An experience sampling study of worry and rumination in psychosis
Abstract
Background: Increasing research effort is being dedicated to investigating the links between emotional processes and psychosis, despite the traditional demarcation between the two. Particular focus has alighted upon two specific anxious and depressive processes, worry and rumination, given the potential for links with aspects of delusions and auditory hallucinations. This study rigorously explored the nature of these links in the context of the daily life of people currently experiencing psychosis. Method: Experience sampling methodology (ESM) was used to assess the momentary links between worry and rumination on the one hand, and persecutory delusional ideation and auditory hallucinations on the other. Twenty-seven participants completed the 6-day experience sampling period, which required repeated self-reports on thought processes and experiences. Multilevel modelling was used to examine the links within the clustered data. Results: We found that antecedent worry and rumination predicted delusional and hallucinatory experience, and the distress they elicited. Using interaction terms, we have shown that the links with momentary symptom severity were moderated by participants' trait beliefs about worry/rumination, such that they were reduced when negative beliefs about worry/rumination (meta-cognitions) were high. Conclusions: The current findings offer an ecologically valid insight into the influence of worry and rumination on the experience of psychotic symptoms, and highlight possible avenues for future intervention strategies.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Several studies have supported the correlation and predictive relationship between rumination and depressive symptoms, anxiety, positive symptoms and negative symptoms.
“Several studies have supported the correlation and predictive relationship between rumination and depressive symptoms,12,13 anxiety,13 positive symptoms13–16 and negative symptoms.17”
From Dispositional Mindfulness and Psychotic Symptoms in Schizophrenia Spectrum Disorders: The Mediating Roles of Rumination and Negative Emotion (2022) · cites this paper as [14]
Cites
Discovering Statistics Using SPSS
Field, A. P., & Miles, J. N. V. (2000) · Medical Entomology and Zoology · Cited by 28,268 · see citing works
The Positive and Negative Syndrome Scale (PANSS) for schizophrenia.
Kay, S. R., Fiszbein, A., & Opler, L. A. (1987) · Schizophrenia Bulletin · doi:10.1093/schbul/13.2.261 · Cited by 21,378 · see citing works
Metacognition and cognitive monitoring: A new area of cognitive–developmental inquiry
Flavell, J. H. (1979) · American Psychologist · doi:10.1037/0003-066x.34.10.906 · Cited by 11,282 · cited 1× · see citing works
“This was based on the understanding that meta-cognitions are stable belief structures (Flavell, 1979) that may vary over time but may not produce sufficient variability over the time course of the study to provide usable data, and thus are more appropriately assessed using traditional measures.”
BackgroundRumination reconsidered: a psychometric analysis.
Treynor, W., Gonzalez, R., & Nolen-Hoeksema, S. (2003) · Cognitive Therapy and Research · doi:10.1023/a:1023910315561 · Cited by 3,808 · see citing works
Validity and reliability of the Experience-Sampling Method
CSIKSZENTMIHALYI, M., & LARSON, R. (1987) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-198709000-00004 · Cited by 2,544 · see citing works
Manic-Depressive Insanity and Paranoia.
(1921) · JAMA · doi:10.1001/jama.1921.02630330070026 · Cited by 1,612 · see citing works
HADDOCK, G., McCARRON, J., TARRIER, N., & FARAGHER, E. B. (1999) · Psychological Medicine · doi:10.1017/s0033291799008661 · Cited by 1,461 · see citing works
Self-citationEffects of rumination and distraction on naturally occurring depressed mood
Nolen-hoeksema, S., & Morrow, J. (1993) · Cognition and Emotion · doi:10.1080/02699939308409206 · Cited by 1,000 · see citing works
Experience sampling research in psychopathology: opening the black box of daily life
Myin-Germeys, I., Oorschot, M., Collip, D., Lataster, J., Delespaul, P., & van Os, J. (2009) · Psychological Medicine · doi:10.1017/s0033291708004947 · Cited by 817 · see citing works
An empirical test of a clinical metacognitive model of rumination and depression
Papageorgiou, C., & Wells, A. (2003) · Cognitive Therapy and Research · doi:10.1023/a:1023962332399 · Cited by 550 · see citing works
Mellings, T. M. B., & Alden, L. E. (2000) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(99)00040-6 · Cited by 506 · cited 1× · see citing works
