Rumination as a Transdiagnostic Phenomenon in the 21st Century: The Flow Model of Rumination

Wong, Stephanie M. Y.; Chen, Eric Y. H.; Lee, Michelle C. Y.; Suen, Y. N.; Hui, Christy L. M.

doi:10.3390/brainsci13071041

Cited by 48Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesMind wandering and attentionMental Health Research Topics

Rumination as a Transdiagnostic Phenomenon in the 21st Century: The Flow Model of Rumination

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Wong, Stephanie M. Y., Chen, Eric Y. H., Lee, Michelle C. Y., Suen, Y. N., Hui, Christy L. M.·2023·Brain Sciences

DOI 10.3390/brainsci13071041PMC PMC10377138

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Abstract

Rumination and its related mental phenomena share associated impairments in cognition, such as executive functions and attentional processes across different clinical conditions (e.g., in psychotic disorders). In recent decades, however, the notion of rumination has been increasingly narrowed to the “self-focused” type in depressive disorders. A closer review of the literature shows that rumination may be construed as a broader process characterized by repetitive thoughts about certain mental contents that interfere with one’s daily activities, not only limited to those related to “self”. A further examination of the construct of rumination beyond the narrowly focused depressive rumination would help expand intervention opportunities for mental disorders in today’s context. We first review the development of the clinical construct of rumination with regard to its historical roots and its roles in psychopathology. This builds the foundation for the introduction of the “Flow Model of Rumination (FMR)”, which conceptualizes rumination as a disruption of a smooth flow of mental contents in conscious experience that depends on the coordinated interactions between intention, memory, affect, and external events. The conceptual review concludes with a discussion of the impact of rapid technological advances (such as smartphones) on rumination. Particularly in contemporary societies today, a broader consideration of rumination not only from a cognition viewpoint, but also incorporating a human–device interaction perspective, is necessitated. The implications of the FMR in contemporary mental health practice are discussed.

