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An Empirical Test of a Clinical Metacognitive Model of Rumination and Depression
Abstract
Rumination has attracted increasing theoretical and empirical interest in the past 15 years. Previous research has demonstrated significant relationships between rumination, depression, and metacognition. Two studies were conducted to further investigate these relationships and test the fit of a clinical metacognitive model of rumination and depression in samples of both depressed and nondepressed participants. In these studies, we collected cross-sectional data of rumination, depression, and metacognition. The relationships among variables were examined by testing the fit of structural equation models. In the study on depressed participants, a good model fit was obtained consistent with predictions. There were similarities and differences between the depressed and nondepressed samples in terms of relationships among metacognition, rumination, and depression. In each case, theoretically consistent paths between positive metacognitive beliefs, rumination, negative metacognitive beliefs, and depression were evident. The conceptual and clinical implications of these data are discussed.
... According to the metacognitive model of rumination and depression (MCM), rumina tion is maintained by metacognitions reflecting on this type of perseverative thinking (Papageorgiou & Wells, 2003). Negative thoughts or other triggers initially activate positive metacognitive beliefs about the usefulness of rumination (e.g., "In order to understand my feelings of depression, I need to ruminate about my problems. ...
... Both, clinical (e.g., Papageorgiou & Wells, 2003) and nonclinical studies (e.g., Solem et al., 2016) have shown that metacognitive beliefs about rumination are significant for the onset (Faissner et al., 2018;Papageorgiou & Wells, 2009) and maintenance (e.g., Solem et al., 2016) of depressive states / depression. ...
... In this way, we would have been even closer to the original model and the respective measurement methods (cf. Papageorgiou & Wells, 2003). ...
Background and Objectives
Comorbidity between major depressive disorder (MDD) and alcohol use disorder (AUD) is highly prevalent but reasons for this association are unclear. Rumination may activate metacognitive beliefs that contribute to the development and maintenance of rumination and depression. Negative metacognitions can further lead to other dysfunctional coping strategies (i.e., consumption of alcohol). We examined whether alcohol reduces (state) metacognitions, rumination and other disorder-specific processes in a group of individuals suffering from MDD.
Method
In an experiment with three randomized conditions we investigated whether the consumption of alcohol, placebo or no alcohol (orange juice) affects (meta-)cognitions, depressive symptoms and / or psychophysiological variables while participants ruminate.
Results
Voluntary rumination increased self-reported sadness, tension and rumination, tensed facial muscles and increased heart rate, but did not affect (state) metacognitions and heart rate variability. The consumption of alcohol did not influence rumination, metacognitions, depressive or psychophysiological measures.
Limitations
We recruited a depressed population but excluded pathological alcohol use due to ethical considerations.
Conclusions
We found no evidence that alcohol consumption affects rumination, metacognitions and other disorder-specific processes in MDD. However, rumination had a negative effect on various depression-specific processes, although it did not activate (negative state) metacognitions.
... The stress hypothesis supposes that stressful life events play an important role in the occurrence of perimenopausal depression (Schmidt et al., 2004). Further, studies have found that attitudes toward menopause and other health perceptions, and metacognition status, may also be involved in perimenopausal depression (Papageorgiou & Wells, 2003;Yılmaz et al., 2011). ...
... It is well known that cognition mediates individual emotional or behavioral responses to stimuli, and depression is relevant to a maladaptive cognitive model, for instance, negative automatic thoughts and dysfunctional schema (Beck, 2002). Wells and Matthews (1996) posited the self-regulatory executive function (S-REF) model of emotional disorders, which proposed that patients with depression had a particular cognitive-attentional "syndrome" consisting of heightened self-focus, repetitive negative cognitions, maladaptive coping behavior, and threat monitoring, which contribute to emotional disturbance (Papageorgiou & Wells, 2003;Wells & Matthews, 1996). Moreover, on the basis of the theoretical hypothesis, they developed the MCQ instrument for the assessment of metacognition. ...
... (c) SDS SS and metacognition questionnaire (MCQ) F3 cognitive self-consciousness scoreworry about the uncontrollability of thoughts (high MCQ F4 score) may be related to depressive symptoms. Similar findings were reported byYılmaz et al. (2011) in voluntary participants andPapageorgiou and Wells (2003) in patients with depression. ...
Objective:
This study investigated the factors associated with the high susceptibility of perimenopausal women to depression.
Methods:
A total of 66 perimenopausal women participated in this study. The Zung self-rating depression scale (SDS) was used to evaluate the intensity of depressive symptoms. The modified Kupperman index (KI) was used to assess common perimenopausal symptoms. Psychosocial factors were assessed via the Eysenck Personality Questionnaire, attitudes toward menopause checklist, and metacognition questionnaire (MCQ). Levels of serum estradiol, testosterone, and progesterone were determined.
Results:
There were statistically significant associations between SDS standard score and the KI scale score (β = .361, p = .001), years of education (β = -.309, p = .005), and F3 cognitive self-consciousness score of MCQ (β = -.234, p = .032; adjusted R2 = .264, F = 8.759, p < .001).
Conclusions:
High susceptibility to depression of perimenopausal women may be related to lower educational level, more severe perimenopausal symptoms, and altered metacognition.
... Building on these foundational models and techniques, which have been tested in varying forms for many disorders including GAD (Wells & King, 2006;Wells et al., 2010), posttraumatic stress disorder (Wells & Colbear, 2012;Wells et al., 2008), and obsessive compulsive disorder (Fisher & Wells, 2008;Rees & van Koesveld, 2008), Papageorgiou and Wells (2003; set about devising and testing a clinical metacognitive model specified for depression. The critical feature of the CAS in MDD is rumination, which consists of cycling thoughts that revolve around particular themes. ...
... p > 0.05). Papageorgiou and Wells (2003) employed the same assessments with a younger, non-clinical sample of 200 psychology students in their Study 2. However, the best model fit differed from that in Study 1, with a direct path from rumination to depression and no indirect path through negative beliefs about the uncontrollability or harm of rumination, possibly reflecting less impaired metacognition. Further, cognitive confidence was only non-significantly influenced by PBRS and NBRS2, with no influence from depression level itself, presumably because of the lower overall levels of depression in the sample. ...
... The previous body of work highlights the role of deficits in the poor functioning of patients and causing more regressions (Majer et al., 2004;Monkul et al., 2007). A depressed individual tends to center attention on the dysfunctional thoughts, reasoning about negative experiences, events, or emotions (Papageorgiou & Wells, 2003) breeding perseveration in the form of rumination and worry (Halvorsen et al., 2015). This perseverative thinking style or cognitive inflexibility is mediated by metacognitive beliefs (Jelinek et al., 2017). ...
... An alternative or simultaneous mechanism may stem from the growth of belief 604 in capacity to cope with stressors in life. Other research has shown that beliefs pertaining to 605 the uncontrollability of repetitive thoughts, typically focused on past failures, is associated with 606 low mood (Papageorgiou & Wells, 2003). Related work has shown that depressive rumination 607 can be reduced by having individuals focus on positive competing memories instead of 608 negative ones (e.g., Ekkers et al., 2011). ...
Evidence supports the effectiveness of self-reflective training approaches for the development of resilience. Building this work, the objective of this study was to investigate the impact of the focus of coping self-reflective activities on resilience by applying a self-reflection approach to a sample of 254 Australian ministry workers. This randomized controlled trial included three attention-matched conditions: (1) self-reflective writing focused on successful coping, (2) self-reflective writing focused on unsuccessful coping or (3) written descriptions of stressor events alone. Participants were assessed across four time points: prior to, immediately post, 3-months, and 6-months after the intervention. Results demonstrated that self-reflective writing was more effective in enhancing perceived resilience than descriptive writing. Analyses also showed greater maintenance of beneficial effects in the successful self-reflection condition, compared to the unsuccessful condition. These findings support the use of self-reflection training to strengthen individuals' psychological resilience, particularly when focused on successful coping situations for those who initially experience more ruminative thought.
... From a metacognitive perspective, rumination is conceptualized as a strategy that some people use to cope with distress (Papageorgiou & Wells, 2003). The most prominent metacognitive theory, the Self-regulatory Executive Function framework (S-REF: Wells & Matthews, 1994), proposes that rumination stems from positive metacognitive beliefs about rumination. ...
Theories of rumination have proposed different psychological factors to place one at risk for repetitive negative thinking. An empirical test that captures the most relevant contributors to rumination within one integrative model is lacking. Building on influential self-regulatory and metacognitive frameworks, we modeled how key constructs in this context relate to ruminative thinking. 498 participants completed online questionnaires including indicators of rumination, metacognition, promotion goal orientation, effortful control, and depression. We estimated regularized partial correlation networks to investigate the general structure of the integrative model and followed these analyses up with directed acyclic graphs to identify potential causal pathways towards rumination. Results demonstrated that: (1) both self-regulatory and metacognitive factors were directly linked to rumination, amongst these were (2) positive beliefs, negative beliefs about uncontrollability, self-consciousness, depression, and effortful control, and (3) we identified multiple potentially causal pathways, suggesting three direct contributors to rumination while controlling for the influence of all other variables: diminished effortful control, positive beliefs, and self-consciousness. This study is the first to integrate metacognitive and self-regulatory frameworks of rumination in a data-driven manner. Our findings suggest that there are multiple pathways towards rumination, which should be incorporated in clinical case conceptualization of rumination and related disorders.
