Distinguishing rumination from worry in clinical insomnia

Research has found that repetitive thought processes, such as worry and rumination, play an important role in several disorders; however, these cognitive processes have not yet been examined in insomnia. This study explores rumination and worry in insomnia by examining: 1) whether those high and low on rumination and worry differ on subjective sleep measures, and 2) whether rumination and worry are distinct processes in insomnia. Participants (N = 242) were diagnosed with an insomnia disorder by sleep experts. Participants completed measures of worry and rumination and maintained a 2-week daily sleep log. Results of a multivariate analysis of variance found no main effect of worry; although high and low ruminators differed on several sleep log indices, including sleep efficiency, wakefulness after sleep onset and sleep quality. Factor analysis supported the idea that rumination and worry are separate constructs. Whereas previous research has focused on worry in insomnia, these findings suggest that rumination is important for understanding sleep disturbance. Further, although rumination and worry are both repetitive thought processes, these results indicate that they are distinct processes within insomnia and should be treated as such. The results are discussed with respect to treatment implications for Cognitive Behavioural Therapy for Insomnia.     

Personality traits as predictors of trauma-related coping self-efficacy: A three-wave prospective study

Aim of the present three-wave study was to examine to what extent personality traits and general self-efficacy measured before exposure to a potentially traumatic event (PTE) prospectively predict coping self-efficacy (CSE) perceptions, and to test whether outcomes are biased by the timing of assessment of personality traits. The study was conducted within a large probability-based multi-wave representative internet panel in the Netherlands (N^total = 1154).ResultsFindings for both personality assessments (2009, 2011) were similar. Among respondents with low levels of PTSD-symptomatology, higher levels of emotional stability and agreeableness were associated with higher levels of CSE, while among those with relatively high levels of PTSD-symptomatology emotional stability alone was independently predictive of CSE. After adding personality traits to the model, general self-efficacy, demographic and event-related variables were not predictive of CSE, with the exception of time since the event for the high-symptoms group.ConclusionsEmotional stability most strongly and systematically predicts CSE following PTE’s, regardless of the moment it was assessed. Agreeableness is only predictive of CSE among those with low levels of PTSD-symptomatology. Timing of assessment of personality did not influence results. In sum the personality traits emotional stability and agreeableness provide (limited) information on CSE levels among adults following PTE’s.     

Attachment and trait forgivingness: The mediating role of angry rumination

Integrating theories of attachment and forgiveness, we predicted that secure attachment reduces angry rumination and promotes forgiveness. To examine this prediction, in Study 1 (n = 213), participants completed the Experience in Close Relationships Scale (ECR; Brennan, Clark, & Shaver, 1998) and the Trait Forgiveness Scale (TFS; Berry, Worthington, O’Connor, Parrott, & Wade, 2005). Individuals who were classified as securely attached displayed greater dispositional forgivingness than did insecurely attached individuals. In Study 2 (n = 218) we included the Dissipation-Rumination Scale (DRS; Caprara, 1986). Results from Study 2 replicated the association between attachment security and greater dispositional forgivingness and confirmed the mediating role of angry rumination in the attachment–forgivingness relation.     

An experiential avoidance conceptualization of depressive rumination: Three tests of the model

This study examined an experiential avoidance conceptualization of depressive rumination in 3 ways: 1) associations among questionnaire measures of rumination, experiential avoidance, and fear of emotions; 2) performance on a dichotic listening task that highlights preferences for non-depressive material; and 3) psychophysiological reactivity in an avoidance paradigm modeled after the one used by Borkovec, Lyonfields, Wiser, and Deihl (1993) in their examination of worry. One hundred and thirty-eight undergraduates completed questionnaire measures and participated in a clinical interview to diagnose current and past episodes of depression. Of those, 100 were randomly assigned to a rumination or relaxation induction condition and participated in a dichotic listening task, rumination/relaxation induction, and depression induction. Questionnaire measures confirmed a relationship between rumination status and avoidance; however, no significant effects were found in the dichotic listening task. Psychophysiological measures indicated no difference in physiological response to a depression induction among high ruminators (HR). However, low ruminators (LR) in the relaxation condition exhibited a larger IBI response than LR in the rumination condition. Overall, these results provide partial support for an avoidance conceptualization of depressive rumination. Implications of these findings are discussed.     

