Rumination following bereavement: an overview
Open accessAbstract
This contribution provides an overview of rumination (i.e., thinking repetitively and recurrently about negative events and/or negative emotions) in adjustment to bereavement. First, we summarise a growing literature on rumination and mental health outcomes of bereavement. Next, we compare two main theories explaining the maladaptive effects of rumination after loss, which hold conflicting implications for clinical practice. The Response Styles Theory (RST) states that rumination is a maladaptive confrontation strategy that perpetuates distress by increasing negative cognitions, impairing problem solving and instrumental behaviour and reducing social support. Conversely, the Rumination as Avoidance Hypothesis (RAH) holds that rumination may serve to avoid painful aspects of the loss, thereby hampering adjustment to bereavement. Crucially, while RST predicts that distraction reduces rumination, RAH predicts that loss exposure is more effective. We review evidence for RST and RAH and their clinical implications and conclude with a brief exploration of ways to reconcile these theories.
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One longitudinal study demonstrated that worry predicted complicated grief symptoms over and above baseline symptoms and background variables.
“One longitudinal study demonstrated that worry predicted CG symptoms over and above baseline symptoms and background variables (Eisma et al., 2017).”
From Emotion Regulatory Strategies in Complicated Grief: A Systematic Review (2021) · cites this paper as Eisma et al., 2017
The ‘grief rumination’ section (page unavailable) reports longitudinal associations between grief rumination and complicated-grief symptoms. The ‘Depressive rumination’ section (page unavailable) describes a baseline-symptom adjustment for a finding about reflection, but the copy does not report that worry predicted complicated grief after adjustment for baseline symptoms and background variables. (LLM, conf=0.78)
Experimental — accuracy not yet measuredThree surveys showed moderate positive associations between worry and complicated grief symptoms concurrently and longitudinally.
“The relationship between worry (repetitive, negative thoughts and images about the future) and CG symptoms was examined in three surveys that showed moderate positive associations between worry and CG symptoms concurrently and longitudinally (Boelen, 2010b; Boelen et al., 2016; Eisma et al., 2017).”
From Emotion Regulatory Strategies in Complicated Grief: A Systematic Review (2021) · cites this paper as Eisma et al., 2017
The ‘grief rumination’ section (page unavailable) reports concurrent and longitudinal associations between grief rumination and complicated-grief symptoms, but it does not identify that thinking as worry about the future. Searches for ‘worry,’ ‘three surveys,’ and worry–grief associations found no passage reporting the claimed moderate associations. (LLM, conf=0.73)
Experimental — accuracy not yet measuredWorry predicted complicated grief symptoms longitudinally over and above baseline symptoms in one study, yet not in another.
“Worry predicted symptoms longitudinally over and above baseline symptoms in one study (Eisma et al., 2017), yet not in another (Boelen et al., 2016).”
From Emotion Regulatory Strategies in Complicated Grief: A Systematic Review (2021) · cites this paper as Eisma et al., 2017
The “grief rumination” section reports longitudinal associations between grief rumination and complicated grief symptoms, but it does not say that worry predicted those symptoms after controlling for baseline symptoms. Searches for worry and longitudinal prediction found no passage establishing the finding attributed to Eisma et al. (2017). (LLM, conf=0.75)
Experimental — accuracy not yet measured
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Cites
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Cited by
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Emotion Regulatory Strategies in Complicated Grief: A Systematic Review
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“Rumination has been found to be concurrently and longitudinally associated with anxiety, depression, post-traumatic stress, and prolonged grief symptoms (e.g., Morina, 2011; Nolen-Hoeksema, Parker, & Larson, 1994; Smith & Ehlers, in press; for a recent review, see Eisma & Stroebe, 2017).”
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“It has been repeatedly shown that rumination is concurrently and longitudinally linked to elevated PG, depression, and PTS levels following loss (Eisma & Stroebe, 2017; Eisma et al., 2012, 2013, 2015; Eisma, et al., 2014; Ito et al., 2003; Morina, 2011; Nolen-Hoeksema, Parker, & Larson, 1994).”
