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

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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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Background
Tratamiento psicológico de los trastornos emocionales en atención primaria: fundamentos teóricos y empíricos del estudio PsicAP
Cordero‐Andrés, P., González‐Blanch, C., Umaran‐Alfageme, O., Muñoz‐Navarro, R., Ruiz‐Rodríguez, P., Medrano, L. A., Hernández-de-Hita, F., Pérez-Poo, T., & Vindel, A. C. (2017) · Ansiedad y Estrés · doi:10.1016/j.anyes.2017.10.004 · Cited by 18
The Interplay of Chronic Interpersonal Stress and Rumination on Nonsuicidal Self-Injury in Youth
Li, Y., Schweizer, T. H., Young, J. F., & Hankin, B. L. (2021) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-021-00820-1 · Cited by 13
“…USA 2 Children’s Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA 1 3 on thoughts about negative events or feelings, and ultimately functions to exacerbate negative emotional states (McLaughlin & Nolen-Hoeksema, 2011; Nolen-Hoeksema, 1991).”
Background
Adolescent girls’ intrapersonal and interpersonal parasympathetic regulation during peer support is moderated by trait and state co‐rumination
Stone, L. B., Silk, J. S., Lewis, G., Banta, M. C., & Bylsma, L. M. (2022) · Developmental Psychobiology · doi:10.1002/dev.22232 · Cited by 13
The Mediating Role of Rumination and Self-Regulation Between Self-Generated Stress and Psychological Well-Being
Yazıcı‐Kabadayı, S., & Öztemel, K. (2022) · Psychological Reports · doi:10.1177/00332941221119415 · Cited by 12
“…borderline (emotionally unstable) personality disorder (Dell ’ Osso et al., 2019; Selby et al., 2016), anger (Rusting & Nolen-Hoeksema, 1998), social withdrawal (King & DeLongis, 2014), anxiety, and depressive disorders (McLaughlin & Nolen-Hoeksema, 2011; Nolen-Hoeksema, 2000; Roger et al., 2011).”
The effect of attention bias modification on depressive symptoms in a comorbid sample: a randomized controlled trial
Bø, R., Kraft, B., Pedersen, M. L., Joormann, J., Jonassen, R., Osnes, K., Harmer, C. J., & Landrø, N. I. (2023) · Psychological Medicine · doi:10.1017/s0033291722003956 · Cited by 13
“Rumination is associated with AB (Hur, Gaul, & Berenbaum, 2019) and is a transdiagnostic mechanism mediating the relation between depression and anxiety (McLaughlin & Nolen-Hoeksema, 2011), and we investigate whether the effect of ABM is mediated by state rumination and change in state rumination.”
Development and Initial Psychometric Evaluation of the Semi-Structured Emotion Regulation Interview
Lee, D. J., Weathers, F. W., Sloan, D. M., Davis, M. T., & Domino, J. L. (2016) · Journal of Personality Assessment · doi:10.1080/00223891.2016.1215992 · Cited by 12
Regulating Rumination by Anger: Evidence for the Mutual Promotion and Counteraction (MPMC) Theory of Emotionality
Zhan, J., Tang, F., He, M. L., Fan, J., Xiao, J., Liu, C., & Luo, J. (2017) · Frontiers in Psychology · doi:10.3389/fpsyg.2017.01871 · Cited by 13
“…al., 2004); however, most researchers consider rumination as a nonadaptive coping style that repeatedly and negatively selffocuses on negative events and emotion (Conway et al., 2000; McLaughlin and Nolen-Hoeksema, 2011; Zetsche et al., 2012; Watkins and Nolen-Hoeksema, 2014; Roley et al., 2015).”
