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.     

The coupling of short sleep duration and high sleep need predicts riskier decision making

Abstract

Objective: To examine how risk-related decision making might be associated with habitual sleep variables, including sleep variability, sleep duration and perceived sleep need in young adults cross-sectionally and longitudinally.

Design: 166 participants completed a 7-day protocol with sleep and risk-related decision-making measures at baseline (T1) and 12 months later (T2).

Results: Habitual short sleep duration (averaging < 6?h nightly) was identified in 11.0% in our sample. After controlling for baseline demographic factors and risk-taking measures, self-reported sleep need at T1 interacted with habitual short sleep in predicting risk taking at follow-up (F_8,139=9.575, adjusted R²=.431, p<.001). T1 greater perceived sleep need predicted more risk taking among short sleepers, but decreased risk taking among normal sleepers at T2. Variable sleep timing was cross-sectionally correlated with making more Risky choices at baseline and fewer Safe choices after loss at follow up.

Conclusions: Young adults with variable sleep timing and those with short sleep duration coupled with high perceived sleep need were more likely to take risks. The moderating effects of perceived sleep need suggest that individual differences may alter the impact of sleep loss and hence should be measured and accounted for in future studies.     

Subjective age and sleep in middle-aged and older adults

Objective: Chronological age is commonly used to explain change in sleep. The present study examines whether subjective age is associated with change in sleep difficulties across middle adulthood and old age.

Design: Participants were drawn from the second (2004–2005) and third (2013–2014) waves of the Midlife in the United States Survey (MIDUS, N = 2350; Mean Age: 55.54 years), the 2008 and 2014 waves of the Health and Retirement Study (HRS, N = 4066; Mean Age: 67.59 years) and the first (2011) and fourth (2014) waves of the National Health and Aging Trends Survey (NHATS, N = 3541; Mean Age: 76.46). In each sample, subjective age, sleep difficulties, depressive symptoms, anxiety and chronic conditions were assessed at baseline. Sleep difficulties was assessed again at follow-up.

Main outcome measures: Sleep difficulties.

Results: An older subjective age at baseline was related to an increase in sleep difficulties over time in the three samples, and was mediated, in part, through more depressive symptoms, anxiety and chronic conditions. Feeling older was associated with an increased likelihood of major sleeping difficulties at follow-up in the three samples.

Conclusion: Subjective age is a salient marker of individuals’ at risk for poor sleep quality, beyond chronological age.     

Anxiety sensitivity and daily cigarette smoking in relation to sleep disturbances in treatment-seeking smokers

ABSTRACT

Although the association between anxiety and sleep disturbance is well-documented, the underlying mechanisms are less clear. Anxiety sensitivity (AS), the fear of physiological arousal and bodily sensations, is a risk factor for anxiety and poor sleep. Smoking also contributes to poor sleep and may compound the effects of AS on sleep quality. This study evaluated the main and interactive effects of AS and cigarettes/day on sleep quality among smokers. Participants (n = 190) were adult treatment-seeking daily smokers who completed a baseline assessment as part of a larger smoking cessation trial. Sleep quality was self-reported. Results indicated that AS was significantly correlated with greater disturbance in sleep duration, subjective sleep quality, sleep onset latency, sleep disturbance, daytime dysfunction, and sleep medication use. There was a significant interaction between AS and cigarettes/day in terms of sleep onset latency, but not other sleep quality indices. AS was associated with significantly longer sleep onset latency minutes among heavier smokers, but not lighter smokers. Specifically, the association between AS and sleep onset latency was significant for those who smoked ≥ 33 cigarettes/day. AS is a psychological factor that may contribute to poor sleep quality, especially in heavy smokers, and thus may be a promising intervention target.     

Emotion regulation mediates the relationship between personality and sleep quality

Objective: Despite a long history of interest in personality as well as in the mechanisms that regulate sleep, the relationship between personality and sleep is not yet well understood. The purpose of this study was to explore how personality affects sleep.

Design: The present cross-sectional study, based on a sample of 1291 participants with a mean age of 31.16 years (SD = 12.77), investigates the impact of personality styles, assessed by the Personality Adjectives Checklist (PACL), on subjective sleep quality, as well as the possible mediation of this relationship by dispositional emotion regulation (ER) styles.

Results: The dispositional use of suppression was a quite consistent predictor of poor subjective sleep quality for individuals scoring high on Confident, Cooperative or Introversive personality traits, but low on Respectful personality traits. Although a positive relationship between reappraisal and subjective sleep quality was found, there was only little evidence for a relationship between the assessed personality styles and the use of cognitive reappraisal.

