Cognitive Therapy and Research

, Volume 35, Issue 3, pp 253–265

Rumination in Clinical Depression: A Type of Emotional Suppression?

  • Gabrielle I. Liverant
  • Barbara W. Kamholz
  • Denise M. Sloan
  • Timothy A. Brown
Original Article

Abstract

This study examined the relationship between rumination and the use of other emotion-regulation strategies in a depressed sample. Sixty outpatients diagnosed with unipolar depression completed questionnaires and participated in a sad mood induction. The mood induction was used to investigate the relationship between the use of rumination and each of two theoretically relevant emotion-regulation strategies—suppression and acceptance. Findings demonstrated that rumination was positively associated with other types of suppression and negatively related to acceptance. Results offer tentative support for the conceptualization of rumination as a maladaptive, cognitive emotion-regulation strategy utilized by depressed individuals in an attempt to suppress their experience of negative emotion. Findings also suggest a potential mechanism of action for efficacious mindfulness and acceptance-based treatments for depression.

Keywords

Rumination Depression Emotion regulation Acceptance 

References

  1. Antony, M. M., Bieling, P. J., Cox, B. J., Enns, M. W., & Swinson, R. P. (1998). Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychological Assessment, 10, 176–181.CrossRefGoogle Scholar
  2. Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.PubMedCrossRefGoogle Scholar
  3. Beck, A. T. (1967). Depression: Clinical experimental, and theoretical aspects. New York: Hoeber.Google Scholar
  4. Beck, A. T. (1991). Cognitive therapy: A 30-year retrospective. American Psychologist, 46, 368–375.PubMedCrossRefGoogle Scholar
  5. Beck, A. T., & Haaga, D. F. (1992). The future of cognitive therapy. Psychotherapy, 29, 34–38.CrossRefGoogle Scholar
  6. Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck depression inventory manual (2nd ed.). San Antonio, TX: Psychological Corporation.Google Scholar
  7. Borkovec, T. D., Ray, W. J., & Stöber, J. (1998). Worry: A cognitive phenomenon intimately linked to affective, physiological, and interpersonal behavioral processes. Cognitive Therapy and Research, 22, 561–576.CrossRefGoogle Scholar
  8. Borkovec, T. D., & Roemer, L. (1995). Perceived functions of worry among generalized anxiety disorder subjects: Distraction from more emotionally distressing topics? Journal of Behavior Therapy and Experimental Psychiatry, 26, 25–30.PubMedCrossRefGoogle Scholar
  9. Brown, T. A. (2007). Temporal course and structural relationships among dimensions of temperament and DSM-IV anxiety and mood disorders. Journal of Abnormal Psychology, 116, 313–328.PubMedCrossRefGoogle Scholar
  10. Brown, T. A., Campbell, L. A., Lehman, C. L., Grisham, J. R., & Mancill, R. B. (2001a). Current and lifetime comorbidity of the DSM-IV anxiety and mood disorders in a large clinical sample. Journal of Abnormal Psychology, 110, 585–599.PubMedCrossRefGoogle Scholar
  11. Brown, T. A., Chorpita, B. F., & Barlow, D. H. (1998). Structural relationships among dimensions of the DSM-IV anxiety and mood disorders and dimensions of negative affect, positive affect, and autonomic arousal. Journal of Abnormal Psychology, 107, 179–192.PubMedCrossRefGoogle Scholar
  12. Brown, T. A., Chorpita, B. F., Korotitsch, W., & Barlow, D. H. (1997). Psychometric properties of the Depression Anxiety Stress Scales (DASS) in clinical samples. Behaviour Research and Therapy, 35, 79–89.PubMedCrossRefGoogle Scholar
  13. Brown, T. A., Di Nardo, P. A., & Barlow, D. H. (1994). Anxiety disorders interview schedule for DSM-IV (ADIS-IV). New York: Oxford University Press.Google Scholar
  14. Brown, T. A., Di Nardo, P. A., Lehman, C. L., & Campbell, L. A. (2001b). Reliability of DSM-IV anxiety and mood disorders: Implications for the classification of emotional disorders. Journal of Abnormal Psychology, 110, 49–58.PubMedCrossRefGoogle Scholar
  15. Campbell-Sills, L., Barlow, D. H., Brown, T. A., & Hofmann, S. G. (2006). Effects of suppression and acceptance on emotional responses of individuals with anxiety and mood disorders. Behaviour Research and Therapy, 44, 1251–1263.PubMedCrossRefGoogle Scholar
