Testing the cognitive catalyst model of depression: does rumination amplify the impact of cognitive diatheses in response to stress?

Integration of tai chi and repetitive transcranial magnetic stimulation for sleep disturbances in older adults: A pilot randomized controlled trial

BACKGROUND

The arousal state has been demonstrated to be involved in the fundamental pathophysiological mechanism of sleep disturbances. Tai chi (TC) and repetitive transcranial magnetic stimulation (rTMS) have been documented to alleviate sleep disturbances by interfering with different arousal components. It is reasonable to assume that combining TC and rTMS could induce synergistic and longer-lasting benefits for sleep disturbances.

METHODS

Thirty-eight older community-dwelling people were randomly assigned to one of three groups: TC plus rTMS (n = 12), TC alone (n = 13), and treat-as-usual (TAU) (n = 13). The interventions were conducted three times per week for 4 weeks for the two intervention groups. The primary outcome was the insomnia severity, while the secondary outcomes were the actigraphy-assessed sleep patterns, use of hypnotic medications, mood states, and quality of life. The mediator outcomes included self-reported somatic arousal and cognitive arousal as well as electroencephalogram (EEG)-assessed cortical arousal. The assessments were conducted at baseline (T0), post-intervention (T1), and 3-month follow-up (T2).

RESULTS

Significant improvements in the insomnia severity were observed in the TC plus rTMS group compared with the TAU group at T1 (Cohen's d = 1.62, p = 0.003) and T2 (Cohen's d = 1.97, p < 0.001). In contrast, significant improvements in the TC alone group were found only at T2 (Cohen's d = 1.03, p = 0.010) when compared with the TAU group. Significant interaction effects were noted on the actigraphy-assessed sleep efficiency (p = 0.015) and total sleep time (p = 0.004), depression (p = 0.003) and stress scores (p = 0.002), and mental function in relation to quality of life (p = 0.042). However, none of the mediators elucidated how combining TC and rTMS could improve the insomnia severity.

CONCLUSION

The research findings are expected to guide further clinical practice in the management of sleep disturbances among older adults using various interventions. Future studies are needed to unravel the underlying mechanism and optimize the protocol to maximize the therapeutic benefits.

Ruminative Variability Predicts Increases in Depression and Social Anxiety

Background

Rumination is a well-established contributor to the severity of depression and anxiety. It is unknown, however, whether individual differences in the temporal dynamics of rumination over time predict longitudinal increases in depression or anxiety.

Methods

The current study examined whether the dynamic indices of ruminative inertia and variability assessed over 14 days via ecological momentary assessment predicted change in symptoms of depression, general anxiety, and social anxiety at a 90-day follow-up (n = 115).

Results

Controlling for ruminative variability, baseline levels of the dependent variable, sex, and mean levels of momentary rumination, ruminative inertia did not predict change in symptoms of depression, general anxiety, or social anxiety at the 90-day follow-up. In contrast, greater ruminative variability predicted increases in symptoms of both depression and social anxiety but not general anxiety at follow-up. Individuals endorsing higher baseline levels of depressive symptoms demonstrated greater amounts of inertia and variability in their momentary rumination. Greater ruminative variability but not inertia was also associated with higher baseline levels of general anxiety and social anxiety.

Conclusions

These results suggest that ruminative variability may be a risk factor for increases in symptoms of depression and social anxiety over time and a potentially useful target for clinical intervention.

Perseveration on suicidal thoughts and images in daily life: An examination of the cognitive model of suicide through a dynamic systems lens

According to the cognitive model of suicide, interactions between hopelessness and attentional biases toward suicidal information create a narrowed attentional focus on suicide as a viable solution, particularly in the presence of life stress, leading to increased suicide risk. This study used a dynamic systems approach to examine the short-term temporal patterns between stress, hopelessness, suicide-specific rumination, and suicidal intent. Adults (N = 237; M = 27.12 years; 62% cisgender women; 87% White/European American) with elevated suicidal ideation completed ecological momentary assessments six times a day for 14 days. A multilevel model approach informed by dynamic systems theory was used to simultaneously assess stable and dynamic temporal processes underlying perceived stress, hopelessness, suicide-specific rumination, and suicidal intent. Each variable demonstrated temporal stability. In support of the cognitive model of suicide, we observed (1) a reciprocal relationship between stress and hopelessness such that stress and hopelessness amplified each other (early-stage processes), and (2) reinforcing loops such that hopelessness, suicide-specific rumination, and suicidal intent amplified each other (later-stage processes). A dynamic systems modeling approach underscored the negative impact of a perpetuating cycle of suicide-specific rumination, deepening hopelessness, and escalating suicidal intent on increasing suicide risk, which may be targets for intervention.

The relationship between the perception of major life events and depression: A systematic scoping review and meta-analysis

BACKGROUND

Major life events can lead to depression in adulthood. However, as predicted by several depression theories, not only the mere occurrence of major life events but also the way people perceive them determines the onset of a depression.

