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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.
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“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
In the citing paper
“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]
In the citing paper
“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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Cites
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To parcel or not to parcel: Exploring the question, weighing the merits
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“This result contrasts with findings from a large number of prospective studies documenting elevated risk for depression among adolescents with anxiety symptoms and disorders (Cole, Peeke, Martin, Truglio, & Seroczynski, 1998; Costello et al., 2003; Merikangas et al., 2003; Pine et al., 1998) and defies easy explanatio…”
ResultRumination reconsidered: a psychometric analysis.
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Emotion Regulation and Psychopathology: The Role of Gender
Nolen–Hoeksema, S. (2012) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-032511-143109 · Cited by 1,413
“…anxiety disorders, rumination is associated with an increased risk for social phobia (Mellings & Alden 2000), posttraumatic stress disorder (Clohessy & Ehlers 1999, Ehlers et al. 1998, Mayou et al. 2002, Murray et al. 2002), and generalized anxiety (McLaughlin & Nolen-Hoeksema 2011, Watkins 2009).”
BackgroundSelf-citationSloan, E., Hall, K., Moulding, R., Bryce, S., Mildred, H., & Staiger, P. K. (2017) · Clinical Psychology Review · doi:10.1016/j.cpr.2017.09.002 · Cited by 1,052
“…association between ER and symptoms of psychopathology) has supported the notion of ER as a transdiagnostic construct across depressive, anxiety, eating, substance use disorders and BPD (Aldao &Nolen-Hoeksema, 2010, 2012a, 2012b; McLaughlin & Nolen-Hoeksema, 2011; Newby, Williams, & Andrews, 2014).”
BackgroundComorbidity of anxiety and depression in children and adolescents: 20 years after
Cummings, C. M., Caporino, N. E., & Kendall, P. C. (2014) · Psychological Bulletin · doi:10.1037/a0034733 · Cited by 1,028
Snyder, H. R., Miyake, A., & Hankin, B. L. (2015) · Frontiers in Psychology · doi:10.3389/fpsyg.2015.00328 · Cited by 946
Emotion regulation strategies in depressive and anxiety symptoms in youth: A meta-analytic review
Schäfer, J. Ö., Naumann, E., Holmes, E. A., Tuschen-Caffier, B., & Samson, A. C. (2017) · Journal of Youth and Adolescence · doi:10.1007/s10964-016-0585-0 · Cited by 941
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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