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Constructive and Unconstructive Repetitive Thought

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The author reviews research showing that repetitive thought (RT) can have constructive or unconstructive consequences. The main unconstructive consequences of RT are (a) depression, (b) anxiety, and (c) difficulties in physical health. The main constructive consequences of RT are (a) recovery from upsetting and traumatic events, (b) adaptive preparation and anticipatory planning, (c) recovery from depression, and (d) uptake of health-promoting behaviors. Several potential principles accounting for these distinct consequences of RT are identified within this review: (a) the valence of thought content, (b) the intrapersonal and situational context in which RT occurs, and (c) the level of construal (abstract vs. concrete processing) adopted during RT. Of the existing models of RT, it is proposed that an elaborated version of the control theory account provides the best theoretical framework to account for its distinct consequences.
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Constructive and Unconstructive Repetitive Thought
Edward R. Watkins
University of Exeter
The author reviews research showing that repetitive thought (RT) can have constructive or unconstructive
consequences. The main unconstructive consequences of RT are (a) depression, (b) anxiety, and (c)
difficulties in physical health. The main constructive consequences of RT are (a) recovery from upsetting
and traumatic events, (b) adaptive preparation and anticipatory planning, (c) recovery from depression,
and (d) uptake of health-promoting behaviors. Several potential principles accounting for these distinct
consequences of RT are identified within this review: (a) the valence of thought content, (b) the
intrapersonal and situational context in which RT occurs, and (c) the level of construal (abstract vs.
concrete processing) adopted during RT. Of the existing models of RT, it is proposed that an elaborated
version of the control theory account provides the best theoretical framework to account for its distinct
consequences.
Keywords: repetitive thought, rumination, worry, cognitive processing, control theory
Repetitive, prolonged, and recurrent thought about one’s self,
one’s concerns and one’s experiences is a mental process com-
monly engaged in by all people (Harvey, Watkins, Mansell, &
Shafran, 2004). Such thinking bridges many topics within psychol-
ogy: social cognition, emotion, motivation, self-regulation, goal
attainment, stress, psychopathology, and mental health. Examples
of such thinking include worry, rumination, perseverative cogni-
tion, emotional processing, cognitive processing, mental simula-
tion, rehearsal, reflection, and problem solving (e.g., Martin &
Tesser, 1996; Mor & Winquist, 2002; Papageorgiou & Wells,
2004; Wyer, 1996). Across these constructs, there is considerable
similarity and overlap in theoretical conceptualizations and oper-
ational definitions. However, because these constructs have
emerged in distinct research domains, they are usually not equated
with one another and have rarely been considered together. More-
over, research has shown that these constructs have diverse out-
comes, such that repetitive thought (RT) can have both uncon-
structive and constructive consequences. For example, on one
hand, within the cognitive processing literature, RT about symp-
toms and upsetting events has been conceptualized as necessary
for people to come to terms with traumatic and upsetting events
(Horowitz, 1985; Pennebaker, 1997; Rachman, 1980; Tedeschi &
Calhoun, 2004). On the other hand, RT about symptoms and
upsetting events has been found to predict future depression (In-
gram, 1990; Nolen-Hoeksema, 1991, 2000; Pyszczynski & Green-
berg, 1987) and poor recovery from traumatic and upsetting
events.
Accounting for the discrepant consequences of RT is critical in
understanding the underlying mechanisms of RT and is of obvious
applied and clinical value, in terms of improving recovery from
traumatic events and reducing vulnerability to anxiety and depres-
sion. Nonetheless, there have been few systematized attempts to
account for the distinct constructive and unconstructive outcomes
of RT (for initial suggestions, see Harvey et al., 2004; Martin &
Tesser, 1996; Nolen-Hoeksema, 2004b; Segerstrom, Stanton, Al-
den, & Shortridge, 2003). Thus, the first aim of the current article
is to address this omission by reviewing and organizing the exten-
sive literature on the distinct consequences of RT in a coherent
way. The second aim is to identify principles and/or mechanisms
that could explain the distinct consequences of RT. The third aim
is to discuss existing models of RT in the light of this review to
determine which theory best accounts for the extant literature on
RT. I first define the constructs used in this review, including the
generic construct repetitive thought, as well as more specific
examples and classes of RT considered in this article. I then
evaluate the evidence relevant to making a distinction between
constructive and unconstructive consequences of RT before sum-
marizing and abstracting the key factors that emerge from this
review to account for these distinct consequences of RT. Finally,
I examine which of the existing models of RT best accounts for
this data.
What Is Meant by RT?
This review focuses on a number of thought processes that that
have been highlighted as important in the wider literature relevant
to self-regulation, psychopathology, and mental and physical
health. A property common to all of these constructs is the process
conceptualized by Segerstrom et al. (2003, p. 909) as “repetitive
thought,”, defined as the “process of thinking attentively, repeti-
tively or frequently about one’s self and one’s world,” which was
proposed to form “the core of a number of different models of
adjustment and maladjustment.” As the rest of this section makes
clear, these different classes of RT encompass a wide range of
conceptualizations, associated with both unconstructive and con-
structive consequences.
