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ORIGINAL ARTICLE
Dimensions of Negative Thinking and the Relations
with Symptoms of Depression and Anxiety in Children
and Adolescents
Lea Rood
Æ
Jeffrey Roelofs
Æ
Susan M. Bo
¨gels
Æ
Lauren B. Alloy
Published online: 29 July 2009
ÓThe Author(s) 2009. This article is published with open access at Springerlink.com
Abstract The current study sought to examine three
forms of negative, repetitive thinking in non-clinical
children and adolescents aged between 10 and 18. More
specifically, this study addressed the degree to which
stress-reactive rumination can be differentiated from other
forms of repetitive thinking, such as emotion-focused
rumination and worry, and the associations between the
various indices of repetitive thinking and symptoms of
anxiety and depression. Participants completed a battery of
self-report questionnaires including measures of stress-
reactive rumination, emotion-focused rumination, worry,
and symptoms of anxiety and depression. Results showed
that stress-reactive rumination, emotion-focused rumina-
tion and worry are related but distinct forms of repetitive
negative thinking. Positive associations were found
between all indices of repetitive thinking and symptoms of
depression and anxiety, but the effects of emotion-focused
rumination disappeared when controlling for the other
forms of repetitive thinking. The findings are discussed in
the light of current theories and previous research, and
directions for future research are provided.
Keywords Anxiety Depression Repetitive thinking
Rumination Worry
Introduction
Unconstructive forms of repetitive thinking may represent
a cognitive vulnerability factor implicated in the develop-
ment and maintenance of various emotional disorders such
as anxiety disorders and depression (e.g., Watkins 2008).
More specifically, repetitive thinking characterized by
negatively valenced thought content (e.g., thoughts about
depressive or anxious mood), a negative intrapersonal
context (e.g., negative mood or negative self-beliefs), and
an abstract level of construal (i.e., thinking about meanings
and implications) is thought to contribute to negative mood
states. In the literature, different types of repetitive thinking
are distinguished, with their own conceptualizations and
qualities. Emotion-focused rumination is considered a
predominantly unconstructive form of repetitive thinking
(see Watkins 2008), which involves repetitive thoughts
about depressive symptoms and the causes and conse-
quences of these symptoms (e.g., Nolen-Hoeksema 1987).
According to the response styles theory (e.g., Nolen-
Hoeksema 1987,1991,1998), engaging in emotion-
focused rumination is related to amplified and prolonged
periods of depression in adults (see for comprehensive
reviews Lyubomirsky and Tkach 2004; Nolen-Hoeksema
1998). In youth, emotion-focused rumination is positively
associated with concurrent levels of depressive symptoms
(e.g., Abela et al. 2004; Muris et al. 2004; Papadakis et al.
2006) and may predict increases in depressive symptoms
over time (e.g., Abela et al. 2002,2007; Burwell and Shirk
2007; Schwartz and Koenig 1996).
Stress-reactive rumination is another form of repetitive
thinking that has been introduced by Alloy et al. (2000),
Robinson and Alloy (2003), as an extension of the response
styles theory. More specifically, stress-reactive rumination
involves the tendency to ruminate on negative inferences
L. Rood (&)J. Roelofs
Department of Clinical Psychological Science, Maastricht
University, P.O. Box 616, 6200 MD Maastricht, The Netherlands
e-mail: L.Rood@maastrichtuniversity.nl
S. M. Bo
¨gels
Department of Education, University of Amsterdam,
Amsterdam, The Netherlands
L. B. Alloy
Temple University, Philadelphia, PA, USA
123
Cogn Ther Res (2010) 34:333–342
DOI 10.1007/s10608-009-9261-y
following stressful events (Robinson and Alloy 2003). The
content of stress-reactive thoughts is consistent with
hopelessness theory (Abramson et al. 1989), but is some-
what different from dysfunctional attitudes (Beck 1967)
that may be focused on beliefs that their happiness depends
on being perfect or others’ approval (see Robinson and
Alloy 2003). That is, stress-reactive rumination involves
the process of repetitively thinking about negative infer-
ences in response to the occurrence of stressful events. As
emotion-focused rumination was theoretically linked to the
maintenance of depressive symptoms, stress-reactive
rumination has been developed to explain the onset of
depressive symptoms. There is indeed some evidence to
suggest that stress-reactive rumination, in combination
with negative cognitive style, contributes to the onset of
depression in adults, and that stress-reactive rumination
may be an even more consistent predictor of the onset and
duration of depressive symptoms than emotion-focused
rumination in adults (Alloy et al. 2000; Robinson and Alloy
2003). However, to the authors’ best knowledge, there have
been no systematic attempts to examine stress-reactive
rumination in relation to symptoms of psychopathology in
youth.