Background
Reflective pondering is associated with executive control for emotional information: An adolescent prospective study
Stewart, T. M., Hunter, S. C., & Rhodes, S. (2019) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2019.101486 · Cited by 13
The Effect of Mindfulness Therapy on Tolerance of Uncertainty and Thought-Action Fusion in Patients with Obsessive-Compulsive Disorder
Azad, M. A., Manshaei, G., & Ghamarani, A. (2019) · Quarterly Journal of Child Mental Health · doi:10.29252/jcmh.6.1.8 · Cited by 12
Cognitive processes in hoarding: The role of rumination
Portero, A. K., Durmaz, D. A., Raines, A. M., Short, N. A., & Schmidt, N. B. (2015) · Personality and Individual Differences · doi:10.1016/j.paid.2015.06.024 · Cited by 12
A Latent Structure Analysis of Cognitive Vulnerability to Depression in Adolescence
Liu, R. T., McArthur, B. A., Burke, T. A., Hamilton, J. L., Mac Giollabhui, N., Stange, J. P., Hamlat, E. J., Abramson, L. Y., & Alloy, L. B. (2019) · Behavior Therapy · doi:10.1016/j.beth.2018.11.004 · Cited by 11
The relationship between sleep quality and depression: Critical roles of reflective and brooding rumination and sleep-related cognition
Wang, T., Li, M., Xu, S., Xiang, A., Xu, X., & Wang, H. (2022) · Psychology Health & Medicine · doi:10.1080/13548506.2022.2124293 · Cited by 11
The Role of Rumination in Anxiety Disorders
Petwal, P., Sudhir, P. M., & Mehrotra, S. (2023) · Journal of Rational-Emotive & Cognitive-Behavior Therapy · doi:10.1007/s10942-023-00513-2 · Cited by 11
“…that suggest that an elevated level of repetitive negative thinking (RNT) is present in depression, anxiety and related disorders, insomnia, substance abuse, and personality disorders (Baer et al., 2012; Ehring & Watkins, 2008; McLaughlin & Nolen-Hoeksema, 2011; Rukmini, Sudhir & Bada Math, 2014).”
Background
Evaluating the Effects of a Self-Help Mobile Phone App on Worry and Rumination Experienced by Young Adults: Randomized Controlled Trial
Edge, D., Watkins, E. R., Newbold, A., Ehring, T. W., Frost, M. M., & Rosenkranz, T. (2024) · JMIR mhealth and uhealth · doi:10.2196/51932 · Cited by 11
“This suggests that engaging in an intervention designed to target RNT may have a preventive effect on depressive symptoms consistent with the wider literature on rumination and worry as vulnerability factors for depression [39,71,72].”
Result
Fluctuations in emotion regulation as a mechanism linking stress and internalizing psychopathology among adolescents: An intensive longitudinal study
Ohashi, Y.-G. B., Rodman, A. M., & McLaughlin, K. A. (2024) · Behaviour Research and Therapy · doi:10.1016/j.brat.2024.104551 · Cited by 13
Self-citation
The association between mindfulness, psychological flexibility, and rumination in predicting mental health and well-being among university students using machine learning and structural equation modeling
Feng, R., Mishra, V., Hao, X., & Verhaeghen, P. (2024) · Machine Learning with Applications · doi:10.1016/j.mlwa.2024.100614 · Cited by 17
Screening for Rumination and Brooding May Be a Feasible Method of Identifying Adolescents at High Risk for Depression
Young, C. C., & Dietrich, M. S. (2014) · Journal of Pediatric Nursing · doi:10.1016/j.pedn.2014.04.010 · Cited by 11
The autonomic correlates of dysphoric rumination and post-rumination savoring
Stone, L. B., Lewis, G., & Bylsma, L. M. (2020) · Physiology and Behavior · doi:10.1016/j.physbeh.2020.113027 · Cited by 11
The Transdiagnostic Role of Rumination in the Comorbidity of PTSD and Depression
Mendoza, N. B., Mordeno, I. G., & Nalipay, M. J. N. (2021) · Journal of Loss and Trauma · doi:10.1080/15325024.2021.2018197 · Cited by 9
