Rumination and Related Constructs

Causes, Consequences, and Treatment of Thinking Too Much

Ashley Borders

• Publisher: Academic Press
• Year: 2020
• ISBN:
  9780128126318
• Topic: Psicologia
• Subtopic: Psicologia clinica

Rumination and Related Constructs: Causes, Consequences, and Treatment of Thinking Too Much synthesizes existing research relating to rumination. Integrating research and theories from clinical, social, cognitive, and health psychology, it features empirical findings related to why people ruminate, as well as treatments that decrease rumination. The book applies a transdiagnostic approach, looking beyond just depression to emphasize the wide range of clinical outcomes associated with repetitive thought. The book additionally describes research on physiological reactivity to rumination, the expression of rumination, potential benefits of rumination, and much more.

• Summarizes research on the emotional, behavioral, and physical consequences of rumination
• Discusses rumination in conjunction with different psychological disorders
• Integrates existing theories about rumination
• Identifies triggers and personality traits that influence whether people ruminate
• Explores cognitive and neural correlates of rumination
• Reviews established treatments for rumination

Section 1

Consequences of rumination

Outline

• Chapter 1 Rumination and mood disorders
• Chapter 2 Rumination and anxiety-related disorders
• Chapter 3 Rumination, anger, and aggression
• Chapter 4 Rumination and dysregulated behaviors
• Chapter 5 Rumination and physical functioning
• Chapter 6 Consequences of expressed rumination

Chapter 1

Rumination and mood disorders

Abstract

This chapter reviews the literature on depressive rumination, or repetitive thinking about the nature, causes, and consequences of depressive symptoms. After describing the development of this construct and the associated response styles theory, I review the empirical evidence linking depressive rumination to maintained or exacerbated sad mood and depressive symptoms. I then explore empirical evidence for the proposed mechanisms of depressive rumination: negative thinking, impaired problem-solving, behavioral avoidance, and poor social support. After an examination of the nascent field of rumination and bipolar disorder, I explore research on gender differences in depressive rumination. The chapter ends with a discussion of moderators of depressive rumination and a proposed theory that integrates the rumination literature with other known predictors of depression.

Keywords

Rumination; depression; response styles theory; bipolar; gender differences; mechanisms; moderators

Overview

This chapter reviews the literature on depressive rumination, or repetitive thinking about the nature, causes, and consequences of depressive symptoms. After describing the development of this construct and the associated response styles theory, I review the empirical evidence linking depressive rumination to maintained or exacerbated sad mood and depressive symptoms. I then explore empirical evidence for the proposed mechanisms of depressive rumination: negative thinking, impaired problem-solving, behavioral avoidance, and poor social support. After an examination of the nascent field of rumination and bipolar disorder, I explore research on gender differences in depressive rumination. The chapter ends with a discussion of moderators of depressive rumination and a proposed theory that integrates the rumination literature with other known predictors of depression.

Ann was a client of mine for almost 2 years. She came to therapy a year after the death of her husband of 47 years. Now 69, she had never lived on her own and felt scared and adrift. She cried often, slept poorly, and had trouble finding the energy to do much of anything. She used to be a painter but seemed to have lost interest in what was once a great passion. Ann and her husband had no children, and she had not returned friends’ calls for a while, so no one checked in on her regularly. Early in our getting to know each other, she shared that she had birthed a son before her marriage but had given him up for adoption. She now found herself constantly wondering about her son and regretting that hasty decision of her 19-year-old self. When Ann was 16 years old, her mother had been accidentally shot and killed by her father during one of their regular shouting matches. Soon after, Ann left her home in Missouri and moved to Los Angeles, trying to escape her grief by losing herself in the excitement of a Hollywood life. Now, however, she found herself reliving that horrible episode, longing for her mother, and feeling guilty for leaving behind her younger sister.

Cognitive theories propose that the content of people’s thoughts contribute to depressive symptoms. For instance, Beck (1967) noted that depressed people have excessively negative views of themselves, others, and the future. These negative beliefs are usually not accurate but contribute to people feeling hopeless and helpless. Beck also proposed that everyone has deeply held and often unconscious core beliefs about themselves and the world. These core beliefs, or schemas, often originate in childhood and are shaped by important people and/or life events. Thus, her parents’ frequent arguments about their children and her mother’s sudden death may have contributed to Ann’s core beliefs that she was defective and that support and love from others was fleeting and unreliable. Negative schemas like this make people more vulnerable to depression if and when they later encounter negative life events that activate relevant schemas. The activated schemas then serve as filters through which people perceive the world. For Ann, the death of her husband activated her negative schemas, which in turn colored the way she perceived events in her life. For instance, her observation that few friends called her triggered automatic thoughts that she was unlovable, rather than the more accurate conclusion that they might think she wanted to be left alone.

