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Rumination as a transdiagnostic factor in depression and anxiety
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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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“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
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“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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]
Experimental — accuracy not yet measuredThe source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“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
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“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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“Depression, for example, is characterized by biases towards negative information and rumination [81]”
From Ventromedial prefrontal–subcortical systems and the generation of affective meaning (2012) · cites this paper as [81]
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“there is evidence that certain elements of cognitive vulnerability (e.g., rumination, McLaughlin & Nolen-Hoeksema, 2011; and negative self-referential processing, Mennin & Fresco, 2013) may be transdiagnostic in nature.”
From A Latent Structure Analysis of Cognitive Vulnerability to Depression in Adolescence (2019) · cites this paper as McLaughlin & Nolen-Hoeksema, 2011
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Evidence-Based Psychological Treatments: An Update and a Way Forward
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“Finally, we used the less well-known LEIDS-R scale to measure rumination, while most studies, including the study of McLaughlin and Nolen-Hoeksema (2011), have used the Ruminative Response Scale (RRS).”
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“Because rumination has been shown to be a transdiagnostic factor related to the development of both anxiety and depression in adolescents (McLaughlin & Nolen-Hoeksema, 2011b), and in order to reduce the number of analyses in this article, we conducted all analyses using a combined measure of…”
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“HUMAN NEUROSCIENCE ORIGINAL RESEARCH ARTICLE published: 19 September 2012 doi: 10.3389/fnhum.2012.00257 The effects of mindfulness-based cognitive therapy on affective memory recall dynamics in depression: a mechanistic model of rumination”
BackgroundInfluentialMental distress and language use: Linguistic analysis of discussion forum posts
Lyons, M. T., Aksayli, N. D., & Brewer, G. (2018) · Computers in Human Behavior · doi:10.1016/j.chb.2018.05.035 · Cited by 126
Family process and youth internalizing problems: A triadic model of etiology and intervention
Schleider, J. L., & Weisz, J. R. (2016) · Development and Psychopathology · doi:10.1017/s095457941600016x · Cited by 123
“More recent theoretical models have identified features distinctive to anxiety and depression, attributing their overlap to shared etiologic influences (Barlow, Allen, & Choate, 2004; Cole, Truglio, & Peeke, 1997; McLaughlin & Nolen-Hoeksema, 2011).”
BackgroundMood Responses Associated With COVID-19 Restrictions
Terry, P. C., Parsons-Smith, R. L., & Terry, V. R. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.589598 · Cited by 107
Kranzler, A., Young, J. F., Hankin, B. L., Abela, J. R. Z., Elias, M. J., & Selby, E. A. (2015) · Journal of Clinical Child & Adolescent Psychology · doi:10.1080/15374416.2014.987379 · Cited by 106
McLaughlin, K. A., Garrad, M. C., & Somerville, L. H. (2015) · Dialogues in Clinical Neuroscience · doi:10.31887/dcns.2015.17.4/kmclaughlin · Cited by 124
Self-citationKircaburun, K., Griffiths, M. D., & Billieux, J. (2019) · Personality and Individual Differences · doi:10.1016/j.paid.2018.11.024 · Cited by 100
Psychological treatment of depressive rumination
Watkins, E. R. (2015) · Current Opinion in Psychology · doi:10.1016/j.copsyc.2015.01.020 · Cited by 116
Smith, C. A., Shewamene, Z., Galbally, M., Schmied, V. A., & Dahlen, H. G. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.11.054 · Cited by 102
Reexamining trait rumination as a system of repetitive negative thoughts: A network analysis
Bernstein, E. E., Heeren, A., & McNally, R. J. (2018) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2018.12.005 · Cited by 103
Translating dynamic defense patterns from rodents to people
Blanchard, D. C. (2017) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2016.11.001 · Cited by 94
Wang, Q., Fang, Y., Huang, H., Lv, W., Wang, X., Yang, T., Yuan, J., Gao, Y., Qian, R., & Zhang, Y. (2021) · Journal of Nursing Management · doi:10.1111/jonm.13265 · Cited by 98
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“21,22 COVID-19-related ruminative thoughts may lead people to be immersed in this stressful situation, which further increases psychological symptoms.”
