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Rumination predicts heightened responding to stressful life events in major depressive disorder and generalized anxiety disorder.
Open accessAbstract
Although studies have documented heightened stress sensitivity in major depressive disorder (MDD) and generalized anxiety disorder (GAD), the mechanisms involved are poorly understood. One possible mechanism is the tendency to ruminate in response to stress. We used ecological momentary assessment to study ruminative thoughts after stressful events in 145 adults with MDD, GAD, comorbid MDD-GAD, or no psychopathology. Diagnosed individuals reported more event-related rumination than controls, even after adjusting for event stressfulness. Rumination was equally common in MDD and GAD and was especially severe among comorbid cases. More rumination immediately after the event predicted poorer affect, more maladaptive behavior, and more MDD and GAD symptoms at the next signal, even when pre-event levels of these variables were controlled. Rumination mediated, but did not moderate, the association of stress with affect and with symptoms. Stress-related rumination was more deleterious for diagnosed than healthy individuals, more intense for more severe clinical cases, and more persistent for cases with a greater temperamental vulnerability for emotional disorders. These results implicate rumination as a mechanism of stress sensitivity and suggest pathways through which it may maintain depression and anxiety in everyday life.
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“Suicidality was not assessed directly, but it may be inferred that reductions in negative affect may reduce suicidality risks.”
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“Based on results from 37 participants, for the intervention group, she reports significant reductions in overall negative affect, F(1, 1798) = 13.8, P = 0.0002; reduced craving immediately post-meditation, (Group × Assessment Type interaction, F(2, 1796) = 12.3, P = 0.0001); and reduced cigarettes smoked per day over time (Group × Day interaction, F(1, 436) = 5.50, P = 0.01).”
From Are smoking cessation treatments associated with suicidality risk? An overview (2016) · cites this paper as [88]
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“contextual CBTs such as mindfulness-based therapy and ACT appear to demonstrate success in treating nicotine addiction and promoting smoking cessation with minimal or no reported increased risk of suicidality.76,78,88”
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“which were further worsened by symptom severity and extensive comorbidity”
From Current state and future directions of technology-based ecological momentary assessment and intervention for major depressive disorder: a systematic review (2019) · cites this paper as [52]
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“Both clinical samples showed higher levels of rumination in response to stressful situations”
From Current state and future directions of technology-based ecological momentary assessment and intervention for major depressive disorder: a systematic review (2019) · cites this paper as [52]
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“rumination significantly mediated the impact of stress on symptoms and affect”
From Current state and future directions of technology-based ecological momentary assessment and intervention for major depressive disorder: a systematic review (2019) · cites this paper as [52]
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“higher rumination after a stressful event predicted greater NA and more maladaptive behaviours”
From Current state and future directions of technology-based ecological momentary assessment and intervention for major depressive disorder: a systematic review (2019) · cites this paper as [52]
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Citations
Cites
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“These behaviors were chosen for their conceptual links with rumination and related forms of perseverative thought and their hypothesized roles as mechanisms through which rumination may influence depression (Nolen-Hoeksema et al., 2008).”
BackgroundResultInfluentialNolen-Hoeksema, S., & Morrow, J. (1991) · Journal of Personality and Social Psychology · doi:10.1037/0022-3514.61.1.115 · Cited by 3,276 · cited 2×
“…around the time of a stressor report higher levels of depressive symptoms over the following weeks and months, even after accounting for pre-stressor levels of depressive symptoms (NolenHoeksema, McBride, & Larson, 1997; Nolen-Hoeksema & Morrow, 1991; NolenHoeksema, Parker, & Larson, 1994).”
BackgroundMethodThe role of rumination in depressive disorders and mixed anxiety/depressive symptoms.
Nolen-Hoeksema, S. (2000) · Journal of Abnormal Psychology · doi:10.1037//0021-843x.109.3.504 · Cited by 2,998 · cited 2×
“Our results align with observations by Nolen-Hoeksema and colleagues (2008) that rumination serves the function of establishing that one’s situation is hopeless, justifying withdrawal, inaction, and avoidant coping.”
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“Its validity was supported by strong associations (both r = .57) with the Ruminative Responses Scale (Nolen-Hoeksema & Morrow, 1991) and the Rumination scale of the Rumination-Reflection Questionnaire (Trapnell & Campbell, 1999).”