“…difficulties engaging away from threat or negative material (Donaldson et al. 2007; Verkuil et al. 2009), misinterpretation of social interactions (Mellings & Alden, 2000; Donaldson & Lam, 2004), attempts at avoidance (Cribb et al. 2006; Moulds et al. 2007) and increased cognitive intrusions…”
BackgroundConnecting neurosis and psychosis: the direct influence of emotion on delusions and hallucinations
Freeman, D. H., & Garety, P. A. (2003) · Behaviour Research and Therapy · doi:10.1016/s0005-7967(02)00104-3 · Cited by 486 · see citing works
Smith, B., Fowler, D. G., Freeman, D. H., Bebbington, P., Bashforth, H., Garety, P. A., Dunn, G., & Kuipers, E. (2006) · Schizophrenia Research · doi:10.1016/j.schres.2006.06.018 · Cited by 443 · see citing works
Ruminative Self-Focus and Negative Affect
Moberly, N., & Watkins, E. (2008) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.117.2.314 · Cited by 441 · see citing works
Metacognitive beliefs about rumination in recurrent major depression
Papageorgiou, C., & Adrian Wells, A. (2001) · Cognitive and Behavioral Practice · doi:10.1016/s1077-7229(01)80021-3 · Cited by 401 · see citing works
Myin‐Germeys, I., Peeters, F., Havermans, R., Nicolson, N. A., DeVries, M. W., Delespaul, P., & Van Os, J. (2003) · Acta Psychiatrica Scandinavica · doi:10.1034/j.1600-0447.2003.02025.x · Cited by 400 · see citing works
Adaptive and maladaptive ruminative self-focus during emotional processing
Watkins, E. R. (2004) · Behaviour Research and Therapy · doi:10.1016/j.brat.2004.01.009 · Cited by 339 · see citing works
Rumination and attention in major depression
Donaldson, C., Lam, D., & Mathews, A. (2007) · Behaviour Research and Therapy · doi:10.1016/j.brat.2007.07.002 · Cited by 337 · see citing works
Virtual reality study of paranoid thinking in the general population
Freeman, D. H., Pugh, K., Antley, A., Slater, M., Bebbington, P., Gittins, M., Dunn, G., Kuipers, E., Fowler, D. G., & Garety, P. A. (2008) · The British Journal of Psychiatry · doi:10.1192/bjp.bp.107.044677 · Cited by 305 · see citing works
Wells, A. (2005) · Cognitive Therapy and Research · doi:10.1007/s10608-005-1652-0 · Cited by 300 · see citing works
Granholm, E. L., Ben‐Zeev, D., Link, P. C., Bradshaw, K., & Holden, J. L. (2011) · Schizophrenia Bulletin · doi:10.1093/schbul/sbr155 · Cited by 300 · see citing works
Mindfulness groups for people with psychosis
Chadwick, P., Taylor, K. N., & Abba, N. (2005) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465805002158 · Cited by 292 · cited 1× · see citing works
“This focus might be incorporated into current psychological interventions, such as the use of mindfulness or worry reduction techniques, which have already begun to be piloted with people experiencing psychosis (Chadwick et al. 2005; Foster et al. 2010).”
BackgroundThe relationship between rumination, avoidance and depression in a non-clinical sample.
Moulds, M. L., Kandris, E., Starr, S., & Wong, A. C. M. (2007) · Behaviour Research and Therapy · doi:10.1016/j.brat.2006.03.003 · Cited by 289 · cited 4× · see citing works
“2009), misinterpretation of social interactions (Mellings & Alden, 2000; Donaldson & Lam, 2004), attempts at avoidance (Cribb et al. 2006; Moulds et al. 2007) and increased cognitive intrusions (Wells & Papageorgiou, 1995; Becker et al.”
BackgroundInfluentialExperience sampling research in individuals with mental illness: reflections and guidance
Palmier-Claus, J. E., Myin-Germeys, I., Barkus, E., Bentley, L., Udachina, A., Delespaul, P. A. E. G., Lewis, S. W., & Dunn, G. (2011) · Acta Psychiatrica Scandinavica · doi:10.1111/j.1600-0447.2010.01596.x · Cited by 287 · see citing works
Dysphoric Rumination Impairs Concentration on Academic Tasks
Lyubomirsky, S., Kasri, F., & Zehm, K. (2003) · Cognitive Therapy and Research · doi:10.1023/a:1023918517378 · Cited by 278 · see citing works
Determinants of occurrence and recovery from hallucinations in daily life
Delespaul, P., deVries, M., & van Os, J. (2002) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s001270200000 · Cited by 247 · see citing works
Freeman, D., Stahl, D., McManus, S., Meltzer, H., Brugha, T., Wiles, N., & Bebbington, P. (2012) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-011-0433-1 · Cited by 246 · see citing works
Worry and the incubation of intrusive images following stress
Wells, A., & Papageorgiou, C. (1995) · Behaviour Research and Therapy · doi:10.1016/0005-7967(94)00087-z · Cited by 229 · cited 2× · see citing works
“…Verkuil et al. 2009), misinterpretation of social interactions (Mellings & Alden, 2000; Donaldson & Lam, 2004), attempts at avoidance (Cribb et al. 2006; Moulds et al. 2007) and increased cognitive intrusions (Wells & Papageorgiou, 1995; Becker et al. 1998; Lyubomirsky et al. 2003; Watkins, 2004).”
