Rumination, worry, cognitive avoidance, and behavioral avoidance: examination of temporal effects

Recently, cross-sectional research has demonstrated that depressive rumination is significantly associated with the tendency to engage in cognitive and behavioral avoidance. This evidence suggests that rumination may be the result of attempts to avoid personally threatening thoughts, in a manner suggested by multiple contemporary theories of worry. This investigation examined the temporal relationship among daily levels of cognitive avoidance, behavioral avoidance, rumination, worry, and negative affect. Seventy-eight adolescents completed baseline questionnaires and then electronically completed daily measures of rumination, worry, behavioral avoidance, and cognitive avoidance, as well as sad and anxious affect for 7 days. Lagged-effect multilevel models indicated that increases in daily sadness were predicted by greater daily rumination and cognitive avoidance. Increases in daily anxiety were predicted by greater daily rumination, worry, and both cognitive and behavioral avoidance. Further, both daily rumination and worry were positively predicted by daily cognitive, but not behavioral, avoidance. Mediation analyses suggested that rumination mediated the effect of cognitive avoidance on both sadness and anxiety. Also, worry mediated the effect of cognitive avoidance on anxiety. Implications for models of avoidance, rumination, and worry are discussed.     

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.     

Relationships between two dimensions of employee perfectionism,postwork cognitive processing,and work day functioning

This daily diary study examined relations between two distinct perfectionism dimensions and work-related cognitions experienced by employees during evening leisure time. Drawing from perseverative cognitive processing theory, we hypothesized that perfectionistic concerns would be related to work-related worry and rumination during post-work evenings. In contrast, we hypothesized that a theoretically more adaptive perfectionist dimension (perfectionistic strivings) would be associated with positively valenced self-reflections about work across consecutive evenings. A sample of 148 full-time workers completed an initial survey, which included a trait perfectionism measure, reported their work-related cognitions across four consecutive evenings of a working week, rated their sleep quality immediately upon awakening on each subsequent morning, and their daily levels of emotional exhaustion and work engagement at the end of each work day. Results showed that perfectionistic concerns were indirectly negatively associated with sleep quality and work day functioning via the tendency to worry and ruminate about work. In contrast, perfectionistic strivings were indirectly positively associated with work day engagement via the propensity to experience positive thoughts about work during evening leisure time. The theoretical and practical implications of these findings are discussed.     

Examining the Relationship Between Worry and Sleep: A Daily Process Approach

There is growing evidence suggesting that worry and sleep are intimately linked. However, the relationship between these two phenomena over the course of a day remains largely unstudied. It is possible that (a) worry predicts sleep disturbance that night, (b) sleep disturbance predicts worry the following day, or (c) there is a bidirectional relationship between worry and sleep disturbance. The present study examined the daily relationship between worry (both during the day and immediately prior to sleep onset) and sleep in 50 high trait worriers who were randomly assigned to one of two interventions aimed at reducing worry as part of a larger study. A daily process approach was utilized wherein participants completed daily reports of sleep and worry during a 7-day baseline period followed by a 14-day intervention period. Results of repeated measures multilevel modeling analyses indicated that worry experienced on a particular day predicted increased sleep disturbance that night during both the baseline and intervention weeks. However, there was no evidence of a bidirectional relationship as sleep characteristics did not predict worry the following day. Additionally, the type of intervention that participants engaged in did not affect the daily relationship between worry and sleep. Results of the present study are consistent with the cognitive model of insomnia (Harvey, 2002) and highlight the importance of addressing and treating worry among individuals with high trait worry and sleep disturbance.     