METHODS

Based on a systematic literature search, we identified 276 studies (Ntotal = 89,600) that examined the relationship between the perception of major life events and depression. We provide an overview of how this relationship has been examined. Furthermore, we meta-analytically integrated 420 effect sizes (172 studies) on the association between the perception of major life events and depression.

RESULTS

Most studies relied on college student samples, were cross-sectional, and were conducted in the United States. A more negative perception of events was significantly associated with higher levels of depressive symptoms (r = 0.28). This association was robust across several design and sample characteristics. Furthermore, the perception of major life events and depression were also longitudinally associated with each other (event perception predicting later depressive symptoms: r = 0.26; depressive symptoms predicting later event perception: r = 0.17).

LIMITATIONS

Longitudinal research on the relationship between depression and the perception of major life events was relatively rare impairing definite conclusions on whether the perception of life events can predict changes in depressive symptoms over time.

CONCLUSION

The perception of major life events is related to depression. However, further longitudinal research considering a range of different perceived event characteristics and using non-Western heterogeneous samples is needed to better understand their relationship.

Negative feedback-seeking in depression: The moderating roles of rumination and interpersonal life stress

OBJECTIVES

Swann's self-verification theory proposes that negative feedback seeking (NFS)-the solicitation of negative feedback from others that confirms one's self-views-works in a negative cycle to maintain and exacerbate depression in the face of interpersonal stress. We propose a cognitive-interpersonal integration account of NFS such that this maladaptive behavior prospectively predicts depression only among those with a trait tendency to ruminate on the causes and consequences of depressed mood and stress.

METHOD

Participants included 91 young adults who were over-sampled for a lifetime history of a unipolar depressive disorder (age 17-33; 69% women; 67% lifetime depressive disorder). At baseline, participants completed a structured diagnostic interview and self-report measures of NFS, rumination, and depression symptoms. In addition, participants engaged in an interpersonal rejection task (the Yale Interpersonal Stressor) followed by a behavioral measure of NFS. At a 3-month follow-up, depression symptoms were again assessed by self-report and exposure to stressful interpersonal life events in the intervening period were assessed with a rigorous contextual interview and independent rating system.

RESULTS

Controlling for baseline depression severity, greater self-reported, and behaviorally assessed NFS predicted greater follow-up depression severity, but only among those with higher trait tendency to ruminate. For self-reported NFS, this association was further moderated by level of interpersonal, but not noninterpersonal, life events experienced over follow-up.

CONCLUSION

These findings suggest that rumination may represent a modifiable intervention target that could break the vicious interpersonal cycle of depression and, thus, mitigate the depressogenic effects of NFS.

Utilizing Random Effects Machine Learning Algorithms for Identifying Vulnerability to Depression

Background

Reliable prediction of clinical progression over time can improve the outcomes of depression. Little work has been done integrating various risk factors for depression, to determine the combinations of factors with the greatest utility for identifying which individuals are at the greatest risk.

Materials and methods

This study demonstrates that data-driven Machine Learning (ML) methods such as Random Effects/Expectation Maximization (RE-EM) trees and Mixed Effects Random Forest (MERF) can be applied to reliably identify variables that have the greatest utility for classifying subgroups at greatest risk for depression. 185 young adults completed measures of depression risk, including rumination, worry, negative cognitive styles, cognitive and coping flexibilities and negative life events, along with symptoms of depression. We trained RE-EM trees and MERF algorithms and compared them to traditional Linear Mixed Models (LMMs) predicting depressive symptoms prospectively and concurrently with cross-validation.

Results

Our results indicated that the RE-EM tree and MERF methods model complex interactions, identify subgroups of individuals and predict depression severity comparable to LMM. Further, machine learning models determined that brooding, negative life events, negative cognitive styles, and perceived control were the most relevant predictors of future depression levels.

Conclusion

Random effects machine learning models have the potential for high clinical utility and can be leveraged for interventions to reduce vulnerability to depression.

Minority stress, repetitive negative thinking, and internalizing symptoms in sexual minorites: Does cognitive content matter?

BACKGROUND

The Psychological Mediation Framework theorizes that repetitive negative thinking (RNT) mediates the relationship between minority stress and mental health, and this theory has been consistently supported by previous research. Yet, it is unclear whether the process or content of RNT is more important in the development of internalizing symptoms in sexual minorities. Consequently, the goal of the current study was to use structural equation modeling to determine whether there are significant indirect effects of repetitive negative thought content in the relationship between minority stress and internalizing psychopathology.

METHODS

Measures of RNT, internalizing symptoms, and proximal minority stress were completed online by 205 cisgender sexual minority adults. Structural equation modeling was used to examine indirect effects of proximal stress on internalizing symptoms through content-independent RNT, depressive rumination, and sexual orientation-related rumination.

