Examining the role of positive and negative metacognitive beliefs in depression

Many psychological models have been developed to explain the development and maintenance of depression. The most widely evaluated model is the cognitive model of depression, and it is against this model that emerging models should be compared. Accordingly, this cross‐sectional study examined whether metacognitive beliefs, as specified in the metacognitive model of depression, would explain additional variance in depressive symptoms over dysfunctional attitudes; the core feature of the cognitive model. Moreover, mediational relationships between metacognitive beliefs, rumination, and depressive symptoms, predicted by the metacognitive model were also explored, whilst controlling for dysfunctional attitudes. A sample of 715 students completed self‐report questionnaires measuring depressive symptoms, rumination, dysfunctional attitudes, and metacognitive beliefs. Regression analyses showed that metacognitive beliefs made a significant statistical contribution to depressive symptoms, after controlling for age, gender, rumination and dysfunctional attitudes. Furthermore, as predicted by the metacognitive model, the relationship between positive metacognitive beliefs and depressive symptoms was fully mediated by rumination, whilst the relationship between negative metacognitive beliefs about uncontrollability and danger and depressive symptoms was partially mediated by rumination. The results provide further empirical support for the metacognitive model of depression and indicate that positive and negative metacognitive beliefs play an integral role in the maintenance of depressive symptoms.     

Gender differences in rumination: A meta-analysis

Starting in adolescence and continuing through adulthood, women are twice as likely as men to experience depression. According to the response styles theory (RST), gender differences in depression result, in part, from women’s tendency to ruminate more than men. A meta-analysis was performed to evaluate gender differences in rumination in adults (k = 59; N = 14,321); additionally, an analysis of subtypes of rumination – brooding and reflection – was conducted (k = 23). Fixed effects analyses indicated that women scored higher than men in rumination (d = .24, p < .01, SEd = .02), brooding (d = .19, p < .01, SEd = .03) and reflection (d = .17, p < .01, SEd = .03); there was no evidence of heterogeneity or publication bias across studies for these effect sizes. Although statistically significant, the effect sizes for gender differences in rumination were small in magnitude. Results are discussed with respect to the RST and gender differences in depression.     

Change in Seasonal Beliefs Mediates the Durability Advantage of Cognitive-Behavioral Therapy Over Light Therapy for Winter Depression

In treating an acute episode of winter depression, cognitive-behavioral therapy for seasonal affective disorder (CBT-SAD) and light therapy are comparably efficacious, with improvement in depression symptoms during CBT-SAD mediated by reduced seasonal beliefs (i.e., maladaptive thoughts about the seasons, light availability, and weather). Here, we tested whether the enduring benefit of CBT-SAD over light therapy following treatment is associated with offsetting seasonal beliefs during CBT-SAD. Currently depressed adults with Major Depression, Recurrent with Seasonal Pattern (N = 177) were randomized to 6 weeks of light therapy or group CBT-SAD and followedup one and two winters after treatment. Outcomes measured during treatment and at each follow-up included depression symptoms on the Structured Clinical Interview for the Hamilton Rating Scale for Depression—SAD Version and Beck Depression Inventory—Second Edition. Candidate mediators measured at pre-, mid-, and posttreatment were SAD-specific negative cognitions (Seasonal Beliefs Questionnaire; SBQ); general depressogenic cognitions (Dysfunctional Attitudes Scale; DAS); brooding rumination (Ruminative Response Scale-Brooding subscale; RRS-B); and chronotype (Morningness-Eveningness Questionnaire; MEQ). Latent growth curve mediation models found a significant positive path from treatment group to the slope of SBQ during treatment, with CBT-SAD showing larger improvements in seasonal beliefs with overall change in seasonal beliefs in the medium-effect range, and significant positive paths from SBQ slope to depression scores at the first and second winter follow-ups, indicating greater change towards more flexible seasonal beliefs during active treatment was associated with less severe depression symptoms following treatment. Estimated indirect effects (treatment group → SBQ change * SBQ change → outcome) were also significant at each follow-up for each outcome with β_indirect ranging from .091 to .162. Models also found significant positive paths from treatment group to the slope of MEQ and RRS-B during treatment, with light therapy showing a greater increase in “morningness” and CBT-SAD showing a greater decrease in brooding during active treatment; however, neither construct emerged as a mediator of follow-up depression scores. Change in seasonal beliefs during treatment mediates both the acute antidepressant and long-term effects of CBT-SAD and explains lower depression severity following CBT-SAD relative to light therapy.     

