Effectiveness of a blended school-based mindfulness program for the prevention of co-rumination and internalizing problems in Dutch secondary school girls: a cluster randomized controlled trial

BACKGROUND

A growing body of literature indicates that adolescent girls who talk with close friends about interpersonal problems or worries in an excessive, speculative way, and with an intense focus on distress (i.e., co-rumination) are at heightened risk for developing internalizing symptoms and disorders as well as reduced friendship quality. However, to date, there are no prevention programs available that target high levels of co-rumination between adolescent girls. As such, we developed the blended school-based mindfulness prevention program Happy Friends, Positive Minds (HFPM) that targets co-rumination at the dyadic level, i.e., between two close female friends. The aim of this trial is to evaluate the effectiveness of HFPM to reduce co-rumination and internalizing problems and to enhance wellbeing and social-emotional behavior in Dutch adolescent girls.

METHODS

A cluster Randomized Controlled Trial (cRCT) will be conducted to evaluate HFPM effectiveness. We will recruit 160 female friendship dyads (n = 320 girls) aged 13 to 15 years who will be characterized by high levels of self-reported co-rumination. The cRCT has two arms: (1) an intervention condition in which 160 girls (80 friendship dyads) will receive the 14-week HFPM program in two consecutive cohorts (cohort 1 in academic year 2023/2024 and cohort 2 in academic year 2024/2025, and (2) a control condition in which 160 girls (80 dyads) will receive care-as-usual (CAU) in two consecutive cohorts (cohort 1 in academic year 2023/2024 and cohort 2 in academic year 2024/2025). Data will be collected at baseline (T0), during the program (T1;T2; T3), immediately after the program (T4), and at 1-year follow-up (T5). Participant-level self-reported risk for (early onset) depression and anxiety, self-reported and observed co-rumination, self- and friend-reported friendship quality, self-reported positive and negative affect, self-reported interpersonal responses to positive affect, and self-reported anhedonia symptoms will be the outcome variables.

DISCUSSION

This study will provide insights into the short-term and long-term effects of the HFPM program on girls' internalizing problems, wellbeing, and social-emotional behavior.

TRIAL REGISTRATION

International Standard Randomized Controlled Trials, identifier: ISRCTN54246670. Registered on 27 February 2023.

Co-rumination and conversational self-focus: Adjustment implications of problem talk in adolescents' friendships

Friendships are central relationships during adolescence. Given the increased experience of stress during adolescence, friends are especially critical sources of support at this time. Although experiencing social support is related to well-being, adolescents' experiences sharing problems with friends is not always positive. In this chapter, we consider two forms of problematic talk, co-rumination and conversational self-focus. Co-rumination refers to conversations about problems that is excessive, repetitive, speculative, and focused on negative affect. Conversational self-focus refers to adolescents re-directing conversations about friends' problems to oneself. Both co-rumination and conversational self-focus are associated with depressive symptoms. However, whereas co-rumination draws friends together and is associated with positive friendship quality, adolescents who engage in conversational self-focus are increasingly rejected by friends. Directions for future research and applied implications of studying social support processes between friends are discussed.

Social interaction matters to job search over the long haul

Based on social cognitive, reasoned action, and basic needs theories, this study examines whether co-rumination with others about the job search mediates the positive relation between state negative affect and job search intentions. In addition, we looked at how this positive indirect effect interacts with the social support received from different sources (such as friends, family, and significant others) at the beginning and six months after the initial job search process. Using a sample of 87 graduates (job seekers) from a Portuguese masters program, we used multilevel modeling to test this moderated mediation. Ages ranged from 22 to 53 years old (M = 29.45; SD = 7.60). Data were collected using measures to assess negative affect, co-rumination, perceived social support, and job search intentions. We found an indirect effect of state negative affect on job search intentions; when job seekers perceive higher levels of social support from significant others at the beginning of the job search, the positive, mediating role of co-rumination in this relationship is increased. Further, for a sub-sample of six-month job seekers, this positive indirect effect increased when there was also an increased perception of social support from family. Discussion focuses on implications for theory and practice and the role of co-rumination for unemployed people during job search.