This cognitive theory of depression has been expanded over the years, and many other types of unhelpful thoughts have been identified, but the basic premise remains the same: the specific content of thoughts that arise in response to negative life events explains the onset and maintenance of depression. There is, however, a second group of cognitive models. These models focus less on the content of thought and more on the process of turning attention inward—a construct called self-focused attention.

Beginning in the early 1970s, researchers began conceptualizing self-focused attention as part of a self-evaluative process in which individuals compare their current and desired states (Duval & Wicklund, 1972). Immediately after a negative event, people automatically increase their self-focus and focus on the discrepancy between current and desired states, presumably in order to understand what went wrong and to try to feel better. This is a natural part of self-regulation, or coping (Carver & Scheier, 1998). In healthy functioning individuals, this self-focus should lead to better understanding and emotion modulation, and perhaps even to behavior change. With the passage of time, therefore, the need for self-focused attention decreases in non-depressed individuals. Another way to think of it is as a negative feedback loop: an undesired event triggers the mind to start paying attention more closely to one’s feelings and thoughts. Ideally, this attention leads to successful regulation, which in turn shuts down the self-focused attention.

However, inward self-focus also elicits negative emotions, particularly when a negative discrepancy exists and when one fails to resolve such a discrepancy. When unresolvable discrepancies occur (e.g., the death of Anne’s husband), the adaptive response might be to avoid further self-focus and move on to alternative goals (e.g., finding new friends). In some instances, however, individuals are unwilling or unable to move on and continue focusing their attention internally. This sustained self-focused attention intensifies negative affect and self-criticism, leading to depression (Pyszczynski & Greenberg, 1987). Once in a depressed mood, people may develop a depressive self-focusing style, in which their default mode is inward focus. These individuals now have a faulty negative feedback loop, in which self-focus is never turned off, even when the situation demands attention elsewhere (Ingram, 1990). In Anne’s case, the self-focused attention triggered by the death of her husband contributed to her sustained depressed mood, which in turn elicited more self-focused attention. And now she focused not only on this one negative incident but other negative experiences in her past. She was stuck in a repetitive, internally-focused thought process—in essence, trapped in her own mind.

In sum, two fairly separate cognitive theories proposed that specific types of thought content and the degree to which people engage in an internal attentional process contribute to depression (Robinson & Alloy, 2003). Susan Nolen-Hoeksema proposed and spent years developing a theory that integrated these two cognitive approaches (Nolen-Hoeksema, 1991; Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008). Her definition of depressive rumination combines negative thought content and sustained self-focus.

Response styles theory: definitions and measurement

Interestingly, the impetus for response styles theory (RST) was not merging two separate cognitive theories of depression, but rather explaining gender differences in the prevalence of depression. After reviewing and refuting other proposed explanations (e.g., genetics, hormones, and sex roles) for why women are diagnosed with depression twice as often as men, Nolen-Hoeksema (1987) argued that women and men have different ways of responding to, or coping with, depressed moods. Her basic hypothesis was that women are more likely to engage in a passive, ruminative response style—whereas men are more likely to engage in an active, distracting response style—when experiencing a sad mood. A ruminative response style amplifies and prolongs transient sad moods, making a longer depressive episode more likely. By contrast, engaging in distracting activities dampens and shortens depressed mood.

As evidence for gender differences in response styles, Nolen-Hoeksema (1987) presented college students with a list of things people do when depressed and asked them to rate how likely they would be to engage in each of the activities. Men scored significantly higher than women on “I avoid thinking of reasons why I’m depressed,” “I do something physical,” “I play a sport,” and “I take drugs”—all activities that distract individuals from sad moods. Women, on the other hand, scored significantly higher on “I try to determine why I’m depressed,” “I talk to other people about my feelings,” and “I cry to relieve the tension”—responses that focus and maintain attention to sad mood.

Building on these results, Nolen-Hoeksema (1991) defined depressive rumination as passive and repetitive thoughts that focus one’s attention on the symptoms, causes, and consequences of depression. She acknowledged that the content of depressive rumination may resemble the negative thoughts that Beck and other cognitive psychologists identified. However, the style, or process, of repetitive thinking makes this construct unique. Similar to rigid self-focused attention, rumination focuses individuals’ attention on their emotional state and therefore inhibits actions or thoughts that might be more adaptive. Unlike theories of self-focused attention, however, Nolen-Hoeksema argued that depressive rumination does not have to be preceded by a negative life event—because sometimes depressed moods do not have a clear triggering cause. Instead, depressive rumination focuses attention on a negative emotional state. She also argued that self-focused attention was conceptualized as an automatic response, whereas depressive rumination is a purposeful coping effort.

In contrast to rumination, distraction involves purposefully turning attention away from depressi...