BackgroundFreeman, D. H., & Garety, P. A. (1999) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s135246589927107x · Cited by 218 · see citing works
Rumination, mood and social problem-solving in major depression
Donaldson, C., & Lam, D. (2004) · Psychological Medicine · doi:10.1017/s0033291704001904 · Cited by 209 · see citing works
Startup, H. M., Freeman, D. H., & Garety, P. A. (2006) · Behaviour Research and Therapy · doi:10.1016/j.brat.2006.04.006 · Cited by 205 · see citing works
Rumination and Experiential Avoidance in Depression
Cribb, G., Moulds, M. L., & Carter, S. (2006) · Behaviour Change · doi:10.1375/bech.23.3.165 · Cited by 204 · see citing works
Foster, C., Startup, H. M., Potts, L. C., & Freeman, D. H. (2009) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2009.09.001 · Cited by 139 · see citing works
Metacognitions in proneness towards hallucinations and delusions
Larøi, F., & der Linden, M. V. (2005) · Behaviour Research and Therapy · doi:10.1016/j.brat.2004.10.008 · Cited by 122 · see citing works
Ben‐Zeev, D., Ellington, K., Swendsen, J. D., & Granholm, E. L. (2010) · Schizophrenia Bulletin · doi:10.1093/schbul/sbq041 · Cited by 112 · see citing works
Social problem solving and trait anxiety as predictors of worry in a college student population
Belzer, K. D., D’Zurilla, T. J., & Maydeu‐Olivares, A. (2002) · Personality and Individual Differences · doi:10.1016/s0191-8869(01)00173-8 · Cited by 109 · see citing works
PETERS, E. R., Williams, S. L., Cooke, M. A., & Kuipers, E. (2011) · Psychological Medicine · doi:10.1017/s0033291711002650 · Cited by 95 · see citing works
Stapinski, L. A., Abbott, M. J., & Rapee, R. M. (2010) · Behaviour Research and Therapy · doi:10.1016/j.brat.2010.07.005 · Cited by 95 · see citing works
Morrison, A., & Wells, A. (2007) · Behaviour Research and Therapy · doi:10.1016/j.brat.2006.11.010 · Cited by 90 · see citing works
Rumination, reflection, intrusive thoughts, and hallucination-proneness: towards a new model.
Jones, S. R., & Fernyhough, C. (2009) · Behaviour Research and Therapy · doi:10.1016/j.brat.2008.09.008 · Cited by 87 · see citing works
Mobile Assessment in Schizophrenia: A Data-Driven Momentary Approach
Oorschot, M., Lataster, T., Thewissen, V., Wichers, M., & Myin‐Germeys, I. (2011) · Schizophrenia Bulletin · doi:10.1093/schbul/sbr166 · Cited by 86 · see citing works
Don’t Worry and Beware of White Bears
Becker, E. S., Rinck, M., Roth, W. T., & Margraf, J. (1998) · Journal of Anxiety Disorders · doi:10.1016/s0887-6185(97)00048-0 · Cited by 84 · see citing works
Mobile Assessment Guide for Research in Schizophrenia and Severe Mental Disorders
Kimhy, D., Myin‐Germeys, I., Palmier‐Claus, J. E., & Swendsen, J. D. (2012) · Schizophrenia Bulletin · doi:10.1093/schbul/sbr186 · Cited by 84 · see citing works
Worry and Anxiety: Is There a Causal Relationship?