“While evidence on the role of rumination to PTSD-MDD comorbidity exists (Hu et al., 2014; McLaughlin & Nolen-Hoeksema, 2011; Michael et al., 2007; Michl et al., 2013; Roley et al., 2015), there are limited studies examining rumination as an underlying transdiagnostic mechanism accounting for…”
Influential
The efficacy of transdiagnostic cognitive behavioural therapy on reducing negative affect, anxiety sensitivity and improving perceived control in children with emotional disorders - a randomized controlled trial
Alaee, E. Q., Saed, O., Khakpoor, S., Ahmadi, R., Mohammadi, M. A., Afrashteh, M. Y., & Morovati, Z. (2022) · Research in Psychotherapy Psychopathology Process and Outcome · doi:10.4081/ripppo.2022.588 · Cited by 13
“…as Negative Affect (NA) (Lonigan, Carey, & Finch, 1994; Lonigan, Hooe, David, & Kistner, 1999), rumination (McLaughlin, Aldao, Wisco, & Hilt, 2014; McLaughlin & Nolen-Hoeksema, 2011), Emotion Regulation (ER) (Kim & Cicchetti, 2010; Martinsen, Kendall, Stark, & Neumer, 2016), disordered attention…”
The correlation between health literacy and mental health literacy in Turkish Society
Akgün, Ş., Kesgi̇n, M. T., & Tok, H. H. (2022) · Perspectives In Psychiatric Care · doi:10.1111/ppc.13146 · Cited by 11
BASES TEÓRICAS Y APOYO EMPÍRICO DE LA INTERVENCIÓN PSICOLÓGICA SOBRE LOS DESÓRDENES EMOCIONALES EN ATENCIÓN PRIMARIA. UNA ACTUALIZACIÓN
Vindel, A. C. (2011) · Ansiedad y Estrés · Cited by 10
A Reformulated Architecture of Cognitive Risks for Psychopathology: Common and Specific Dimensions and Links to Internalizing Outcomes in Adolescence
Schweizer, T. H., Snyder, H. R., & Hankin, B. L. (2018) · Assessment · doi:10.1177/1073191118804878 · Cited by 12
“Rumination relates to anxiety in youth and adults concurrently and prospectively (e.g., McLaughlin & Nolen-Hoeksema, 2011; Selby, Anestis, & Joiner, 2008); self-criticism relates to social phobia and posttraumatic stress disorder (PTSD) in adults (e.g., Cox, Fleet, & Stein, 2004; Sharhabani-Arzy,…”
Background
Factors Associated With Ruminative Thinking in Individuals With Gender Dysphoria
da Silva, D. C., Salati, L. R., Villas-Bôas, A. P. D. S., Schwarz, K., Fontanari, A. M. V., Soll, B. M. B., Costa, Â. B., Hirakata, V. N., Schneider, M. A., & Lobato, M. I. R. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.602293 · Cited by 12
“It can also be described as the persistent tendency to harbor selfcentered thoughts, intrinsic in people in general, but which can become dangerous to psychological health and can accompany different clinical conditions (2, 3).”
Background
Study protocol and methods for Easing Pelvic Pain Interventions Clinical Research Program (EPPIC): a randomized clinical trial of brief, low-intensity, transdiagnostic cognitive behavioral therapy vs education/support for urologic chronic pelvic pain syndrome (UCPPS)
Lackner, J. M., Jaccard, J. J., Quigley, B. M., Ablove, T. S., Danforth, T. L., Firth, R. S., Gudleski, G. D., Krasner, S. S., Radziwon, C. D., Vargovich, A. M., et al. (2022) · Trials · doi:10.1186/s13063-022-06554-9 · Cited by 10
Emotion regulation, negative self-evaluation, and social anxiety symptoms: The mediating role of depressive symptoms
Mehrizi, S. H. A. A., Amani, O., Feyzabadi, A. M., & Kolae, Z. E. B. (2022) · Current Psychology · doi:10.1007/s12144-022-03225-5 · Cited by 10
Effectiveness of unified protocol for trans diagnostic treatment in children with anxiety disorders: A randomized control trial
Ahadianfard, P., Gharraee, B., Aghebati, A., & Habibi, M. (2023) · Journal of Education and Health Promotion · doi:10.4103/jehp.jehp_1578_22 · Cited by 10
“,51‑55] There is evidence of common cognitive and behavioral risk factors, [56] such as repetitive negative thinking [57,58] and behavioral avoidance.”
Background
Reexamining gender differences and the transdiagnostic boundaries of various conceptualizations of perseverative cognition.
