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Rumination as a transdiagnostic factor in depression and anxiety
Open accessAbstract
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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Subgroup Analysis in Burnout: Relations Between Fatigue, Anxiety, and Depression
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Self-citationCognitive Control and Rumination in Youth: The Importance of Emotion
Hilt, L. M., Leitzke, B. T., & Pollak, S. D. (2014) · Journal of Experimental Psychopathology · doi:10.5127/jep.038113 · Cited by 66
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“This may reduce rumination and avoidance, which are known to be cognitive processes underlying depression and anxiety (McLaughlin & Nolen-Hoeksema, 2011; Spinhoven et al., 2014).”
BackgroundHappy Thoughts: Mind Wandering Affects Mood in Daily Life
Welz, A., Reinhard, I., Alpers, G. W., & Kuehner, C. (2017) · Mindfulness · doi:10.1007/s12671-017-0778-y · Cited by 63
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Cognitive Risks in Developmental Psychopathology
Hankin, B. L., Snyder, H. R., & Gulley, L. D. (2016) · Wiley eBooks · doi:10.1002/9781119125556.devpsy308 · Cited by 55
“It has been suggested that addressing repetitive negative thinking, broadly defined, represents an efficient way to target the cognitive risk and maintenance factors that are transdiagnostically present across multiple psychopathologies (McLaughlin & Nolen-Hoeksema, 2011).”
BackgroundSchmidt, D., Seehagen, S., Vocks, S., Schneider, S., & Teismann, T. (2016) · Cognitive Therapy and Research · doi:10.1007/s10608-016-9759-z · Cited by 58
“Yet, other studies did find rumination to predict depressive as well as anxious symptoms (McLaughlin and Nolen-Hoeksema 2011; Nolen-Hoeksema 2000).”
BackgroundAssociations between depression, anxious arousal and manifestations of psychological inflexibility
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“disorders (McLaughlin and Nolen-Hoeksema, 2011).”
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“Thus, it is possible that emotion recognition and regulation difficulties of comorbid psychopathology seen in patients with ASD (Aldao et al., 2010; McLaughlin & Nolen-Hoeksema, 2011; Weissman et al., 2019) are associated with alexithymia (Bilotta et al., 2016; Laloyaux et al., 2015).”
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“Both impulsivity and rumination are seen as transdiagnostic susceptibility factors in adolescents, contributing to the development and persistence of internalizing symptoms throughout adolescence (104, 105) and particularly among girls (106).”
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“…Awareness of the Mind-Body Connection to predict depression might be related to the central role of cognitive mechanisms (such as rumination) in depression (McLaughlin & Nolen-Hoeksema, 2011; Olatunji et al., 2013), in comparison with other processes such as mind-body connection (Lo et al., 2013).”
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“In a recent study, McLaughlin and Nolen-Hoeksema (2011) found that rumination accounts for a significant proportion of comorbidity between depression and anxiety in adolescents and adults.”
Adolescent Emotion Regulation and Future Psychopathology: A Prospective Transdiagnostic Analysis
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“The RRS has good reported internal consistency (α = .90; McLaughlin and Nolen-Hoeksema, 2011).”
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“Rumination involves a passive pattern of perseverative focus on the cause and consequences of particular emotional experiences (McLaughlin & Nolen-Hoeksema, 2011).”
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“For example, the maladaptive ER strategy of rumination has been linked to increases in hostility (Borders et al., 2010), anger (Martin & Dahlen, 2005), and depression and anxiety (McLaughlin & Nolen-Hoeksema, 2011).”
BackgroundNeurocognitive therapeutics: from concept to application in the treatment of negative attention bias
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“For example, excessive attention to negative affective information has been identified as a fundamental process observed across diagnosis that may underlie the development of multiple disorders [3,4].”
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“Individuals with internalising problems tend to be more reflective and introspective (McLaughlin & Nolen-Hoeksema, 2011); arguably the findings may have been different if more boys, who characteristically present with externalising problems, had taken part.”
BackgroundRuminative brooding is associated with salience network coherence in early pubertal youth
Ordaz, S. J., LeMoult, J., Colich, N. L., Prasad, G., Pollak, M., Popolizio, M., Price, A., Greicius, M. D., & Gotlib, I. H. (2016) · Social Cognitive and Affective Neuroscience · doi:10.1093/scan/nsw133 · Cited by 41
“Importantly, longitudinal studies indicate that both youth and adults who ruminate are more likely to subsequently develop depression (Nolen-Hoeksema et al. , 2008) and other forms of psychopathology (Joormann et al. , 2006; McLaughlin and Nolen-Hoeksema, 2011).”
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“McLaughlin and Nolen-Hoeksema [17] demonstrated that rumination might be considered a transdiagnostic factor that accounts for the co-occurrence of symptoms of depression and anxiety, highlighting concurrent and prospective associations in two large samples of adults and adolescents.”