RESULTS

Significant direct effects of proximal minority stress on internalizing symptoms were observed. Indirect effects of proximal stress on internalizing symptoms were observed for content-independent RNT and depressive rumination, but not sexual orientation-related rumination.

CONCLUSIONS

The current study provides evidence that the process and affective valence of RNT contributes more to internalizing symptoms in sexual minorities when compared with sexual orientation-related content. Theoretical and clinical implications are discussed.

Decentering predicts attenuated perseverative thought and internalizing symptoms following stress exposure: A multi-level, multi-wave study

While research identifies a growing list of risk factors for anxiety and depression, it is equally important to identify potential protective factors that may prevent or reduce vulnerability to developing internalizing psychopathology. We hypothesized that forms of perseverative thinking, such as rumination and worry, act as mechanisms linking negative life experiences and prospective symptoms of anxiety and depression. More specifically, we investigated whether decentering, the meta-cognitive capacity to adopt a distanced perspective toward one's thoughts and feelings, serves as a protective factor at various points along this mediational pathway. A sample of 181 undergraduate students were recruited and assessed at five time points over a 12-week period. Multilevel modeling indicated that decentering was associated with an attenuated impact of (1) negative events on prospective depressive symptoms; (2) negative events on prospective brooding, and (3) brooding, pondering and worry on prospective internalizing symptoms. Multilevel moderated mediation analyses provided partial support for the hypothesis that perseverative thinking would mediate the longitudinal associations between negative life events and internalizing symptoms, with decentering attenuating risk at several connections of the indirect pathways. The strongest support was provided for moderated mediation models in which decentering was associated with attenuated relationships between negative events, brooding, and symptoms of depression. This study is the first to elucidate the role of decentering as a protective factor against anxiety and depressive symptoms at different points in the path from stress to perseverative thought to internalizing symptoms. Decentering therefore may be a critical target for clinical intervention to promote resilience against anxiety and depression.

A transdiagnostic model of low self-esteem: pathway analysis in a heterogeneous clinical sample

BACKGROUND

Low self-esteem (LSE) has been associated with several psychiatric disorders, and is presumably influenced by transdiagnostic factors. Our study was based both on investigations of the relationship between depression and LSE (vulnerability, scar, reciprocal models) and on theories of cognitive factors contributing to the development and maintenance of LSE, such as Melanie Fennell's model, the catalyst model and the Self-Regulatory Executive Function model.

AIMS

Based on the theories above, in our cross-sectional study we aimed at understanding more specifically the transdiagnostic factors that can maintain LSE in a heterogeneous clinical sample.

METHOD

Six hundred and eleven out-patients were assessed by SCID-I and self-report questionnaires. The model was tested by structural equation modelling.

RESULTS

Based on the fit indices, the hypothesis model did not fit the data; therefore, a modified transdiagnostic model was emerged. This model made a good fit to the data [χ2 (12, n=611)=76.471, p<.001; RMSEA=.080, CFI=.950, TLI=.913] with a strong explanatory power (adj R2=.636). Severe stressful life events and depressive symptoms lead to LSE indirectly. Self-blame, perfectionism, seeking love and hopelessness have been identified as mediating factors in the relationship between depressive symptoms and LSE. Although there was a significant correlation between state-anxiety and LSE, as well as LSE and rumination, these two factors did not fit into the model.

CONCLUSIONS

The new transdiagnostic model of LSE has great potential in the treatment of various mental conditions and may serve as a guide to developing more focused and more effective therapeutic interventions.

Nocturnal cognitive arousal is associated with objective sleep disturbance and indicators of physiologic hyperarousal in good sleepers and individuals with insomnia disorder

BACKGROUND

Cognitive arousal is central to models of sleep disturbance and insomnia, but findings remain mixed regarding whether cognitive arousal is associated with objective sleep disturbance and physiologic hyperarousal. This study explored associations of objective nocturnal wakefulness and indicators of physiologic hyperarousal with cognitive arousal in healthy sleepers and individuals with insomnia.

METHODS

In sum, 52 adults (51.9% women; 18 with insomnia disorder, 34 healthy sleepers) underwent two overnight polysomnography (PSG) studies (adaptation + baseline nights) and a multiple sleep latency test (MSLT). Baseline depression was assessed and presleep cognitive arousal and somatic arousal were recorded for each night. Multivariate regression was used to evaluate associations of PSG sleep parameters with insomnia, cognitive arousal, and somatic arousal.

RESULTS

Analyses showed that high levels of nocturnal cognitive arousal were associated with prolonged sleep latency, lower sleep efficiency, and shorter total sleep time by PSG on both nights. An association between nocturnal cognitive arousal and wake after sleep onset was observed on night one only. Moreover, greater nocturnal cognitive arousal was associated with greater likelihood of obtaining short sleep and with longer MSLT sleep latencies. Insomnia diagnosis, depression, and somatic arousal were not associated with PSG sleep parameters or MSLT latency.