... It has been found to maintain and exacerbate depressed mood and depressive and anxiety symptoms. It can also reduce an individual's willingness to engage in activities and sense of mastery over one's life (Papageorgiou & Wells, 2003). Depression and anxiety can cause significant human, social, and financial costs (Seligman et al., 2007), with affected individuals experiencing greater life stress and impaired performance (Ruscio et al., 2016). ...
Research shows the detrimental effects of rumination on individuals’ cognitive performance. However, there is limited research regarding rumination interference on task performance. The aim of this study was to investigate the link between rumination and cognition and explore if its impact is better described by Baddeley’s working memory model or Borkovec’s cognitive avoidance theory of worry. A laboratory experiment was conducted comparing three ruminative valence groups (negative, neutral, and positive). The aim was to explore individuals’ performance on a verbal and visual free-recall task and determine interference effects. Task scores pre- and post-rumination were collected from 69 university student participants and two 3 × 2 ANOVAs were conducted. The results suggest rumination may not interfere with individuals’ verbal and visual task performance, indicating the link between rumination and cognition may not be as significant as previously suggested. Furthermore, the results suggest that Baddeley’s model is a better description of rumination impacts on task performance compared to Borkovec’s theoretical model.
... People often engage in rumination to find explanations for their problems. More than reaching a solution, repeatedly thinking about stressors aggravates the symptoms of anger, anxiety, stress, and depression (Martin & Dahlen, 2005;Papageorgiou & Wells, 2003). In addition to impaired problem-solving skills, rumination also reduces social support (Nolen-Hoeksema et al., 2008) which is a protective buffer against stress. ...
The present study examined the role of cognitive emotion-regulation strategies in acculturative stress and spiritual well-being of international students. Measures of Cognitive Emotion-Regulation, Acculturative Stress, and Spiritual Well-Being (measured in terms of religious wellbeing and existential wellbeing) were administered on a sample of 100 female international students living in Varanasi. The findings showed that maladaptive emotion regulation strategies were associated with greater acculturative stress and lower spiritual well-being while adaptive emotion regulation strategies were associated with lower acculturative stress and higher spiritual well-being. Furthermore, stepwise multiple regression analysis was performed to explore the predictive role of emotion regulation on acculturative stress and spiritual well-being. Acculturative stress was positively predicted by 'rumination' and 'blaming others', and negatively predicted by 'positive refocusing'. The use of 'acceptance' strategy positively predicted religious well-being while 'blaming others' negatively predicted religious well-being. Existential well-being was positively predicted by 'positive reappraisal' and negatively predicted by 'catastrophizing' and 'putting into perspective'. Consistent with previous studies in this area, the present findings suggest that emotion regulation may have definite role in intercultural adjustment of international students. Results are discussed in light of existing research and their implications are outlined.
... In such cases, repetitive questioning seems to gradually turn into worries and negative feelings (Aldao et al., 2010;Miranda & Nolen-Hoeksema, 2007). As people try to understand themselves, they get caught up in their own thoughts and start ruminating (Papageorgiou & Wells, 2003). Following this reasoning, self-reflection evolves into self-rumination in the event that there is no temporal closure of self-focused attention. ...
Studies on self-focused emotion-regulation strategies such as self-rumination and self-reflection report both positive and negative effects. It however remains unclear how self-reflection and self-rumination are interdependent, and when they affect well-being. In this study, the mediation effect of self-rumination on the relationships between self-efficacy, self-reflection, and life satisfaction was investigated together with social support as a moderator in this regard. A representative sample of Dutch employees (N = 489) completed a questionnaire package. We used hierarchical multiple regression analysis to test for moderated mediation. Our findings indicate that self-rumination acts as a mediator between self-reflection and life satisfaction. When social support was taken into account as a moderator, the indirect effects of self-efficacy and self-reflection were stronger and significant in the high social support condition. More knowledge about the factors that induce, influence, and perpetuate self-rumination could lead to timely intervention and effective assistance to enhance psychological well-being.
... Several past studies have investigated the contribution of different sets of metacognitive beliefs in trait worry and obsessive-compulsive symptoms (Wells & Papageorgiou, 1998), hypochondriasis (Bouman & Meijer, 1999), predisposition to auditory hallucinations (Morrison et al., 2000), depression (Papageorgiou & Wells, 2003), post-traumatic stress disorder (Roussis & Wells, 2006), state anxiety (Spada et al., 2008), alcohol use and problem drinking (Spada et al., 2009), trait-anxiety , gambling disorder (Rogier et al., 2021), and common symptoms of psychopathology (Nordahl, Ødegaard et al., 2019). Overall, results have supported positive relations between metacognitive beliefs and psychopathology while articulating that metacognitive therapy (MCT; Wells, 2009) could show favourable treatment outcomes by effectively producing metacognitive change. ...
In the metacognitive model of psychological disorders, metacognitive strategies and corresponding underlying metacognitive beliefs intensify and maintain emotional distress symptoms. In the current study, our three objectives were to evaluate and replicate the network structure of dysfunctional metacognitions as assessed with the MCQ-30, to examine its stability when adding relevant covariates in the form of metacognitive strategies (worry and rumination) and symptoms (anxiety and depression), and to evaluate how different sets of dysfunctional metacognitions are more or less strongly linked differently to metacognitive strategies and symptoms. A cross-sectional university sample with a mean age of 26 years (N = 440; Males = 156, Females = 283) completed the Metacognitions Questionnaire-30, Penn State Worry Questionnaire, Ruminative Response Scale, and Hopkins Symptom Checklist. Data were analysed using psychological network analysis in R-studio statistical software. The network structure of dysfunctional meta-cognitions replicated well with item clusters that correspond to clinically meaningful substructures in the metacognitive model. Negative metacognitive beliefs and beliefs about uncontrollability might have more functional significance in the mutual connections between dysfunctional meta-domains as well as the connections with metacognitive strategies and symptoms. For worry and anxiety, negative beliefs about uncontrollability and corresponding danger of worry were more prominently connected in the network structure. For rumination, cognitive self-consciousness was more prominent, whereas for depression, need for control was more prominently connected. Support was found for mutual interdependence between different sets of dysfunctional metacognitive beliefs, that metacognitive beliefs are linked to but separate from metacognitive strategies, and that these may function together in affecting emotional distress symptoms
... [89]Additionally, both positive and negative beliefs showed moderate associations with rumination, but positive beliefs showed low associations with depression whereas negative beliefs showed moderate associations with depression [7]. Compared to non-depressed students, the effect of negative beliefs on depression in clinically depressed individuals increased [86]. According to these results, the association between depression and negative beliefs might be stronger than depression and positive beliefs, which indicate that negative beliefs about rumination might potentially cause individuals' depressive symptoms to deteriorate. ...
Background
Rumination, a transdiagnostic factor in different psychopathological conditions, is believed to be activated and sustained by dysfunctional metacognition. The Positive Beliefs about Rumination Scale (PBRS) and the Negative Beliefs about Rumination Scale (NBRS) have been used to measure the metacognitive beliefs of rumination and have been investigated in many cultural contexts. However, it remains unclear whether these scales can work as well for the Chinese population. Therefore, this study aimed to explore the psychometric properties of the Chinese versions of these scales and to test the metacognitive model of rumination for students with different levels of depression.
Methods
The PBRS and NBRS were forward-backward translated into Mandarin. In total 1,025 college students were recruited to complete a battery of web-based questionnaires. Exploratory factor analysis, confirmatory factor analysis, and correlation analysis were used to test the structure, validity, and reliability of the two scales, as well as their item correlations with rumination.
Results
A new two-factor structure of the PBRS (rather than the original one-factor model) and a new three-factor structure of the NBRS (rather than the original two-factor model) were extracted. The goodness-of-fit indices of these two factor models showed they had a good to very good fit with the data. The internal consistency and construct validity of PBRS and NBRS were also affirmed.
Conclusion
The Chinese versions of the PBRS and the NBRS were generally shown to be reliable and valid, but their newly extracted structures fit the Chinese college students better than their original structures. These new models of PBRS and NBRS are of value to be further explored in Chinese population.
... Information overload creates a stressful situation because of the inability to access, understand, or utilize the necessary information (Bawden & Robinson, 2009;Misra & Stokols, 2012;Wurman et al., 2001). When individuals are in a stressful situation and receive a great deal of negative information about the event without taking positive action, they develop ruminative thinking, which in turn triggers negative emotions (Papageorgiou & Wells, 2003). ...
The COVID-19 pandemic has led to a generally high level of state anxiety resulting from the high contagiousness of the disease and strict prevention and control policies. The present study mainly focused on the relationship between the individual intolerance of uncertainty and state anxiety in the regular epidemic prevention and control phase in China, and aimed to investigate the mediating role of information overload and rumination, as well as the moderating role of self-compassion. A total of 992 Chinese residents from 31 provinces participated in this study, and completed questionnaires regarding intolerance of uncertainty, information overload, self-compassion, rumination, and state anxiety. Descriptive statistics and correlation analyses, as well as tests for mediating effects and moderated chain mediating effects, were performed on the data using SPSS 26.0 and Process 3.5 macro program. The findings indicated that intolerance of uncertainty significantly predicted individual state anxiety. Information overload mediates the effects of intolerance of uncertainty and state anxiety. Rumination also mediates the effect of uncertainty intolerance on state anxiety. Information overload and rumination have a chain mediation effect on the link between intolerance of uncertainty and state anxiety. Self-compassion mediates the effect of information overload on rumination. The results illuminate theoretical and practical implications in the regular epidemic prevention and control phases and reveal the protective role of self-compassion.