Attentional Biases and their Push and Pull with Rumination and Co-Rumination is Based on Depressive Symptoms: a Prospective Study of Adolescents

Emotion regulation (ER) is central to adolescent mental health and wellbeing. However, the mechanisms underlying two common ER strategies - rumination and its interpersonal counterpart, co-rumination - are insufficiently understood in youth. Past research has documented that attentional disengagement biases are associated with rumination in adults, particularly among individuals with elevated depressive symptoms. Extending this line of research, the current study investigated whether attentional disengagement biases predicted rumination and co-rumination in adolescents based on their symptoms of depression. Using a multi-wave prospective design, 91 early adolescents (47% female, M_age = 12.87) completed a measure of depressive symptoms and the Affective Posner Task to assess early and late attentional processes at baseline. Adolescents also completed measures of rumination and co-rumination at baseline and every 3-months for one year. A multivariate means-as-outcomes multilevel model indicated that early disengagement biases for sad and happy faces interacted with depressive symptoms to predict later rumination and co-rumination. Critically, the direction of findings across rumination and co-rumination differed based on depressive symptoms. Results are the first to delineate a distinct pattern of attentional disengagement biases that predict rumination versus co-rumination in early adolescents. Findings extend theoretical conceptualizations of rumination to youth and provide the first account of cognitive mechanisms underlying co-rumination.

Within-person Changes in Co-rumination and Rumination in Adolescence: Examining Heterogeneity and the Moderating Roles of Gender and Time

Although previous work has consistently identified positive associations between co-rumination and rumination during adolescence, little to no research has examined how this relationship operates on the person-specific level. The current study aimed to extend current developmental theories of co-rumination and rumination by examining within-person associations between these constructs. Survey data was collected from 1502 adolescents (M_age = 13.20; 52% girls; 52% non-Hispanic White) every six-months across the span of 3.5 years. The results showed that at time-points when adolescents reported co-ruminating more than their usual level, they reported concurrent increases in rumination. This association was stronger for boys and strengthened over time. Despite substantial between-person heterogeneity, 97% of adolescents showed positive associations between co-rumination and rumination. This research has important implications for mental health professionals, school systems, and parents who may look to teach adolescents about effective emotion-regulation.

A systematic review of maladaptive interpersonal behaviors and eating disorder psychopathology

While maladaptive interpersonal behaviors have been implicated in models of psychopathology, particularly depression, maladaptive interpersonal behaviors have received limited attention in the eating disorder (ED) literature. Further, the extant literature on maladaptive interpersonal behaviors in relation to ED psychopathology has yet to be synthesized. Therefore, the aim of this systematic review was to characterize the literature on maladaptive interpersonal behaviors and ED psychopathology. Inclusion criteria for the review were: availability of the study in English, empirical journal article, inclusion of human subjects, and reporting an association between at least one maladaptive interpersonal behavior and one measure of ED psychopathology. Databases searched were PsycInfo and PubMed across all dates (up to September 2020). Data was extracted from articles, and main findings were synthesized; quality scores were provided using a modified version of the Newcastle Ottawa Scale. There were 35 studies with 36 independent samples included in the review. Most studies evidenced significant bivariate associations between maladaptive interpersonal behaviors and ED psychopathology. That is, higher levels of maladaptive interpersonal behaviors were generally associated with greater disordered eating, bulimic symptoms, and body image concerns. Although limited to a minority of studies, some studies identified prospective associations and significant mediators and moderators of associations. This systematic review supports further research on maladaptive interpersonal behaviors and ED psychopathology. Given a number of significant limitations in the literature identified in this review, there are an array of avenues for future research on maladaptive interpersonal behaviors and ED psychopathology.

Stop talking about it already! Co-ruminating and social media focused on COVID-19 was associated with heightened state anxiety, depressive symptoms, and perceived changes in health anxiety during Spring 2020

BACKGROUND

Social distancing presents a significant obstacle for relationships and threatens mental health. Identifying maladaptive, voluntary coping strategies may inform how to maintain interpersonal relationships and mental health during quarantine. Co-ruminating with peers on negative events, moods and fears has adjustment trade-offs of increasing depression and anxiety risk while also enhancing friendship quality. Similarly, social media use is associated with social benefits and risk to mental health. We extend prior research by examining whether co-ruminating on COVID-19, social media use, and social media use focused on COVID-19 during social isolation was associated with heightened depression and anxiety symptoms but also lower loneliness and higher social support during initial lockdown measures in the USA.