  16. Conway, M., Csank, P. A. R., Holm, S. L., & Blake, C. K. (2000). On individual differences in rumination on sadness. Journal of Personality Assessment, 75, 404–425.PubMedCrossRefGoogle Scholar
  17. Costa, P. T., & McCrae, R. R. (1991). NEO five factor inventory: Form S. Odessa, FL: Psychological Assessment Resources.Google Scholar
  18. Davey, G. C. L., Tallis, F., & Capuzzo, N. (1996). Beliefs about the consequences of worrying. Cognitive Therapy and Research, 20, 499–520.CrossRefGoogle Scholar
  19. Di Nardo, P. A., Brown, T. A., & Barlow, D. H. (1994). Anxiety Disorders Interview Schedule for DSM-IV: Lifetime Version (ADIS-IV-L). San Antonio, TX: Psychological Corporation.Google Scholar
  20. Dozois, D. J. A., Dobson, K. S., & Ahnberg, J. L. (1998). A psychometric evaluation of the Beck Depression Inventory-II. Psychological Assessment, 10, 83–89.CrossRefGoogle Scholar
  21. Ehlers, A., Mayou, R. A., & Bryant, B. (2003). Cognitive predictors of posttraumatic stress disorder in children: Results of a prospective longitudinal study. Behaviour Research and Therapy, 41, 1–10.PubMedCrossRefGoogle Scholar
  22. Erskine, J. A. K., Kvavilashvili, L., & Kornbrot, D. E. (2007). The predictors of thought suppression in young and old adults: Effects of rumination, anxiety, and other variables. Personality and Individual Differences, 42, 1047–1057.CrossRefGoogle Scholar
  23. Fresco, D. M., Frankel, A. N., Mennin, D. S., Turk, C. L., & Heimberg, R. G. (2002). Distinct and overlapping features of rumination and worry: The relationship of cognitive production to negative affective states. Cognitive Therapy and Research, 26, 179–188.CrossRefGoogle Scholar
  24. Garnefski, N., & Kraaj, V. (2007). The Cognitive Emotion Regulation Questionnaire: Psychometric features and prospective relationships with depression and anxiety in adults. European Journal of Psychological Assessment, 23, 141–149.CrossRefGoogle Scholar
  25. Garnefski, N., Teerds, J., Kraaij, V., Legerstee, J., & ven den Kommer, T. (2004). Cognitive emotion regulation strategies and depressive symptoms: Differences between males and females. Personality and Individual Differences, 36, 267–276.CrossRefGoogle Scholar
  26. Gratz, K. L., & Roemer, L. (2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. Journal of Psychopathology and Behavioral Assessment, 26, 41–54.CrossRefGoogle Scholar
  27. Greenberg, M. S., & Beck, A. T. (1989). Depression versus anxiety: A test of the content-specificity hypothesis. Journal of Abnormal Psychology, 98, 9–13.PubMedCrossRefGoogle Scholar
  28. Gross, J. J., & Levenson, R. W. (1995). Emotion elicitation using films. Cognition and Emotion, 9, 87–108.CrossRefGoogle Scholar
  29. Haaga, D. A., Dyck, M. J., & Ernst, D. (1991). Empirical status of the cognitive theory of depression. Psychological Bulletin, 110, 215–236.PubMedCrossRefGoogle Scholar
  30. Hayes, S. C., Strosahl, K. D., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experiential approach to behavior change. New York: Guilford Press.Google Scholar
  31. Hertel, P. T. (1998). Relation between rumination and impaired memory in dysphoric moods. Journal of Abnormal Psychology, 107, 166–172.PubMedCrossRefGoogle Scholar
  32. Joormann, J. (2006). Differential effects of rumination and dysphoria on the inhibition of irrelevant emotional material: Evidence from a negative priming task. Cognitive Therapy and Research, 30, 149–160.CrossRefGoogle Scholar
  33. Joormann, J., & Gotlib, I. H. (2008). Updating the contents of working memory in depression: Interference with irrelevant negative material. Journal of Abnormal Psychology, 117, 182–192.PubMedCrossRefGoogle Scholar
  34. Joormann, J., Dkane, M., & Gotlib, I. H. (2006). Adaptive and maladaptive components of rumination? Diagnostic specificity and relation to depressive biases. Interpretive biases and ruminative thought: Experimental evidence and clinical implications, special issue (pp. 269–280).Google Scholar
  35. Just, N., & Alloy, L. B. (1997). The response styles theory of depression: Tests and an extension of the theory. Journal of Abnormal Psychology, 106, 221–229.PubMedCrossRefGoogle Scholar
  36. Kamholz, B. W., Hayes, A. M., Carver, C. S., Gulliver, S. B., & Perlman, C. A. (2006). Identification and evaluation of cognitive affect-regulation strategies: Development of a self-report measure. Cognitive Therapy and Research, 30, 227–262.CrossRefGoogle Scholar