... The results have shown that although in the tested single models the well-being of young people (DG and WPDG) is influenced by negative metacognitive beliefs or beliefs about superstitions, punishment and responsibility, the main dysfunctional metacognitive beliefs related to the well-being of depressed adolescents are positive beliefs about worrying. According to Papageorgiou & Wells [30], these beliefs are about ruminations. In the opinion of these researchers, it is a strategy characteristic of patients who want to cope with stress and symptoms of depression. ...
Background:
The aim of the cross-sectional study was to conduct an exploratory analysis of identifying factors related to mood, metacognitive beliefs, and limitation on individual freedom associated with lockdown restrictions during COVID-19, and to determine whether they may be relevant to the deteriorating well-being of adolescents.
Methods:
A total of 387 adolescents (M = 15.37; SD = 1.62): 85 with depression (DG) and 302 without any psychiatric diagnosis group (WPDG) were examined using the health survey and the CDI-2 questionnaire to assess the symptoms and severity of depression and MCQ-A to measure the intensity of dysfunctional metacognitive beliefs.
Results:
The feeling of restriction of freedom had an influence on worsened well-being in the whole group of responders OR = 4.15; p < 0.001 but was more in the DG than the WPDG (OR = 20.00; p < 0.001 vs. OR = 4.77; p < 0.001). Positive metacognitive beliefs were related to well-being (DG), but no effect was observed in the WPDG (OR = 0.88; p < 0.05 vs. OR = 1.05; p = 0.136). The lower age of the WPDG negatively impacted well-being (OR = 1.20; p < 0.05).
Conclusions:
Dysfunctional metacognitive beliefs and the feeling of restriction of freedom are important in the deterioration of adolescents' well-being, but these factors have a stronger impact on well-being in the DG.
... Various studies support the generic metacognitive model as well as disorder-specific elaborations (Nordahl et al., 2019;Roelofs et al., 2007); yet, a conceptualization of suicidal ideation and behavior on the basis of the metacognitive model is still pending. Building on the metacognitive model of depression (Papageorgiou and Wells, 2003), the processes outlined in Fig. 1 might be assumed. ...
Background:
Rumination about suicide has recently been identified as a risk factor for suicidal behavior. According to the metacognitive model of emotional disorders, the activation and maintenance of rumination is dependent on specific metacognitive beliefs. On this background, the current study is concerned with the development of a questionnaire to assess suicide-specific positive and negative metacognitive beliefs.
Methods:
Factor structure, reliability and validity of the Scales for Suicide-related Metacognitions (SSM) were investigated in two samples comprised of participants suffering from lifetime suicide ideation. Participants of sample 1 (N = 214; 81.8% female; Mage = 24.9, SDage = 4.0) took part in a single assessment using an online survey. Participants of sample 2 (N = 56; 71.4% female; Mage = 33.2, SDage = 12.2) took part in two online assessments within a two week time-period. To establish convergent validity questionnaire-based assessments of suicidal ideation, general and suicide specific rumination and depression were used. Furthermore, it was analyzed whether suicide-related metacognitions predict suicide-specific rumination cross-sectionally and prospectively.
Results:
Factor analyses revealed a two-factor structure of the SSM. Results indicated good psychometric properties, and provided evidence for construct validity and stability of the subscales. Positive metacognitions predicted concurrent and prospective suicide-specific rumination beyond the effect of suicide ideation and depression and rumination predicted concurrent and prospective negative metacognitions.
Conclusion:
Taken together the results provide initial evidence that the SSM is a valid and reliable measure of suicide-related metacognitions. Furthermore, findings are in line with a metacognitive conceptualization of suicidal crises and provide first indications of factors that might be relevant for the activation and maintenance of suicide-specific rumination.
... Using Cronbach's alpha, this scale ranges from 0.88 to 0.92, which indicates its high internal consistency (Lumit, 2004). The intraclass correlation for five times of measurement is 0.75 and the retest correlation is 0.67 for a period of more than 12 months (Pappageorgior and Wells, 2003). Cronbach's alpha in Iranian samples is 0.90 and the retest reliability coefficient is 0.82 with a time interval of three weeks (Latfinia, 2007). ...
This research was conducted to compare the effectiveness of the treatment of the ability to enjoy based on the healthy human theory and cognitive behavioral therapy on rumination and metacognitive beliefs of women involved in an emotional divorce in Isfahan city. The current study was quasi-experimental with a pre-test-post-test design and a 1-month follow-up with a control group. The statistical population of the present study was all women involved in emotional divorce who referred and were referred to counseling centers in Isfahan city. Among these people, 54 were replaced in three groups of 18 people (two test groups and one control group) using the available sampling method. The treatment course was the ability to enjoy based on the healthy human theory and cognitive behavioral therapy in 8 treatment sessions (2 hours and two times a week). However, the control group did not receive any intervention. The research tools were the emotional divorce questionnaire (Gottman, 1994), the rumination questionnaire (Nolen-Hoeksma & Morrow, 1991), and the metacognitive beliefs questionnaire (Wells, 1997). For data analysis, analysis of variance with repeated measurements was performed using SPSS 24 software. The results showed that the treatment of the ability to enjoy based on the healthy human theory effectively reduced rumination and metacognitive beliefs in women involved in an emotional divorce in the post-test and follow-up phase. Its effect remained stable over time (p
... Individuals who show ruminative reactions as a result of these negative emotions may not be solution-oriented in the face of problems. 10 Because these individuals may have weak interpersonal relationships, they can only look at problems from a single perspective, not from a solutionoriented and different perspective. 11 When this situation is evaluated in terms of sports, sports is a phenomenon that allows people to discharge their negative emotions and can be effective in controlling these emotions. ...
Aim: The aim of this research is to investigate the correlation between the metacognition levels of the students of the faculty of sports sciences and their ruminative thought styles. Method: The research is carried out using the correlational survey model. The universe of the research consists of sports science students studying at Hatay Mustafa Kemal University, Faculty of Sports Sciences, Department of Coaching, Physical Education and Sports Teaching, Recreation and Sports Management. The sample of the study, on the other hand, is a total of 287 sports science students, 131 female and 156 male, selected by convenience sampling. Pearson correlation and regression techniques are used in the analysis of the data. Results: As a result of the research, it is determined that there is a moderately significant positive correlation between metacognitive awareness scores and ruminative thought style scores. In addition, it is determined that metacognitive awareness is a significant predictor of ruminative thought. Conclusion: Based on the results of the research, excessive control of cognitions may cause repetitive thoughts. Keywords: Sports sciences faculty, student, metacognition, ruminative thought
... It is equally noteworthy that adolescents' creativity did not moderate the link between intrusive rumination and depression. As proven by the results, the association between intrusive rumination and depression is robust, supported by numerous cross-sectional and longitudinal studies (17,96,97). Some studies have shown that intrusive rumination is one of the main symptoms of depression (98). ...
Background
Until now, the COVID-19 pandemic is still affecting the study and life of Chinese adolescents. Adolescents in high school were likely to experience intrusive rumination to cope with undesirable changes, which could increase the risk of depression. However, few studies have examined the effects of a sense of security and creativity underlying this relationship. This study aims to explore the relationship between intrusive rumination and depression and further examines the mediating role of the sense of security and the moderating role of the creativity in adolescents. This study could provide detailed guidance for government and media to avoid adolescents’ excessive post event reflection on public health incidents.
Methods
This study investigated 1,269 high school students (748 girls and 521 boys) using the questionnaire method, including revised Event-Related Rumination Inventory (ERRI), Security Questionnaire (SQ), Runco Ideational Behavior Scale (RIBS), and Patient Health Questionnaire (PHQ-9).
Results
The results showed that intrusive rumination was positively associated with adolescents' depression, and a sense of security could mediate this relationship. Moreover, a possible cut-off of creativity that serves as a breakpoint below and above that can pinpoint where the association between sense of security and depression in adolescents. In particular, compared to less creative adolescents, highly creative adolescents showed higher indirect effects of intrusive rumination on depression. The association between a sense of security and depression is also more robust for highly creative adolescents.
Conclusions
These results demonstrate that a sense of security may be a protective factor for depression during the COVID-19 pandemic. There are also differences in adolescents' responses to adverse events with different levels of creativity.
... Among the possible reactions to a traumatic event, are repeatedly focusing on that experience, the emotions that it aroused, and analyzing its causes and consequences (Nolen-Hoeksema et al., 2008). The ruminative thought style emerges as an attempt to understand and resolve the situation, even though it has been demonstrated that rumination is negatively related to problem solving (Papageorgiou & Wells, 2003). Furthermore, it can interfere with an individual's ability to solve problems by favoring indecision and paralyzing decision-making (Ward, Lyubomirsky, Sousa & Nolen-Hoeksema, 2003). ...
Dissociation is a complex phenomenon which is present in a wide variety of psychiatric disorders and also in the general population. The objective of this study was to examine the relationship between childhood and adolescent traumas and development of dissociative phenomena in a nonclinical population, emphasizing the potentially mediating role of rumination, intrusive thoughts and negative affect in a population with no psychiatric pathology in adulthood. The sample was comprised of 337 participants from the general population (58.8% women) with a mean age of 33.10 years (SD: 14.08). They completed the Juvenile Victimization Questionnaire (JVQ), the Ruminative Response Scale (RRS), the White Bear Suppression Scale (WBSI), the Dissociative Experience Scale, 2d ver. Rev. (DES-II) and the Depression, Anxiety and Stress Scale (DASS-21). The results supported the starting hypotheses showing a positive correlation between childhood and adolescent trauma and dissociation, and between childhood and adolescent trauma and rumination, intrusive thoughts and negative affect, and mediation of these variables between childhood and adolescent trauma and dissociative states. The relationship between trauma in early ages and dissociation in adulthood is complex. Although the design used in this study was cross-sectional, the results are compatible with the starting hypothesis that rumination, intrusive thoughts and negative affect mediate this relationship.
