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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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ResultRumination reconsidered: a psychometric analysis.
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Appendix B. Structured Clinical Interview for Prolonged Grief Disorder
Prigerson, H. G., Viola, M., Lichtenthal, W. G., Rogers, M., Derry, H. M., She, W. J., Gordon-Elliott, J. S., & Maciejewski, P. K. (2023) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379934.bm02 · Cited by 1
The role of parenting in the development of rumination
Douglas, J. L. (2013) · UEA Digital Repository (University of East Anglia) · Cited by 1
Distress after criminal victimization quantitative and qualitative aspects in a two-year perspective
Semb, O. (2011) · DiVA at Umeå University (Umeå University) · Cited by 1
Mindfulness and rumination: stress pathways for caregivers of persons living with dementia.
Savla, J., Mansoor, M., Kim, N., Hagemann, L., Luci, K., & Sapra, M. (2026) · The Gerontologist · doi:10.1093/geront/gnag103
“However, 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.”
The Effects of Repetitive Thought and Construal Level on Alcohol Consumption
Kiselica, A. M. (2015) · Digital Commons - University of South Florida (University of South Florida)
Editorial, Special Issue in Honour of Professor Susan Nolen-Hoeksema
Krans, J. (2014) · Journal of Experimental Psychopathology · doi:10.1177/204380871400500301
Schweiger, U., & Sipos, V. (2014) · Zeitschrift für Klinische Psychologie und Psychotherapie · doi:10.1026/1616-3443/a000295
Anderson, K. S. (2012) · DigitalCommons (California Polytechnic State University)
Depressives Grübeln: Konsequenzen, Theorie und Behandlung
Teismann, T., Hanning, S., von Brachel, R., & Willutzki, U. (2012) · Springer eBooks · doi:10.1007/978-3-642-25229-7_1
Exploring Emotional Memory as a Potential Mechanism Explaining the Effectiveness of Mindfulness.
Dong, B. (2015) · Brandeis Institutional Repository
Battista, S. R. (2014) · DalSpace (Dalhousie University)
Mindfulness in Bipolar Disorder and Major Depressive Disorder
Hosseini, S. (2014) · MacSphere (McMaster University) · doi:10.71548/24268 · Cited by 1
Perfeccionismo, pensamento perseverativo negativo e perturbações do comportamento alimentar
Monteiro, E. C. S. (2015) · Portuguese National Funding Agency for Science, Research and Technology (RCAAP Project by FCT)
Speegle, K. C., Barnett, R. V., Forthun, L. F., & Mastrodicasa, J. (2016) · Journal of Student Affairs Inquiry Improvement and Impact · doi:10.18060/27835
“This relationship affirms other literature linking general rumination (not specific to a certain life domain) to potential issues like anxiety and depression (Wilkinson, Croudace, & Goodyer, 2013; McLaughlin & Nolen-Hoeksema, 2011).”
BackgroundEmotion Regulation Strategy Use and Posttraumatic Stress Disorder
Lee, D. J. (2013)
Buchholz, K. R. (2015) · IRL - University of Missouri, St. Louis (University of Missouri–St. Louis)
Catastrophizing Pain; A More Feminine Characteristics of Pain & Discomfort
Naseem, U., & Ahmed, S. (2016) · International Journal of Women Empowerment · doi:10.29052/2413-4252.v2.i1.2016.10-21
Final Synthesis and Conclusions
Riskind, J. H., & Rector, N. A. (2018) · Springer eBooks · doi:10.1007/978-1-4939-8782-5_17
Maisam, S., Mami, S., Mohammadzadeh, J., Ahmadi, V., & Kakabraee, K. (2019) · Annals of Military and Health Sciences Research · doi:10.5812/amh.84155
“Many factors, including mood and anxiety symptoms, have been suggested to identify the relationship between generalized anxiety disorder and other emotional comorbidities (3).”
BackgroundDehnabi, A., Radfar, E., & Radsepehr, H. (2019) · International Clinical Neuroscience Journal · doi:10.15171/icnj.2019.02
Cho, S., & Jo, H.-I. (2017) · Korea Journal of Counseling · doi:10.15703/kjc.18.6.201712.37
الفروق فی العلاقة بین التسامح واجترار الأفکار لدى المعنفات وغیر المعنفات
الستار, ر. م. ع. (2017) · دراسات نفسية · doi:10.21608/psj.2017.97430
Singhani, S. (2020) · Digital Access to Scholarship at Harvard (DASH) (Harvard University)
Ip, K. I. (2020) · Deep Blue (University of Michigan)
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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