CONCLUSIONS

Heightened cognitive arousal at night is linked to objective sleep disturbances and indicators of physiologic hyperarousal at night and during the day. For patients with insomnia, cognitive arousal may contribute to the 24-hr physiologic hyperarousal. Cognitive arousal may be a critical therapeutic target for severe or treatment-resistant sleep disturbance.

Are cognitive variables that maintain insomnia also involved in shift work disorder?

OBJECTIVE

Shift Work Disorder (SWD) is explained mainly by a misalignment between the sleep schedule and the circadian rhythm. However, the possible role of cognitive variables in maintaining SWD remains unknown. Therefore, the objective of this study is to evaluate whether cognitive variables known to maintain insomnia in day workers might also be involved in perpetuating SWD.

DESIGN

Cross-sectional.

SETTING

Sleep laboratory.

PARTICIPANTS

Twenty-five shift workers diagnosed with SWD (84% females; mean age = 35.9) and 22 shift workers who are good sleepers (91% females; mean age = 34.1).

MEASUREMENTS

The participants completed a sleep diary for two weeks, answered questionnaires, and underwent the Harvey's semistructured interview and the catastrophizing procedure. Data from the catastrophizing procedure underwent a content analysis.

RESULTS

Compared with good sleepers, shift workers with SWD reported experiencing more thoughts that keep them awake, more presleep cognitive arousal, more dysfunctional beliefs related to worries and helplessness, and more selective attention toward worries and noises. However, the two groups did not differ on the tendency to catastrophize about difficulties falling asleep. Furthermore, 12 catastrophizing themes were identified in the entire sample, the most frequently endorsed being "sleepiness and energy" and "performance at work."

CONCLUSIONS

The results suggest that cognitive variables may play a role in maintaining SWD. Finally, worries that interfere with sleep in shift workers are related to their work context.

Reducing Stress and Preventing Depression (RESPOND): Randomized Controlled Trial of Web-Based Rumination-Focused Cognitive Behavioral Therapy for High-Ruminating University Students

Background

Prevention of depression is a priority to reduce its global disease burden. Targeting specific risk factors, such as rumination, may improve prevention. Rumination-focused Cognitive Behavioral Therapy (RFCBT) was developed to specifically target depressive rumination.

Objective

The primary objective of this study was to test whether guided Web-based RFCBT (i-RFCBT) would prevent the incidence of major depression relative to usual care in UK university students. The secondary objective was to test the feasibility and estimated effect sizes of unguided i-RFCBT.

Methods

To address the primary objective, a phase III randomized controlled trial was designed and powered to compare high risk university students (N=235), selected with elevated worry/rumination, recruited via an open access website in response to circulars within universities and internet advertisements, randomized to receive either guided i-RFCBT (interactive Web-based RFCBT, supported by asynchronous written Web-based support from qualified therapists) or usual care control. To address the secondary objective, participants were also randomized to an adjunct arm of unguided (self-administered) i-RFCBT. The primary outcome was the onset of a major depressive episode over 15 months, assessed with structured diagnostic interviews at 3 (postintervention), 6, and 15 months post randomization, conducted by telephone, blind to the condition. Secondary outcomes of symptoms of depression and anxiety and levels of worry and rumination were self-assessed through questionnaires at baseline and the same follow-up intervals.

Results

Participants were randomized to guided i-RFCBT (n=82), unguided i-RFCBT (n=76), or usual care (n=77). Guided i-RFCBT reduced the risk of depression by 34% relative to usual care (hazard ratio [HR] 0.66, 95% CI 0.35 to 1.25; P=.20). Participants with higher levels of baseline stress benefited most from the intervention (HR 0.43, 95% CI 0.21 to 0.87; P=.02). Significant improvements in rumination, worry, and depressive symptoms were found in the short-to-medium term. Of the 6 modules, guided participants completed a mean of 3.46 modules (SD 2.25), with 46% (38/82) being compliant (completing ≥4 modules). Similar effect sizes and compliance rates were found for unguided i-RFCBT.

Conclusions

Guided i-RFCBT can reduce the onset of depression in high-risk young people reporting high levels of worry/rumination and stress. The feasibility study argues for formally testing unguided i-RFCBT for prevention: if the observed effect sizes are robustly replicated in a phase III trial, it has potential as a scalable prevention intervention.