  37. Levitt, J. T., Brown, T. A., Orsillo, S. M., & Barlow, D. H. (2004). The effects of acceptance versus suppression of emotion on subjective and psychophysiological response to carbon dioxide challenge in patients with panic disorder. Behavior Therapy, 35, 747–766.CrossRefGoogle Scholar
  38. Liverant, G. I., Brown, T. A., Barlow, D. H., & Roemer, L. (2008). Emotion regulation in unipolar depression: The effects of acceptance and suppression of subjective emotional experience on the intensity and duration of sadness and negative affect. Behaviour Research and Therapy, 46, 1201–1209.PubMedGoogle Scholar
  39. Lovibond, P. F., & Lovibond, S. H. (1995). The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behaviour Research and Therapy, 33, 335–342.PubMedCrossRefGoogle Scholar
  40. Lyubomirsky, S., & Nolen-Hoeksema, S. (1993). Self-perpetuating properties of dysphoric rumination. Journal of Personality and Social Psychology, 65, 339–349.PubMedCrossRefGoogle Scholar
  41. Ma, S. H., & Teasdale, J. D. (2004). Mindfulness-based cognitive therapy for depression: Replication and exploration of differential relapse and prevention effects. Journal of Consulting and Clinical Psychology, 72, 31–40.PubMedCrossRefGoogle Scholar
  42. MacKinnon, D. P., & Dwyer, J. H. (1993). Estimating mediating effects in prevention studies. Evaluation Review, 17, 144–158.CrossRefGoogle Scholar
  43. MacKinnon, D. P., Warsi, G., & Dwyer, J. H. (1995). A simulation study of mediation effect measures. Multivariate Behavioral Research, 30, 41–62.PubMedCrossRefGoogle Scholar
  44. Mayer, J. D., & Stevens, A. A. (1994). An emerging understanding of the reflective (meta-) experience of mood. Journal of Research in Personality, 28, 351–373.CrossRefGoogle Scholar
  45. Mennin, D. S., Heimberg, R. G., Turk, C. L., & Fresco, D. M. (2002). Applying an emotion regulation framework to integrative approaches to generalized anxiety disorder. Clinical Psychology: Science and Practice, 9, 85–90.CrossRefGoogle Scholar
  46. Miranda, R., & Nolen-Hoeksema, S. (2007). Brooding and reflection: Rumination predicts suicidality at one-year follow up in a community sample. Behaviour Research and Therapy, 45, 3088–3095.PubMedCrossRefGoogle Scholar
  47. Moulds, M. L., Kandris, E., Starr, S., & Wong, A. (2007). The relationship between rumination, avoidance, and depression in a nonclinical sample. Behaviour Research and Therapy, 45, 251–261.PubMedCrossRefGoogle Scholar
  48. Nezu, A. M., Ronan, G. F., Meadows, E. A., & McClure, K. S. (2003). Practitioner’s guide to empirically based measures of depression. Norwell, MA: Kluwer.Google Scholar
  49. Nolen-Hoeksema, S. (1991). Responses to depression and their effects on the duration of depressive episodes. Journal of Abnormal Psychology, 100, 569–582.PubMedCrossRefGoogle Scholar
  50. Nolen-Hoeksema, S. (2000). The role of rumination in depressive disorders and mixed anxiety/depressive symptoms. Journal of Abnormal Psychology, 109, 504–511.PubMedCrossRefGoogle Scholar
  51. Nolen-Hoeksema, S., & Morrow, J. (1991). A prospective study of depression and posttraumatic stress symptoms after a natural disaster: The 1989 Loma Prieta earthquake. Journal of Personality and Social Psychology, 61, 115–121.PubMedCrossRefGoogle Scholar
  52. Nolen-Hoeksema, S., Wisco, B. E., & Lyubormirsky, S. (2008). Rethinking rumination. Perspectives on Psychological Science, 3, 400–424.CrossRefGoogle Scholar
  53. Papageorgiou, C., & Wells, A. (1999). Process and meta-cognitive dimensions of depressive and anxious thoughts and relationships with emotional intensity. Clinical Psychology and Psychotherapy, 6, 156–162.CrossRefGoogle Scholar
  54. Richards, J. M., & Gross, J. J. (1999). Composure at any cost? The cognitive consequences of emotion suppression. Personality and Social Psychology Bulletin, 25, 1033–1044.CrossRefGoogle Scholar
  55. Richards, J. M., & Gross, J. J. (2000). Emotion regulation and memory: The cognitive costs of keeping one’s cool. Journal of Personality and Social Psychology, 79, 410–424.PubMedCrossRefGoogle Scholar
  56. Richards, J. M., & Gross, J. J. (2006). Personality and emotional memory: How regulating emotion impairs memory for emotional events. Journal of Research in Personality, 40, 631–651.CrossRefGoogle Scholar
