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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.
... Hence, different theoretical standpoints put somewhat different emphasis on potential targets when alleviating rumination and depression. Although prior models have yielded a significant amount of empirical evidence (e.g., Watkins & Brown, 2002;Papageorgiou & Wells, 2003;Roberts et al., 2020;Ólafsson et al., 2020), as to date only limited research has focused on how multiple of these factors specifically contribute to rumination. Related to this, the current literature lacks a comprehensive empirical model that captures multiple links between the key cognitive processes and rumination within a unified framework. ...
... In contrast to Tamm et al. (2024), we also observed direct pathways from depression and perfectionism to rumination. Similar links between core cognitive processes and rumination have been suggested by metacognitive and self-regulatory theoretical models; although focal aspects of rumination are somewhat different in each theory (e.g., Koster et al., 2011;Martin & Tesser, 1996;Matthews & Wells, 2003;Papageorgiou & Wells, 2003;Watkins & Roberts, 2020). For example, the model fits with the propositions made by the metacognitive model of rumination (Papageorgiou & Wells, 2003) which proposes that positive beliefs about rumination activate and maintain rumination, resulting in activation of negative beliefs about uncontrollability and harmfulness of rumination, and related to this, further increases in rumination. ...
... Similar links between core cognitive processes and rumination have been suggested by metacognitive and self-regulatory theoretical models; although focal aspects of rumination are somewhat different in each theory (e.g., Koster et al., 2011;Martin & Tesser, 1996;Matthews & Wells, 2003;Papageorgiou & Wells, 2003;Watkins & Roberts, 2020). For example, the model fits with the propositions made by the metacognitive model of rumination (Papageorgiou & Wells, 2003) which proposes that positive beliefs about rumination activate and maintain rumination, resulting in activation of negative beliefs about uncontrollability and harmfulness of rumination, and related to this, further increases in rumination. The metacognitive theory suggests a loop-like process between rumination and metacognitive processes. ...
Background
Rumination plays a major role in various forms of psychopathology. In a recent study, we tested the main predictions of the key processes that drive rumination from major metacognitive and self-regulation theories of rumination by using a data-driven network analytical approach. This study aimed to replicate these findings and extend the approach to worry.
Methods
The study followed the original procedures. Participants were recruited from Academic Prolific (n = 500, 241 men and 257 women, age range 18–85).
Results
The current study largely replicated the original findings. The regularized partial correlation network for rumination did not significantly differ from the one obtained in the original study in terms of network structure (network structure invariance: M = 0.16, p < .96) and level of connectivity (global strength invariance: S = 0.235, p < .69). Bayesian network analysis replicated the main results from the first study: positive beliefs about rumination, cognitive self-consciousness, and effortful control were directly linked to rumination. Moreover, we found potential causal links from depression and perfectionism to rumination. We applied a similar approach to explore the mechanisms behind worry. The results suggest a moderate correlation between worry and rumination (r = .68, p < .05) and some specificity to the mechanisms governing worry.
Conclusions
There are multiple cognitive factors that are directly linked to rumination and worry. This study is the first to replicate an integrated network that captures the cognitive building blocks of rumination, and to test its extension to worry. These findings provide empirical proof for the reliability of the rumination network and support the integrative theories of rumination and related psychopathology.
... For instance, while the metacognitive model of rumination mostly focuses on the importance of (positive) beliefs about rumination as the core trigger and maintaining factor of rumination (Matthews & Wells, 2003), self-regulatory approaches put the key focus on goal discrepancy (e.g., Strauman, 2015) and the role of cognitive control in rumination (e.g., Koster et al., 2015;Gross, 1999). Although prior models have yielded a significant amount of empirical evidence (e.g., Watkins & Brown, 2002;Papageorgiou & Wells, 2003;Roberts et al., 2020;Ólaffson et al., 2020), as to date only limited research has focused on how multiple of these factors specifically contribute to rumination. ...
... In contrast to Tamm et al. (2024), we also observed direct pathways from depression and perfectionism to rumination. Similar links between the core aspects of rumination have been suggested by metacognitive and selfregulatory theoretical models; although focal aspects of rumination are somewhat different in each theory (e.g., Matthews & Wells, 2003;Watkins & Roberts, 2020;Papageorgiou & Wells, 2003;Koster et al., 2011;Martin & Tesser, 1996). For example, the model fits with the propositions made by the metacognitive model of rumination (Papageorgiou & Wells, 2003) which proposes that positive beliefs about rumination activate and maintain rumination, resulting in activation of negative beliefs about uncontrollability and harmfulness of rumination, and related to this, further increases in rumination. ...
... Similar links between the core aspects of rumination have been suggested by metacognitive and selfregulatory theoretical models; although focal aspects of rumination are somewhat different in each theory (e.g., Matthews & Wells, 2003;Watkins & Roberts, 2020;Papageorgiou & Wells, 2003;Koster et al., 2011;Martin & Tesser, 1996). For example, the model fits with the propositions made by the metacognitive model of rumination (Papageorgiou & Wells, 2003) which proposes that positive beliefs about rumination activate and maintain rumination, resulting in activation of negative beliefs about uncontrollability and harmfulness of rumination, and related to this, further increases in rumination. The metacognitive theory suggests a loop-like process between rumination and metacognitive processes. ...
Background: Rumination plays a major role in various forms of psychopathology. In a recent study, we tested the main predictions of the key processes that drive rumination from major metacognitive and self-regulation theories of rumination by using a data-driven network analytical approach. This study aimed to replicate these findings and extend the approach to worry. Methods: The study followed the original procedures. Participants were recruited from Academic Prolific (n=500).Results: The current study largely replicated the original findings. The regularized partial correlation network for rumination did not significantly differ from the one obtained in the original study in terms of network structure and level of connectivity (p>.6). Bayesian network analysis replicated the main results from the first study: positive beliefs about rumination, cognitive self-consciousness, and effortful control were directly linked to rumination.Moreover, we found potential causal links from depression and perfectionism to rumination.We applied a similar approach to explore the mechanisms behind worry. The results suggest amoderate correlation between worry and rumination (r=.67) and some specificity to the mechanisms governing worry.Conclusions: There are multiple cognitive factors that are directly linked to rumination and worry. These findings contribute to the cognitive theories of depression and anxiety.
... Given the adverse implications of academic burnout, identifying relevant variables for its mitigation becomes imperative. Dysfunctional metacognitions have been spotlighted as significant contributors to emotional problems, presenting a pertinent avenue for exploring the genesis and persistence of academic burnout (Holeva et al., 2001;Morrison & Wells, 2003;Papageorgiou & Wells, 2003;Wells and Cartwright-Hatton 2004). ...
... The prevalence of academic burnout is particularly notable in higher education settings, highlighting a pressing need to address this issue comprehensively. Given the intricate connection between dysfunctional metacognitions and emotional complications, understanding the role of metacognitive processes could shed new light on the mechanisms underlying academic burnout, paving the way for informed interventions to alleviate this chronic condition and foster a healthier educational environment for students (Aguayo et al., 2019;Dyrbye et al., 2006;Edu-Valsania et al., 2022;Frydenberg & Lewis, 2004;Holeva et al., 2001;Madigan & Curran, 2022;Maslach et al., 2001;Morrison & Wells, 2003;Papageorgiou & Wells, 2003;Salmela-Aro et al., 2009;Schaufeli et al., 2002;. ...
