State and Trait Rumination Effects on Overt Attention to Reminders of Errors in a Challenging General Knowledge Retrieval Task

Rumination burdens the updating of working memory

Working memory is a vital, but capacity-limited, cognitive instrument that requires frequent updating as our goals and environment change. Individuals diagnosed with depression have a reduced capacity compared with the general population, as they have a propensity to fixate on negative information, even when it is not relevant for the task at hand. Here we investigated how characteristics of psychiatric illnesses, such as rumination, affect a person's ability to efficiently update emotional information in mind. We used both neutral and negative pictures of scenes in a working memory updating task that required participants to occasionally replace items held in mind during a brief delay period. Participants were presented with a probe item at the end of each trial and asked to report whether that item was in their current memory set. Responses were slowest and least accurate for images that had been replaced (i.e., "lures"), indicating there was some difficulty in successfully updating working memory in this paradigm. Participants who have both a high propensity to ruminate and a low working memory capacity were significantly more likely to false alarm to these lures. While emotional valence did not impact accuracy for these participants, their false alarms were faster for negative stimuli compared with neutral stimuli, indicating that task-irrelevant emotional information was more difficult to remove from working memory. These results demonstrate how rumination impairs goal-directed behavior by obscuring the boundary between relevant and irrelevant information in working memory.

Psychometric Properties of the Chinese Version of the Brief State Rumination Inventory

State rumination, unlike trait rumination which is described as a persistent and stable response style, is usually triggered by a specific stressful event and causes negative emotions within a short period of time. The measurement methods of trait rumination, such as the ruminative response scale (RRS), are therefore not fully applicable to state rumination. Recently, researchers have developed the brief state rumination inventory (BSRI) to characterize state rumination, addressing the gap in the field of accurate measurement of state rumination. To develop such an effective tool in the Chinese context, we developed a Chinese version of the BSRI and tested its psychometric properties. Two studies were conducted to address the research goal. In Study 1, we recruited 512 subjects, each of whom completed the Chinese version of the BSRI, RRS, emotional regulation questionnaire (ERQ), depression–anxiety–stress scale (DASS), and positive and negative affect scale (PANAS). Results showed that the scores of the BSRI were positively correlated with all other scale scores (ps < 0.001), and the correlation with the RRS was the highest, indicating that the BSRI showed good convergent validity. Additionally, the Cronbach's alpha coefficient for the Chinese version of the BSRI was 0.93. Study 2 aimed to examine the ecological validity of the Chinese version of the BSRI. We recruited another 54 subjects who were randomly divided into two groups, with 27 in the rumination induction group and 27 in the distraction group, and recorded the BSRI scores of the two groups before and after a specific experiment. We found there was a significant increase in BSRI scores after rumination induction (t = 3.91, p < 0.001), while there was no significant difference in the concrete distraction group before and after the experiment (t = 0.70, p = 0.48). In sum, the Chinese version of the BSRI showed good reliability and validity for assessing state rumination in the general Chinese population.

Worry and rumination predict insomnia in patients with coronary heart disease: a cross-sectional study with long-term follow-up

STUDY OBJECTIVES

Insomnia is highly prevalent and associated with anxiety and depression in patients with coronary heart disease patients. The development of effective psychological interventions is needed. Worry and rumination are potential risk factors for the maintenance of insomnia, anxiety, and depression that may be modified by psychological treatment grounded in the Self-Regulatory Executive Function model. However, the relationships between worry, rumination, anxiety and depression, and insomnia are not known. Therefore, we investigated these relationships both cross-sectionally and longitudinally among patients with coronary heart disease.

METHODS

A cross-sectional study consecutively included 1,082 patients in 2014-2015, and 686 were followed up after mean of 4.7 years. Data were gathered from hospital records and self-report questionnaires comprising assessment of worry (Penn State Worry Questionnaire), rumination (Ruminative Responses Scale), anxiety and depression (Hospital Anxiety and Depression Scale), and insomnia (Bergen Insomnia Scale).

RESULTS

Insomnia correlated moderately with all other psychological variables (R 0.18-0.50, all P values < .001). After adjustments for anxiety and depression, odds ratios for insomnia at baseline were 1.27 (95% confidence interval 1.08-1.50) and 1.60 (95% confidence interval 1.31-1.94) per 10 points increase of worry and rumination, respectively. Corresponding odds ratios for insomnia at follow-up were 1.28 (95% confidence interval 1.05-1.55) and 1.38 (95% confidence interval 1.09-1.75). Depression was no longer significantly associated with insomnia after adjustments for worry and rumination, but anxiety remained significant.

CONCLUSIONS

Worry and rumination predicted insomnia both cross-sectionally and prospectively, even after controlling for anxiety and depression, although anxiety remained significant. Future studies may test psychological interventions targeting these factors in patients with coronary heart disease and insomnia.

CITATION

Frøjd LA, Papageorgiou C, Munkhaugen J, et al. Worry and rumination predict insomnia in patients with coronary heart disease: a cross-sectional study with long-term follow-up. J Clin Sleep Med. 2022;18(3):779-787.