MethodBrosschot, J. F., Gerin, W., & Thayer, J. F. (2006) · Journal of Psychosomatic Research · doi:10.1016/j.jpsychores.2005.06.074 · Cited by 1,643
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Repetitive Negative Thinking as a Transdiagnostic Process
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Repetitive negative thinking as a transdiagnostic process
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“These results provide support for an emerging view of rumination (Nolen-Hoeksema & Watkins, 2011), and of perseverative thought more broadly (Ehring & Watkins, 2008), as a transdiagnostic rather than a disorder-specific process.”
ResultSelf-perpetuating properties of dysphoric rumination.
Lyubomirsky, S., & Nolen-Hoeksema, S. (1993) · Journal of Personality and Social Psychology · doi:10.1037//0022-3514.65.2.339 · Cited by 709 · cited 1×
“…impact of stress by inhibiting instrumental action is consistent with an experiment wherein dysphoric individuals, after being induced to ruminate, reported decreased willingness to engage in pleasant activities despite expecting these events to be enjoyable (Lyubomirsky & Nolen-Hoeksema, 1993).”
ResultMichl, L. C., McLaughlin, K. A., Shepherd, K., & Nolen-Hoeksema, S. (2013) · Journal of Abnormal Psychology · doi:10.1037/a0031994 · Cited by 694
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The effects of worry and rumination on affect states and cognitive activity.
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“One pathway, suggested by experimental research (Andrews & Borkovec, 1988; McLaughlin et al., 2007), is that rumination directly increases the negative emotions and symptoms that are central to emotional disorders.”
BackgroundWatkins, E. R., Mullan, E., Wingrove, J., Rimes, K., Steiner, H., Bathurst, N., Eastman, R., & Scott, J. (2011) · British Journal of Psychiatry · doi:10.1192/bjp.bp.110.090282 · Cited by 410
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Rumination and psychological distress among bereaved partners.
Nolen–Hoeksema, S., McBride, A., & Larson, J. M. (1997) · Journal of Personality and Social Psychology · doi:10.1037//0022-3514.72.4.855 · Cited by 376
Adaptive and maladaptive ruminative self-focus during emotional processing
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“…response to induced stress and is associated with heightened physiological responding, delayed recovery from the stressor, and increased reactivity to a subsequent upsetting event (Watkins, 2004; Watkins, Moberly, & Moulds, 2008; Zoccola, Dickerson, & Zaldivar, 2008; Zoccola, Quas, & Yim, 2010).”
BackgroundChronic psychosocial stress at work and risk of depression: evidence from prospective studies
Siegrist, J. (2008) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-008-5024-0 · Cited by 316 · cited 2×
“Stress sensitivity has been identified as a risk factor for the development and maintenance of emotional disorders (Mezulis, Funasaki, Charbonneau, &, Hyde, 2010; Morris, Ciesla, & Garber, 2010; Morris, Rao, & Garber, 2012; Siegrist, 2008).”
BackgroundEffects of daily events on mood states in major depressive disorder.
Peeters, F. P. M. L., Nicolson, N. A., Berkhof, J. H., Delespaul, P., & deVries, M. W. (2003) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.112.2.203 · Cited by 314 · cited 1×
“These findings replicate prior EMA studies in which rumination partially or fully mediated the association of stressful life events with negative and positive affect (Genet & Siemer, 2012; Moberly & Watkins, 2008; Peeters et al., 2003).”
ResultThompson, R. J., Mata, J., Jaeggi, S. M., Buschkuehl, M., Jonides, J., & Gotlib, I. H. (2012) · Journal of Abnormal Psychology · doi:10.1037/a0027978 · Cited by 292
Watkins, E. R., Moberly, N. J., & Moulds, M. L. (2008) · Emotion · doi:10.1037/1528-3542.8.3.364 · Cited by 286 · cited 2×
“assessed rumination using two items which, although yielding a reliable composite that correlated highly with trait measures, could not capture all features that may moderate the sensitizing influence of rumination (e.g., abstract versus concrete processing of the stressor; content of accompanying self-beliefs; Watkin…”
BackgroundMethodStress sensitivity and the development of affective disorders
Bale, T. L. (2006) · Hormones and Behavior · doi:10.1016/j.yhbeh.2006.06.033 · Cited by 243 · cited 1×
“We supplemented these analyses with tests of within-person mediated effects using procedures detailed in Bauer, Preacher, and Gil (2006) and Bolger and Laurenceau (2013) and performed in Mplus v7.”