The Role of Metacognition in Self-Critical Rumination: An Investigation in Individuals Presenting with Low Self-Esteem

No research, to date, has directly investigated the role of metacognition in self-critical rumination and low self-esteem. The aims of this study are: to investigate the presence of metacognitive beliefs about self-critical rumination; the goal of self-critical rumination and its stop signal; and the degree of detachment from intrusive self-critical thoughts. Ten individuals reporting both a self-acknowledged tendency to judge themselves critically and having low self-esteem were assessed using metacognitive profiling, a semi-structured interview. All participants endorsed both positive and negative metacognitive beliefs about self-critical rumination. Positive metacognitive beliefs concerned the usefulness of self-critical rumination as a means of improving cognitive performance and enhancing motivation. Negative metacognitive beliefs concerned the uncontrollability of self-critical rumination and its negative impact on mood, motivation and perception of self-worth. The primary goal of engaging in self-critical rumination was to achieve a better or clearer understanding of a given trigger situation or to feel more motivated to resolve it. However, only four participants were able to identify when this goal had been achieved, which was if the trigger situation were not to occur again. Participants unanimously stated that they were either unable to detach from their self-critical thoughts or could do so some of the time with varying degrees of success. More often than not, though, self-critical thoughts were viewed as facts, would rarely be seen as distorted or biased, and could take hours or days to dissipate. These findings provide preliminary evidence that specific facets of metacognition play a role in the escalation and perseveration of self-critical rumination.     

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.     

Trait mindfulness and attention to emotional information: An eye tracking study

Biased attention for emotional information is associated with the emotional disorders. Trait mindfulness is associated with lower depression and anxiety and with improved attentional control. Mindfulness is also related to lower levels of brooding rumination. The current study examined the association between trait mindfulness, brooding rumination, depressed and anxious state moods, and attention to emotional visual stimuli utilizing eye tracking methodology. Participants were 158 undergraduates. Trait mindfulness was negatively associated with attention to sad and threatening stimuli, but was not associated with attention to positive or neutral stimuli. There was an indirect effect of mindfulness on attention to sad stimuli through brooding rumination. Data are cross sectional but provide initial evidence that mindfulness may partially exert its effects on depression and anxiety by lessening attention to negatively-valenced stimuli.     

Role of anxiety and brooding in specificity of autobiographical recall

Overgeneral schemas and lack of autobiographical memory (AM) specificity about our past experiences can predict mood disturbance. Rumination, functional avoidance and executive processes are the main explanatory variables of such overgenerality. However, in non‐clinical samples, rumination predicts overgenerality most consistently after the induction of dysphoric mood. Anxiety also activates rumination. Furthermore, anxiety predicts memory performance and has effects on mood which are independent of the effects of rumination. So, what might be the role of anxiety in autobiographical memory performance? A sample of 210 voluntary participants reported measures of autobiographical memory, anxiety, rumination (brooding and reflection), functional avoidance and executive functions (semantic and phonetic verbal fluency task). Autobiographical performance (specificity) was negatively associated with brooding and age and positively with phonetic verbal fluency but not with functional avoidance and anxiety. However, anxiety and brooding were positively correlated even after controlling for depression scores. Moreover, using structural equation modeling, anxiety showed a significant indirect effect on autobiographical specificity through brooding rumination. These results suggest a possible association of anxiety with autobiographical recall through brooding rumination.     