BackgroundLiu, Y., Feng, Q., & Guo, K. (2023) · Frontiers in Psychology · doi:10.3389/fpsyg.2023.1190836 · Cited by 50
“When individuals are immersed in negative emotions, they will repeatedly reflect the causes and fall into thinking traps, leading to depression (Nolen-Hoeksema et al., 2008; McLaughlin and Nolen-Hoeksema, 2011), while such negative emotions will stimulate individuals to form more false cognitive biases (Lyubomirsky et…”
BackgroundMcEvoy, P. M., Erceg‐Hurn, D. M., Anderson, R., Campbell, B. N. C., & Nathan, P. R. (2015) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2015.07.003 · Cited by 39
Trait Affect, Emotion Regulation, and the Generation of Negative and Positive Interpersonal Events
Hamilton, J. L., Burke, T. A., Stange, J. P., Kleiman, E. M., Rubenstein, L. M., Scopelliti, K. A., Abramson, L. Y., & Alloy, L. B. (2017) · Behavior Therapy · doi:10.1016/j.beth.2017.01.006 · Cited by 38
Peters, A. T., Burkhouse, K. L., Kinney, K. L., & Phan, K. L. (2018) · Psychological Medicine · doi:10.1017/s0033291718003203 · Cited by 41
“More specifically, brooding is the component of rumination most strongly associated with IP (Nolen-Hoeksema et al., 2008; Aldao et al., 2010; McLaughlin and Nolen-Hoeksema, 2011) and also involved in the maintenance of symptoms in individuals exposed to ELA and other types of adversity, such as interpersonal trauma (R…”
BackgroundProvenzano, J., Fossati, P., Dejonckheere, E., Verduyn, P., & Kuppens, P. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.06.051 · Cited by 37
Aldao, A., McLaughlin, K. A., Hatzenbuehler, M. L., & Sheridan, M. A. (2014) · Journal of Experimental Psychopathology · doi:10.5127/jep.039113 · Cited by 45
“The abbreviated CRSQ rumination scale demonstrated good reliability in this study (α = 0.81), which is nearly identical to that one generated by studies utilizing the full CRSQ measure (Abela et al., 2002, α .76, α .84; McLaughlin & Nolen-Hoeksema, 2011, α = 86 ).”
MethodInfluentialSelf-citationBelloch, A. (2012) · Revista de Psicopatología y Psicología Clínica · doi:10.5944/rppc.vol.17.num.3.2012.11845 · Cited by 40
Schiller, M., Hammen, C. L., & Shahar, G. (2016) · Self and Identity · doi:10.1080/15298868.2015.1131736 · Cited by 45
“Brooding is implicated in various forms of psychological distress (Just & Alloy, 1997; McLaughlin & nolen-Hoeksema, 2011; Miranda & nolen-Hoeksema, 2007; nolen-Hoeksema & Davis, 1999; nolen-Hoeksema, 2000; nolen-Hoeksema, Stice, Wade, & Bohon, 2007; Roberts, Gilboa, & Gotlib, 1998; Treynor, et al.,…”
Lux, B. K., Andrews‐Hanna, J. R., Han, J.-H., Lee, E., & Woo, C. (2022) · Science Advances · doi:10.1126/sciadv.abn8616 · Cited by 36
Baggio, T., Grecucci, A., Meconi, F., & Messina, I. (2023) · Sensors · doi:10.3390/s23020610 · Cited by 37
“Rumination especially, which refers to the persistent focus on the feelings and thoughts associated with negative events and their consequences, can contribute to a difficulty in the production and implementation of effective solutions to problems, less propensity to engage in other constructive activities, and to the…”
BackgroundGrant, D. M., Judah, M. R., Mills, A. C., Lechner, W. V., Davidson, C. L., & Wingate, L. R. (2013) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-013-9399-5 · Cited by 42
“…of depression led to increased anxiety through rumination, but did not find evidence that anxiety at Time 1 led to depressive symptoms at Time 3 (McLaughlin and Nolen-Hoeksema 2011), we also tested an alternative model in which depressive symptoms led to increased brooding and reassurance…”
InfluentialÅström, E., Seif, A., Wiberg, B., & Carelli, M. G. (2018) · Psychopathology · doi:10.1159/000494882 · Cited by 37
Clarke, E., & Kiropoulos, L. A. (2021) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2021.100101 · Cited by 46
Rumination's effect on suicide ideation through grit and gratitude: A path analysis study
White, E. J., Kraines, M. A., Tucker, R. P., Wingate, L. R., Wells, T. T., & Grant, D. M. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.01.086 · Cited by 36
Mediators of transdiagnostic group cognitive behavior therapy
Talkovsky, A. M., & Norton, P. J. (2014) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2014.09.017 · Cited by 35
Feruglio, S., Matiz, A., Grecucci, A., Pascut, S., Fabbro, F., & Crescentini, C. (2020) · Psychology and Health · doi:10.1080/08870446.2020.1836178 · Cited by 38
“As known, rumination, most of all, plays a crucial role in the onset and maintenance of internalizing disorders, especially depression and anxiety (McLaughlin & Nolen-Hoeksema, 2011; Watkins, 2008).”