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Perseverative cognitive processes such as worry and rumination are linked to extended cortisol activation.
“This bidirectional relationship has been demonstrated in multiple studies, with perseverative cognitive processes such as worry and rumination linked to extended cortisol activation [28].”
From Pre-Sleep Anxiety: Mechanisms and Therapeutic Approaches in Clinical Practice. (2026) · cites this paper as [28]
Section 2.2.3 discusses stress-reactive rumination and depressive symptoms, while Section 2.2.5 discusses neural mechanisms of perseveration. Neither addresses cortisol activation. Searches for cortisol activation, the HPA axis, and prolonged endocrine responses found no passage linking worry or rumination to extended cortisol activation. (LLM, conf=0.72)
Experimental — accuracy not yet measured
The interaction between HPA axis activity and cognitive arousal is bidirectional: rising cortisol amplifies cognitive arousal, and heightened cognitive arousal increases cortisol levels.
“The interaction between HPA axis activity and cognitive arousal is bidirectional: rising cortisol amplifies cognitive arousal, and heightened cognitive arousal in turn increases cortisol levels, creating a self-perpetuating cycle of anxiety and sleep disturbance.”
From Pre-Sleep Anxiety: Mechanisms and Therapeutic Approaches in Clinical Practice. (2026) · cites this paper as [28]
Section 3.2 discusses how affect and attention can perpetuate ruminative thoughts, but it does not address cortisol or HPA-axis activity. Searches for “HPA axis,” “cortisol,” and their interaction with cognitive arousal found no passage supporting the claimed bidirectional mechanism or its proposed link to sleep disturbance. (LLM, conf=0.76)
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“Meanwhile, the PEP theory postulates that those with social anxiety tend to internally review their behaviors following engagement in distressing social events [37,40].”
Background
Changes in Ruminative Thinking Mediate the Clinical Benefits of Mindfulness: Preliminary Findings
Heeren, A., & Philippot, P. (2010) · Mindfulness · doi:10.1007/s12671-010-0037-y · Cited by 148 · see citing works
An experience sampling study of worry and rumination in psychosis
Hartley, S., Haddock, G., Vasconcelos e Sa, D., Emsley, R., & Barrowclough, C. (2014) · Psychological Medicine · doi:10.1017/s0033291713002080 · Cited by 138 · see citing works
A Meta-Analysis of Autobiographical Memory Studies in Schizophrenia Spectrum Disorder
Berna, F. S., Potheegadoo, J., Aouadi, I., Ricarte, J. J., Allé, M., Coutelle, R., Boyer, L., Cuervo-Lombard, C.-V., & Danion, J. (2015) · Schizophrenia Bulletin · doi:10.1093/schbul/sbv099 · Cited by 136 · see citing works
Relationships between depressive rumination, anger rumination, and borderline personality features.
Baer, R. A., & Sauer-Zavala, S. E. (2010) · Personality Disorders Theory Research and Treatment · doi:10.1037/a0019478 · Cited by 132 · see citing works
PTSD as meaning violation: Testing a cognitive worldview perspective.
Park, C. L., Mills, M. A., & Edmondson, D. E. (2010) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/a0018792 · Cited by 130 · see citing works
The role of maladaptive cognitive emotion regulation strategies and social anxiety in problematic smartphone and social media use
Zsido, A. N., Arató, N., Láng, A., Lábadi, B., Pakai-Stecina, D. T., & Bandi, S. A. (2021) · Personality and Individual Differences · doi:10.1016/j.paid.2021.110647 · Cited by 130 · cited 1× · see citing works
“As discussed, the narrowing of research focus towards depressive rumination took off in the 1990s before the advent of smartphones, which have critically transformed human interactions with social and digital environments [19,175].”
Background
The relevance of cognitive emotion regulation to psychotic symptoms - A systematic review and meta-analysis.
Ludwig, L., Werner, D., & Lincoln, T. (2019) · Clinical Psychology Review · doi:10.1016/j.cpr.2019.101746 · Cited by 126 · see citing works
Rumination and Age: Some Things Get Better
Sütterlin, S., Paap, M. C. S., Babic, S., Kübler, A., & Vögele, C. (2012) · Journal of Aging Research · doi:10.1155/2012/267327 · Cited by 123 · see citing works
The neural underpinnings of cognitive flexibility and their disruption in psychotic illness
Waltz, J. A. (2017) · Neuroscience · doi:10.1016/j.neuroscience.2016.06.005 · Cited by 122 · see citing works
Transdiagnostic Mechanisms of Psychopathology in Youth: Executive Functions, Dependent Stress, and Rumination
Snyder, H. R., Friedman, N. P., & Hankin, B. L. (2019) · Cognitive Therapy and Research · doi:10.1007/s10608-019-10016-z · Cited by 121 · see citing works
Obsessive-compulsive disorder: Its conceptual history in France during the 19th century
Berrios, G. E. (1989) · Comprehensive Psychiatry · doi:10.1016/0010-440x(89)90052-7 · Cited by 118 · cited 1× · see citing works
“By the 1800s and 1900s, the excessive and involuntary tendency to fixate on certain thoughts and ideas had also been described as “idee irresistible” [29] and “idees fixes” [30].”
Background
On Remembering, Repeating and Working Through
Sandler, J., & Sandler, A. (2018) · Routledge eBooks · doi:10.4324/9780429479410-7 · Cited by 116 · see citing works
Rumination interacts with life stress to predict depressive symptoms: An ecological momentary assessment study
Connolly, S. L., & Alloy, L. B. (2017) · Behaviour Research and Therapy · doi:10.1016/j.brat.2017.07.006 · Cited by 114 · cited 1× · see citing works
“Interestingly, longitudinal and ecological momentary assessment studies have found that stress-reactive rumination, but not self-focused depressive rumination, can interact with external life stressors to increase depressive symptoms [38,39].”
Background
Transdiagnostic and disease-specific abnormalities in the default-mode network hubs in psychiatric disorders: A meta-analysis of resting-state functional imaging studies
Doucet, G. E., Janiri, D., Howard, R., O’Brien, M., Andrews‐Hanna, J. R., & Frangou, S. (2020) · European Psychiatry · doi:10.1192/j.eurpsy.2020.57 · Cited by 112 · see citing works
Interpretation training to target repetitive negative thinking in generalized anxiety disorder and depression.
Hirsch, C. R., Krahé, C., Whyte, J., Loizou, S., Bridge, L., Norton, S., & Mathews, A. (2018) · Journal of Consulting and Clinical Psychology · doi:10.1037/ccp0000310 · Cited by 108 · see citing works
Why do imagery and perception look and feel so different?
Koenig-Robert, R., & Pearson, J. (2021) · Philosophical Transactions of the Royal Society B: Biological Sciences · doi:10.1098/rstb.2019.0703 · Cited by 104 · see citing works
Cognitive impairment of executive function as a core symptom of schizophrenia
Wobrock, T., Ecker, U. K. H., Scherk, H., Schneider-Axmann, T., Falkai, P., & Gruber, O. (2008) · The World Journal of Biological Psychiatry · doi:10.1080/15622970701849986 · Cited by 102 · see citing works
Anger in PTSD: Is there a need for a concept of PTSD-related posttraumatic anger?
McHugh, T., Forbes, D., Bates, G. W., Hopwood, M., & Creamer, M. C. (2011) · Clinical Psychology Review · doi:10.1016/j.cpr.2011.07.013 · Cited by 101 · see citing works