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“Based on these seemingly contradictory accounts, a recent review concludes that the two frameworks may be complementary and that there may be more than one way to effectively address grief rumination [13].”
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“…grief over and above demographic and loss‐ related characteristics, depressive and trait rumination, and neuroticism in bereaved individuals both concurrently and longitudinally (e.g., Eisma et al., 2012; Eisma et al., 2014; Eisma, Schut, et al., 2015; for a review: Eisma & Stroebe, 2017).”
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BackgroundAttachment and grief in young adults after the loss of a close friend: a qualitative study
Johnsen, I., & Tømmeraas, A. M. (2022) · BMC Psychology · doi:10.1186/s40359-022-00717-8 · Cited by 12 · see citing works
“Rumination about the death and the deceased may lead to poorer adjustment to the loss, and a more complicated grief processing [34].”
BackgroundPatel, P. S., Desai, N. D., Shah, S. H., & Shah, S. (2022) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228221075207 · Cited by 12 · see citing works
“Such intense distress can lead to depression and other psychological morbidities (Eisma & Stroebe, 2017).”
BackgroundKaya-Demir, D., & Çırakoğlu, O. C. (2021) · Death Studies · doi:10.1080/07481187.2021.1936295 · Cited by 11 · see citing works
“Thus, bereaved individuals may have more depressive or anxious grief experiences (Eisma & Stroebe, 2017).”
BackgroundWu, Y., & Song, J. (2025) · Behavioral Sciences · doi:10.3390/bs15040431 · Cited by 13 · see citing works
“…as avoidance hypothesis suggests that rumination is a form of cognitive avoidance strategy, and it interferes with the acceptance of the loss, prevents individuals from integrating memories of the loss with existing memories, and exacerbates grief (Stroebe et al., 2007; Eisma & Stroebe, 2017).”
Kristensen, P., Dyregrov, K., & Dyregrov, A. (2017) · European Journal of Psychotraumatology · doi:10.1080/20008198.2018.1463795 · Cited by 10 · see citing works
“A visit to the site of death can be considered an in-vivo exposure to the reality of the death, and can reduce negative or maladaptive ruminations (Eisma & Stroebe, 2017).”
BackgroundPaths to positive growth in parents bereaved by drug-related death: A mixed-method study
Titlestad, K. B., Kristensen, P., O’Connor, M., Hystad, S. W., & Dyregrov, K. (2022) · Frontiers in Psychology · doi:10.3389/fpsyg.2022.982667 · Cited by 11 · see citing works
“Though rumination is often a burden, it can be helpful for dealing with emotional reactions, distracting the bereaved from the most painful aspects of the loss (Eisma and Stroebe, 2017) and, in the long run, can be part of a growth process (Tedeschi and Calhoun, 2004b).”
BackgroundYousefi, S., & Ashouri, A. (2023) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228231189539 · Cited by 9 · see citing works
“These items can be effective in emotional adjustment problems that are essential for emotion regulation; therefore, bereaved people may experience more sadness and depression, or anxiety (Eisma & Stroebe, 2017).”
Bienestar subjetivo: el papel de la rumia, optimismo, resiliencia y capacidad de recibir apoyo
Aragón, R. S. (2020) · Ciencias Psicológicas · doi:10.22235/cp.v14i2.2222 · Cited by 9 · see citing works
Thimm, J. C., Kristensen, P., Aulie, I. F., Larsen, I. M., & Johnsen, I. (2024) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2950 · Cited by 8 · see citing works
Adaptive and harmful autobiographical remembering after the loss of a loved one
Wolf, T., Strack, V., & Bluck, S. (2021) · Aging & Mental Health · doi:10.1080/13607863.2021.2003299 · Cited by 8 · see citing works
“As such, it seems important to encourage those who have lost a loved one to not only engage in remembering (eisma & Stroebe, 2017), but to help them frame how they use those recollections, ensuring that they do so in adaptive ways.”
