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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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“This conclusion is congruent with a previous finding that rumination, which accounts for the temporal co-occurrence of internalizing disorders, may explain the association of aggressive behaviors with subsequent increases in anxiety symptoms (78).”
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“Considering that the ERN has been linked with anxiety disorders and there have been studies showing associations between anxiety and rumination (McLaughlin & Nolen-Hoeksema, 2011), we also sought to test whether the ERN moderated associations between rumination and prospective anxiety symptoms in…”
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“Additionally, future studies may examine rumination as a transdiagnostic risk factor (McEvoy et al. 2013; McLaughlin & Nolen-Hoeksema 2011) and mediator (Luca 2019) among associations between moral injury and mental health outcomes.”
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BackgroundAnxiety and Depression in Northern Plains American Indian Youth: Evidence for Resilience and Risk
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BackgroundRumination as a Transdiagnostic Notion
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“Rumination in adults has been reported as a partial mediator of concurrent associations between anxiety and depression [16].”
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“Rumination has been recognized as a trans-diagnostic process that occurs in different emotional disorders (McLaughlin and Nolen-Hoeksema, 2011) and plays a causal role in the development of intrusive memories (Fawcett et al., 2015).”
Baker, P. A., Seydavi, M., Akbari, M., Spada, M. M., & Kolubinski, D. C. (2024) · Journal of Rational-Emotive & Cognitive-Behavior Therapy · doi:10.1007/s10942-024-00559-w · Cited by 3
“Seventh, the role of childhood adversities was not explored; however, it may moderate the association between stressful life events that occur in adulthood and psychological disorders (see Mansueto & Faravelli, 2017, 2022; McLaughlin and Nolen-Hoeksema, 2011; Wang et al., 2022).”
Decision-Making, Pro-variance Biases and Mood-Related Traits
Lin, W., & Dolan, R. J. (2024) · Computational Psychiatry · doi:10.5334/cpsy.114 · Cited by 2
Kérébel, A., Caille, J.-A., & Sackur, J. (2024) · Consciousness and Cognition · doi:10.1016/j.concog.2024.103735 · Cited by 3
Daily rumination and diurnal cortisol patterns in Latino adolescents: The moderating role of sex
Trent, K., Gusman, M. S., Mendes, S. H., & Doane, L. D. (2025) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2025.107389 · Cited by 2
Camia, M., Ciaramidaro, A., Benassi, E., Giovagnoli, S., Angelini, D., Rubichi, S., & Scorza, M. (2025) · Healthcare · doi:10.3390/healthcare13101211 · Cited by 4
“…promoting psychological adjustment, whereas dysfunctional emotion regulation processes could exacerbate the severity of psychopathological symptoms, such as anxiety and depression, which are especially relevant in students with SLD, given their increased vulnerability to emotional distress [39,40].”
Rumination and Coping as Pathways from Stress to Emotional Exhaustion among Hospital Pharmacists
Rehman, S., Rehman, E., & Ahmad, M. (2025) · International Journal of Mental Health Promotion · doi:10.32604/ijmhp.2025.063582 · Cited by 2
Murgueitio, N., Trueba, A. F., & Pluck, G. C. (2025) · Children and Youth Services Review · doi:10.1016/j.childyouth.2025.108430 · Cited by 3
Hankin, B. L., Schweizer, T. H., & Young, J. F. (2025) · Clinical Psychological Science · doi:10.1177/21677026251335346 · Cited by 2
“In addition, rumination functions as a transdiagnostic risk factor (McLaughlin & Nolen-Hoeksema, 2011; Snyder et al., 2019; Watkins & Roberts, 2020).”
Adaptive Suppression of Motivational Biases Increases With Mood/Anxiety Traits
Scholz, V., Algermissen, J., Kandroodi, M. R., Gillan, C. M., & den Ouden, H. E. M. (2026) · Biological Psychiatry Cognitive Neuroscience and Neuroimaging · doi:10.1016/j.bpsc.2026.06.001 · Cited by 3
Ghadampour, E., Radmehr, P., & Yousefvand, L. (2017) · Quarterly of Horizon of Medical Sciences · doi:10.18869/acadpub.hms.23.2.141 · Cited by 2
Paulus, D. J., Kauffman, B. Y., Garey, L., Jardin, C., Manning, K. F., Bakhshaie, J., Garza, M. J., Ochoa‐Perez, M., Lemaire, C. M., & Zvolensky, M. J. (2017) · Behavior Modification · doi:10.1177/0145445517725867 · Cited by 3
“Past work has identified rumination as a transdiagnostic factor related to depression and anxiety (McLaughlin & Nolen-Hoeksema, 2011).”