Conclusion: The present results indicate that in the evaluation of subjective sleep, the impact of personality and ER processes, such as emotion suppression, should be taken into account.     

Personality,hedonic balance and the quality and quantity of sleep in adulthood

Objective: Sufficient and good-quality sleep is important for individual functioning. This study explored associations between personality and sleep duration and sleep quality in adulthood. The mediating role of hedonic balance and the moderating roles of age and sex were also explored.

Method: A nationally representative sample of Australian adults (n = 14,065; M_age = 44.4 years; 53.1% women) completed self-report measures of personality, sleep, hedonic balance and demographic variables (e.g. health status, employment status) in late 2013.

Results: After controlling for demographic variables, we found that high neuroticism was associated with poorer sleep quality, and both long and short sleep durations (a curvilinear relationship). Small effects were also observed relating high extraversion and low openness to better sleep quality. Hedonic balance mediated all linear and non-linear associations between personality and sleep. Additional moderator analyses showed that high openness was more strongly related to poor sleep quality among men and young adults. High neuroticism was more strongly related to poor sleep quality among men.

Conclusion: Findings indicate that personality is important for sleep in adulthood and that hedonic balance features a prominent role in this association.     

‘I feel better when…’: An analysis of the memory-experience gap for peoples’ estimates of the relationship between health behaviours and experiences

Objective: People often overestimate how strongly behaviours and experiences are related. This memory-experience gap might have important implications for health care settings, which often require people to estimate associations, such as “my mood is better when I exercise”. This study examines how subjective correlation estimates between health behaviours and experiences relate to calculated correlations from online reports and whether subjective estimates are associated with engagement in actual health behaviour.

Design: Seven-month online study on physical activity, sleep, affect and stress, with 61 online assessments.

Main Outcome Measures: University students (N = 168) retrospectively estimated correlations between physical activity, sleep, positive affect and stress over the seven-month study period.

Results: Correlations between experiences and behaviours (online data) were small (r = ?.12–.14), estimated correlations moderate (r = ?.35–.24). Correspondence between calculated and estimated correlations was low. Importantly, estimated correlations of physical activity with stress, positive affect and sleep were associated with actual engagement in physical activity.

Conclusion: Estimation accuracy of relations between health behaviours and experiences is low. However, association estimates could be an important predictor of actual health behaviours. This study identifies and quantifies estimation inaccuracies in health behaviours and points towards potential systematic biases in health settings, which might seriously impair intervention efficacy.     

Can self-compassion improve sleep quality via reduced rumination?

ABSTRACT

Poor sleep quality is highly prevalent in modern societies and can be associated with a multitude of problems for individuals and organizations, and also for society at large. Thus, there is a demand for efficient treatments. We suggest that short self-compassion interventions will improve sleep quality via reducing ruminative thoughts, a key variable associated with poor sleep quality. We ran three studies to test this hypothesis. In Study 1 (correlational data), a positive relationship between self-compassion and sleep quality emerged in students’ self-reports. This effect was mediated by rumination. In Study 2, students in two different self-compassion intervention conditions reported higher sleep quality compared to a control condition. Again, rumination mediated this effect. In Study 3, patients with major depressive disorder reported a significant increase in sleep quality and a significant decrease of ruminative thoughts after one week in a daily self-compassion intervention (compared to patients in a control condition). Limitations and implications for future research, such as the need of placebo control groups, objective sleep quality measures, and person–intervention fit designs are discussed.     

Exploring the associations shared by mood,pain-related attention and pain outcomes related to sleep disturbance in a chronic pain sample

Objective: Sleep disturbance in chronic pain is common, occurring in two-thirds of patients. There is a complex relationship between chronic pain and sleep; pain can disrupt sleep and poor sleep can exaggerate pain intensity. This may have an impact on both depressive symptoms and attention to pain. This study aims to evaluate the relationship between chronic pain and sleep, and the role of mood and attention.

Methods: Chronic pain patients, recruited from a secondary care outpatient clinic, completed self-report measures of pain, sleep, depressive symptoms and attention to pain. Hierarchical regression and structural equation modelling were used to explore the relationships between these measures. Participants (n = 221) were aged between 20 and 84 (mean = 52) years.

Results: The majority of participants were found to be ‘poor sleepers’ (86%) with increased pain severity, depressive symptoms and attention to pain. Both analytical approaches indicated that sleep disturbance is indirectly associated with increased pain severity Instead the relationship shared by sleep disturbance and pain severity was further associated with depressive symptoms and attention to pain.

Conclusions: Our results indicate that sleep disturbance may contribute to clinical pain severity indirectly though changes in mood and attention. Prospective studies exploring lagged associations between these constructs could have critical information relevant to the treatment of chronic pain.     