Acute aerobic exercise hastens emotional recovery from a subsequent stressor
Bernstein, E. E., & McNally, R. J. (2017) · Health Psychology · doi:10.1037/hea0000482 · Cited by 93
Low emotional awareness as a transdiagnostic mechanism underlying psychopathology in adolescence
Weissman, D. G., Nook, E. C., Dews, A. A., Miller, A. B., Lambert, H. K., Sasse, S. F., Somerville, L. H., & McLaughlin, K. A. (2020) · Clinical Psychological Science · doi:10.1177/2167702620923649 · Cited by 91
“…and difficulties with emotion regulation are a well-established transdiagnostic risk factor for psychopathology (Aldao, Nolen-Hoeksema, & Schweizer, 2010; Burns, Jackson, & Harding, 2010; McLaughlin, Aldao, Wisco, & Hilt, 2014; McLaughlin & Nolen-Hoeksema, 2011; MessmanMoore & Bhuptani, 2017).”
Self-citationDell’Osso, B. M., Cafaro, R., & Ketter, T. A. (2021) · International Journal of Bipolar Disorders · doi:10.1186/s40345-020-00207-z · Cited by 90
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The Flexibility Hypothesis of Healing
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“We also hypothesized that the scales will have strong associations with severity of posttraumatic stress disorder (PTSD) symptoms (Bovin et al., 2016) and rumination (McLaughlin & Nolen-Hoeksema, 2011).”
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Fawcett, J. M., Benoit, R. G., Gagnepain, P., Salman, A., Bartholdy, S., Bradley, C. E., Chan, D. K. Y., Roche, A., Brewin, C. R., & Anderson, M. C. (2014) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2014.10.009 · Cited by 89
“More recently, rumination has been recognized as a transdiagnostic process that is present in many anxiety and affective disorders (Ehring, Kleim, & Ehlers, 2011; McLaughlin & Nolen-Hoeksema, 2011), and appears to have a causal impact on the development of intrusive memories (Ball & Brewin, 2012).”
BackgroundAdrian, M. C., Jenness, J. L., Kuehn, K. S., Smith, M. R., & McLaughlin, K. A. (2019) · Development and Psychopathology · doi:10.1017/s0954579419000543 · Cited by 87
“Consistent with numerous prior studies (McLaughlin & Nolen-Hoeksema, 2011; Nolen-Hoeksema, 2000; Nolen-Hoeksema, Stice, Wade, & Bohon, 2007; NolenHoeksema et al., 2008), rumination was associated with anxiety and depression both cross-sectionally and longitudinally.”
BackgroundResultSelf-citationKaplan, D. M., Palitsky, R., Carey, A. L., Crane, T. E., Havens, C. M., Medrano, M. R., Reznik, S. J., Sbarra, D. A., & O'Connor, M. (2018) · Journal of Clinical Psychology · doi:10.1002/jclp.22585 · Cited by 76
“For example, there is substantial evidence for the association of rumination with depression and anxiety (McLaughlin & Nolen-Hoeksema, 2011).”
BackgroundThe importance of mindfulness in psychosocial distress and quality of life in dermatology patients
Montgomery, K., Norman, P., Messenger, A. G., & Thompson, A. R. (2016) · British Journal of Dermatology · doi:10.1111/bjd.14719 · Cited by 75
A systematic review of the psychometric properties of death anxiety self-report measures
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Zuo, N., Fang, J., Lv, X., Zhou, Y., Yang, H., Li, T., Tong, H., Wang, X., Wang, W.-D., & Jiang, T. (2012) · PLoS ONE · doi:10.1371/journal.pone.0037561 · Cited by 75
“Measures of rumination are primarily utilized to assess the behavior of negative thoughts and to measure the intensity of memory rehearsal [2,3,4,5].”