Mood-as-input and depressive rumination

This article describes a test of mood-as-input theory predictions as applied to a rumination task in a nonclinical population. An experimenter-controlled interview was used to allow participants to reflect on a personal period of depression while in an experimentally-induced mood state (either negative or positive) or while deploying a specific stop rule for the task (either an “as many as can” or “feel like continuing” stop rule). As predicted by mood-as-input theory, persistence at the rumination task was greatest in the group experiencing negative mood while deploying an “as many as can” stop rule, and this suggests a mechanism that may contribute to perseverative depressive rumination. It is argued that the variables that contributed to perseveration in this study are already known to be characteristic of ruminative thinkers (e.g. negative mood and positive metacognitive beliefs about rumination that will command the deployment of “as many as can” stop rules for rumination). It is also argued that mood-as-input processes may provide a common mechanism for perseverative rumination and perseverative worry, and this common mechanism may account for many of the similarities between these two functionally-distinct activities.     

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.

     

Metacognitive therapy in recurrent depression: A case replication series in Denmark

Metacognitive therapy (MCT) for depression is derived from the Wells and Matthews (1994) self‐regulatory model, in which a Cognitive‐Attentional Syndrome (CAS) is the cause of psychological disorders. MCT for depression focuses on identifying patients' CAS and helps them to stop it. The CAS consists of worry, rumination and dysfunctional coping strategies. The focus in MCT is on removing the CAS by challenging positive and negative metacognitive beliefs and eliminating dysfunctional behaviors. In this case series, MCT was delivered to four depressed Danes and treatment was evaluated in 5–11 sessions of up to one hour each. An A‐B design with follow‐up at 3 and 6 months was conducted and the primary outcome was Beck's Depression Inventory II (BDI‐II). We measured CAS processes with the Major depressive Disorder Scale (MDD‐S). The results of the case series showed clinically significant improvements in depressive symptoms, rumination and metacognitive beliefs and the effects were still present at follow‐up for all patients. The small number of patients and decreasing baselines observed in some cases limits the conclusions. However, the results suggest that this treatment is feasible and was associated with large improvements in symptoms when delivered away from its point of origin and in a Danish help‐seeking sample.     

Brooding Rumination and Risk for Depressive Disorders in Children of Depressed Mothers

The goal of the current study was to examine the role of brooding rumination in children at risk for depression. We found that children of mothers with a history of major depression exhibited higher levels of brooding rumination than did children of mothers with no depression history. Examining potential mechanisms of this risk, we found no evidence for shared genetic influences (BDNF or 5-HTTLPR) or modeling of mothers’ rumination. However, we did find that children with a history of prior depressive disorders exhibited higher current levels of brooding rumination than children with no depression history. Importantly, children’s brooding predicted prospective onsets of new depressive episodes over a 20-month follow-up even when we statistically controlled for depressive symptom levels at the initial assessment, suggesting that the predictive effect of brooding rumination in children was not due simply to co-occurring depressive symptoms.     

Functional connectivity of reflective and brooding rumination in depressed and healthy women

Ruminative thinking is related to an increased risk for major depressive disorder (MDD) and perpetuates negative mood states. Rumination, uncontrollable negative thoughts about the self, may comprise both reflective and brooding components. However, only brooding rumination is consistently associated with increased negativity bias and negative coping styles, while reflective rumination has a less clear relationship with negative outcomes in healthy and depressed participants. The current study examined seed-to-voxel (S2.V) resting-state functional connectivity (FC) in a sample of healthy (HC) and depressed (MDD) adult women (HC: n=50, MDD: n=33). The S2V FC of six key brain regions, including the left and right amygdala, anterior and posterior cingulate cortex (ACC, PCC), and medial and dorsolateral prefrontal cortices (mPFC, dlPFC), was correlated with self-reported reflective and brooding rumination. Results indicate that HC and MDD participants had increased brooding rumination associated with decreased FC between the left amygdala and the right temporal pole. Moreover, reflective rumination was associated with distinct FC of the mPFC, PCC, and ACC with parietal, occipital, and cingulate regions. Depressed participants, compared with HC, exhibited decreased FC between the PCC and a region in the right middle frontal gyrus. The results of the current study add to the understanding of the neural underpinnings of different forms of self-related cognition—brooding and reflective rumination—in healthy and depressed women.     