  57. Roemer, L., & Orsillo, S. M. (2005). An acceptance-based behavioral therapy for generalized anxiety disorder. In S. M. Orsillo & L. Roemer (Eds.), Acceptance and mindfulness-based approaches to anxiety: Conceptualization and treatment (pp. 213–240). New York: Springer Science and Business Media.CrossRefGoogle Scholar
  58. Roemer, L., Orsillo, S. M., & Salters-Pedneault, K. (2008). Efficacy of an acceptance-based behavior therapy for generalized anxiety disorder: Evaluation in a randomized controlled trial. Journal of Consulting and Clinical Psychology, 76, 1083–1089.PubMedCrossRefGoogle Scholar
  59. Rottenberg, J., Ray, R. R., & Gross, J. J. (2007). Emotion elicitation using films. In J. A. Coan & J. J. B. Allen (Eds.), The handbook of emotion elicitation and assessment (pp. 1–58). New York: Oxford University Press.Google Scholar
  60. Segal, Z. V., Williams, J. M. G., & Teasdale, J. D. (2002). Mindfulness-based cognitive therapy for depression: A new approach to preventing relapse. New York: Guilford Press.Google Scholar
  61. Segerstrom, S. C., Tsao, J. C. I., Alden, L. E., & Craske, M. G. (2000). Worry and rumination: Repetitive thought as a concomitant and predictor of negative mood. Cognitive Therapy and Research, 24, 671–688.CrossRefGoogle Scholar
  62. Sheppard, L. C., & Teasdale, J. D. (2004). How does dysfunctional thinking decrease during recovery from major depression. Journal of Abnormal Psychology, 113, 64–71.PubMedCrossRefGoogle Scholar
  63. Stöber, J., & Borkovec, T. D. (2002). Reduced concreteness of worry in generalized anxiety disorder: Findings from a therapy study. Cognitive Therapy and Research, 26, 89–96.CrossRefGoogle Scholar
  64. Stroebe, M., Boelen, P. A., van den Hout, M., Stroebe, M., Wolfgang, S., Salemink, E., et al. (2007). Ruminating coping as avoidance: A reinterpretation of its function in adjustment to bereavement. European Archives of Psychiatry and Clinical Neuroscience, 257, 462–472.PubMedCrossRefGoogle Scholar
  65. Teasdale, J. D. (1983). Negative thinking in depression: Cause, effect, or reciprocal relationship? Advances in Behaviour Research and Therapy, 5, 3–25.CrossRefGoogle Scholar
  66. Treynor, W., Gonzalez, R., & Nolen-Hoeksema, S. (2003). Rumination reconsidered: A psychometric analysis. Cognitive Therapy and Research, 27, 247–259.CrossRefGoogle Scholar
  67. Watkins, E., & Moulds, M. L. (2005). Positive beliefs about rumination in major depression—A replication and extension. Personality and Individual Differences, 39, 73–82.CrossRefGoogle Scholar
  68. Watkins, E., & Moulds, M. L. (2007). Reduced concreteness of rumination in depression: A pilot study. Personality and Individual Differences, 43, 1386–1395.CrossRefGoogle Scholar
  69. Watkins, E., Moulds, M., & Mackintosh, B. (2005). Comparisons between rumination and worry in a non-clinical population. Behaviour Research and Therapy, 43, 1577–1585.PubMedCrossRefGoogle Scholar
  70. Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54, 1063–1070.PubMedCrossRefGoogle Scholar
  71. Wegner, D. M., & Zanakos, S. (1994). Chronic thought suppression. Journal of Personality, 62, 615–640.CrossRefGoogle Scholar
  72. Wells, A., & Papageorgiou, C. (1998). Relationships between worry, obsessive-compulsive symptoms and meta-cognitive beliefs. Behaviour Research and Therapy, 36, 899–913.CrossRefGoogle Scholar
  73. Wenzlaff, R. M., & Luxton, D. D. (2003). The role of thought suppression in depressive rumination. Cognitive Therapy and Research, 27, 293–308.CrossRefGoogle Scholar
  74. Zettle, R. D. (2007). ACT for depression: A clinician’s guide to using acceptance and commitment therapy in treating depression (p. 309). Oakland: New Harbinger Publications, xii.Google Scholar

Copyright information

© US Government 2010

Authors and Affiliations

  • Gabrielle I. Liverant
    • 1
  • Barbara W. Kamholz
    • 2
  • Denise M. Sloan
    • 3
  • Timothy A. Brown
    • 4
  1. 1.VA Boston Healthcare System and Boston University School of MedicineBostonUSA
  2. 2.VA Boston Healthcare System and Boston UniversityBostonUSA
  3. 3.National Center for PTSD at VA Boston Healthcare System and Boston University School of MedicineBostonUSA
  4. 4.Boston UniversityBostonUSA

Personalised recommendations