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Cited by 842Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMental Health Research TopicsIdentity, Memory, and Therapy

Rumination as a transdiagnostic factor in depression and anxiety

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McLaughlin, Katie A., Nolen-Hoeksema, Susan·2011·Behaviour Research and Therapy
DOI 10.1016/j.brat.2010.12.006PMC PMC3042543
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Abstract

The high rate of comorbidity among mental disorders has driven a search for factors associated with the development of multiple types of psychopathology, referred to as transdiagnostic factors. Rumination is involved in the etiology and maintenance of major depression, and recent evidence implicates rumination in the development of anxiety. The extent to which rumination is a transdiagnostic factor that accounts for the co-occurrence of symptoms of depression and anxiety, however, has not previously been examined. We investigated whether rumination explained the concurrent and prospective associations between symptoms of depression and anxiety in two longitudinal studies: one of adolescents (N=1065) and one of adults (N=1317). Rumination was a full mediator of the concurrent association between symptoms of depression and anxiety in adolescents (z=6.7, p< .001) and was a partial mediator of this association in adults (z=5.6, p< .001). In prospective analyses in the adolescent sample, baseline depressive symptoms predicted increases in anxiety, and rumination fully mediated this association (z=5.26, p< .001). In adults, baseline depression predicted increases in anxiety and baseline anxiety predicted increases in depression; rumination fully mediated both of these associations (z=2.35, p= .019 and z=5.10, p< .001, respectively). These findings highlight the importance of targeting rumination in transdiagnostic treatment approaches for emotional disorders.

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Crossref · 10.1016/j.brat.2010.12.006

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  • Reduced avoidance and suppression may interrupt the feedback loop that amplifies anxiety and depression.

    “This may interrupt the feedback loop that amplifies anxiety and depression [30, 58–60].”

    From Emotion Regulation as a Mechanism of Mindfulness in Individual Cognitive-Behavioral Therapy for Depression and Anxiety Disorders (2024) · cites this paper as [60]

    The Discussion (page unavailable) describes rumination as a mediator of the reciprocal relationship between anxiety and depression and suggests targeting rumination in treatment. It does not say that reducing avoidance or suppression interrupts that relationship; those are different processes from the one studied. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Reducing perseverative and avoidant emotion regulation strategies is a pathway to mitigating anxiety and depression symptoms.

    “The first pathway to mitigating anxiety and depression symptoms involves reducing perseverative and avoidant emotion regulation strategies, such as rumination, avoidance, and suppression, which are known to maintain and exacerbate internalizing psychopathology [29, 58–62].”

    From Emotion Regulation as a Mechanism of Mindfulness in Individual Cognitive-Behavioral Therapy for Depression and Anxiety Disorders (2024) · cites this paper as [60]

    The Discussion (page unavailable) recommends targeting rumination in treatments for emotional disorders and reports that a rumination-focused treatment reduced depression and associated comorbidity. It does not establish that reducing avoidance or suppression mitigates anxiety and depression symptoms, so the broader claim about all three strategies exceeds this source. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Rumination, avoidance, and suppression maintain and exacerbate internalizing psychopathology.

    “The first pathway to mitigating anxiety and depression symptoms involves reducing perseverative and avoidant emotion regulation strategies, such as rumination, avoidance, and suppression, which are known to maintain and exacerbate internalizing psychopathology [29, 58–62].”

    From Emotion Regulation as a Mechanism of Mindfulness in Individual Cognitive-Behavioral Therapy for Depression and Anxiety Disorders (2024) · cites this paper as [60]

    The Introduction reports that rumination can increase depressed and anxious mood, and the Discussion describes its association with the onset and maintenance of emotional disorders (page numbers unavailable). The passages support the claim about rumination, but do not establish that avoidance or suppression maintain or exacerbate internalizing psychopathology. (LLM, conf=0.88)

    Experimental — accuracy not yet measured

  • Anxiety and rumination are dynamically and reciprocally related rather than strictly ordered.

    “growing evidence suggests that anxiety and rumination are likely dynamically and reciprocally related (McLaughlin & Nolen-Hoeksema, 2011; Tamm et al., 2024) rather than strictly ordered.”

    From Mindfulness and rumination: stress pathways for caregivers of persons living with dementia. (2026) · cites this paper as McLaughlin & Nolen-Hoeksema, 2011

    The Results (Mediation Analyses; page unavailable) show that baseline anxiety predicted later rumination in adults, while rumination predicted later anxiety in adolescents. This supports associations in both directions, but the paper does not establish a reciprocal anxiety–rumination process within the same longitudinal analysis; its statement about “reciprocal relations” in the Discussion refers to depression and anxiety. (LLM, conf=0.82)

    Experimental — accuracy not yet measured

  • Repetitive negative thinking is a common process across anxiety disorders.

    “Repetitive negative thinking is a common process across anxiety disorders (McLaughlin & Nolen-Hoeksema, 2011).”

    From Participant experiences of change in mindfulness-based stress reduction for anxiety disorders. (2020) · cites this paper as McLaughlin & Nolen-Hoeksema, 2011

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Research works printed but not linked: 2

  1. Barlow DH Anxiety and its disorders 2002 New York Guilford Press
  2. Harvey AG Watkins E Mansell W Shafran R Cognitive behavioural processes across psychological disorders 2004 Oxford, United Kingdom Oxford University Press

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Authors
McLaughlin, K. A., & Nolen-Hoeksema, S.
Affiliations
Harvard University (US)
Corresponding author
McLaughlin, Katie A.
ORCID
McLaughlin, Katie A.
Venue
Behaviour Research and Therapy
Publisher
Elsevier BV
Published
2011-03
Volume
49
Issue
3
Pages
186-193
ISSN
0005-7967 (ISSN-L)
DOI
10.1016/j.brat.2010.12.006
PMC
PMC3042543
OpenAlex
W2005147092
Cited by
842
References
78
Citations by year
2026: 83 · 2025: 68 · 2024: 64 · 2023: 96 · 2022: 72 · 2021: 75 · 2020: 61 · 2019: 53 · 2018: 53 · 2017: 39 · 2016: 37 · 2015: 43 · 2014: 41 · 2013: 26 · 2012: 23
FWCI
23.03
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Behaviour Research and Therapy (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Mental Health (K01MH092526)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
  • Social Sciences › Psychology › Developmental and Educational Psychology › Identity, Memory, and Therapy
Keywords
rumination, transdiagnostic factors, depression, anxiety, comorbidities, mediation, adolescents, adults, prospective associations, transdiagnostic treatment
MeSH terms
Adolescent, Adult, Anxiety Disorders, Depressive Disorder, Female, Humans, Longitudinal Studies, Male, Psychiatric Status Rating Scales, Surveys and Questionnaires, Risk Factors, Thinking

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