This research was supported by Project Grants 065809 and 080099 from
the Wellcome Trust, United Kingdom.
Correspondence concerning this article should be addressed to Edward
Watkins, Mood Disorders Centre, School of Psychology, University of
Exeter, Washington Singer Laboratories, Perry Road, Exeter EX4 4QG,
United Kingdom. E-mail: e.r.watkins@exeter.ac.uk
Psychological Bulletin Copyright 2008 by the American Psychological Association
2008, Vol. 134, No. 2, 163–206 0033-2909/08/$12.00 DOI: 10.1037/0033-2909.134.2.163
163
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Depressive Rumination (Nolen-Hoeksema, 1991)
Nolen-Hoeksema defined depressive rumination as “behaviors
and thoughts that focus one’s attention on one’s depressive symp-
toms and on the implications of these symptoms” (Nolen-
Hoeksema, 1991, p. 569) and as “passively and repetitively focus-
ing on one’s symptoms of distress and the circumstances
surrounding these symptoms” (Nolen-Hoeksema, McBride, & Lar-
son, 1997). Nolen-Hoeksema’s Response Styles Theory (RST;
1991, 2000, 2004a, 2004b) hypothesized that depressive rumina-
tion is a particular response style to depressed mood, which is
causally implicated in the onset and maintenance of depression.
Depressive rumination is typically assessed on the Response Styles
Questionnaire (RSQ; Nolen-Hoeksema & Morrow, 1991), which
asks participants to endorse how much they ruminate in response
to sad or depressed mood (e.g., “When you feel sad, down or
depressed how often do you: Think ‘Why do I always react this
way?’”). A related questionnaire is the Rumination on Sadness
Scale (RSS; Conway, Csank, Holm, & Blake, 2000), which as-
sesses tendency to engage in RT when feeling sad, down, or blue
(e.g., “I repeatedly analyze and keep thinking about the reasons for
my sadness”).
Rumination (Martin & Tesser, 1996)
Rumination was defined 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). Within this conceptual-
ization, rumination is RT on a theme related to personal goals and
concerns, which can have either constructive or unconstructive
consequences, depending on whether the RT helps or hinders the
progress toward the unattained goal that triggered the rumination.
It is assessed with the Global Rumination Scale, which measures
the extent to which an individual dwells on problems and concerns
(W. D. McIntosh & Martin, 1992).
Worry
Worry has been defined as “a chain of thoughts and images,
negatively affect-laden and relatively uncontrollable” and as “an
attempt to engage in mental problem-solving on an issue whose
outcome is uncertain but contains the possibility of one or more
negative outcomes” (Borkovec, Robinson, Pruzinsky, & Depree,
1983, p. 9). Worry typically involves RT about future potential
threat, imagined catastrophes, uncertainties, and risks (e.g., “What
if they have an accident?”). It is conceptualized as an attempt to
avoid negative events, to prepare for the worst, and to problem
solve, and it is linked to unconstructive outcomes including in-
creased negative affect, interference with cognitive function, and
disruptions to physiological processes (Borkovec, Ray, & Stober,
1998). However, worry is also proposed to serve a number of
constructive functions when it is objective, controllable, and brief
(Tallis & Eysenck, 1994): (a) an alarm function that interrupts
ongoing behavior and directs attention to an issue demanding
immediate priority; (b) a prompt function, keeping an individual
aware of potential unresolved threats; and (c) a preparation func-
tion, motivating an individual to prepare for difficulties and to
adopt adaptive behaviors that reduce potential threat. The Penn
State Worry Questionnaire (PSWQ; see Davey, 1993, for a dis-
cussion of this and other measures; Meyer, Miller, Metzger, &
Borkovec, 1990) assesses predisposition to worry (e.g., “I am
always worrying about something”).
Perseverative Cognition
Perseverative cognition has been defined as “the repeated or
chronic activation of the cognitive representation of one or more
psychological stressors” and is hypothesized to be a core feature of
worry, rumination, and other forms of RT (Brosschot, Gerin, &
Thayer, 2006; Brosschot, Pieper, & Thayer, 2005; Pieper &
Brosschot, 2005). Perseverative cognition is hypothesized to in-
volve repeated cognitive representations of a psychological prob-
lem or crisis, which acts to prolong the immediate psychological
and physiological responses to such life events and daily stressors
such that the body’s systems associated with stress (e.g., cardio-
vascular, hypothalamic–pituitary–adrenal, and immune systems)
become chronically activated, leading to the development of dis-
ease (Brosschot et al., 2006; A. R. Schwartz et al., 2003).
