Rethinking rumination
Open accessAbstract
The response styles theory ( Nolen-Hoeksema, 1991 ) was proposed to explain the insidious relationship between rumination and depression. We review the aspects of the response styles theory that have been well-supported, including evidence that rumination exacerbates depression, enhances negative thinking, impairs problem solving, interferes with instrumental behavior, and erodes social support. Next, we address contradictory and new findings. Specifically, rumination appears to more consistently predict the onset of depression rather than the duration, but rumination interacts with negative cognitive styles to predict the duration of depressive symptoms. Contrary to original predictions, the use of positive distractions has not consistently been correlated with lower levels of depressive symptoms in correlational studies, although dozens of experimental studies show positive distractions relieve depressed mood. Further, evidence now suggests that rumination is associated with psychopathologies in addition to depression, including anxiety, binge eating, binge drinking, and self-harm. We discuss the relationships between rumination and worry and between rumination and other coping or emotion-regulation strategies. Finally, we highlight recent research on the distinction between rumination and more adaptive forms of self-reflection, on basic cognitive deficits or biases in rumination, on its neural and genetic correlates, and on possible interventions to combat rumination.
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A core feature of distress disorders is maladaptive self-referential processing, including worry and rumination.
“A core feature of distress disorders is the engagement of maladaptive self-referential processes, including the metacognitive processes of worry and rumination (Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008; Wells, 2005).”
From Changes in Decentering and Reappraisal Temporally Precede Symptom Reduction During Emotion Regulation Therapy for Generalized Anxiety Disorder With and Without Co-Occurring Depression. (2019) · cites this paper as Nolen-Hoeksema et al., 2008
In “Rumination and Worry” (page unavailable), the paper describes worry and rumination as self-focused, repetitive thoughts associated with and exacerbating depression and anxiety. It also calls worry a defining feature of generalized anxiety disorder. These passages support the connection, but do not establish maladaptive self-referential processing as a core feature of distress disorders generally or classify both processes as metacognitive. (LLM, conf=0.82)
Experimental — accuracy not yet measuredHigher levels of DM have been frequently associated with lower levels of rumination and lower levels of depression and anxiety.
“Higher levels of DM have been frequently associated with lower levels of rumination28,29 and lower levels of depression and anxiety.30”
From Dispositional Mindfulness and Psychotic Symptoms in Schizophrenia Spectrum Disorders: The Mediating Roles of Rumination and Negative Emotion (2022) · cites this paper as [30]
The cited paper’s “Interventions to Overcome Rumination” section says mindfulness techniques may reduce rumination, supporting the proposed direction of the relationship. It discusses mindfulness practices and interventions, however, rather than reporting that higher levels of dispositional mindfulness (DM) have frequently been associated with lower measured levels of rumination. The separate depression-and-anxiety clause is attached to citation 30, not this source; page information was not available in our copy. (LLM, conf=0.82)
Experimental — accuracy not yet measuredRumination delays adaptive coping strategies and increases avoidant coping strategies.
“Furthermore, rumination delays adaptive coping strategies and increases avoidant coping strategies (37, 42).”
From How do children with Tourette’s syndrome and their caregivers live with the disorder? A systematic review of qualitative evidence (2022) · cites this paper as [37]
The “Poor Problem Solving” section (page not provided) reports that rumination can interfere with finding and implementing effective solutions, supporting the claim about delayed adaptive coping. The “Rumination in Relation to Other Coping and Emotion-Regulation Strategies” section (page not provided) reports an association with avoidance, but does not establish that rumination increases avoidant coping strategies. (LLM, conf=0.85)
Experimental — accuracy not yet measuredPsychological inflexibility is a susceptibility factor for depression because it is characterised by a permanent, rigid style of reacting with rumination.
“The literature quotes psychological inflexibility as asusceptibility factor for depression, because it is characterised by apermanent, rigid style of reacting with rumination (Nolen-Hoeksema et al . 2008).”
From Effectiveness of a training programme based on acceptance and commitment therapy aimed at older adults – no moderating role of cognitive functioning (2021) · cites this paper as Nolen-Hoeksema et al . 2008
The “Rumination and Depression” section reports that a tendency to ruminate is relatively stable and predicts more prolonged depression and greater likelihood of depressive disorders. The “Cognitive Deficits and Biases in Depressive Rumination” section also links rumination to difficulty switching strategies. But the paper does not identify psychological inflexibility as the susceptibility factor, and it explicitly says rumination does not show absolute stability; “permanent” overstates the evidence. Page numbers were not available in our copy. (LLM, conf=0.89)
Experimental — accuracy not yet measuredMuch psychological theorizing about the nature of GAD and MDD in terms of disruption of mind and body has been predicated on a functional relationship between motivational intensity and negative self-referentiality.