Trial Registration

ISRCTN Registry ISRCTN12683436; https://www.isrctn.com/ISRCTN12683436 (Archived by WebCite at http://www.webcitation.org/77fqycyBX)

International Registered Report Identifier (IRRID)

RR2-10.1186/s13063-015-1128-9

Treating insomnia improves depression, maladaptive thinking, and hyperarousal in postmenopausal women: comparing cognitive-behavioral therapy for insomnia (CBTI), sleep restriction therapy, and sleep hygiene education

INTRODUCTION

Depression increases during menopause, and subclinical depressive symptoms increase risk for major depression. Insomnia is common among postmenopausal women and increases depression-risk in this already-vulnerable population. Recent evidence supports the efficacy of cognitive-behavioral therapy for insomnia (CBTI) to treat menopausal insomnia, but it remains unclear whether treating insomnia also alleviates co-occurring depressive symptoms and depressogenic features. This trial tested whether CBTI improves depressive symptoms, maladaptive thinking, and somatic hyperarousal in postmenopausal women with insomnia; as well as whether sleep restriction therapy (SRT)-a single component of CBTI-is equally efficacious.

MATERIALS AND METHODS

Single-site, randomized controlled trial. 117 postmenopausal women (56.34 ± 5.41 years) with peri-or-postmenopausal onset of chronic insomnia were randomized to three treatment conditions: sleep hygiene education control (SHE), SRT, and CBTI. Blinded assessments were performed at baseline, posttreatment, and six-month follow-up.

RESULTS

CBTI produced moderate-to-large reductions in depressive symptoms, whereas SRT produced moderate reductions but not until six months posttreatment. Treatment effects on maladaptive thinking were mixed. CBTI and SRT both produced large improvements in dysfunctional beliefs about sleep, but weaker influences on presleep cognitive arousal, rumination, and worry. Presleep somatic arousal greatly improved in the CBTI group and moderately improved in the SRT group. Improvements in depression, maladaptive thinking, and hyperarousal were linked to improved sleep. SHE produced no durable treatment effects.

CONCLUSIONS

CBTI and SRT reduce depressive symptoms, dysfunctional beliefs about sleep, and presleep somatic hyperarousal in postmenopausal women, with CBTI producing superior results. Despite its cognitive emphasis, cognitive arousal did not respond strongly or durably to CBTI. NAME: Behavioral Treatment of Menopausal Insomnia: Sleep and Daytime Outcomes. URL: clinicaltrials.gov.

REGISTRATION

NCT01933295.

Integrating the Hopelessness Model and the Response Style Theory in an Adolescent Sample

Integrations of cognitive models of depression, specifically, the hopelessness model (Abramson et al. Psychological Bulletin, 96, 358-372, 1989) and the response style theory (Nolen-Hoecksema et al. Journal of Abnormal Psychology, 101, 405-422, 1992) have been suggested but no previous study has compared the integrations of these models with each other and the original models. Further, previous studies only tested the associations between composite scores of inferences, from the hopelessness model, and rumination (incl. brooding and reflection), from the response style theory. Thus, a 3-wave study using self-report instruments with 519 adolescents was conducted (mean age_{Wave 1} = 16.09 years; SD = 0.70; 62.7% female; 72.8% European American, 14.7% African-American, 5.4% Latino, 4.4% mixed race/ethnicity, 1.4% Asian/Pacific Islander, 0.8% Native American, and 0.6% identified as "other"). The school serves predominantly working to middle class families and almost one third of the students were eligible for free or reduced lunch programs. AMOS and RMediation were used to calculate and compare five different theory-driven models. The findings of the study provide support for an integrated model in which both brooding and reflection are influenced by individual inferences and interact with individual inferences while affecting depressive symptoms. In addition, reflection plays an unexpectedly important role in this integrated model. Age and cognitive development are discussed as possible explanations for this finding.

Testing the cognitive catalyst model of rumination with explicit and implicit cognitive content

BACKGROUND AND OBJECTIVES

The cognitive catalyst model posits that rumination and negative cognitive content, such as negative schema, interact to predict depressive affect. Past research has found support for this model using explicit measures of negative cognitive content such as self-report measures of trait self-esteem and dysfunctional attitudes. The present study tested whether these findings would extend to implicit measures of negative cognitive content such as implicit self-esteem, and whether effects would depend on initial mood state and history of depression.

METHOD

Sixty-one undergraduate students selected on the basis of depression history (27 previously depressed; 34 never depressed) completed explicit and implicit measures of negative cognitive content prior to random assignment to a rumination induction followed by a distraction induction or vice versa. Dysphoric affect was measured both before and after these inductions.

RESULTS

Analyses revealed that explicit measures, but not implicit measures, interacted with rumination to predict change in dysphoric affect, and these interactions were further moderated by baseline levels of dysphoria.

LIMITATIONS

Limitations include the small nonclinical sample and use of a self-report measure of depression history.

CONCLUSIONS

These findings suggest that rumination amplifies the association between explicit negative cognitive content and depressive affect primarily among people who are already experiencing sad mood.