METHODS

Adults were recruited through social media (n = 345) to complete self-report surveys on co-rumination, social media use, social distancing, social support from March-May 2020. During this cross-sectional assessment, in addition to completing surveys on current depressive symptoms and state and health anxiety, participants also provided retrospective report of their perceived health anxiety levels six months prior.

RESULTS

Co-ruminating on COVID-19 with peers and greater time on social media focused on COVID-19 predicted perceived increases in health anxiety and were also associated with higher depressive symptoms and state anxiety, even after controlling for significant demographic predictors. Further, in the context of social distancing, both interaction strategies failed to confer social benefits.

CONCLUSIONS

Results have direct implications for maintaining psychosocial health during social distancing restrictions. Adults may modify how they engage with peers by limiting COVID-19 content on social media and COVID-19 discussion.

Co-rumination across in-person and digital communication: Associations with affect and relationship closeness in adolescents

INTRODUCTION

Despite the prominence of interpersonal emotion regulation, particularly during adolescence, it is a relatively understudied area of investigation. Co-rumination is an interpersonal emotion regulation strategy that is frequently used by adolescents. Traditional examinations of co-rumination have focused on its occurrence in person, while largely overlooking digital modes of communication. This study was the first to investigate adolescents' co-rumination across multiple communication modalities (i.e., in person, text, social media, phone) and its downstream association with affect and relationship closeness. Specifically, we examined: (1) the frequency of co-rumination across modalities, (2) the effect of co-rumination in one modality on the future use of co-rumination within that same modality (i.e., stability) and across other modalities (i.e., generalization); and (3) the prospective relation of co-rumination on negative affect, positive affect, and relationship closeness.

METHODS

Adolescents (n = 71; 33 girls and 38 boys; M_age = 12.70 years) residing in Canada completed twice-daily diary surveys for 14 days.

RESULTS

Findings indicated that adolescents co-ruminate across all modes of communication, particularly in person. There also was evidence of co-rumination stability and generalization over time for some modes of communication (within phone and from social media to in-person interactions), but not for others. Co-rumination through text and over the phone had affective and/or social benefits, whereas co-rumination through social media predicted diminished positive affect. We also identified ways these findings differed by gender.

CONCLUSIONS

Implications for adolescents' emotional and social development and the field of co-rumination are discussed.

Co-Rumination and Depressive Symptoms in Adolescence: Prospective Associations and the Mediating Role of Brooding Rumination

Although relationships between co-rumination and depressive symptoms have often been found, little research attention has been given to mechanisms underlying this association. The current study investigated brooding rumination as a mediator of the relationship between co-rumination and depressive symptoms. Analyses were performed on data of 1549 adolescents (53.4% girls; M_age = 12.93, range 9-17) using three waves of data with 1-year intervals. Mediated and indirect effects were investigated by means of cross-lagged analyses. The results indicated that co-rumination was not predictive of depressive symptoms 2 years later. However, co-rumination did have an indirect effect on prospective depressive symptoms through brooding rumination. Additional analyses looking into the directionality of effects showed that neither brooding rumination nor depressive symptoms were predictive of relative increases in one's tendency to co-ruminate. Multi-group analyses further showed that findings were not moderated by gender or age. The current study contributes to the growing literature on the role of interpersonal and intrapersonal affect-regulation styles in predicting depressive symptoms and suggests that passive and catastrophic problem talk with same-sex friends may get internalized into maladaptive and repetitive thinking patterns.