Worry is yet another form of repetitive negative thinking
and can be defined as a chain of thoughts and images that
are negatively affect-laden and relatively uncontrollable
(Borkovec et al. 1983; Roemer and Borkovec 1993).
Although worry has problem-solving qualities (e.g.,
Borkovec et al. 1983), excessive worrying has been con-
sidered a key element of generalized anxiety disorder
(American Psychiatric Association 2000), but has also been
found to play a role in other anxiety problems such as
obsessive-compulsive disorder, social phobia, and panic
disorder (e.g., Borkovec 1994; Dugas et al. 1998; Muris
2007). In youth, high levels of worry seem to be associated
with more anxiety symptoms (e.g., Weems et al. 2000) and
the level of induced panic symptoms (e.g., Leen-Feldner
et al. 2006). Research with clinically anxious youth has
demonstrated that worry is not only present in generalized
anxiety disorder, but also in separation anxiety disorder and
social phobia (e.g., Perrin and Last 1997; Weems et al.
2000).
Another important issue is the relationship between the
different forms of repetitive thought and symptoms of
depression and anxiety. So far, most research has focused
on the relationships between emotion-focused rumination
and worrying on the one hand, and symptoms of depression
and anxiety on the other hand. In keeping with the notion
that emotion-focused rumination and worry can be con-
sidered transdiagnostic variables (e.g., Harvey et al. 2004),
there is evidence to suggest that both forms of negative
repetitive thinking are related to both anxiety and depres-
sion symptoms in adults (e.g., Blagden and Craske 1996;
Fresco et al. 2002; Molina et al. 1998; Muris et al. 2005;
Nolen-Hoeksema 2000; Roberts et al. 1998; Sarin et al.
2005; Starcevic 1995; Watkins 2004) and youth (e.g.,
Calmes and Roberts 2007; Fresco et al. 2002; Hong 2007;
Muris et al. 2004; Segerstrom et al. 2000). To date, there is
no research that has examined whether stress-reactive
rumination is a transdiagnostic variable in terms of rela-
tions with both symptoms of anxiety and depression.
Taken together, from a theoretical and conceptual point
of view, emotion-focused rumination, stress-reactive
rumination, and worry represent three dimensions of neg-
ative thinking that have a certain degree of overlap, par-
ticularly with respect to being unconstructive repetitive
thoughts. Despite the overlap, a number of studies have
addressed the extent to which emotion-focused rumination
and worry can be distinguished (Fresco et al. 2002; Muris
et al. 2004; Watkins et al. 2005). Factor analytic studies
have revealed that emotion-focused rumination and worry
are related, but distinct, as they load on different inter-
correlated factors (see Fresco et al. 2002; Muris et al.
2004). Several other researchers have failed to find as much
difference between emotion-focused rumination and worry
(e.g., Segerstrom et al. 2000; Watkins et al. 2005), where
the only difference found was temporal orientation, with
emotion-focused rumination focused on the past and worry
focused on the future. To date, there are no factor analytic
studies that have investigated the degree of distinctiveness
between stress-reactive rumination and other forms of
repetitive thinking. The aim of the present study was to
examine whether stress-reactive rumination is an inde-
pendent form of negative repetitive thinking by means of a
joint exploratory factor analysis comprising the items from
three self-report scales of emotion-focused rumination,
stress-reactive rumination, and worrying, respectively, in
children and adolescents. Given important developmental
differences such as the emergence, stabilization, and
crystallization of cognitive vulnerability factors for
depression between younger and older participants (see
Abela and Hankin 2008), we conducted two separate factor
analyses in the younger sample (ages 10–13) and the older
sample (ages 14–18). The second aim of this study was to
examine cross-sectional relations between stress-reactive
rumination, and symptoms of depression and anxiety. The
extent to which the three forms of repetitive thinking were
related to symptoms of depression and anxiety was inves-
tigated by assessing the association with and without
controlling for the effects of the other forms of repetitive
thinking, age, gender, and for concurrent anxiety/depres-
sion symptoms. From a transdiagnostic perspective, we
hypothesized that all three dimensions (i.e., emotion-
focused rumination, stress-reactive rumination and worry-
ing) would account for a significant portion of the variance
in symptoms of depression and anxiety.
334 Cogn Ther Res (2010) 34:333–342
123
Methods
Participants and Procedure
Two samples were used in the current study. Participants of
sample one were recruited at primary and secondary
schools in the southern regions of The Netherlands. First,
principals of schools were approached and informed about
the purpose of the study. When given permission to recruit
at their school, the researchers came into the classrooms
during regular class and held a 10-min talk in front of all
pupils. The purpose of the study was explained as ‘exam-
ining the influence of the way teenagers think on what they
feel’. Subsequently, informed consent forms were handed
out and returned 2 weeks later. Response rates varied
somewhat per school. On average, 25% of the youngsters
who were approached agreed to participate in a 3-year
longitudinal study. There was no compensation in turn for
participation. Written informed consent was obtained from
all parents and from the children where appropriate. A total
number of 805 participants (323 boys and 482 girls)
completed the baseline measurement of the longitudinal
study. Of these individuals, some had more than 10%
missing values on one of the measures included in the
current study and were therefore excluded for that specific
measure. As a consequence, sample size ranged between
779 and 805 across the various analyses. The mean age of
the sample was 12.4 (SD =1.9), ranging from 10 to 18.
