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A Habit-Goal Framework of Depressive Rumination

February 2014
Journal of Abnormal Psychology 123(1):24-34

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University of Exeter

Rumination has been robustly implicated in the onset and maintenance of depression. However, despite empirically well-supported theories of the consequences of trait rumination (response styles theory; Nolen-Hoeksema, 1991), and of the processes underlying state episodes of goal-oriented repetitive thought (control theory; Martin & Tesser, 1989, 1996), the relationship between these theories remains unresolved. Further, less theoretical and clinical attention has been paid to the maintenance and treatment of trait depressive rumination. We propose that conceptualizing rumination as a mental habit (Hertel, 2004) helps to address these issues. Elaborating on this account, we propose a framework linking the response styles and control theories via a theoretical approach to the relationship between habits and goals (Wood & Neal, 2007). In this model, with repetition in the same context, episodes of self-focused repetitive thought triggered by goal discrepancies can become habitual, through a process of automatic association between the behavioral response (i.e., repetitive thinking) and any context that occurs repeatedly with performance of the behavior (e.g., physical location, mood), and in which the repetitive thought is contingent on the stimulus context. When the contingent response involves a passive focus on negative content and abstract construal, the habit of depressive rumination is acquired. Such habitual rumination is cued by context independent of goals and is resistant to change. This habit framework has clear treatment implications and generates novel testable predictions. (PsycINFO Database Record (c) 2014 APA, all rights reserved).

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A Habit-Goal Framework of Depressive Rumination

Edward R. Watkins

University of Exeter and University of Western Australia

Susan Nolen-Hoeksema

Yale University

Rumination has been robustly implicated in the onset and maintenance of depression. However, despite

empirically well-supported theories of the consequences of trait rumination (response styles theory;

Nolen-Hoeksema, 1991), and of the processes underlying state episodes of goal-oriented repetitive

thought (control theory; Martin & Tesser, 1989,1996), the relationship between these theories remains

unresolved. Further, less theoretical and clinical attention has been paid to the maintenance and treatment

of trait depressive rumination. We propose that conceptualizing rumination as a mental habit (Hertel,

2004) helps to address these issues. Elaborating on this account, we propose a framework linking the

response styles and control theories via a theoretical approach to the relationship between habits and

goals (Wood & Neal, 2007). In this model, with repetition in the same context, episodes of self-focused

repetitive thought triggered by goal discrepancies can become habitual, through a process of automatic

association between the behavioral response (i.e., repetitive thinking) and any context that occurs

repeatedly with performance of the behavior (e.g., physical location, mood), and in which the repetitive

thought is contingent on the stimulus context. When the contingent response involves a passive focus on

negative content and abstract construal, the habit of depressive rumination is acquired. Such habitual

rumination is cued by context independent of goals and is resistant to change. This habit framework has

clear treatment implications and generates novel testable predictions.

Keywords: rumination, control theory, response styles, goal, habit

Depressive rumination is the tendency to repetitively analyze

oneself and one’s problems, concerns, and feelings of distress and

depressed mood (Nolen-Hoeksema, 1991;Watkins, 2008). Pro-

spective longitudinal and experimental studies have implicated

depressive rumination in the onset and maintenance of symptoms

and diagnosis of major depression (Nolen-Hoeksema, 2000;

Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008;Watkins, 2008),

as well as anxiety disorders, eating disorders, and substance/

alcohol abuse, leading to the hypothesis that it is a transdiagnostic

pathological process (Harvey, Watkins, Mansell, & Shafran, 2004;

Ehring & Watkins, 2008;Nolen-Hoeksema & Watkins, 2011).

The principal theory concerning depressive rumination is the

response styles theory (RST; Nolen-Hoeksema, 1991), which hy-

pothesizes that depressive rumination is a stable, enduring, and

habitual trait-like tendency to engage in repetitive self-focus in

response to depressed mood (see Nolen-Hoeksema et al., 2008).

RST argues that depressive rumination leads to depression by

enhancing negative mood-congruent thinking, impairing problem

solving, and interfering with instrumental behavior, with these

mechanisms confirmed in experimental studies (Nolen-Hoeksema,

1991;Nolen-Hoeksema et al., 2008).

A distinct alternative view of rumination is provided by

control theory accounts, which define it as “a class of conscious

thoughts that revolve around a common instrumental theme and

that recur in the absence of immediate environmental demands

requiring the thoughts” (Martin & Tesser, 1996, p. 7). This account

explains the conditions leading to state episodes of ruminative

thought. It hypothesizes that state rumination is initiated by, and

focused on, a perceived discrepancy between one’s goals and one’s

current state and continues until the goal is either attained or

abandoned (Martin & Tesser, 1989,1996). Unlike RST, this ac-

count encompasses both normal and constructive versus abnormal

and unconstructive forms of repetitive thought: Goal-oriented ru-

mination can be helpful if focus on the unresolved goal facilitates

progress, but unhelpful if it only serves to increase salience of the

discrepancy. Consistent findings confirm that unattained person-

ally important goals predict repetitive thought in real-world studies

(see Watkins, 2008).

Watkins (2008) examined what processes determine whether

repetitive thought has unconstructive versus constructive conse-

quences. During rumination, negative thought content, negative

context (e.g., negative mood), and abstract-evaluative thinking

focused on the meaning and implications of negative events (e.g.,

asking “Why?”) relative to concrete thinking, focused on the

details, process, and context of negative events (e.g., asking

“How?”), contribute to unconstructive outcomes. In control theory,

goals, events, and actions can be represented at different levels of

abstraction within a hierarchy ranging from abstract representa-

tions capturing their decontextualized gist and characterizing why

they occurred or are performed, down to concrete representations

of their contextual and situational details characterizing how they

occurred or are to be performed. Effective self-regulation requires

Edward R. Watkins, Mood Disorders Centre, School of Psychology,

University of Exeter, Exeter, United Kingdom, and School of Psychology,

University of Western Australia, Perth, Australia; Susan Nolen-Hoeksema,

Department of Psychology, Yale University.

Correspondence concerning this article should be addressed to Edward R.

Watkins, Sir Henry Wellcome Building for Mood Disorders Research, University

of Exeter, Perth, Australia, EX4 4GG. E-mail: e.r.watkins@exeter.ac.uk

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This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.

2014, Vol. 123, No. 1, 24–34 0021-843X/14/$12.00 DOI: 10.1037/a0035540

flexible movement through the hierarchy to match circumstances.

Overly abstract processing of negative information was hypothe-

sized and found to be unhelpful because it increases the personal

importance of events and exacerbates emotional reactivity (Wat-

kins, Moberly, & Moulds, 2008) and impairs problem-solving by

limiting the availability of detailed alternative plans (Watkins &

Moulds, 2005). This elaborated control theory account (Watkins,

2008) provides a partial reconciliation between RST and control

theory because it identifies abstract-evaluative thinking focused on

negative content as pathological, consistent with the RST charac-

terization of depressive rumination as focusing on the causes and

implications of depressive mood.

Despite the successes of these theories, key questions such as

“What are the developmental antecedents of individual differences

in rumination?” and “What makes it so difficult to break free of

rumination once it has begun?” remain unanswered (Nolen-

Hoeksema et al., 2008, p. 418). Moreover, the relationship be-

tween state episodes of goal-oriented repetitive thought and the trait

tendency toward depressive rumination is unresolved. Are they sepa-

rate and distinct processes? Or do some individuals transition from

state episodes of goal-oriented rumination into more habitual de-

pressive rumination?

A major but relatively unelaborated implication within RST is

that depressive rumination is a habitual cognitive response to

negative mood (Nolen-Hoeksema et al., 2008). We propose that

more explicitly considering rumination as a mental habit (see

Hertel, 2004) has value in generating potential insights and testable

hypotheses relevant to these issues. Habits are behaviors that are

performed frequently in stable contexts (Ji & Wood, 2007). In

classical conditioning and learning theory (e.g., Hull, 1943), habits

are learned behavioral responses to situational cues that have

become established through a history of systematic repetition and

reinforcement. A stimulus–response (S-R) habit is learnt when a

particular behavioral response is contingent on the stimulus (Dick-

inson, 1985;Mackintosh, 1983;Rescorla & Wagner, 1972). For

example, with overtraining or training with interval schedules of

reward contingency, animals learn to perform a response habitu-

ally to set cues, even when the reward is devalued, for example, by

making animals mildly ill with a lithium chloride injection after

consuming sucrose pellets (Dickinson, 1985).