... Dysfunctional metacognitive beliefs have been associated with a range of psychological disorders, including generalized anxiety disorder, obsessions, PTSD, psychosis, and depression, illustrating a positive correlation between these disorders and dysfunctional metacognitions (Holeva et al., 2001;Morrison, 2001;Morrison et al., 2000;Morrison & Wells, 2003;Papageorgiou & Wells, 2003;Sellers et al., 2016;Wells & Carter, 2001;Wells & Papageorgiou, 1998). These beliefs, whether positive or negative, can influence the severity and frequency of symptoms, highlighting a crucial role in the onset and persistence of psychological conditions (Morrison, 2001;Morrison et al., 2015). ...
This study explores the mediating role of mindfulness in the relationship between metacognition and academic burnout, a prevalent issue in higher education affecting students' well-being and academic performance. Utilizing a structural equation modeling approach, the study examined the hypothesized pathways grounded on the Self-regulatory Executive Function (S-REF) model in a sample of university students. Results corroborated all hypothesized relationships, denoting a positive prediction of academic burnout through dysfunctional metacognitions, a decrease in which was observed with heightened mindfulness. The bootstrap analysis confirmed mindfulness's partial mediation between metacognition and academic burnout, establishing a significant indirect effect. The study highlights mindfulness's mitigating role against the adverse impacts of dysfunctional metacognitions on academic burnout, advocating for mindfulness-based interventions in educational settings to foster student resilience and well-being. Future research should further delve into this nuanced relationship to foster effective educational strategies.
... However, CAS could impact people by forcing them into perseverative, toxic, and persistent thinking styles. CAS results from incorrect metacognitive beliefs (MBs) and is controlled by these positive and negative MBs. Positive MBs about rumination and unhelpful coping and negative MBs such as uncontrollability and harmfulness of this process lead to depression and anxiety (9). Empirical studies have demonstrated that MBs play an important role in depression (9). ...
... CAS results from incorrect metacognitive beliefs (MBs) and is controlled by these positive and negative MBs. Positive MBs about rumination and unhelpful coping and negative MBs such as uncontrollability and harmfulness of this process lead to depression and anxiety (9). Empirical studies have demonstrated that MBs play an important role in depression (9). Several studies examined the relationship between MBs and depression in healthy participants and found further evidence for the metacognitive model of depression (10,11). ...
... From a metacognitive perspective, rumination is conceptualized as a strategy that some people use to cope with distress 42 . The most prominent metacognitive theory, the Self-regulatory Executive Function framework (S-REF 11 ), proposes that rumination stems from positive metacognitive beliefs about rumination. ...
... Moreover, the multinode-loop hypothesis is further supported by empirical findings from another network study which focused on describing the associations between state rumination, self-criticism and behavioral executive control 97 . This is in accordance with the metacognitive models that suggest that the vicious cycles between beliefs about rumination, depression, metacognitive efficiency and confidence may be the underlying cause for persistence of depression 16,42 . Systematic feedback loops have also been proposed by other theories, including a broader system's dynamic framework that includes biological, cognitive, as well as societal and environmental factors that can reinforce rumination and depression 98 . ...
Theories of rumination have proposed different psychological factors to place one at risk for repetitive negative thinking. A comprehensive empirical test that captures the most relevant contributors to rumination 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 unique associations between the different constructs and followed these analyses up with directed acyclic graphs to identify potential 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 and harm, cognitive self-consciousness, depression, effortful control, perfectionism, and (lack of) cognitive confidence, and (3) we identified multiple directed pathways, suggesting three direct contributors to rumination while controlling for the influence of all other variables: diminished effortful control, positive beliefs, and cognitive self-consciousness. This study is the first to comprehensively assess 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.
... The positive metacognitive beliefs breed rumination evaluating it as a coping mechanism that could lead to paramount harmful social and interpersonal consequences. Later, these consequences generate negative metacognitive beliefs about rumination (inducing worry and uncontrollability) inducing decreased cognitive confidence among individuals in depressive states (Halvorsen et al. 2014, Papageorgiou andWells 2003). ...
... Aarzoo GUPTA 1 , Santha KUMARI 2 Metacognition, therefore, can be understood as an information processing system that monitors, interprets, evaluates and regulates content, and content organization processes (Flavell 1979, Papageorgiou andWells 2003). An individual in the state of depression centres attention on NATs and continues to ruminate about negative experiences, events or emotions. ...
Metacognitive beliefs operate through cognitive attentional syndrome, where attention concentrated on negative automatic thoughts results in rumination. This perseverative thinking style manifesting in the form of rumination and worry intensifies depression. This study aims to assess the effect of cognitive behaviour therapy (CBT) on metacognitive beliefs, symptom severity, quality of life, and functionality. A pre-post study design comparing CBT-alone and CBT-with-medication was employed using purposive sampling to recruit 40 participants diagnosed with depressive disorders. All the participants received 10 sessions of CBT. Pre and post assessment measures were Beck Depression Inventory-II, Metacognitive Questionnaire-30, World Health Organization Quality of Life-Brief, and Global Assessment of Functioning. Paired t-test analysis revealed significant difference on outcome measures in both groups. Between-subject analysis revealed that the CBT-alone group was not significantly different in terms of improvement than CBT-with-medication group even when confounding variables were statistically controlled by way of testing analysis of covariance and propensity score match (nearest neighbour match).
... Benedetto et al., (2022) [90] found that negative metacognitive beliefs about worry were associated with anxiety in a clinical sample of adolescents but not in a non-clinical sample of adolescents. Moreover, Papageorgiou & Wells (2003) [91] tested the fit of the S-REF model in depressed and non-depressed participants. While the S-REF model fitted the data well for the depressed sample, it did not fit well for the nondepressed sample. ...
... Benedetto et al., (2022) [90] found that negative metacognitive beliefs about worry were associated with anxiety in a clinical sample of adolescents but not in a non-clinical sample of adolescents. Moreover, Papageorgiou & Wells (2003) [91] tested the fit of the S-REF model in depressed and non-depressed participants. While the S-REF model fitted the data well for the depressed sample, it did not fit well for the nondepressed sample. ...
Emotional distress is common in young people with epilepsy (YPwE). According to the Self-Regulatory Executive Function (S-REF) model, maladaptive metacognitive beliefs and perseverative thinking are fundamental in the development and maintenance of emotional distress. As emotional distress and perseverative thinking can highly fluctuate over short intervals in YPwE, it is important to account for this variability when testing the utility of psychological models. Experience sampling methodology (ESM) was therefore used to explore the momentary relationship between metacognitive beliefs, perseverative thinking, and emotional distress in YPwE. Eighteen participants diagnosed with epilepsy (aged 12-17 years) completed the 10-day ESM period. Participants were prompted to complete the ESM assessment five times daily. The ESM assessment assessed participant's momentary levels of metacognitive beliefs, perseverative thinking (i.e., worry and rumination), and emotional distress (i.e., anxiety and depression). A series of multilevel regression analyses indicated that metacognitive beliefs were significantly positively associated with worry, rumination, anxiety and depression. After controlling for worry and rumination, respectively, metacognitive beliefs did not account for additional variance in anxiety or depression. Findings provide preliminary support for the utility of the S-REF model for emotional distress in YPwE. Metacognitive therapy, which is underpinned by the S-REF model, may be an appropriate intervention for emotional distress in YPwE. Future studies should assess the mediational relationship between metacognitive beliefs, perseverative thinking, and emotional distress using time-lagged models.