Predicting anger in social anxiety: The mediating role of rumination

Anger and the way that anger is expressed have been linked to attrition and poorer treatment outcomes in patients with Social Anxiety Disorder (e.g., Erwin, B. A., Heimberg, R. G., Schneier, F. R. & Liebowitz, M. R. (2003). Anger experience and expression in social anxiety disorder: Pretreatment profile and predictors of attrition and response to cognitive-behavioral treatment. Behavior Therapy, 34, 331–350). Understanding the connection between social anxiety and anger may be one way to improve outcomes in this population. A cross-sectional regression design was used in a sample of 363 undergraduates to examine the suggestion that ruminative thought is a critical factor linking social anxiety to anger. In support of this hypothesis, brooding fully mediated the relationship between social anxiety and trait anger and partially mediated the relationship between social anxiety and outward anger expression. The relationship between brooding and anger suppression became non-significant after depression was controlled. In contrast, reflective pondering partially mediated the relationship between social anxiety and anger suppression. These results suggest that addressing rumination may be useful in the treatment of socially anxious patients who struggle with anger. They also support the utility of considering multiple forms of rumination and multiple anger outcomes in a single study.     

The influence of rumination and defensiveness on negative affect in response to experimental stress

Previous experiments investigating the influence of rumination on negative affect have often manipulated the timing and content of rumination, which may be problematic as rumination is phenomenologically experienced as uncontrollable. In the present experiment, rumination was not manipulated, but measured as an individual tendency before the experiment. Furthermore, it was tested whether defensiveness would reduce the higher degree of negative affect often associated with rumination. Fifty-six participants completed questionnaires measuring rumination and defensiveness and participated in a phrase completion task, rating negative affect before and after the task. Correlational analyses showed that rumination was positively associated (p < 0.05) with affect responses (r range = 0.35-0.61), whereas defensiveness was negatively associated with affect responses (r range =-0.27-0.32). Four groups of high and low rumination and defensiveness scorers were created using median splits. An ANOVA showed that scoring high on defensiveness did not reduce the negative affect experienced by high ruminating participants.     

Toward the bigger picture: Concrete and abstract thinking about a transgression,and the role of time in interpersonal forgiveness

Rumination is commonly considered detrimental to forgiveness. In contrast, we propose that different forms of post-transgression thinking are differentially effective for forgiveness, depending on their timing. Concrete thinking focuses on event details, whereas abstract thinking abstracts from details and views the event in a broader context. Following construal level theory, we propose that concrete thinking is increasingly ill-matched, and abstract thinking better matched, to the construal abilities and motivation afforded by psychological distance. Hence, over time, concrete thinking would be negatively, and abstract thinking positively, associated with forgiveness. Two correlational recall studies, with time since transgression measured (Study 1) or manipulated (Study 2), demonstrated that with greater temporal distance concrete thinking was more negatively, and abstract thinking more positively, related to forgiveness. Study 3 employed a prospective-longitudinal methodology over five time-points; intra-individual decrease in concrete thinking and increase in abstract thinking over time were related to higher levels of forgiveness.     