Wood and Neal (2007, p. 843) defined habits as “learned dis-

positions to repeat past responses. They are triggered by features of

the context that have covaried frequently with past performance,

including performance locations, preceding actions in a sequence,

and particular people.” Habitual behavior typically involves some

automaticity (Verplanken, 2006;Verplanken & Orbell, 2003;

Wood, Tam, & Witt, 2005). A behavior can be conceptualized as

automatic on several distinct dimensions: lack of conscious aware-

ness, not requiring extensive resources to be performed (e.g.,

performed equally well under cognitive load vs. not under load),

lack of control, and lack of conscious intent (Bargh, 1994). Ver-

planken, Friborg, Wang, Trafimow, and Woolf (2007, p. 526)

proposed that a habit is “a behavior that has a history of repetition,

is characterized by a lack of awareness and conscious intent, is

mentally efficient, and is sometimes difficult to control.”

As a response that occurs frequently, unintentionally, and repet-

itively to the same emotional context (depressed mood), depressive

rumination fulfils all of these conceptualizations of habit. Its gold

standard measure, the Response Styles Questionnaire (Nolen-

Hoeksema & Morrow, 1991), assesses the frequency of repeated

ruminative behaviors in response to the stable internal context of

feeling sad, down, or depressed. Depressive ruminators report that

rumination occurs without conscious intent, and that they are

unable to control it (Watkins & Baracaia, 2001). A self-reported

index of habitual negative thinking capturing frequency, lack of

conscious awareness, lack of conscious intent, mental efficiency,

and difficulty in control was positively correlated with both trait

and state rumination (Verplanken et al., 2007).

More explicitly, Hertel (2004) hypothesizes that rumination is a

habit of thought, noting that the initiation of an episode of rumi-

nation often occurs automatically, without conscious awareness or

effort. Hertel argues that impairments in cognitive control may

enable the emergence of such mental habits. Situations in which

stimulus and task dimensions do not inherently constrain and guide

attention (e.g., tasks with lax external control) afford habitual

rumination in patients with depression (Hertel, 1998), whereas

situations constrained to force participants to sustain attention on

particular task stimuli do not (Hertel & Rude, 1991). Outlining an

argument further developed here, Hertel (2004, p. 208) proposes

that “the best antidote to maladaptive habits is a new set of habits”

formed through repeated practice at more controlled responses.

In this article, we focus on analyzing depressive rumination as

a habit, consistent with Hertel (2004), while adding Wood and

Neal’s (2007) empirically supported theoretical framework. We

propose that applying this habit-goal framework provides a means

to understand the relationship between trait depressive rumination

(RST) and goal-oriented state repetitive thought (control theory),

helps to explain why rumination may be hard to change, and

suggests novel therapeutic implications and testable predictions.

A Habit-Goal Framework of Depressive Rumination

Wood and Neal (2007) argue that repeated performance of a

behavior in a consistent context can lead to the development of

habitual responding via (a) associative learning and (b) instrumen-

tal learning. They identify three interrelated principles that sum-

marize the development and performance of habits: (a) habits are

cued by context; (b) habit context–response associations are not

mediated by goals; and (c) because habits are acquired slowly with

experience, they are inherently conservative and tend to persist

even in the face of antagonistic current goals or intentional behav-

ior. These principles reflect properties within conditioning models

(Mackintosh, 1983;Rescorla & Wagner, 1972), in which (a) habits

are acquired when responses are contingent on stimulus contexts;

(b) S-R habit strength is not mediated by goals; (c) because habits

are acquired slowly, they extinguish or countercondition slowly.

We propose that these principles provide a useful framework to

consider how the consequences of habits may play out in depres-

sive rumination, with implications for understanding and treating

depressive rumination.

First Principle: Habits are Directly Cued by Context

as a Result of Frequent Covariation of the Behavior

With the Cueing Context

Wood and Neal (2007, p. 844) propose that “habits typically are

the residue of past goal pursuit: they arise when people repeatedly

use a particular behavioral means in particular contexts to pursue

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HABIT FRAMEWORK OF DEPRESSIVE RUMINATION

their goals.” Such context cues become automatic triggers for the

behavioral response, such that the behavior is controlled by the

presence or absence of the cue, rather than mediated by an implicit

or explicit goal. Thus, a goal-based response that occurs frequently

and contingently to a particular context could result in the devel-

opment of a habitual response to that context, consistent with

classic S-R theories of learning (Mackintosh, 1983). Context in-

cludes physical setting (e.g., bedroom), time of day, the people

(e.g., alone), behaviors performed prior to, and internal state (e.g.,

mood, fatigue; Ji & Wood, 2007), and any combination thereof in

which the behavior typically occurs.

The formation of associative links between the habitual re-

sponse and a potential cueing context requires the repeated coacti-

vation of the mental representations of both response and context,

as a consequence of contingent pairings between the response and

the cueing context across multiple episodes in the environment.

The learning of a habit (S-R association) requires the context and

the response to occur close together in time (temporal contiguity),

and for the potential habitual response (e.g., rumination) to be

contingent on the stimulus context. With repetition across multiple

episodes, incremental changes are hypothesized to occur in pro-

cedural memory, such that the common features of response and

context become learnt and encoded (Gupta & Cohen, 2002). Im-

portantly, multiple different behaviors occurring in a particular

context will weaken any reliable covariation and contingency

between any one particular habitual behavior and the contextual

cue: “The greater the numbers of behaviors linked to a given

context, the lesser the capacity for the context to cue any one

behavior directly” (Wood & Neal, 2007, p. 858).

Implications for depressive rumination. This habit-goal

framework suggests that depressive rumination will become a

habitual trait if state episodes of ruminative thought are contingent

on the context of negative mood, such that the negative mood state

becomes an automatic cue for ruminative thought. This account

provides a mechanism by which state episodes of repetitive

thought initiated by goal discrepancy (consistent with control

theory) can become habitual if such thinking is contingent on a

co-occurring context (negative affect; consistent with RST). With

respect to goal-discrepancy accounts of rumination (Martin &

Tesser, 1989,1996;Watkins, 2008), the identification of an unre-

solved goal (or of insufficient goal progress) can directly generate

repetitive thought as a function of increased priming and accessi-

bility of goal-relevant information, and the perseverance of goal-

related thoughts (Brunstein & Gollwitzer, 1996;Goschke & Kuhl,

1993;Martin & Tesser, 1989;Zeigarnik, 1938).

Control theory accounts (Carver & Scheier, 1982) and goal

models of emotion (Oatley & Johnson-Laird, 1987) also predict

that insufficient goal progress can generate negative affect (e.g.,

perceived loss of valued goal produces sadness). These dual effects

of unresolved goals afford the opportunity for sad mood (or other

mood states) to co-occur with repetitive thought, making it a

potential mechanism for developing habitual repetitive thought.

Building on Wood and Neal (2007), this goal-habit framework

suggests that habitual rumination can emerge as an unintended

residue of goal-oriented repetitive thought.

However, the repetitive thought produced by unresolved goals is

not necessarily pathological: As noted earlier, goal-oriented repet-

itive thought can be constructive (Watkins, 2008). Thus, the habit

of pathological depressive rumination would only develop under

conditions in which the form of state repetitive thought contingent

on a stable context (e.g., depressed mood) was predominantly

passive, negative, and abstract. If, over time, an individual used a

range of different behaviors (e.g., distraction, abstract thought) in

response to unresolved goals and associated negative mood, there

may be no distinct contingency between context and response, and

no particular habit would develop. Conversely, the repeated use of

concrete action-oriented thinking in the face of goal discrepancy

might buffer against the development of unhelpful rumination-as-

a-habit (Watkins, 2008), instead forming a helpful habit of prob-

lem solving to sad mood. Thus, the co-occurrence of episodes of

goal-discrepancy rumination and negative mood is insufficient to

result in trait depressive rumination, explaining why many people

can experience occasional episodes of negative rumination without

necessarily developing depressive-rumination-as-a-habit.