... Meta-cognitive beliefs can be divided in: (1) positive meta-cognitive beliefs about control strategies that impact on inner events and (2) negative meta-cognitive beliefs concerning the significance, controllability, and danger of inner events (Wells, 2000). Coherently with the S-REF model, meta-cognition has been investigated as a feature of generalized anxiety disorder, post-traumatic stress disorder, obsessive-compulsive and panic disorder, and depression on adult populations (Cucchi et al., 2012;Holeva et al., 2001;Papageorgiou and Wells, 2003). Previous research suggests that children as young as 7 years of age endorse both positive and negative beliefs about worry, and that these beliefs are positively associated with emotional symptoms (Ellis and Hudson, 2011). ...
Several types of stress factors are likely to be implied in the development, maintenance, and transmission of rumination: genetic/temperamental factors, cognitive factors, family factors, and societal/cultural factors. The current chapter focuses on the etiological factors involved in the development of a ruminative thinking style in childhood. In the first part of the chapter, the most important studies on the topic are reviewed in detail, illustrating differences in genetic and neurobiological correlates, as well as environmental risk factors. A discussion on the role of rumination in the development and/or maintenance of psychopathological symptomatology is also proposed, especially focusing on internalizing and externalizing manifestations.
The last part of the chapter reviews studies investigating the metacognitive factors as possible pathways of the relation between rumination and childhood symptoms, suggesting prevention and intervention techniques for parents, mental-health professionals and policymakers.
... Ruminations would therefore be a key factor in the exacerbation of depressive mood and in the perpetuation of depressive symptoms [13], by acting as a gear that would prevent the constructive resolution of the disorder [14]. As a result, ruminations are significantly associated with depression [15], and a more severe expression of its symptomatology [16]. ...
Context: It is well documented that, in adults, women are more prone to ruminate than men, and rumination and depression are robustly correlated. However, very little is known about how these links evolve as aging. The age-related cognitive and identity evolutions deeply modify the elderly’s overall functioning, legitimizing this issue. Method: Sixty-four participants were recruited by seniors’ networks. The participants had to be over 65 years old, without cognitive impairment or chronic pain. The experiment included the Geriatric Depression Scale (GDS), to assess the presence and severity of depression, and the Mini-CERTS, which evaluates the frequency of both analytic and experiential repetitive thoughts. The Mental Alternation Test (MAT) was used as a preliminary test to help ensure that participants did not have cognitive impairment. Participants were contacted over the phone. A structured interview and a MAT test were used to assess the inclusion criteria. If the participant matched the required profile, the GDS and the mini-CERTS were administered in random order. Results: Results show a negative correlation between frequency of constructive repetitive thoughts and depression (r = -.49; p <.001) and a positive correlation between frequency of rumination and depression (r = .40; p <.001). No significant difference was shown regarding gender and frequency of ruminations (p> .05). Discussion: These results validate the maintenance of the links between repetitive thinking and depression during aging, but not the difference between men and women. These findings encourage the use of rumination-focused therapies in the treatment of depression in the elderly.
... For example, the CAS is associated with general emotional distress as well as mood and anxiety disorders symptoms (Fergus et al., 2012(Fergus et al., , 2013Olatunji et al., 2013;Spinhoven et al., 2015). Evidence suggests that the CAS plays a vital role in the development of disorders such as major depressive disorder (Papageorgiou & Wells, 2001a, 2001bPapageorgiou & Wells, 2003), posttraumatic stress disorder (Papageorgiou & Wells, 2001b;Wells & Sembi, 2004), and obsessive-compulsive disorder (Fisher & Wells, 2005;Myers et al., 2009;Wells & Sembi, 2004). ...
The cognitive attentional syndrome (CAS) is a core concept within metacognitive theory. The premise of the CAS is related to metacognition, however its role in psychopathology is distinct. Due to the complex nature of the CAS, a theoretically ¶ driven and psychometrically sound self-report measure of the CAS for the Arabic population is yet to be developed. To fill this gap, we translated the Multidimensional Cognitive Attentional Syndrome Scale (MCASS) into the Arabic language and tested its structural validity. The MCASS was translated according to the standard guidelines of forward-translation followed by backward-translation of two independent translators. The Arabic version of the MCASS was pilot tested on a sample of 30 participants. In Study 1, the MCASS was administered to a larger sample (N = 1027), selected from 22 Arabic-speaking countries in the Arab League countries, and exploratory factor analysis (EFA) was used to examine the factor structure of the measure. Those who participated in Study 1 were excluded from participating in Study 2. Confirmatory factor analysis (CFA) was used in Study 2 (N = 567)to assess the latent factor structure of MCASS, which supported a six-factor model. Notably, the substance use subscale was eliminated because of its unsuitability in the cultural context of Arabic-speaking countries. Results support multidimensional assessment of the CAS using the MCASS, and demonstrate suitability for use in Arab speaking samples. Implications of this study and recommendations for use of the Arabic version of MCASS are discussed Q3 ¶. ARTICLE HISTORY
... Also, depressive symptoms can reinforce cognitive distortions associated with picking (63,66). Metacognitive functions are known to be pathological in depression and anxiety disorders (67)(68)(69). It is unclear whether the metacognitive functions in TTM and SPD are caused by the psychopathology of the disease or by the severity of depression and anxiety. ...
Objective: This study aimed to compare the metacognitive functions of patients diagnosed with trichotillomania (TTM) and skin picking disorder (SPD) with those of healthy controls (HCs). Method: The study was conducted with 125 participants, 32 of whom had TTM, 47 had SPD, and 46 were HCs. A Sociodemographic Data Form, the Metacognition Questionnaire-30 (MCQ-30), Clinical Global Impression (CGI), Beck Depression Inventory (BDI), and Beck Anxiety Inventory (BAI) were administered to the participants. Results: It was determined that the subscale scores of "uncontrollability and danger" and "need to control thoughts" were significantly higher in patients with TTM and SPD compared with the HCs. There was a positive correlation between the patients' CGI scores and their MCQ-total scores. A positive and significant relationship was found between BDI and "uncontrollability and danger," "need to control thoughts," "cognitive self-consciousness," and MCQ-total scores. There was a positive correlation between the BAI and other subscales except for "positive beliefs" and MCQ-total scores. Conclusion: Our study reveals dysfunctional metacognitions in TTM and SPD patient groups. The subdimensions of "uncontrollability and danger" and "need to control thoughts" are dysfunctional metacognitions that are prominent in both patient groups.
... Metacognition and theory of mind are widely studied and evaluated in psychiatric conditions (Grotte & Solom, 2015;Papageorgiou & Wells, 2003;Wells & Cartwright-Hatton, 2004). However, there is limited data regarding the relationship between headaches, particularly migraine and metacognition, and maladaptive automatic thoughts in the adult population. ...
This cross-sectional study investigates the relationship between problematic metacognitions, negative cognitive content and emotional distress, and migraine-related disability among adult migraine patients. The migraine group consisted of 74 patients. Forty-seven healthy volunteers with similar sociodemographic characteristics were selected as the comparison group. Sociodemographic form, Migraine Disability Assessment Scale, Depression Anxiety Stress Scale, Automatic Thought Questionnaire, and Metacognition Questionnaire-30 were administered. Our results showed that higher depression, anxiety, stress levels, and negative automatic thoughts are significantly associated with more significant migraine disability. Our data also showed that high levels of depression and increased headache frequency predict migraine-related severe disability. We found that the frequency of headaches over three months and positive beliefs about worry significantly predicted the presence of chronicity in migraine. Our findings may help determine different approaches such as cognitive behavioral therapy and relaxation techniques in treating migraine.
Rumination and worry are cognitive processes characterized by repetitive, negative, and unproductive thoughts that are difficult to terminate. For many years, it was thought that children were incapable of rumination and worry. However, research shows that children can and do ruminate and worry, with most children experiencing nonpathological rumination and worry at times. Rumination and worry have the potential to become maladaptive and lead to psychological disorders such as major depressive disorder and generalized anxiety disorder, as well as a range of other deleterious consequences. Research supports the efficacy of cognitive–behavioral therapy for child worry; however, effective treatment programs for child rumination have yet to be developed and tested. Various theories and models have attempted to conceptualize rumination and worry, with further pediatric research in the area clearly needed.
Background
Using the Self-Regulatory Executive Function model as a basis, this study explored whether, in patients with eating disorders (EDs), metacognitions and repetitive negative thinking are associated with higher levels of emotion dysregulation.
Methods
104 outpatients with eating disorders and 104 controls from the general population were recruited. Emotion dysregulation, metacognitions, rumination, worry, anxiety, and depression were assessed. T-tests, Mann–Whitney tests, correlation and hierarchal regression analyses were run.
Results
Patients with EDs, compared to controls, reported significantly higher levels of emotion dysregulation, positive beliefs worry, negative beliefs about thoughts concerning uncontrollability and danger, beliefs about the need to control thoughts, rumination, and worry. Beliefs about the need to control thoughts and worry significantly predicted emotion dysregulation.