BackgroundWilson, M. (2023) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228231169801 · Cited by 7 · see citing works
“It is suggested that cognitive and emotional avoidance following bereavement is linked to ruminative thinking, with individuals actively avoiding painful aspects of the loss (Eisma & Stroebe, 2017).”
Utrecht grief rumination scale (UGRS): Psychometric study of validation of the Portuguese version
Araújo, L., Albuquerque, S., Coelho, A., Delalibera, M., & Paulino, P. (2023) · Death Studies · doi:10.1080/07481187.2023.2272984 · Cited by 6 · see citing works
“Because it involves systematic confrontation with the aspects of loss that the individual seeks to avoid (Eisma & Stroebe, 2017).”
BackgroundResultInfluentialValidasi Struktur Internal Alat Ukur Refleksi Diri Adaptif melalui CFA
Bahiyah, S., & Savitri, S. I. (2018) · Jurnal Psikologi · doi:10.22146/jpsi.34966 · Cited by 6 · see citing works
I will keep your memory! Reasons for remembering lost loved ones
Pociūnaitė-Ott, J., & Wolf, T. (2023) · Applied Cognitive Psychology · doi:10.1002/acp.4132 · Cited by 6 · see citing works
Cognitive Avoidance Questionnaire: Factor structure and psychometric properties.
Latorre, J. M., López, M. N., Payeras, M., Ros, L., Heras, J., & Ricarte, J. J. (2020) · Anales de Psicología · doi:10.6018/analesps.397711 · Cited by 6 · see citing works
Guevara, J. E., Gilbert, S., Murdock, K. W., Stowe, R. P., & Fagundes, C. P. (2019) · Stress and Health · doi:10.1002/smi.2867 · Cited by 5 · see citing works
“Rumination and distress after the death of a spouse may be particularly problematic (Eisma & Stroebe, 2017) due to the promotion of a dysregulated immune system (Fagundes et al., 2018).”
BackgroundMindfulness in Adaptation to Bereavement: A Systematic Review
Sun, X., Schroevers, M. J., Lessing, M., Karsten, J., & Eisma, M. (2025) · Clinical Psychology and Psychotherapy · doi:10.1002/cpp.70198 · Cited by 4 · see citing works
“…on the causes and consequences of the loss—may exacerbate emotional problems by reinforcing self-critical thoughts and pro-longing negative emotional states, and distracting people from painful loss-related memories and emotions (Eisma et al. 2020; Eisma et al. 2013; Eisma and Stroebe 2017).”
Self-citationSandler, I. N., Tein, J., Hoppe, R., Uhlman, R. N., & Wolchik, S. A. (2024) · Development and Psychopathology · doi:10.1017/s0954579424001834 · Cited by 4 · see citing works
Huang, M., & Habermas, T. (2021) · Journal of Clinical Psychology · doi:10.1002/jclp.23146 · Cited by 5 · see citing works
“In general, in PG, ruminative processing of loss was involved in maintaining psychopathology (Eisma & Stroebe, 2017).”
BackgroundEisma, M. C., Janshen, A., & de Haan, N. (2025) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.70053 · Cited by 4 · see citing works
“…notions, rumination is concurrently and longitudinally related to post-loss mental health, including depressive symptoms and prolonged grief symptoms (e.g., Eisma et al. 2013; Eisma, Schut, et al. 2015; Smith, Wild, and Ehlers 2024; Thimm et al. 2024; for reviews: Eisma and Stroebe 2017, 2021).”
Self-citationGuilt and Unfinished Business in Bereavement: Rumination as a Pathway to Prolonged Grief and Trauma
Albuquerque, S., Pereira, B. B., Coelho, A., & Pinto, R. J. (2025) · Journal of Clinical Medicine · doi:10.3390/jcm14238582 · Cited by 3 · see citing works
“Rumination may disrupt this process by overemphasizing loss-oriented processing, keeping attention focused on the deceased and on painful emotions [6], or by serving as an avoidance strategy that prevents individuals from confronting the reality of death [1].”