“In particular, much of the psychological theorizing about the nature of GAD and MDD in terms of disruption of mind and body has been predicated on a functional relationship between the kinds and intensity of visceral and psychological sensations that one experiences (i.e., motivational intensity) and the ways by which one attempts to respond to their arising (i.e., negative self-referentiality; B”
From Distinct functional connectivities predict clinical response with emotion regulation therapy (2017) · cites this paper as Nolen-Hoeksema et al., 2008
The “Rumination and Worry” section links self-focused repetitive thought to both depression and anxiety, and discusses worry as a response to negative affect that may reduce physiological arousal. It does not characterize these responses in terms of “motivational intensity” or establish that much theorizing about GAD and MDD rests on the proposed relationship. (LLM, conf=0.81)
Experimental — accuracy not yet measured
The practice of mindfulness was possibly able to clarify the effects of rumination as a self-critical questioning of one's own emotions and circumstances.
“Several studies found that the practice of mindfulness was possibly able to clarify the effects of rumination as a self-critical questioning of one's own emotions and circumstances.22,23”
From Mindfulness in mood and anxiety disorders: A review of the literature (2017) · cites this paper as [23]
In “Self-Regulation Theories” (page unavailable), the paper contrasts evaluative thoughts about oneself, emotions, and circumstances with nonjudgmental mindful awareness. “Interventions to Overcome Rumination” (page unavailable) suggests mindfulness may reduce rumination. It does not say that practicing mindfulness clarifies the effects of rumination; it discusses reduction rather than clarification. (LLM, conf=0.78)
Experimental — accuracy not yet measuredWorry and rumination, as forms of NSRP, are negatively reinforced when aversive emotions decrease.
“Theorists (e.g., Borkovec et al., 2004; Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008; Watkins, 2008) have argued that NSRP including worry and rumination becomes negatively reinforced by the reduction in aversive emotions.”
From What, me worry and ruminate about dsm-5 and rdoc? The importance of targeting negative self-referential processing (2013) · cites this paper as Nolen-Hoeksema et al., 2008
Repetitive negative thinking includes worry and rumination and is both a risk factor for and a common symptom of anxiety and depression.
“Repetitive negative thinking (RNT), which includes worry and rumination, is both a risk factor for and a common symptom of anxiety and depression15–17”
From An exploration into the relationship between insomnia and repetitive negative thinking among cancer survivors. (2025) · cites this paper as [15]
A capacity to change cognitions and relinquish one's original interpretation may undermine passive, repetitive elaborative processes central to transdiagnostic psychopathology and promote flexibility allowing more effective, rather than habitual, behavioral reactions.
“A capacity to change cognitions and relinquish one’s original interpretation may undermine passive, repetitive elaborative processes central to transdiagnostic psychopathology (e.g., rumination; Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008) and promote flexibility that allows for more effective, rather than habitual, behavioral reactions.”
From United we stand: emphasizing commonalities across cognitive-behavioral therapies. (2013) · cites this paper as Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008
Rumination is a vulnerability factor for depression.
“an important strand of research on cognition in depression has identified rumination as a vulnerability factor for depression (Nolen Hoeksema et al., 2008).”
From Psychological flexibility as a fundamental aspect of health (2010) · cites this paper as Nolen Hoeksema et al., 2008
RNT is a well-established vulnerability factor for depression symptoms.
“RNT is a well-established vulnerability factor for depression symptoms (Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008).”
From The search for universal transdiagnostic and trans-therapy change processes: Evidence for intolerance of uncertainty (2016) · cites this paper as Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008
Rumination is a repetitive negative thinking pattern associated with depressive and anxiety disorders.
“rumination, a repetitive negative thinking pattern associated with depressive and anxiety disorders [93,94]”
Avoidant and repressive coping strategies may be adaptive in the short term but do not provide much help in eventual problem-solving.
“The pain experienced by patients with TS is due to the ironic process of thought inhibition (36), suggesting that avoidant and repressive coping strategies may be adaptive in the short term but do not provide much help in eventual problem-solving (37).”
From How do children with Tourette’s syndrome and their caregivers live with the disorder? A systematic review of qualitative evidence (2022) · cites this paper as [37]
Self-blame may have a negative effect on the overall cognitive, emotional, and behavioral aspects of children with TS.
“Considering that rumination increases depression and negative thoughts and impairs problem- solving abilities (37), self-blame may have a negative effect on the overall cognitive, emotional, and behavioral aspects of children with TS.”
From How do children with Tourette’s syndrome and their caregivers live with the disorder? A systematic review of qualitative evidence (2022) · cites this paper as [37]
Rumination and worry constitute forms of negative self-absorption that prevents the individual from relating in an adaptive manner to current situations and challenges.
“Rumination and worry constitute forms of negative self-absorption (Ingram, 1990; Mor & Winquist, 2002; Nolen-Hoeksema et al., 2008) that prevents the individual from relating in an adaptive manner to current situations and challenges.”