Set-Shifting Ability and Schizophrenia: A Marker of Clinical Illness or an Intermediate Phenotype?
Ceaser, A. E., Goldberg, T. E., Egan, M. F., McMahon, R. P., Weinberger, D. R., & Gold, J. M. (2008) · Biological Psychiatry · doi:10.1016/j.biopsych.2008.05.009 · Cited by 100 · cited 1× · see citing works
“Perseverative thinking and difficulties in set-shifting, representing other related forms of perseverative cognitions, have also long been linked to prefrontal dysfunctions in schizophrenia [90,91].”
Background
Cognitive behavioral group therapy for social phobia with or without attention training: A controlled trial
McEvoy, P. M., & Perini, S. J. (2008) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2008.10.008 · Cited by 95 · see citing works
Recent Advances in Research on Cognition and Emotion in OCD: A Review
Calkins, A. W., Berman, N. C., & Wilhelm, S. (2013) · Current Psychiatry Reports · doi:10.1007/s11920-013-0357-4 · Cited by 94 · cited 1× · see citing works
“One example of ruminative processes is the phenomenon of “obsessions” in OCD, which are described as self-generated intrusive repetitive thinking that is difficult to control and disengage from [71,72].”
Background
The Cascade of Stress: A Network Approach to Explore Differential Dynamics in Populations Varying in Risk for Psychosis
Klippel, A., Viechtbauer, W., Reininghaus, U., Wigman, J. T. W., van Borkulo, C. D., MERGE, Myin‐Germeys, I., & Wichers, M. (2017) · Schizophrenia Bulletin · doi:10.1093/schbul/sbx037 · Cited by 94 · see citing works
Effects of recurrent violence on post-traumatic stress disorder and severe distress in conflict-affected Timor-Leste: a 6-year longitudinal study
Silove, D. M., Liddell, B. J., Rees, S. J., Chey, T., Nickerson, A., Tam, N., Zwi, A. B., Brooks, R., Sila, L. L., & Steel, Z. (2014) · The Lancet Global Health · doi:10.1016/s2214-109x(14)70196-2 · Cited by 93 · see citing works
Facilitating Flexible Problem Solving: A Cognitive Load Perspective
Kalyuga, S., Renkl, A., & PAAS, F. G. W. C. (2010) · Educational Psychology Review · doi:10.1007/s10648-010-9132-9 · Cited by 92 · see citing works
Varieties of perseveration: A comparison of two taxonomies
Goldberg, E. (1986) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/01688638608405191 · Cited by 90 · cited 1× · see citing works
“Like rumination, perseveration involves unintentional yet persistent and context-inappropriate thoughts [92], although multiple modalities can be implicated, spanning beyond semantic repetitions to perseverative cognition and motor phenomena [93].”
Background
Responses to Positive Affect in Daily Life: Positive Rumination and Dampening Moderate the Association Between Daily Events and Depressive Symptoms
Li, Y. I., Starr, L. R., & Hershenberg, R. (2017) · Journal of Psychopathology and Behavioral Assessment · doi:10.1007/s10862-017-9593-y · Cited by 88 · see citing works
Rumination in major depressive and bipolar disorder – a meta-analysis
Kovács, L. N., Takács, Z. K., Tóth, Z., Simon, E., Schmelowszky, Á., & Kökönyei, G. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.07.131 · Cited by 88 · 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
Suicide-Specific Rumination Relates to lifetime suicide attempts above and beyond a variety of other suicide risk factors
Rogers, M. L., & Joiner, T. E. (2018) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2017.12.017 · Cited by 86 · see citing works
Thinking too much: rumination and psychopathology
Ehring, T. W. (2021) · World Psychiatry · doi:10.1002/wps.20910 · Cited by 85 · see citing works
Can't get it off my brain: Meta-analysis of neuroimaging studies on perseverative cognition.
Makovac, E., Fagioli, S., Rae, C., Critchley, H., & Ottaviani, C. (2019) · Psychiatry research. Neuroimaging · doi:10.1016/j.pscychresns.2019.111020 · Cited by 84 · cited 1× · see citing works
“Increased activity has been detected in functional imaging studies in the orbitofrontal cortex, the anterior and posterior cingulate gyrus, the insula, the caudate nucleus, and the anterior thalamus regions [73].”
Background
Paranoia and post-traumatic stress disorder in the months after a physical assault: A longitudinal study examining shared and differential predictors
Freeman, D., Thompson, C., Vorontsova, N., Dunn, G., Carter, L.-A., Garety, P., Kuipers, E., Slater, M., Antley, A., Glucksman, E., et al. (2013) · Psychological Medicine · doi:10.1017/s003329171300038x · Cited by 79 · see citing works
The role of rumination in illness trajectories in youth: linking trans-diagnostic processes with clinical staging models
Grierson, A. B., Hickie, I. B., Naismith, S. L., & Scott, J. L. (2016) · Psychological Medicine · doi:10.1017/s0033291716001392 · Cited by 79 · see citing works
Rumination and negative smartphone use expectancies are associated with greater levels of problematic smartphone use: A latent class analysis
Elhai, J. D., Yang, H., Dempsey, A. E., & Montag, C. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.112845 · Cited by 77 · see citing works
Efficacy of psychological interventions targeting cognitive biases in schizophrenia: A systematic review and meta-analysis
Sauvé, G., Lavigne, K. M., Pochiet, G., Brodeur, M. B., & Lepage, M. (2020) · Clinical Psychology Review · doi:10.1016/j.cpr.2020.101854 · Cited by 76 · see citing works
Civil unrest, COVID-19 stressors, anxiety, and depression in the acute phase of the pandemic: a population-based study in Hong Kong
Hou, W. K., Lee, T. M. C., Liang, L., Li, T. W., Liu, H., Ettman, C. K., & Galea, S. (2021) · Social Psychiatry and Psychiatric Epidemiology · doi:10.1007/s00127-021-02037-5 · Cited by 73 · see citing works
The role of rumination in posttraumatic stress disorder and posttraumatic growth among adolescents after the wenchuan earthquake
Wu, X., Zhou, X., Wu, Y., & An, Y. (2015) · Frontiers in Psychology · doi:10.3389/fpsyg.2015.01335 · Cited by 71 · cited 1× · see citing works
“, realization and appreciation of personal strength and life and new possibilities) [82], which further suggest differential pathways between involuntary and voluntary ruminative thoughts, with the latter showing more resemblance to constructive repetitive thinking and goal-oriented rumination.”
Working Memory Training Improves Emotion Regulation Ability
Xiu, L., Wu, J., Chang, L., & Zhou, R. (2018) · Scientific Reports · doi:10.1038/s41598-018-31495-2 · Cited by 69 · see citing works
A neglected reality of mass media during COVID-19: Effect of pandemic news on individual's positive and negative emotion and psychological resilience
Giri, S. P., & Maurya, A. K. (2021) · Personality and Individual Differences · doi:10.1016/j.paid.2021.110962 · Cited by 64 · see citing works
Neural mechanism in anterior prefrontal cortex for inhibition of prolonged set interference
Konishi, S., Chikazoe, J., Jimura, K., Asari, T., & Miyashita, Y. (2005) · Proceedings of the National Academy of Sciences · doi:10.1073/pnas.0500585102 · Cited by 62 · cited 1× · see citing works
“The inability to shift-set and switch responses relevant to the context may be related to the failure of multiple inhibitory systems in the lateral prefrontal cortex [77].”
Background
Altered default mode network connectivity in adolescents with post-traumatic stress disorder
