Rumination, post-traumatic growth and distress: Structural equation modelling with cancer survivors

Abstract

Objective: Theoretical models of post-traumatic growth (PTG) have been derived in the general trauma literature to describe the post-trauma experience that facilitates the perception of positive life changes. To develop a statistical model identifying factors that are associated with PTG, structural equation modelling (SEM) was used in the current study to assess the relationships between perception of diagnosis severity, rumination, social support, distress, and PTG.
Method: A statistical model of PTG was tested in a sample of participants diagnosed with a variety of cancers (N5313).
Results: An initial principal components analysis of the measure used to assess rumination revealed three components: intrusive rumination, deliberate rumination of benefits, and life purpose rumination. SEM results indicated that the model fit the data well and that 30% of the variance in PTG was explained by the variables. Trauma severity was directly related to distress, but not to PTG. Deliberately ruminating on benefits and social support were directly related to PTG. Life purpose rumination and intrusive rumination were associated with distress.
Conclusions: The model showed that in addition to having unique correlating factors, distress was not related to PTG, thereby providing support for the notion that these are discrete constructs in the post-diagnosis experience. The statistical model provides support that postdiagnosis experience is simultaneously shaped by positive and negative life changes and that one or the other outcome may be prevalent or may occur concurrently. As such, an implication for practice is the need for supportive care that is holistic in nature.

Morris, B. A., & Shakespeare-Finch, J. (2010). Rumination, post-traumatic growth and distress: Structural equation modelling with cancer survivors. [Electronic version]. Psycho-Oncology.

Trait-impulsivity moderates the relationship between rumination and number of major depressive episodes among cigarette smokers

Abstract

Background Despite the high prevalence of major depression among cigarette smokers, little is known about biobehavioural mechanisms that increase smoker's susceptibility to depression.

Aims The present study examined whether trait-impulsivity would moderate the relationship between rumination and number of past major depressive episodes (MDEs) among smokers (N=128).

Method Data were derived from baseline screening questionnaires and structured diagnostic interviews of two studies examining emotional responses of smokers with a history of major depression compared with smokers without depression histories.

Results As predicted, the interaction betwen rumination and trait-impulsivity was a significant predictor of MDE recurrence (beta= 0.408, p = .oo6, R2 change = 0.104) but not among those with low levels of impuslivity (beta = 0.203, p = 0.126, R2 change = 0.028).

Conclusions High levels of trait-impulsivity may increase vulnerability to rumination and MDE recurrence among smokers, potentially facilitating the likelihood of experiencing clinically revelant depressogenic consequences (e.g. suicidal ideation and behaviour).

McChargue, D. E., Drevo, S., Herrera, M. J., Doran, N., Salvi, S., & Klanecy, A. K. (2011). trait-impulsivity moderates the relationship between rumination and number of major depressive episodes among cigarette smokers, Mental Health and Substamce Use, 4, 96-104.

Maladaptive perfectionism, depression and rumination

Harris, P. W., Pepper, C. M., & Maack, D. J. (2008). The relationship between maladaptive perfectionism and depressive symptoms: The mediating role of rumination. Personality and Individual Differences,44, 150–160.

Abstract

Maladaptive perfectionism is associated with both rumination and depressive symptoms (Frost, Marten, Lahart, & Rosenblate, 1990). In the current study we tested whether rumination, as well as the rumination components of reflective pondering and brooding, mediates the relationship between maladaptive perfectionism and depressive symptoms. College students (N = 96) completed the Multidimensional Perfectionism Scale-Frost (Frost et al., 1990) and retrospectively reported levels of rumination on the Response Styles Questionnaire (Nolen-Hoeksema, 1991) and depressive symptoms on the Beck Depression Inventory II (Beck, Steer, & Brown, 1996) following a disappointing exam. Consistent with our model, rumination mediated the relationship between maladaptive perfectionism and depressive symptoms. Brooding, a component of rumination, also mediated this relationship whereas reflective pondering was a partial mediator. Results support a model whereby students who score high on maladaptive perfectionism report higher depressive symptoms through a mechanism of rumination.