From Participant experiences of change in mindfulness-based stress reduction for anxiety disorders. (2020) · cites this paper as Nolen-Hoeksema et al., 2008
Repetitive negative thinking has been linked with sleep difficulties in populations with and without psychiatric diagnoses.
“RNT has been linked with sleep difficulties in various populations, both with and without psychiatric diagnoses.15”
From An exploration into the relationship between insomnia and repetitive negative thinking among cancer survivors. (2025) · cites this paper as [15]
The discussion of major depression (section “Nolen”; page unavailable) mentions poor sleep maintenance as a possible state-dependent process, but does not link sleep difficulties to rumination. Searches for sleep difficulties and insomnia found no passage reporting the claimed association in populations with and without psychiatric diagnoses. (LLM, conf=0.75)
Experimental — accuracy not yet measuredThe pain experienced by patients with TS is due to the ironic process of thought inhibition.
“The pain experienced by patients with TS is due to the ironic process of thought inhibition (36), suggesting that avoidant and repressive coping strategies may be adaptive in the short term but do not provide much help in eventual problem-solving (37).”
From How do children with Tourette’s syndrome and their caregivers live with the disorder? A systematic review of qualitative evidence (2022) · cites this paper as [37]
The Interventions to Overcome Rumination section says negative thoughts can rebound after suppression, but it does not link that process to pain in patients with TS. Searches for TS, patient pain, and ironic thought inhibition found no passage addressing the claimed cause of pain. Citation (37) attaches to the separate coping-strategies clause, which is not judged here. (LLM, conf=0.76)
Experimental — accuracy not yet measuredWorrying and rumination become negatively reinforced by reduction in aversive emotions.
“It has been shown that both worrying and rumination become negatively reinforced by the reduction in aversive emotions (Borkovec et al., 1998; Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008).”
From Toward a Cognitive-Behavioral Classification System for Mental Disorders (2014) · cites this paper as Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008
Rumination can increase risk of suicidal thoughts and behaviors.
“rumination can increase the risk of suicidal thoughts and behaviors,58”
From A meta-analysis of emotional regulation outcomes in psychological interventions for youth with depression and anxiety (2021) · cites this paper as [58]
NSRPs are common processes in many forms of psychopathology, including GAD and MDD, and include repetitive or perseverative thought such as rumination and worry.
“NSRPs are common processes in many forms of psychopathology, including GAD and MDD, and includes repetitive or perseverative thought (Watkins, 2008) such as rumination (e.g., repetitive thinking about past mistakes aimed at reducing distress related to perceived losses; Nolen-Hoeksema et al., 2008) and worry (e.g., repetitive thinking about future events aimed at reducing distress that arises from”
From Emotion Regulation Therapy: A Mechanism-Targeted Treatment for Disorders of Distress (2017) · cites this paper as Nolen-Hoeksema et al., 2008
Rather than effectively engaging adaptive emotion regulation strategies, individuals with distress disorders alternatively utilize perseverative strategies that may be employed to compensate for a negative emotional state, chiefly by enveloping it in elaborative negative self-referential processing.
“Rather than effectively engaging adaptive emotion regulation strategies, individuals with distress disorders alternatively utilize perseverative strategies that may be employed to compensate for a negative emotional state, chiefly by enveloping it in elaborative negative self-referential processing (Borkovec et al., 2004; Nolen-Hoeksema et al., 2008; Mennin and Fresco, 2013).”
From Emotion Regulation Therapy: A Mechanism-Targeted Treatment for Disorders of Distress (2017) · cites this paper as Nolen-Hoeksema et al., 2008
The genetic risk of depression is likely due to small effects of hundreds or thousands of common genetic variants, with overrepresentation of genes affecting brain development, inflammation, bioenergetics and neuronal signalling.
“The genetic risk of depression is likely due to small effects of hundreds or thousands of common genetic variants, with overrepresentation of genes affecting brain development, inflammation, bioenergetics and neuronal signalling.”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [262]
Every individual carries some risk variants for depression, and a polygenic score predicts the genetic liability to depression better than any specific genetic variant.
“The large number of common variants involved 262-264 entails that every individual carries some risk variants for depression, and a polygenic score (indexing the individual's load of risk variants) predicts the genetic liability to depression better than any specific genetic variant. 265”
From Time for united action on depression: a Lancet–World Psychiatric Association Commission (2022) · cites this paper as [262]
Initially rumination may be goal-directed and use attentional resources, but persistent rumination involves poorer thinking quality and less constructive attention to negative thoughts.
“Where initially rumination may be goaldirected and engage attentional resources, persistent rumination is characterized by reduced quality of thinking with attention being deployed to negative thoughts in a less constructive way (Nolen-Hoeksema et al., 2008).”