This habit-goal framework suggests hypotheses about the de-

velopmental antecedents of individual differences in depressive

rumination. The formation of habitual depressive rumination is

hypothesized to involve two background conditions: (a) environ-

ments and situations that generate repeated and frequent episodes

of goal-discrepancy repetitive thought contiguous and contingent

with negative mood (and other contextual cues, e.g., behavior of

others; locations), such as the experience of having hard-to-

abandon personally important goals chronically thwarted (e.g.,

chronic stress, abuse, or trauma); and (b) a restricted repertoire of

coping behaviors and/or reduced flexibility in selecting behaviors

within this repertoire, constraining individuals toward passive and

abstract responses, which increases the likelihood of unhelpful

episodes of repetitive thought becoming contingent to negative

mood.

To date, these background conditions have tended to be studied

in isolation. A novel prediction from this framework is that the

effect of one background condition on the formation of

rumination-as-a-habit will be moderated by the presence or ab-

sence of the other condition. Being in an ongoing difficult situation

will not necessarily lead to habitual depressive rumination: Ongo-

ing difficulties may lead to episodes of state rumination as a

normal and often adaptive response to unresolved goals, but this

will not result in habitual depressive rumination unless unhelpful

episodes of repetitive thought are contingent on the associated context

(e.g., sad mood), which will be facilitated by a reduced range of

coping options. Conversely, having a tendency toward abstract

processing or passive responses will not necessarily lead to habit-

ual depressive rumination, unless there are ongoing unresolved

goals that afford the opportunity for repeated episodes of repetitive

thought in a co-occurring context, leading to repetitive thought

being contingent on negative mood. Of course, some circum-

stances may simultaneously produce both conditions (e.g., neglect,

abuse), and are thus significant risk factors for habitual rumination.

Consistent with exposure to chronically unresolved goals acting

as a setting condition, trait depressive rumination is associated

with history of sexual abuse, emotional abuse, and assault, which

reflect situations in which major personal goals of safety, affilia-

tion, and sense-making tend to be chronically unresolved (e.g.,

Conway, Mendelson, Giannopoulos, Csank, & Holm, 2004;Spa-

sojevi´

c & Alloy, 2002). Further, ongoing chronic stress and re-

duced sense of mastery in women predicted increases in trait

rumination over time (Nolen-Hoeksema, Larson, & Grayson,

1999).

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26 WATKINS AND NOLEN-HOEKSEMA

This account hypothesizes that developmental circumstances

and socialization processes that encourage limited and passive

responding increase the likelihood of developing habitual rumina-

tion. Such circumstances include overcontrolling parenting, re-

duced positive reinforcement, and socialization into the stereotypi-

cally feminine gender role identity.

Operant conditioning approaches hypothesize that when active

responses repeatedly fail to receive sufficient positive reinforce-

ment, the contingency learnt is that there is no value in being

active, leading to a reduced behavioral repertoire and increased

passive responding (Ferster, 1973). Thus, any environment char-

acterized by reduced positive reinforcement is hypothesized to

engender the development of passive responding. Mothers who did

not explicitly encourage their 5- to 7-year-old children to try

different approaches, and who told the child what to do, had

children who become more helpless, passive, and poorer at active

problem solving when faced with an upsetting and frustrating

situation (Nolen-Hoeksema, Mumme, Wolfson, & Guskin, 1995).

Consistent with such parenting being associated with habitual

rumination, in a retrospective design, Spasojevi´

c and Alloy (2002)

found that undergraduates who reported overcontrolling parenting

during their childhood reported increased trait rumination, after

controlling for levels of psychopathology. Further, in a multiwave

prospective study, Gaté et al. (2013) found that laboratory obser-

vation of reduced positive maternal behavior (indexed by fre-

quency of happy, pleasant, or caring affect, and approving, vali-

dating, affectionate, or humorous statements) when discussing and

planning a pleasant event with the child at age 12 prospectively

predicted trait depressive rumination in the child at age 15, but

only in girls. Thus, fewer validating and caring responses from

mothers to daughters when jointly planning a pleasant event pre-

dicted later rumination. This gender effect is consistent with the

commonly found gender difference in the expression of rumina-

tion, with rumination more frequent in girls and women than boys

and men (Nolen-Hoeksema et al., 1999), with this gender differ-

ence emerging in early adolescence (ages 12 to 13; Jose & Brown,

2008).

This gender difference in rumination may partially reflect de-

velopmental differences in the socialization into gender role iden-

tities. The stereotypically feminine gender role identity emphasizes

greater focus on emotions and passivity. Therefore, socialization

into this gender role is hypothesized to increase the likelihood of

developing rumination-as-a-habit. Consistent with this, in a pro-

spective longitudinal study, Broderick and Korteland (2004) found

that 9- to 12-year-old schoolchildren strongly identifying with the

feminine role identity reported significantly more trait rumination

at follow-up, regardless of gender. Cox, Mezulis, and Hyde (2010)

found that greater feminine gender role identity among children at

age 11, and maternal encouragement of emotion expression in

response to the child completing a difficult math task, each sepa-

rately mediated the relationship between child gender and the

development of trait depressive rumination at age 15, after con-

trolling for trait rumination at age 11.

An abstract style of responding to difficulties is also implicated

in impaired problem solving and reduced action orientation (Wat-

kins, 2008). In healthy individuals, there appears to be flexibility

and contextual variability in the use of abstract versus concrete

processing, with individuals adopting abstract processing as a

default mode, particularly when in positive mood, but switching

toward concrete processing in response to difficulties and sad

mood (Beukeboom & Semin, 2005;Watkins, 2011). This flexibil-

ity in regulating processing mode to different contexts is hypoth-

esized to be functional, with concrete processing aiding problem

solving, and thus adaptive for difficult situations, whereas abstract

processing aids longer-term planning, generalization, and consis-

tency and stability of behavior toward long-term goals across time

and situations, and is thus adaptive when things are going well.

There are individual differences in the tendency and/or ability to

regulate processing mode to context, with depressed patients im-

paired at becoming more concrete in response to sad mood relative

to healthy controls (Watkins, 2011;Watkins, Moberly, & Moulds,

2011). We hypothesize that these individual differences influence

the formation of habitual depressive rumination: Impaired regula-

tion of processing mode reduces flexibility in responding and

increases the likelihood of episodes of repetitive thought being

unhelpful, providing circumstances for such thinking to become

contingent on low mood.

Such dysregulation of processing mode could reflect deficits in

cognitive control: Individuals with deficits in executive/inhibitory

control, either because of greater cognitive load or reduced cog-

nitive resources, may be impaired at effectively regulating pro-

cessing in response to situational demands (Watkins, 2011). Dys-

regulation of processing mode could also be the consequence of

past developmental learning and parenting style. Praising or crit-

icizing a child generically (i.e., as a person, “You are a good boy”),

rather than giving feedback on the specific process and concrete

behavior (e.g., “You came up with a good solution”), can lead

children to think in abstract trait terms (for both positive and

negative events), leading to helplessness in response to later mis-

takes (Cimpian, Arce, Markman, & Dweck, 2007;Kamins &

Dweck, 1999).

The hypothesized relationship between habitual depressive ru-

mination and a restricted coping repertoire is probably bidirec-

tional. As well as a reduced range of coping strategies increasing

the chance of episodes of unhelpful repetitive thought becoming

contingent on negative mood, habitual rumination may also reduce

flexibility in selecting coping strategies. Rumination mediates the

relationship between induced negative affect and working memory

capacity (Curci, Lanciano, Soleti, & Rimé, 2013) and causally

reduces central executive functioning (Watkins & Brown, 2002),

which are implicated in flexible responding.

Second Principle: Habit Context–Response

Associations Are Not Mediated by Goals

Wood and Neal (2007) suggest that the habitual response is then

activated by the perception of the cues in the context in which the

behavior has been repeatedly performed, such that the habit is

performed without mediation by a goal. Supporting this account,

contexts, but not goals, automatically trigger overt habit perfor-

mance (Ji & Wood, 2007;Neal, Wood, Labrecque, & Lally, 2012).

For strong habits, attitudes and intentions have limited predictive

power on behavior, whereas one index of habit strength (opera-

tionalized by combining frequency and stability of behavior to the

same context) predicts how much people repeat behavior, even in

the absence of an explicit supporting goal (Ji & Wood, 2007;Neal

et al., 2012;Ouellette & Wood, 1998).