Ethnicity was not reported but it is estimated that about
95% of the sample were Caucasian. Participants completed
a battery of questionnaires at home, as part of a 3-year
follow-up study. Participants could indicate whether they
preferred completing the questionnaires on the internet or
on paper. The majority (78.3%) filled in the questionnaires
on the internet and the remaining 21.7% preferred the
paper-and-pencil version. The proportion of the sample that
exhibited clinically significant levels of depressive symp-
toms was 12.9% (CDI cut off score C16; see Timbremont
et al. 2004). As for clinical levels of trait anxiety symp-
toms, 7.5% of the girls and 8.4% of the boys scored above
the cut off scores of two standard deviations above the
mean (STAIC cut off score for girls C46; for boys C42;
see Bakker et al. 1989).
For the purpose of the factor analysis, data from a sec-
ond sample which also completed the three questionnaires
assessing negative repetitive thinking (see ‘‘Measures’’),
was used and combined with sample one. In the second
sample, a total of 801 children and adolescents (367 boys
and 434 girls) with a mean age of 12.9 years (SD =2.1,
age range 10–18 years) participated. The vast majority of
the youth ([95%) were Caucasian. The self-report mea-
sures were completed during regular class time. The tea-
cher and a research assistant were available to answer
questions and to ensure confidential responding. Response
rates were higher (40%), which is probably due to the
difference in commitment to a study with a single mea-
surement and with three waves. The combined dataset
resulted in two groups of 1,078 children aged 10–13, and
528 adolescents aged 14–18.
Measures
Repetitive Negative Thinking
The children’s response styles scale (CRSS; Ziegert and
Kistner 2002; Dutch version: Muris et al. 2004) is a self-
report questionnaire that measures the tendency to ruminate
and the tendency to seek distraction in response to feelings
of sadness in children. The CRSS consists of 20 items and is
based on the response styles questionnaire for adults (RSQ;
Nolen-Hoeksema and Morrow 1991). The rumination sub-
scale (10 items) represents thoughts and behaviours that
maintain the focus on emotions (e.g., ‘‘When I’m feeling
sad, I think about the other times I felt that way’’). Items are
rated on a five-point Likert type scale (i.e., 1 =never,
2=almost never, 3 =sometimes, 4 =often, and
5=always). Reliability of the CRSS in terms of internal
consistency is good (a=.81) and validity is adequate to
good (Muris et al. 2004; Ziegert and Kistner 2002).
The stress-reactive rumination scale for children (SRRS-
C) is a downward extension of the same scale developed for
adults (SRRS; Robinson 1997; Robinson and Alloy 2003).
The SRRS-C aims to measure the frequency of negative
thoughts about the negative inferences following stressful
events (e.g., ‘‘I think about how the stressful event was
totally my fault’’). The SRRS-C consists of nine items and
participants are instructed to score the frequency of each
item on a four-point Likert type scale (i.e., 1 =almost
never, 2 =sometimes, 3 =often, 4 =almost all the time).
Reliability and discriminant validity of the adult version of
the SRRS are acceptable (Robinson and Alloy 2003). The
child version of the SRRS was translated into Dutch, and
subsequently back translated by a native English speaker
and was then approved by the original authors.
The Penn state worry questionnaire for children and
adolescents (PSWQ-C; Chorpita et al. 1997; Dutch version:
Muris et al. 2004) is a self-report questionnaire which aims
to measure the tendency to worry in an excessive and
uncontrollable way (e.g., ‘‘I am really bothered by the
worrying I do’’ and ‘‘I really worry about things’’). Items
are scored on a four-point Likert type rating scale (i.e.,
0=never, 1 =seldom, 2 =often, 3 =always). The
PSWQ-C is reliable in terms of internal consistency and
possesses high convergent and discriminant validity (Muris
et al. 2004). Test–retest stability is good (Chorpita et al.
1997).
Cogn Ther Res (2010) 34:333–342 335
123
Depressive Symptoms
The children’s depression inventory (CDI; Kovacs 1981;
Dutch version: Timbremont and Braet 2001,2002) is based
on the Beck depression inventory for adults. The CDI is a
widely used self-report questionnaire which aims to measure
the level of depressive symptoms in children from 7 to
17 years old. It consists of 27 items, covering feelings of
sadness, self-guilt, loss of appetite, insomnia, and adjustment
to school. For each item, three statements are given. The
subject has to choose one of three statements (e.g., ‘‘I am sad
sometimes/I am often sad/I am always sad’’) that represents
best how he or she has been feeling the last 2 weeks. Reli-
ability in terms of internal consistency is good and the con-
vergent validity of the CDI is supported. The CDI has some
overlap with anxiety symptoms which reduces the discrim-
inant validity of the CDI (Timbremont and Braet 2001).
