and data were collected from 388 full-time employees in India.

Findings

The results show that psychological safety mediated the impact abusive supervision had on knowledge hiding. Further, this impact was weakened by higher self-esteem as employees with higher self-esteem were less affected by the impact of abusive supervision on psychological safety and knowledge hiding; but this impact was amplified by more co-rumination as employees who co-ruminated more were also more affected by abusive supervision in psychological safety and knowledge hiding.

Research limitations/implications

A cross-sectional design and the use of self-reported questionnaires are a few limitations of this study.

Originality/value

This study took a purposeful deviation from the traditional path of organizational justice to the study of abusive supervision and psychological safety and endeavored an alternate route, one of resource conservation. Further, employees have diverse reasons that heighten or dampen their inclination to hide knowledge from others in the workplace. The study examines co-rumination and self-esteem as possible boundary conditions.

The relationship between suicide-specific rumination and suicidal intent above and beyond suicidal ideation and other suicide risk factors: A multilevel modeling approach

Suicide-specific rumination, characterized by perseveration on and difficulties disengaging from suicidal thoughts and ideas, has been linked to increased suicide risk; however, previous studies were limited by the use of a cross-sectional design and relatively lower risk samples. This study aimed to replicate and extend previous findings by examining the short-term longitudinal association between suicide-specific rumination and suicidal intent, controlling for numerous robust covariates, in a sample of community-based adults at high risk for suicide, who were recruited from suicide-related forums online. Ninety-one adults with significant suicidal ideation (M_age = 27.03, SD = 8.64; 53.8% female, 44.0% male, 1.1% non-binary, 1.1% transgender female) completed brief online self-report measures at six time-points, each three days apart. Multilevel modeling analyses indicated that suicide-specific rumination was associated with suicidal intent, above and beyond suicidal ideation, perceived burdensomeness, thwarted belongingness, agitation, insomnia, nightmares, and sociodemographic characteristics. Further, a lagged model demonstrated that suicide-specific rumination predicted subsequent time-point suicidal intent, controlling for current suicidal intent and all other covariates. Overall, these findings suggest that perseverating on one's suicidal thoughts may serve as a proximal factor that increases suicide risk. Future investigations should explore potential mechanisms of this association, as well as interventions that may reduce suicide-specific rumination.

Rumination in the Context of Anger and Sadness: Differential Effects on State Agitation

BACKGROUND

Agitation is an important transdiagnostic factor for several mental health disorders and a significant risk factor for dangerous or maladaptive coping behaviors. How an individual responds to experiences of agitation itself may also play a crucial role in conferring risk towards maladaptive behaviors. Specifically, ruminating on high arousal emotions, such as anger, will also be more likely to initiate and maintain agitation, thereby increasing risk for impulsive and maladaptive behaviors.

METHODS

Undergraduate students (N=117) were randomly assigned to an emotion induction condition (i.e., control, sadness only, anger only, sadness and anger) followed by either a control condition or a rumination induction. They completed measures on subjective emotional state and agitation at baseline, after emotion induction, after rumination induction, and at the end of session.

RESULTS

Agitation was influenced by negative affect broadly with each experimental condition leading to agitation. Anger influenced momentary change in agitation and sustained agitation when combined with rumination.

LIMITATIONS

The majority of participants in the current study were young, white females and the findings may not generalize to individuals of diverse genders and cultures who may have experience and cope with agitation differently.

CONCLUSIONS

Recognizing and mitigating rumination during moments of anger may help decrease a clients' use of problematic coping behaviors.

Resilience and Mental Well-Being During the COVID-19 Pandemic: Serial Mediation by Persistent Thinking and Anxiety About Coronavirus

Reports to date indicate that the COVID-19 pandemic outbreak has negatively impacted mental health in the general population. On the other hand, positive associations of mental resilience and well-being have been widely demonstrated. The objective of this study was to assess the links between resilience (Brief Resilience Scale), persistent thinking about COVID-19 (Obsession with COVID-19 Scale), coronavirus anxiety (Coronavirus Anxiety Scale), and well-being (World Health Organization's 5-item Well-being Index) using serial mediation. The study considered online survey data from 1,547 Poles aged 18-78 (62% of whom were women). Bootstrap sampling analysis revealed that persistent thinking about COVID-19 (M1) and coronavirus anxiety (M2) partially mediate the relationship between resilience and well-being. The results of this study indicate that persistent thinking may be dysfunctional for mental health, as it inflates pandemic anxiety and disrupts well-being. Moreover, practitioners should focus on interventions enhancing resilience in order to reduce negative mental effects during the spread of a pandemic infectious disease.