Linking attentional control and PTSD symptom severity: the role of rumination

Although deficits in attentional control have been linked to posttraumatic stress disorder (PTSD), the mechanism that may account for this association has not been fully elucidated. The present study examined rumination as a mediator of the relationship between attentional control and PTSD symptoms. Veterans with PTSD and trauma-exposed veterans without PTSD completed measures of attentional control, rumination, and PTSD symptom severity. As predicted, the findings showed that veterans with PTSD reported significantly lower levels of attentional control than veterans without PTSD. Veterans with PTSD also reported significantly higher levels of rumination than veterans without PTSD. Subsequent analysis of the total sample revealed that the relationship between attentional control and PTSD symptom severity was accounted for by excessive rumination. Attentional control may contribute to PTSD symptoms through excessive rumination. Attentional control and rumination may be important targets for PTSD interventions.     

Repetitive negative thinking mediates the association between perfectionism and psychological distress

Our objective was to analyze the relationships between Repetitive negative thinking (RNT), perfectionism and psychological distress. Specifically we wanted to test if RNT mediates the relationship between perfectionism and psychological distress. 788 college students completed self-report questionnaires to evaluate perfectionism trait dimensions [Evaluative concerns (EC) and Positive strivings (PS)], RNT dimensions [Repetitive thinking (RT) and Cognitive interference and unproductivity (CIU)], perceived stress, and perceived support. Psychological distress was measured with the Profile of Mood States subscales: Depression (D), Tension–anxiety (TA), Anger–hostility (AH), Fatigue–inertia (FI) and Vigor–anxiety (VA). After controlling for perceived stress and support, perfectionism dimensions and RNT (particularly CIU) remained a significant predictors of psychological distress. CIU was a partial mediator of the relationship between EC and D, TA, AH, FI and VA and a full mediator of the relationship of PS with D and FI. Whereas the effect of negative perfectionism on emotional disturbances was potentiated by RNT, PS was only associated to it when high levels of RNT were also present. Showing that Positive striving effects on psychological distress may be a function of specific mediators, these results contribute to a better understanding of the nature of positive perfectionism.     

Gaze-fixation and pupil dilation in the processing of emotional faces: The role of rumination

Sustained attentional processing of negative information plays a significant role in the development and maintenance of depression. The present study examines the relationships between rumination, a relevant factor in information processing in depression, and the attentional mechanisms activated in individuals with different levels of depression severity when attending to emotional information (i.e., sad, angry and happy faces). Behavioural and physiological indicators of sustained processing were assessed in 126 participants (39 dysphoric and 87 non-dysphoric) using eye-tracking technology. Pupil dilation and total time attending to negative faces were correlated with a global ruminative style in the total sample once depression severity was controlled. Furthermore, in dysphoric participants the brooding component of rumination was specifically associated with the total time attending to sad faces. Finally, bootstrapping analyses showed that the relationships between global rumination and pupil diameter to emotional faces were accounted by total time attending to emotional faces, specifically for participants reporting lower levels of depression severity. The results support the idea that sustained processing of negative information is associated with a higher ruminative style and indicate differential associations between these factors at different levels of depressive symptomatology.     

Difficulties in disengaging attentional resources from self-generated thoughts moderate the link between dysphoria and maladaptive self-referential thinking

Negative emotions increase self-focused attention, a core feature of depression and anxiety-related disorders. However, the cognitive mechanisms associated with the tendency to self-focus—and, conversely, with the ability to voluntarily disengage attentional resources from the self and direct them towards the external environment—remain poorly understood. Thus, this study aimed to examine whether a specific cognitive control mechanism that directs attention between self-generated thoughts and external information might moderate the relationship between dysphoria and maladaptive self-referential thinking. Results showed that dysphoria increases the frequency of rumination, self-blame, and catastrophising, especially for participants who have more difficulty in switching from self-generated thoughts to information provided by the environment. These results shed new light on the cognitive mechanisms underlying maladaptive self-referential thinking associated with dysphoria. More specifically, this specific cognitive mechanism might play a key role in the maintenance or amplification of a depressed mood.     