Viard, A., Mutlu, J., Chanraud, S., Guenolé, F., Egler, P., Gérardin, P., Baleyte, J., Dayan, J., Eustache, F., & Guillery‐Girard, B. (2019) · NeuroImage Clinical · doi:10.1016/j.nicl.2019.101731 · Cited by 62 · see citing works
Lashing Out after Stewing over Public Insults: The Effects of Public Provocation, Provocation Intensity, and Rumination on Triggered Displaced Aggression
Vasquez, E. A., Pedersen, W. C., Bushman, B. J., Kelley, N. J., Demeestere, P., & Miller, N. (2012) · Aggressive Behavior · doi:10.1002/ab.21453 · Cited by 61 · see citing works
Rumination and Overgeneral Autobiographical Memory in Adolescents: An Integration of Cognitive Vulnerabilities to Depression
Hamlat, E. J., Connolly, S. L., Hamilton, J. L., Stange, J. P., Abramson, L. Y., & Alloy, L. B. (2014) · Journal of Youth and Adolescence · doi:10.1007/s10964-014-0090-2 · Cited by 61 · see citing works
Information Processing in PTSD: Evidence for Biased Attentional, Interpretation, and Memory Processes
Bomyea, J. A., Johnson, A., & Lang, A. J. (2016) · Psychopathology Review · doi:10.5127/pr.037214 · Cited by 61 · see citing works
Focused Daydreaming and Mind-Wandering
Dorsch, F. (2014) · Review of Philosophy and Psychology · doi:10.1007/s13164-014-0221-4 · Cited by 58 · see citing works
Structure in the stream of consciousness: Evidence from a verbalized thought protocol and automated text analytic methods
Sripada, C., & Taxali, A. (2020) · Consciousness and Cognition · doi:10.1016/j.concog.2020.103007 · Cited by 57 · see citing works
Fear and Anger Responses to Local News Coverage of Alcohol-Related Crimes, Accidents, and Injuries: Explaining News Effects on Policy Support Using a Representative Sample of Messages and People
Goodall, C. E., Slater, M. D., & Myers, T. A. (2013) · Journal of Communication · doi:10.1111/jcom.12020 · Cited by 55 · see citing works
Rumination and emotion-related biases in refreshing information.
Bernblum, R., & Mor, N. (2010) · Emotion · doi:10.1037/a0018427 · Cited by 55 · see citing works
Reducing attentional capture of emotion by broadening attention: Increased global attention reduces early electrophysiological responses to negative stimuli
Gable, P. A., & Harmon‐Jones, E. (2012) · Biological Psychology · doi:10.1016/j.biopsycho.2012.02.006 · Cited by 53 · see citing works
Positive and negative affect, depression, and cognitive processes in the Cognition in the Study of Tamoxifen and Raloxifene (Co-STAR) Trial
Danhauer, S. C., Legault, C., Bandos, H., Kidwell, K., Costantino, J. P., Vaughan, L., Avis, N. E., Rapp, S. R., Coker, L. H., Naughton, M., et al. (2012) · Aging Neuropsychology and Cognition · doi:10.1080/13825585.2012.747671 · Cited by 52 · see citing works
Cognitive and neural models of threat appraisal in psychosis: a theoretical integration
Underwood, R., Kumari, V., & Peters, E. (2016) · Psychiatry Research · doi:10.1016/j.psychres.2016.03.016 · Cited by 51 · see citing works
Testing the CaR–FA–X model: Investigating the mechanisms underlying reduced autobiographical memory specificity in individuals with and without a history of depression.
Sumner, J. A., Mineka, S., Adam, E. K., Craske, M. G., Vrshek‐Schallhorn, S., Wolitzky-Taylor, K. B., & Zinbarg, R. E. (2014) · Journal of Abnormal Psychology · doi:10.1037/a0037271 · Cited by 50 · cited 1× · see citing works
“According to the CaRFAX model, the fixation on selected thoughts and the further diminishing of executive resources could also contribute to overgeneral memories [49,50], and it has been shown to be implicated in not only depression but also PTSD and psychosis spectrum disorders [51–54].”
Method
Analysis of Default Mode Network in Social Anxiety Disorder: EEG Resting-State Effective Connectivity Study
Al‐Ezzi, A. A. A., Kamel, N., Faye, I., & Ebenezer, E. G. M. (2021) · Sensors · doi:10.3390/s21124098 · Cited by 49 · see citing works
A Risk Algorithm for the Persistence of Suicidal Thoughts and Behaviors During College
Mortier, P., Kiekens, G., Auerbach, R. P., Cuijpers, P. J., Demyttenaere, K., Green, J. G., Kessler, R. C., Nock, M. K., Zaslavsky, A. M., & Bruffaerts, R. (2017) · The Journal of Clinical Psychiatry · doi:10.4088/jcp.17m11485 · Cited by 48 · see citing works
Rumination, depressive symptoms and awareness of illness in schizophrenia.
Thomas, N., Ribaux, D., & Phillips, L. J. (2014) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465812000884 · Cited by 47 · see citing works
Ever-present threats from information technology: the Cyber-Paranoia and Fear Scale
Mason, O. J., Stevenson, C., & Freedman, F. (2014) · Frontiers in Psychology · doi:10.3389/fpsyg.2014.01298 · Cited by 47 · see citing works
Delusions About the Internet
Catalano, G., Catalano, M. C., Embi, C. S., & FRANKEL, R. L. (1999) · Southern Medical Journal · doi:10.1097/00007611-199906000-00010 · Cited by 46 · see citing works
Mapping autobiographical memory in schizophrenia: Clinical implications
Ricarte, J. J., Ros, L., Latorre, J. M., & Watkins, E. (2017) · Clinical Psychology Review · doi:10.1016/j.cpr.2016.11.004 · Cited by 45 · see citing works
Decoding rumination: A machine learning approach to a transdiagnostic sample of outpatients with anxiety, mood and psychotic disorders
Júnior, É. D. M. S., Passos, I. C., Scott, J. L., Bristot, G., Scotton, E., Mendes, L. S. T., Knackfuss, A. C. U., Gerchmann, L., Fijtman, A., Träsel, A. R., et al. (2019) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2019.12.005 · Cited by 45 · see citing works
Neural Correlates of Smartphone Dependence in Adolescents
Tymofiyeva, O., Yuan, J. P., Kidambi, R., Huang, C., Henje, E., Rubinstein, M. L., Jariwala, N., Max, J. E., Yang, T. T., & Xu, D. (2020) · Frontiers in Human Neuroscience · doi:10.3389/fnhum.2020.564629 · Cited by 44 · see citing works
Attention bias for paranoia-relevant visual stimuli in schizophrenia
Moritz, S., & Laudan, A. (2007) · Cognitive Neuropsychiatry · doi:10.1080/13546800601119982 · Cited by 42 · see citing works
Attention bias toward threatening faces in women with PTSD: eye tracking correlates by symptom cluster
Powers, A., Fani, N., Murphy, L., Briscione, M., Bradley, B., Tone, E. B., Norrholm, S. D., & Jovanovic, T. (2019) · European Journal of Psychotraumatology · doi:10.1080/20008198.2019.1568133 · Cited by 38 · see citing works
Development and Initial Validation of a Scale Assessing Suicide-Specific Rumination: The Suicide Rumination Scale
Rogers, M. L., Law, K. C., Houtsma, C., Tucker, R. P., Anestis, M. D., & Joiner, T. E. (2021) · Assessment · doi:10.1177/10731911211033897 · Cited by 38 · see citing works
Rumination and Negative Symptoms in Schizophrenia
Halari, R., Premkumar, P., Farquharson, L., Fannon, D., Kuipers, E., & Kumari, V. (2009) · Journal of Nervous & Mental Disease · doi:10.1097/nmd.0b013e3181b3af20 · Cited by 37 · see citing works
Internet-related psychosis−a sign of the times.
Nitzan, U., Shoshan, E., Lev‐Ran, S., & Fennig, S. (2011) · PubMed · Cited by 37 · see citing works
Engaging in Creativity Broadens Attentional Scope
Wronska, M. K., Kolańczyk, A., & Nijstad, B. A. (2018) · Frontiers in Psychology · doi:10.3389/fpsyg.2018.01772 · Cited by 37 · see citing works
A review of autobiographical memory studies on patients with schizophrenia spectrum disorders