The psychometric properties of the cognitive emotion regulation questionnaire (CERQ) in a clinical sample of adults with recurrent depression

BACKGROUND

Affective dysregulation is central to depression. However, emotion regulation (ER) tendencies in depression remain poorly understood. It is critical, therefore, to validate measures of habitual ER in clinical populations. The current study aimed to validate the Cognitive Emotion Regulation Questionnaire (CERQ) in a sample of individuals with a history of recurrent depression who are currently in remission.

METHOD

The CERQ measures ER tendencies with 36 self-report items that are divided into nine subscales. Each subscale is purported to assess one of five adaptive and four maladaptive ER strategies. The CERQ was administered to 476 adults (mean age = 46.76 years; 75% female) that were currently in remission with a history of recurrent depression, who were recruited from primary care settings. We first investigated the CERQ's nine factor structure, internal consistency, convergent and criterion validity.

RESULTS

The nine-factor structure did not fit the CERQ structure in a sample of individuals with recurrent depression and convergent validity was poor. Instead, a five-factor structure fit the data best and showed acceptable convergent and criterion validity.

LIMITATIONS

The generalisability of the findings may be limited due to relative lack of diversity in terms of gender and ethnicity of the sample.

CONCLUSION

These results suggest that the taxonomic structure of the CERQ does not fit emotion regulation patterns in adults with a history of depression. These findings highlight the importance of validating measures in clinical samples.

Maladaptive Rumination Mediates the Relationship between Self-Esteem, Perfectionism, and Work Addiction: A Largescale Survey Study

Background: Empirical evidence suggests that low self-esteem and high perfectionism are significant personality correlates of work addiction, but the mechanisms underlying these relationships are still unclear. Consequently, exploring cognitive mechanisms will help to better understand work addiction. For instance, rumination is one of the under-researched topics in work addiction, although it may explain specific thinking processes of work-addicted individuals. The purpose of the study was to test the mediating role of maladaptive rumination (i.e., brooding) in the relationship between personality and addiction. Methods: In a largescale cross-sectional, unrepresentative, online study, 4340 adults with a current job participated. The following psychometric instruments were used: Work Addiction Risk Test Revised, Rosenberg Self-Esteem Scale, Multidimensional Perfectionism Scale, and Ruminative Response Scale. Results: It was found that self-oriented perfectionism, socially prescribed perfectionism, and self-esteem had both direct and indirect relationships with work addiction via the mediating effect of maladaptive rumination. The two paths involving brooding explained 44% of the direct relationship. Conclusions: The study demonstrated that brooding type of rumination as a putatively maladaptive strategy explains why individuals characterized by low self-esteem and high perfectionism may have a higher risk of work addiction. The results suggest that cognitive-affective mechanisms in work addiction are similar to those found in other addictive disorders.

Sociotropy, Autonomy and Emotional Symptoms in Patients with Major Depression or Generalized Anxiety: The Mediating Role of Rumination and Immature Defenses

The relationships between dimensions of personality (sociotropy and autonomy), coping strategies (rumination: brooding and reflection subtypes, and immature defenses) and symptoms of depression and anxiety were explored in patients with Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD). A total of 279 patients completed questionnaires including measures of personality dimensions, rumination, immature defenses, depression and anxiety. Our findings suggested that sociotropy and autonomy may be associated with both depressive and anxious symptoms in patients with MDD and with GAD. Multiple mediation analyses indicated that brooding always acted as a mediating link between personality vulnerabilities (sociotropy and autonomy) and depressive and anxiety symptoms, independently of the patient group. In addition, in patients with MDD and those with GAD, brooding and immature defenses functioned together by linking sociotropy and autonomy, respectively, with depressive symptoms. Our results also showed that, in patients with GAD, both types of rumination explained the relationship between sociotropy and autonomy and anxiety symptoms. Overall, our findings provided evidence of the transdiagnostic role of the brooding, linking the vulnerability of personality dimensions and emotional symptoms. They also indicated that reflection and immature defenses can operate in conjunction with brooding, depending on the type of vulnerability and emotional context.