MethodWeiss, J. A. (2014) · Clinical Psychology: Science and Practice · doi:10.1111/cpsp.12084 · Cited by 73
Bravo, A. J., Pilatti, A., Pearson, M. R., Mezquita, L., Ibáñez, M. I., & Ortet, G. (2017) · Addictive Behaviors · doi:10.1016/j.addbeh.2017.08.028 · Cited by 79
“Rumination has been identified as an important transdiagnostic mechanism associated with a range of psychopathology (McEvoy, Watson, Watkins, & Nathan, 2013; McLaughlin & Nolen-Hoeksema, 2011).”
Liu, J., Peh, C.-X., Simard, S., Griva, K., & Mahendran, R. (2018) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2018.06.004 · Cited by 72
Wang, S. B., Lydecker, J. A., & Grilo, C. M. (2017) · European Eating Disorders Review · doi:10.1002/erv.2499 · Cited by 78
“Together, these suggest that rumination may differentially impact body dissatisfaction for patients with EDs and those with obesity.”
BackgroundInfluentialGulley, L. D., Hankin, B. L., & Young, J. F. (2015) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-015-9997-7 · Cited by 79
“The use of separate questionnaires to distinguish between changes in depressive versus anxious symptoms contributes to a growing area of research focusing on a transdiagnostic approach to studying risk for psychopathology (see McLaughlin and Nolen-Hoeksema 2011).”
McEvoy, P. M., Hyett, M. P., Ehring, T. W., Johnson, S. L., Samtani, S., Anderson, R., & Moulds, M. L. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.02.072 · Cited by 69
Cognitive debt and Alzheimer’s disease
Marchant, N. L., & Howard, R. J. (2015) · Journal of Alzheimer's Disease · doi:10.3233/jad-141515 · Cited by 68
“Even in this population rumination and worry are associated with negative affect [78] and predict symptoms of depression and anxiety [98] [99].”
Backgrounddu Pont, A., Rhee, S. H., Corley, R. P., Hewitt, J. K., & Friedman, N. P. (2017) · Clinical Psychological Science · doi:10.1177/2167702617720747 · Cited by 72
“Some longitudinal research indicates that rumination may be a risk factor for psychopathology (e.g., McLaughlin & Nolen-Hoeksema, 2012; Nolen-Hoeksema, 2000), although it may also be a symptom or consequence of psychopathology (NolenHoeksema et al., 2007).”
BackgroundResultNegative influences of Facebook use through the lens of network analysis
Faelens, L., Hoorelbeke, K., Fried, E. I., Raedt, R. D., & Koster, E. H. W. (2019) · Computers in Human Behavior · doi:10.1016/j.chb.2019.02.002 · Cited by 78
The Role of Emotion Regulation in Video Gaming and Gambling Disorder
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Kindred, R., Bates, G. W., & McBride, N. L. (2022) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2022.102640 · Cited by 79
A dorsomedial prefrontal cortex-based dynamic functional connectivity model of rumination
Kim, J., Andrews‐Hanna, J. R., Eisenbarth, H., Lux, B. K., Kim, H. J., Lee, E., Lindquist, M. A., Losin, E. A. R., Wager, T. D., & Woo, C. (2023) · Nature Communications · doi:10.1038/s41467-023-39142-9 · Cited by 69
Allbaugh, L. J., Wright, M. O., & Folger, S. F. (2016) · Anxiety, Stress, & Coping · doi:10.1080/10615806.2015.1015422 · Cited by 64
Palmieri, S., Mansueto, G., Scaini, S., Caselli, G., Sapuppo, W., Spada, M. M., Sassaroli, S., & Ruggiero, G. M. (2021) · Journal of Clinical Medicine · doi:10.3390/jcm10112448 · Cited by 66
Metadata
- 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)
- 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
- green
- www.ncbi.nlm.nih.gov
- 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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