... a series of psychological disorders, including generalized anxiety disorder [5], depressive disorder [6][7][8], paranoia disorder [9], obsessive-compulsive disorder [10,11] and post-traumatic stress disorder [12]. Accordingly, numerous studies report that modifying dysfunctional metacognitive beliefs can relieve clinical symptoms [13][14][15]. ...
... In line with the theoretical predictions, large number of empirical studies have reported that dysfunctional metacognitive beliefs are associated with Generally, studies report good internal consistency, testretest reliability and convergent validity. MCQ-30 subscales are found to be related to higher clinical symptoms [5][6][7][8][9][10][11][12], lower quality of life [24], and more childhood adversities [25]. Furthermore, recent studies also reported significant prospective associations of MCQ-30 subscales and psychopathology [26,27]. ...
This study aimed to examine the psychometric properties of the Metacognitions Questionnaire-30 (MCQ-30) in a sample
of Chinese adolescents (1382 boys, 1445 girls) aged 11 to 18 years. Confirmatory factor analysis was performed to assess
factor structure, as well as, measurement invariance across demographic groups and clinical symptoms. The results of
confirmatory factor analyses supported the original five-factor model. Configural, metric and scalar invariance of the fivefactor
model were also supported by gender, age, ethnicity, residence, parental education level, depression and anxiety
status. Furthermore, all five subscales demonstrated good internal consistency (Cronbach alphas > 0.75) and test-retest
reliability (intra-class correlation coefficients > 0.45). Finally, the five factors were positively related to symptoms of
depression, anxiety, and irritability and negatively related to positive childhood experiences and life satisfaction, indicating
excellent validity. The findings provide initial evidence that the MCQ-30 is a valid measure for use in Chinese adolescents.
... Wells' (2011) metacognitive model posits that metacognitions determine how individuals think about and respond to negative cognitive beliefs and associated negative mood. Specifically, the cognitive attentional syndrome, which consist of "worry and rumination, heightened self-focused attention, monitoring for signs of potential threat and counterproductive coping strategies" (Huntley and Fisher, 2016) is implicated in depression (Papageorgiou and Wells, 2003). Positive metacognitive beliefs about the usefulness of dwelling on thoughts and ruminating (e.g., "Worrying helps me to get things sorted out in my mind") are addressed in MCT-Silver. ...
... Positive metacognitive beliefs about the usefulness of dwelling on thoughts and ruminating (e.g., "Worrying helps me to get things sorted out in my mind") are addressed in MCT-Silver. Metacognitive beliefs are associated cross-sectionally with depressive symptoms (Papageorgiou and Wells, 2003) and predict depression onset (Papageorgiou and Wells, 2009) and severity (Weber and Exner, 2013), even after accounting for negative cognitive beliefs . Initial support exists for the malleability of metacognitive beliefs through psychological interventions Jelinek et al., 2017b;Normann et al., 2014;Özgüç and Tanriverdi, 2022); however, to date none of these studies have examined metacognitions in older adults. ...
... The positive metacognitive beliefs breed rumination evaluating it as a coping mechanism that could lead to paramount harmful social and interpersonal consequences. Later, these consequences generate negative metacognitive beliefs about rumination (inducing worry and uncontrollability) inducing decreased cognitive confidence among individuals in depressive states (Halvorsen et al. 2014, Papageorgiou andWells 2003). ...
... Aarzoo GUPTA 1 , Santha KUMARI 2 Metacognition, therefore, can be understood as an information processing system that monitors, interprets, evaluates and regulates content, and content organization processes (Flavell 1979, Papageorgiou andWells 2003). An individual in the state of depression centres attention on NATs and continues to ruminate about negative experiences, events or emotions. ...
Metacognitive beliefs operate through cognitive attentional syndrome, where attention concentrated on negative automatic thoughts results in rumination. This perseverative thinking style manifesting in the form of rumination and worry intensifies depression. This study aims to assess the effect of cognitive behaviour therapy (CBT) on metacognitive beliefs, symptom severity, quality of life, and functionality. A pre-post study design comparing CBT-alone and CBT-with-medication was employed using purposive sampling to recruit 40 participants diagnosed with depressive disorders. All the participants received 10 sessions of CBT. Pre and post assessment measures were Beck Depression Inventory-II, Metacognitive Questionnaire-30, World Health Organization Quality of Life- Brief, and Global Assessment of Functioning. Paired t-test analysis revealed significant difference on outcome measures in both groups. Between-subject analysis revealed that the CBT-alone group was not significantly different in terms of improvement than CBT-withmedication group even when confounding variables were statistically controlled by way of testing analysis of covariance and propensity score match (nearest neighbour match). Keywords: Cognitive behaviour therapy, metacognition, depressive disorders, metacognitive beliefs, depression, quality of life.
... This process refers to going over events in memory to find knowledge assumed by the individual to help reconcile oneself concerning blame and responsibility for traumatic events but may have the paradoxical effect that it maintains symptoms and distress. In line with our results, previous studies have also reported a role for (low) cognitive confidence along negative metacognitive beliefs in other types of emotional distress such as depression (Papageorgiou & Wells, 2003), obsessive-compulsive symptoms (Hermans et al., 2008), and social anxiety (H. Nordahl & Wells, 2017). ...
Objective: The Metacognitions Questionnaire–30 (MCQ-30) was developed to measure individual differences in endorsement of maladaptive metacognitive beliefs. Previous research shows the MCQ-30 possesses good psychometric properties. However, there is limited research on psychometric properties of the MCQ-30 in clinical samples, and the scale has not previously been validated in patients with posttraumatic stress disorder (PTSD). The aim of this study was therefore to evaluate the psychometric properties of the MCQ-30 in a sample of PTSD patients. Method: A sample of 290 patients diagnosed with PTSD completed self-report questionnaires measuring trauma symptoms and metacognitive beliefs. The sample consisted of 225 women and 65 men (M = 33.90 years; range 18–69 years). Confirmatory factor analysis was used to investigate the factorial structure of the MCQ-30, and the internal consistency and convergent validity were evaluated. A linear regression analysis was used to evaluate unique associations between metacognitive subscales and trauma symptoms. Results: The confirmatory factor analysis supported the proposed five-factor structure of MCQ-30, and the subscales demonstrated good internal consistency. All five subscales were associated with trauma symptoms of which negative metacognitive beliefs and cognitive confidence showed unique relationships to symptoms. Conclusion: The MCQ-30 demonstrates promising validity in assessing generic metacognitive beliefs among PTSD patients, suggesting its utility in both clinical practice and research contexts.
... A growing number of metacognitive measures have been developed and validated for specific disorders or problem behaviours (e.g., gambling, Spada et al., 2015;alcohol use, Spada & Wells, 2008;rumination, Kolubnski et al, 2017;Papageorgiou & Wells, 2003;health anxiety, Bailey & Wells, 2015;anger, Moeller et al., 2019;and insomnia, Waine et al., 2009) to enable sensitive assessment of unique cognitive processes, improve validity, and support targeted intervention (Spada & Wells, 2008;Wells, 2000Wells, , 2009. While metacognition has been explored in conditions with a body image component such as eating disorders (Aloi et al., 2020), obesity (Woolrich et al., 2008), and body dysmorphic disorder Nikfarjam et al., 2015), no metacognitive measure relating specifically to physical appearance currently exists. ...