InfluentialO’Hara, K. L., Wolchik, S. A., Rhodes, C. A., Uhlman, R. N., Sandler, I. N., & Tein, J. (2023) · Journal of Pediatric Psychology · doi:10.1093/jpepsy/jsad052 · Cited by 3 · see citing works
Ecological Validity of Grief Rumination Measures Among Bereaved People
Zhou, S., Zhang, X., Lenferink, L. I. M., & Tang, S. (2025) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.70135 · Cited by 2 · see citing works
A neurobiological perspective on prolonged grief disorder
Bryant, R. A., Breukelaar, I. A., & Korgaonkar, M. S. (2026) · Trends in Neurosciences · doi:10.1016/j.tins.2026.01.001 · Cited by 3 · see citing works
Measurement of Yearning in Bereaved Spouses
Waters, L. M. (2023) · Illness Crisis & Loss · doi:10.1177/10541373231163296 · Cited by 2 · see citing works
Psychometric Properties of the Persian Version of Utrecht Grief Rumination Scale
Ashouri, A., Yousefi, S., Abdoli, F., Nasirimoghadam, A., & Aliyaki, H. (2024) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228241286923 · Cited by 2 · see citing works
“Techniques such as exposure (Eisma & Stroebe, 2017) and behavioral activation (Eisma et al., 2015) have been suggested as effective therapeutic strategies to reduce ru-mination and improve the mental state of bereaved individuals.”
van Dijk, I., Boelen, P. A., de Keijser, J., Reitsma, L., & Lenferink, L. I. M. (2025) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2025.100879 · Cited by 2 · see citing works
Xu, X., Qian, W., Wen, J., Tang, S., & Wang, J. (2026) · Journal of Affective Disorders · doi:10.1016/j.jad.2026.121985 · Cited by 1 · see citing works
François, T. L., Hilberdink, C. E., Haelewyn, A., Lehodey, A., Soussi, C., Delarue, M., Hébert, O., Landeau, B., Chételat, G., & Bui, E. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.05.042
Cuddy, L., & Ellithorpe, M. E. (2025) · Media Psychology · doi:10.1080/15213269.2025.2554102 · Cited by 1 · see citing works
Life After the Storm: An Examination of Bereavement and Posttraumatic Growth Among Urban Adolescents
Platt, K. J., Marshall, H. M., Bogusz, P. A., Jason, L. A., Carter, J. S., & Grant, K. E. (2025) · OMEGA - Journal of Death and Dying · doi:10.1177/00302228251315294 · Cited by 1 · see citing works
“Additionally, rumination can prolong distress by intensifying negative emotions and interfering with problem-solving (Eisma & Stroebe, 2017).”
Rodríguez, Y. N. F., & Aragón, R. S. (2021) · Psicología y Salud · doi:10.25009/pys.v32i1.2713 · Cited by 1 · see citing works
Finkelstein‐Fox, L., Park, C. L., Eigsti, I., Awao, S., & Mancini, A. D. (2023) · Stress and Health · doi:10.1002/smi.3310 · 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
Tang, S. (2020) · Springer eBooks · doi:10.1007/978-3-319-69892-2_1027-1
PHOTON SPECTRUM FROM BREMSSTRAHLUNG
Gluckstern, R. L., Hull, M. H., & BREIT, G. A. (1953) · OSTI OAI (U.S. Department of Energy Office of Scientific and Technical Information)
Parkes, C. M. (2017) · Bereavement Care · doi:10.1080/02682621.2017.1392764
Self-management in rehabilitation practice
Jansma, F. F. I. (2023) · doi:10.33612/diss.808975265
Seraji, A., Nasrabadi, T., Nayeri, N. D., & Nasrollah, S. (2024) · Research Square · doi:10.21203/rs.3.rs-3884744/v1
Can self-distancing benefit adjustment to bereavement? A multi-method investigation
Zhou, N., Ren, F., Cao, C., She, Z., Smith, K. V., & Xi, J. (2025) · Social Science & Medicine · doi:10.1016/j.socscimed.2025.117743
Psychological resilience, tendency to ruminate, and well-being in young adults
Ryś, M., Grabowski, A., & Mazurek, A. (2025) · The Person and the Challenges. The Journal of Theology, Education, Canon Law and Social Studies Inspired by Pope John Paul II · doi:10.15633/pch.15212
Prolonged grief and insomnia symptoms in cancer-bereaved parents: a latent class analysis
Sveen, J., Eisma, M. C., Pohlkamp, L., Kreicbergs, U. C., & Lenferink, L. I. M. (2026) · BMC Psychiatry · doi:10.1186/s12888-026-07955-9
“For example, the Rumination as Avoid-ance Hypothesis holds that rumination on the causes and consequences of the loss could serve to suppress/distract oneself from painful aspects of the loss, thereby hampering the cognitive processing of the loss and exacerbating grief [for a review: 64].”
