Why do people ruminate in dysphoric moods?

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Abstract

Rumination has been recognised as an important maintaining factor in depression. Most assessment up until now has been concerned with what people ruminate about and the frequency of the rumination, rather than exploring the reasons for rumination. A sample (n=61) self-identified as suffering from rumination reported the reasons they ruminated in response to open-ended questions. Approximately 80% of participants reported at least one perceived benefit of rumination. The most frequently reported benefits of rumination were increasing self-awareness and understanding of the depression, and solving problems/preventing future mistakes. A scale was also developed to provide a quantitative measure of the reasons for ruminating. Participants with higher levels of self-reported rumination endorsed significantly more strongly the reasons for ruminating than participants with lower levels of self-reported rumination. The scale showed sufficient validity and reliability in this preliminary study to indicate that further use is appropriate. The implications for understanding and treating rumination are discussed.

Introduction

Rumination has been increasingly recognised as an important component of depression. Nolen-Hoeksema, 1987, Nolen-Hoeksema, 1991) defined rumination as thoughts and behaviours that focus the depressed individual’s attention on his or her symptoms and the possible causes and consequences of those symptoms. Rumination therefore includes much of the repetitive and recurrent self-focused thinking found in depression, which include analysing the reasons for failure and low mood. Such thinking is often characterised by questions, such as “Why did this happen to me? Why do I feel like this? Why do I keep getting things wrong?”.

Ruminative thinking has been repeatedly implicated in the maintenance of depression. Nolen-Hoeksema and Morrow (1991) found that high levels of rumination prior to an earthquake predicted greater levels of subsequent depression and stress. Nolen-Hoeksema, Morrow and Fredrickson (1993) showed that people have consistent styles of responding to depressed moods and that the more ruminative responses people engaged in, the longer their periods of depressed mood. Nolen-Hoeksema, Parker and Larson (1994) found that in bereaved adults, a ruminative style at 1 month after the bereavement predicted depression at 6 months, even after controlling for initial depression levels, social support, stress and gender. Just and Alloy (1997) found that nondepressed participants who reported that they ruminate to depressed mood were more likely to experience a depressive episode over 18 months than participants who reported that they distract themselves from the symptoms. Rumination is therefore implicated in both the maintenance of depression and the risk for future episodes of depression.

Furthermore, experimental studies have compared a rumination condition involving focus on depressed mood and its causes and consequences, with a distraction condition, in which people think about visual images unrelated to emotion. Relative to distraction, rumination maintains and exacerbates depressed mood (both an induced depressed mood, Morrow & Nolen-Hoeksema, 1990, and naturally occurring depressed mood, Nolen-Hoeksema & Morrow, 1993). Rumination has also been shown to increase global negative attributions and reduce the effectiveness of problem solving (Lyubomirsky & Nolen-Hoeksema, 1995) and increase the accessibility of negative memories (Lyubomirsky, Caldwell & Nolen-Hoeksema, 1998) relative to distraction.

The importance of rumination in depression has been further underlined by ruminative self-focus being a central tenet of important theoretical models of depression (Teasdale and Barnard, 1993, Pyszczynski and Greenberg, 1987). Furthermore, clinical observation suggests that depressed patients subjectively find rumination extremely distressing and upsetting.

Given the negative effects of self-focus on depressed mood and thinking (Carver and Scheier, 1990, Ingram and Smith, 1984), and the evidence for the dysfunctional effects of rumination, the question remains why depressed patients continue to ruminate over long periods of time. One possible explanation for maintained rumination is the existence of beliefs that rumination is of benefit.

Recent research in the field of worry has suggested that worry may be maintained by beliefs that worry is useful (Borkovec and Lyonfields, 1993, Borkovec et al., 1998, Freeston et al., 1994, Wells, 1995, Wells, 1997). For example, generalised anxiety disorder (GAD) is characterised by high levels of worry, consisting of recurrent, mainly verbal thoughts focusing on possible future difficulties, for example “What if this goes wrong?”. Research in GAD has suggested that worry is maintained by beliefs about both the positive functions and negative consequences of worry, so-called meta-cognitive beliefs (beliefs about thinking) (Wells, 1995). There is a considerable co-morbidity between depression and generalised anxiety disorder (Butler, Fennell, Robson & Gelder, 1991). Furthermore, rumination is similar to worry, in that both involve recurrent streams of thoughts and images associated with unpleasant affect, although the focus is different, with rumination involving the analysis of past and current difficulties and losses, rather than imagining possible future difficulties. This similarity raises the possibility that, like worry, rumination is influenced by meta-cognitive beliefs. For example, rumination might be maintained by positive meta-cognitive beliefs such as “rumination helps me to solve problems” or “rumination helps me make sense of past events”. Furthermore, rumination may be exacerbated by negative meta-cognitive beliefs such as “I can’t control rumination”. Within this analysis, rumination may initially be a strategic response deliberately chosen to manage difficult situations, which then becomes automatic with repetition.