Understanding the relationship between suicidality, current depressed mood, personality, and cognitive factors

OBJECTIVES

Links between suicidality and depressed mood are well established. There is, however, little information about the emotional regulation processes that underlie the relationship between suicidality and current low mood, and how these processes differ between groups of never-suicidal (NS), suicidal ideators, and suicide attempters. As suicidality and depression are heterogeneous constructs, this study aimed to conduct within- and between-group comparisons of known suicide risk factors that are associated with emotion regulation (neuroticism, trait aggression, brooding, impulsivity, and overgeneral autobiographical memories).

DESIGN

Correlational design using between- and within-group comparisons from self-report measures.

METHODS

Inter- and intragroup differences were identified using Pearson's correlation coefficients and tests of difference. An analysis of indirect effects was used to investigate whether the relationship between suicidality and current low mood was mediated by neuroticism, trait aggression, brooding, impulsivity, and overgeneral autobiographical memories, and if this relationship varied according to group type.

RESULTS

Brooding appeared to be a consistent feature of all three groups and was closely related to current low mood. Compared to the NS group, the relationship between suicide attempts and current low mood showed greater associations with brooding, trait aggression, and overgeneral autobiographical memories. Compared to the NS group, the suicidal ideation group showed stronger associations with neuroticism and impulsivity, but these factors did not correlate with low mood.

CONCLUSION

These results suggest a need for larger studies to focus on heterogeneity within suicidal populations and consider how different combinations of risk factors may heighten or reduce suicide risk.

PRACTITIONER POINTS

It is well known that the severity and intensity of suicide and depressed presentations vary because of underlying dispositional and contextual factors (Fried & Nesse, ) which, in turn, affect how events are interpreted and responded to. Despite this, there is little research about how these mechanisms operate in different types of suicide groups, and their influence on the relationship between suicidality and current low mood. Understanding interrelationships that affect current low mood is of clinical significance because past suicidal history and deteriorations in already negative mood are linked to repeated suicide attempts and completion. Our findings show that ruminative brooding, defined as a tendency to repeatedly think about emotional aspects of an event, consistently correlates with current low mood across different types of suicidal groups (NS, suicidal ideators, and suicide attempters), and across analyses. Findings also show that suicidal ideation and attempt groups were associated with specific personality characteristics that increased the propensity of emotional responding and interpretation compared to the NS group. The relationship between suicide attempt and current low mood had a higher propensity to be influenced by trait aggression, brooding, and overgenerality compared to the NS group. In contrast, although the suicidal ideation group correlated more strongly with neuroticism and impulsivity, these factors did not influence current low mood. In terms of clinical practice, these findings imply that specific styles of interpretation and thinking may maintain the relationship between suicidality and current low mood. Given the cross-sectional nature of the study, however, it is not possible to imply causality. Nevertheless, the findings obtained provide some support for transdiagnostic models of cognitive-behavioural processes that could be developed further.

The Role of Rumination and Stressful Life Events in the Relationship between the Qi Stagnation Constitution and Depression in Women: A Moderated Mediation Model

The qi stagnation constitution is associated with depression in traditional Chinese medicine. It is unclear how rumination and stressful life events affect the relationship between the qi stagnation constitution and depression. The Qi Stagnation Constitution Scale, Ruminative Response Scale, Center for Epidemiologic Studies Depression Scale, and Adolescent Self-Rating Life Events Checklist were used to assess this association in 1200 female college students. The results revealed that the qi stagnation constitution was positively associated with depression. Furthermore, rumination was a partial mediator of the relationship between the qi stagnation constitution and depression. In addition, stressful life events moderated the direct effect and mediating effect of the qi stagnation constitution on depression. These findings indicate that rumination and stressful life events may affect the relationship between the qi stagnation constitution and depression in women.

Psychometric properties of the 10-item ruminative response scale in Chinese university students

BACKGROUND

Rumination increases vulnerability to depression, exacerbates and perpetuates negative moods. This study was aimed to examine the psychometric properties of the Chinese version of the 10-item Ruminative Response Scale (RRS-10) in a large undergraduate sample.

METHODS

A sample of 5,236 university students finished the RRS and the Center for Epidemiological Studies Depression Scale (CES-D). Confirmatory Factor Analysis (CFA) was performed to examine the two-factor structure and the measurement equivalence of the RRS-10 across gender. The internal consistency, test-retest reliability, correlations among RRS, RRS-10 and CES-D were also explored. In addition, gender difference on rumination and the relationship between rumination and depression were further investigated.

RESULTS

The two-factor model of RRS-10 fit the data reasonably and had acceptable internal consistency and test-retest reliability in Chinese undergraduates sample. And the measurement equivalence of the RRS-10 was acceptable across gender in Chinese university students. Findings in respect of latent means and manifest means revealed non-significant gender difference in RRS-10. Besides, participants with high-level rumination had more depressive symptoms than those with low-level rumination.

CONCLUSIONS

The Chinese version of the RRS-10 showed good psychometric properties and was measurement invariant across gender in undergraduates.