Adaptive and maladaptive rumination

Joormann, J., Dkane, M., & Gotlib, I. H. (2006). Adaptive and maladaptive components of rumination? Diagnostic specificity and relation to depressive biases. Behavior Therapy, 37, 269–280.

Abstract

The present study investigated the validity of the two-factor solution of items selected from the Rumination Scale of the Response Style Questionnaire proposed by Treynor, Gonzalez, and Nolen-Hoeksema (2003). In the first part of this study we used samples of currently depressed (MDD), formerly depressed (FD), socially anxious (SP), and healthy control participants to examine whether the brooding and reflective pondering components differentiate participants with an anxiety disorder from participants with depression. In the second part of this study we examined whether these components of rumination were differentially related to cognitive biases in depression. Overall, the MDD group exhibited higher brooding scores than did all other groups; SP and FD groups did not differ from each other but obtained higher brooding scores than did the control participants. Only the MDD and the control groups differed on the reflective pondering factor. Importantly, brooding and reflective pondering were differentially related to cognitive biases. Specifically, the correlation between brooding/reflective pondering and memory bias was not significant when depressive symptoms were partialed out. The correlation between brooding and attentional bias for sad faces, however, remained significant even when current depressive symptoms were taken into account. In sum, our results support the formulation that rumination is composed of an adaptive reflective pondering factor and a maladaptive brooding factor.

Rumination and distraction

Trask, P. C., & Sigmon, S. T. (1999). Ruminating and distracting: The effects of sequential tasks on depressed mood. Cognitive Therapy and Research, 23, 231-246.

Abstract

Response styles theory (Nolen-Hoeksema, 1987) provided the impetus for recent research efforts investigating the effects of rumination and distraction on depressed mood. This study elaborates on previous research by examining the sequential effects of engaging in ruminating and distracting tasks. Results from two studies indicated that initially engaging in a ruminating task maintained postinduction levels of dysphoric mood, whereas initially engaging in a distracting task reduced levels of dysphoric mood. More important, however, were the effects of task order on mood. When particip ants engaged in a distracting task following a ruminating task, dysphoric mood, which had been maintained with a ruminating task, was reduced to premoodinduction levels. Of equal importance, individuals who ruminated after distracting maintained their current mood and did not report an increase in depressed mood. In the second study, engaging in sequential rumination tasks further prolonged depressed mood, whereas engaging in sequential distraction tasks reduced depressed mood. The results suggest that, although engaging in a rumination task maintains depressed mood and engaging in a distraction task reduces it, the order in which these tasks are performed is also important. The implications of these results for response styles theory are discussed.

Rumination, adolescents and depression

Kuyken, W., Watkins, E., Holden,E., & Cook, W. (2006). Rumination in adolescents at risk for depression. Journal of Affective Disorders, 96, 39-47.

Abstract

Background: Identifying high-risk adolescents and understanding first onset of depression in adolescence are important steps in reducing depression morbidity. There is compelling evidence that the personality dimension neuroticism is a risk factor for depression, but the vulnerability mechanism is not yet understood. This study examined the association between a hypothesized psychological vulnerability factor (rumination) and depression in adolescents.
Methods: A behavioural high-risk design differentiated a sample of 326 adolescents (aged 14–18) as either at normal or high risk for depression (operationalized as scores on a measure of neuroticism).
Results: Adolescents at risk for depression reported more rumination than adolescents not at risk. We hypothesized that the well established relationship between neuroticism and depression would be mediated by rumination in cross-sectional analyses, and our findings suggest that rumination partially mediated this relationship.
Conclusions: The findings tentatively suggest that neuroticism acts as a risk factor for adolescent onset depression through increased tendency towards brooding rumination (i.e. moody self-evaluative dwelling) in response to depressed mood. Prospective and experimental research examining this mechanism is required.

Rumination and memory

Moulds, M. L., Kandris, E.,& Williams, A. D. (2007). The impact of rumination on memory for self-referent material. Memory, 15, 814-821.