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HABIT FRAMEWORK OF DEPRESSIVE RUMINATION

Implications for depressive rumination. The goal-habit

framework suggests that depressive rumination would be triggered

by the relevant cueing context (e.g., negative mood) in the absence

of a personally important unresolved goal or of an intention to

think about the related concern. The habit being directly cued by

context means that depressive rumination can occur without direct

intention and without effort. Once the habit is formed, rumination

can still occur even if the unresolved goals that originally triggered

episodes of state repetitive thought have been attained or aban-

doned. Moreover, negative mood states induced by processes other

than a perceived goal discrepancy, such as direct physical or

biological effects (e.g., effect of weather, pharmacological agent),

or direct responses to stimuli (e.g., empathic response to another’s

distress, watching a sad movie), could then trigger rumination,

extending the range of situations cueing this response.

This principle could be tested by adapting the methodologies

used by Ouellette and Wood (1998) and Neal et al. (2012) in which

habit strength, context, explicit goals, self-efficacy, attitudes, and

beliefs are examined as prospective predictors of the repeated

behavior (episodes of depressive rumination). Habit strength is

hypothesized to predict subsequent ruminative behavior, as as-

sessed by diary or experience sampling methods, over and above

motivational and belief variables.

Motivated cueing and instrumental learning. In addition to

associative learning, Wood and Neal (2007, p. 846) propose that

habit associations may also arise through a process in which the

reward value of response outcomes (e.g., positive affect from eating

popcorn) is conditioned onto context cues (e.g., movie theater) that

have historically accompanied the receipt of those rewards. This

analysis builds on instrumental learning theories in which habits

develop as organisms learn context–response associations in order to

obtain rewarding events.

In this process of motivated cueing, given sufficient repetitions,

the reward associated with a response is conditioned on the con-

textual cue, such that the cue then motivates the response by

activating a desire or urge toward the response as an opportunity to

acquire the associated reward.

Because depressive rumination has such clear negative conse-

quences, it is not obvious what potential reward value or instru-

mental function it may have. Nonetheless, motivated cueing could

potentially cement the strength of the habit if robust reinforcing

functions for rumination exist.

Rumination has been hypothesized to act as avoidance that is

negatively reinforced by reducing distress. Martell, Addis, and

Jacobson (2001, p. 121) proposed that “although rumination may

be experienced as aversive to the individual, it is possible that it is

maintained by the avoidance of even more aversive conditions.”

Rumination may put off overt action and avoid the risk of actual

failure and humiliation, or serve to avoid unwanted personal char-

acteristics (e.g., becoming selfish) through constant vigilance and

criticism of one’s performance. Nolen-Hoeksema et al. (2008)

hypothesized that rumination is reinforced by the reductions in

distress that come from withdrawing from aversive situations and

from being relieved of responsibility for outcomes. Although trait

rumination is correlated with avoidance (e.g., Giorgio et al., 2010),

this is not direct evidence that rumination has an avoidant function.

Rumination may also have perceived positive reward value as a

means to increase understanding and insight into self, feelings, and

problems, and to make sense of difficulties (Lyubomirsky &

Nolen-Hoeksema, 1993;Watkins & Baracaia, 2001). Believing

that rumination increases understanding predicts the maintenance

of trait rumination over 8 weeks prospectively (Kingston, Watkins,

& O’Mahen, 2013), while experimentally manipulating appraisals

that rumination is helpful versus unhelpful for understanding prob-

lems causally influenced state rumination occurring to a subse-

quent failure task (Kingston & Watkins, 2013).

However, there is no direct experimental evidence of whether

depressive rumination has any reinforcing qualities and whether

they consolidate it as a habit. Testing this functional hypothesis is

challenging: Each individual may have his or her own idiosyn-

cratic function(s) for rumination, making it hard to detect the

effects of manipulating rumination on functional outcomes within

standardized experimental conditions. Experimental studies also

need to ensure that the function under test is of value to the

participant. For example, there is no point in testing for an

avoidant function unless the study design exposes the participant

to a sufficiently negative experience that is meaningful and moti-

vating for the participant to avoid. Kingston, Watkins, and Nolen-

Hoeksema (2013) exposed undergraduates to the challenging sit-

uation of believing they had to be assertive to a friend or family

member about a difficult issue, before randomizing them to rumi-

nating about this situation versus thinking over the situation in a

nonruminative way, and assessed various indices of avoidance as

dependent variables. Consistent with Nolen-Hoeksema et al.’s

(2008) hypothesis, rumination increased justification for avoidance

by reducing sense of responsibility and increasing certainty that

efforts would be fruitless, relative to the control condition.

This design only tested whether manipulating rumination influ-

ences outcomes that enable inference about function. A necessary

further stage to test the functional hypothesis is to examine

whether such inferred functions increase the use of rumination.

One potential next step is to test whether individual differences in

the effect of manipulated rumination on justification for avoidance

prospectively predicts trait rumination.

Third Principle: Because Habits Are Acquired Slowly

With Experience, They Are Conservative and Do Not

Alter in Response to Current Goals or Infrequent

Counterhabitual Responses

Wood and Neal (2007, p. 844) argue that “habits arise from

context–response learning that is acquired slowly with experience.

As a result, habit dispositions do not alter in response to people’s

current goals or occasional counterhabitual responses. Thus, habits

possess conservative features that constrain their relation with

goals.” Hertel (2004, p. 208) noted that “habits of thought are

difficult to oppose.” Habits are insensitive and resistant to changes

in goals, outcomes, and intentions, including the devaluing of

outcomes (Dickinson, 1985).

Because control of a habitual behavior is outsourced directly to

those contextual cues that have been reliably paired with past

enactment of the behavior, habits are enacted and performed

without reference to goals or outcomes. Because a habitual behav-

ior is not especially sensitive to either outcomes or goals, it

continues to be performed even if it has unhelpful outcomes.

Further, because automatic cueing of behavior in response to

contextual cues is likely to be more immediately available and

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28 WATKINS AND NOLEN-HOEKSEMA

require less executive capacity than more deliberate and thoughtful

actions, it will tend to take precedence over intentional behaviors.

Thus, when in conflict with habits, goals have little impact on

actual behavior. Similarly, when goals are in concert with habits

and both dictate the same response, goals effectively become

epiphenomena.

Implications for depressive rumination. This analysis sug-

gests that once rumination becomes a habit, it will be hard to stop

even if new behavioral goals are adopted, even if it has negative

consequences, or even if the rumination is at odds with an indi-

vidual’s attitudes and intentions. This is consistent with the phe-

nomenological quality reported by patients of “not being able to

help” ruminating (Watkins & Baracaia, 2001). Intentions to stop

ruminating alone are unlikely to be successful and habitual rumi-

nation will be resistant to change. The goal-habit framework thus

provides a partial explanation of why patients find it so difficult to

break free of rumination once it has begun, even when they

recognize it has negative consequences.

Implications for the Treatment of

Depressive Rumination

This framework offers a fresh approach to considering interven-

tions for depressive rumination when allied with the literature on

successful habit change. It suggests, for the reasons noted thus far,

that interventions focused on changing individual’s beliefs, atti-

tudes, and intentions, and on providing new information, are

unlikely to be effective at changing habitual behaviors, as empir-

ically confirmed by Verplanken and Wood (2006) and Webb and

Sheeran (2006). Changing goals, persuasion, cognitive restructur-

ing, or psychoeducation is thus hypothesized to be less effective at

changing depressive rumination. Although trait rumination has not

been frequently examined in randomized controlled trials of psy-

chological interventions, the few extant studies suggest that rumi-

nation does not change significantly in response to cognitive–

behavioral therapy (CBT; Schmaling, Dimidjian, Katon, &

Sullivan, 2002) or that elevated rumination predicts worse out-

comes to CBT (Jones, Siegle, & Thase, 2008). We hypothesize

that the more rumination is a strong (vs. weak) habit, the harder it

will be for patients to stop, and the less successful information-

based interventions will be (Webb & Sheeran, 2006).

Instead, Wood and Neal (2007, p. 860) propose that “interven-

tions to maximize habit change provide people with concrete tools

for controlling habit cueing.” The current framework suggests that

habits can be broken by altering or avoiding exposure to the cues

that trigger habit performance (Verplanken & Wood, 2006). Re-

moving contextual cues could occur as a consequence of deliberate

attempts to control cue exposure, which may require ongoing and

sustained effortful control to identify and avoid relevant cues, or

from unplanned changes that occur naturally as a consequence of

life events, such as moving to a new house or changing jobs. Wood

et al. (2005) found that when the location or environment associ-

ated with a habitual behavior (e.g., TV watching) changed when

students transferred to a new university, the behavior became less

habitual.