Predictors of stress generation in Turkish young adults: The role of rumination and excessive reassurance seeking

The stress generation model posits that not only stressful life-events predict depressive symptoms, but also depressive-prone individuals think and behave in ways that make them more vulnerable to experience life-stress. Evidence has supported the bi-directional relationship between stress and depressive symptoms, and there has been an attempt in identifying vulnerability factors for stress generation. Yet, there is a need for studies focusing on multiple risk factors and a replication of findings in non-Western samples. The aim of the present study was to examine the role of rumination and excessive reassurance seeking (ERS) in stress generation in a sample of Turkish young adults. A sample of 318 Turkish college students reported on their rumination, ERS, intensity of stressful life-events and depressive symptoms. A subsample of 162 participants also completed a measure of life-events 5 months later. Cross-sectional results showed that rumination and ERS contribute to life-stress over and above depressive symptoms and gender. Mediational analyses indicated that ERS does not mediate the relationship between rumination and life-stress at 5 months. Rather, rumination fully mediated the relationship between ERS and future life-stress. Results provide evidence for stress generation, and highlight the interconnection between rumination and ERS.     

Distinguishing between level and impact of rumination as predictors of depressive symptoms: An experience sampling study

Rumination—repetitively thinking about one's emotional state, its causes and consequences—exacerbates negative mood and plays an important role in the aetiology and maintenance of depression. Yet, it is unclear whether increased vulnerability to depression is associated with simply how much a person ruminates, or the short-term impact rumination has on a person's negative mood. In the current study, we distinguish between the level versus the impact of rumination, and we examine how each uniquely predicts changes in depressive symptoms over time in an undergraduate sample. Using experience sampling, we assessed students’ (N = 101) subjective experiences of positive and negative affect and their use of rumination and distraction in daily life for seven days. Participants also reported their depressive symptoms before and after the experience sampling. Increases in depressive symptoms over the week were predicted by how much people ruminated, but not by its impact on negative mood.     

Impact of rumination versus distraction on anxiety and maladaptive self-beliefs in socially anxious individuals

A large body of experimental evidence has demonstrated the adverse effects of rumination on depressive mood and cognitions. In contrast, while prominent models of social phobia (Clark & Wells, 1995; Rapee & Heimberg, 1997) have proposed rumination as a key maintaining factor, the effects of rumination in social anxiety have not been extensively explored. In a sample of (N = 93) undergraduates, this study investigated the impact of rumination versus distraction following a social-evaluative task on anxiety and another key component of social phobia: maladaptive self-beliefs. Relative to distraction, rumination maintained anxiety in both high and low socially anxious individuals, and maintained unconditional beliefs in high socially anxious individuals. The results support models of social phobia and also suggest important theoretical extensions. Implications for the treatment of social anxiety are discussed.     

Intrusive thoughts mediate the association between neuroticism and cognitive function

Although research has established a negative association between trait neuroticism and cognition, little is known about the mechanisms that underlie this relationship. We examined the tendency to experience intrusive thoughts and negative affect as potential mediators of the relationship between neuroticism and cognitive performance. We hypothesized that the tendency to experience intrusive thoughts reflects ineffective attentional control and would account for the relationship between neuroticism and cognitive performance over and above the mediating effect of negative affect. Three hundred seventeen adults (M_age = 49.43) completed a series of attention-demanding cognitive tasks as well as self-report measures of intrusive thoughts, negative affect, and neuroticism. Intrusive thoughts mediated the association between trait neuroticism and cognitive performance beyond negative affect. These findings are consistent with the hypothesis that the tendency to experience intrusive thoughts is a mechanism through which trait neuroticism influences cognitive performance.     