The effect of rebranding generic medicines on drug efficacy and side effects

Objectives: Subjective age is an important correlate of health, well-being, and longevity. So far, little is known about short-term variability in subjective age and the circumstances under which individuals feel younger/older in daily life. This study examined whether (a) older adults’ felt age fluctuates on a day-to-day basis, (b) daily changes in health, stressors, and affect explain fluctuations in felt age, and (c) the daily associations between felt age and health, stressors, or affect are time-ordered.

Method: Using an eight-day daily diary approach, N = 43 adults (60–96 years, M = 74.65, SD = 8.19) filled out daily questionnaires assessing subjective age, health, daily stressors, and affect. Data were analysed using multilevel modelling.

Main outcome measures: Subjective age, health, daily stressors, affect.

Results: Intra-individual variability in felt age was not explained by time but by short-term variability in other variables. Specifically, on days when participants experienced more than average health problems, stress, or negative affect they felt older than on days with average health, stress, or negative affect. No time-ordered effects were found.

Conclusion: Bad health, many stressors, and negative affective experiences constitute circumstances under which older adults feel older than they typically do. Thus, daily measures of subjective age could be markers of health and well-being.     

The relationship among resilience,rumination and posttraumatic growth in hemodialysis patients in North China

Research has indicated that clinical serious disease may lead to posttraumatic growth (PTG). However, little is known about PTG among hemodialysis (HD) patients. The study examined the relationship among resilience, rumination and PTG among Chinese HD patients. 196 HD patients were recruited from a tertiary hospital in a Northern city of China between 1 June 2015 and 30 May 2016. Patients were surveyed using the Posttraumatic Growth Inventory-Chinese version, Connor-Davidson Resilience Scale, and Chinese Event Related Rumination Inventory. Correlation analyses showed that resilience was most highly positively correlated with PTG (r = .70, p < .001), deliberate rumination moderately correlated to PTG (r = .50, p < .001), and intrusive rumination was lower negatively related to PTG (r = –.26, p < .001). Regression analyses showed that age, gender, duration of dialysis, resilience and deliberate rumination had significant associations with PTG (β = ?.31, p ＜ .0001; β = –.14, p = .002; β = .10, p = .032; β = .44, p < .001; β = .20, p < .001). They together explained 65% of the total variance in PTG (F [8,195] = 46.74, p < .001). However, intrusive rumination was not associated with PTG (p > .05). The results suggested that resilience and deliberate rumination may be instrumental for PTG improvement.     

How do Rumination and Social Problem Solving Intensify Depression? A Longitudinal Study

In order to examine how rumination and social problem solving intensify depression, the present study investigated longitudinal associations among each dimension of rumination and social problem solving and evaluated aspects of these constructs that predicted subsequent depression. A three-wave longitudinal study, with an interval of 4 weeks between waves, was conducted. Japanese university students completed the Beck Depression Inventory-Second Edition, Ruminative Responses Scale, Social Problem-Solving Inventory-Revised Short Version, and Interpersonal Stress Event Scale on three occasions 4 weeks apart (n = 284 at Time 1, 198 at Time 2, 165 at Time 3). Linear mixed models were analyzed to test whether each variable predicted subsequent depression, rumination, and each dimension of social problem solving. Rumination and negative problem orientation demonstrated a mutually enhancing relationship. Because these two variables were not associated with interpersonal conflict during the subsequent 4 weeks, rumination and negative problem orientation appear to strengthen each other without environmental change. Rumination and impulsivity/carelessness style were associated with subsequent depressive symptoms, after controlling for the effect of initial depression. Because rumination and impulsivity/carelessness style were not concurrently and longitudinally associated with each other, rumination and impulsive/careless problem solving style appear to be independent processes that serve to intensify depression.     

Daily and trait rumination: diurnal cortisol patterns in adolescent girls

Rumination is a maladaptive form of emotion regulation associated with psychopathology. Research with adults suggests that rumination covaries with diurnal cortisol rhythms, yet this has not been examined among adolescents. Here, we examine the day-to-day covariation between rumination and cortisol, and explore whether trait rumination is associated with alterations in diurnal cortisol rhythms among adolescent girls. Participants (N?=?122) provided saliva samples 3 times per day over 3 days, along with daily reports of stress and rumination, questionnaires assessing trait rumination related to peer stress, and diagnostic interviews assessing depression and anxiety. Greater rumination than usual during the day was associated with lower cortisol awakening responses the following morning, but this effect was not significant after accounting for wake time and an objective measure of adherence to the saliva sampling protocol. Trait rumination was associated with lower average cortisol levels at waking and flatter diurnal slopes, accounting for wake time, protocol compliance, and other factors. These patterns may help to explain why rumination is related to the development of psychopathology.     