Why Family Communication Matters: the Role of Co-rumination and Topic Avoidance in Understanding Post-Disaster Mental Health

Although families can be a source of support post-disaster, depending on how they communicate about their stress, their attempts at support can be helpful or harmful. This study explored the moderating role of topic avoidance and co-rumination on post-disaster mental health (MH) in a sample of 485 parent-child dyads following severe floods affecting Texas. Parents (69.0% female) and their oldest child between the ages of 10-19 years (M = 13.75 years, SD = 2.56) completed online surveys approximately one-year post-flooding. Participants reported their flood exposure, life stressors since the disaster, topic avoidance, co-rumination, and MH symptoms (posttraumatic stress symptoms [PTSS], depression, anxiety). Structural equation models tested a moderated-mediation model of whether communication processes moderated the associations of flood exposure and life stressors on MH. They did not moderate the association of flood exposure to PTSS, but did have a moderating role for depression and anxiety. At low levels of topic avoidance, there was no association between flood exposure and child anxiety or depression. However, at mean and high levels of topic avoidance, there was a significant, positive association between flood exposure and child anxiety and depression. Co-rumination impacted both parents and children. For parents, there was no association between flood exposure and depression or anxiety when co-rumination was low or mean-level. However, flood exposure increased risk for depression and anxiety at high levels of co-rumination. A similar pattern emerged for children. Results for life stressors were nuanced. Overall, this suggests that communication can influence post-disaster MH.

Parent-Adolescent Communication Influences on Anxious and Depressive Symptoms in Early Adolescence

The unique developmental changes and important role of parents during early adolescence warrants consideration of parent-adolescent communication, including open communication, co-problem-solving, and co-rumination, and its influences on adolescents' anxious and depressive symptoms. In this study, 400 early adolescents (M age = 12.49; 54% female) recruited from a middle school completed electronic questionnaires at two time points, 5 months apart. While most bivariate associations examined between communication processes and adolescents' symptoms were significant, path analyses found unique patterns. Specifically, over time, paternal open communication was negatively associated with adolescent anxious and depressive symptoms while paternal co-rumination was positively associated with depressive, but not anxious, symptoms. In contrast, few maternal communication factors were significantly linked to adolescents' internalizing symptoms, with only maternal co-rumination surprisingly being negatively linked to depressive symptoms over time. The results suggest how parents communicate with their children may be important as early adolescents develop problem-solving and adaptive coping skills to successfully navigate new experiences.

Co-Rumination Moderates the Relation between Emotional Competencies and Depressive Symptoms in Adolescents: a Longitudinal Examination

Research suggests co-rumination during adolescence has developmental tradeoffs that result in elevated self-disclosure and intimacy between friends but also can be associated with increases in depression (Rose et al. 2007; Rose 2002). The current study further examined this paradox by assessing the role of emotional competencies in co-rumination as they predict depressive symptoms over a 2-year period. We tested whether co-rumination moderated the relation between emotional awareness and emotion regulation and depressive symptoms in reciprocated best friend dyads. At Time 1, 202 adolescents (101 same-sex best friend dyads; M_age = 12.68, 52.5% girls, 76.6% White, middle-class) reported on their emotional competencies (i.e., emotional awareness and perceptions of their friend's anger and sadness regulation), and depressive symptoms as well as engaged in a discussion task where co-rumination was observed. Multilevel modeling (Actor-Partner Interdependence Modeling) was used to account for similarity within friend dyads. The results indicated that when girls engaged in high levels of co-rumination, poor emotional awareness was related to greater depressive symptoms in their friend. Regarding the analyses of emotion regulation, at high levels of co-rumination, Friend A's perceptions of stronger anger regulation by Friend B predicted fewer depressive symptoms in Friend A. Stronger sadness regulation in Friend B at high levels of co-rumination predicted fewer depressive symptoms in Friend B. Our findings highlight the potentially adaptive nature of emotional competencies that may ameliorate the negative sequelae of co-rumination as adolescents are afforded the opportunity to discuss problems, better understand their emotions, skills that are then associated with fewer depressive symptoms over time.