MethodRuminative self-focus, negative life events, and negative affect
Moberly, N. J., & Watkins, E. R. (2008) · Behaviour Research and Therapy · doi:10.1016/j.brat.2008.06.004 · Cited by 221 · cited 2×
“In the only EMA study on this topic to date, ruminative self-focus and negative affect (NA) were sampled eight times daily for one week in an unselected community sample, with participants recording in a paper diary any event that elicited negative emotions (Moberly & Watkins, 2008).”
BackgroundResultUse of ecological momentary assessment in mood disorders research
Wenze, S. J., & Miller, I. W. (2010) · Clinical Psychology Review · doi:10.1016/j.cpr.2010.06.007 · Cited by 205 · cited 1×
“Ecological momentary assessment (EMA) has several unique advantages for addressing these gaps in the literature (Wenze & Miller, 2010).”
BackgroundStressful life events and the onset of a generalized anxiety syndrome
(1987) · American Journal of Psychiatry · doi:10.1176/ajp.144.9.1178 · Cited by 203
Schwarzer, R., & Schulz, U. (2003) · Handbook of Psychology · doi:10.1002/0471264385.wei0902 · Cited by 194
Rumination and Cortisol Responses to Laboratory Stressors
Zoccola, P. M., Dickerson, S. S., & Zaldivar, F. P. (2008) · Psychosomatic Medicine · doi:10.1097/psy.0b013e31817bbc77 · Cited by 173
Rumination, Worry, Cognitive Avoidance, and Behavioral Avoidance: Examination of Temporal Effects
Dickson, K. S., Ciesla, J. A., & Reilly, L. C. (2012) · Behavior Therapy · doi:10.1016/j.beth.2011.11.002 · Cited by 173
Intensive Longitudinal Methods
Wade, T. D. (2017) · Springer eBooks · doi:10.1007/978-981-287-104-6_100140 · Cited by 173
Verkuil, B., Brosschot, J. F., Gebhardt, W. A., & Thayer, J. F. (2010) · Journal of Experimental Psychopathology · doi:10.5127/jep.009110 · Cited by 155 · cited 1×
“For example, theorists have suggested that rumination prolongs the impact of a stressor by keeping the stressor “alive”—and the individual activated—even after the stressor has ended (Brosschot et al., 2006; Verkuil et al., 2010).”
BackgroundTransition from stress sensitivity to a depressive state: longitudinal twin study
Wichers, M., Geschwind, N., Jacobs, N., Kenis, G., Peeters, F., Derom, C., Thiery, E., Delespaul, P., & van Os, J. (2009) · British Journal of Psychiatry · doi:10.1192/bjp.bp.108.056853 · Cited by 151
Rumination moderates the effects of daily events on negative mood: Results from a diary study.
Genet, J. J., & Siemer, M. (2012) · Emotion · doi:10.1037/a0028070 · Cited by 141 · cited 2×
“In a second study that used daily diary methods, undergraduates rated at bedtime (a) their current mood and (b) the most unpleasant event of the day and their ruminative response to it (Genet & Siemer, 2012).”
BackgroundResultAndrews, V. H., & Borkovec, T. D. (1988) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/0005-7916(88)90006-7 · Cited by 131
Johnson, E. I., Grondin, O., Barrault, M., Faytout, M., Helbig, S., Husky, M., Granholm, E. L., Loh, C., Nadeau, L., Wittchen, H., et al. (2009) · International Journal of Methods in Psychiatric Research · doi:10.1002/mpr.276 · Cited by 122
Self-citationRuscio, A. M., Seitchik, A. E., Gentes, E. L., Jones, J. D., & Hallion, L. S. (2011) · Behaviour Research and Therapy · doi:10.1016/j.brat.2011.10.001 · Cited by 115
Self-citationMorris, M. C., Ciesla, J. A., & Garber, J. (2010) · Journal of Abnormal Psychology · doi:10.1037/a0019036 · Cited by 114
Mezulis, A. H., Funasaki, K., Charbonneau, A. M., & Hyde, J. S. (2009) · Cognitive Therapy and Research · doi:10.1007/s10608-009-9281-7 · Cited by 110
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Computerized ambulatory monitoring in mood disorders: Feasibility, compliance, and reactivity
Husky, M. M., Gindre, C., Mazure, C. M., Brebant, C., Nolen-Hoeksema, S., Sanacora, G., & Swendsen, J. (2010) · Psychiatry Research · doi:10.1016/j.psychres.2010.04.045 · Cited by 62
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Espejo, E. P., Hammen, C. L., & Brennan, P. A. (2011) · Research on Child and Adolescent Psychopathology · doi:10.1007/s10802-011-9552-0 · Cited by 47 · cited 2×
“In a second study that used daily diary methods, undergraduates rated at bedtime (a) their current mood and (b) the most unpleasant event of the day and their ruminative response to it (Genet & Siemer, 2012).”