Hence, this framework suggests that one way to reduce depres-

sive rumination is to alter or reduce exposure to its triggering

context. When the cueing context for rumination involves a par-

ticular location (e.g., bedroom), person, preceding behavior (e.g.,

sitting down for a coffee after work), or environmental feature

(e.g., sad music), environmental modification to remove or avoid

the triggering context is hypothesized to interrupt depressive ru-

mination.

One context identified by Hertel (1998,2004) is situations that

lack external control over attention and that therefore afford mind

wandering. Habitual rumination is more likely to occur when the

current activity or task does not externally constrain attentional

focus. Habitual rumination will be triggered during tasks that are

open-ended, unstructured, and rely on self-control, and when an

individual has an “empty” unplanned period of time, such as lying

in bed doing nothing. Introducing more structure and constraints

into activities may change the context to reduce the triggering of

habitual rumination.

A long-term reduction in rumination is possible if contextual

cues can be permanently removed or consistently avoided. How-

ever, this strategy is dependent on individuals being able to accu-

rately identify cues for habits, requiring a detailed functional and

contextual analysis to determine the triggering cues for rumination,

although this may not always be successful. Consistent with this

hypothesis, an intervention incorporating functional analysis and

stimulus control (rumination-focused CBT, Watkins et al., 2007;

utilizing behavioral activation principles, Martell et al., 2001)

successfully reduced depression and rumination (Watkins et al.,

2011) in a randomized controlled trial. However, this treatment

had multiple components, and the effectiveness of stimulus control

has not been tested as a separate intervention. This framework

predicts that stimulus control alone will reduce trait depressive

rumination when there are identifiable environmental cues tracta-

ble to modification.

However, when the cueing context is an internal state, such as a

negative mood, as typical for depressive rumination, it is less

straightforward to permanently alter or avoid the context. This

framework predicts that reducing the negative mood would, at

least temporarily, reduce the enactment of the depressive rumina-

tion habit. This framework predicts that any intervention that

reduces negative mood, whether antidepressant medication, psy-

chotherapy, distraction, or change in circumstances, would reduce

the expression of habitual rumination by removing one cue that

triggers the ruminative habit. Consistent with this, self-reported

trait rumination reduces as acute symptoms of depression diminish

(Roberts, Gilboa, & Gotlib, 1998).

However, a key implication of this framework is that removing

the context does not change the context–response association

underlying the habit but only limits its expression. On any subse-

quent return of the triggering context, such as another period of sad

or depressed mood, the ruminative habit would reoccur. This

analysis therefore predicts that any interventions that improve

mood state will temporarily disrupt depressive rumination, but

only interventions that directly modify the context–response asso-

ciation will lead to long-standing reductions in depressive rumi-

nation and associated depressive vulnerability. In sum, improve-

ments in mood can temporarily reduce rumination by removing a

potential cue for the habit. However, because of their conservative

nature, habits are easily reactivated and do not change unless the

S-R association itself is counterconditioned.

This account can partially explain the high rates of relapse and

recurrence (50% to 80%) and the limited sustained recovery (less

than one third at 1 year) obtained for even our best interventions

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HABIT FRAMEWORK OF DEPRESSIVE RUMINATION

for depression (Hollon et al., 2002). We hypothesize that many

interventions for depression improve symptoms in the short term

through positive expectancy, remoralization, increased activation,

and therapist support, but because they do not directly target

depressogenic habits like rumination, they leave patients vulnera-

ble to relapse. A novel testable prediction is that posttreatment

measures indexing habit strength for rumination (and alternative

coping strategies) will better prospectively predict sustained re-

covery for depression than posttreatment beliefs, expectancies, and

symptoms. One such measure is the Self-Report Habit Index,

which measures the frequency and automaticity of behavior, has

good reliability and validity predicting actual habitual behavior

(Orbell & Verplanken, 2010;Verplanken & Orbell, 2003;Ver-

planken et al., 2007), and is adaptable for different behaviors.

This key implication suggests that directly targeting the auto-

matic context–response association will improve the efficacy and

durability of interventions for rumination and depression. Marteau,

Hollands, and Fletcher (2012) noted that most interventions aimed

at changing health-related behaviors target reflective processes

rather than automatic habits, and that this may explain the relative

inefficacy of these interventions. We propose that this analysis is

equally pertinent to improving mental health, because automatic

mental habits (e.g., rumination) are a central process within psy-

chopathology.

To be effective at modifying the context–response association,

and thereby reducing habitual rumination, the unhelpful rumina-

tive response to the cueing context needs to be replaced with a

more helpful response, with the patient in effect learning a new

more adaptive habit. This echoes Hertel’s (2004, p. 209) recom-

mendation toward “the training of new habits through practice in

control.” Changing these habits requires “counterconditioning or

training to associate the triggering cue with a response that is

incompatible and thereby conflicts with the unwanted habit”

(Wood & Neal, 2007, p. 859). Such an intervention involves

repeated practice at utilizing an alternative incompatible coping

strategy (e.g., concrete thinking, relaxation) in response to the

identified triggering contextual cue (e.g., sad mood) to develop the

new context–response association. Critically, this habit analysis

predicts that systematically counterconditioning alternative func-

tional responses to the cueing context for rumination will improve

prevention of relapse and recurrence, whether as a distinct acute

treatment or following successful acute treatment of depression.

This analysis suggests that traditional CBT approaches such as

thought challenging will not necessarily be effective at changing

habitual rumination. Successfully challenging a thought or belief

would not change the underlying S-R habit. However, thought

challenging could potentially be an effective intervention for ru-

mination if repetitively trained as an alternative coping skill in

response to cues for rumination.

By the same logic, cognitive bias modification (CBM) ap-

proaches used to change negative biases (Hertel & Mathews, 2011)

are likely to have value in reducing habitual rumination. CBM

typically involves the repeated training of desired responses; in-

corporates programmed contingencies between stimuli, responses,

and desirable outcomes (e.g., faster task performance); and is

assumed to involve the same associative and instrumental learning

processes as habit formation, and to work on processes that are

often outside conscious awareness. Thus, Hertel and Mathews

(2011, p. 528) argued that “in interpretation retraining, contingen-

cies between ambiguous situations and their preexperimental res-

olutions are, in effect, counterconditioned.” There is now initial

evidence supporting the assumption that CBM influences mental

habits: Hertel, Holmes, and Benbow (in press) used a variant of

Jacoby’s (1996) process dissociation approach to confirm that

interpretation bias training changed automatic, habitual processes

rather than controlled recollection. Further, there is growing evi-

dence that rumination is associated with biases in disengaging

attention from negative information (Koster, De Lissnyder, Derak-

shan, & De Raedt, 2011), abstract construal (Watkins, 2008), and

negative interpretative bias (Mor, Hertel, Ngo, Schachar, & Redak,

in press). CBM approaches therefore seem particularly pertinent to

changing mental habits. The effects of CBM may perhaps be

enhanced by training adaptive biases in response to contextual

cues for unwanted habits, with Hertel and Mathews (2011, p. 529)

arguing that “training should incorporate situational cues that

typically provoke the deployment of negative biases in real life.”

Practice may need to be more extensive than typically employed

in current psychological interventions. Lally, Van Jaarsveld, Potts,

and Wardle (2010) examined the development of habits for vol-

unteers practicing an eating, drinking, or exercise behavior daily in

the same context. Self-reported automaticity of the trained re-

sponse increased with repetition in the consistent context, but took

a median of 66 repetitions to reach a training plateau, with con-

siderable individual variation. Moreover, to ensure the required

cueing context (e.g., mood state) is active prior to practicing the

alternative response, treatment may require active attempts to

engineer the cueing context in therapy sessions, such as mood

challenges or in imago exposure to cues. Such challenges provide

an opportunity to test whether the habitual response to the cue has

changed. This framework suggests that assessing the habitual

nature of rumination and alternative coping strategies during ther-

apy has clinical value to determine whether a new habit has

successfully been trained. Practice and training would optimally

continue until the new adaptive habit reaches a self-reported as-

ymptote.