Gana, K., Martin, B., & Canouet, M.-D. (2001) · Psychopathology · doi:10.1159/000049314 · Cited by 77 · see citing works
The role of metacognitive beliefs in auditory hallucinations
Lobban, F. A., Haddock, G., Kinderman, P., & Adrian Wells, A. (2002) · Personality and Individual Differences · doi:10.1016/s0191-8869(01)00123-4 · Cited by 75 · see citing works
Self-citationKelly, J., Gooding, P., Pratt, D., Ainsworth, J., Welford, M., & Tarrier, N. (2012) · Journal of Mental Health · doi:10.3109/09638237.2011.638001 · Cited by 73 · cited 1× · see citing works
“Furthermore, ESM could be harnessed to deliver momentary interventions (Granholm et al. 2012; Kelly et al. 2012), which, when triggered by heightened levels of worry and/or rumination, instigate a short individualized intervention strategy to reduce the impact on distressing experiences.”
BackgroundInteracting effects of worry and anxiety on attentional disengagement from threat.
Verkuil, B., Brosschot, J., Putman, P., & Thayer, J. (2009) · Behaviour Research and Therapy · doi:10.1016/j.brat.2008.11.003 · Cited by 69 · see citing works
Time, Context, and Subjective Experiences in Schizophrenia
deVries, M. W., & Delespaul, P. (1989) · Schizophrenia Bulletin · doi:10.1093/schbul/15.2.233 · Cited by 57 · see citing works
BIRCHWOOD, R. W. S. &. M. (1997) · Journal of Mental Health · doi:10.1080/09638239718617 · Cited by 50 · see citing works
Appraisals, psychotic symptoms and affect in daily life
PETERS, E. R., Lataster, T., Greenwood, K., Kuipers, E., Scott, J. L., Williams, S., Garety, P. A., & Myin‐Germeys, I. (2011) · Psychological Medicine · doi:10.1017/s0033291711001802 · Cited by 49 · see citing works
Developing Treatments of Persistent Persecutory Delusions
Hepworth, C., Startup, H. M., & Freeman, D. H. (2011) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0b013e318229cfa8 · Cited by 46 · see citing works
The Experience Sampling Method in psychosis research
Myin‐Germeys, I., Delespaul, P., & van Os, J. (2003) · Current Opinion in Psychiatry · doi:10.1097/00001504-200304002-00006 · Cited by 42 · see citing works
357 – Appraisals, psychotic symptoms and affect in daily life
PETERS, E. R., Myin‐Germeys, I., Williams, S., Greenwood, K., Kuipers, E., Scott, J. L., & Garety, P. A. (2008) · Schizophrenia Research · doi:10.1016/j.schres.2007.12.424 · Cited by 40 · see citing works
Hartley, S., Haddock, G., & Barrowclough, C. (2011) · Behaviour Research and Therapy · doi:10.1016/j.brat.2011.10.007 · Cited by 21 · see citing works
Self-citationClassification of depressive illness: a re-evaluation
Foulds, G. A., & Bedford, A. (1976) · Psychological Medicine · doi:10.1017/s0033291700007443 · Cited by 15 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Reflecting on rumination: Consequences, causes, mechanisms and treatment of rumination
Watkins, E. R., & Roberts, H. (2020) · Behaviour Research and Therapy · doi:10.1016/j.brat.2020.103573 · Cited by 862 · see citing works
Physiological concomitants of perseverative cognition: A systematic review and meta-analysis.
Ottaviani, C., Thayer, J. F., Verkuil, B., Lonigro, A., Medea, B., Couyoumdjian, A., & Brosschot, J. F. (2016) · Psychological Bulletin · doi:10.1037/bul0000036 · Cited by 476 · see citing works
Advances in understanding and treating persecutory delusions: a review
Freeman, D., & Garety, P. (2014) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-014-0928-7 · Cited by 348 · see citing works
Freeman, D., Dunn, G., Startup, H., Pugh, K., Cordwell, J., Mander, H., Černis, E., Wingham, G., Shirvell, K., & Kingdon, D. (2015) · The Lancet Psychiatry · doi:10.1016/s2215-0366(15)00039-5 · Cited by 295 · see citing works
The role of emotion regulation in the characterization, development and treatment of psychopathology
Lincoln, T. M., Schulze, L., & Renneberg, B. (2022) · Nature Reviews Psychology · doi:10.1038/s44159-022-00040-4 · Cited by 234 · see citing works
Transdiagnostic mechanisms in depression and anxiety: The role of rumination and attentional control
Hsu, K. J., Beard, C., Rifkin, L., Dillon, D. G., Pizzagalli, D. A., & Björgvinsson, T. (2015) · Journal of Affective Disorders · doi:10.1016/j.jad.2015.08.008 · Cited by 167 · see citing works
Killikelly, C., He, Z., Reeder, C., & Wykes, T. (2017) · JMIR mHealth and uHealth · doi:10.2196/mhealth.7088 · Cited by 105 · see citing works
Mulligan, L. D., Haddock, G., Emsley, R., Neil, S. T., & Kyle, S. D. (2016) · Journal of Abnormal Psychology · doi:10.1037/abn0000180 · Cited by 101 · see citing works
Self-citationBallesio, A., Bacaro, V., Vacca, M., Chirico, A., Lucidi, F., Riemann, D., Baglioni, C., & Lombardo, C. (2021) · Sleep Medicine Reviews · doi:10.1016/j.smrv.2020.101378 · Cited by 87 · see citing works
The everyday dynamics of rumination and worry: Precipitant events and affective consequences
Kircanski, K., Thompson, R. J., Sorenson, J., Sherdell, L., & Gotlib, I. H. (2018) · Cognition and Emotion · doi:10.1080/02699931.2017.1278679 · Cited by 76 · see citing works
“These items were based on prior ESM studies (e.g., Hartley et al., 2014; Moberly & Watkins, 2008a) and were pilot-tested for feasibility and clarity.”