Zhang, Y., Kuhn, S. K., Jobson, L., & Haque, S. (2019) · BMC Psychiatry · doi:10.1186/s12888-019-2346-6 · Cited by 35 · see citing works
The effect of mental progression on mood.
Mason, M. F., & Bar, M. (2011) · Journal of Experimental Psychology General · doi:10.1037/a0025035 · Cited by 34 · see citing works
Rumination about obsessive symptoms and mood maintains obsessive-compulsive symptoms and depressed mood: An experimental study.
Wahl, K., van den Hout, M., Heinzel, C. V., Kollárik, M., Meyer, A. H., Benoy, C., Berberich, G., Domschke, K., Gloster, A. T., Gradwohl, G., et al. (2021) · Journal of Abnormal Psychology · doi:10.1037/abn0000677 · Cited by 33 · see citing works
Incidental and Intentional Memory: Their Relation with Attention and Executive Functions
Kontaxopoulou, D., Beratis, I., Fragkiadaki, S., Pavlou, D., Yannis, G., Economou, A., Papanicolaou, A. C., & Papageorgiou, S. G. (2017) · Archives of Clinical Neuropsychology · doi:10.1093/arclin/acx027 · Cited by 32 · see citing works
Overgeneral autobiographical memory bias in clinical and non-clinical voice hearers
Jacobsen, P. C., PETERS, E. R., Ward, T., Garety, P. A., Jackson, M. C., & Chadwick, P. (2018) · Psychological Medicine · doi:10.1017/s0033291718000570 · Cited by 32 · see citing works
Preoccupation and distress are relevant dimensions in delusional beliefs.
Sisti, D., Rocchi, M., Siddi, S., Mura, T., Manca, S., Preti, A., & Petretto, D. (2012) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2012.02.005 · Cited by 31 · cited 1× · see citing works
“, [96–99]) and is also directly relevant to experiences of paranoia and hallucinations in subthreshold psychotic-like experiences [100].”
Background
Rumination, Brooding, and Reflection: Prospective Associations with Suicide Ideation and Suicide Attempts
Horwitz, A. G., Czyz, E. K., Berona, J., & King, C. (2018) · Suicide and Life-Threatening Behaviour · doi:10.1111/sltb.12507 · Cited by 31 · cited 1× · see citing works
“Of note, while depressive rumination has also been found to be a precursor of suicidal ideation and behaviors [83,84], a number of studies have discussed the phenomenon of”
Background
Mental Health Risks after Repeated Exposure to Multiple Stressful Events during Ongoing Social Unrest and Pandemic in Hong Kong: The Role of Rumination: Risques pour la santé mentale après une exposition répétée à de multiples événements stressants d’agitation sociale durable et de pandémie à Hong Kong: le rôle de la rumination
Wong, S. M. Y., Hui, C. L. M., Wong, C. S. M., Suen, Y. N., Chan, S. K. W., Lee, E. H. M., Chang, W. C., & Chen, E. Y. H. (2020) · The Canadian Journal of Psychiatry · doi:10.1177/0706743720979920 · Cited by 31 · see citing works
Self-citation
Prevalence and correlates of suicidal behaviours in a representative epidemiological youth sample in Hong Kong: the significance of suicide-related rumination, family functioning, and ongoing population-level stressors
Wong, S. M. Y., Ip, C. H., Hui, C. L. M., Suen, Y. N., Wong, C. S. M., Chang, W. C., Chan, S. K. W., Lee, E. H. M., Lui, S. S. Y., Chan, K. T., et al. (2022) · Psychological Medicine · doi:10.1017/s0033291722001519 · Cited by 31 · see citing works
Self-citation
Dampening, Positive Rumination, and Positive Life Events: Associations with Depressive Symptoms in Children at Risk for Depression
Gilbert, K., Luking, K. R., Pagliaccio, D., Luby, J. L., & Barch, D. M. (2016) · Cognitive Therapy and Research · doi:10.1007/s10608-016-9798-5 · Cited by 29 · see citing works
Are rumination and neuroticism genetically or environmentally distinct risk factors for psychopathology?
du Pont, A., Rhee, S. H., Corley, R. P., Hewitt, J. K., & Friedman, N. P. (2019) · Journal of Abnormal Psychology · doi:10.1037/abn0000430 · Cited by 29 · see citing works
Attentional bias in euthymic bipolar I disorder
Peckham, A., Johnson, S. L., & Gotlib, I. H. (2015) · Cognition & Emotion · doi:10.1080/02699931.2015.1014313 · Cited by 28 · see citing works
Prospective prediction of PTSD and depressive symptoms during social unrest and COVID-19 using a brief online tool
Wong, S. M. Y., Hui, C. L. M., Wong, C. S. M., Suen, Y. N., Chan, S. K. W., Lee, E. H. M., Chang, W., & Chen, E. Y. H. (2021) · Psychiatry Research · doi:10.1016/j.psychres.2021.113773 · Cited by 28 · see citing works
Self-citation
Examination of the Relation Between PTSD Symptoms, Smartphone Feature Uses, and Problematic Smartphone Use
Contractor, A. A., Weiss, N. H., & Elhai, J. D. (2018) · Social Science Computer Review · doi:10.1177/0894439318770745 · Cited by 27 · see citing works
The Perseverative Thinking Questionnaire in Patients with Persecutory Delusions
Černis, E., Dunn, G., Startup, H. M., Kingdon, D., Wingham, G., Evans, N., Lister, R., Pugh, K., Cordwell, J., Mander, H., et al. (2015) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465815000533 · Cited by 26 · see citing works
Cognitive Bias Modification for Threat Interpretations: Impact on Anxiety Symptoms and Stress Reactivity
Rozenman, M., Gonzalez, A., Logan, C., & Goger, P. (2020) · Depression and Anxiety · doi:10.1002/da.23018 · Cited by 24 · see citing works
Cognitive bias modification for paranoia (CBM-pa): a randomised controlled feasibility study in patients with distressing paranoid beliefs
Yiend, J., Lam, C. L. M., Schmidt, N. B., Crane, B., Heslin, M., Kabir, T., McGuire, P. K., Meek, C., Mouchlianitis, E. D., PETERS, E. R., et al. (2022) · Psychological Medicine · doi:10.1017/s0033291722001520 · Cited by 24 · see citing works
Rumination-Focused Cognitive Behavioral Therapy Decreases Anxiety and Increases Behavioral Activation Among Remitted Adolescents
Feldhaus, C. G., Jacobs, R. H., Watkins, E. R., Peters, A. T., Bessette, K. L., & Langenecker, S. A. (2020) · Journal of Child and Family Studies · doi:10.1007/s10826-020-01711-7 · Cited by 23 · see citing works
Attentional biases to emotional scenes in schizophrenia: An eye-tracking study
Navalón, P., Serrano, E., Almansa, B., Perea, M., Benavent, P., Domínguez, A., Sierra, P., Cañada, Y., & García‐Blanco, A. (2021) · Biological Psychology · doi:10.1016/j.biopsycho.2021.108045 · Cited by 22 · see citing works
The impact of social unrest and pandemic on mental health of young people in Hong Kong: The transdiagnostic role of event-based rumination
Wong, S. M. Y., Hui, C. L. M., Suen, Y. N., Wong, C. S. M., Chan, S. K. W., Lee, E. H. M., Chang, W. C., & Chen, E. Y. H. (2021) · Australian & New Zealand Journal of Psychiatry · doi:10.1177/00048674211025710 · Cited by 22 · see citing works
Self-citation
David Hartley's psychobiological associationism and the Legacy of Aristotle*
Buckingham, H. W., & Finger, S. (1997) · Journal of the History of the Neurosciences · doi:10.1080/09647049709525683 · Cited by 21 · see citing works
Cognitive Interpretation Bias: The Effect of a Single Session Moderate Exercise Protocol on Anxiety and Depression
Seraphine, C. C., Cooper, N. R., Mirinalee, R., & Mackintosh, B. (2018) · Frontiers in Psychology · doi:10.3389/fpsyg.2018.01363 · Cited by 21 · see citing works
Impact of smartphone overuse on 1-year severe depressive symptoms and momentary negative affect: Longitudinal and experience sampling findings from a representative epidemiological youth sample in Hong Kong