Nocturnal cognitive arousal is associated with objective sleep disturbance and indicators of physiologic hyperarousal in good sleepers and individuals with insomnia disorder

BACKGROUND

Cognitive arousal is central to models of sleep disturbance and insomnia, but findings remain mixed regarding whether cognitive arousal is associated with objective sleep disturbance and physiologic hyperarousal. This study explored associations of objective nocturnal wakefulness and indicators of physiologic hyperarousal with cognitive arousal in healthy sleepers and individuals with insomnia.

METHODS

In sum, 52 adults (51.9% women; 18 with insomnia disorder, 34 healthy sleepers) underwent two overnight polysomnography (PSG) studies (adaptation + baseline nights) and a multiple sleep latency test (MSLT). Baseline depression was assessed and presleep cognitive arousal and somatic arousal were recorded for each night. Multivariate regression was used to evaluate associations of PSG sleep parameters with insomnia, cognitive arousal, and somatic arousal.

RESULTS

Analyses showed that high levels of nocturnal cognitive arousal were associated with prolonged sleep latency, lower sleep efficiency, and shorter total sleep time by PSG on both nights. An association between nocturnal cognitive arousal and wake after sleep onset was observed on night one only. Moreover, greater nocturnal cognitive arousal was associated with greater likelihood of obtaining short sleep and with longer MSLT sleep latencies. Insomnia diagnosis, depression, and somatic arousal were not associated with PSG sleep parameters or MSLT latency.

CONCLUSIONS

Heightened cognitive arousal at night is linked to objective sleep disturbances and indicators of physiologic hyperarousal at night and during the day. For patients with insomnia, cognitive arousal may contribute to the 24-hr physiologic hyperarousal. Cognitive arousal may be a critical therapeutic target for severe or treatment-resistant sleep disturbance.

Intolerance of Uncertainty and Mental Wellbeing: Serial Mediation by Rumination and Fear of COVID-19

The novel coronavirus-2019 (COVID-19) pandemic has become globally widespread with millions of confirmed cases and many countries implementing various levels of quarantine. Therefore, it is important to investigate the psychological consequences of this process, given the unique situation that has been experienced globally. Therefore, the present study examined whether intolerance of uncertainty was related to mental wellbeing and whether this relationship was mediated by rumination and fear of COVID-19. The sample comprised 1772 Turkish individuals (aged between 18 and 73 years) from 79 of 81 cities in Turkey, who completed measures of mental wellbeing, intolerance of uncertainty, rumination, and fear of COVID-19. Results of serial mediation analyses showed that intolerance of uncertainty had a significant direct effect on mental wellbeing. Rumination and fear of COVID-19, in combination, serially mediated the association between intolerance of uncertainty and mental wellbeing. The findings are discussed within the framework of the psychological consequences of the COVID-19 pandemic and related literature.

Attentional bias effect on post-traumatic outcomes in children after earthquake: Mediation role of rumination

After traumatic events, children with different types of attentional biases produce different psychological reactions with the help of the rumination process. A sample of 909 middle school students was taken from the Yunnan Ludian earthquake-affected area. Measurement scales of the Chinese version of the Attention to Positive and Negative Information Scale (APNI), the Chinese version of the Children's Revised Impact of Event Scale (CRIES), and the Revised Post-traumatic Growth Inventory for Children (PTG-C) were used to assess the attentional bias, risk of post-traumatic stress disorder (PTSD), and post-traumatic growth (PTG), respectively. The effect of self-reported attention bias was explored by using a structural equation model and bias-corrected bootstrap test on children's psychological reaction after trauma. The results show that there is a positive relationship between self-reported negative attentional bias and PTSD symptoms partially mediated by intrusive rumination and the negative relationship between self-reported positive attentional bias and PTSD symptoms. On the other hand, the relationship between self-reported positive attentional bias and PTG was positive and partially mediated by deliberate rumination. Furthermore, intrusive rumination did not affect PTG indirectly but mediated the relation of deliberate rumination.

