Rumination and implicit avoidance following bereavement: An approach avoidance task investigation
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Background and objectives Rumination, a risk factor in adjustment to bereavement, has often been considered a confrontation process. However, building on research on worry in generalized anxiety disorder (GAD) and rumination in post-traumatic stress disorder (PTSD), researchers recently developed the Rumination as Avoidance Hypothesis (RAH), which states that rumination after bereavement serves to avoid the reality of the loss. In the present study, RAH was tested by investigating if rumination is associated with implicit loss avoidance. Methods An Approach Avoidance Task (AAT) was used to assess automatic behavior tendencies. Using a joystick, 71 persons who recently lost a first-degree relative (90.1% women), pulled stimuli toward themselves or pushed them away from themselves. Stimuli represented the loss (picture deceased + loss word), were loss-related but ambiguous (picture deceased + neutral word; picture stranger + loss word), or were non-loss-related (picture stranger + neutral word; puzzle picture + X's). Results Participants who ruminated more were relatively faster in pushing loss stimuli away from themselves and slower in pulling loss stimuli towards themselves, implying more rumination was associated with stronger implicit loss avoidance. Effects were maintained after controlling for depressive or post-traumatic stress symptom levels, but not when controlling for prolonged grief symptom levels. Limitations Conjugally bereaved women were overrepresented in the sample, which limits generalizability of results. The study was correlational, precluding causal inferences. Conclusions In line with RAH, rumination was positively associated with loss avoidance. This may indicate that the application of exposure-based techniques can reduce rumination and loss-related psychopathology.
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Eisma, Rinck, et al. (2015) reported null results regarding the relation between push-pull difference score and complicated grief symptoms, in a regression controlling for age and rumination.
“Eisma, Rinck, et al. (2015) similarly reported null-results regarding the relation between this pushpull difference score and CG symptoms, in a regression analysis also controlling for age and rumination levels.”
From Emotion Regulatory Strategies in Complicated Grief: A Systematic Review (2021) · cites this paper as Eisma, Rinck, et al. (2015)
Findings on approach and avoidance tendencies in complicated grief are mixed, comprising positive associations, null results, and negative associations.
“Yu et al., 2017), sometimes null-results (Eisma, Rinck, et al., 2015), and sometimes negative associations (Maccallum et al., 2015).”
From Emotion Regulatory Strategies in Complicated Grief: A Systematic Review (2021) · cites this paper as Eisma, Rinck, et al., 2015
Laboratory studies have yielded equivocal findings on avoidance of loss-related cues and complicated grief, sometimes yielding positive associations, sometimes null results, and sometimes negative associations.
“However, laboratory studies have yielded equivocal findings on avoidance of loss-related cues and CG, sometimes yielding positive associations (Gander et al., 2018; Yu et al., 2017), sometimes null-results (Eisma, Rinck, et al., 2015), and sometimes negative associations (Maccallum et al., 2015).”
From Emotion Regulatory Strategies in Complicated Grief: A Systematic Review (2021) · cites this paper as Eisma, Rinck, et al., 2015
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Kennis, M., Dewitte, M. D., T'Sjoen, G. G., Stinkens, K., Sack, A. T., & Duecker, F. (2024) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2024.106963 · Cited by 4 · see citing works
Chapter 7. Treatment of Prolonged Grief Disorder
Skritskaya, N. A., Charney, M. E., Simon, N. M., & Shear, M. K. (2023) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379934.lg07 · Cited by 3 · see citing works
Effects of Rumination Processing Modes on the Tendency to Avoid Failure
Kambara, K., Ogata, A., & Kira, Y. (2017) · Current Psychology · doi:10.1007/s12144-017-9655-z · Cited by 3 · see citing works
Beyond goodbye: daily emotion regulation sensed from deceased loved ones
Stelzer, E., Flores, M. A., Butler, E., Greenberg, J., Mehl, M. R., Sbarra, D. A., & O'Connor, M. (2025) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2025.100972 · Cited by 2 · see citing works
Whys and What Ifs: Writing and Anxiety Reduction in Individuals Bereaved by Addiction
Thatcher, C. (2021) · Journal of Creativity in Mental Health · doi:10.1080/15401383.2021.1924097 · Cited by 3 · see citing works