Background
Appearance beliefs may negatively impact body image and psychological wellbeing. Accordingly, this study aimed to develop the Metacognitions about Physical Appearance Questionnaire (MPAQ).
Method
An initial 30-items were formulated after thematic analysis of clinicians’ (N = 23) reports regarding appearance-based metacognitive beliefs and feedback from laypeople. A cross-sectional design across two non-clinical samples (Sample 1 N = 370, Mage = 39.36, 79% female; Sample 2 N = 463, Mage = 30.88, 81% female) was then used to determine the factor structure, reliability, and validity of the MPAQ.
Results
Initial factor analyses supported a reduced 20-item MPAQ across two subscales (positive and negative beliefs about worry or rumination on physical appearance). Correlated residuals and cross-loadings detected with confirmatory factor analysis further reduced the MPAQ to 15 items (seven for positive, eight for negative). Reliability and convergent, discriminant, and incremental validity of the MPAQ-15 were supported in both samples.
Conclusion
The current study provides preliminary support for the MPAQ as a reliable and valid measure of metacognitions about physical appearance. The measure may be beneficial for researchers and clinicians working with individuals with body image concerns. Further psychometric evaluation of the MPAQ is recommended, including test-retest reliability and validation of the measure in diverse populations.
... Building on the metacognitive model of depression (Papageorgiou & Wells, 2003), Forkmann et al. (2023) recently proposed a metacognitive model of suicidality (see Fig. 1). ...
Objective
The metacognitive model of suicidality proposes that positive metacognitions about suicide (PMS) activate a cognitive attentional syndrome (CAS), i.e., suicide-specific rumination, attentional fixation, and thought suppression, which in turn activates negative metacognitions about suicide (NMS) and an aggravation of suicidality. Preliminary evidence supports the model assumptions; however, a more comprehensive investigation is missing by now.
Methods
One hundred eighty-six participants (148 female [79.6%]; age M = 28.3 (SD = 9.8)) with lifetime suicidal ideation filled in self-report measures of suicide ideation/behavior, all CAS-components, and metacognitions about suicide.
Results
All elements of the CAS correlated significantly with each other and with concurrent suicidal ideation. PMS predicted suicide-specific rumination and attentional fixation. All CAS-components predicted NMS. Suicide-specific rumination, attentional fixation, and positive and negative metacognitions differentiated between lifetime suicide attempters and non-attempters.
Conclusion
Results are in line with the metacognitive model of suicidality and warrant further studies regarding the model assumptions.
... Improvements in mental health, including symptoms of bipolar disorder (Murnane et al., 2016), MDD (Kauer et al., 2012), and PTSD (Ehlers et al., 2003), have been associated with both mental health self-monitoring practices (Eisenstadt et al., 2021;Gatto et al., 2022) and positive changes in metacognition during treatment (Nordahl & Wells, 2017;Solem et al., 2009). Metacognitive dysfunction has been associated with psychological vulnerability (Bailey & Wells, 2016;Gwilliam et al., 2004;Myers & Wells, 2005;Myers et al., 2009;Wells, 2019), as well as predicting symptoms of PTSD (Bennett & Wells, 2010), AUD (Spada et al., 2007), GAD (Bailey & Wells, 2016), MDD (Papageorgiou & Wells, 2003, 2009, and anxiety disorders (Bailey & Wells, 2015;Bürgler et al., 2021;Nordahl & Wells, 2017;Spada et al., 2008). Enhanced pre-treatment meta-cognitive capacity has also been linked to treatment success independent of negative emotions in patients with AUD (Spada et al., 2009). ...
The current study was designed to assess for associations between self-report mental health disorder symptom change scores and the frequency of monthly mental health self-monitoring surveys, amongst Royal Canadian Mounted Police (RCMP) cadets during training (i.e., starting the Cadet Training Program [CTP] to pre-deployment). Participants were RCMP cadets (n = 355). Multiple linear regression models were conducted to assess relationships between mental health disorder symptom change scores and the frequency of monthly self-monitoring during the CTP, adjusting for sociodemographic variables and pre-training mental health disorder symptom scores. The frequency of monthly self-monitoring was statistically significantly inversely associated with changes in mental health disorder symptoms during the CTP (R 2 = .13 to .47), meaning more frequent monthly self-report monitoring was related to decreases in symptoms. Regular mental health self-monitoring may help to directly mitigate mental health challenges among RCMP through increased self-awareness, and by facilitating proactive self-care and earlier access to evidence-based care. Trial registration: Pre-registration with aspredicted.org for the RCMP Study and associated hypotheses occurred on 7 November 2019 with the name, "Risk and resiliency factors in the RCMP: A prospective investigation" (#30654).
... One of the explanations for this is that traumatic childhood experiences result in the development of ineffective coping strategies (Barlow 2004; Cludius, Mennin, and Ehring 2020; Snyder, Friedman, and Hankin 2019) such as excessive focusing on events themselves, the emotions they provoke, and analysing their causes and effects (Aldao, Nolen-Hoeksema, and Schweizer 2010;Nolen-Hoeksema, Wisco, and Lyubomirsky 2008;Snyder, Friedman, and Hankin 2019). This is known as rumination and arises as an attempt to understand and resolve the situation, although rumination has been shown to be negatively related to problem solving and is maladaptive for coping with stressful life events (Battista et al. 2023;Michael et al. 2007;Papageorgiou and Wells 2003;Snyder, Friedman, and Hankin 2019). Another response to traumatic experiences is the appearance of intrusive thoughts. ...
Background
The transdiagnostic and network model approaches to psychopathology have emerged as an alternative to taxonomic systems. The main goal was to examine the network structure of the transdiagnostic dimensions of emotional disorders in adolescents with subclinical emotional symptoms. In addition, cross‐sectional network analyses were conducted to investigate the relationships between transdiagnostic dimensions, psychopathology, and socio‐emotional adjustment.
Method
The sample consisted of a total of 476 adolescents from 85 schools from different provinces in Spain with subthreshold anxiety and depression. The mean age was 13.77 years ( SD = 1.43, range: 10–18 years), 73.9% were female. Several questionnaires assessing transdiagnostic dimensions of emotional disorders, mental health difficulties, self‐esteem, perceived social support, sense of belonging at school, and prosocial behaviour were used.
Results
A strong interrelation was found between the transdiagnostic variables, except with the positive temperament dimension. The dimensions with the greatest weight were those of traumatic re‐experiencing, intrusive cognitions, avoidance, neuroticism, and depressed mood. Negative relationships were found between the transdiagnostic dimensions of emotional disorders and the protective factors included in the study. Stability analyses indicated that the networks were accurately estimated.
Conclusion
The present paper points to the value of conceptualising emotional disorders from a transdiagnostic and network model perspective. In addition, the work provides new insights into the nature of the relationships between transdiagnostic dimensions of emotional disorders, and the role played by risk and protective factors.
... Показано, что употребление каннабиса и других психоактивных веществ является предиктором перехода от суицидальных мыслей и намерений к попыткам [120]. В старшем подростковом возрасте завершается формирование когнитивных функций, что ведет к возникновению более сложных и интенсивных когнитивных нарушений, например навязчивых мыслей (руминаций), усиливающих переживания безнадежности и бессмысленности, тесно связанных с суицидальным поведением [121][122][123]. Кроме того, подростковый возраст сопровождается тенденцией к группирован ию со сверстниками, что способствует возникновению имитационного поведения, в том числе рискованного и суицидального [124]. ...