Psychosocial correlates of depressive rumination

The study examined the relationship between brooding, the maladaptive sub-component of depressive rumination, an important cognitive mechanism implicated in the aetiology of depression, and a range of depressogenic psychosocial factors, including insecure attachment styles and maladaptive interpersonal behaviours. It was hypothesised that brooding (but not the more adaptive reflection component) is associated with an attachment pattern characterised by fear of rejection, and an interpersonal style characterised by submissiveness. Currently depressed (n = 29), previously depressed (n = 42) and never-depressed (n = 32) adults completed self-report measures assessing depressive symptoms, rumination (brooding and reflection), attachment orientation and maladaptive interpersonal behaviours. The study hypotheses were partially supported: After controlling for gender and depressive symptoms, brooding was significantly associated with one indicator of underlying rejection concerns (rejection sensitivity, p = .05), but was not associated with another indicator of underlying rejection concerns (anxious attachment style) or with avoidant attachment style. After controlling for depressive symptoms, brooding was uniquely associated with the submissive interpersonal style (p < .01). Brooding was not correlated with needy or cold interpersonal styles after controlling for depressive symptoms.     

Individual differences in anger and displaced aggression: The role of metacognitive beliefs and anger rumination

Metacognitive model is a theoretical approach aimed to explain emotion dysregulation and others emotion-related issues, such anger, and aggressive behavior. From this model, people having higher maladaptive metacognitive beliefs (e.g., “I can't control my thoughts”) are more likely to activate and maintain anger rumination and, in turn, to experience higher levels of anger and to act aggressively. Preliminary evidence shows the role of metacognitive beliefs on anger rumination and anger levels, whereas no studies have examined its association with aggressive behavior. This study first examined the associations between metacognitive beliefs, anger rumination, anger levels, and the propensity to engage in displaced aggression, and second, the mediation role of anger rumination in the relations among metacognitive beliefs and anger and displaced aggression. Participants were 947 students and non-students from general population recruited in two different countries (Australia and Spain). Correlational analyses revealed a similar pattern of results in the Australian and Spanish sample, with participants having dysfunctional metacognitive beliefs also showing higher anger rumination, higher levels of anger and a higher tendency to act aggressively. Structural equation analyses revealed the associations of metacognitive beliefs with anger levels and displaced aggression was fully mediated by anger rumination in both samples. These results suggest that metacognitive beliefs should be considered in comprehensive models and in the therapy of anger problems and aggression.     

Depressive Rumination and Co-Morbidity: Evidence for Brooding as a Transdiagnostic Process

A sample of 116 patients with unipolar mood disorders referred to a specialist research clinic were assessed to investigate (a) whether rumination is a transdiagnostic process that is related to co-morbid Axis I and II symptoms and diagnosis in depressed patients; (b) whether common findings in the depressive rumination literature could be replicated in a recurrent depressed sample. Consistent with the transdiagnostic hypothesis, rumination was positively associated with both depression and anxiety, brooding was related to co-morbid obsessive-compulsive disorder and generalized anxiety disorder, and rumination was associated with traits associated with borderline personality disorder, most notably self-report of unstable relationships and inconsistent sense of self. As predicted, rumination was equivalent in currently depressed and formerly depressed patients, suggesting that rumination is not simply dependent on mood state or clinical status. As predicted, the brooding subtype most strongly correlated with depressed and anxious symptoms, consistent with previous observations that brooding is the more maladaptive form of rumination. As predicted, rumination was associated with reports of sexual abuse. Inconsistent with previous findings, there was no gender difference in rumination.     

Rumination, experiential avoidance, and dysfunctional thinking in eating disorders

The majority of research in eating disorders (ED) has investigated the content of disorder-specific thoughts, while few studies have addressed underlying cognitive-affective processes. A better understanding of processes underpinning ED may have important implications for treatment development. Two studies were conducted that investigated levels of rumination, beliefs about rumination, experiential avoidance, and aspects of schematic thinking in individuals with eating pathology. The latter was assessed with a newly designed ED-Sentence Completion Task (ED-SCT). Study 1 (N = 177) examined relations between ED psychopathology and these variables in a student population. Extending this, Study 2 (N = 26) assessed differences between patients with anorexia nervosa and healthy control participants. The results showed that ED psychopathology was related to disorder-specific cognitions, experiential avoidance as well as ruminative brooding but not reflection. A follow-up of anorexia nervosa patients indicated that changes in ED psychopathology were associated with changes in dysfunctional attitudes and maladaptive cognitive-affective processes. These findings highlight cognitive processes that may play an important role in the maintenance of eating pathology.     