Rumination predicts heightened responding to stressful life events in major depressive disorder and generalized anxiety disorder

Although studies have documented heightened stress sensitivity in major depressive disorder (MDD) and generalized anxiety disorder (GAD), the mechanisms involved are poorly understood. One possible mechanism is the tendency to ruminate in response to stress. We used ecological momentary assessment to study ruminative thoughts after stressful events in 145 adults with MDD, GAD, comorbid MDD-GAD, or no psychopathology. Diagnosed individuals reported more event-related rumination than controls, even after adjusting for event stressfulness. Rumination was equally common in MDD and GAD and was especially severe among comorbid cases. More rumination immediately after the event predicted poorer affect, more maladaptive behavior, and more MDD and GAD symptoms at the next signal, even when pre-event levels of these variables were controlled. Rumination mediated, but did not moderate, the association of stress with affect and with symptoms. Stress-related rumination was more deleterious for diagnosed than healthy individuals, more intense for more severe clinical cases, and more persistent for cases with a greater temperamental vulnerability for emotional disorders. These results implicate rumination as a mechanism of stress sensitivity and suggest pathways through which it may maintain depression and anxiety in everyday life.

Negative cognitive styles synergistically predict suicidal ideation in bipolar spectrum disorders: a 3-year prospective study

Rates of suicidal ideation and behavior are extremely high in bipolar spectrum disorders (BSDs). However, relatively little work has evaluated potentially synergistic relationships between cognitive and emotion-regulatory processes proposed by theoretical models of suicidality in BSDs. The present study evaluated whether negative cognitive style and subtypes of rumination would exacerbate the impact of self-criticism on suicidal ideation in a prospective study of individuals with BSDs. Seventy-two young adults with BSDs (bipolar II, bipolar NOS, or cyclothymia) completed diagnostic interviews and trait measures of self-criticism, negative cognitive style, and brooding and reflective rumination at a baseline assessment. The occurrence of suicidal ideation was assessed as part of diagnostic interviews completed every 4 months for an average of 3 years of follow-up. Negative cognitive style and reflective rumination strengthened the association between self-criticism and the prospective occurrence of suicidal ideation across follow-up. Individuals with high levels of self-criticism in conjunction with negative cognitive style or reflective rumination were most likely to experience the onset of suicidal ideation. Self-criticism may work synergistically with negative cognitive style and rumination to confer risk for suicidal ideation in bipolar spectrum disorders. These results support theoretical models of suicidality in BSDs and indicate that evaluating and understanding negative cognitive styles may help to identify individuals who are at risk of suicide.

A two-factor model of relapse/recurrence vulnerability in unipolar depression

The substantial health burden associated with major depressive disorder (MDD) is a product of both its high prevalence and the significant risk of relapse, recurrence, and chronicity. Establishing recurrence vulnerability factors (VFs) could improve the long-term management of MDD by identifying the need for further intervention in seemingly recovered patients. We present a model of sensitization in depression vulnerability, with an emphasis on the integration of behavioral and neural systems accounts. Evidence suggests that VFs fall into 2 categories: dysphoric attention and dysphoric elaboration. Dysphoric attention is driven by fixation on negative life events, and is characterized behaviorally by reduced executive control, and neurally by elevated activity in the brain's salience network. Dysphoric elaboration is driven by rumination that promotes overgeneral self- and contextual appraisals, and is characterized behaviorally by dysfunctional attitudes, and neurally by elevated connectivity within normally distinct prefrontal brain networks. Although few prospective VF studies exist from which to catalogue a definitive neurobehavioral account, extant data support the value of the proposed 2-factor model. Measuring the continued presence of these 2 VFs during recovery may more accurately identify remitted patients who would benefit from targeted prophylactic intervention.

A seven day actigraphy-based study of rumination and sleep disturbance among young adults with depressive symptoms

OBJECTIVES

Trait ruminators exhibit significantly higher levels of sleep disturbance than those without this cognitive vulnerability. However, support for the sleep disruptive effects of state rumination, especially in the pre-sleep period, is rare, and hindered by methodological drawbacks such as self-report and single night assays of sleep. Finally, despite the pervasiveness of the ruminative response style among individuals with depression, the association between rumination and sleep disturbance has not been explored in this population. The present study employed a week-long daily sampling approach to examine the effects of naturally occurring pre-sleep rumination on self-reported and actigraphy-based sleep among individuals with high depressive symptomatology.

METHODS

Forty-two university students (19.6±3.2 yo;73.8% female), all of whom reported at least moderate levels of depressive symptoms, completed a short questionnaire after waking each morning for seven days. On this questionnaire, they self-reported sleep indices from the previous night and levels of engagement in pre-sleep rumination. Sleep was also monitored throughout this period via wrist actigraphy. Hierarchical-linear-modeling was used to examine the association between nightly rumination and sleep.