Conclusions
Among patients with EDs emotion dysregulation appears to be associated with the endorsement of beliefs about the need to control thoughts and worry. Beliefs about the need to control thoughts and worry could be a suitable therapeutic target to reduce emotion dysregulation among patients with EDs.
The mechanisms underlying a tendency among individuals with depression to report personal episodic memories with low specificity remain to be understood. We assessed a sample of undergraduate students with dysphoria to determine whether depression relates to a broader dysregulation of balancing accuracy and informativeness during memory reports. Specifically, we investigated metamnemonic processes using a quantity-accuracy profile approach. Recall involved three phases with increasing allowance for more general, or coarse-grained, responses: (a) forced-precise responding, requiring high precision; (b) free-choice report with high and low penalty incentives on accuracy; (c) a lexical description phase. Individuals with and without dysphoria were largely indistinguishable across indices of retrieval, monitoring, and control aspects of metamemory. The results indicate intact metacognitive processing in young individuals with dysphoria and provide no support for the view that impaired metacognitive control underlies either memory deficits or bias in memory reports that accompany dysphoria.
This study aimed to develop the Metacognitive Skills Assessment in a Research Proposal Writing Context (MSARPW), a multidimensional measure, based on student perspectives, for assessing metacognitive skills in thesis writing, and assess the instrument's psychometric properties using item factor analysis (IFA) and multidimensional item response models. The 40-item MSARPW was administered to 602 Indonesian university students (Mage = 25.254 SDage = 6.854). The IFA showed that the two-dimensional factor structure of MSARPW was satisfactory; however, only 24 of the 40 items were found to fit the model. Multidimensional graded response models (MGRM) were applied to the subsequent 24-item MSARPW, which showed that one item (Item 4) did not satisfy the criteria. The estimated reliabilities of each subscale showed that the 23-item MSARPW has good internal consistency (0.891 and 0.902). To conclude, the 23-item MSARPW appears to be a valid and reliable tool for assessing metacognitive skills in the context of research-proposal writing among Indonesian university students.
This research was conducted to compare the effectiveness of the treatment of the ability to enjoy based on the healthy human theory and cognitive behavioral therapy on rumination and metacognitive beliefs of women involved in an emotional divorce in Isfahan city. The current study was quasi-experimental with a pre-test-post-test design and a 1-month follow-up with a control group. The statistical population of the present study was all women involved in emotional divorce who referred and were referred to counseling centers in Isfahan city. Among these people, 54 were replaced in three groups of 18 people (two test groups and one control group) using the available sampling method. The treatment course was the ability to enjoy based on the healthy human theory and cognitive behavioral therapy in 8 treatment sessions (2 hours and two times a week). However, the control group did not receive any intervention. The research tools were the emotional divorce questionnaire (Gottman, 1994), the rumination questionnaire (Nolen-Hoeksma & Morrow, 1991), and the metacognitive beliefs questionnaire (Wells, 1997). For data analysis, analysis of variance with repeated measurements was performed using SPSS 24 software. The results showed that the treatment of the ability to enjoy based on the healthy human theory effectively reduced rumination and metacognitive beliefs in women involved in an emotional divorce in the post-test and follow-up phase. Its effect remained stable over time (p<0.05). Also, cognitive behavioral therapy effectively reduced rumination only in the post-test phase and reduced metacognitive beliefs in the post-test and follow-up phase, and its effect remained stable over time. According to the obtained results, pleasure therapy based on healthy human theory and cognitive behavior is considered one of the effective methods in treating cognitive problems.
Background: Little is known regarding the prevalence of psychiatric disorders in patients with both coronary heart disease (CHD) and type D personality, and whether these patients may benefit from psychotherapy that modifies metacognitive beliefs implicated in disorder maintenance. This study explored prevalence rates among these patients and associations between type D characteristics, rumination and metacognitions.
Methods: Forty-seven consecutive patients with CHD who scored positive for type D personality were included in this pre-planned study. Participants underwent structured clinical interviews for mental and personality disorders and completed questionnaires assessing rumination and metacognitions.
Results: Mean age was 53.8 (SD 8.1) years and 21.3% were female. At least one mood disorder or anxiety disorder was found in 70.2% and 61.7% of the patients. The most common disorders were major depressive disorder (59.6%), social phobia (40.4%), and generalized anxiety disorder (29.8%). At least one personality disorder was detected in 42.6%. Only 21% reported ongoing treatment with psychotropic medication whereas none had psychotherapy. Metacognitions and rumination were significantly associated with negative affectivity (0.53–0.72, p < .001) but not social inhibition.
Conclusion: Mood and anxiety disorders were highly prevalent and relatively untreated among these patients. Future studies should test the metacognitive model for type D personality.
Objectives:
The current research explored the interplay between intuition, meaning in life, and psychopathology. Specifically, we investigated whether experiential and reflective components of meaning in life are associated with depressive symptoms and personality pathology, whether intuition is related to the experience of meaning, and whether psychopathology has disruptive effects on intuition as well as on the link between intuition and the experience of meaning.
Methods:
We tested our preregistered hypotheses in two independent studies. In Study 1, N = 448 participants completed self-report instruments assessing the experiential and the reflective dimensions of meaning in life, depressive symptoms, and impairments in personality functioning. Intuition was operationalized as the ability to intuitively detect semantic coherence in an experimental task. Additionally, self-reported confidence in intuition was assessed. In Study 2, we aimed to replicate our findings and hypotheses that emerged from Study 1 with a new sample of N = 1189 participants.
Results:
In both studies, participants with more depressive symptoms or higher levels of personality pathology experienced life as less meaningful but reflected significantly more about meaning in life. The intuitive ability to discriminate between coherence and incoherence in the experimental task was neither related to the experience of meaning in life nor to psychopathology, but more confidence in intuition was associated with experiencing life as more meaningful and with less psychopathological symptoms. It was tentatively supported that the association between meaning in life and intuition was moderated by psychopathology.
Conclusion:
The findings are discussed in terms of their clinical implications and regarding the cognitive-affective processes potentially underlying people's experience of life being meaningful.
Objective: The aim of this work was to review evidence on the association between psychological rumination and distress in those diagnosed with cancer. Methods: Six databases were searched for studies exploring rumination alongside overall assessments of psychological distress, depression, anxiety, or stress. Results: Sixteen studies were identified. Rumination was associated with distress cross-sectionally and longitudinally. However, once baseline depression was controlled for, the association was no longer seen. The emotional valence of ruminative thoughts and the style in which they were processed, rather than their topic, was associated with distress. Brooding and intrusive rumination were associated with increased distress, deliberate rumination had no association, and reflection/instrumentality had mixed findings. Conclusions: This review highlights that it is not necessarily the topic of content, but the style and valence of rumination that is important when considering its association with distress. The style of rumination should be the target of clinical intervention, including brooding and intrusion.
The main objective of this paper was to define the differences in the effects of traditional strength bodyweight training matched load weight training with kettlebells. Forty young karate athletes aged 10 to 14 were divided in two experimental groups: standard experimental group 1 (EKS 1) – strength training with bodyweight (n=20), and experimental group 2 (EKS 2) (n=20)– strength kettlebell training. All respondents were subjected to anthropometric measurement
and twelve motoric tests (coordination, three repetitive strength, and segmental movement speed tests, three each), to determine the difference of effects on motor abilities. Both groups had frequency of two training sessions a week during six weeks period. Groups were matched by training load parameters, with the weight added training being the only difference in EKS 2.
The results measurement showed that the EKS 1 significantly progressed in four motoric tests: (1 test trivial effect, 2 tests small effect, 1 test moderateeffect). EKS 2 achieved significantlyhigher effects, with statistically significant progress in
applied motoric tests (1 trivial effect, 7 tests small effects, and 4 tests moderate effects). The results of this research show progress inmotor abilities for both strength training groups, with more significant changes observed in the
group with additional weight load, confirming the justifiability of the application of kettlebell as additional load in young karate athletes.
Keywords: weight training, bodyweight training, kettlebell
One aspect of metacognition is the ability to judge the accuracy of our own performance, even in the absence of external feedback, which is often measured using confidence ratings.
Past research suggests that confidence is lower in Major Depressive Disorder (MDD). Less is known about the ability of MDD patients to discriminate correct from incorrect performance (metacognitive efficiency). The metacognitive performance of aged MDD patients (62-89y) was compared to an age-matched control group. A younger control group (21-28y) was included to also explore the relationship between age and metacognitive performance.
We found no difference in confidence bias nor metacognitive efficiency between MDD patients and age-matched controls. We found age-related differences in metacognition: normal aging was associated with higher confidence but lower metacognitive efficiency. The overconfidence was specifically driven by overconfidence in incorrect trials. Our results point to the importance of age while investigating the relation between MDD and metacognitive performance.
In contrast to the traditionally formulated antagonism of »biological« and »psycho-social«, this work follows a systemic (»synergetic«) research perspective with the aim of investigating psychosocial and neurophysiological changes. This approach required a multi-level approach and a pre-post design. The focus of this thesis was to investigate for the first time the »systemic« interaction of psychosocial risk factors of depressed patients and neuronal processes with high density EEG in the course of inpatient treatment at the Christian Doppler Clinic Salzburg.
During stressful events, we are all trying to cope. We may not be equal depending on our emotional, psychological, and mental states. During the COVID-19 pandemic, we could try to avoid negative information processing and anxiogenics content to prevent unhealthy thinking processes. One of the processes we can observe regarding our way of thinking and its impact on our psychological well-being is
Metacognition.