To our knowledge, there has only been one explicit attempt to

test repeated training of an alternative response to the contextual

cues for rumination as an intervention. Building on the evidence

that concrete processing is an adaptive alternative to depressive

rumination (Watkins, 2008), a proof-of-principle randomized con-

trolled trial found that training dysphoric individuals to be more

concrete when faced with difficulties reduced depression, anxiety,

and rumination relative to a no-treatment control (Watkins, Baey-

ens, & Read, 2009). Concreteness training is a form of CBM that

involves repeated practice at focusing on the specific details,

context, and sequence of difficult events, and asking “How the

event happened?” During the training, concrete thinking is explic-

itly used as a response to identified warning signs for rumination

and is practiced repeatedly with audio-recorded exercises.

In a Phase II randomized controlled trial, concreteness training

was found to be superior to treatment-as-usual in reducing rumi-

nation, worry, and depression in patients with major depression

recruited in primary care (Watkins et al., 2012). A control relax-

ation training condition, in which patients practiced progressive

relaxation as an alternative response to cues for rumination, also

significantly reduced depression relative to treatment-as-usual and

did not significantly differ from concreteness training. These re-

sults suggest that repeated training in any functional alternative

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30 WATKINS AND NOLEN-HOEKSEMA

response to rumination may be an effective intervention, consistent

with the current habit analysis.

Relative to relaxation training, concreteness training signifi-

cantly reduced trait rumination, suggesting that interposing a cog-

nitive alternative may be more effective at reducing habitual

rumination, perhaps because it facilitates adaptive repetitive

thought in place of maladaptive repetitive thought as an example

of transfer-appropriate processing (see Hertel & Mathews, 2011,

for full discussion). Moreover, consistent with the hypothesis that

concreteness training works through establishing an alternative

habitual response to replace rumination, the benefits of concrete-

ness training were significantly stronger in those patients who

reported that the practiced self-help response had become habitual

(Watkins et al., 2012).

This habit analysis has implications for the generalizability and

sustainability of clinical improvement. Several theorists (Bouton,

2000;Hertel & Mathews, 2011;Wood & Neal, 2007) have noted

that new patterns of associative learning (i.e., new functional S-R

associations) intended to replace older patterns of associations are

inherently unstable, enabling the original patterns of learning to

recur under certain circumstances. These recurrences occur be-

cause the original learning that underpins the unwanted habit

remains intact following counterconditioning or extinction, with

new learning overlaid on the original learning. In these circum-

stances, a conditioned cue (e.g., sad mood) is in the position of

potentially signaling two available cue–response associations (e.g.,

rumination vs. concrete thinking). Which association is predomi-

nant and which behavior it evokes will be determined by the

current occasion-setting context. If there are differences between

the setting contexts under which the original learning and subse-

quent counterconditioning occur, shifts back to the original setting

context can renew the original relationship and original contingen-

cies. A key implication of considering rumination-as-habit is that

despite conditioning of new responses, the old habitual response

can recur under particular circumstances, potentially leading to

relapse. Thus, even after successful counterconditioning of a new

habitual response to sad mood, there may be a lapse back into

rumination when the conditioned cue is encountered in a different

setting context.

Moreover, because the original unwanted habit typically results

from a large number of learning trials in which the triggering cue

and the habitual response were paired over many different settings

and situations, more setting contexts will be associated with the

original unwanted habit than the replacement habit, which may be

constrained to fewer contexts (e.g., the therapeutic setting). One

way to counter these renewal effects is to promote the retrieval of

the new learning (i.e., the new habit) through explicit retrieval cues

and reminders throughout and after the training (e.g., flashcards,

texts from therapist; Hertel & Mathews, 2011). Another approach

is to increase the generalization of the counterconditioning by

conducting the training across different and varied contexts (e.g.,

using multiple variants of the cueing context; pairing sad mood

with new response in different settings, such at home, at the office,

when alone, and with other people; see Hertel & Mathews, 2011,

for further detail).

In addition, the performance of unwanted habits becomes more

likely when individuals are under cognitive load, distracted, pre-

occupied, or stressed (Botvinick & Bylsma, 2005;Schwabe &

Wolf, 2011). We hypothesize that the habitual ruminative response

is more likely to be triggered under circumstances of stress, pres-

sure, or fatigue. The ruminative response is thus likely to be

hardest to stop at those times when individuals most need to stop

it.

The habit literature suggests that a further way to control habit-

ual rumination is by “inhibiting the performance of the habitually

cued response once it has been activated” (Wood & Neal, 2007,p.

854). Quinn, Pascoe, Wood, and Neal (2010) provided evidence

from episode-sampling studies that vigilant monitoring (thinking

“don’t do it”; watching for slipups) was the best strategy for

self-control of strong habits in daily life, relative to do nothing,

stimulus control, and distraction. However, inhibition of habitual

behaviors requires the availability of sufficient levels of effortful

self-control: On days when students had a sustained load on

self-control, they were more likely to fail at overriding habitual

behaviors but not nonhabitual behaviors (Neal & Wood, 2007).

Moreover, self-control is a finite resource that is depleted follow-

ing effortful attempts to inhibit or control thoughts, feelings, and

actions (Muraven & Baumeister, 2000). It is likely to be reduced

in patients with depression (Joormann, 2010). This raises questions

over the long-term sustainability of effortful inhibition of strong

habits in daily life. Inhibition of habitual responses may most

usefully contribute to long-term change by interrupting a habitual

response to enable a new pattern of responding to be countercon-

ditioned.

Focusing on self-control and inhibition in habits is particularly

relevant to habitual rumination because difficulties in turning

attention away from negative stimuli are characteristic of rumina-

tion. It remains unresolved to what extent these difficulties reflect

difficulties in disengaging attention from negative material (Koster

et al., 2011) and/or difficulties in inhibiting no-longer-relevant

material (Joormann, 2006,2010). Consistent with the former,

habitual rumination is correlated with selective attentional bias

toward sad faces (Joormann, 2004;Joormann, Dkane, & Gotlib,

2006) and negative words (Donaldson, Lam, & Mathews, 2007),

although the causal direction of this relationship is not yet deter-

mined. Consistent with the latter, habitual rumination is correlated

with poor performance on inhibition-related tasks, including neg-

ative affective priming (e.g., Joormann, 2006) and suppression-

induced forgetting (Hertel & Gerstle, 2003), and with difficulties

in removing now-irrelevant information from working memory

(Joormann & Gotlib, 2008;Joormann, Levens, & Gotlib, 2011).

Interventions that strengthen inhibitory control or effortful self-

control may thus have potential to reduce the expression of habit-

ual rumination. There is preliminary evidence that it may be

possible to improve working memory capacity through repeated

training on cognitive tasks (e.g., Jaeggi, Buschkuehl, Jonides, &

Perrig, 2008), and that repeated practice can strengthen self-

regulatory control (Muraven & Baumeister, 2000). If robust and

replicable, such cognitive training has potential to improve self-

control of habitual rumination as part of a treatment intervention,

particularly if combined with counterconditioning of alternative

responses.

We note that this habit analysis is not necessarily unique to

rumination. Because the theoretical framework is based on generic

concepts of conditioning and habit formation, the principles artic-

ulated could be applied to other behaviors and emotional regula-

tion strategies. Nevertheless, our focus in this article is to consider

the value of applying this approach to habitual rumination, and to

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HABIT FRAMEWORK OF DEPRESSIVE RUMINATION

reconcile state episodes of repetitive thought engendered by goal

discrepancy with trait habitual tendency toward rumination. We

further note that rumination may be harder to break than other

habits, such as those involving overt behavioral routines. First,

rumination tends to be triggered by internal states, which makes it

harder to successfully use stimulus and environmental control.

Second, changing habits requires a concerted and deliberate at-

tempt at self-control in the form of generating an alternative

nonhabitual response. However, habitual rumination reduces an

individuals’ ability to exert such self-control because of its impact

on executive control and working memory (e.g., Curci et al., 2013;

Watkins & Brown, 2002). Thus, unlike many habits, by dint of

occupying mental resources, rumination may be harder to change,

indicating the importance of training ruminators into new habits,

for example, by CBM.