“You Lose Some Good Friends”: Death and Grief in Assisted Living
Plys, E., Smith, R. W., & Portz, J. D. (2022) · Journal of Social Work in End-of-Life & Palliative Care · doi:10.1080/15524256.2022.2050339 · Cited by 1 · see citing works
Chapter 2. Bereavement, Grief, and Prolonged Grief Disorder in Children and Adolescents
Cozza, S. J., & Ogle, C. M. (2023) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379934.lg02 · Cited by 1 · see citing works
Cozza, S. J., & Fisher, J. E. (2023) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379934.lg01 · Cited by 1 · see citing works
Chapter 4. Defining and Diagnosing Prolonged Grief Disorder
Maciejewski, P. K., & Prigerson, H. G. (2023) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379934.lg04 · Cited by 1 · see citing works
Deuter, C. E., Smit, J., Kaczmarczyk, M., Wingenfeld, K., Otte, C., & Kuehl, L. K. (2021) · Comprehensive Psychoneuroendocrinology · doi:10.1016/j.cpnec.2021.100077 · Cited by 1 · see citing works
Tang, S. (2021) · Springer eBooks · doi:10.1007/978-3-030-22009-9_1027 · Cited by 1 · see citing works
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 · see citing works
Cleffken, R. (2015) · Utrecht University Repository (Utrecht University)
Psychological outcomes of those experiencing early pregnancy loss
Bendavid, J. (2019) · Minerva Access (University of Melbourne)
Tang, S. (2020) · Springer eBooks · doi:10.1007/978-3-319-69892-2_1027-1
Mirabolfathi, V., Moradi, A., Choobin, M. H., & Derakhshan, N. (2020) · Advances in Cognitive Science · doi:10.30699/icss.22.1.49
Ruminatif Düşünce Biçimi ve Düşünce Eylem Kaynaşmasının Yaşantısal Kaçınmayla İlişkisi
ŞIK, A., & Çam, S. (2023) · Çukurova Üniversitesi Sosyal Bilimler Enstitüsü Dergisi · doi:10.35379/cusosbil.1228760
Chapter 5. Clinically Relevant Correlates of Prolonged Grief Disorder
Maciejewski, P. K., & Prigerson, H. G. (2023) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379934.lg05
Reynolds, C. F., Cozza, S. J., Maciejewski, P. K., Prigerson, H. G., Shear, M. K., Simon, N. M., Zisook, S., & Skritskaya, N. A. (2023) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379934.lg08
(2023) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379934.bm01
Chapter 3. Clinical Management of Bereaved Patients With and Without Prolonged Grief Disorder
Iglewicz, A., Clark, A., & Zisook, S. (2023) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379934.lg03
Chapter 6. Epidemiology of Prolonged Grief Disorder
Maciejewski, P. K., & Prigerson, H. G. (2023) · American Psychiatric Association Publishing eBooks · doi:10.1176/appi.books.9781615379934.lg06
Struggling with closure? Here are some things you can try
Boucher, C. M. (2025) · doi:10.64628/aam.j7nqkvdhe
Troubles du sommeil et déterminants psychopathologiques
Faccini, J. (2022) · theses.fr (ABES) · doi:10.70675/fd05872cz888az41cez96bdzbc308491be49
de Keijser, J. (2021) · Bohn Stafleu van Loghum eBooks · doi:10.1007/978-90-368-2683-9_12
Ritter, K. M., & Stompe, T. (2026) · Trauma and Emergency Medicine · doi:10.46439/trauma.3.009
- Authors
- Eisma, M. C., Rinck, M., Stroebe, M. S., Schut, H. A. W., Boelen, P. A., Stroebe, W., & van den Bout, J.
- Affiliations
- Utrecht University (NL)
- Radboud University Nijmegen (NL)
- University of Groningen (NL)
- Corresponding author
- Eisma, Maarten C.
- Venue
- Journal of Behavior Therapy and Experimental Psychiatry
- Publisher
- Elsevier BV
- Published
- 2015-06
- Volume
- 47
- Pages
- 84-91
- ISSN
- 0005-7916 (ISSN-L)
- OpenAlex
- W2111397871
- Cited by
- 68
- References
- 58
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 1 · 2023: 17 · 2022: 5 · 2021: 6 · 2020: 11 · 2019: 5 · 2018: 6 · 2017: 5 · 2016: 3 · 2015: 4
- FWCI
- 4.73
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Behavior Therapy and Experimental Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, other-oa)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Radboud Repository (Radboud University) (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Funders
- Dutch Association for Scientific Research (NWO) (91208009)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Grief, Bereavement, and Mental Health
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Social Psychology › Death Anxiety and Social Exclusion
- Keywords
- rumination, loss avoidance, bereavement, approach-avoidance task, prolonged grief disorder, grief adjustment, exposure therapy
- MeSH terms
- Adaptation, Psychological, Adult, Avoidance Learning, Bereavement, Female, Humans, Male, Middle Aged, Photic Stimulation, Reaction Time, Task Performance and Analysis, Thinking, Visual Perception, Young Adult
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