Background이유현, Choi, W., & Jeong, S. (2018) · Korea Journal of Counseling · doi:10.15703/kjc.19.2.201804.125 · Cited by 2
Adaptación y evidencias de validez de la Escala de Estilos de Respuesta en niños argentinos
Zamora, E. V., del Valle, M. V., Introzzi, I. M., & Richard’s, M. M. (2020) · Revista de Psicología Clínica con Niños y Adolescentes · doi:10.21134/rpcna.2020.07.1.2 · Cited by 2
Rumiación cognitiva y su relación con las psicopatologías internalizantes: Una Revisión Sistemática
Toro, R., Vulbuena-Martin, M., Riveros-Lopez, D., Zapata-Orjuela, M., & Florez-Tovar, A. (2020) · PSICUMEX · doi:10.36793/psicumex.v10i2.345 · Cited by 4
Bailey, A. J., Romeu, R. J., & Finn, P. (2022) · Psychological Medicine · doi:10.1017/s0033291721005572 · Cited by 2
“Measures of rumination are strongly related to both measures of anxiety and depression, and have a clear theoretical relationship with both disorders (McEvoy, Watson, Watkins, & Nathan, 2013; McLaughlin & Nolen-Hoeksema, 2011).”
BackgroundElbay, R. Y., Karatepe, H. T., Ulaşoğlu, C., & Görmez, A. (2021) · Journal of Clinical Psychology in Medical Settings · doi:10.1007/s10880-021-09780-6 · Cited by 2
L'approche transdiagnostique en psychopathologie
Baeyens, C. (2016) · Dunod eBooks · doi:10.3917/dunod.mones.2016.01.0101 · Cited by 2
Taghvaeinia, A., & Zarei, F. (2022) · Shenakht Journal of Psychology and Psychiatry · doi:10.32598/shenakht.9.3.44 · Cited by 2
Using Buddhist Meditation-informed Hypnotic Techniques to Manage Rumination: Two Case Illustrations
Otani, A. (2023) · International Journal of Clinical and Experimental Hypnosis · doi:10.1080/00207144.2022.2160259 · Cited by 2
“Thus, rumination is a transdiagnostic construct relevant to a range of psychopathologies (Luca, 2019; McLaughlin & Nolen-Hoeksema, 2011).”
BackgroundSierra-Murguía, M. A., Contreras, G. N., Guevara-Sanginés, M. L., & Blázquez, F. P. (2021) · Interdisciplinaria Revista de Psicología y Ciencias Afines · doi:10.16888/interd.2022.39.1.9 · Cited by 2
Gender Differences in Co-rumination, Co-worry, and Internalizing Symptoms in Late Adolescence
Dombrowski, C. V. (2014) · OpenCommons - UConn (University of Connecticut) · Cited by 2
Davis, D. (2018) · ThinkIR: The University of Louisville's Institutional Repository (University of Louisville) · doi:10.18297/etd/3137 · Cited by 3
Watkins, E. R. (2015) · Emerging Trends in the Social and Behavioral Sciences · doi:10.1002/9781118900772.etrds0294 · Cited by 2
Resting HRV as a trait marker of rumination in healthy individuals? A large cross-sectional analysisPreprint
Li, Z., Pulopulos, M. M., Allaert, J., Smet, S. D., Wandel, L. D., Kappen, M., Puttevils, L., Razza, L. B., Schoonjans, E., Vanhollebeke, G., et al. (2022) · doi:10.22541/au.167156295.58669034/v1 · Cited by 2
Conradi, H. S. W., Nguyen, T., Lawal, O. A., & Carlson, L. E. (2025) · Global Advances in Integrative Medicine and Health · doi:10.1177/27536130251367051 · Cited by 1
de Waal, N., Nyklíček, I., van der Gucht, K., Pop, V. J. M., & Boekhorst, M. G. B. M. (2025) · Journal of Child and Family Studies · doi:10.1007/s10826-024-02968-y · Cited by 1
“Repetitive negative thinking, as both a symptom of and transdiagnostic factor for depression and anxiety (Kle-manski et al., 2017; McLaughlin & Nolen-Hoeksema, 2011; Nolen-Hoeksema et al., 2008), may also put fathers at risk for suboptimal bonding either in a direct manner or as a precursor of…”
Sizemore, K. M., Samrock, S., Gray, S., Marcotte, D., & Rendina, H. J. (2020) · Mindfulness · doi:10.1007/s12671-020-01315-8 · Cited by 2
“2015), and is a transdiagnostic factor for depression and anxiety (Mclaughlin and Nolen-Hoeksema 2011).”
BackgroundSafi, J. M., Rescigno, S. M., & Shih, J. H. (2022) · Journal of Prevention and Health Promotion · doi:10.1177/26320770221111757 · Cited by 1
“Rumination is considered a transdiagnostic factor, in that it plays a role in explaining both the co-occurrence and etiology of depression and anxiety symptoms (McLaughlin & Nolen-Hoeksema, 2011).”
Background
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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