Vergara‐Lopez, C., Valencia, E. M. H., Grados, M., Ortiz, E., Charvis, J. S., & Lopez-Vergara, H. I. (2024) · Psychological Assessment · doi:10.1037/pas0001326 · Cited by 12
Ruminative thinking mediates the effects of exposure to adverse life events on psychotic-like experiences
Fazio, L., Raio, A., Banaschewski, T., Bokde, A. L. W., Desrivières, S., Flor, H., Garavan, H., Gowland, P. A., Grigis, A., Heinz, A., et al. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1434470 · Cited by 11
Neuroscience for Clinicians: Translational Clinical Neuroscience to Inspire Clinical Practice and Research
Li, H., Goldin, P. R., & Siegle, G. J. (2021) · Elsevier eBooks · doi:10.1016/b978-0-12-818697-8.00190-4 · Cited by 11
A developmental analysis of dimensions of empathy during early adolescence: Behavioral empathy but not cognitive empathy is associated with lower psychopathology
Cherewick, M., Schmiege, S. J., Hipp, E., Leiferman, J. A., Njau, P. F., & Dahl, R. E. (2022) · PLOS Global Public Health · doi:10.1371/journal.pgph.0001231 · Cited by 10
“Why is everyone always angry with me?!”: When thinking ‘why’ leads to generalization
Lier, J. V., Vervliet, B., Boddez, Y., & Raes, F. (2014) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2014.11.008 · Cited by 10
Brooding Rumination and Internalizing Symptoms in Childhood: Investigating Symptom Specificity in a Multi-Wave Prospective Study
López, C. M., Felton, J. W., Driscoll, K. A., & Kistner, J. A. (2012) · International Journal of Cognitive Therapy · doi:10.1521/ijct.2012.5.3.240 · Cited by 10
“Rumination has also been proposed as an explanation for comorbidity of anxiety and depression (McLaughlin & Nolen-Hoeksema, 2011).”
Background
Repetitive negative thinking following exposure to a natural stressor prospectively predicts altered stress responding and decision-making in the laboratory
Stamatis, C. A., Puccetti, N. A., Charpentier, C. J., Heller, A. S., & Timpano, K. R. (2020) · Behaviour Research and Therapy · doi:10.1016/j.brat.2020.103609 · Cited by 12
How Daily Mindfulness Predicts Life Satisfaction: From the Perspective of Mindfulness Coping Model
Xue, Y. W., & Xiang, Y. (2022) · The Journal of Psychology · doi:10.1080/00223980.2022.2085236 · Cited by 10
“This conclusion is supported by empirical studies that individuals with higher levels of rumination reported higher levels of depression and anxiety (McLaughlin & Nolen-Hoeksema, 2011; Nolen-Hoeksema, 2000; Papageorgiou & Wells, 2009).”
Result
Anxiety and Depression Predict the Paths Through Which Rumination Acts on Behavior: A Daily Diary Study
Riley, K. E., Cruess, D. G., Park, C. L., Tigershtrom, A., & Laurenceau, J. (2019) · Journal of Social and Clinical Psychology · doi:10.1521/jscp.2019.38.5.409 · Cited by 10
Examining the latent structure of emotional awareness and associations with executive functioning and depression
Eckland, N. S., Letkiewicz, A. M., & Berenbaum, H. (2021) · Cognition & Emotion · doi:10.1080/02699931.2021.1885349 · Cited by 9
“However, it is also possible that these facets of emotional awareness may be protective against processes like unpleasant repetitive thinking (e.g. rumination or worry; Eckland & Berenbaum, in press), which are prospectively linked to depression (McLaughlin & Nolen-Hoeksema, 2011).”
Background
Attention Problems and Restlessness as Transdiagnostic Markers of Severity and Treatment Response in Youth with Internalizing Problems
Aitken, M., & Andrade, B. F. (2021) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-021-00797-x · Cited by 10
“…spectrum, including rumination and difficulty directing attention away from negative thoughts (Bishop, 2007; Disner et al., 2011; Hankin, 2008; McLaughlin & Nolen-Hoeksema, 2011; Nolen-Hoeksema & Watkins, 2011), may explain the association between symptom severity and attention problems in…”
Background
Relationship between rumination, self-compassion, and psychological health among Japanese university students: A cross-sectional study
Yamasaki, K., Sampei, A., & Miyata, H. (2024) · PLoS ONE · doi:10.1371/journal.pone.0297691 · Cited by 9
“In accordance with these ideas, several meta-analyses have suggested that rumination can lead to increased levels of anxiety and depression [7–9].”
BackgroundResult
Valence-specific EEG microstate modulations during self-generated affective states
Nazare, K., & Tomescu, M. I. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1300416 · Cited by 9

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: green
www.ncbi.nlm.nih.gov
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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Rumination as a transdiagnostic factor in depression and anxiety

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