BackgroundResultWisco, B. E., & Nolen–Hoeksema, S. (2008) · Elsevier eBooks · doi:10.1016/b978-0-08-045078-0.00010-1 · Cited by 44 · cited 1×
“Theorists have speculated that rumination increases maladaptive behaviors such as withdrawal, inactivity, and avoidance that, in turn, exacerbate depression (Wisco & Nolen-Hoeksema, 2008).”
BackgroundAnhedonia and Increased Stress Sensitivity: Two Promising Endophenotypes for Major Depression
Vrieze, E., & Claes, S. J. (2009) · Current Psychiatry Reviews · doi:10.2174/157340009788971083 · Cited by 15 · cited 1×
“…not only experience greater life stress (Blazer, Hughes, & George, 1987; Kendler, Karkowski, & Prescott, 1998) but exhibit heightened sensitivity to stress, reacting more strongly than healthy individuals even to relatively minor stressors (Bale, 2006; Vrieze & Claes, 2009; Wichers et al., 2009).”
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Reflecting on rumination: Consequences, causes, mechanisms and treatment of rumination
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“11 Tanno, 2013, 2014) and to mediate the role of life str ss and negative events in prospectively predicting negative affect and depressive symptoms ver several weeks in both nonclinical (Genet & Siemer, 2012; Moberly & Watkins, 2008b) and clini cal samples (Ruscio et al., 2015) and to moderate the role of life stress…”
BackgroundVachon, H., Viechtbauer, W., Rintala, A., & Myin-Germeys, I. (2019) · Journal of Medical Internet Research · doi:10.2196/14475 · Cited by 252
“Designs vary from 2 [18] to 50 evaluations per day [19], occurring at fixed [20], semirandom [21], or random time intervals [22], for 1 [23] to 150 days [24], using paper-and-pencil [25] or electronic devices [26], Likert scales [27], or visual analogue scales [28], and with questionnaires varying…”
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Harkness, K. L., & Monroe, S. M. (2016) · Journal of Abnormal Psychology · doi:10.1037/abn0000178 · Cited by 223
“For example, in an experience sampling study of adults with MDD and/or generalized anxiety disorder (GAD), Ruscio et al. (2015) prompted 145 participants eight times per day for one week to rate the ‘stressfulness’ of the most significant event they had experienced since the last signal, as well as…”
Background
Metadata
- Authors
- Ruscio, A. M., Gentes, E. L., Jones, J. D., Hallion, L. S., Coleman, E. S., & Swendsen, J.
- Affiliations
- University of Pennsylvania (US)
- Université de Bordeaux (FR)
- Venue
- Journal of Abnormal Psychology
- Published
- 2015-02
- Volume
- 124
- Issue
- 1
- Pages
- 17-26
- ISSN
- 0021-843X (ISSN-L)
- 1939-1846
- PMC
- PMC4332541
- OpenAlex
- W2137352759
- Cited by
- 228
- References
- 55
- Citations by year
- 2026: 12 · 2025: 29 · 2024: 20 · 2023: 37 · 2022: 20 · 2021: 26 · 2020: 24 · 2019: 17 · 2018: 14 · 2017: 17 · 2016: 9 · 2015: 3
- FWCI
- 21.59
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Journal of Abnormal Psychology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Sponsor name not included (K01 MH076162, R01 MH094425)
- University Research Foundation
- 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, stress sensitivity, major depressive disorder, generalized anxiety disorder, comorbidities, life events, affect, maladaptive behavior, mediation
- MeSH terms
- Adolescent, Adult, Anxiety Disorders, Major Depressive Disorder, Female, Humans, Life Change Events, Male, Middle Aged, Psychiatric Status Rating Scales, Stress, Psychological, Thinking, Young Adult
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