大学生压力和睡眠质量：反刍思维和心理韧性的链式中介作用

采用大学生压力量表、反刍思维量表、青少年心理韧性量表和匹兹堡睡眠指数量表调查684位大学生(被试平均年龄为20.26岁;SD = 1.08),探讨反刍思维和心理韧性在压力和睡眠质量之间的链式中介作用。结果表明：(1)压力对睡眠质量有显著的负向预测作用;(2)压力可通过反刍思维和心理韧性的独立中介作用及反刍思维和心理韧性的链式中介作用间接预测睡眠质量。本研究揭示了压力和睡眠质量的关系及作用机制,深化了大学生压力对睡眠质量影响的研究。     

Repetitive Thought and Self-Reported Sleep Disturbance

Repetitive thought has been focused upon as a transdiagnostic risk factor for depression, anxiety, and poor physical health. Among the forms of repetitive thought, rumination and worry are considered to play important roles in the onset and maintenance of insomnia. However, there have been few attempts to clarify the similarities, differences, and interaction between the functions of rumination and worry in sleep problems. Furthermore, no study has investigated the prospective relationships between these two forms of repetitive thought and sleep disturbance. In the present study, we examined the prospective associations between repetitive thought and subjective sleep quality, measured by a self-report questionnaire. A total of 208 undergraduates participated in a 2-wave longitudinal survey with an interval of 3 weeks between assessments. Hierarchical multiple regression analyses showed that baseline rumination predicted reduction in the follow-up assessment of subjective sleep quality, controlling for levels of depressive and anxious symptoms. This main effect of rumination was qualified by the levels of worry; for individuals with higher levels of worry, rumination was associated with greater reduction in subjective sleep quality. These results suggest that both rumination and worry have unique associations with sleep and that their interaction is especially important in sleep problems.     

Testing the benefits of expressive writing for workplace embitterment: a randomized control trial

Clinicians working in occupational health services often recognize features of embitterment in organizations; however, research on interventions for embitterment are scarce. The present study aimed to assess the effectiveness of an expressive writing intervention on working adults who experience workplace embitterment. Employing a randomized control trial we sought to test an expressive writing intervention for its effects on reducing embitterment, work-related rumination and sleep quality and assess whether the effect of the intervention was maintained over time by following up participants after one and three months. Findings partially supported our hypothesis as results showed that participants who completed the expressive writing intervention (N = 23) did not show significantly lower levels of embitterment, affective rumination, higher levels of detachment, either improved sleep quality, compared to participants who completed the factual writing (N = 21), when baseline values were controlled for. However, when looking at the mean scores embitterment and affective rumination levels diminished, detachment levels increased and sleep quality improved throughout the course of the intervention for both groups. Given the stability of embitterment and as findings from this study indicate embitterment diminished after a writing exercise irrespective of emotional disclosure taking place or not, further research and investigation are warranted.     

Effects of dispositional self-focus,appraisal and attention instructions on responses to a threatening stimulus

Abstract

Two studies are reported which explored the relationship between self-focused attention and anxiety. The first study tested the hypotheses that self-focused attention is associated with anxiety in threatening situations and that the relationship is mediated by negative appraisal processes. Study 1 showed no significant interaction between self-focus and negative appraisal on state-anxiety. However, self-focus was associated with increments in state-anxiety, high levels of worry and somatic symptom reports in a threatening situation. The relationship between self-focus and state-anxiety was mediated by somatic symptoms. Study 2 used cognitive and somatic self-attention instructions and external focus instructions to verify the hypothesis that self-focus on somatic arousal is associated with anxiety. It is concluded that specific self-focusing tendencies are associated with the elicitation and exacerbation of anxiety.     

The interplay between relationship effectiveness,life stress,and sleep: A prospective study

Research has shown that greater stress responses predict worse sleep and that the quality of one's current romantic relationship predicts one's sleep. Despite these established links, research has not examined connections between ongoing patterns of interpersonal experiences and competencies (relationship effectiveness) and stress exposure on sleep. Participants in the Minnesota Longitudinal Study of Risk and Adaptation (MLSRA) completed measures assessing relationship effectiveness and stress exposure at ages 23 and 32 years, as well as sleep quality/duration at age 37 years. Analyses demonstrate that relationship effectiveness at age 23 years positively predicts sleep quality—but not sleep duration—at age 37 years via reduced stress exposure at age 32 years. These findings highlight the effects of relationship effectiveness and stress exposure across early to middle adulthood on sleep.     