Anxiety Symptoms
The trait version of the Spielberger state-trait anxiety inven-
tory for children (STAI-TC; Spielberger et al. 1973;Dutch
version: Bakker et al. 1989) is based on the STAI for adults
(Spielberger et al. 1970). The STAI-TC consists of 20 items
that aim to measure trait anxiety (e.g., ‘‘I am afraid to do things
wrong’’). Items are rated on a three-point Likert type scale
(i.e., 1 =almost never, 2 =sometimes, 3 =often). Reli-
ability and convergent validity of the STAI-TC are good, but
the discriminant validity remains questionable due to overlap
with depressive symptoms (Muris et al. 2002).
Statistical Analysis
The data were analysed using SPSS version 13.0. For indi-
viduals with \10% missing on values of a single self-report
measure, a regression technique was used to impute the
missing values by estimating the value on the basis of the
scores of that individual on the remaining items, as well as on
the scores ofothers on the itemfor which a score was missing.
For the factor analyses, data from two samples were combined
to obtain a sufficient number of participants to do factor
analysis in children and adolescents separately. A principal
factor analysis with oblimin rotation (which allows the
obtained factors to be intercorrelated) was carried out on the
items of the SRRS-C, the rumination scale of the CRSS and
the PSWQ-C, separately for the two age categories of 10–13
and 14–18. In order to determine the number of factors to
retain, we relied on parallel analysis (O’Connor 2000), which
is considered a sophisticated procedure for selecting the
number of factors in a factor analysis (e.g., Hayton et al. 2004).
The advantage of parallel analysis over other factor retention
methods is that it corrects for the effects ofsampling error.By
means of parallel analysis, random eigenvalues are generated
from random data, based on the number of variables and
sample size of the data one wishes to analyse. Subsequently,
the random eigenvalues have to be compared to the eigen-
values produced by the factor analysis. The number of factors
to retain is determined by the number of eigenvalues, for
which the real eigenvalue obtained by factor analysis is greater
than the random eigenvalue. When an eigenvalue generated
from the exploratory factor analysis is higher than the random
eigenvalue generated from the parallel analysis, it can be
assumed that the eigenvalue represents a real factor, that
accounts for more variance than a parallel component based
on random data (see Hayton et al. 2004). Further, the scree-
plots were inspected visually. Subsequently, the internal
consistency of the obtained dimensions of repetitive thinking
was determined by computing reliability coefficients (Cron-
bach’s alpha).
For the second aim of this study, analyses were carried
out on data from sample one, for which measures of
depressive and anxiety symptoms were available. First, to
examine the concurrent criterion validity, zero-order corre-
lations between the forms of repetitive thought, and symp-
toms of depression and anxiety were computed. Second, to
examine the relative predictive validity of the dimensions of
negative thinking, we computed partial correlation coeffi-
cients between each type of negative thinking and symptoms
of depression, controlling for the other two types of negative
thinking, age, gender, and anxiety symptoms. For example,
in the computation of the partial correlation between
depressive symptoms and stress-reactive rumination, we
controlled for worry, emotion-focused rumination, age,
gender, and symptoms of anxiety. In a similar vein, we
computed partial correlations between each type of negative
thinking and anxiety symptoms, controlling for the other two
types of negative thinking, age, gender, and depressive
symptoms. As an aside, gender differences on the self-report
measures and differences on the total scores of the measures
for those who completed the questionnaires by computer or
paper were tested by means of t-tests over the whole sample.
Results
Joint Factor Analysis on SRRS-C, CRSS, and PSWQ-C
Items
An exploratory joint principal factor analysis (PFA) was
carried out on all 33 items of the SRRS-C, CRSS, and
PSWQ-C, in a sample of children aged 10–13 (N=1,078),
and in a sample of adolescents aged 14–18 (N=528). Par-
allel analysis was used as a method to determine the number
of factors to retain. For the sample aged 10–13, the first five
eigenvalues obtained with PFA were 11.41, 2.61, 1.60, 1.06,
and 1.02, while the random eigenvalues obtained by means
336 Cogn Ther Res (2010) 34:333–342
123
of parallel analysis were 1.38, 1.33, 1.29, 1.26, and 1.24.
Thus, three factors should be retained according to the par-
allel test. In addition, the scree test supported a three-factor
model as a clear break was found after the third factor.