From Understanding depressive rumination from a cognitive science perspective: The impaired disengagement hypothesis (2011) · cites this paper as Nolen-Hoeksema et al., 2008
The negative effects of rumination on depression may be mediated by interference with effective problem solving, engagement in instrumental rewarding behaviours, or access to social support.
“with evidence that this may in part be due to interference with effective problem solving, engagement in instrumental rewarding behaviours or access to social support, which have been proposed as mediators of the negative effects of rumination (Lyubomirsky & Tkach, 2004;Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008;E. R. Watkins, 2008).”
From Perseverative negative thinking predicts depression in people with acute coronary syndrome (2019) · cites this paper as Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008
In non-cardiac populations, social support, problem solving and instrumental behaviours may be important in explaining the association of rumination with depression.
“Research in non-cardiac populations suggests these factors may be important in explaining the association of rumination with depression (Lyubomirsky & Tkach, 2004;Nolen-Hoeksema et al., 2008;E. R. Watkins, 2008)”
From Perseverative negative thinking predicts depression in people with acute coronary syndrome (2019) · cites this paper as Nolen-Hoeksema et al., 2008
Rumination is a risk factor for depression and psychological distress.
“For example, rumination is a risk factor for psychological distress and depression (Nolen-Hoeksema et al. 2008)”
From Dispositional Mindfulness and Psychological Health: a Systematic Review (2018) · cites this paper as Nolen-Hoeksema et al. 2008
Poor regulatory skills constitute a vulnerability and maintenance feature among a wide range of mental disorders.
“Ample evidence has suggested that poor regulatory skills constitute a vulnerability and maintenance feature among a wide range of mental disorders (Rottenberg et al., 2005; Mennin and Farach, 2007; Nolen-Hoeksema et al., 2008).”
From New Technologies for the Understanding, Assessment, and Intervention of Emotion Regulation (2019) · cites this paper as Nolen-Hoeksema et al., 2008
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Self-citationRuminative coping with depressed mood following loss.
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Self-citationThe response styles theory of depression: Tests and an extension of the theory.
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Self-citationEffects of responses to depression on the remediation of depressive affect.
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Self-citationWhy ruminators are poor problem solvers: clues from the phenomenology of dysphoric rumination.
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Self-citationDepressive rumination : nature, theory and treatment
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“We found that people who score high on our self-report scale of rumination show more perseverative errors on the Wisconsin Card Sort Task than do people who score low on rumination, even after controlling for group differences in levels of depression (Davis & Nolen-Hoeksema, 2000).”
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Self-citationRumination and overgeneral memory in depression: Effects of self-focus and analytic thinking.
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“Rumination and worry share an abstract, over-general thinking style (Sto¨ber, 1996; Watkins & Teasdale, 2001; Watkins, Teasdale, & Williams, 2000).”
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Self-citationMediating effects of rumination and worry on the links between neuroticism, anxiety and depression
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Self-citationAllure of negative feedback: Self-verification strivings among depressed persons.
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Dissociating medial frontal and posterior cingulate activity during self-reflection
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Self-citationRumination-focused cognitive behaviour therapy for residual depression: A case series
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“Future investigations that test the self-reflective consequences of bulimic behaviors and substance abuse should be conducted to determine whether these behaviors actually do provide an escape from ruminative self-awareness.”
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“Cor-relational studies show that rumination is positively related to suppression or avoidance of distressing feelings and thoughts (Moulds, Kandris, Starr, & Wong, 2007; Nolen-Hoeksema & Morrow, 1991; Wenzlaff & Luxton, 2003).”
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- Authors
- Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S.
- Affiliations
- Yale University
- Yale University (US)
- University of California, Riverside (US)
- Venue
- Perspectives on Psychological Science
- Publisher
- SAGE Publications
- Published
- 2008-09
- Volume
- 3
- Issue
- 5
- Pages
- 400-424
- ISSN
- 1745-6916 (ISSN-L)
- 1745-6924
- OpenAlex
- W4211130665
- Semantic Scholar
- 369b741775686c14974158cb6b18893c95b9ae59
- Cited by
- 5,172
- References
- 209
- Citations by year
- 2026: 420 · 2025: 477 · 2024: 445 · 2023: 426 · 2022: 440 · 2021: 451 · 2020: 356 · 2019: 328 · 2018: 305 · 2017: 280 · 2016: 266 · 2015: 241 · 2014: 196 · 2013: 161 · 2012: 137
- FWCI
- 103.94
- Type
- journal article
- Language
- en
- Open access
- green
- escholarship.org
- Locations
- Perspectives on Psychological Science (publishedVersion)
- PubMed (publishedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- 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, response styles theory, depression, negative cognitive style, positive distraction, worry, coping strategies, emotion regulation, self-reflection, cognitive biases, anxiety, binge eating, binge drinking, self-harm, social support
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