Abstract

Previous findings have linked rumination to the enhanced retrieval of negative memories (Lyubormirsky, Caldwell, & Nolen-Hoeksema, 1998) and overgeneral autobiographical memories (Watkins & Teasdale, 2004) in depression. However, little is known of the impact of rumination on the encoding of information, and in particular, self-referent information. This study examined the impact of rumination on selfreferent encoding in high (BDI-II]13) and low (BDI-II55) dysphoric participants. Participants were randomly allocated to a rumination or distraction condition, and then completed the experimental task in which they rated a series of adjectives (positive, negative) as either self- or other-descriptive, and later received a memory test for the adjectives. Not surprisingly, high-dysphoric participants endorsed more negative and less positive adjectives as self-descriptive. Counter to our prediction, high-dysphoric participants allocated to the rumination condition did not endorse more negative adjectives as selfreferent. However, consistent with our hypothesis, high-dysphoric participants who ruminated recalled more negative self-referent words, after controlling for the proportion of words endorsed as selfdescriptive. The findings demonstrate that rumination results in enhanced memory for negative, selfrelated material, and raises the possibility that this may serve as another pathway via which the negative evaluations of the self observed clinically in depression are maintained.

Worry versus rumination

Hong, R. Y. (2007). Worry and rumination: Differential associations with anxious and depressive symptoms and coping behavior. Behaviour Research and Therapy, 45, 277–290.

Abstract

Worry and rumination are closely allied cognitive processes that impact on the experience of anxious and depressive symptoms. Using a prospective design, this study examined overlapping and distinct features of worry and rumination in relation to symptoms and coping behavior in a nonclinical sample of Singaporean college students. Worry and rumination were highly correlated, but they retained distinct components that predicted anxious and depressive symptoms differentially within and across time. Specifically, worry was uniquely associated with anxious and depressive symptoms whereas rumination was uniquely related to depression. In comparison to rumination, worry emerged as the dominant cognitive vulnerability factor that predicted increments in symptoms over time. With regards to coping behavior, low perceived coping effectiveness partially mediated the relation between worry and increases in anxiety and depression. Conversely, rumination uniquely predicted higher disengagement from problems, which resulted in further exacerbation of depressive mood. These results demonstrated not only the distinct features of worry and rumination on coping behavior, but also the different coping pathways by which they differentially impact on subsequent symptoms.

Rumination and alcohol-aggression expectancies

Borders, A., Barnwell, S. S., & Earleywine, M. (2007). Alcohol-aggression expectancies and dispositional rumination moderate the effect of alcohol consumption on alcohol-related aggression and hostility. Aggressive Behavior, 33, 327−338.

Abstract

Alcohol consumption increases aggression, but only in some drinkers. This study extends previous work to show how expectancies for alcohol-induced aggression and dispositional rumination moderate the link between alcohol consumption and alcohol-related aggression and hostility in a sample of 285 men and women. Alcohol-aggression expectancies and quantity of alcohol interacted to predict alcohol-related hostility and aggression. Trait rumination moderated the effect of alcohol consumption on aggressive acts. Finally, women who ruminated were more likely to report alcohol-related aggression than were men who ruminated. These results suggest that alcohol expectancies for aggression and rumination constitute two important cognitive facilitators of alcohol-related aggression and hostility, and that gender plays an important role in these relations.

Rumination and sleep

Carney, C. E., Edinger, J. E., Meyer, B., Lindman, L., & Istre, T. (2006). Symptom-focused rumination and sleep disturbance. Behavioral Sleep Medicine, 4, 228-241.

Abstract

Rumination can prolong negative mood, disrupt sleep, and increase depression risk. Although there is evidence that poor sleepers ruminate, no studies have identified the ruminative content relevant for sleep disturbance. This study investigated (a) the association between rumination and sleep and (b) the ruminative content of poor sleepers. Results revealed that self-defined poor sleepers (n = 104) were more prone than self-defined good sleepers (n = 139) to ruminate and that the ruminative content was symptom focused (e.g., poor sleepers ruminated on causes of dysphoria, concentration, and fatigue symptoms). As dysphoria, reduced concentration, and fatigue are all commonly experienced daytime symptoms of insomnia, this preliminary finding of symptom-focused rumination should be further evaluated as a risk factor for further sleep disturbance in clinical samples as well as a possible link between insomnia and depression

A roadmap to rumination

Smith, J. M., & Alloy, L. B. (2009). A roadmap to rumination: A review of the definition, assessment, and conceptualization of this multifaceted construct. Clinical Psychology Review, 29, 116–128.