Bartlett’s tests for sphericity were significant and all MSA
values were higher than .80, indicating that the variables
involved correlate with each other and with more than one
variable, which means that factor analysis can be applied to
these data in a meaningful way. The communalities ranged
from .24 to .53, indicating that all items explained a unique
part of the variance across all factors. The three-factor model
explained 42.1% of the variance. The first factor consisted of
all PSWQ-C items and was therefore labelled the ‘worry-
scale’; the second factor consisted of CRSS items repre-
senting the ‘emotion-focused rumination scale’, whereas all
SRRS-C items loaded on the third factor, the ‘stress-reactive
rumination scale’. None of the items loaded significantly
(i.e., [.30) on more than one factor. Factor loadings of all
items are shown in Table 1. The reliability in terms of
internal consistency of the three dimensions was good
Table 1 Factor loadings (pattern coefficients) as obtained by principal factor analysis with Oblimin rotation of the PSWQ-C, SRRS-C and CRSS
Item Item description Factor 1 Factor 2 Factor 3
B13 C14 B13 C14 B13 C14
PSWQ-C 10 I have been a worrier all my life .77 .77 -.10 -.01 .01 -.04
PSWQ-C 13 I worry all the time .75 .86 -.05 -.08 .00 -.07
PSWQ-C 6 I’m always worrying about something .74 .83 -.04 -.07 -.03 .00
PSWQ-C 2 I really worry about things .72 .73 .06 .06 -.07 -.00
PSWQ-C 12 Once I start worrying, I can’t stop .69 .65 .00 .07 .01 .06
PSWQ-C 9 I worry about everything .68 .79 -.08 .01 .08 -.11
PSWQ-C 7 I find it hard to quit worrying when I want to .67 .53 .09 .07 -.08 .13
PSWQ-C 3 I worry about a lot of things .66 .67 .02 .03 .08 .07
PSWQ-C 4 I know I shouldn’t worry so much, but I just can’t help it .63 .72 .12 .08 -.02 .05
PSWQ-C 11 I notice that I have been worrying about things .62 .63 .03 .10 .13 .11
PSWQ-C 5 When I’m under pressure I worry a lot .59 .58 .12 .08 -.02 .10
PSWQ-C 1 I’m really bothered by the worrying I do .54 .63 .10 .15 .09 .06
PSWQ-C 8 As soon as I finish something, I start worrying about all kind of other things .52 .64 -.04 -.05 .09 .02
PSWQ-C 14 I’m always worrying about the things I need to do, until they’re finished .45 .49 .12 .12 .11 .13
CRSS 19 When I’m feeling sad, I think about how I feel -.01 -.02 .71 .79 -.00 .02
CRSS 13 When I’m feeling sad, I think about why it is I feel this way -.09 -.06 .68 .67 -.05 .06
CRSS 4 When I’m feeling sad, I withdraw and think about why I feel that way .09 .10 .61 .70 -.07 -.05
CRSS 16 When I’m feeling sad, I think about the things that have happened over and over again .11 .14 .60 .58 .04 .13
CRSS 20 When I’m feeling sad, I think about something that happened and wish it had gone better -.08 .02 .59 .51 .19 .28
CRSS 7 When I’m feeling sad, I isolate myself to think about my feelings .05 -.01 .58 .76 -.01 -.12
CRSS 11 When I’m feeling sad, I think about the other times that things didn’t go the way
I wanted
.04 .17 .56 .43 .02 .14
CRSS 2 When I’m feeling sad, I think about that I should have done things differently .06 .05 .50 .44 .14 .28
CRSS 1 When I’m feeling sad, I think about the other times that I felt this way .03 .19 .49 .33 .12 .21
CRSS 8 When I’m feeling sad, I think: why can’t I stop feeling this way? .05 .21 .47 .46 .07 .10
SRRS-C 4 I think about how terrible the stressful event was -.00 .15 -.08 -.11 .76 .65
SRRS-C 5 I think about the stressful event and wish it had gone better -.02 .03 .04 .01 .68 .70
SRRS-C 7 I think about the causes of the stressful event -.04 -.11 .01 .11 .60 .51
SRRS-C 6 I think about how the stressful event will negatively affect my life .08 .08 .02 -.01 .59 .62
SRRS-C 2 I think about what the occurrence of the stressor means about me .03 .12 .04 .11 .53 .47
SRRS-C 1 I think about how the stressful event was all my fault .15 .24 .03 -.04 .50 .53
SRRS-C 9 I think about how things like this always happen to me .17 .21 .04 .04 .49 .46
SRRS-C 3 I think about how things could have gone differently -.01 -.02 .16 .09 .48 .62
SRRS-C 8 I think about how important the stressful event is for me .00 -.07 .05 .02 .46 .56
PSWQ-C =worry; CRSS =emotion-focused rumination; SRRS-C =stress-reactive rumination. Factor loadings on the corresponding factors
are displayed in ‘‘Italic’’
Cogn Ther Res (2010) 34:333–342 337
123
(stress-reactive rumination: a=.84, worry: a=.92, and
emotion-focused rumination: a=.86).
