Treatment of rumination maintained by automatic reinforcement: a comparison of extra portions during a meal and supplemental post‐meal feedings

This study evaluated the effects of two satiation procedures, large portions and supplementary feedings, as interventions for rumination maintained by automatic reinforcement for an individual with developmental disabilities. Results showed that supplemental feedings produced a greater reduction in the rate of rumination than the large portions treatment. Additionally, 30 min supplemental feedings were more effective than 15 min supplemental feedings. Copyright © 2007 John Wiley & Sons, Ltd.     

A comparison of noncontingent reinforcement,other competing stimulation,and liquid rescheduling for the treatment of rumination

Modified versions of three popular nonaversive treatments for rumination in a person with profound developmental delay were evaluated using an alternating treatments design (ATD) as a component of an ABAB design. Results showed that the most effective intervention involved noncontingent feeding every 20 s for the 30 min immediately following a meal. Further analysis demonstrated that no significant increase in rumination occurred during the 60 min after the treatment procedure had expired, thus indicating that rumination was not merely postponed. Results are discussed in terms of their relation to currently popular (satiation) interventions for the treatment of rumination in individuals with developmental disability. Future research needs are proposed from an analysis of known behavioral and physiological variables and their possible interactions. ©1997 by John Wiley & Sons, Ltd.     

Brief functional analysis and supplemental feeding for postmeal rumination in children with developmental disabilities

Rumination is a serious problem demonstrated by some people with developmental disabilities, but previous research has not included a functional analysis and has rarely compared intervention methods during the assessment process. We conducted functional analyses with 2 children who displayed postmeal rumination and subsequently evaluated a supplemental feeding intervention following meals. Results showed that noncontingent food or liquid presentation effectively reduced rumination with both children.     

A seven year follow-up of treating rumination with dietary satiation

”Fred“, a man with profound mental retardation who was 24 years old at the beginning of this study, was referred for treatment of rumination. A number of minimally restrictive interventions, including administration of Zantac, extra fluids, and delivery of peanut butter after meals, had been used without success. In April of 1989 Fred began a satiation diet with ad libitum access to starchy foods or to fruits and vegetables, in addition to his regular meals. His baseline weight was 82 pounds and he ruminated during 58% of 10 s intervals measured during 20 min post-meal observations. During the first month of the satiation diet, Fred's ruminating declined to 6% of measured intervals, he consumed a mean of 163 fluid ounces of extra food per day, and his weight increased to 90 pounds. After 4 months' treatment, Fred's ruminating had declined to zero, his food consumption had stabilized at approximately 65 extra ounces of food per day, and his weight had stabilized at about 120 pounds. Starting in August 1990, in an effort to minimize weight gain, extra food was limited to 50% of Fred's ad libitum food consumption (averaged over the previous 6 weeks). Fred's weight gradually declined to about 100 pounds with zero rumination over the next two years. In August 1992 Fred's ruminating accelerated to 17% of intervals and he was again offered ad libitum food access. Over the next 7 months, rumination declined to zero and his weight increased slightly to about 105 pounds. This study shows that rumination that had not responded to less restrictive procedures was suppressed for 7 years via dietary satiation. Although dietary satiation is not without some risk, Fred has suffered no adverse effects from the procedure, other than gaining approximately one-third of his baseline weight. © 1997 John Wiley & Sons, Ltd.     

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.     

Prolonged grief disorder symptoms in bereaved internally displaced Tiv persons in Nigeria: associations with rumination,rebirth concerns and gender

ABSTRACT

There is burgeoning research on prolonged grief disorder (PGD) among several vulnerable populations but PGD symptoms have been scarcely examined among bereaved internally displaced persons (IDPs). This study investigated the associations of rumination, rebirth concerns and gender with symptoms of PGD following conflict-related bereavement. Participants were 379 Nigerian IDPs who were of the Tiv ethnic group. They provided demographics and completed self-report measures grief and rumination, while concern about rebirth status of the deceased was assessed using a single item which requested participants to indicate whether they had any concerns about the re-incarnation of the deceased. Results showed that gender was not associated with PGD symptoms. High intrusive rumination and high deliberate rumination were associated with increased PGD symptoms in males and females. Rebirth concern was associated with high PGD symptoms in males but not in females. Findings highlight the need for socio-culturally-informed screening/intervention in the wake of conflict-related bereavement.     