大学生社会支持对睡眠质量的影响：多重中介模型的检验

以360名大学生为被试,采用匹兹堡睡眠质量指数量表、领悟社会支持量表、担忧问卷以及状态焦虑量表,考察了担忧、焦虑在社会支持和睡眠质量关系之间的多重中介作用。结果表明,复合式多重中介模型能够较好地解释焦虑和担忧在社会支持与睡眠质量之间所起的中介作用。     

Ruminative Inertia,Emotion Regulation,and Depression: A Daily-Diary Study

Emotional suppression and cognitive reappraisal are emotion regulation strategies that have been linked to the severity of depression. Recent research has shown that greater ruminative inertia (i.e., rumination that is more resistant to change across time) is also associated with higher levels of depressive symptoms in clinical samples. However, it is unknown how tendencies to use suppression or reappraisal might be related to the inertia of rumination from day to day. After completing a baseline assessment of depressive symptoms and trait emotional suppression and cognitive reappraisal use, undergraduates (n = 94) completed daily-diary questionnaires assessing rumination for two weeks. Both higher depressive symptoms and greater tendencies to use suppression predicted stronger ruminative inertia, while tendencies to use reappraisal were unrelated to ruminative inertia. These results suggest that maladaptive emotion regulation strategies may contribute to a pattern of rumination that is more resistant to change over time. They also provide the first evidence that ruminative inertia is positively associated with depressive symptoms in a nonclinical sample.     

The everyday dynamics of rumination and worry: precipitant events and affective consequences

ABSTRACT

Rumination and worry are two perseverative, negatively valenced thought processes that characterise depressive and anxiety disorders. Despite significant research interest, little is known about the everyday precipitants and consequences of rumination and worry. Using an experience sampling methodology, we examined and compared rumination and worry with respect to their relations to daily events and affective experience. Participants diagnosed with Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD), co-occurring MDD–GAD, or no diagnosis carried an electronic device for one week and reported on rumination, worry, significant events, positive affect (PA), and negative affect (NA). Across the clinical groups, occurrences of everyday events predicted subsequent increases in rumination, but not worry. Further, higher momentary levels of rumination, but not worry, predicted subsequent decreases in PA and increases in NA. Thus, in these clinical groups, rumination was more susceptible to daily events and produced stronger affective changes over time. We discuss implications for theory and clinical intervention.     

Cognitive Behavioural Therapy and Applied Relaxation for Generalized Anxiety Disorder: A Time Series Analysis of Change in Worry and Somatic Anxiety

The present study examined symptom change profiles in patients with generalized anxiety disorder (GAD) receiving either cognitive behavioural therapy (CBT) or applied relaxation (AR). It was hypothesized that (a) changes in worry would uniquely predict changes in somatic anxiety for most participants receiving CBT and (b) changes in somatic anxiety would uniquely predict changes in worry for most participants in the AR condition. Twenty participants (CBT n = 10; AR n = 10) completed daily ratings of worry and somatic anxiety during therapy, and multivariate time series analysis was used to assess the causal impact of each variable on the other. The hypotheses were not supported because we found no evidence of a match between individual symptom change profiles and treatment condition. Rather, a bidirectional relationship between worry and somatic anxiety was observed in 80% of participants receiving CBT and 70% of participants receiving AR. When only treatment responders were considered, 83% of participants receiving CBT and 86% of those receiving AR had such a bidirectional effect. The findings are discussed in terms of models of psychopathology that posit dynamic interactions between symptom clusters and in terms of the value of examining treatment mechanisms at the individual level.     