Methods: We recruited 104 outpatients in 2018. In 2020, during the pandemic,
we recruited 216 outpatients and 176 healthy controls. We assessed their level of metacognition with the MCQ30 scale together with Suicidal risk and Hopelessness.
Results: All three groups showed significant differences, with the nonclinical sample having higher scores in MCQ30. Regression revealed the different profiles where Hopelessness was the only predictor for the clinical sample, whereas metacognition was an adjunctive predictor of suicidal risk for the nonclinical sample.
Conclusion: Our results showed that the COVID-19 crisis influenced metacognitive
levels for the nonclinical sample but not for the clinical population. Moreover, Hopelessness predicted suicide risk for both populations, but Metacognition was also a predictive factor for the nonclinical sample. We conclude with the possible impact of preventive measures based on Metacognitive work that can be created out of these results.
Generation Z's (gen z) sharing of personal information on social media is a growing phenomenon with significant ramifications. Existing research, however, focuses on examining the role of social and/or psychological factors and fails to consider how and when social, psychological, and organizational factors affect gen z's willingness to share personal information on social media. To fill this gap, we propose a conceptual model based on the tenets of sociometer theory, to understand the dynamics of gen z's willingness to share personal information while considering its process and boundary conditions. Using a sequential multi‐study design, we conducted an experiment followed by a survey to test our hypotheses using data collected from gen z in India. Our findings show that when gen z feels socially isolated/anxious, they are more likely to share personal information on social media. The effect of social isolation on sharing of personal information increases when gen z fear that they are missing out on the rewarding experiences others are having, are engaged in repetitive negative thoughts and perceive their firm's privacy policy as transparent and ethical. Our findings provide a better understanding of why, how, and when gen z's are willing to share personal information on social media. We extend existing limited research on the psychological aspects of digital natives' interaction with modern technologies. Our results equip social media marketing and brand managers with the knowledge they need to increase gen z's willingness to share personal information.
Background
Rumination, a transdiagnostic factor in different psychopathological conditions, is believed to be activated and sustained by dysfunctional metacognition. The Positive Beliefs about Rumination Scale (PBRS) and the Negative Beliefs about Rumination Scale (NBRS) have been used to measure the metacognitive beliefs of rumination and have been investigated in many cultural contexts. However, it remains unclear whether these scales can work as well for the Chinese population. Therefore, this study aimed to explore the psychometric properties of the Chinese versions of these scales and to test the metacognitive model of rumination for students with different levels of depression.
Methods
The PBRS and NBRS were forward-backward translated into Mandarin. In total 1,025 college students were recruited to complete a battery of web-based questionnaires. Exploratory factor analysis, confirmatory factor analysis, and correlation analysis were used to test the structure, validity, and reliability of the two scales, as well as their item correlations with rumination.
Results
A new two-factor structure of the PBRS (rather than the original one-factor model) and a new three-factor structure of the NBRS (rather than the original two-factor model) were extracted. The goodness-of-fit indices of these two factor models showed they had a good to very good fit with the data. The internal consistency and construct validity of PBRS and NBRS were also affirmed.
Conclusion
The Chinese versions of the PBRS and the NBRS were generally shown to be reliable and valid, but their newly extracted structures fit the Chinese college students better than their original structures. These new models of PBRS and NBRS are of value to be further explored in Chinese population.
The cognitive attentional syndrome (CAS) is a core concept within metacognitive theory. The premise of the CAS is related to metacognition, however its role in psychopathology is distinct. Due to the complex nature of the CAS, a theoretically driven and psychometrically sound self-report measure of the CAS for the Arabic population is yet to be developed. We translated the Multidimensional Cognitive Attentional Syndrome Scale (MCASS) into the Arabic language and tested its structural validity. The MCASS was translated according to the standard guidelines of forward-translation followed by backward-translation. In Study 1, the MCASS was administered to a larger sample (N = 1027), selected from 22 Arabic-speaking countries in the Arab League countries, and exploratory factor analysis (EFA) was used to examine the factor structure of the measure. Those who participated in Study 1 were excluded from participating in Study 2. Confirmatory factor analysis (CFA) was used in Study 2 (N = 567) to assess the latent factor structure of MCASS, which supported a six-factor model. Results support multidimensional assessment of the CAS using the MCASS, and demonstrate suitability for use in Arab speaking samples. Implications of this study and recommendations for use of the Arabic version of MCASS are discussed.
The purpose of this research was to
determine the effect of spiritual
therapy on modification of
metacognitive beliefs among PTSD
veterans children. the population
consisted of shahed students in islamic
azad university-Roudhen branch in
2016 For selecting of sample based on
entry criteria identified 20 students
,then were assigned in experimental
and control groups.the participants
completed the Questionnaire of Well’s
metacognitive belifes in pretest ,past
test and follow up test . For analysis of
data were used two way mixed
ANOVA . The results showd that the
effect of spiritual therapy on
uncontrolabity of thoughts , cognitive self awarness,and lack of cognitive
confidence was significant.Also these
effects in consistent after one month.It
is suggested that psychologists and
psychotherapist used the spiritual
therapy on modification of
metacognitive belifes.
Researchers have studied non-human primate cognition along different paths, including social cognition, planning and causal knowledge, spatial cognition and memory, and gestural communication, as well as comparative studies with humans. This volume describes how primate cognition is studied in labs, zoos, sanctuaries, and in the field, bringing together researchers examining similar issues in all of these settings and showing how each benefits from the others. Readers will discover how lab-based concepts play out in the real world of free primates. This book tackles pressing issues such as replicability, research ethics, and open science. With contributors from a broad range of comparative, cognitive, neuroscience, developmental, ecological, and ethological perspectives, the volume provides a state-of-the-art review pointing to new avenues for integrative research.
A variety of studies have linked mood disorders to a ruminative style of thinking, particularly involving events and happenings from the past. When an individual’s early expectations of life are not met, depression may follow. In existential terms, depression may be linked to an individual failing to embrace the potentialities afforded by freedom. Post-event rumination, usually involving shorter time frames, has also been linked to social anxiety disorder, with individuals thinking over social encounters and how these were interpreted by others. Finally, regret and shame over early happenings can be involved in a range of pure obsessions, illness anxiety disorder and related conditions. It will be argued that all of these phenomena can be understood in existential terms and that this analysis is more in keeping with the way clients express their difficulties than typical cognitive and behavioural formulations.
The flow of human thoughts is frequently plagued by unwanted cognitive activity, which has the unfortunate power to interfere with task performance, planning, social behaviour, and many other aspects of our lives. Importantly, repetitive negative thoughts and memories play a major role in psychopathology and represent a fundamental transdiagnostic process which deserves experimental and clinical attention. Inhibitory deficits on the one hand and metacognitive beliefs on the other are thought to play a key role in maintaining intrusive repetitive memories and thoughts in a variety of mental health difficulties (Major Depressive Disorder, Post-Traumatic Stress Disorder, Obsessive-Compulsive Disorder, Generalized Anxiety Disorder). This thesis argues against Daniel Wegner’s Ironic Process Theory (Chapter 1) and examines the impact of thought suppression on intrusive Autobiographical Memories with two studies: an fMRI study (Study 1, Chapter 2), and a behavioural study (Study 2, Chapter 3). These two studies represent the first attempt to employ the Autobiographical Think/No-Think task (ATNT), a novel version of the Think/No-Think task solely based on autobiographical memories provided by each participant. In particular, Study 1 investigates the neural correlates of the ATNT task using functional Magnetic Resonance Imaging, and Study 2 explores the introduction of trial-by-trial intrusion ratings in the ATNT task and considers the affective consequences of thought suppression using Skin Conductance Response (SCR). This thesis also probes for the first time the relationship between metacognitive beliefs, intrusive memories, and thought control abilities using the standard Think/No-Think paradigm and manipulating participants’ metacognitive beliefs about the usefulness and the uncontrollability of repetitive intrusive thinking (Study 3, Chapter 4). After a general discussion (Chapter 5), this thesis reflects on the philosophical and ethical implications of forgetting, from a personal, psychological, and historical point of view (Chapter 6).
Background and Objectives: Previous research suggests that rumination acts as a mediating mechanism in the association between depression and drinking motives, particularly drinking to cope, as well as negative alcohol-related consequences. In this study, we tested the connections between depressive symptoms, rumination, drinking motives, alcohol consumption, and alcohol-related problems in a clinically depressed population (N = 209). Methods: Structural equation modeling was used to test the models. Specifications were based on the results of a previously evaluated model in a sample of college students. Results: The complex model showed a significant positive association between depressive symptoms and rumination. Drinking motives (enhancement and coping) were linked to more negative alcohol-related consequences. In a simplified model, pronounced depressive symptoms were associated with both increased ruminative thinking and more negative alcohol-related problems. Rumination was connected with stronger drinking motives (combined in one general factor), which were again associated with alcohol consumption and alcohol-related problems. Limitations: The use of self-report measures to determine diagnostic validity. Conclusions: In a clinically depressed sample, depressive symptoms were linked to increased negative alcohol-related consequences. This association was partially explained by rumination and drinking motives. However, rumination was less relevant than previous studies suggested.
Mildly-to-moderately depressed and nondepressed subjects were randomly assigned to spend 8 minutes focusing their attention on their current feeling states and personal characteristics (rumination condition) or on descriptions of geographic locations and objects (distraction condition). Depressed subjects in the rumination condition became significantly more depressed, whereas depressed subjects in the distraction condition became significantly less depressed. Rumination and distraction did not affect the moods of nondepressed subjects. These results support the hypothesis that ruminative responses to depressed mood exacerbate and prolong depressed mood. whereas distracting response shorten depressed mood.