Consistent with the possibility that meta-cognitive beliefs might influence rumination, Lyubomirsky and Nolen-Hoeksema (1993) suggested that depressed people might ruminate because they believed that they were gaining insight into their feelings and problems. Lyubomirsky and Nolen-Hoeksema found that dysphoric undergraduates rated themselves as less insightful than nondysphoric undergraduates. Furthermore, they found that both dysphoric and nondysphoric subjects who participated in a rumination condition reported having greater insight than dysphoric and nondysphoric subjects who participated in a distraction condition. Dysphoric people, then, may ruminate as an attempt to redress their perceived poor insight, even though such rumination will maintain a depressed mood.

Whilst the Lyubomirsky and Nolen-Hoeksema (1993) study demonstrated that an experimental manipulation of rumination could influence perceived insight, it did not ascertain whether people who ruminate hold positive beliefs about rumination and whether such beliefs are associated with naturally occurring rumination. The purpose of the present study was: (1) to investigate the phenomenology of the beliefs held about rumination; (2) to investigate whether beliefs in rumination are related to the degree of rumination. This article presents both quantitative and qualitative data pertinent to beliefs about rumination. Firstly, participants who reported difficulties with rumination answered a series of questions about their experience of rumination. This interview schedule was designed to maximise the idiosyncratic reporting of reasons and benefits associated with rumination, without limiting the range of possible responses. Secondly, the same sample completed a preliminary scale designed to measure the extent to which people endorse various beliefs about rumination. Face valid items were drafted according to current views of rumination. This scale was designed to provide a quantitative measure of beliefs concerning rumination, comparable across all subjects. The principal hypothesis of the study was that greater belief in the benefits of rumination would be associated with greater degrees of rumination. It was predicted that participants with high levels of rumination (scoring above median on the Response Styles Questionnaire, Nolen-Hoeksema & Morrow, 1991) would endorse positive beliefs about rumination to a significantly greater extent than participants with low levels of rumination. The study would also provide a preliminary test of the instrument’s properties by examining internal consistency, the ability of the scale to distinguish between levels of rumination (criterion related validity) and the relationships to measures of rumination and emotional distress (convergent and discriminant validity).

Section snippets

Subjects and procedure

Participants were recruited in response to an article in “A Single Step”, a booklet distributed to members of Depression Alliance, a British charity for sufferers of depression. The article discussed rumination in depression and asked people who were interested in research on rumination to contact the experimenters. A self-selected sample of people who had identified themselves as suffering from rumination was therefore recruited (n=61). There were 14 men and 41 women, with six participants

Participants

The mean BDI for the participants was 24.5 (SD=10.55), indicating that the participants were a moderately dysphoric group. The mean Trait Anxiety score on the State Trait Anxiety Inventory was 59.1 (SD=10.8, n=45). The mean score on the Ruminative Response Scale was 37.2 (SD=10.4) expressed as a total score (1.7 expressed as the mean response per item). This level of rumination compares with the mean total rumination score of 35.7 (SD=12.3) found in 73 unipolar major depression out-patients,

Discussion

The results confirm the prediction that high ruminators would endorse perceived benefits for rumination to a significantly greater degree than low ruminators would. High levels of self-reported rumination are correlated with high levels of endorsements of positive reasons for rumination. Ruminators appear to have ambivalent views about rumination, with practically all participants reporting serious disadvantages to rumination, but at the same time 80% of responders reporting at least one

References (26)

  • A.T Beck et al.

    Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation

    Clinical Psychology Review

    (1988)
  • S Cartwright-Hatton et al.

    Beliefs about worry and intrusions: The Meta-Cognitions Questionnaire and its correlates

    Journal of Anxiety Disorders

    (1997)
  • M.H Freeston et al.

    Why do people worry?

    Personality and Individual Differences

    (1994)
  • A.T Beck et al.

    An inventory for measuring depression

    Archives of General Psychiatry

    (1961)
  • T.D Borkovec et al.

    Worry: Thought suppression of emotional processing

  • T.D Borkovec et al.

    Worry: A cognitive phenomenon intimately linked to affective, physiological and interpersonal behavioral processes

    Cognitive Therapy and Research

    (1998)
  • G Butler et al.

    A comparison of behavior therapy and cognitive behavior therapy in the treatment of generalised anxiety disorder

    Journal of Consulting and Clinical Psychology

    (1991)
  • C.S Carver et al.

    Origins and functions of positive and negative affect: A control-process view

    Psychological Review

    (1990)
  • J Cohen

    Weighted kappa: Nominal scale agreement with provision for scaled disagreement or partial credit

    Psychological Bulletin

    (1968)
  • R.E Ingram et al.

    Depression and internal vs external locus of attention

    Cognitive Therapy and Research

    (1984)
  • N Just et al.

    The Response Styles Theory of Depression: Tests and an extension of the theory

    Journal of Abnormal Psychology

    (1997)
  • S Lyubomirsky et al.

    Effects of ruminative and distracting responses to depressed mood on retrieval of autobiographical memories

    Journal of Personality and Social Psychology

    (1998)
  • S Lyubomirsky et al.

    Self-perpetuating properties of dysphoric rumination

    Journal of Personality and Social Psychology

    (1993)
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