The factor analysis in the adolescent sample yielded
comparable results. The first five eigenvalues obtained by
factor analysis were 13.51, 2.64, 1.48, .99, and .94, while the
first five random eigenvalues obtained by means of parallel
analysis were 1.56, 1.48, 1.43, 1.38, and 1.34. This means that
also in the sample of adolescents, a three-factor structure with
factors ‘worry’, ‘stress-reactive rumination’, and ‘emotion-
focused rumination’ could be retained. Factor loadings are
displayed in Table 1. All items loaded significantly ([.30) on
their corresponding factors. Communalities ranged from .27
to .63. The three-factor model explained 48.8% of the vari-
ance. The reliability in terms of internal consistency of the
three dimensions was good (stress-reactive rumination:
a=.85, worry: a=.94, and emotion-focused rumination:
a=.90). Noteworthy to mention, we also carried out the
factor analysis over the total group of children and adolescents
aged 10–18 years (N=1,606). Results were similar to those
obtained in the child (10–13) and adolescent (14–18) samples
separately: a three-factor structure emerged (‘worry’, ‘stress-
reactive rumination’ and ‘emotion-focused rumination’), with
all items loading significantly ([.30) and exclusively on their
corresponding factor.
General Statistics, Gender Differences, and Reliability
Descriptive statistics of the scales used in sample one and
two are presented in Table 2. A number of remarks with
respect to these findings need to be made. First, gender
differences examined by means of t-tests showed that girls
had significantly higher scores than boys on all question-
naires except for the CDI (alpha at .05). Second, a series of
t-tests showed that individuals who completed the
questionnaires on the internet had significantly higher
scores on the CRSS and PSWQ (alpha at .05) compared to
those who used the paper-and-pencil version. Third, reli-
ability in terms of internal consistency is adequate to good
and is displayed in Table 2. Finally, total scores on the CDI
were positively skewed and showed positive kurtosis and
were therefore subjected to a root square transformation
which ‘normalised’ the total scores of these variables.
Discriminant Validity of the SRRS-C
Stress-reactive rumination (SRRS-C) correlated highly with
worry (PSWQ-C), r=.70, and with emotion-focused rumi-
nation (CRSS), r=.65 (Table 3). When correcting the cor-
relation coefficients for attenuation (unreliability), the
correlation coefficient between SRRS-C and PSWQ-C was
.77 and the correlation coefficient between SRRS-C and
CRSS was .74. Thus, correcting for the attenuation effect did
not result in a nearly perfect association, which indicates that
the factors measure distinct constructs. Thus, the SRRS-C,
PSWQ-C, andthe CRSS are threeforms of repetitive thinking
that have a certain degree of overlap but can still be
distinguished.
Concurrent Criterion Validity and Relative Predictive
Validity
Table 3presents the zero-order correlation coefficients and
partial correlation coefficients (in parentheses) between all
self-report measures. As can be seen in Table 3, the three
forms of repetitive thinking all show moderate to high
associations with depressive and anxiety symptoms. The
strongest relationships were found for worry (PSWQ-C),
followed by stress-reactive rumination (SRRS-C), and
Table 2 Descriptive statistics and internal consistency (alpha) for all questionnaires for sample 1 (N=779–805) and sample 2 (N=799–801),
for the total sample, and for girls and boys separately
Total sample Girls Boys Gender difference
MSD Alpha MSD MSD tp
Sample 1
Depression (CDI) 8.0 6.3 .87 8.3 6.6 7.5 5.9 1.7 .084
Trait anxiety (STAI-TC) 30.5 7.9 .91 31.6 8.0 28.9 7.4 4.7 \.001
Stress-reactive rumination (SRRS-C) 16.7 5.1 .88 17.2 5.2 16.0 4.8 3.2 .002
Worry (PSWQ-C) 12.0 8.1 .94 13.0 8.1 10.7 7.8 3.8 \.001
Emotion-focused rumination (CRSS) 16.4 7.7 .87 17.5 7.3 14.9 7.9 4.8 \.001
Age 12.4 1.9 – 12.4 1.9 12.3 1.7 1.2 .221
Sample 2
Stress-reactive rumination (SRRS-C) 16.7 4.8 .82 17.1 5.1 16.2 4.5 2.8 .005
Worry (PSWQ-C) 12.4 7.2 .92 14.2 7.4 10.3 6.4 8.3 \.001
Emotion-focused rumination (CRSS) 15.6 8.0 .88 17.7 7.7 13.2 7.7 8.0 \.001
CDI children’s depression inventory, STAI-TC Spielberger state-trait anxiety inventory for children (trait version), SRRS-C stress-reactive
rumination scale for children, PSWQ-C Penn state worry questionnaire for children, CRSS children’s response styles scale
338 Cogn Ther Res (2010) 34:333–342
123
emotion-focused rumination (CRSS). With respect to the
partial correlation coefficients between the three forms of
repetitive thinking on the one hand, and symptoms of
depression and anxiety on the other hand, worry emerged
as a significant and strong predictor of anxiety symptoms,
whereas modest relations were found between worry and
depression, and between stress-reactive rumination and
symptoms of anxiety and depression.