Rumination mediates the relationships of fear and guilt to posttraumatic stress disorder and posttraumatic growth among adolescents after the Ya'an earthquake

Background: Although previous research has demonstrated that fear and guilt have an effect on posttraumatic stress disorder (PTSD), it is still unclear how these two emotions affect posttraumatic growth (PTG). Moreover, few studies have examined the mechanisms by which fear and guilt affect PTSD and PTG. Guided by Lee et al.'s theory of PTSD generation mechanisms and Calhoun and Tedeschi's PTG theory, the current study proposes that intrusive rumination (IR) and deliberate rumination (DR) may play a mediating role in the effects of guilt and fear on PTSD and PTG. Objective: This study aimed to simultaneously examine the mediating roles of IR and DR in the relationship between fear, guilt, PTSD, and PTG. Method: This study employed a two-wave longitudinal design. A total of 408 adolescent survivors were assessed using self-report questionnaires after the Ya'an earthquake in China. Measures were obtained for trauma exposure, subjective fear, survivor guilt, IR, and DR at three and a half years after the Ya'an earthquake (Time 1), while PTSD and PTG were assessed at time point four and a half years after the Ya'an earthquake (Time 2). Results: The results showed that both fear and guilt had a direct and positive effect on PTSD and PTG. Fear and guilt were positive predictors of PTSD and negative predictors of PTG through the mediating variable of IR. DR mediated the relationship between guilt and PTG but not PTSD, and also mediated the relationship between IR and PTG. Conclusions: Study findings indicate that fear, guilt, and intrusive rumination may contribute to PTSD symptoms in adolescent trauma survivors. Results also suggest that adolescent survivors can grow emotionally and psychologically following traumatic events, and that directed rumination may contribute to such growth. Interventions that reduce fear, guilt, and intrusive rumination while increasing directed rumination may assist adolescent trauma survivors in recovery and growth.

Emotion Differentiation as a Protective Factor Against the Behavioral Consequences of Rumination: A Conceptual Replication and Extension in the Context of Social Anxiety

Rumination is thought to play a central role in affective disorders such as social anxiety disorder (SAD). Past research indicates that rumination tends to exacerbate negative emotions and increase the risk of engaging in maladaptive coping behaviors (e.g., avoiding social activities). However, little is known on how to effectively protect against the negative outcomes of rumination. Previously, Zaki, Coifman, Rafaeli, Berenson, and Downey (2013) found that negative emotion differentiation (NED) protected against rumination and nonsuicidal self-injury in borderline personality disorder. Nevertheless, it is unclear whether this protective effect would extend to other populations and behaviors. Therefore, the present investigation sought to replicate and extend Zaki et al.'s (2013) findings in the context of SAD. In two studies, we examined if NED would moderate the positive association between rumination and frequency of social avoidance. Study 1 involved 29 individuals who met criteria for SAD with or without co-occurring major depressive episode, while Study 2 involved a nonclinical sample of 190 college students. All participants completed a measure of rumination and an experience-sampling diary which provided indices of NED and social avoidance. The results from both studies were unanimous: NED significantly moderated the relationship between rumination and social avoidance such that the positive association between rumination and social avoidance was significant for low but not moderate to high NED. Overall, the findings provide a conceptual replication of Zaki et al. (2013) and further evidence for the protective effects of NED against the maladaptive behavioral consequences of rumination across populations.

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.

Perseverative negative thinking predicts depression in people with acute coronary syndrome

OBJECTIVE

Depression is common in people who have experienced recent Acute Coronary Syndrome (ACS), and predicts worse medical outcomes. Mechanisms underpinning the development of depression and its association with poor medical outcomes are unclear however. The aim of this study was to investigate the role of perseverative negative thinking (e.g. worry and rumination) in predicting depression in people with recent ACS.

METHODS

Adults attending specialist inpatient and outpatient cardiology services who had recently experienced ACS were invited to participate in this observational prospective cohort study. Questionnaire assessments were completed within 6months of index ACS (baseline), then 2months and 6months later.

RESULTS

169 participants (131 male (78%), median age 68 (±16) years) completed baseline questionnaires, and 111 completed follow-ups. After controlling for the effects of key covariates, baseline rumination was a significant predictor of depression at 6months, accounting for 2% of the variance in depression. This association was partially mediated by poor problem-solving ability and lack of social support. Neither worry nor rumination at baseline were significant predictors of quality of life at 6months.

CONCLUSIONS

Rumination is a significant independent predictor of depression, and this association may be partially explained by deficits in problem-solving ability and reduced social support. Both rumination and problem solving may provide useful targets for the development of evidence-based interventions to reduce depression among people with coronary heart disease.