This paper presents an analysis of depression based upon several standard information-processing concepts. According to this analysis, the initial experience of depression can be conceptualized as resulting from the activation of an affective structure referred to as a depression-emotion node. Once this unit is activated, depressive cognitions are proposed to recycle through the individual's cognitive networks, serving to maintain depressive affect. It is suggested that this depressive recycling process holds several cognitive and behavioral implications for the depressed individual. Potential mediating and exacerbating factors for this process are discussed, and the relationship of the present analysis to current theory and research in depression is considered.
Measures of emotional health and styles of responding to negative moods were obtained for 137 students 14 days before the Loma Prieta earthquake. A follow-up was done 10 days again 7 weeks after the earthquake to test predictions about which of the students would show the most enduring symptoms of depression and posttraumatic stress. Regression analysis showed that students who, before the earthquake, already had elevated levels of depression and stress symptoms and a ruminative style of responding to their symptoms had more depression and stress symptoms for both follow-ups. Students who were exposed to more dangerous or difficult circumstances because of the earthquake also had elevated symptom levels 10 days after the earthquake. Similarly, students who, during the 10 days after the earthquake, had more ruminations about the earthquake were still more likely to have high levels of depressive and stress symptoms 7 weeks after the earthquake.
The effects of different types of responses to a depressed mood on the duration and severity of the mood were examined. On the basis of Nolen-Hoeksema's (1987) response styles theory of depression, it was hypothesized that distracting, active responses would be more effective in alleviating a depressed mood than would ruminative, passive responses. A depressed mood was induced in 35 male and 34 female Ss, and subjects were randomly assigned to engage in 1 of 4 types of responses: an active task that distracted them from their mood; a passive, distracting task; an active task designed to lead to ruminations about their mood; or a passive, ruminative task. As predicted, the greatest remediation of depressed mood was found in Ss in the distracting-active response condition, followed in order by the distracting-passive, ruminative-active, and ruminative-passive response conditions. Degree of rumination had a greater impact on remediation of depressive affect than level of activity, with greater rumination leading to lesser remediation of depressive affect. In addition, the effects of the response tasks were limited to depressed mood. The implications of these results for interventions with depressed persons are discussed.
In a longitudinal study of 253 bereaved adults, people with poorer social support, more concurrent stressors, and higher levels of postloss depression reported more rumination than people with better social support, fewer stressors, and lower initial depression levels. Women reported more rumination than men. People with a ruminative style at 1 month were more likely to have a pessimistic outlook at 1 month, which was associated with higher depression levels at 6 months. People with a more ruminative style were more depressed at 6 months, even after controlling for initial depression levels, social support, concurrent stressors, gender, and pessimism. Additional stressors and high depression scores at 1 month were also associated with higher levels of depression at 6 months.
The authors tested and extended S. Nolen-Hoeksema's (1991) response styles (RSs) theory of depression by assessing the role of RSs in the onset of depressive episodes (DEs), controlling for the effects of concurrent depression, examining the dispositional aspects of RS, clarifying the role of distraction in the course of a DE, and studying the predictive validity of the Response Styles Questionnaire, Nondepressed (ND) participants who reported that they ruminate in response to their depressive symptoms were more likely to experience a DE over 18 months than were participants who reported that they distract themselves from their symptoms. Both a ruminative RS as measured in an ND state and the use of rumination during the first DE predicted the severity of that episode. In contrast, neither trait nor state rumination predicted the duration of the first DE. Participants showed moderate stability of RSs over 1 year and responded in a consistent manner when depressed.
It was hypothesized that women are more vulnerable to depressive symptoms than men because they are more likely to experience chronic negative circumstances (or strain), to have a low sense of mastery, and to engage in ruminative coping. The hypotheses were tested in a 2-wave study of approximately 1,100 community-based adults who were 25 to 75 years old. Chronic strain, low mastery, and rumination were each more common in women than in men and mediated the gender difference in depressive symptoms. Rumination amplified the effects of mastery and, to some extent, chronic strain on depressive symptoms. In addition, chronic strain and rumination had reciprocal effects on each other over time, and low mastery also contributed to more rumination. Finally, depressive symptoms contributed to more rumination and less mastery over time.
Wells and Matthews (1994, 1996) proposed that perseverative negative thinking, such as depressive rumination and anxious worry, is supported by metacognitive beliefs concerning the functions and consequences of these styles of thinking. However, to date no studies have investigated metacognitive beliefs about rumination. This study examined the presence and content of metacognitive beliefs about rumination in patients with recurrent major depression. To achieve this aim, a semistructured interview was conducted with each patient. The results showed that all patients held positive and negative beliefs about rumination. Positive beliefs appear to reflect themes concerning rumination as a coping strategy. Negative beliefs seem to reflect themes concerning uncontrollability and harm, and interpersonal and social consequences of rumination. The conceptual and clinical implications of the results are discussed.
This study evaluated the effectiveness of Attention Training (ATT; Wells, 1990) in the treatment of recurrent major depression. This technique is based on an information processing model of emotional disorders (Wells & Matthews, 1994) in which self-focused attention and metacognition maintain dysfunction. ATT was evaluated in a consecutive single-case series of patients referred for treatment of recurrent major depression. Patients were assigned to no-treatment baselines of 3 to 5 weeks, administered five to eight weekly sessions of ATT, and followed up at 3, 6, and 12 months posttreatment. The effects of ATT on depression, anxiety, negative automatic thoughts, rumination, self-focused attention, and metacognition were assessed. Following ATT, all patients showed clinically significant reductions in depression and anxiety. Reductions in negative automatic thoughts, rumination, and attentional and metacognitive factors showed similar improvements. All scores fell within the normal range on completion of ATT. Treatment gains were maintained at the 12-month follow-up assessments. However, randomized controlled trials of ATT are required before firm conclusions can be drawn.
Studies suggest that young children are quite limited in their knowledge about cognitive phenomena—or in their metacognition—and do relatively little monitoring of their own memory, comprehension, and other cognitive enterprises. Metacognitive knowledge is one's stored knowledge or beliefs about oneself and others as cognitive agents, about tasks, about actions or strategies, and about how all these interact to affect the outcomes of any sort of intellectual enterprise. Metacognitive experiences are conscious cognitive or affective experiences that occur during the enterprise and concern any aspect of it—often, how well it is going. Research is needed to describe and explain spontaneous developmental acquisitions in this area and find effective ways of teaching metacognitive knowledge and cognitive monitoring skills. (9 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
[This book] is written for students of cognitive psychology, and also for clinicians and researchers in the areas of cognition, stress and emotional disorders. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
This book helps to develop an understanding of the internal rules and processes that guide thinking, and the factors that lead individuals to become trapped in cycles of negative and distorted thought. In a new approach to cognitive therapy, A. Wells addresses limitations of cognitive theories and describes how metacognition, self-attentional processes, and worry/rumination strategies are central to emotional vulnerability, to the maintenance of trauma-related stress reactions, to and emotional disorders. Using the meta-cognitive model, the author describes in detail new clinical strategies which help to guide the clinician towards a fresh cognitive approach to changing negative thoughts, distorted beliefs, and distressing emotions. The audience for this book includes trainee therapists, practitioners, and experts working at the frontiers of cognitive therapy. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Cognitive theorists have argued that different types of thinking characterize different emotional states. Recently, in an information-processing model of emotional disorder, Wells and Matthews (1994, 1996) argue that it is not only the content of thought but also the process and meta-cognitive dimensions of particular types of thinking that may be implicated in problem maintenance. However, little is known about how different types of thinking overlap and differ. This study compared the process and meta-cognitive characteristics of naturally occurring depressive and anxious thoughts in a non-clinical sample. We also investigated relationships between thought dimensions and intensity of emotional responses for each type of thought. Subjects were provided with a diary for recording and rating the content of their first and second depressive and anxious thoughts occurring during a two-week period. The results showed that although depressive and anxious thoughts were rated similarly on a number of dimensions, significant differences emerged, and particular dimensions of thought, other than belief level, were associated with emotional intensity. The conceptual and clinical implications of these findings are briefly discussed. Copyright © 1999 John Wiley & Sons, Ltd.
Despite the negative consequences of depressive rumination, little is known about the factors that may be linked to a predisposition to ruminate. Wells and Matthews (1994) suggested that rumination is associated with underlying metacognitive beliefs. Papageorgiou and Wells (in press) provided evidence for the presence of positive and negative metacognitive beliefs about rumination in recurrent major depression. A series of studies concerned with the development and validation of a measure of positive beliefs about rumination, the Positive Beliefs About Rumination Scale (PBRS), is reported. Factor analyses of the scale demonstrated a single factor. The PBRS showed high internal consistency and test-retest reliability, and good psychometric properties of concurrent, convergent, and discriminant validity. The scale was used to test relations between positive beliefs, rumination, and depression. The results were consistent with path models in which rumination mediated the effects of positive beliefs about rumination on state and trait depression.
A case of relaxation induced anxiety in a patient with Panic Disorder is reported. The study reports the use of an attentional training procedure which was effective in eliminating panic and facilitated tension reduction without producing anxiety. A two treatment (ABCB) design revealed that a procedure evoking external attentional focus eliminated panic attacks, whereas autogenic training increased the frequency of panic attacks and the intensity of anxiety. The possible roles of self-focus in mediating panic and the effects of relaxation are briefly discussed.