Abstract

Rumination has been widely studied and is a crucial component in the study of cognitive vulnerabilities to depression. However, rumination means different things in the context of different theories, and has not been uniformly defined or measured. This article aims to review models of rumination, as well as the various ways in which it is assessed. The models are compared and contrasted with respect to several important dimensions of rumination. Guidelines to consider in the selection of a model and measure of rumination are presented, and suggestions for the conceptualization of rumination are offered. In addition, rumination's relation to other similar constructs is evaluated. Finally, future directions for the study of ruminative phenomena are presented. It is hoped that this article will be a useful guide to those interested in studying the multifaceted construct of rumination.

Ruminative thoughts

Wyer, R. E. (Ed.) (1996). Ruminative thoughts. Advances in Social Cognition Volume IX. Mahwah, NJ: Lawrence Erlbaum Associates. Preview here.

Chapters:

1. Some ruminative thoughts (Abraham & Tesser)

2. Goal engagement and the ruminative experience (Carver)

3. Restructuring and realigning mental models: Ruminations as guides to cognitive home repair (Clark)

4. Ruminations on the rebound (Erber & Wegner)

5. Some thoughts about thinking (Gohm, Isbell, & Wyer)

6. Thinking about goals, glue and the meaning of life (King & Pennebaker)

7. Theories of thought flow : Points of kinship and fertile contrasts (Klinger)

8. Attention inhibition: Does it underlie ruminative thought? (Linville)

9. Chewing the cud and other ruminations (Nolen-Hoeksema)

10. Recurrent thought: Implications forattitudes and persuasion (Petty, Jarvis, & Evans)

11. When do unconscious goals cloud our minds? (Uleman)

12. Rumination: When all else fails (Waenke & Schmid)

13. Clarifying our thoughts (Martin & Tesser)

Rumination, Negative Cognition, Depressed Mood

Rumination, negative cognition and their interactive effects on depressed mood.

Ciesla, J. A., & Roberts, J. E. (2007). Rumination, negative cognition and their interactive effects on depressed mood. Emotion, 7, 555-565.

Abstract

Response styles theory posits that rumination represents a trait vulnerability to depression. Recent evidence has suggested that rumination predicts changes in depression more strongly among individuals with high levels of negative cognition. Three studies evaluated this model of interactive vulnerabilities. Study 1 provided empirical support for the distinction between rumination and negative cognitive content. The next 2 studies investigated the interactive model in the laboratory. Study 2 randomly assigned participants to either ruminate or distract following a sad mood induction. This study found that rumination was more strongly associated with dysphoria among individuals who report high levels of negative cognition. Similarly, Study 3 found that rumination and negative cognition interact to predict changes in dysphoria across a no-task delay period following a sad mood induction. These studies provide support for an interactive model in which rumination amplifies the deleterious effects of negative cognition.

A copy of the full article can be found here.

Chewing the cud and other ruminations

While rumination is often seen as goal-orientated and instrumental, Susan Nolen-Hoeksema discusses rumination as a maladaptive process, differentiating it from the problem-solving process proposed by others such as Martin and Tesser.

Key elements include:

Rumination versus problem-solving
Rumination and mood
Rumination and current theories

Martin, L. L., & Tesser, A. (1996). Some ruminative thoughts. In R. S. Wyer (Ed.) Advances in social cognition (Vol. IX) (pp. 3-47). USA: Lawrence Erlbaum Associates.

Preview available here.

Some Ruminative Thoughts

A chapter by key rumination researchers Leonard Martin and Abraham Tesser, outlining key elements of rumination with a goal-focused orientation.