Talking Together, Thinking Alone: Relations among Co-Rumination, Peer Relationships, and Rumination

Girls are more likely to engage in rumination, associated with the development of mental health problems, as well as report higher levels of friendship quality, hypothesized to protect against these disorders. The current study examined whether co-rumination may drive simultaneous increases in rumination and changes in friendship quality among adolescents. The project included 360 participants (43% boys), ages 9.8 to 15.8 years, and analyses revealed that co-rumination mediated the link between female sex and both rumination and negative friendship quality. There was also a bidirectional relation between co-rumination and positive friendship quality. These findings highlight several pathways by which co-rumination mediates the relation between sex and both maladaptive (i.e. rumination, negative friendship quality) and adaptive (i.e. positive friendship quality) outcomes.

Talking Together, Thinking Alone: Relations among Co-Rumination, Peer Relationships, and Rumination

Girls are more likely to engage in rumination, associated with the development of mental health problems, as well as report higher levels of friendship quality, hypothesized to protect against these disorders. The current study examined whether co-rumination may drive simultaneous increases in rumination and changes in friendship quality among adolescents. The project included 360 participants (43% boys), ages 9.8 to 15.8 years, and analyses revealed that co-rumination mediated the link between female sex and both rumination and negative friendship quality. There was also a bidirectional relation between co-rumination and positive friendship quality. These findings highlight several pathways by which co-rumination mediates the relation between sex and both maladaptive (i.e. rumination, negative friendship quality) and adaptive (i.e. positive friendship quality) outcomes.

The role of co-rumination and adrenocortical attunement in young women's close friendships

Attunement, or synchrony, of behavior and physiology has been well documented in family, mother-child, and romantic relationships. This study aimed to determine whether attunement of the hypothalamic-pituitary-adrenal (HPA) axis occurs in women's close friendships, and the role of a common social style, co-rumination in that attunement. Saliva samples (later assayed for cortisol) were collected from 37 dyads (74 individuals) during a laboratory task in which they were either asked to work together toward a common goal (control task) or discuss interpersonal problems, providing opportunity for co-rumination. Findings suggest that friends demonstrated adrenocortical attunement prior to engaging in either task, and that the level of attunement prior to the task predicted co-rumination and its components for both groups. Co-rumination, in turn, predicted adrenocortical attunement after the task. These findings suggest that bidirectional attunement of HPA activity may serve a bonding function within women's close friendships. Implications for how these findings fit with the tend-and-befriend hypothesis are discussed.

Co-Rumination Exacerbates Stress Generation among Adolescents with Depressive Symptoms

Through stress generation, individuals' own thoughts and behaviors can actually lead to increases in their experience of stress. Unfortunately, stress generation is especially common among individuals who are already suffering from elevated depressive symptoms. However, despite the acknowledgement that some individuals with depressive symptoms generate greater stress than others, few studies have identified specific factors that could exacerbate stress generation among individuals with depressive symptoms. The present study examines co-rumination as a factor that might exacerbate stress generation among adolescents with depressive symptoms using a short-term longitudinal design. Considering these processes among adolescents was critical given that many youth experience increases in depressive symptoms at this developmental stage and that co-rumination also becomes more common at adolescence. Participants were 628 adolescents (326 girls; 302 boys) who reported on their depressive symptoms, experiences of stress, and co-rumination with a best friend. Interpersonal stressors (peer and family stress) and non-interpersonal stressors (school and sports stress) were assessed. Consistent with past research, adolescents with depressive symptoms experienced greater interpersonal and non-interpersonal stress over time. Importantly, co-rumination interacted with both depressive symptoms and gender in predicting increases in peer stress. Depressive symptoms predicted the generation of peer stress only for girls who reported high levels of co-rumination with friends. Implications for protecting youth with depressive symptoms against stress generation are discussed.

Co-rumination buffers the link between social anxiety and depressive symptoms in early adolescence

OBJECTIVES

We examined whether co-rumination with online friends buffered the link between social anxiety and depressive symptoms over time in a community sample.

METHODS

In a sample of 526 participants (358 girls; Mage  = 14.05) followed at three time points, we conducted a latent cross-lagged model with social anxiety, depressive symptoms, and co-rumination, controlling for friendship stability and friendship quality, and adding a latent interaction between social anxiety and co-rumination predicting depressive symptoms.