1
Emotion-focused
rumination was no longer associated with either depression
or anxiety symptoms when worry and stress-reactive
rumination were controlled. One may argue that controlling
for highly interrelated variables may affect the findings
with respect to partial correlations due to multicollinearity
of the independent variables. Therefore, we ran a series of
linear regression analyses with scores of the depression and
anxiety scales as the dependent variables and the three
forms of repetitive thinking as independent variables.
Variance inflation factors (VIF) ranged between 1.83 and
2.93 indicating that multicollinearity did not influence the
results.
Discussion
The current study sought to examine three forms of negative
repetitive thinking in children and adolescents. More specif-
ically, this study addressed (1) the degree to which stress-
reactive rumination can be differentiated from other forms of
repetitive thinking, such as emotion-focused rumination and
worry in children and adolescents, and (2) the associations
between the various indices of repetitive thinking and symp-
toms of anxiety and depression. The stress-reactive rumina-
tion scale for children was developed for the purpose of this
study and is a downward extension of the stress-reactive
rumination scale used in adults (Robinson and Alloy 2003).
A joint exploratory factor analysis on items of three
measures tapping stress-reactive rumination (SRRS-C),
emotion-focused rumination (CRSS), and worry (PSWQ-C)
yielded a three-factor model both in children aged between
10 and 13 and adolescents aged between 14 and 18 years.
Taking into account that the measures are intercorrelated,
the results show that three forms of repetitive negative
thinking can be distinguished in both age groups. These
findings are in line with and add to previous findings
concerning the degree to which rumination and worry can
be differentiated (e.g., Fresco et al. 2002; Muris et al.
2004). More specifically, the results indicate that stress-
reactive rumination is a unique form of repetitive thinking
in addition to emotion-focused rumination and worry.
Another implication of the finding that age did not seem to
moderate the factor structure is that repetitive negative
thinking as a vulnerability to depression can be applied to
child and adolescent samples. These findings are in line
with past research (e.g., Abela et al. 2007). However, it
should be kept in mind that these findings may reflect the
wording of the materials used such that items with ‘‘worry’’
in their description tend to group together, whereas items
with ‘‘feeling sad’’, ‘‘think about’’ or ‘‘stressful events’’ in
their description tend to group together as well. Despite
this limitation of the use of questionnaires, the data provide
evidence that stress-reactive rumination is independent
from emotion-focused rumination and worry.
All three forms of repetitive negative thinking showed
positive and significant associations with symptoms of
Table 3 Associations between all self-report measures (N=785–805)
1. 2. 3. 4. 5. 6.
1. Depression (CDI) –
2. Trait anxiety (STAI-TC) .69* –
3. Stress-reactive rumination (SRRS-C) .59* (.16*) .68* (.17*) –
4. Worry (PSWQ-C) .62* (.11*) .77* (.46*) .70* –
5. Emotion-focused rumination (CRSS) .44* (-.01) .55* (.06) .65* .58* –
6. Age .12 .11 .17* .14 .12 –
7. Gender .05 .17* .11* .14* .17* .04
Partial correlations coefficients are presented in parentheses
CDI children’s depression inventory, STAI-TC Spielberger state-trait anxiety inventory for children (trait version), SRRS-C stress-reactive
rumination scale for children, PSWQ-C Penn state worry questionnaire for children, CRSS children’s response styles scale
*p\.005
1
An anonymous reviewer suggested controlling for negative cogni-
tive style in order to ensure that the uncontrolled confound of negative
cognitive style was not driving the associations between stress-
reactive rumination and depressive and anxiety symptoms. Negative
cognitive style is a composite score of scales measuring the inferences
about the globality and stability of the causes of a negative event,
inferences about the consequences of an event, and inferences about
the self (Hankin and Abramson 2002). When controlling for negative
cognitive style, the partial correlations between stress-reactive
rumination and symptoms of depression and anxiety remained
significant (pr =.13, p\.001, and pr =.16, p\.001, respectively).