The narrative review of modern literature examines epidemiological data concerning suicidal behavior of children and adolescents in various countries, both in relation to completed suicide and other manifestations of the suicidal process, such as nonsuicidal self-injury, suicidal thoughts, intentions, attempts. Based on extensive literature research, the authors highlight the main epidemiological factors influencing suicidal behavior, including the contribution of the COVID-19 pandemic, and consider modern ideas about the trajectory of suicidal behavior in children and adolescents. The implementation of the global task of preventing suicidal behavior requires careful analysis of statistical data and identification of risk groups to create a more targeted approach to the prevention of suicidal behavior.
... Rumination as Mediator between Technological stress and Emotional Detachment Due to its related to unhappy outcomes like anxiety and the use of detrimental face procedures, rumination an intellectual process highlight by recurrent, passive attention on one's anguish and its cause has been the area of much psychological research (Nolen-Hoeksema, 1991); (Conway et al., 2000). It is concept to be a homogeneous personality attributes and acknowledgment technique that makes anxiety symptoms inadequate and makes it tremendous to solve problems (Nolen-Hoeksema et al., 2007); (Papageorgiou & Wells, 2003). Scholars have emphasize its detrimental influence on mental health and stressed its implication as a susceptibility factor for the commencement and conservation of anxiety (Cooney et al., 2010); (Denson et al., 2011). ...
Pakistan's banking sector is at the forefront of digital transformation, but this progress comes with a hidden cost-techno-stress. Our study, designed with your professional needs, explores how information overload, work-life intrusion, and other tech-related anxieties impact employee well-being and commitment. We examine the prevalence of techno-stress and its links to negative thinking, emotional detachment, and career satisfaction. We aim to develop practical strategies to reduce techno-stress, fostering employee well-being and organizational effectiveness. Using surveys, we analyze how different forms of rumination affect mental health and productivity. We propose interventions to boost employee satisfaction and organizational efficiency by minimizing negative tech stressors and promoting healthy detachment. We analyze the complex relationships between techno-stress and related factors through rigorous methodology. This research underscores the need for context-specific solutions in Pakistan's banking sector, offering valuable insights and actionable recommendations to cultivate a supportive work environment that thrives alongside technological advancements.
... Previous studies have provided strong evidence of longitudinal associations between physical illness and depression and anxiety symptoms as well as the high comorbidity between sleep disturbance, depression, and anxiety (22)(23)(24). Abundant research has also established the robust associations between perceived stress, (mal)adaptive cognitions, and depression and anxiety symptoms (25,26). For instance, depression symptoms are precipitated by major stressful events and recurrent symptoms are triggered by subsequent minor stressors (27). ...
Background
Research has established the link between physical health, stress and cognition, and social connection with depression and anxiety. Nevertheless, an understanding of the comorbidity of depression and anxiety symptoms and their complex interrelationships with relevant factors remains still limited. This study investigated the complex pattern of interplay between depression and anxiety symptoms and pertinent physical, cognitive, and social factors and potential gender differences.
Methods
Using a sample of 600 middle-aged men and women, depression and anxiety as well as physical health, perceived stress and mastery, and social connection were assessed. The network structure of depression and anxiety symptoms and risk and resilience factors were characterized by examining interrelationships and the centrality indices of Strength and Bridge Strength. Gender differences were examined using the Network Comparison Test.
Results
Perceived stress and mastery were central bridge factors influencing comorbid depression and anxiety symptoms, and perceived stress, anhedonia, and mastery exhibited strong inter-connections to each other. The connections of physical health-anhedonia and sleep disturbance-irritability were stronger in men than in women, while social connection with family was linked to interpersonal problems only in women.
Conclusions
The results underscore that prevention and interventions targeting reducing perceptions of stress and promoting mastery would prevent onset or recurrence of depression and anxiety symptoms among middle-aged men and women. Engaging in behavioral activities to maintain physical health and ensuring adequate sleep could be particularly beneficial for men in reducing overall symptom severity.
... RST conceptualizes RNT as a dysfunctional cognitive reaction to negative affect, which maintains depression by intensifying and prolonging negative affect. Paradoxically, a frequent self-reported reason to engage in RNT is to understand and reduce negative emotions (Papageorgiou & Wells, 2003). However, in line with RST, excessive RNT appears to have the contrary effect. ...
... Defined as a series of relatively uncontrollable thoughts and images imbued with negative emotions (Borkovec et al., 1983), worry has been associated with efforts aimed at controlling and avoiding negative emotions by diverting attention from emotional experiences (Kashdan et al., 2008;Roemer et al., 2005;Salters-Pedneault et al., 2006) and it was found as a significant predictor of depressive and anxiety symptoms (Hoyer et al., 2009;Taylor & Snyder, 2021). Similarly, rumination, which refers to "repetitive, prolonged, and recurrent negative thinking about one's self, feelings, personal concerns and upsetting experiences" (Watkins & Roberts, 2020, p. 1), can be utilized as an emotional regulation strategy to understand the causes and meanings of the personal problems (Cludius et al., 2020;Papageorgiou & Wells, 2003) but eventually may lead to exacerbation of psychopathology, intensification of negative emotions, and impaired problem-solving (Watkins & Roberts, 2020). Due to their roles in the initiation and maintenance of various mental disorders, worry and rumination have been regarded as transdiagnostic risk factors for anxiety and mood disorders (Arditte et al., 2016;Hummel et al., 2021;McEvoy et al., 2013). ...
Objective: Insomnia as a disorder on its own or as a symptom of other mental disorders can lead to significant distress and lower quality of life. By exacerbating negative affect and emotion dysregulation, poor sleep and insomnia can contribute to the initiation and maintenance of mental disorders. The aim of this cross-sectional study was to investigate the relationship between insomnia severity and overall psychiatric symptoms (anxiety, depression, obsessive-compulsive symptoms, somatization, phobic anxiety, hostility, interpersonal sensitivity, paranoid ideation, and psychoticism), and the mediational roles of worry and rumination in this relationship.
Method: The data was collected from a community sample of 1444 participants (females 69.39%, Mage = 27.95, SD = 9.37) who completed self-report measures of insomnia severity, worry, rumination, and psychiatric symptoms. The mediational roles of worry and rumination were tested with mediation analysis using the PROCESS Macro.
Results: It was found that insomnia severity (β = 0.20, p < .001) significantly predicted psychiatric symptoms directly and via worry and rumination (β = 0.33, p < .001), meaning that worry and rumination partially mediated the relationship between insomnia severity and psychiatric symptoms. The findings were similar after controlling for smoking status, daily screen time, coffee consumption in the evening, weekly exercise frequency, and pre-sleep screen time.
Conclusions: Interventions targeting the reduction of insomnia severity and maladaptive emotion regulation strategies (e.g., worry and rumination), as well as the enhancement of adaptive emotion regulation strategies (e.g., positive refocusing and mindfulness), may alleviate the adverse effects of insomnia on psychiatric symptoms.
... Rumination is the repetitive focus on the emotional experience, its causes and effects [48,49]. This strategy is used to further understand and solve problems [50]. However, it can inhibit positive problem-solving [51] and lead to indecision and difficulty in taking action [52]. ...