Do daily dynamics in rumination and affect predict depressive symptoms and trait rumination? An experience sampling study

BACKGROUND AND OBJECTIVES

Rumination has been shown to prospectively predict the onset of depression. However, it is unclear how rumination and affect in daily life influence the development of depressive symptoms. The present study examined whether the structure of dynamics in rumination and affect could prospectively predict depressive symptoms and trait rumination in an undergraduate sample (n = 63).

METHODS

The main index used was entropy, which reflects the instability of a system's structure. Momentary rumination and affect were assessed eight times per day for a period of seven days. Additionally, depressive symptoms and trait rumination were measured at the beginning of the experiment and at six weeks follow-up.

RESULTS

The results showed that entropy significantly predicted trait rumination at follow-up (and depressive symptoms at trend level) while taking into account baseline depressive symptoms and trait rumination.

LIMITATIONS

The follow-up measurements conducted six weeks after the baseline were relatively short. Further research may test the predictive effect of the structure over a longer period and confirm its effect by using different indices that describe the structure.

CONCLUSIONS

These findings indicate that examining the structure of the dynamics in momentary rumination and affect holds promise for understanding the risk for depression.

Mediational role of rumination and reflection on irrational beliefs and distress

BACKGROUND

The cognitive restructuring of maladaptive beliefs within many cognitive behavioural psychotherapies typically encourages the client to undertake self-reflection. However, whilst self-consciousness can aid self-regulation, it is also implicated in a broad Grange of psychopathologies. The extent to which self-consciousness is associated with psychological distress is yet to be fully determined, but recent literature suggests that irrational beliefs, as proposed within rational emotive behaviour theory (REBT) may play an important role.

AIMS

The aim of the study was to test the mediational effects of self-consciousness, specifically reflection and rumination, on the relationship between irrational beliefs and psychological distress. Based on past research, it was hypothesized that reflection and rumination would mediate the positive relationship between irrational beliefs and psychological distress. We expected irrational beliefs to interact with rumination to positively predict psychological distress, and irrational beliefs to interact with reflection to negatively predict psychological distress.

METHOD

The present research tested a structural equation model (SEM) in which rumination and reflection mediated the relationship between irrational beliefs and psychological distress.

RESULTS

Results indicated that rumination mediates the positive relationship between irrational beliefs and psychological distress. However, in contrast to our hypotheses, significant mediation did not emerge for reflection.

CONCLUSIONS

This study is the first to show how irrational beliefs and rumination interact to predict psychopathology using advanced statistical techniques. However, future research is needed to determine whether similar mediational effects are evident with rational beliefs as opposed to irrational beliefs.

[Depressed, biased, forgetful: The interaction of emotional and cognitive dysfunctions in depression]

Major depressive disorder is characterized by changes in the emotional state, e. g. the diminished experience of positive emotions, as well as cognitive impairments such as concentration and memory difficulties. These emotional and cognitive dysfunctions are closely interrelated and play a key role for the development and maintenance of depressive symptoms. For instance, patients with depression show negatively biased information processing that affects attention and memory as well as their reaction to feedback. In addition, there is an increased motivation to avoid negatively evaluated conditions and at the same time a reduced motivation to approach positive goals. Furthermore, depressed patients often show a specific style of thinking, called rumination, which involves repeated, intensive thinking about the causes, consequences and symptoms of one's own negative feelings. In this review, the different relationships between emotional, motivational and cognitive symptoms of depressive patients will be presented and the influence of their interaction on cognitive performance will be discussed. The highlighted clinical relevance of emotional-cognitive dysfunctions should be considered more often in therapeutic interventions for depressed patients.

Treating insomnia improves depression, maladaptive thinking, and hyperarousal in postmenopausal women: comparing cognitive-behavioral therapy for insomnia (CBTI), sleep restriction therapy, and sleep hygiene education

INTRODUCTION

Depression increases during menopause, and subclinical depressive symptoms increase risk for major depression. Insomnia is common among postmenopausal women and increases depression-risk in this already-vulnerable population. Recent evidence supports the efficacy of cognitive-behavioral therapy for insomnia (CBTI) to treat menopausal insomnia, but it remains unclear whether treating insomnia also alleviates co-occurring depressive symptoms and depressogenic features. This trial tested whether CBTI improves depressive symptoms, maladaptive thinking, and somatic hyperarousal in postmenopausal women with insomnia; as well as whether sleep restriction therapy (SRT)-a single component of CBTI-is equally efficacious.