RESULTS

Nightly variations in pre-sleep rumination were predictive of significantly longer actigraphy- and diary-based sleep onset latency (SOL). Notably, a 1 SD increase on the pre-sleep rumination scale was associated with an approximately 7 minute increase in actigraphy-based SOL, even after controlling for baseline sleep disturbance and depressive symptoms.

CONCLUSIONS

These data offer compelling evidence for the impact of pre-sleep rumination on sleep onset, providing insight into one potential mechanism that triggers sleep disturbance among individuals with depressive symptoms.

Rumination and overgeneral autobiographical memory in adolescents: an integration of cognitive vulnerabilities to depression

During adolescence, rates of depression dramatically increase and girls become twice as likely as boys to develop depression. Research suggests that overgeneral autobiographical memory and rumination are vulnerability factors for depressive symptoms in adolescence that may be triggered by stressful life events. The current longitudinal study included 160 early adolescents (Mage = 12.44 years, 60.0 % African American, 40.0 % Caucasian, and 56.2 % female). At baseline, adolescents completed measures of current depressive symptoms, rumination, and specificity of autobiographical memories. Approximately 9 months later, the adolescents completed measures of current depressive symptoms and stressful life events that had occurred between baseline and follow-up. Analyses indicated that girls with more overgeneral autobiographical memories in combination with higher levels of rumination were most vulnerable to experiencing increases in depressive symptoms following stressful life events. Additionally, retrieving more specific autobiographical memories appeared to buffer against the impact of negative life events on depressive symptoms among both boys and girls. Memory specificity may play a protective role in depression risk, suggesting that memory specificity training interventions may prove beneficial for adolescents.

Interference resolution moderates the impact of rumination and reappraisal on affective experiences in daily life

Research has shown that cognitive control processes play a central role in emotion regulation. While most research has examined whether individual differences in such processes are related to the use of these strategies, a crucial next step involves examining whether such differences influence their impact on people's feelings, especially in normal daily life. The present study examined whether impairments in cognitive control (measured using an affective interference resolution task) moderate the impact of using rumination and reappraisal on affective experiences in everyday life (assessed using experience sampling methods). Multilevel analyses revealed that difficulties removing previously relevant negative information from working memory were associated with a larger increase in negative affect following rumination, and smaller increase and decrease in positive and negative affect, respectively, following reappraisal. These findings show that impaired interference resolution for negative information aggravates the deleterious effects of rumination and curbs the benefits of reappraisal in daily life.

Rumination, worry, cognitive avoidance, and behavioral avoidance: examination of temporal effects

Recently, cross-sectional research has demonstrated that depressive rumination is significantly associated with the tendency to engage in cognitive and behavioral avoidance. This evidence suggests that rumination may be the result of attempts to avoid personally threatening thoughts, in a manner suggested by multiple contemporary theories of worry. This investigation examined the temporal relationship among daily levels of cognitive avoidance, behavioral avoidance, rumination, worry, and negative affect. Seventy-eight adolescents completed baseline questionnaires and then electronically completed daily measures of rumination, worry, behavioral avoidance, and cognitive avoidance, as well as sad and anxious affect for 7 days. Lagged-effect multilevel models indicated that increases in daily sadness were predicted by greater daily rumination and cognitive avoidance. Increases in daily anxiety were predicted by greater daily rumination, worry, and both cognitive and behavioral avoidance. Further, both daily rumination and worry were positively predicted by daily cognitive, but not behavioral, avoidance. Mediation analyses suggested that rumination mediated the effect of cognitive avoidance on both sadness and anxiety. Also, worry mediated the effect of cognitive avoidance on anxiety. Implications for models of avoidance, rumination, and worry are discussed.

Emotion regulation characteristics and cognitive vulnerabilities interact to predict depressive symptoms in individuals at risk for bipolar disorder: a prospective behavioural high-risk study

Recent work has identified behavioural approach system (BAS) sensitivity as a risk factor for the first onset and recurrence of mood episodes in bipolar disorder, but little work has evaluated risk factors for depression in individuals at risk for, but without a history of, bipolar disorder. The present study evaluated cognitive styles and the emotion-regulatory characteristics of emotional clarity and ruminative brooding as prospective predictors of depressive symptoms in individuals with high versus moderate BAS sensitivity. Three separate regressions indicated that the associations between dysfunctional attitudes, self-criticism, and neediness with prospective increases in depressive symptoms were moderated by emotional clarity and brooding. Whereas brooding interacted with these cognitive styles to exacerbate their impact on depressive symptoms, emotional clarity buffered against their negative impact. These interactions were specific to high-BAS individuals for dysfunctional attitudes, but were found across the full sample for self-criticism and neediness. These results indicate that emotion-regulatory characteristics and cognitive styles may work in conjunction to confer risk for and resilience against depression, and that some of these relationships may be specific to individuals at risk for bipolar disorder.