Reciprocal Relations of Worry,Rumination, and Psychopathology Symptoms After Loss: A Prospective Cohort Study

Bereavement can precipitate symptoms of depression, prolonged grief disorder, and posttraumatic stress disorder. Targeting repetitive negative thought (i.e., worry, rumination) in treatment may help reduce post-loss psychopathology. Yet, evidence on longitudinal associations of depressive rumination and worry with post-loss psychopathology symptoms has been mixed and the directions of effects are still unclear. Recently bereaved adults (78% female) completed questionnaires assessing depressive rumination (brooding), worry, and depression, prolonged grief and posttraumatic stress symptoms 11 times in 1.5 month intervals. We applied random-intercept cross-lagged panel models (RICLPMs) to examine reciprocal within-person associations between worry and psychopathology symptoms, between rumination and these symptoms, and between worry and rumination. Main findings were that worry showed reciprocal relationships with psychopathology symptoms (although worry did not consistently predict prolonged grief symptoms). Depressive rumination was predicted by psychopathology symptoms, but not vice versa. Worry showed reciprocal relations with depressive rumination. Findings suggest that worry may be part of a downward spiral, enhancing psychopathology symptoms following loss, whereas depressive rumination is solely a consequence of such symptoms.     

Associations Between Psychological Factors and Nighttime/Daytime Symptomatology in Insomnia

Purpose: The aim of this study was to examine psychological factors in insomnia and the association between psychological mechanisms and nighttime and daytime symptoms. Methods: A cross-sectional examination in the general population was used. The study sample consisted of 1890 participants from the general population. The participants completed a survey on nighttime and daytime symptoms, health outcomes, and psychological factors. Results: Relative to poor and normal sleepers, the insomnia group had higher scores on worry, beliefs, physiologic arousal, monitoring/attentional bias, and safety behaviors than the other two groups, and the poor sleepers exhibited a similar pattern relative to the normal sleepers. High total wake time was associated with more worry, physiologic arousal, and safety behaviors (26.3% variance), low sleep restoration with more worry, unhelpful beliefs, and monitoring/attentional bias (28.2% variance), and low sleep quality with higher scores on all the psychological mechanisms (35.8% variance). Elevated daytime symptoms were related to more unhelpful beliefs and monitoring/attentional bias (44.3% variance). Conclusion: The findings indicate that psychological factors are linked to nighttime and daytime symptomatology in insomnia.     

Applicability of the cognitive model of generalized anxiety disorder to adolescents’ sleep quality: A cross-sectional and longitudinal analysis

BackgroundPoor sleep quality is a prevalent health issue among adolescents, and few studies have examined the variables affecting adolescents’ sleep quality from the perspective of the co-occurrence of sleep issues and anxiety disorders. Therefore, the current study investigated whether the cognitive model of generalized anxiety disorder applies to adolescents’ sleep quality.MethodIn Study 1, a total of 2042 adolescents were recruited and they completed questionnaires relating to worry, intolerance of uncertainty (IU), negative problem orientation (NPO), cognitive avoidance (CA), and sleep quality. In Study 2, a total of 379 adolescents participated in a six-month longitudinal survey to verify the model that was obtained in Study 1.ResultsStudy 1 showed the modified cognitive model of generalized anxiety disorder can be applied to adolescents’ sleep quality. Specifically, IU was a higher-order vulnerability factor that directly affected worry, and indirectly fostered worry via NPO and CA, where worry only mediated the relationships between IU, NPO, and sleep quality. However, CA exerted no independent effect on worry or sleep quality beyond the influences of IU and NPO, therefore, it dropped out of the final model. Study 2 partially confirmed the above model again from the longitudinal perspective.ConclusionThe present study constructs a new model to explain adolescents’ sleep quality, providing a foundation for future interventions.     