Research on the development of emotions and their function as indicators of psychological adjustment has increased dramatically in recent years. The importance of emotion recognition and regulation for understanding normal development and the development of psychopathology is now undeniable. From an early age, the ability to recognise and modulate emotional responses to cope appropriately with environmental demands is associated with cognitive, behavioural and social development. This chapter aims to critically review the research field of emotion regulation, its relationship to emotional intelligence and its contribution to cognitive and social functioning in young children (up to the age of six), placing a dual emphasis on the role of physiological systems in emotion regulation and on the interface between neurophysiological and behavioural perspectives. Challenges and future directions in emotion regulation research will be discussed.
... 531). In cases in which depression contributes to unproductive recall and rumination about perceived failures (Papageorgiou & Wells, 2003), CBT's cognitive restructuring (Beck, 1979) is recommended to challenge unhelpful appraisals and substitute them with more useful and realistic appraisals. Rumination is consistent with Wong and Watt's (1991) description of unproductive obsessive reminiscence. ...
... 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). ...
Background
Cognitive retraining or remediation approaches dispense high levels of stimulation and new learning tasks, leading to an increased neural connections, which facilitate rapid recovery in patients with neurological as well as psychiatric conditions.
Objectives
The current study aimed to investigate the effect of cognitive retraining (CR) in depressive disorders. We assigned 40 patients with mild to moderate depression to two sample groups, with 20 participants each: CR alone and CR with medicine. A 6-week CR module was delivered, and participants’ scores on measures such as the Beck Depression Inventory-II, Metacognition Questionnaire 30, World Health Organization Quality of Life- Brief, and Global Assessment of Functioning were compared.
Results
Analysis using Stata/IC version 16 included descriptive statistics, paired and independent t-tests, analysis of covariance, and propensity score matching. Cohen's d was computed to determine the effect size. Within-group analysis revealed statistically significant differences in pre-post scores of the outcome measures ( p < .05) and large effect size ( d = 3.41; d = 3.60) in both groups. The difference in scores of outcome measures between the groups was not significant ( p > .05) even when covariates were controlled, or nearest neighbor match analysis was carried out. CR is effective in alleviating symptoms and dysfunctional metacognitive beliefs in addition to enhancing functioning and quality of life.
Conclusions
CR-based interventions may be essential mental health services owing to growing research in psychotherapy via virtual modes such as tele- and video-conferencing. These interventions can substantiate both prevention and remedy.
... 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.
... 2 The metacognitive model of depression was developed by Papageorgiou and Wells. 3 The main features of this model consist of positive metacognitive beliefs requiring rumination so as to find answers to emotions and problems when depressed, and negative metacognitive beliefs about the uncontrollability 168 of rumination and the danger of depressive experiences, decreased cognitive awareness of rumination, and false coping behaviors. ...
Background: Dysfunctional metacognitive beliefs form the basis of the formation and maintenance of psychopathologies. In our study, we planned to examine the common aspects of the concepts of dysfunctional metacognition, experiential avoidance, and behavioral inhibition system in depressed patients compared to healthy individuals and their effects on each other. Methods: Fifty-five depressed patients and as a control group 54 healthy volunteers par-ticipated in the study. Beck Depression Inventory, Beck Anxiety Inventory, Metacognitions Questionnaire 30, Acceptance and Action Questionnaire II, and Behavioral Inhibition and Behavioral Activation Scale were used in the study. Results: Median (minimum–maximum) Acceptance and Action Questionnaire II score was 9 (7-35) points in the control group and 30 (9-46) points in the depressed patient group (P < .001). A statistically significant difference between the groups was observed only in the Behavioral Activation Scale—reward responsiveness subscale, with 20 (14-30) points in the control group and 23 (13-36) points in the patient group. A statistically significant difference was observed between the groups in all Metacognitions Questionnaire 30 sub-scale scores (P < .001). A statistically significant positive correlation was found between depression scores and experiential avoidance (r = 0.751; P < .001), reward responsiveness (r = 0.329; P < .001) and metacognition subscale scores. In addition, a positive correlation was found between experiential avoidance and metacognition subscale scores (P < .001). Conclusion: The data we obtained support the fact that as the severity of depression increases, the patients more strongly stick to dysfunctional metacognitive beliefs, exert more frequently experiential avoidance and less often impulsive behaviors. Considering these clinical features may contribute favorably to the individualized psychotherapy process.
... 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.
... Endişe ve ruminasyonla ilgili olumlu üstbilişsel inançlar, ruminasyonun kontrol edilemezliğine ilişkin olumsuz üstbilişsel inançlar ve kişinin düşüncelerini kontrol etme ihtiyacına ilişkin üstbilişsel inançlar depresyonda belirli bir rol oynar görünmektedir (Roelofs, Huibers, Peeters, Arntz, & van Os, 2010). İki uçlu ve tek uçlu depresyonda üstbilişsel model çeşitli çalışmalarda araştırılmıştır (Papageorgiou & Wells, 2003;Kazemi & Ghorbani 2012). ...
... 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.
analytical thinking, which characterizes rumination and worry, has been shown to be a risk and maintenance factor for psychological disorders, yet there are no accessible, reliable measures that can be easily administered to assess this cognitive process. Student paramedics are at elevated risk of developing mental health difficulties associated with rumination and worry due to the nature of their work. The current study describes the development and validation of the Concrete and Abstract Thinking measure (CAT) in a sample of student paramedics. The scenario-based CAT measure was systematically developed. An initial pool of scenarios was generated based on previous research and the Worry Domains Questionnaire. A total of 14 paramedics, inclusive of student paramedics, evaluated the content of the scenarios. Final items were determined based on best-fit using confirmatory factor analysis. Two-hundred student paramedics completed the CAT measure and associated measures and 96.6% completed it again for test-retest reliability. Abstract items of the CAT measure showed good internal consistency (α=.87), test-retest reliability (ICC = .88) and good factorial, construct and criterion validity. The CAT measure was significantly associated with measures of perseverative thinking (r = .52), rumination (r = .42), worry (r = .50), depression (r = .32), anxiety (r = .41), posttraumatic stress disorder (r = .23), self-efficacy (r = -.32) and resilience (r = -.30). Overall, the CAT measure showed robust psychometric properties, evidencing good validity and reliability. The CAT measure offers a user-friendly, valid, reliable and population-specific measure of concrete and abstract thinking whilst also providing a model of how abstract thinking could be assessed in a range of populations at risk of developing mental health disorders.
Thought-related features are prevalent within psychopathologies, with around 50% of psychiatric disorders including aspects of thought in their diagnostic criteria. Even among higher levels of transdiagnostic work and a stronger focus on thought-related phenomenon, a gap remains between cognitive and clinical fields. Here, we aimed to bridge the gap between these two fields by providing a high-level organization of the most prevalently studied mental health-related aspects of thought. In this review, we surveyed the thought literature with a focus on clinical disorders with thought-related phenomena in their diagnostic criteria. From our review we identified three high level dimensions of thoughts: the content of thought, the dynamics of thought, and the relationship to thought. Within each of these levels, we then expanded on the specific aspects of thought highlighted in the cognitive and clinical literature. Identification of these categorical themes will help to isolate the specific aspects of thought driving the persistence of mental health disorders. Knowledge of the underlying cognitive mechanisms that drive disorder-related impairment can then be used to create more effective and targeted interventions.