Conclusion

We have articulated a habit-goal framework of depressive ru-

mination that elaborates on conceptualizations of depressive rumi-

nation as a mental habit (Hertel, 2004) and recent work consider-

ing the relationship between goals and habits (Wood & Neal,

2007). This approach links RST and control theory by explicating

the mechanisms and conditions by which state episodes of goal-

discrepancy repetitive thought could develop into habitual depres-

sive rumination. Further, this habit account generates new insights

and testable predictions concerning the developmental antecedents

of individual differences in rumination. The habitual nature of

depressive rumination provides a partial account of why it can be

so difficult to break free from rumination. Understanding the

possible conditions and mechanisms that influence habit formation

and habit change provides a new perspective on how to optimize

psychological interventions for depressive rumination.

This manuscript reflects an ongoing collaboration between the

authors, with an original draft complete when Susan Nolen-

Hoeksema tragically passed away. It is hoped that, in some small

part, this final manuscript pays tribute to Susan, her wisdom and

thoroughness, her friendship, and her work by elaborating on her

seminal conceptualization of rumination and showing new insights

and value. Susan was first in research, first in teaching, and first in

the hearts of her peers and students; as a collaborator, she made

ideas flow in a way that was exciting and exhilarating: She will be

greatly missed.

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34 WATKINS AND NOLEN-HOEKSEMA

Aversive well‐being comparisons in dysphoria and the role of brooding rumination

Article

Full-text available

Mar 2023
BRIT J CLIN PSYCHOL

Objectives: Individuals frequently engage in comparisons on how they are doing relative to different standards. According to the general comparative-processing model, comparisons can be perceived as aversive (appraised as threatening the motives of the comparer) or appetitive (appraised as consonant with, or positively challenging the motives). Research indicates that aversive comparisons are associated with depression. We hypothesize that aversive comparisons play a significant role in the relationship between brooding rumination and depression. Drawing on central propositions of control theory that discrepancies instigate rumination, we investigated the mediating role of brooding rumination in this relationship. Reflecting the different directionality, we also examined whether well-being comparisons mediate the relationship between brooding rumination and depression. Methods: Dysphoric participants (N = 500) were administered measures of depression and brooding rumination, and the Comparison Standards Scale for Well-being. The latter assesses aversive social, temporal, counterfactual, and criteria-based comparisons regarding their (a) frequency, (b) perceived discrepancy to the standard, and (c) engendered affective valence. Results: The relationship between the frequency of aversive comparisons with depression was partially accounted for by comparison discrepancy and engendered affective valence and brooding rumination. The relationship between rumination and depression was partially mediated by sequential comparison processes. Conclusions: Longitudinal research needs to unravel the underlying directionality of the relationship between depression, brooding, and comparison. Relevant clinical implications of well-being comparison are discussed.

The Mediating Role of Rumination in the Relation between Basic Psychological Need Frustration and Depressive Symptoms

Article

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Feb 2023

Research within the framework of Basic Psychological Need Theory (BPNT) finds strong associations between basic need frustration and depressive symptoms. This study examined the role of rumination as an underlying mechanism in the association between basic psychological need frustration and depressive symptoms. A cross-sectional sample of N = 221 adults (55.2% female, mean age = 27.95, range = 18–62, SD = 10.51) completed measures assessing their level of basic psychological need frustration, rumination, and depressive symptoms. Correlational analyses and multiple mediation models were conducted. Brooding partially mediated the relation between need frustration and depressive symptoms. BPNT and Response Styles Theory are compatible and can further advance knowledge about depression vulnerabilities.

Early Emergence of Rumination has no Association with Performance on a Non-affective Inhibitory Control Task

Article

Full-text available

Jan 2023
CHILD PSYCHIAT HUM D

Rumination is a vulnerability for depression and potentially linked to inhibitory control weaknesses. We aimed to replicate the association observed in adults between inhibitory control and rumination in adolescents, and to examine putative moderating roles of childhood maltreatment and perceived family cohesion in an adolescent sample at risk for depression due to familial/personal history. Ninety adolescents aged 11–17 (M = 14.6, SD = 1.8) completed self-report scales of rumination, maltreatment, and family cohesion, and performed a task assessing inhibitory control. Hierarchical regression models showed no significant relation between inhibitory control and moderator variables on rumination. However, adolescents who reported higher levels of maltreatment and who perceived lower family cohesion tended to indicate higher levels of rumination (BChilhood Maltreatment = 27.52, 95% CIs [5.63, 49.41], BFamily Cohesion = -0.40, 95% CIs [-0.65, -0.15]). These findings demonstrate an alternative understanding of factors that increase depression onset risk and recurrence in adolescents.

The Mediating Role of Rumination in the Relation between Basic Psychological Need Frustration and Depressive Symptoms

Article

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Jan 2023

Negative cognitive beliefs, positive metacognitive beliefs, and rumination as mediators of metacognitive training for depression in older adults (MCT-Silver)

Article

Full-text available

Mar 2023

Background Metacognitive Training for Depression in older adults (MCT-Silver; www.uke.de/mct-silver ) is a cognitive-behavioral based group intervention that aims at reducing depression by targeting (meta)cognitive beliefs and rumination. In the present study, it was examined whether negative cognitive beliefs, positive metacognitive beliefs and/or rumination may be implicated as mediators of MCT-Silver’s effects on depression. Materials and methods We conducted a secondary analysis of a randomized controlled trial comparing MCT-Silver to an active control intervention (cognitive remediation) including 66 older adults (60 years and older) with complete baseline data. Clinician-rated (Hamilton Depression Rating Scale) and self-reported (Beck Depression Inventory-II) depression, negative cognitive beliefs (Dysfunctional Attitudes Scale-18B), positive metacognitive beliefs (positive beliefs subscale; Metacognition Questionnaire-30) and rumination (10-item Ruminative Response Scale) were assessed before (pre) and after 8 weeks of treatment (post), as well as 3 months later (follow-up). It was examined whether change in depression (pre- to follow-up) was mediated by change in negative cognitive beliefs, positive metacognitive beliefs and/or rumination (pre- to post-assessment). Results Mediation results differed for self-reported vs. clinician-rated depression. The effect of MCT-Silver on reduction in clinician-rated depression was mediated by a reduction in self-reported rumination, whereas reduction in self-reported depression was mediated by a reduction in negative cognitive beliefs. Positive metacognitive beliefs were not a significant mediator for either outcome. Conclusion The current study provides initial evidence for the roles of negative cognitive beliefs and rumination in the treatment of depression in later life with MCT-Silver. Given the divergence of findings and lack of causal precedence, mechanisms of change for MCT-Silver cannot yet be equivocally identified.

Real-Time fMRI Functional Connectivity Neurofeedback Reducing Repetitive Negative Thinking in Depression: A Double-Blind, Randomized, Sham-Controlled Proof-of-Concept Trial

Article

Jan 2023

Introduction: Repetitive negative thinking (RNT) is a cognitive process focusing on self-relevant and negative experiences, leading to a poor prognosis of major depressive disorder (MDD). We previously identified that connectivity between the precuneus/posterior cingulate cortex (PCC) and right temporoparietal junction (rTPJ) was positively correlated with levels of RNT. Objective: In this double-blind, randomized, sham-controlled, proof-of-concept trial, we employed real-time functional magnetic resonance imaging neurofeedback (rtfMRI-nf) to delineate the neural processes that may be causally linked to RNT and could potentially become treatment targets for MDD. Methods: MDD-affected individuals were assigned to either active (n = 20) or sham feedback group (n = 19). RNT was measured by the Ruminative Response Scale-brooding subscale (RRS-B) before and 1 week after the intervention. Results: Individuals in the active but not in the sham group showed a significant reduction in the RRS-B; however, a greater reduction in the PCC-rTPJ connectivity was unrelated to a greater reduction in the RRS-B. Exploratory analyses revealed that a greater reduction in the retrosplenial cortex (RSC)-rTPJ connectivity yielded a more pronounced reduction in the RRS-B in the active but not in the sham group. Conclusions: RtfMRI-nf was effective in reducing RNT. Considering the underlying mechanism of rtfMIR-nf, the RSC and rTPJ could be part of a network (i.e., default mode network) that might collectively affect the intensity of RNT. Understanding the relationship between the functional organization of targeted neural changes and clinical metrics, such as RNT, has the potential to guide the development of mechanism-based treatment of MDD.

