Rumination predicts heightened responding to stressful life events in major depressive disorder and generalized anxiety disorder.

Abstract

Although studies have documented heightened stress sensitivity in major depressive disorder (MDD) and generalized anxiety disorder (GAD), the mechanisms involved are poorly understood. One possible mechanism is the tendency to ruminate in response to stress. We used ecological momentary assessment to study ruminative thoughts following stressful events in 145 adults with MDD, GAD, comorbid MDD-GAD, or no psychopathology. Diagnosed individuals reported more event-related rumination than controls, even after adjusting for event stressfulness. Rumination was equally common in MDD and GAD and was especially severe among comorbid cases. More rumination immediately after the event predicted poorer affect, more maladaptive behavior, and more MDD and GAD symptoms at the next signal, even when pre-event levels of these variables were controlled. Rumination mediated, but did not moderate, the association of stress with affect and with symptoms. Stress-related rumination was more deleterious for diagnosed than healthy individuals, more intense for more severe clinical cases, and more persistent for cases with a greater temperamental vulnerability for emotional disorders. These results implicate rumination as a mechanism of stress sensitivity and suggest pathways through which it may maintain depression and anxiety in everyday life.Correspondence concerning this article should be addressed to Ayelet Meron Ruscio, Department of Psychology, University of Pennsylvania, 3720 Walnut Street, Philadelphia, PA 19104. ruscio@psych.upenn (Blazer, Hughes, & George, 1987;Kendler, Karkowski, & Prescott, 1998) but exhibit heightened sensitivity to stress, reacting more strongly than healthy individuals even to relatively minor stressors (Bale, 2006;Vrieze & Claes, 2009;Wichers et al., 2009). Stress sensitivity has been identified as a risk factor for the development and maintenance of emotional disorders (Mezulis, Funasaki, Charbonneau, &, Hyde, 2010;Morris, Ciesla, & Garber, 2010;Morris, Rao, & Garber, 2012;Siegrist, 2008). However, little is known about the mechanisms underlying stress sensitivity, nor the pathways through which they contribute to symptoms in daily life.Rumination may be one mechanism linking stress with depression and anxiety (Brosschot, Gerin, & Thayer, 2006;Ciesla, Felton, & Roberts, 2011;Verkuil, Brosschot, Gebhardt, &Thayer, 2010). Rumination reflects a negative, repetitive style of thinking about present and past symptoms, loss, and failure (Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008). Whereas initial conceptualizations of rumination emphasized its focus on symptoms and their causes and consequences, more recent elaborations have broadened the concept to include attention to negative life events that the individual has experienced (Alloy et al., 2000;Smith & Alloy, 2009). Moreover, while rumination originally was proposed as a causal and maintaining factor for depression, a growing body of research suggests that rumination may be equally associated with anxiety (e.g., Nolen-Hoeksema, 2000), underscoring ...

Co-variation between stressful events and rumination predicts depressive symptoms: An eighteen months prospective design in undergraduates

“…Indeed, if these abstract and selfevaluative cognitions regarding the symptoms of distress are recursively activated and rehearsed, symptoms of distress are likely to be maintained (rather than overcome) and become depressogenic (Robinson & Alloy, 2003; Papageorgiou & Wells, 2004;Watkins & Nolen-Hoeksema, 2014). Therefore, rumination may be a cognitive mechanism that mediates the association between stress and depressive symptoms/depression (Ruscio et al, 2015).…”

“…This implies that measuring rumination in relation to stressful events over time would more optimally predicts depressive symptoms at a later point in time compared with a single measurement of habitual rumination. Nevertheless, to date, only few studies investigated rumination in relation to stressful events using multiple measurements across time, usually only assessing a general tendency to ruminate (e.g., Robinson and Alloy, 2003), or not including lengthy follow-up assessments (e.g., Ruscio et al, 2015).…”

“…Indeed, if these abstract and selfevaluative cognitions regarding the symptoms of distress are recursively activated and rehearsed, symptoms of distress are likely to be maintained (rather than overcome) and become depressogenic (Robinson & Alloy, 2003; Papageorgiou & Wells, 2004;Watkins & Nolen-Hoeksema, 2014). Therefore, rumination may be a cognitive mechanism that mediates the association between stress and depressive symptoms/depression (Ruscio et al, 2015).Even though many theoretical models exist, the principal theory on depressive rumination is the Responses Styles Theory (RST; Nolen-Hoeksema, 1991), which hypothesizes that depressive rumination is a stable and habitual, trait-like tendency to engage in repetitive selffocused thoughts in response to depressed mood (see Nolen-Hoeksema et al, 2008).Prospective and longitudinal studies provide strong evidence that individual differences in rumination, measured as stable trait, predict the future onset, duration and recurrence of a major depressive episode (e.g., Nolen-Hoeksema et al, 2008), also after controlling for baseline depressive symptoms (e.g., Spasojevic & Alloy, 2001). Moreover, rumination is found to be an important mediating factor in the longitudinal stress-depression relationship in a community sample (e.g., Michl, McLaughlin, Shepherd, & Nolen-Hoeksema, 2013), by 4 enhancing negative, mood congruent thinking (Nolen-Hoeksema et al, 2008).…”

“…This implies that measuring rumination in relation to stressful events over time would more optimally predicts depressive symptoms at a later point in time compared with a single measurement of habitual rumination. Nevertheless, to date, only few studies investigated rumination in relation to stressful events using multiple measurements across time, usually only assessing a general tendency to ruminate (e.g., Robinson and Alloy, 2003), or not including lengthy follow-up assessments (e.g., Ruscio et al, 2015).Hence, in the current study, an eighteen months prospective design, including a multiwave assessment of stressful events and rumination, was utilized. This study was performed in a large unselected sample of undergraduates before, during, and after a mid-term exam period (a period with prominent naturally occurring stressful events).…”

Implication incidence age groups in cancer patients who suffer from death rumination disorder and employed psychological defense styles

“…Other studies implicate rumination as a mechanism of stress sensitivity and suggest pathways through which it may maintain depression and anxiety in everyday life. 17 Oncologist diagnosis leads to stressful and depression mood hence patient engage death rumination. Stressful life events induce rumination, this is potentially useful targets that is preventing the onset of depression and anxiety.…”