Exposure to bullying behaviors has been associated with a variety of negative health outcomes, such as sleep complaints. However, the current state of the knowledge is limited regarding the short-term bullying processes. Thus, we conducted research with two different time frames, to analyze short- (diary) and medium-term (monthly) associations of workplace bullying with insomnia. In the first study, we used a daily diary research design, with a sample of 147 participants ( N = 735 occasions). In the second study, we used a longitudinal design with four waves and two months of time lag, with a sample of 139 heterosexual couples ( N = 278 participants; N = 1,112 occasions). Multilevel analyses showed that, in the first study, there was an indirect effect of bullying on sleep severity through rumination. In the second study, rumination transmitted the indirect effect of bullying on sleep satisfaction and sleep impact. In addition, we found a partial mediation effect of rumination between bullying and sleep severity. Furthermore, we also found a contagion of employees’ and their partners’ insomnia symptoms (i.e., severity and sleep impact). The results of this study provide some insight into the mechanisms underlying workplace bullying’s effects on sleep and identify a differential effect based on time lag.
The emotional cascade model (ECM) proposes a significant perspective on the development of borderline personality disorder (BPD), suggesting that experiencing multiple emotional cascades leads to the emergence and progression of BPD over time. The ECM proposed by Selby et al. (Behav Res Ther 46(5):593–611, 2008) provides a broad model for understanding the association between aversive negative emotional states and a wide array of dysregulated behaviors and is a unique one to explain the interplay between emotion dysregulation and behavioral dysregulation. Emotional cascades have been introduced according to a real-time phenomenon, in which there is an event, an emotional cascade, and dysregulated behaviors. According to the ECM, the core psychopathology in BPD is eventuated from emotional cascades. The emotional cascade suggests the association between unpleasantly aversive emotions and behavioral dysregulation is elucidated by a vicious self-perpetuating cycle of rumination, negative thoughts, and negative emotion. These emotional cascades occur more frequently and intensely in BPD individuals in comparison with other externalizing disorders, such as eating disorders. In line with the ECM, there is a reciprocal association between negative emotion and ruminative processes which leads to a “cascade of emotion,” which is commenced via an emotion-elicited event. This event entails an individual to ruminate intensely, which contributes to exacerbating the intensity of emotion. While the intensity of emotion rises, it becomes a hard task for an individual with BPD to elude from emotional experience through distracting attention, and in turn, an individual’s attention may be focused on emotional stimuli. Therefore, a positive feedback loop between rumination and negative affect will be generated.
A practical handbook providing a succinct overview of the different aspects of mental health disorders, facilitating a solid base knowledge of the field of psychiatry. Offering a systematic, straightforward approach, the book covers the importance and relevance of mental health disorders, their causes, presentation, and the best approaches for their treatment. Written by mental health professionals with a high level of expertise and practical experience in the treatment of patients with mental health issues, the book includes numerous clinical vignettes, bulleted lists, tables, diagrams, and algorithms to facilitate understanding. It covers the important topics across psychiatry, including the psychiatric interview; psychosocial theories and their implications for psychiatry; neurostimulation treatments; the suicidal patient; and dementias, as well as full coverage of the depressive, bipolar, anxiety, and psychotic disorders. Essential reading for medical students, trainees in psychiatry, and other healthcare professionals interested in expanding their knowledge of psychiatry and mental health.
Metacognition refers to the individual’s ability to recognize their cognitive processes, develop strategies based on
these processes, and organize strategies appropriately for the situation. According to Flavell's model,
metacognition enables the monitoring, evaluation, and, when necessary, organization of learning and thinking
processes. Metacognitive knowledge is classified as declarative, procedural, and conditional knowledge. These
types of knowledge increase the individual's awareness of their thoughts and make learning processes more
effective. Metacognitive beliefs express the value an individual attributes to their thoughts and can be positive or
negative. Positive metacognitive beliefs include the belief that worry or rumination can produce beneficial results.
In contrast, negative metacognitive beliefs carry the fear that these processes may cause harm if they cannot be
controlled. In psychopathologies, it is observed that negative metacognitive beliefs are common and individuals
develop dysfunctional thought patterns. Regarding psychopathologies, it has been observed that disorders in
metacognitive functions negatively affect cognitive processes and play an important role in the development of
mental disorders such as anxiety disorders, depression, obsessive-compulsive disorder, post-traumatic stress
disorder, and eating disorders. Inadequate metacognitive control can cause a person to establish dysfunctional
thought patterns and develop maladaptive coping skills. The negative consequences of these processes can lead to
poor prognosis for mental disorders. This review examines the basic concepts of metacognition and its relationship
to mental disorders, emphasizing the effects of metacognitive processes on emotional regulation and cognitive
appraisal. The study of metacognition makes important contributions to understanding the cognitive basis of psychpathology
Background
Although meta-cognitive and emotional beliefs are linked to higher psychological distress, little is known about the potential antecedents of these beliefs. On the other hand, the emotional schema model and metacognitive therapy posit that negative meta-cognitive and emotional beliefs generate negative repetitive thinking (NRTs) that lead to the development of psychological distress. In a meta-cognitive integrative model, we examined: (a) whether the link between emotional abuse and psychological distress was mediated serially by meta-cognitive beliefs (MCBs) and NRTs; (b) whether the relationship between emotional abuse and psychological distress was mediated serially by negative beliefs about emotional (NBEs) and NRTs.
Methods
Between 2021 and 2024, 514 outpatients (Mage = 29.29; SD = 10.88) completed the Emotional Abuse Questionnaire (EAQ), Metacognitions Questionnaire (MCQ-30), Leahy Emotional Schema Scale (LESS), Perseverative Thinking Questionnaire (PTQ), and Kessler Psychological Distress Scale (K10). The PROCESS SPSS macro was used to conduct serial multiple mediation analysis.
Results
The multilevel mediation model demonstrated that the positive relationship between emotional abuse and psychological distress was partially mediated by MCBs, NBEs, and NRTs, and serially mediated by MCBs and then NRTs. The results also showed that the link between emotional abuse and psychological distress was mediated serially by NBEs and NRTs after controlling for age and gender. The model explained much of the variance in psychological distress (R2 = 0.52).
Conclusion
The current study contributes to the literature by validating a conceptual model to confirm the association between emotional abuse and psychological distress. The hypothesized model in the present study also suggested the salience of the emotional schema model and metacognitive model in predicting psychological distress. Our results also support that NRTs are strategies utilized to cope with MCBs and NBEs.
Background:
Cognitive flexibility is a key factor underlying emotion regulation (ER) and mental health. However, the impact of cognitive flexibility on flexible deployment of ER strategies in changing contexts remains unknown. This study investigated the effects of cognitive flexibility on two noteworthy ER constructs (strategy use and flexibility) and examined downstream impacts on negative affect.
Methods:
Healthy adult participants (N = 202) completed a 10-day experience sampling protocol. Cognitive flexibility, daily ER (including flexibility and ten specific strategies) and negative affect in daily life were measured. We conducted multilevel regression and mediation models to examine associations among cognitive flexibility, daily ER, and negative affect in daily life.
Results:
Higher cognitive flexibility predicted higher ER flexibility - indicated by strategy - situation fit, use of meta-ER skills and between-strategy variability - as well as higher use of reappraisal and problem solving, but lower use of worry. Mediation analyses suggested that enhanced ER flexibility and reduced use of worry linked cognitive flexibility to reduced negative affect.
Conclusions:
Overall, findings have important implications for understanding the effects of cognitive flexibility on rigid versus flexible ER in ever-changing situations.