Stuck in the past? Rumination-related memory integration

Article

Mar 2023
BEHAV RES THER

Memories connected to ruminative concerns repetitively capture attention, even in situations designed to alter them. However, recent research on memory updating suggests that memory for benign substitutes (e.g., reinterpretations) might be facilitated by integration with the ruminative memories. As a first approach, two experiments (Ns = 72) mimicked rumination-related memories with rumination-themed stimuli and an imagery task. College undergraduates screened for ruminative status first studied and imaged ruminative cue-target word pairs, and then in a second phase they studied the same cues re-paired with benign targets (along with new and repeated pairs). On the test of cued recall of benign targets, they judged whether each recalled word had been repeated or changed across the two phases (or was new in the second phase). When target changes were not remembered, recall of benign targets revealed proactive interference that was insensitive to ruminative status. However, when participants remembered change and the ruminative targets, their recall of benign targets was facilitated, particularly if they identified as ruminators (Experiment 1). When the test simply asked for recall of either or both targets (Experiment 2), ruminators recalled both targets more frequently than did others. These outcomes suggest that ruminative memories might provide bridges to remembering associated benign memories, such as reinterpretations, under conditions consistent with everyday ruminative retrieval.

“Don't [ruminate], be happy”: A cognitive perspective linking depression and anhedonia

Article

Feb 2023
CLIN PSYCHOL REV

Anhedonia, a lack of pleasure in things an individual once enjoyed, and rumination, the process of perseverative and repetitive attention to specific thoughts, are hallmark features of depression. Though these both contribute to the same debilitating disorder, they have often been studied independently and through different theoretical lenses (e.g., biological vs. cognitive). Cognitive theories and research on rumination have largely focused on understanding negative affect in depression with much less focus on the etiology and maintenance of anhedonia. In this paper, we argue that by examining the relation between cognitive constructs and deficits in positive affect, we may better understand anhedonia in depression thereby improving prevention and intervention efforts. We review the extant literature on cognitive deficits in depression and discuss how these dysfunctions may not only lead to sustained negative affect but, importantly, interfere with an ability to attend to social and environmental cues that could restore positive affect. Specifically, we discuss how rumination is associated to deficits in working memory and propose that these deficits in working memory may contribute to anhedonia in depression. We further argue that analytical approaches such as computational modeling are needed to study these questions and, finally, discuss implications for treatment.

Is rumination associated with psychological distress after a cancer diagnosis? A systematic review

Article

Jan 2023
J PSYCHOSOC ONCOL

Objective: The aim of this work was to review evidence on the association between psychological rumination and distress in those diagnosed with cancer. Methods: Six databases were searched for studies exploring rumination alongside overall assessments of psychological distress, depression, anxiety, or stress. Results: Sixteen studies were identified. Rumination was associated with distress cross-sectionally and longitudinally. However, once baseline depression was controlled for, the association was no longer seen. The emotional valence of ruminative thoughts and the style in which they were processed, rather than their topic, was associated with distress. Brooding and intrusive rumination were associated with increased distress, deliberate rumination had no association, and reflection/instrumentality had mixed findings. Conclusions: This review highlights that it is not necessarily the topic of content, but the style and valence of rumination that is important when considering its association with distress. The style of rumination should be the target of clinical intervention, including brooding and intrusion.

The bidirectional associations of rumination with values-based action and depression among young adults in the school-to-work transition

Article

Dec 2022
J AFFECT DISORDERS

Background: School-to-work transition is crucial for young adults, requiring them to maintain their values-based action, even though this task is likely to cause rumination associated with depression. In the HExAGoN model, individuals with rumination tend to engage in abstract-analytic thought (AAT) but not in concrete-experiential thought (CET). Although this inflexible style of thought is assumed to decrease values-based action and increase depression, no empirical research has examined these relationships in young adults during their transition period. Therefore, this study examined the bidirectional relationships between AAT, CET, depression, and values-based action in young adults. Methods: A one-year five-wave longitudinal survey was conducted on 756 third-year university students who engaged in job searches in Japan. Cross-lagged panel model and random-intercept cross-lagged panel model were used to estimate the bidirectional relationships at the between-person and within-person levels, respectively. Results: AAT and CET had bidirectional associations with depression and values-based action at the between-person level. Furthermore, CET decreased depression and marginally improved values-based action at the within-person level. Limitations: The study comprised only university students in Japan and had a high attrition rate. Conclusions: The findings suggest that CET can reduce depression and improve values-based action in young adults undergoing the transition. It may also expand the understanding of the treatment and prevention of depression in young adults.

Some ruminative thoughts

Article

Full-text available

Jan 1996

Interventions to Break and Create Consumer Habits

Article

Full-text available

Mar 2006

Interventions to change everyday behaviors often attempt to change people’s beliefs and intentions. As the authors explain, these interventions are unlikely to be an effective means to change behaviors that people have repeated into habits. Successful habit change interventions involve disrupting the environmental factors that automatically cue habit performance. The authors propose two potential habit change interventions. “Downstream-plus” interventions provide informational input at points when habits are vulnerable to change, such as when people are undergoing naturally occurring changes in performance environments for many everyday actions (e.g., moving households, changing jobs). “Upstream” interventions occur before habit performance and disrupt old environmental cues and establish new ones. Policy interventions can be oriented not only to the change of established habits but also to the acquisition and maintenance of new behaviors through the formation of new habits.

An Integrated Examination of Risk Factors for Repetitive Negative Thought

Article

Full-text available

May 2013

The two most common forms of repetitive negative thought (RNT) are rumination and worry, which are both repeatedly implicated in the onset and maintenance of depression and anxiety disorders. It is therefore of theoretical and clinical value to understand why people engage in worry and rumination, despite their negative consequences. A variety of vulnerability factors have been implicated, including distal factors relating to personality, abuse, and overcontrolling parenting; and proximal cognitive factors, including abstract processing and perceptions of the function of repetitive thought (RT). The current study provided a cross-sectional examination of these vulnerability factors alongside rumination and worry in a large sample of adults, with reference to a new integrative model of RNT. Structural equation modelling analyses indicated that a model in which neuroticism and emotional abuse were related to RNT via their association with perceptions about the function of RT provided a good fit to the data.

Theoretical and computational analysis of skill learning, repetition priming, and procedural memory

Article

Apr 2002

This article analyzes the relationship between skill learning and repetition priming, 2 implicit memory phenomena. A number of reports have suggested that skill learning and repetition priming can be dissociated from each other and are therefore based on different mechanisms. The authors present a theoretical analysis showing that previous results cannot be regarded as evidence of a processing dissociation between skill learning and repetition priming. The authors also present a single-mechanism computational model that simulates a specific experimental task and exhibits both skill learning and repetition priming, as well as a number of apparent dissociations between these measures. These theoretical and computational analyses provide complementary evidence that skill learning and repetition priming are aspects of a single underlying mechanism that has the characteristics of procedural memory.

Toward a motivational and structural theory of ruminative thought

Article

Jan 1989

Explaining the Gender Difference in Depressive Symptoms

Article

Nov 1999

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.

Automaticity in situ: Direct context cuing of habits in daily life

Article

The four horsemen of automaticity: Awareness, intention, efficiency and control in social perception and cognition

Article

J.A. Bargh

Memory for Emotional and Nonemotional Events in Depression A Question of Habit?

Chapter

Jan 2004

Paula T Hertel

This chapter addresses what is by far the largest research area in the examination of memory in clinical groups - research conducted with depressed or naturally unhappy (but possibly non-diagnosed) people. It explores the connection between memory phenomena and habits of thought. More so than most anxious people, depressed people ruminate about their troubles. The practiced thought patterns of rumination facilitate memory for emotionally consistent events and interfere with memory for other events. Moreover, these habits take over under conditions of poor cognitive control, the main feature of cognition in depression. Here, depression is used imprecisely to refer to both diagnostic categories and the self-reported state of dysphoria. "Dysphoria" is used to denote undiagnosed negative affect, of the sort that produces moderate-to-high scores on the Beck Depression Inventory. The chapter argues that the negative consequences of habitual thinking can be overcome by external control or by the training of new habits of thought.

Conditioning and Associative Learning

Article

Jan 1983
AM J PSYCHOL

A Habit-Goal Framework of Depressive Rumination

Abstract

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