Rumination is independently associated with poor psychological health: Comparing emotion regulation strategies

Objective: Emotion regulation (ER) strategies are related to psychological health, with most work examining reappraisal and suppression. Yet, emerging findings suggest that rumination may have stronger relationships with psychological health, namely depression, than other ER strategies. This paper replicated and extended this work by testing whether rumination was independently associated with a range of poor psychological health risk indicators and outcomes. In addition, it explored whether the reason why rumination is so deleterious to health is because it underlies the stress–health relationship.

Design: Participants (n = 218) completed measures online.

Main outcome measures: Surveys assessed ER strategies (reappraisal, suppression, proactive coping, emotion support seeking, and rumination), health risk indicators (hostility, optimism, self-esteem), health outcomes (depression, poor sleep quality, anxiety) and perceived chronic stress.

Results: Multivariate regression analyses revealed rumination as the only ER strategy with a consistent independent effect on all the health risk indicators and outcomes. Bootstrapping analyses revealed indirect effects of perceived chronic stress on all the health variables via rumination.

Conclusion: Rumination had a deleterious relationship with psychological health, perhaps because rumination underlies the relationship between stress and psychological health. Results have implications for interventions, particularly emphasizing the need to target ruminative thinking after stressful experiences.     

自我控制对睡眠质量的影响:反刍思维与就寝拖延的中介作用

本研究主要考察了自我控制对睡眠质量的影响作用,以及反刍思维和就寝拖延的中介作用。采用相关量表对1104名大学生进行问卷调查。研究结果表明:(1)自我控制可以负向预测睡眠质量问题、反刍思维和就寝拖延。(2)自我控制还通过反刍思维和就寝拖延的单独中介及序列中介,间接影响睡眠质量。     

Examining the role of emotional avoidance in the relationship between posttraumatic stress disorder symptom severity and worry

A growing body of literature suggests that worry is a cognitive activity functioning to avoid unpleasant internal experiences such as negative thoughts, emotions, and somatic responses. Given the highly aversive internal events associated with posttraumatic stress disorder (PTSD), individuals experiencing PTSD symptoms following exposure to a traumatic event may be particularly motivated to engage in avoidant regulation strategies such as worry. Surprisingly, however, few studies to date have examined the relationship between PTSD and worry as well as potential factors that might explain this association. Therefore, the goal of this study was to examine the association between PTSD symptom severity and worry and the extent to which emotional avoidance explains this relationship. To this end, 207 college students with a history of traumatic exposure (meeting Criterion A for a PTSD diagnosis) completed a series of questionnaires assessing history of exposure to potentially traumatic events, PTSD symptom severity, emotional avoidance tendencies, and worry. Results demonstrated that PTSD symptom severity was positively associated with worry and emotional avoidance. Further, emotional avoidance was found to fully account for this relationship, providing support for the proposed emotionally avoidant function of worry. The implications of these findings for future research and the treatment of worry among individuals with a history of traumatic exposure are discussed.     

Effects of momentary assessed stressful events and worry episodes on somatic health complaints

Somatic health complaints are extremely common and are responsible for a large part of human suffering and healthcare costs. It has been recognised that psychosocial stress can affect somatic health. According to the 'perseverative cognition hypothesis', stressful events affect somatic health because people keep on worrying about them. Worry would prolong stress-related physiological activity that can ultimately lead to health problems. In this ambulatory study we tested whether stressful events and worry predict daily somatic complaints, and whether worry mediates the effects of stressful events. In addition, it was tested whether these effects were independent from negative affect. Using electronic diaries, 69 teachers (age 21-60 years) from Dutch primary and secondary schools reported daily stressful events, worry episodes, negative affect and somatic complaints for a period of 6 days. Results showed that worry intensity predicted the number of somatic complaints and mediated the effect of stressful events on somatic complaints. Furthermore, these results were independent from biobehavioural variables and daily negative affect. These findings support the perseverative cognition hypothesis proposing that the negative somatic health effects of stressful events are largely due to the worry; that is, to the prolonged cognitive representation of stressors.