Wong, S. M., Chen, E. Y., Wong, C. S., Suen, Y., Chan, D. L., Tsang, S. H., Wong, T., Cheung, C., Chan, K., Lui, S. S., et al. (2022) · Psychiatry Research · doi:10.1016/j.psychres.2022.114939 · Cited by 21 · see citing works
Self-citation
Aberrant default mode connectivity in adolescents with early-onset psychosis: A resting state fMRI study
Hilland, E., Johannessen, C. H., Jonassen, R., Alnæs, D., Jørgensen, K. N., Barth, C., Andreou, D., Nerland, S., Wortinger, L. A., Smelror, R. E., et al. (2021) · NeuroImage Clinical · doi:10.1016/j.nicl.2021.102881 · Cited by 20 · see citing works
Layer-specific reduced neuronal density in the orbitofrontal cortex of older adults with obsessive–compulsive disorder
de Oliveira, K. C., Grinberg, L. T., Hoexter, M. Q., Brentani, H., Suemoto, C. K., Nery, F. G., Lima, L. C., Alho, A. T. D. L., Farfel, J. M., Ferretti‐Rebustini, R. E. D. L., et al. (2018) · Brain Structure and Function · doi:10.1007/s00429-018-1752-8 · Cited by 18 · see citing works
Training Positive Rumination in Expressive Writing to Enhance Psychological Adjustment and Working Memory Updating for Maladaptive Ruminators
Yang, H., & Li, H. (2020) · Frontiers in Psychology · doi:10.3389/fpsyg.2020.00789 · Cited by 18 · see citing works
Selective attention for negative information and depression in schizophrenia
Waters, F., Badcock, J. C., & Maybery, M. T. (2006) · Psychological Medicine · doi:10.1017/s0033291705007026 · Cited by 17 · see citing works
Induced ideas of reference during social unrest and pandemic in Hong Kong
Wong, S. M. Y., Hui, C. L. M., Wong, C. S. M., Suen, Y. N., Chan, S. K. W., Lee, E. H. M., Chang, W. C., Wong, G. H. Y., & Chen, E. Y. H. (2021) · Schizophrenia Research · doi:10.1016/j.schres.2021.01.027 · Cited by 17 · cited 1× · see citing works
“A recent study conducted amid large-scale social unrest and COVID-19 in Hong Kong has also reported event-based rumination to be significantly associated with the psychotic-like experience of ideas of reference in a large community sample [81].”
BackgroundSelf-citation
Mental disengagement mediates the effect of rumination on smartphone use: A latent growth curve analysis
Khoo, S. S., & Yang, H. (2021) · Computers in Human Behavior · doi:10.1016/j.chb.2021.106757 · Cited by 17 · see citing works
Age-Related Differences of Rumination on the Loneliness–Depression Relationship: Evidence From a Population-Representative Cohort
Tong, H., Hou, W. K., Liang, L., Li, T. W., Liu, H., & Lee, T. M. C. (2021) · Innovation in Aging · doi:10.1093/geroni/igab034 · Cited by 17 · see citing works
The interplay among paranoia, social relationships and negative affectivity in a heterogeneous clinical sample: A network analysis
Januška, J., Straková, A., Dančík, D., Pečeňák, J., Heretik, A., & Hajdúk, M. (2021) · Journal of Experimental Psychopathology · doi:10.1177/20438087211067626 · Cited by 17 · see citing works
Intrusive and Repetitive Thought after Stress: A Replication Study
Horowitz, M. J., Becker, S. S., & Moskowitz, M. (1971) · Psychological Reports · doi:10.2466/pr0.1971.29.3.763 · Cited by 16 · see citing works
Dispositional Mindfulness and Psychotic Symptoms in Schizophrenia Spectrum Disorders: The Mediating Roles of Rumination and Negative Emotion
Lam, 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
Rumination, intolerance of uncertainty and paranoia in treatment resistant psychosis
Lebert, L., Turkington, D., Freeston, M., & Dudley, R. (2020) · Psychosis · doi:10.1080/17522439.2020.1798489 · Cited by 13 · see citing works
Youth mental health care in a context of large‐scale collective stress
Chen, E. Y. H., & Wong, S. M. Y. (2022) · World Psychiatry · doi:10.1002/wps.20932 · Cited by 13 · see citing works
Self-citation
A test of the CaR-FA-X mechanisms and depression in adolescents
Fisk, J., Ellis, J. A., & Reynolds, S. (2018) · Memory · doi:10.1080/09658211.2018.1518457 · Cited by 12 · cited 1× · see citing works
“According to the CaRFAX model, the fixation on selected thoughts and the further diminishing of executive resources could also contribute to overgeneral memories [49,50], and it has been shown to be implicated in not only depression but also PTSD and psychosis spectrum disorders [51–54].”
Method
Communal coping and rumination in the aftermath of Chile earthquake: Multiple mediation analysis of the relationship between subjective severity and posttraumatic growth
García, F. E., & Włodarczyk, A. (2018) · Journal of Community & Applied Social Psychology · doi:10.1002/casp.2350 · Cited by 11 · see citing works
A study on attentional bias and response inhibition of facial expressions in manic patients: evidence from eye movement
Liu, Y., Liu, T., Zhao, J., Huang, S., Lai, W., Yang, H., Xu, D., Zhang, M., & Rong, H. (2019) · International Journal of Psychiatry in Clinical Practice · doi:10.1080/13651501.2019.1569238 · Cited by 10 · see citing works
Effects of analytical (abstract) versus experiential (concrete) induced rumination of negative self defining memories on schizotypic symptoms
Ricarte, J. J., Ros, L., Fernández‐Pérez, D., Nieto, M., & Latorre, J. M. (2018) · Scandinavian Journal of Psychology · doi:10.1111/sjop.12464 · Cited by 9 · see citing works
Attentional processing biases to threat in schizophrenia: Evidence from a free-viewing task with emotional scenes
Navalón, P., Perea, M., Benavent, P., Sierra, P., Domínguez, A., Iranzo, C., Serrano-Lozano, E., Almansa, B., & García‐Blanco, A. (2021) · Journal of Psychiatric Research · doi:10.1016/j.jpsychires.2021.09.044 · Cited by 9 · see citing works
Associations between hypomania proneness and attentional bias to happy, but not angry or fearful, faces in emerging adults
Gruber, J., Maclaine, E., Avard, E., Purcell, J., Cooper, G., Tobias, M. R., Earls, H. A., Wieland, L., Bothe, E., Boggio, P. S., et al. (2020) · Cognition & Emotion · doi:10.1080/02699931.2020.1810638 · Cited by 8 · see citing works
Protecting the brain against bad news
Blades, R. (2021) · Canadian Medical Association Journal · doi:10.1503/cmaj.1095928 · Cited by 8 · see citing works
Vulnerability to Psychosis, Ideas of Reference and Evaluation with an Implicit Test
Bendala-Rodríguez, P., Senín‐Calderón, C., Peluso, L., & Testal, J. F. R. (2019) · Journal of Clinical Medicine · doi:10.3390/jcm8111956 · Cited by 7 · see citing works
Effects of antipsychotics on rumination in patients with first-episode psychosis.
Lee, Y., Kang, N.-I., Lee, K.-H., Piao, Y.-H., Cui, Y., Kim, S.-W., Lee, B., Kim, J. J., Yu, J.-C., Lee, K. Y., et al. (2020) · Progress in Neuro-psychopharmacology and Biological Psychiatry · doi:10.1016/j.pnpbp.2020.109983 · Cited by 6 · see citing works
Ruminative and mood associations for age differences in social and directive reasons to think and talk about life experiences
Ricarte, J. J., Ros, L., Latorre, J. M., & Barry, T. J. (2020) · PLoS ONE · doi:10.1371/journal.pone.0235378 · Cited by 6 · see citing works
Selective Attention to Threat is Specific to Delusions in First-Episode Psychosis
Bendall, S., Lim, M. H., Álvarez‐Jiménez, M., Hulbert, C. A., McGorry, P. D., & Jackson, H. J. (2014) · Journal of Experimental Psychopathology · doi:10.5127/jep.034613 · Cited by 4 · see citing works