Rumination often leads to maladaptive consequences. Some studies report cross‐national disparities regarding the extent to which people ruminate, as well as its consequences. This study aimed to quantify the disparities in rumination between European (United Kingdom [UK]) and East Asian (Japan) countries, as well as compare its relation with depression. Gender differences were also examined. An online questionnaire survey targeting residents aged between 20 and 69 years was conducted in July 2022. Data from 3,551 participants (UK: N = 1,891, Japan: N = 1,660) were analyzed statistically using 2 × 2 multivariate analysis of variance and moderation analyses. Results showed a greater inclination towards rumination among UK residents, in comparison to those residing in Japan. The magnitude of rumination–‐depression association differed by country, with the association being more pronounced in the UK. Females displayed a higher inclination towards rumination in both the UK and Japan. In both countries, a robust association exists between rumination and concurrent depression. Implications of the findings and future directions are discussed.
Objective: Depression is a common psychiatric condition that has many factors in its
etiology and can cause serious impairment in functionality. Childhood traumatic
experiences negatively affect the development of individuals in physical, mental, and
social areas and lead to the emergence of various psychiatric diseases in the long term.
According to the metacognition hypothesis, which evaluates the role of strategies to
evaluate, monitor, and control cognitions in psychiatric diseases, traumatic
experiences in childhood cause maladaptive metacognitive beliefs in individuals.
Developing positive and negative beliefs causes the emergence of psychiatric diseases
and negatively affects the quality of life. Although there are a limited number of
studies in this context in the literature, there is no study on the effect of these factors
on the sexual quality of life. The aim of this study is to determine how childhood
traumas affect metacognition and the sexual quality of life in women with major
depressive disorder.
Materials and Methods: The sample of the study, which has a cross-sectional design,
was comprised of 91 female patients aged 20–49 who applied to the Gulhane Training
and Research Hospital Department of Psychiatry, were diagnosed with major
depressive disorder and had a regular sexual life, and 99 healthy female volunteers as
a control group who were similar in terms of the characteristics specified. During the
interview, the participants' sociodemographic data were recorded, and the Depression
Anxiety Stress Scale (DASS-21), Childhood Trauma Scale (CTQ-33), Metacognition
Scale (MCQ-30), and Sexual Life Quality Scale-Female were administered. The
obtained data were analyzed with appropriate statistical methods.
Results: The mean age of 190 participants included in the study was 32.34±7.73 years,
and the mean education year was 14.44±5.03 years. According to the structural
equation model, childhood traumas had a significant and moderate positive effect on
the Depression-Anxiety-Stress Scale-21 (standardized regression coefficient: 0.44;p<0.001) and Metacognitions Questionnaire - 30 (standardized regression coefficient:
0.36; p<0.001). It was determined that it had a negative and significant effect on the
Sexual Quality of Life Questionnaire-Female (standardized regression coefficient: -
0.35; p<0.001). While depression, anxiety, and stress levels (Standardized regression
coefficient: -0.28; p = 0.014) had a statistically significant negative effect on the
quality of sexual life, it was found that the Metacognitions Questionnaire - 30
(Standardized regression coefficient: 0.09; p = 0.388) did not have a statistically
significant effect on the sexual quality of life.
Conclusion: In the current study, which evaluated the mediating effect of childhood
traumas on metacognition and sexual quality of life in female patients with major
depressive disorder, it was determined that childhood traumas had a direct effect on
metacognition and sexual quality of life, and it also had an indirect effect on sexual
quality of life by affecting depression, anxiety, and stress levels. Further studies on the
etiology and treatment of depression, which is at risk of becoming chronic and can
affect the quality of life of individuals in all areas including sexual life if left untreated,
will contribute to the literature.
Keywords: Depression, metacognition, childhood, trauma, sexual life
The current study examined co-rumination among married men and women and its influence on their reports of marital quality and depressive symptoms. Data were collected online through social media from 78 married men and 78 married women resulting in a total sample of 156 individuals residing in urban centers in Pakistan. Each participant had been married for at least one year, was at least 18 years old, and lived with their marital partner at the time of the survey. Although the results from multiple regression analyses revealed an increase in co-rumination was related to a decrease in the levels of depression, the moderating effect of the sex of participants indicated that the negative relationship between co-rumination and depression was only significant for married women. Furthermore, co-rumination was positively associated with marital relationship satisfaction. The findings suggest that that co-rumination with one’s spouse has implications for improved mental health and marital satisfaction among married men and women in Pakistani families.
Background: The transdiagnostic and network model approaches to psychopathology have emerged as an alternative to taxonomic systems. The main goal was to examine the network structure of the transdiagnostic dimensions of emotional disorders in adolescents with subclinical emotional symptoms. In addition, cross-sectional network analyses were conducted to investigate the relationships between transdiagnostic dimensions and socio-emotional adjustment.
Method: The sample consisted of a total of 476 adolescents from 85 schools from different provinces in Spain with subthreshold anxiety and depression. The mean age was 13.77 years (SD = 1.43, range 10 to 18 years), 73.9% were female. Several questionnaires assessing transdiagnostic dimensions of emotional disorders, mental health difficulties, self-esteem, perceived social support, feeling of belonging at school, and prosocial behavior were used.
Results: A strong interrelation was found between the transdiagnostic variables, except with the positive temperament dimension. The dimensions with the greatest weight were those of traumatic reexperiencing, intrusive cognitions, avoidance, neuroticism, and depressed mood. Negative relationships were found between the transdiagnostic variables and the protective factors included in the study. Stability analyses indicated that the networks where accurately estimated.
Conclusion: The present paper points to the value of conceptualizing emotional disorders from a transdiagnostic and network model perspective. In addition, the work provides new insights into the nature of the relationships between transdiagnostic dimensions of emotional disorders, and the role played by risk and protective factors.
Response styles to depressive mood, which are ruminative or distractive responses, have both adaptive and maladaptive forms. The adaptiveness of ruminative/distractive responses is associated with decentering. However, whether decentering increases using adaptive response styles or adaptive (maladaptive) response styles heighten (lower) decentering levels remains unclear. This short-term longitudinal survey examined the sequential influence of decentering on response styles and the indirect effect of decentering on depression through response styles. One hundred twenty-six Japanese undergraduates completed questionnaires on response styles, decentering, and depressive symptoms at two points in time, four weeks apart. Cross-lagged panel analyses indicated that decentering predicted lower maladaptive ruminative and distractive responses and a higher adaptive ruminative response. Adaptive ruminative response predicted higher decentering. Furthermore, mediation analyses showed that decentering influenced depression through adaptive/maladaptive ruminative responses. Results suggest that an individual’s decentering level partly determines which response style is likely to be used when an initial depressive mood is experienced.
It is known that the repetitive and persistent ruminative thought style in depression is closely related to metacognition. In Türkiye, studies on this subject in depressed patients are relatively limited.This study aimed to examine the relationships between metacognitions and ruminative thought style in individuals diagnosed with depression.The data was collected between 01.05.2021 and 31.12.2022 from 210 depression patients who applied to psychiatric clinics of a state hospital in the Black Sea Region. Introductory Information Form, Ruminative Thought Style Scale and Metacognition-30 Scale were used to collect data. The Spearman correlation test was used to determine the correlations. Path analysis was used to test how metacognitions predicted ruminative thought in depressive individuals. It was determined that there was a statistically significant and moderately positive correlation between the mean scores of ruminative thought style and psychopathological metacognitive activity (r=0.477; p
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.
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.
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.
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 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.
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.
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.
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.
[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.
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.
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