When thinking hurts: Attachment,rumination, and postrelationship adjustment

The current study used an attachment framework to explore postrelationship rumination and adjustment. Young adults (N= 231) involved in a romantic relationship that (a) was of 3 months duration or longer and (b) ended in the last 12 months participated in the study. The study assessed rumination generally (brooding, regret, and reflection), and specifically concerning the ended relationship (relationship preoccupation and romantic regret). At the general level, brooding and regret were associated with more negative adjustment, whereas reflection was associated with more positive adjustment. At the relationship level, both relationship preoccupation and romantic regret were associated with more negative adjustment. Models tested indicated that rumination largely mediated the association between attachment anxiety and adjustment.     

Anxiety,Depression, and Procrastination Among Students: Rumination Plays a Larger Mediating Role than Worry

Procrastination is prevalent among students and is associated with negative outcomes, including poor academic performance and psychological distress. Research also suggests that anxiety and depression can exacerbate procrastination; however, the mechanisms associated with the development of procrastination are less understood. The current study aimed to clarify the role of negative repetitive thought (i.e., rumination and worry) in the links between anxiety and procrastination, and depression and procrastination. Ninety-one undergraduate students completed self-report measures of anxiety, depression, worry, brooding rumination, and procrastination, and two multiple mediator models were tested. Procrastination was positively correlated with the study variables, including medium effects for anxiety and depression, a large effect for rumination, and a small effect for worry. Rumination independently mediated the relationships between anxiety and procrastination, and depression and procrastination. Worry did not independently mediate these relationships. The current findings suggest rumination plays a larger role in the links between anxiety, depression, and procrastination than worry. Thus, students with higher levels of anxiety and depression engage in more negative repetitive thought, which may contribute to procrastinatory behavior as a result of a preoccupation with depressing or painful thoughts about the past.     

Rumination is characterized by valence-specific impairments in switching of attention

The ability to flexibly switch attention between emotional and non-emotional information in working memory is considered important in stress-resilience and is impaired in mood disorders. A recent theory claims that this component of attention is specifically related to ruminative thought. To further investigate this claim we report two new experiments using the internal shift task (IST). In Experiment 1 (N = 27) we examined the stability of switching ability measured using the IST through examination of internal consistency (stability within the task) and test–retest-reliability (stability over time) over two weeks. Results indicate relatively high stability of switching ability measured with the IST. In Experiment 2 the IST was administered to a pre-selected undergraduate sample of high (N = 20) and low ruminators (N = 20). The main findings were that rumination was related to attentional switching impairments, specifically in the context of emotional information. The switching impairments were most pronounced when negative information was held in working memory. The attentional switching impairments were most strongly related to the depressive brooding component of rumination. The results of this study lend further support to the proposed link between rumination and switching abilities.     

The distressed (Type D) and Five-Factor Models of personality in young,healthy adults and their association with emotional inhibition and distress

The distressed (Type D) personality (the combination of negative affectivity and social inhibition traits) has been associated with adverse health outcomes. This study investigated the validity of the Type D construct against the Five-Factor Model (FFM) of personality, and its association with emotional control and distress. In total 498 university students (mean age 28.9 ± 8.4 years) completed the Type D scale (DS14), and measurements for the FFM of personality, emotional control, anxiety, depression and stress. The construct validity of the Icelandic DS14 was confirmed. The Type D components negative affectivity and social inhibition were strongly associated with neuroticism and extraversion of the FFM (r = 0.82 and r = −0.67, respectively). Negative affectivity also correlated with rehearsal/rumination (r = 0.58) and social inhibition with emotional inhibition (r = 0.54), indicative of emotional control. Type D personality (40% of sample) was associated with higher levels of anxiety, depression and stress. The Type D personality components were associated with the FFM of personality, emotional control and emotional distress. Importantly, social and emotional inhibition were closely related, providing novel information about the presence of emotional inhibition within the social inhibition trait.