RESULTS

Social anxiety predicted depressive symptoms, but no direct links between social anxiety and co-rumination emerged. Instead, co-rumination buffered the link between social anxiety and depressive symptoms for adolescents with higher but not lower levels of social anxiety.

CONCLUSIONS

These findings indicate that co-rumination exerted a positive influence on interpersonal relationships by diminishing the influence from social anxiety on depressive symptoms over time.

Co-Rumination Exacerbates Stress Generation among Adolescents with Depressive Symptoms

Through stress generation, individuals' own thoughts and behaviors can actually lead to increases in their experience of stress. Unfortunately, stress generation is especially common among individuals who are already suffering from elevated depressive symptoms. However, despite the acknowledgement that some individuals with depressive symptoms generate greater stress than others, few studies have identified specific factors that could exacerbate stress generation among individuals with depressive symptoms. The present study examines co-rumination as a factor that might exacerbate stress generation among adolescents with depressive symptoms using a short-term longitudinal design. Considering these processes among adolescents was critical given that many youth experience increases in depressive symptoms at this developmental stage and that co-rumination also becomes more common at adolescence. Participants were 628 adolescents (326 girls; 302 boys) who reported on their depressive symptoms, experiences of stress, and co-rumination with a best friend. Interpersonal stressors (peer and family stress) and non-interpersonal stressors (school and sports stress) were assessed. Consistent with past research, adolescents with depressive symptoms experienced greater interpersonal and non-interpersonal stress over time. Importantly, co-rumination interacted with both depressive symptoms and gender in predicting increases in peer stress. Depressive symptoms predicted the generation of peer stress only for girls who reported high levels of co-rumination with friends. Implications for protecting youth with depressive symptoms against stress generation are discussed.

Adolescents' co-rumination and stress predict affective changes in a daily-diary paradigm

Co-rumination has been related to both high quality friendship and depressive symptoms. However, little is known regarding the extent to which co-rumination may be detrimental, its distinction from rumination and potential gender differences in co-rumination. This study used a modified version of Rose's Co-rumination Questionnaire (Rose, 2002) to examine the behaviour of daily co-rumination with daily stress and negative affect among adolescents. Results demonstrated that co-rumination did not have a main effect in predicting negative affect, but did evidence a significant interaction with life stress. Additionally, co-rumination demonstrated incremental utility above that of rumination. Finally, gender differences were not supported. In conclusion, this investigation revealed that co-rumination exacerbates the effects of life stress and is predictive of increased internalising symptoms.

Brief report: preliminary evidence that co-rumination fosters adolescents' depression risk by increasing rumination

Mounting research shows that the tendency to co-ruminate with peers regarding ongoing problems increases adolescents' depression risk; however, the means by which this interpersonal process fosters risk has not been identified. This said, theorists have proposed that co-rumination increases depression risk, in part, by increasing one's tendency to ruminate when alone. We tested this hypothesis in a study of 201 high-school freshmen who completed two assessments, six months apart. Supporting the proposed model, co-rumination predicted prospective increases in rumination and rumination predicted increases in depressive symptoms. The direct effect of co-rumination on depressive symptom change was not significant. Results indicate that co-rumination with friends may serve to increase rumination, which in turn increases depression risk.

Body talk and body-related co-rumination: associations with body image, eating attitudes, and psychological adjustment

Talk about physical appearance and body image is common among young women. We investigated how body talk (negative, positive/self-accepting, and co-ruminative) is related to body image, body-related cognitive distortions, disordered eating, psychological adjustment, and friendship quality via hierarchical regression analyses (controlling for social desirability and body mass index). In a sample of young adult women (N=203), negative body talk was, as predicted, negatively related to body satisfaction and self-esteem and positively related to appearance investment, body-related cognitive distortions, disordered eating, and depression, but not friendship quality. Self-accepting/positive body talk was negatively related to body-related cognitive distortions and positively related to body satisfaction, self-esteem, and friendship quality. Body-related co-rumination demonstrated adjustment trade-offs, being related to body-related cognitive distortions, disordered eating, and higher friendship quality. Results indicated no advantage to negative body talk, both individual and relationship benefits from positive/self-accepting body talk, and mixed outcomes for body-related co-rumination.