On the links between self-discrepancies, rumination, metacognitions, and symptoms of depression in undergraduates

The present study aimed to test the central components of Papageorgiou and Wells' (2003) non-clinical metacognitive model of rumination and depression that is grounded on the Self-Regulatory Executive Function (S-REF) model of emotional disorders [Wells, A., & Matthews, G. (1994). Attention and emotion: A clinical perspective. Hove, UK: Lawrence Erlbaum.]. A second aim of this study was to extend the non-clinical model with the concept of self-discrepancy in line with the S-REF model. Data of the current study were collected in a large sample of non-clinical Dutch undergraduates (N=196), who completed a battery of questionnaires including measures of rumination, positive and negative metacognitions, depressive symptoms, and self-discrepancy (i.e., actual-ideal, actual-ought, and actual-feared discrepancies). Hypothesized relationships among these variables were tested by means of structural equation modelling. Following some theoretically consistent modifications, the model was an adequate fit to the data. With respect to the second aim of the study, self-discrepancies were directly linked to symptoms of depression as well as indirectly via the cognitive processes involved in the metacognitive model of rumination and depression. Evidence was found for positive beliefs about rumination to partially mediate the relation between self-discrepancy and rumination. Clinical implications of the findings, including implementation of a metacognitive-focused cognitive therapy of depression, and suggestions for future research are discussed.     

An all‐or‐nothing thinking turns into darkness: Relations between dichotomous thinking and personality disorders1

Dichotomous thinking is an individual's propensity to think in terms of binary opposition. While this thinking style may be useful for quick decision‐making, some clinical psychologists have indicated that such a style is related to personality disorders. Oshio (2009 ) revealed that the Dichotomous Thinking Inventory (DTI) has significant positive correlations with borderline personality and narcissism. This study examines whether dichotomous thinking is associated with cluster A, B, and C personality disorders. The participants comprised 152 Japanese undergraduates (84 male and 68 female). They completed the DTI and Ten Personality Styles scale (10 PesT; Nakazawa (2006 )), developed from the definitions of personality disorders in the DSM‐IV. Structural equation modeling supported the hierarchical factor structure of personality disorders. The dichotomous thinking effects “cluster” level of disorders more than other levels. The results indicated that thinking dichotomously may lead to wide‐ranging personality disorders.     

Incidental retrieval of emotional contexts in post-traumatic stress disorder and depression: an fMRI study

In the present study, we used fMRI to assess patients suffering from post-traumatic stress disorder (PTSD) or depression, and trauma-exposed controls, during an episodic memory retrieval task that included non-trauma-related emotional information. In the study phase of the task neutral pictures were presented in emotional or neutral contexts. Participants were scanned during the test phase, when they were presented with old and new neutral images in a yes/no recognition memory task. fMRI results for the contrast between old and new items revealed activation in a predominantly left-sided network of cortical regions including the left middle temporal, bilateral posterior cingulate, and left prefrontal cortices. Activity common to all three groups when correctly judging pictures encoded in emotional contexts was much more limited. Relative to the control and depressed groups the PTSD group exhibited greater sensitivity to correctly recognised stimuli in the left amygdala/ventral striatum and right occipital cortex, and more specific sensitivity to items encoded in emotional contexts in the right precuneus, left superior frontal gyrus, and bilateral insula. These results are consistent with a substantially intact neural system supporting episodic retrieval in patients suffering from PTSD. Moreover, there was little indication that PTSD is associated with a marked change in the way negatively valenced information, not of personal significance, is processed.     

Interference resolution moderates the impact of rumination and reappraisal on affective experiences in daily life

Research has shown that cognitive control processes play a central role in emotion regulation. While most research has examined whether individual differences in such processes are related to the use of these strategies, a crucial next step involves examining whether such differences influence their impact on people's feelings, especially in normal daily life. The present study examined whether impairments in cognitive control (measured using an affective interference resolution task) moderate the impact of using rumination and reappraisal on affective experiences in everyday life (assessed using experience sampling methods). Multilevel analyses revealed that difficulties removing previously relevant negative information from working memory were associated with a larger increase in negative affect following rumination, and smaller increase and decrease in positive and negative affect, respectively, following reappraisal. These findings show that impaired interference resolution for negative information aggravates the deleterious effects of rumination and curbs the benefits of reappraisal in daily life.