MATERIALS AND METHODS

Single-site, randomized controlled trial. 117 postmenopausal women (56.34 ± 5.41 years) with peri-or-postmenopausal onset of chronic insomnia were randomized to three treatment conditions: sleep hygiene education control (SHE), SRT, and CBTI. Blinded assessments were performed at baseline, posttreatment, and six-month follow-up.

RESULTS

CBTI produced moderate-to-large reductions in depressive symptoms, whereas SRT produced moderate reductions but not until six months posttreatment. Treatment effects on maladaptive thinking were mixed. CBTI and SRT both produced large improvements in dysfunctional beliefs about sleep, but weaker influences on presleep cognitive arousal, rumination, and worry. Presleep somatic arousal greatly improved in the CBTI group and moderately improved in the SRT group. Improvements in depression, maladaptive thinking, and hyperarousal were linked to improved sleep. SHE produced no durable treatment effects.

CONCLUSIONS

CBTI and SRT reduce depressive symptoms, dysfunctional beliefs about sleep, and presleep somatic hyperarousal in postmenopausal women, with CBTI producing superior results. Despite its cognitive emphasis, cognitive arousal did not respond strongly or durably to CBTI. NAME: Behavioral Treatment of Menopausal Insomnia: Sleep and Daytime Outcomes. URL: clinicaltrials.gov.

REGISTRATION

NCT01933295.

Integrating the Hopelessness Model and the Response Style Theory in an Adolescent Sample

Integrations of cognitive models of depression, specifically, the hopelessness model (Abramson et al. Psychological Bulletin, 96, 358-372, 1989) and the response style theory (Nolen-Hoecksema et al. Journal of Abnormal Psychology, 101, 405-422, 1992) have been suggested but no previous study has compared the integrations of these models with each other and the original models. Further, previous studies only tested the associations between composite scores of inferences, from the hopelessness model, and rumination (incl. brooding and reflection), from the response style theory. Thus, a 3-wave study using self-report instruments with 519 adolescents was conducted (mean age_{Wave 1} = 16.09 years; SD = 0.70; 62.7% female; 72.8% European American, 14.7% African-American, 5.4% Latino, 4.4% mixed race/ethnicity, 1.4% Asian/Pacific Islander, 0.8% Native American, and 0.6% identified as "other"). The school serves predominantly working to middle class families and almost one third of the students were eligible for free or reduced lunch programs. AMOS and RMediation were used to calculate and compare five different theory-driven models. The findings of the study provide support for an integrated model in which both brooding and reflection are influenced by individual inferences and interact with individual inferences while affecting depressive symptoms. In addition, reflection plays an unexpectedly important role in this integrated model. Age and cognitive development are discussed as possible explanations for this finding.

Lifetime acute suicidal affective disturbance symptoms account for the link between suicide-specific rumination and lifetime past suicide attempts

BACKGROUND

Suicide-specific rumination, defined as rumination about one's suicidal thoughts, intentions, and plans, and Acute Suicidal Affective Disturbance (ASAD) have each been proposed as relevant and proximal predictors of suicidal behavior. The purpose of the current study was to examine relations between suicide-specific rumination, ASAD, and previous number of lifetime suicide attempts, particularly whether ASAD accounted for the association between suicide-specific rumination and previous lifetime suicide attempts.

METHODS

Undergraduate students with a past history of suicidality (N = 300) completed measures of their suicide-specific rumination, lifetime ASAD symptoms, and lifetime history of suicide attempts on an online questionnaire in exchange for course credit.

RESULTS

ASAD accounted for the association between suicide-specific rumination and lifetime number of past suicide attempts. This effect was particularly driven by suicidal intent aspect of ASAD, as opposed to the ASAD social alienation, self-alienation, and overarousal facets. An alternative model indicated that suicide-specific rumination did not account for the association between ASAD and lifetime past suicide attempts.

LIMITATIONS

This study utilized exclusively self-report measures and a cross-sectional design, thereby precluding inferences of causality.

CONCLUSIONS

These findings indicated that ASAD may explain the relationship between suicide-specific rumination and lifetime past suicide attempts. Future research using a prospective design is needed to elucidate these patterns and determine causal relationships.

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.