Key sections:

Common features of rumination
Modes of ruminative thought
The mechanics of rumination (discrepancies in goal progress, controlling rumination)
Additional considerations (role in affect, individual differences)
Theory of rumination review

Martin, L. L., & Tesser, A. (1996). Some ruminative thoughts. In R. S. Wyer (Ed.) Advances in social cognition (Vol. IX) (pp. 3-47). USA: Lawrence Erlbaum Associates.

Preview available here.

Rumination Reconsidered

Re-visiting the Ruminative Response Styles Questionnaire.

Treynor, W., Gonzalez. R., Nolen-Hoeksema, S. (2003). Rumination reconsidered: A psychometric analysis. Cognitive Therapy and Research, 27, 247–259. Link to full article here.

Abstract

In an attempt to eliminate similar item content as an alternative explanation for the relation between depression and rumination, a secondary analysis was conducted using the data from S. Nolen-Hoeksema, J. Larson, and C. Grayson (1999). After constructing a measure of rumination unconfounded with depression content, support for a two factor model of rumination was found. These analyses indicate that the 2 components, reflective pondering and brooding, differentially relate to depression in terms of predictive ability and gender difference mediation. The results presented here support the general premise of Nolen-Hoeksema’s Response Styles Theory (S. Nolen-Hoeksema 1987) that rumination can contribute to more depressive symptoms and to the gender difference in depression, but suggest important refinements of the theory. Such refinements include the need to differentiate between the reflective pondering component of rumination and the brooding component in rumination research.

Rumination measures

An investigation of the extent to which differing definitions of rumination represent a single construct.

Siegle, G. J., Steinhauer, S. R., Carter, C. S., & Thase, M. E. 'Convergence and Divergence in Rumination Measures'

Presentation to the Association for the Advancement of Behavior Therapy, New Orleans, November 18, 2000

Abstract

Rumination has been associated with increased vulnerability to, maintenance of, and delays in recovery from depression. Yet, different researchers define rumination differently. A number of experiments were conducted to examine the extent to which these definitions represent a single construct and thus, the extent to which they are associated with aspects of depression. First, seven rumination scales were administered to 189 undergraduates. Generalizability analysis suggested that the scales were not responded to consistently by participants, though each scale had adequate internal consistency. Follow-up examinations suggested that while the scales overlap to some extent they measure different dimensions of rumination. The second study involved giving the same measures to depressed and never-depressed individuals during information processing tasks designed to provoke sustained processing of emotional information. Reaction times, pupil dilation (a correlate of cognitive load) and functional magnetic resonance imaging (fMRI) were used to assess sustained brain activity during the tasks. Scores on many of the administered rumination scales were highly correlated with reaction time biases, sustained pupil dilation to negative information, and sustained amygdala activation. Results suggest that while measures of rumination may tap different phenomena, they have similar physiological correlates.

Assessment and Measurement of Depressive Rumination

“Reflection” by François Texier, Google image search 'Rumination'

'Assessment and Measurement of Depressive Rumination' by Olivier Luminet, from the book Depressive Rumination by Papageorgiou and Wells.

The Rumination Rut

An older article (2003) for general reading in Psychology Today, The Rumination Rut, provides a brief explanation of rumination and its role in depression. It touches briefly on the work by Susan Nolen-Hoeksema on gender differences in rumination and depression. It also suggests how to identify tendencies to rumination and strategies for breaking the rumination cycle.

Depression's Evolutionary Roots

An article by Paul W. Andrews and J. Anderson Thomson Jr. in the current (Jan 2010) edition of Scientific American Mind suggesting rumination as beneficial in ending depressive episodes.
Key concepts

The brain’s ability to enter a depressed state has been preserved throughout evolution, suggesting that depression is an adaptation.

Depression promotes focused rumination about problems. People in this state of mind are better at solving complex social dilemmas.

Effective therapies encourage patients to engage in rumination, allowing them to find solutions to their problems and end their depressive episode.

Unfortunately PPV if you can't access it otherwise but you can read a preview here.

Flies in the face of some pretty substantial work suggesting otherwise. Thoughts anyone?