Advances in treating generalized anxiety disorder (GAD) are likely to result from a better understanding of the dysfunctional cognitive mechanisms underlying persistent worrying. In a cognitive model of GAD, Wells (1995) proposed that pathological worry is maintained by maladaptive metacognitions (negative beliefs about worry concerning uncontrollability and danger, and negative appraisal of worrying [meta-worry]) and linked behaviors. Twenty-four patients with GAD were compared with sex-matched groups — social phobia, panic disorder, and nonpatients — on measures of negative metacognitions and worry. It was hypothesized that patients with GAD would obtain higher negative metacognitive belief scores and higher meta-worry scores than the other groups; differences in negative metacognitions would be independent of the general frequency of worry. A group of individuals with major depression was also examined as a subsidiary exploration of relative metacognitive and worry characteristics of this disorder. All of the hypotheses were upheld in the univariate ANOVAs. There was a loss of one hypothesized significant difference between the GAD and panic disorder groups in meta-worry when general worry frequency was controlled. However, the GAD group still had higher meta-worry scores than the panic group. This effect appears to be the result of patients with panic having intermediate meta-worry scores falling between the GAD and other groups. Differences between the GAD group and all other groups in negative metacognitive beliefs concerning uncontrollability and danger remained when general worry was controlled. The results add further support to the cognitive model, and treatment implications are briefly discussed.
The first part of this book examines the problem of depression, evidence about it and answers previously offered in the literature. The second part describes the Interacting Cognitive Subsystems model (ICS), its advocacy of two levels of meaning and the way it addresses emotion. The third part examines how the model handles mood and memory effects. The fourth part of the book discusses ICS, negative thinking and the maintenance of depression. Part five deals with ICS, depression and psychological treatment and the concluding part raises some broader issues concerning the application of psychology theories in real world contexts.
The response styles theory suggests that rumination in response to depressed mood exacerbates and prolongs depression, while distraction ameliorates and shortens it. Gender differences in response styles are said to contribute to the observed gender differences in the prevalence of unipolar depression. While empirical support for the theory has been found from a variety of non-clinical studies, its generalizability to clinically depressed patient populations remains unclear.
A cohort of 52 unipolar depressed in-patients was assessed with the Response Styles Questionnaire during in-patient stay (T1) and 4 weeks after discharge (T2). The patients were followed up 4 months after discharge (T3). Clinical assessment included the SCAN-PSE-10.
Moderate and statistically significant retest-stabilities for rumination and distraction were found, comparable for patients with stable and changing depression status from T1 to T2. A cross-sectional diagnosis of a major depressive episode was associated with rumination, while gender was not. Post-discharge baseline rumination (T2), adjusted for concurrent depression, predicted follow-up levels of depression (T3), and, in patients who were non-remitted at post-discharge baseline, it predicted presence of a major depressive episode at follow-up (T3). Results on distraction were more ambiguous.
Our results suggest that rumination is likely to have a deteriorating impact on the course of clinical episodes of depression in unipolar depressed patients. Larger longitudinal patient studies are needed to validate these findings.
I propose that the ways people respond to their own symptoms of depression influence the duration of these symptoms. People who engage in ruminative responses to depression, focusing on their symptoms and the possible causes and consequences of their symptoms, will show longer depressions than people who take action to distract themselves from their symptoms. Ruminative responses prolong depression because they allow the depressed mood to negatively bias thinking and interfere with instrumental behavior and problem-solving. Laboratory and field studies directly testing this theory have supported its predictions. I discuss how response styles can explain the greater likelihood of depression in women than men. Then I intergrate this response styles theory with studies of coping with discrete events. The response styles theory is compared to other theories of the duration of depression. Finally, I suggest what may help a depressed person to stop engaging in ruminative responses and how response styles for depression may develop.
The Inventory to Diagnose Depression (IDD) is a self-report scale designed to diagnose DSM-III major depressive disorder (MDD). In our analysis, its test-retest reliability and internal consistency were high. The IDD was significantly associated with other self-report and interviewer rated depression scales and was sensitive to clinical change. Diagnostic agreement between the IDD and clinician's diagnosis of MDD was as high as that found in studies examining the interrater reliability of the diagnosis of MDD. Moreover, our results suggested that the IDD may aid clinicians in detecting secondary depression and distinguishing psychotic depression from nonaffective psychoses. The IDD may be particularly useful in light of the recent evidence that American psychiatrists continue to underdiagnose depression and overdiagnose schizophrenia.
Hypotheses about the effects of self-focused rumination on interpretations of events and interpersonal problem solving were tested in 3 studies with dysphoric and nondysphoric participants. Study 1 supported the hypothesis that dysphoric participants induced to ruminatively self-focus on their feelings and personal characteristics would endorse more negative, biased interpretations of hypothetical situations than dysphoric participants induced to distract themselves from their mood, or nondysphoric participants. Study 2 showed that dysphoric participants who ruminated were more pessimistic about positive events in their future than the other 3 groups. Study 3 showed that dysphoric ruminating participants generated less effective solutions to interpersonal problems than the other 3 groups. In Studies 1 and 3, dysphoric ruminating participants also offered the most pessimistic explanations for interpersonal problems and hypothetical negative events. In all 3 studies, dysphoric participants who distracted were as optimistic and effective in solving problems as non-dysphoric participants.
Hypotheses about the self-perpetuating properties of ruminative responses to depressed mood were tested in 2 laboratory studies and 2 questionnaire studies with dysphoric and nondysphoric Ss. Studies 1 and 2 supported the hypothesis that dysphorics induced to engage in self-focused rumination would report reduced willingness to engage in pleasant, distracting activities that could lift their moods, even if they believed they would enjoy such activities. Studies 3 and 4 confirmed the hypothesis that dysphorics induced to ruminate in response to their moods would feel they were gaining insight into their problems and their emotions. Therefore, they might have avoided distraction because they believed it would interfere with their efforts to understand themselves. Depressed mood alone, in the absence of rumination, was not associated with either lower willingness to participate in distractions or an enhanced sense of insightfulness.
This report describes the development of the Meta-Cognitions Questionnaire to measure beliefs about worry and intrusive thoughts. Factor analyses of the scale demonstrated five empirically distinct and relatively stable dimensions of meta-cognition. Four of the factors representing beliefs were: Positive Beliefs About Worry: Negative Beliefs About the Controllability of Thoughts and Corresponding Danger; Cognitive Confidence; and Negative Beliefs about Thoughts in General, including Themes of Superstition, Punishment and Responsibility. The fifth factor represented Meta-Cognitive processes-Cognitive Self-Consciousness-a tendency to be aware of and monitor thinking. The measure showed good psychometric properties on a range of indices of reliability and validity. Scores on the questionnaire subscales predicted measures of worry proneness, proneness to obsessional symptoms, and anxiety. Regression analyses showed that the independent predictors of worry were: Positive Beliefs about Worry; Negative Beliefs About the Controllability of Thoughts and Corresponding Danger: and Cognitive Confidence. Significant differences in particular MCQ subscales were demonstrated between patients with intrusive thoughts, clinical controls and normals. The implications of these findings for models of worry and intrusive thoughts are discussed.
It was hypothesized that women are more vulnerable to depressive symptoms than men because they are more likely to experience chronic negative circumstances (or strain), to have a low sense of mastery, and to engage in ruminative coping. The hypotheses were tested in a 2-wave study of approximately 1,100 community-based adults who were 25 to 75 years old. Chronic strain, low mastery, and rumination were each more common in women than in men and mediated the gender difference in depressive symptoms. Rumination amplified the effects of mastery and, to some extent, chronic strain on depressive symptoms. In addition, chronic strain and rumination had reciprocal effects on each other over time, and low mastery also contributed to more rumination. Finally, depressive symptoms contributed to more rumination and less mastery over time.
EQS structural equations program manual EQS for Windows user's guide Beliefs about worry and intrusions: The Meta-Cognitions Questionnaire and its correlates
- Dc Washington
- Author
- P M Bentler
- P M Bentler
- E J C Wu
Washington, DC: Author. Bentler, P. M. (1995). EQS structural equations program manual. Encino, CA: Multivariate Software, Inc. Bentler, P. M., & Wu, E. J. C. (1995). EQS for Windows user's guide. Encino, CA: Multivariate Software, Inc. Cartwright-Hatton, S., & Wells, A. (1997). Beliefs about worry and intrusions: The Meta-Cognitions Questionnaire and its correlates. Journal of Anxiety Disorders, 11, 279–296.
EQS for Windows user's guide
- P M Bentler
- E J C Wu
Effects of rumination and initial severity on response to cognitive therapy for depression. Poster session presented at the 33rd Annual Convention of the Association for Advancement of Behavior Therapy
- G J Siegle
- S Sagrati
- C E Crawford
Siegle, G. J., Sagrati, S., & Crawford, C. E. (1999, November). Effects of rumination and initial severity on
response to cognitive therapy for depression. Poster session presented at the 33rd Annual Convention
of the Association for Advancement of Behavior Therapy, Toronto, Canada.
Diagnostic and statistical manual of mental disorders
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.).
Washington, DC: Author.
Dimensions of depressive rumination and anxious worry: A comparative study. Paper presented at the 33rd Annual Convention of the Association for Advancement of Behavior Therapy
- C Papageorgiou
- A Wells
Papageorgiou, C., & Wells, A. (1999b, November). Dimensions of depressive rumination and anxious
worry: A comparative study. Paper presented at the 33rd Annual Convention of the Association for
Advancement of Behavior Therapy, Toronto, Canada.