Flagged first, then by citations

Research works printed but not linked: 7

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Sorted by citations

Association between rumination, suicidal ideation and suicide attempts in persons with depressive and other mood disorders and healthy controls: A systematic review and meta-analysis
Le, G. H., Wong, S., Au, H. C. T., Badulescu, S., Gill, H., Vasudeva, S., Teopiz, K. M., Rhee, T. G., Ho, R., Kwan, A. T. H., et al. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.09.118 · Cited by 36 · see citing works
Self-citation
Glimpse on 21st century new phobias; a predictive model of nomophobia
Ceobanu, C., Marian, A., & Apostolache, R. (2023) · Frontiers in Public Health · doi:10.3389/fpubh.2023.1252099 · Cited by 30 · see citing works
Research progress on the neural circuits mechanisms of anxiety
Gong, W. (2025) · Frontiers in Neural Circuits · doi:10.3389/fncir.2025.1609145 · Cited by 13 · see citing works
“However, translating preclinical findings faces unique challenges due to the complexity of human cognitive processes, such as rumination, which engage cortical circuits underrepresented in rodent models (Wong et al., 2023).”
Emotional Distress and Body Dissatisfaction: The Mediating Role of Social Media and Emotional Regulation
López-Montón, M., Aonso-Diego, G., & Estévez, A. (2024) · Behavioral Science · doi:10.3390/bs14070580 · Cited by 13 · see citing works
“These findings are consistent with previous studies showing that rumination [76] and catastrophizing [77] are transdiagnostic variables observed in multiple psychopathologies, such as post-traumatic stress disorder, obsessive-compulsive disorder, anxiety disorders, depressive disorders, and body…”
Result
Exploring how cognitive-behavioral physical activity links ruminative thinking and mental wellbeing in sports high school adolescents
DERELİOĞLU, M., Vural, M., ÇİMEN, E., SAKİ, Ü., Saraçoğlu, Y. Y., Karataş, B., SAÇ, A., Yamaner, E., Halmatov, M., Yılmaz, C., et al. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1665882 · Cited by 11 · see citing works
Ruminative thinking mediates the effects of exposure to adverse life events on psychotic-like experiences
Fazio, L., Raio, A., Banaschewski, T., Bokde, A. L. W., Desriviéres, S., Flor, H., Garavan, H., Gowland, P., Grigis, A., Heinz, A., et al. (2024) · Frontiers in Psychology · doi:10.3389/fpsyg.2024.1434470 · Cited by 11 · see citing works
The Potential of Wearable Sensors for Detecting Cognitive Rumination: A Scoping Review
Arnold, V. X., & Young, S. D. (2025) · Sensors · doi:10.3390/s25030654 · Cited by 9 · see citing works
“…significant given that rumination manifests as a transdiagnostic symptom across mental health conditions, including depression, generalized anxiety, post-traumatic stress disorder, social anxiety disorder, obsessive–compulsive disorder, bipolar disorder, and psychosis spectrum disorder [7,29–33].”
Scaffolded Rumination: The Case of Problematic Smartphone Use
Rovetta, F. F. (2024) · Topoi · doi:10.1007/s11245-024-10140-w · Cited by 7 · see citing works
Evaluating the efficacy of rumination-focused cognitive-behavioral therapy in alleviating depression, negative affect, and rumination among patients with recurrent major depressive disorder: a randomized, multicenter clinical trial
Hasani, M., Zenoozian, S., Ahmadi, R., Khakpoor, S., Saberi, S., Pirzeh, R., & Saed, O. (2025) · BMC Psychiatry · doi:10.1186/s12888-025-07065-y · Cited by 8 · see citing works
Movement Toward Dimensional Symptom Models of Comorbid Obsessive–Compulsive Disorder and Eating Disorders
Levinson, C. A., Kapadia, A., Sandoval-Araujo, L. E., Vanzhula, I. A., & Machry, K. (2025) · Annual Review of Clinical Psychology · doi:10.1146/annurev-clinpsy-081423-020831 · Cited by 6 · see citing works
What do the PHQ-9, the GAD-7 and their variants miss in assessing young people presenting to youth mental health services?
Cotton, S., Menssink, J. M., Rickwood, D., Filia, K., Watson, A., Hasty, M. K., Herrman, H., Parker, A. G., Hetrick, S. E., Hickie, I. B., et al. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.120188 · Cited by 5 · see citing works
Brooding rumination as a mediator of the association between default mode and central executive network connectivity and general psychopathology: a resting state EEG study
Imperatori, C., Rossi, E. D., Allegrini, G., Carbone, G. A., Benvenuti, S. M., Adenzato, M., Dell’Acqua, C., Presti, A. L., Ardito, R. B., & Farina, B. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.120535 · Cited by 5 · see citing works
“…a transdiagnostic process involved in the development and maintenance of psychopathology in both clinical and non-clinical individuals (Cano-L ´ opez et al., 2022; Clancy et al., 2020; Ehring, 2021; Grierson et al., 2016; Luca, 2019; Rood et al., 2009; Snyder et al., 2019; Wong et al., 2023).”
Longitudinal Relationships Between Rumination and Depression Symptoms and the Influence of Lag Duration Among College Students
Zou, H.-Y., Ma, X.-H., Li, X., & Zhang, W. (2025) · International Journal of Cognitive Behavioral Therapy · doi:10.1007/s41811-025-00252-5 · Cited by 8 · see citing works
“The relationship between them may exhibit a cumulative effect of symptoms (Wong et al., 2023).”
Childhood emotional neglect and depression in emerging adults: Exploring the roles of rumination and resilience
Zhong, X. B., Li, S., & Zhou, W. (2025) · Acta Psychologica · doi:10.1016/j.actpsy.2025.105272 · Cited by 4 · see citing works
Effects of Pain-Related Features, Maladaptive Cognitions, Depression, and Anxiety on Pain-Related Disability: A Questionnaire-Based Cross-Sectional Study
Şentürk, E., Geniş, B., Zorbozan, E., & Selcan, A. (2024) · Medical Bulletin of Haseki · doi:10.4274/haseki.galenos.2024.9393 · Cited by 4 · see citing works
“Rumination, defined as repetitive thinking about one’s feelings and concerns, contributes to distorted thoughts and unhealthy coping mechanisms that reinforce overshining patterns (29).”
Background
What makes self-forgiveness so difficult (for some)? Understanding the lived experience of those stuck in self-condemnation
Woodyatt, L., de Vel‐Palumbo, M., Barron, A., Harous, C., Wenzel, M., & de Silva, S. (2025) · Self and Identity · doi:10.1080/15298868.2025.2513878 · Cited by 4 · see citing works
“2008; Luca, 2019; S. M. Wong et al., 2023).”
Homocysteine, hopelessness, rumination, affective temperaments, and clinical course in patients with bipolar disorder-1
Aydın, E. F., Özcan, H., Yılmaz, S., Aşkın, S., Laçin, T. K., & Donbaloğlu, E. N. (2024) · Nordic Journal of Psychiatry · doi:10.1080/08039488.2024.2347633 · Cited by 4 · see citing works
Neural mechanisms underlying implicit emotion regulation deficit in relational and nonrelational trauma PTSD: Insights from the Nested Hierarchical Model of Self
Guo, Y., Xiong, Q., Tan, Y., Zhao, J., Liu, S., Jia, J., Zhang, Z., Zhang, Y., & Ren, Z. (2025) · Psychological Medicine · doi:10.1017/s0033291725101505 · Cited by 3 · see citing works
Breakfast skipping and depressive symptoms in an epidemiological youth sample in Hong Kong: the mediating role of reduced attentional control
Wong, S. M. Y., Choi, O., Suen, Y. N., Hui, C. L. M., Lee, E. H. M., Chan, S. K. W., & Chen, E. Y. H. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1574119 · Cited by 3 · see citing works
Self-citation
The Future-oriented Repetitive Thought (FoRT) scale: Validation in Chinese samples and application in the schizophrenia spectrum
Liu, J., Chen, T., Cui, J., Lai, W., Zhang, Q., Ye, J., Yang, T., Wang, Y., & Chan, R. C. K. (2024) · Asian Journal of Psychiatry · doi:10.1016/j.ajp.2024.104083 · Cited by 3 · see citing works
Intraindividual coupling of rumination and depressed affect in adults: Effects of perceived parental warmth and psychological control during adolescence
Tran, T., & Liu, Q. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.02.029 · Cited by 2 · see citing works
Investigating cultural influences on the associations between rumination and symptoms of posttraumatic stress disorder among European Australian and Chinese Australian trauma survivors
Li, J. H., Qiu, L. S., Wong, J., Lau, W., Bryant, R. A., Lies, J., Liddell, B. J., & Jobson, L. (2025) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2025.100924 · Cited by 2 · see citing works
Latent profile analysis of rumination subtypes and associations with suicidal ideation and behavior
Ha, H., & Shim, E. (2025) · Death Studies · doi:10.1080/07481187.2025.2591318 · Cited by 2 · see citing works