Rejection sensitivity prospectively predicts increased rumination

Converging research findings indicate that rumination is correlated with a specific maladaptive interpersonal style encapsulating submissive (overly-accommodating, non-assertive and self-sacrificing) behaviours, and an attachment orientation characterised by rejection sensitivity. This study examined the prospective longitudinal relationship between rumination, the submissive interpersonal style, and rejection sensitivity by comparing two alternative hypotheses: (a) the submissive interpersonal style and rejection sensitivity prospectively predict increased rumination; (b) rumination prospectively predicts the submissive interpersonal style and rejection sensitivity. Currently depressed (n = 22), previously depressed (n = 42) and never depressed (n = 28) individuals completed self-report measures assessing depressive rumination and key psychosocial measures of interpersonal style and behaviours, at baseline and again six months later. Baseline rejection sensitivity prospectively predicted increased rumination six months later, after statistically controlling for baseline rumination, gender and depression. Baseline rumination did not predict the submissive interpersonal style or rejection sensitivity. The results provide a first step towards delineating a potential casual relationship between rejection sensitivity and rumination, and suggest the potential value of clinical assessment and intervention for both rejection sensitivity and rumination in individuals who present with either difficulty.     

THE RELATION OF FOOD QUANTITY TO RUMINATION BEHAVIOR

Preliminary work suggested that the quantity of food ingested by retarded individuals who usually ruminated following meals was related to the frequency and duration of ruminating responses. This possible relation was experimentally examined by systematically varying food quantity from regular portions to satiation levels for three retarded individuals who exhibited high levels of ruminating. A clear functional relation of food quantity to ruminating emerged, with satiation procedures producing rapid and large decreases in the relatively high frequencies and durations of ruminating characteristic of baseline food quantity conditions.     

Neural correlates of rumination in depression

Rumination, or recursive self-focused thinking, has important implications for understanding the development and maintenance of depressive episodes. Rumination is associated with the worsening of negative mood states, greater affective responding to negative material, and increased access to negative memories. The present study was designed to use fMRI to examine neural aspects of rumination in depressed and healthy control individuals. We used a rumination induction task to assess differences in patterns of neural activation during ruminative self-focus as compared with a concrete distraction condition and with a novel abstract distraction condition in 14 participants who were diagnosed with major depressive disorder and 14 healthy control participants. Depressed participants exhibited increased activation in the orbitofrontal cortex, subgenual anterior cingulate, and dorsolateral prefrontal cortex as compared with healthy controls during rumination versus concrete distraction. Neural activity during rumination versus abstract distraction was greater for depressed than for control participants in the amygdala, rostral anterior cingulate/medial prefrontal cortex, dorsolateral prefrontal cortex, posterior cingulate, and parahippocampus. These findings indicate that ruminative self-focus is associated with enhanced recruitment of limbic and medial and dorsolateral prefrontal regions in depression. Supplemental materials for this article may be downloaded from http://cabn.psychonomic-journals.org/content/supplemental.     

CHEWING GUM AS A TREATMENT FOR RUMINATION IN A CHILD WITH AUTISM

Rumination involves regurgitation of previously ingested food, rechewing the food, and reswallowing it. In the current study, a child with autism displayed chronic rumination, resulting in the decay and subsequent removal of several teeth. After several treatments failed, including thickened liquids and starch satiation, the participant was taught to chew gum. His rumination decreased significantly when gum was made available. Results suggest that access to chewing gum may be an effective treatment for rumination in some individuals.     

The Goal of Biological Parenthood and Emotional Distress From Infertility: Linking Parenthood to Happiness

This study examined the relationship between construals of the parenthood goal and emotional reactions to fertility difficulties. Mcintosh and Martin's (1992) goal linkage model predicts that individuals experiencing fertility difficulties who strongly link biological parenthood to happiness (i.e., those who strongly believe that having a biological child is necessary for happiness and life satisfaction) will ruminate more about this unfulfilled goal than will individuals who engage in less linking. The model also predicts that greater rumination leads to greater emotional distress and that rumination will mediate the relationship between linking and emotional distress. To examine these hypotheses, 69 women experiencing difficulty conceiving completed questionnaires that assessed linking, rumination, and emotional distress. Results support the hypotheses from the goal linkage model: Linking predicted rumination, rumination predicted emotional distress, and rumination mediated the relationship between linking and distress.     