Self-citationUndoing death: Counterfactual thinking and emotional adaptation to bereavement.
Eisma, M., van der Laan, J. F., Boer, N. D., Doornbos, M., Brouwer, C., & Epstude, K. (2026) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/j.jbtep.2026.102103
Self-citationThe resilience problem for grief
Markovic, J. (2026) · Philosophical Psychology · doi:10.1080/09515089.2026.2688126
Park, C., Emrich, M., Hall, M. E. L., Shannonhouse, L., Kapic, K. M., McMartin, J., & Aten, J. (2026) · Death Studies · doi:10.1080/07481187.2026.2682810
Rajabi, M., Pourshahbaz, A., Taremian, F., & Asl, E. M. (2026) · Journal of Education and Health Promotion · doi:10.4103/jehp.jehp_69_25
“This analysis considered several factors: the theoretical foundations of grief rumination models that indicate the construct’s multidimensionality, [11,14,42] the factorial structure results from prior international validations, [13,14,20‑23] the satisfactory fit indices of the items within this…”
Well-being comparisons and mental health outcomes following loss: a two-wave longitudinal study
Schlechter, P., Hoppen, T. H., Bonanno, G. A., & Nexhmedin Morina, B. (2026) · European Journal of Psychotraumatology · doi:10.1080/20008066.2026.2686574
“While avoidance showed relatively limited effects compared to other variables, its positive association with depression and PTSD at specific time points underscores its role as a maladaptive coping strategy (Eisma & Stroebe, 2017).”
Guilt in bereavement: The role of experiential avoidance and rumination
Alves, M. I., & Neto, D. D. (2026) · Death Studies · doi:10.1080/07481187.2026.2704579
Reciprocal Temporal Associations Between Grief Rumination and Daily Affect in Bereavement
Liu, J., Zhou, S., & Tang, S. (2026) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.70316
Ruminasyon Konulu Yayınların Bibliyometrik Analizi
Doğan, M. N., Arslan, C., & Hamarta, E. (2026) · KIRŞEHİR EĞİTİM FAKÜLTESİ DERGİSİ · doi:10.29299/kefad.1692205
- Authors
- Eisma, M. C., & Stroebe, M. S.
- Affiliations
- University of Groningen (NL)
- Corresponding author
- Eisma, Maarten C
- Stroebe, Margaret S
- Venue
- Bereavement Care
- Publisher
- Cruse Bereavement Care
- Published
- 2017-05-04
- Volume
- 36
- Issue
- 2
- Pages
- 58-64
- ISSN
- 0268-2621 (ISSN-L)
- 1944-8279
- OpenAlex
- W2735491261
- Cited by
- 73
- References
- 43
- Citations by year
- 2026: 12 · 2025: 11 · 2024: 5 · 2023: 9 · 2022: 5 · 2021: 9 · 2020: 9 · 2019: 4 · 2018: 4 · 2017: 3
- FWCI
- 6.78
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Bereavement Care (publishedVersion, cc-by-nc-nd)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by-nc-nd)
- 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 › Anthropology › Death, Funerary Practices, and Mourning
- Keywords
- rumination, bereavement, grief, adaptation to loss, response styles theory, distraction, negative thinking, social support, mental health outcomes
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