Cogn Ther Res (2010) 34:333–342 339
123
depression and anxiety. In general, worry showed the
strongest associations with depression and anxiety symp-
toms, followed by stress-reactive rumination. In general,
rumination as well as worry were equally strongly related
to depressive symptoms as to anxiety symptoms, adding to
past research showing that rumination and worry are not
specific to depression and anxiety symptoms, respectively
(e.g., Blagden and Craske 1996; Fresco et al. 2002; Molina
et al. 1998; Muris et al. 2005; Nolen-Hoeksema 2000;
Roberts et al. 1998; Sarin et al. 2005; Starcevic 1995;
Watkins 2004). These findings support the viewpoint that
repetitive negative thinking that takes the form of emotion-
focused rumination, stress-reactive rumination, or worry,
can be seen as a transdiagnostic variable (e.g., Harvey et al.
2004).
In examining the relative contribution of the three forms
of repetitive negative thinking controlling for the other
two, worry and stress-reactive rumination were signifi-
cantly associated with depression and anxiety symptoms.
Thus, despite the significant zero-order correlation coeffi-
cients between emotion-focused rumination and symptoms
of anxiety and depression, emotion-focused rumination
was no longer significant when controlling for the effects
of stress-reactive rumination and worry. The finding that
emotion-focused rumination did not account for a signifi-
cant portion of the variance in depression was not in line
with our hypothesis. However, it does add to previous
research showing that worry ruled out emotion-focused
rumination as a predictor of depressive and anxiety
symptoms (Muris et al. 2004). From a theoretical
perspective, the response styles theory posits that emotion-
focused rumination is implicated in the duration of nega-
tive mood and includes items that refer to the situation in
which one is already feeling depressed (Nolen-Hoeksema
1991). Stress-reactive rumination on the other hand is
theoretically linked to the onset of depressive symptoms
(see Robinson and Alloy 2003), while the occurrence of
worry also is not necessarily dependent on a sad mood
state. Therefore, stress-reactive rumination and worry may
be stronger predictors of depressive symptoms than emo-
tion-focused rumination in a non-clinical sample as the
current one, where significant negative mood states may be
less prevalent. The role of emotion-focused rumination in
clinical samples of depressed children suffering from
negative mood states needs investigation.
The findings of the present study underscore the
importance of targeting not only the content of thoughts,
but also the thought process in interventions with depressed
and anxious youth. For example, in cognitive therapy, it
may be important to specifically challenge ruminative or
worrisome thoughts. In this light, one may also wish to
consider challenging positive (e.g., ‘‘Worry/rumination
helps me overcome my problems’’) and negative
metacognitions about worry and rumination (e.g., ‘‘Other
children will reject me if I worry/ruminate that much’’ or ‘‘I
may go crazy if I keep on worrying/ruminating’’) and to
use strategies such as postponing worrying or rumination to
test the (negative) metacognition that one has no control
over repetitive thinking (see Wells and Papageorgiou
2004). Other approaches that have received a lot of atten-
tion recently are mindfulness-based interventions. These
might be especially effective in reducing repetitive thought
processes, by learning to emotionally disengage from
recurrent negative thoughts instead of letting them affect
one’s mood. An example of a mindfulness based inter-
vention is mindfulness based cognitive therapy (Segal et al.
2002).
This study has some limitations that need to be
addressed. First, the study was cross-sectional in nature
making it impossible to draw conclusions about cause-
effect relations. More specifically, the cross-sectional nat-
ure of the study makes it difficult to discern whether high
levels of repetitive thinking result in more anxiety and
depression or whether high levels of anxiety and depression
may lead to more repetitive thinking. Studies that employ
prospective intervals are needed to examine the predictive
value and the stability of the various forms of repetitive
thinking (see Hankin 2008). Experimental studies in which
repetitive thinking can be manipulated are also warranted
to determine the causal nature of repetitive thinking in
depressive and anxiety symptoms. Second, the sample used
in the current study was predominantly white European,
which may limit the generalisability of the findings to other
cultures. Furthermore, a minority (25%) of the approached
children and adolescents decided to participate. It is pos-
sible that this sample is biased in some way. However, as
we did not gather demographic information about variables
such as ethnicity or socio-economic status, it is not possible
to compare the final sample to expected rates.
Despite these limitations, the results of the current study
seem to indicate that stress-reactive rumination can be
uniquely identified as a form of repetitive thinking in
addition to emotion-focused rumination and worry. Future
research should be aimed at bringing together various
variables that are thought to play a role in juvenile
depression and anxiety such as various forms of repetitive
thinking, negative cognitive styles, and puberty. The
inclusion of life events and daily hassles makes it possible
to contribute to a further understanding of depression and
anxiety in youth within a diathesis-stress account.
Acknowledgments This study was supported by an NWO Social
Sciences Research VENI Grant No. 451-05-019, awarded to
Dr. Jeffrey Roelofs.
Open Access This article is distributed under the terms of the
Creative Commons Attribution Noncommercial License which
340 Cogn Ther Res (2010) 34:333–342
123
permits any noncommercial use, distribution, and reproduction in any
medium, provided the original author(s) and source are credited.
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