Switching and backward inhibition in major depressive disorder: the role of rumination

Previous studies have demonstrated that individuals with major depressive disorder have difficulties switching attention from one task set to another. In the current study we examined whether ruminative thinking drives the switching deficits of depressed individuals. A secondary, more exploratory, goal of this study was to examine whether state rumination would impair depressed individuals' ability to activate a new task set, to inhibit a no longer relevant task set, or both. Participants underwent either a rumination induction or a distraction induction and then completed a backward inhibition task that measures general switching abilities and the ability to inhibit previous task sets. Although depression was not related to switching ability as a main effect, depressed individuals who were induced to ruminate exhibited poorer switching ability than did both depressed and control individuals who were distracted from ruminating and control participants who were induced to ruminate. These findings suggest that depressed individuals are characterized by switching deficits only if they are ruminating. Moreover, the finding that state rumination did not affect participants' ability to inhibit previous task sets suggests that state rumination primarily impairs noninhibitory task-switching processes. It is interesting that the opposite pattern of results was obtained for trait rumination, which was related to inhibitory deficits during switching, but not to generally poorer switching. Thus, state and trait rumination may be associated with dissociable cognitive deficits.     

ESTABLISHING OPERATIONS AND REINFORCEMENT EFFECTS

Positive reinforcement procedures have had a major impact on educational programs for the developmentally disabled; nevertheless, variation in reinforcer effectiveness both within and across individuals is a common phenomenon. This study examined one class of variables—establishing operations—that might influence the effectiveness of reinforcers. Five developmentally disabled adult males participated. Responding on one of two motor tasks—switch closure or block placement—was assessed during baseline, satiation, and deprivation conditions with respect to three classes of consequences: small food items, music, and social praise. Deprivation and satiation conditions were constructed so as not to alter significantly the normal course of events in a subject's day. For example, food deprivation entailed scheduling sessions just prior to a subject's regular lunch, and social deprivation involved limiting a subject's access to social interaction for 15 minutes, during which time the subject had access to an assortment of other activities. Results showed that each stimulus class functioned as reinforcement with different degrees of effectiveness during satiation versus deprivation conditions. These results are discussed in light of previous research on enhancement of reinforcer efficacy as well as the assessment and identification of functional reinforcers, and implications are presented for future research and client habilitation.     

Treatment of chronic food refusal in a young developmentally disabled child

Chronic food refusal is a common problem among young children with developmental disabilities. Children with chronic food refusal may require supplemental tube feedings or parental feedings. A multicomponent treatment package consisting of escape–avoidance extinction, shaping and positive reinforcement was effective in establishing a normal oral feeding pattern with a 1.5 years old developmentally disabled child who was fed by gastrostomic tube. Treatment effects generalized to the home setting and were maintained during follow‐up. After treatment, tube‐feeding was discontinued. Copyright © 1999 John Wiley & Sons, Ltd.     

Decreasing rumination using a starchy food satiation procedure

A starchy food satiation procedure was evaluated in an ABAB withdrawal design on the post‐meal rumination of a nine‐year‐old girl with autism. During treatment unlimited quantities of starchy foods were provided following each meal. High rates of rumination occurred during baseline conditions, followed by an immediate decrease in rumination during treatment. Rumination decreased to 82 and 97% of baseline during the first and second treatment conditions, respectively. In addition, follow‐up probes were conducted at irregular intervals for 4 years following treatment, during which zero or near‐zero rates of rumination were sustained. This study extends the literature on the functional relation between increased starchy food quantity and rumination in adults to rumination with a young child, and demonstrates maintenance of the treatment effect for 4 years. Copyright © 2002 John Wiley & Sons, Ltd.     