MethodResultRumination as a Transdiagnostic Phenomenon in the 21st Century: The Flow Model of Rumination
Wong, S. M. Y., Chen, E. Y. H., Lee, M. C. Y., Suen, Y. N., & Hui, C. L. M. (2023) · Brain Sciences · doi:10.3390/brainsci13071041 · Cited by 48 · see citing works
Sellers, R., Wells, A., & Morrison, A. P. (2018) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2132 · Cited by 32 · see citing works
Bergmann, N., Hahn, E., Hahne, I., Zierhut, M., Ta, T. M. T., Bajbouj, M., Pijnenborg, G. H. M., & Böge, K. (2021) · Frontiers in Psychology · doi:10.3389/fpsyg.2021.708808 · Cited by 23 · see citing works
Núñez, D., Godoy, M. I., Gaete, J., Faúndez, M. J., Campos, S., Fresno, A., & Spencer, R. (2021) · PLOS ONE · doi:10.1371/journal.pone.0256686 · Cited by 20 · see citing works
Wang, W., Xu, W., Chander, A., Nepal, S., Buck, B., Pakhomov, S., Cohen, T., Ben-Zeev, D., & Campbell, A. (2023) · Proceedings of the ACM on Interactive, Mobile, Wearable and Ubiquitous Technologies · doi:10.1145/3610890 · Cited by 19 · see citing works
Compliance in experience sampling methodology: the role of demographic and clinical characteristics
Hartley, S., Varese, F., Vasconcelos e Sa, D., Udachina, A., Barrowclough, C., Bentall, R. P., Lewis, S. W., Dunn, G., Haddock, G., & Palmier-Claus, J. (2014) · Psychosis · doi:10.1080/17522439.2012.752520 · Cited by 16 · see citing works
Self-citationLam, A. H. Y., Cheung, Y. T. D., Wong, K. H., Leung, S. F., & Chien, W. T. (2022) · Neuropsychiatric Disease and Treatment · doi:10.2147/ndt.s338133 · Cited by 13 · see citing works
- Authors
- Hartley, S., Haddock, G., Vasconcelos e Sa, D., Emsley, R., & Barrowclough, C.
- Affiliations
- Greater Manchester Mental Health NHS Foundation Trust (GB)
- University of Manchester (GB)
- Manchester Academic Health Science Centre (GB)
- Corresponding author
- Hartley, S.
- Venue
- Psychological Medicine
- Publisher
- Cambridge University Press (CUP)
- Published
- 2013-08-19
- Volume
- 44
- Issue
- 8
- Pages
- 1605-1614
- ISSN
- 0033-2917 (ISSN-L)
- 1469-8978
- OpenAlex
- W2098977605
- Cited by
- 138
- References
- 55
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 17 · 2023: 11 · 2022: 9 · 2021: 12 · 2020: 21 · 2019: 16 · 2018: 10 · 2017: 11 · 2016: 7 · 2015: 11 · 2014: 3 · 2013: 1
- FWCI
- 5.20
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychological Medicine (publishedVersion)
- PubMed (publishedVersion)
- Research Explorer (The University of Manchester) (submittedVersion)
- Funders
- National Institute for Health and Care Research
- National Institutes of Health
- Programme Grants for Applied Research
- National Institute of Mental Health
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
- Keywords
- psychosis, worry, rumination, persecutory delusions, auditory hallucinations, metacognition, delusional ideation, distress
- MeSH terms
- Adult, Anxiety, Delusions, Depression, Female, Hallucinations, Humans, Male, Psychotic Disorders
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