BackgroundMarr, N. S., Zainal, N. H., & Newman, M. G. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.01.079 · Cited by 41
Beshārat, M. A., Atari, M., & Mirjalili, R. S. (2019) · Practice in Clinical Psychology · doi:10.32598/jpcp.7.4.281 · Cited by 37
“…responsible factors for comorbidities, as well as common cognitive factors introduced as transdiagnostic processes (Gillan, Fineberg, & Robbins, 2017; Harvey, Watkins, Mansell, & Shafran, 2004; Mansell, Harvey, Watkins, & Shafran, 2008; McLaughlin & Nolen-Hoeksema, 2011; Torres, et al., 2016).”
Anxiety and rumination moderate menstrual cycle effects on mood in daily life
Welz, A., Huffziger, S., Reinhard, I., Alpers, G. W., Ebner‐Priemer, U., & Kuehner, C. (2015) · Women & Health · doi:10.1080/03630242.2015.1101739 · Cited by 34
Mohammadkhani, P., Abasi, I., Pourshahbaz, A., Mohammadi, A., & Fatehi, M. (2016) · Iranian Journal of Psychiatry and Behavioral Sciences · doi:10.17795/ijpbs-5047 · Cited by 36
“Most of the aforementioned studies found no differences (7-13), but some others revealed small or medium differences (14-16).”
BackgroundLiu, J., Peh, C. X., & Mahendran, R. (2016) · Body Image · doi:10.1016/j.bodyim.2016.11.001 · Cited by 43
“Furthermore, previous research reports that vacillating between thoughts of hopelessness and uncertainty is likely to account for the high comorbidity rates between depression and anxiety (McLaughlin & Nolen-Hoeksema, 2011; Nolen-Hoeksema, 2000).”
BackgroundShigemoto, Y. (2021) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0001061 · Cited by 34
Self-Compassion and Rumination Type Mediate the Relation between Mindfulness and Parental Burnout
Paucsik, M., Urbanowicz, A. M., Leys, C., Kotsou, I., Baeyens, C., & Shankland, R. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18168811 · Cited by 42
“Conversely, research has shown that ruminations increase anxiety and depression symptoms [38,39].”
BackgroundThe relationship between positive future thinking, brooding, defeat and entrapment
O’Connor, R. C., & Williams, J. M. G. (2014) · Personality and Individual Differences · doi:10.1016/j.paid.2014.06.016 · Cited by 41
“…variability could be explained in terms of three psychological factors known to be implicated in the aetiology and course of psychological distress (McLaughlin & Nolen-Hoeksema, 2011; Miranda, Tsypes, Gallagher, & Rajappa, 2013; O’Connor & Nock, 2014; O’Connor, Smyth, Ferguson, Ryan, & Williams,…”
BackgroundBorelli, J. L., Smiley, P. A., Rasmussen, H. F., Gomez, A. L., Seaman, L. C., & Nurmi, E. L. (2016) · Behavioural Brain Research · doi:10.1016/j.bbr.2016.07.035 · Cited by 34
Webb, C. A., Swords, C. M., Lawrence, H. R., & Hilt, L. M. (2022) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000763 · Cited by 42
Chasing Clarity: Rumination as a Strategy for Making Sense of Emotions
Vine, V., Aldao, A., & Nolen–Hoeksema, S. (2014) · Journal of Experimental Psychopathology · doi:10.5127/jep.038513 · Cited by 36
Self-citationPost-event rumination and social anxiety: A systematic review and meta-analysis
Edgar, E. V., Richards, A., Castagna, P. J., Bloch, M., & Crowley, M. J. (2024) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2024.03.013 · Cited by 33
Gao, L., Yang, C., Yang, X., Chu, X., Liu, Q., & Zhou, Z. (2021) · Asian Journal Of Social Psychology · doi:10.1111/ajsp.12471 · Cited by 33
Understanding associations between rumination and inflammation: A scoping review
Szabo, Y. Z., Burns, C., & Lantrip, C. (2022) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2022.104523 · Cited by 35
Pruessner, L., Timm, C., Kalmar, J., Bents, H., Barnow, S., & Mander, J. (2024) · Depression and Anxiety · doi:10.1155/2024/9081139 · Cited by 37
“This may interrupt the feedback loop that ampli fi es anxiety and depression [30, 58 – 60].”
BackgroundCellphone addiction explains how cellphones impair learning for lecture materials
Lee, S., McDonough, I. M., Mendoza, J. S., Brasfield, M. B., Enam, T., Reynolds, C., & Pody, B. C. (2021) · Applied Cognitive Psychology · doi:10.1002/acp.3745 · Cited by 31
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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