The Effect of State and Trait Self-Critical Rumination on Acute Distress: An Exploratory Experimental Investigation

Self-critical rumination is a process whereby individuals focus attention on past failures and inadequacies without consideration for improvement or problem-solving. Past research has demonstrated that self-critical rumination is a separate process from the experience of having intrusive self-critical thoughts and that engaging in self-critical rumination is strongly correlated with beliefs that it is uncontrollable or represents a weakness of character. What is less clear at this time, however, is the impact that self-critical rumination has on levels of distress when faced with failure. Thirty volunteers who were not experiencing significant levels of depression were randomly assigned across three groups: one rumination and two controls. Acute distress was measured prior to and immediately following a task, as well as upon debrief. Individuals expected to complete an impossible task, who experienced simulated self-critical rumination experienced greater levels of acute distress than controls immediately following the task. There was also a significant correlation between reported levels of trait self-critical rumination, negative metacognitive beliefs and self-esteem with levels of distress following debrief when controlling for initial levels of distress and group membership. The use of subjective self-reports and small sample size limits the findings of this exploratory study. Engaging in self-critical rumination, and associated negative metacognitive beliefs, may have a significant impact on levels of acute distress following a recent failure.

     

When self-help is no help: Traditional cognitive skills training does not prevent depressive symptoms in people who ruminate

A randomized trial was conducted to test the efficacy of three self-directed prevention intervention workbooks for depression. Cognitively at-risk college freshmen were randomly assigned to one of three conditions: traditional cognitive, non-traditional cognitive, and academic skills. Consistent with hypotheses, participants who were high in rumination and experienced stress exhibited significantly greater levels of depressive symptoms after completing the traditional cognitive skills workbook than after completing the other two workbooks. This pattern of results held post-intervention and 4 months later. These findings indicate that rumination may hinder ones ability to identify and dispute negative thoughts (at least without the help of a trained professional). The results underscore the importance of identifying individual difference variables that moderate intervention efficacy. They also raise concerns about the potential benefits of self-help books, an industry that generates billions of dollars each year.     

An analysis of the effectiveness of university counselling services

It is important to demonstrate replicable evidence of the effectiveness of counselling procedures. The study aimed to contribute to the currently limited evidence base examining the effectiveness of university student counselling in the UK. Information on therapeutic outcome [based on Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) scores] for 305 individuals attending a large UK university counselling service was analysed. Following counselling intervention: there was a statistically significant improvement in CORE-OM scores with 63% of individuals showing a reliable improvement and only 2% showing a reliable deterioration. Of those who began with a score in the clinical range, 49% showed a clinically significant change. These results provide additional evidence for the effectiveness of university counselling interventions. Future research should aim to build on this preliminary research using randomised controlled trial designs.     

Depressive rumination and the C957T polymorphism of the DRD2 gene

Depressed individuals who ruminate have difficulties learning from punishment and suppressing task-irrelevant information. The C957T polymorphism of the DRD2 gene, which affects functioning of D2 dopamine receptors (DRD2) that are expressed predominantly in the indirect pathway of the basal ganglia, has been found to influence suppression and punishment learning. Given these associations, we examined in the present study whether depressive rumination is related to the C957T polymorphism in 317 clinically depressed individuals and 317 never-depressed control individuals. A 2 × 2 (diagnostic group ×C957T polymorphism) analysis of variance conducted on depressive rumination scores yielded a significant interaction of group and C957T: Individuals with two 957C alleles reported higher levels of depressive rumination than did individuals with one or two 957T alleles if they were depressed, but not if they were healthy. The present findings suggest that the dopaminergic system and DRD2 are related to the frequency of maladaptive rumination in depressed individuals. Thus, DRD2 may be an important target for the pharmacological treatment of depressive rumination.     

Using e-learning modules to teach ongoing-visual inspection of functional analyses

Despite the effectiveness of function-based treatments, most clinicians do not conduct functional analyses (FA). The time required to conduct an FA is a major barrier preventing their use. One way to increase FA efficiency is to discontinue the analysis as soon as it has produced clear results. Saini et al. (2018) evaluated a structured procedure for ongoing-visual inspection of FAs and found that it produced accurate interpretations while averaging 40% fewer sessions than author interpretation. This study evaluated the efficacy of an e-learning module for training registered behavior technicians (RBTs) to implement ongoing visual inspection of FAs. Following training, 5 of the 6 participants showed mastery of ongoing visual inspection, and the final participant did so with the addition of supplemental procedures. We discuss how this training may increase the efficiency of FAs by teaching individuals who are less experienced in FA methodology when to seek supervision from a supervising Board Certified Behavior Analyst® (BCBA).