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.     

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.     

Rumination in migraine: Mediating effects of brooding and reflection between migraine and psychological distress

Objective: The relationship between migraine and psychological distress has been consistently reported in cross-sectional and longitudinal studies. We hypothesised that a stable tendency to perseverative thoughts such as rumination would mediate the relationship between migraine and psychological distress.

Design and Main Outcomes Measures: Self-report questionnaires measuring depressive rumination, current psychological distress and migraine symptoms in two independent European population cohorts, recruited from Budapest (N = 1139) and Manchester (N = 2004), were used. Structural regression analysis within structural equation modelling was applied to test the mediational role of brooding and reflection, the components of rumination, between migraine and psychological distress. Sex, age and lifetime depression were controlled for in the analysis.

Results: Migraine predicted higher brooding and reflection scores, and brooding proved to be a mediator between migraine and psychological distress in both samples, while reflection mediated the relationship significantly only in the Budapest sample.

Conclusions: Elevated psychological distress in migraine is partially attributed to ruminative response style. Further studies are needed to expand our findings to clinical samples and to examine how rumination links to the adjustment to migraine.     

Effects of a prevention program for divorced families on youth cortisol reactivity 15 years later

Objective: We examined whether an empirically based, randomised controlled trial of a preventive intervention for divorced mothers and children had a long-term impact on offspring cortisol regulation.

Design: Divorced mothers and children (age 9–12) were randomly assigned to a literature control condition or the 11-week New Beginnings Program, a family-focused group preventive intervention for mothers and children in newly divorced families.

Main Outcome Measures: Fifteen years after the trial, offspring salivary cortisol (n = 161) was measured before and after a social stress task.

Results: Multilevel mixed models were used to predict cortisol from internalizing symptoms, externalizing symptoms, group assignment and potential moderators of intervention effects. Across the sample, higher externalizing symptoms were associated with lower cortisol reactivity. There was a significant group-by-age interaction such that older offspring in the control group had higher reactivity relative to the intervention group, and younger offspring in the control group exhibited a decline across the task relative to younger offspring in the intervention group.

Conclusions: Preventive interventions for youth from divorced families may have a long-term impact on cortisol reactivity to stress. Results highlight the importance of examining moderators of program effects.     

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.     

Assessing the effect of a Cognitive Behaviour Therapy (CBT)-based workshop on work-related rumination,fatigue, and sleep

This quasi-experimental longitudinal study assessed the effect of a one-day Cognitive Behaviour Therapy (CBT)-based workshop on work-related rumination, chronic fatigue, and sleep quality. We hypothesized that participants who attended the workshop would report lower levels of affective work-related rumination, chronic fatigue, and improved sleep quality, at follow-up, 6 months after workshop completion. Two hundred and twenty-seven participants took part in the study, with 102 participants attending a one-day workshop delivered in their workplace. Participants completed an online questionnaire at two time-points, with follow-up occurring 6 months after initial survey completion. Results showed that participants who took part in the CBT workshop reported significantly lower levels of affective rumination (p = .03) and chronic fatigue (p = .003), at follow-up in comparison with individuals who did not attend the workshop; however, there were no significant differences between the groups in self-reported sleep quality (p = .06). A combination of more effective recovery both at work and outside of work may explain the reductions in both affective rumination and fatigue over time. This study adds to the recovery from work literature by providing initial support for a one-day CBT-based workshop delivered in the workplace.     

The effects of daily co-occurrence of affect on older adults’ reactivity to health stressors

Objectives: The present study examined age differences among older adults in the daily co-occurrence of affect and its potential role in buffering the negative effects of health stressors.

Design: Participants were from the Veterans Affairs Normative Aging Study and included 249 young-old adults (age = 60–79 years, M = 71.6) and 64 old-old adults (age = 80–89, M = 82.9) who completed questionnaires assessing stressors, physical health symptoms, and positive and negative affect for eight consecutive days.

Results: An independent samples t-test showed young-old and old-old adults did not significantly differ in their mean levels of daily co-occurrence of affect. The between-person relationships among stressors, health and daily co-occurrence of affect revealed that neither stressors nor health were significantly related to daily co-occurrence of affect. However, results from a multilevel model revealed a three-way cross-level interaction (health stressor × age group × co-occurrence of affect) where old-old adults with higher levels of co-occurrence of affect were less emotionally reactive to health stressors than young-old adults.

Conclusion: These findings provide support for the assertion that co-occurrence of affect functions in an adaptive capacity and highlight the importance of examining domain-specific stressors.