The correlation between latent types of emotional processing, physical exercise and aggressive behavior among middle school students: a study based on latent profile analysis
Chu, J., Yang, Y., & Wu, J. (2026) · Frontiers in Psychology · doi:10.3389/fpsyg.2026.1815526 · Cited by 2 · see citing works
“Emotional rumination refers to the reflection and in-depth thinking of past negative experiences, which makes individuals indulge in a vicious circle of negative emotional processing (Wong et al., 2023).”
Can a brief guided nature walk reduce distress and improve resilience, mindful attention, and sleep quality? Evidence from a pilot study with two-week follow-up
Wong, S. M. Y., So, M. M., Suen, Y. N., Hui, C. L. M., & Chen, E. Y. H. (2025) · International Journal of Environmental Health Research · doi:10.1080/09603123.2025.2455991 · Cited by 2 · see citing works
Self-citation
Mindful Attention as a Buffer Between Prospective Exposure to Stressful Life Events and Psychiatric Symptoms in Young People
So, M. M., Wong, S. M. Y., Hui, C. L. M., Suen, Y. N., Chan, S. K. W., Lee, E. H. M., & Chen, E. Y. H. (2025) · Journal of Loss and Trauma · doi:10.1080/15325024.2025.2493954 · Cited by 1 · see citing works
“…including depression and anxiety, as well as PTSD, are characterized by heightened stress reactivity, excessive attention toward the self and the traumatic event, and difficulties in emotion regulation (Badour & Feldner, 2013; Clark et al., 1994; Nolen-Hoeksema & Morrow, 1991; Wong et al., 2023).”
InfluentialSelf-citation
The Efficacy of Mindfulness-Based Stress Reduction in Mitigating Rumination and Anxiety Sensitivity Among Adolescents with Social Anxiety Disorder
Bavi, S., Salar, A. R., Talayeri, A., & Bahmaei, H. (2025) · Journal of Contemporary Psychotherapy · doi:10.1007/s10879-025-09676-8 · Cited by 1 · see citing works
“These thoughts hinder adaptive problem-solving and exacerbate negative thoughts in obsessive-compulsive disorder patients (Wong et al., 2023).”
Development and evaluation of an intervention package to alleviate the psychological effects of premenstrual syndrome in adolescent girls
Asadi, H., Kivi, H. G., & Samarein, Z. A. (2025) · BMC Women s Health · doi:10.1186/s12905-025-03690-7 · Cited by 1 · see citing works
“Despite the growing recognition of these mechanisms, few interventions specifically target these cognitive dimensions, particularly in adolescent populations [31, 32].”
Rethinking Mental Health Assessment: A Network-Based Approach to Understanding University Students’ Well-Being with Exploratory Graph Analysis
García-Pérez, L., González, M. D. M. C., & Mota, J. A. P. S. (2025) · Youth · doi:10.3390/youth5040116 · Cited by 1 · see citing works
“Common mechanisms, such as cognitive rumination (Wong et al., 2023), emotional hypervigilance (Meng et al., 2020), and difficulties in emotion regulation (Menefee et al., 2022), contribute to their interconnection.”
The mediating role of rumination between fear of disease progression and sleep disturbance in melanoma patients: a dual-perspective analysis based on person-centered and variable-centered approaches
Huang, Q., Yue, F., Shi, W., Lei, Y., & Jiang, T. (2025) · Frontiers in Public Health · doi:10.3389/fpubh.2025.1710386 · Cited by 1 · see citing works
Linguistic markers of rumination in military personnel: A psycholinguistic analysis of narratives and inner speech
Августюк, М. М., Балашов, Е. М., Pasichnyk, I., & Kalamazh, R. (2025) · East European Journal of Psycholinguistics · doi:10.29038/avh · Cited by 1 · see citing works
Neural correlates of rumination in psychiatric disorders: A systematic review of fMRI evidence
Carneiro, A. M., da Silva, V. A., Razza, L. B., Vanderhasselt, M., Brunoni, A. R., & da Silva, P. H. R. (2026) · Behavioural Brain Research · doi:10.1016/j.bbr.2026.116181 · Cited by 1 · see citing works
EEG alpha rhythm modulation using sham neurofeedback during attentional control in a virtual reality environment
Gonzales, C. B. A., Rosales, M. G., Mista, C., Arévalo, D. A. (., Tabernig, C. B., & Manresa, J. A. B. (2026) · Cortex · doi:10.1016/j.cortex.2026.03.020 · Cited by 1 · see citing works
The Role of Emotion Dysregulation, Impulsiveness and Rumination in Psychopathology: Evidence from an Italian Sample of Adolescents and Young Adults
Aprile, S. F., Avanzato, C., Alù, F., Concerto, C., Cutrufelli, P., Mineo, L., Privitera, G., Petralia, A., Rodolico, A., Caraci, F., et al. (2026) · Brain Sciences · doi:10.3390/brainsci16060620 · Cited by 1 · see citing works
“This pattern aligns with contemporary transdiagnostic models that conceptualize repetitive negative thinking as a central mechanism cutting across internalizing symptom clusters and related complaints such as somatic distress [33].”
Structural Examination of the Relationships Between Insecure Attachment Styles and Intolerance of Uncertainty: The Mediating Role of Rumination in Predicting Obsessive–Compulsive Symptoms in High School Students
Homayoon, M., Damirchi, E. S., & Abdoli, A. (2026) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2026.101137 · Cited by 1 · see citing works
Generative artificial intelligence addiction is prospectively associated with psychotic-like experiences: Evidence from a two-wave longitudinal mediation and network study
Tang, S., Yu, M., 张向晖, & Zhang, Z. (2026) · Computers in Human Behavior Reports · doi:10.1016/j.chbr.2026.101301 · Cited by 1 · see citing works
Individual Rumination in Adult Cancer Care: A Concept Analysis
Cao, J., & Üzar‐Özçetin, Y. S. (2025) · Seminars in Oncology Nursing · doi:10.1016/j.soncn.2024.151802 · Cited by 1 · see citing works
Pre-Sleep Anxiety: Mechanisms and Therapeutic Approaches in Clinical Practice.
Song, S., Irfan, M., Tahir, Z., Garrison, K. A., & Ziskind, S. (2026) · Current Sleep Medicine Reports · doi:10.1007/s40675-026-00370-2
Research Progress on the Psychopathological Mechanism of Bodily Distress Disorder
应, 修. (2024) · Advances in Psychology · doi:10.12677/ap.2024.148574
The ruminative cycle in smokers: on the relationship between cigarette smoking behaviour, rumination, difficulties in thought suppression, and emotion regulation
Rusconi, P., Ales, F., Giromini, L., & Ando, A. M. C. (2025) · Journal of Cognitive Psychology · doi:10.1080/20445911.2025.2449725
“…about one’s negative emotions and the events that caused them (e.g. Ferguson et al., 2024; Nolen-Hoeksema, 1991; Nolen-Hoeksema et al., 2008; Wong et al., 2023), often associated with avoidance (e.g. Ferguson et al., 2024; Wong et al., 2023) and usually viewed as a maladaptive emotion…”
Effects of Obesity on the Relationship Between Eating Behaviours and Cognitive Emotion Regulation in Chinese College Students: A Network Analysis
Jiang, W., Shi, Z., & Zhang, X. (2025) · European Eating Disorders Review · doi:10.1002/erv.3207
Unveiling the aftermath of choice: exploring health insurance buyer’s regret using mixed method approach
Kumari, N., Mishra, N., & Shivani, S. (2026) · International Journal of Pharmaceutical and Healthcare Marketing · doi:10.1108/ijphm-06-2025-0121
From Social Media Addiction to Appearance Anxiety During Early Adolescence: the Roles of Self-Rumination and Gender in a Two-Wave Longitudinal Study
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Authors: Wong, S. M. Y., Chen, E. Y. H., Lee, M. C. Y., Suen, Y. N., & Hui, C. L. M.
Affiliations: University of Hong Kong (HK)
Corresponding author: Chen, Eric Y. H.
ORCID: Wong, Stephanie M. Y.
Chen, Eric Y. H.
Suen, Y. N.
Hui, Christy L. M.
Venue: Brain Sciences
Publisher: MDPI AG
Published: 2023-07-08
Volume: 13
Issue: 7
Pages: 1041
ISSN: 2076-3425 (ISSN-L)
DOI: 10.3390/brainsci13071041
PMC: PMC10377138
OpenAlex: W4383817969
Cited by: 48
References: 186
Citations by year: 2026: 14 · 2025: 25 · 2024: 8 · 2023: 1
FWCI: 2.03
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (vor)
Locations: Brain Sciences (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
Life Sciences › Neuroscience › Cognitive Neuroscience › Mind wandering and attention
Social Sciences › Psychology › Experimental and Cognitive Psychology › Mental Health Research Topics
Keywords: rumination, transdiagnostic mechanisms, depressive rumination, executive function, attention, psychosis, smartphone use, human-device interaction, mental health interventions

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Rumination as a Transdiagnostic Phenomenon in the 21st Century: The Flow Model of Rumination

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