Cognitive and Emotional Processing
Cognitive processing has been defined as the process of actively
thinking about a stressor, the thoughts and feelings it evokes, and
its implications for one’s life and future (J. E. Bower, Kemeny,
Taylor, & Fahey, 1998; Greenberg, 1995), thus falling within the
definition of RT (Silver, Boone, & Stone, 1983). Cognitive pro-
cessing accounts propose that RT about upsetting events, for
example in the form of persistent intrusions about the event, is part
of the process of attempting to resolve the discrepancy between
stressful events and core beliefs and assumptions (Greenberg,
1995; Horowitz, 1985; McCann, Sakheim, & Abrahamson, 1988;
D. N. Mcintosh, Silver, & Wortman, 1993). Such accounts hy-
pothesize that in response to a stressful experience, people think
repetitively about their experience in order to work it through,
make sense of it, and integrate it into their beliefs and assumptions
about the world (Harber & Pennebaker, 1992; Horowitz, 1986;
Janoff-Bulman, 1992; Tait & Silver, 1989). Similarly, RT is hy-
pothesized to be a central process in the development of posttrau-
matic growth, defined as “the experience of significant positive
change arising from the struggle with a major life crisis” (Calhoun,
Cann, Tedeschi, & McMillan, 2000, p. 521; see also Calhoun &
Tedeschi, 1998; Tedeschi & Calhoun, 2004). Tedeschi and Cal-
houn (2004) proposed that major traumatic events challenge or
destroy key aspects of individuals’ beliefs and goals, producing
emotional distress, which in turn produces RT in order to resolve
the distress, leading to personal growth.
Emotional processing has been defined as volitional efforts to
acknowledge and understand the significance of one’s emotions
and is operationalized as persistent focus and analysis of feelings
(e.g., “I take time to figure out what I’m really feeling”; Stanton,
Danoff-Burg, et al., 2000; Stanton, Kirk, Cameron, & Danoff-
Burg, 2000). Emotional processing has been associated with both
constructive outcomes, such as better adjustment, and unconstruc-
tive outcomes, such as increased distress.
Planning, Problem Solving, and Mental Simulation
RT can also take the form of cognitive coping strategies, such as
anticipatory coping, planning, rehearsal, and problem solving.
164
WATKINS
Problem solving has been conceptualized as involving several
stages: definition or appraisal of the problem, generation of alter-
native solutions, selection of alternatives, implementing the chosen
solution, and evaluating its effectiveness (D’Zurilla & Goldfried,
1971), each of which could involve RT. Plan rehearsal involves
envisioning the steps or strategies one could use to achieve a
desired outcome and often involves repetitive mental rehearsing of
future actions and situations. Similarly, mental simulation has been
defined as the imaginative and imitative mental construction and
representation of some event or series of events (Taylor, Pham,
Rivkin, & Armor, 1998; Taylor & Schneider, 1989). Repeated
mental simulation can be an important process in planning, coping,
and self-regulation, via rehearsal of likely future events or by
replaying past events (Pham & Taylor, 1999). Mental simulations
can also take the form of “painful ruminations that plague many
people suffering from depression or reacting to trauma” (Taylor et
al., 1998, p. 431), for example, an individual repetitively replaying
a memory of a car accident.
Counterfactual Thinking
Counterfactual thinking is the generation of imagined mental
representations of alternative versions of the past (Roese, 1997;
upward if better than what actually happened, e.g., “If only I had
studied more, I would have done better”; downward if worse than
reality, e.g., “If I had turned left, I would have crashed”). Repeated
counterfactual thinking is often prompted by negative affect and in
response to difficult events (Roese & Olson, 1993). Upward coun-
terfactuals can have unconstructive consequences, such as exacer-
bating shame, guilt, anxiety, sadness, and regret (Mandel, 2003;
Markman, Gavanski, Sherman, & McMullen, 1993; Niedenthal,
Tangney, & Gavanski, 1994; Sanna, 1997), and can have construc-
tive consequences, such as generating inferences about the causes
of previous difficulties, guiding effective preparative and preven-
tive behavior (Mandel & Lehman, 1996; Roese, 1997).
Defensive Pessimism
Defensive pessimism is characterized by (a) setting low expec-
tations about future outcomes and (b) a “thinking through” pro-
cess, called reflectivity/reflection, in which individuals extensively
reflect on and rehearse possible “worst-case scenarios” of what
could go wrong prior to an event and then imagine how these
negative outcomes might be prevented (Cantor & Norem, 1989;
Norem & Cantor, 1986a, 1986b; Norem & Chang, 2002; Norem &
Illingworth, 1993, 2004; Spencer & Norem, 1996). Defensive
pessimism is conceptualized as strategically serving (a) a self-
protective goal of preparing for possible failure and (b) a motiva-
tional goal of increasing effort to enhance the possibility of doing
well (Sanna, 1996, 2000; Showers, 1992; Showers & Ruben,
1990).
Reflection
Reflection has been defined as chronic self-consciousness that
involves playful exploration of novel, unique, or alternative self-
perceptions, motivated by curiosity and pleasurable, intrinsic in-
terest in philosophical thinking (Trapnell & Campbell, 1999). The
construct of reflection developed as an attempt to explain the
“self-absorption paradox,” which reflects the fact that private
self-consciousness is positively associated with both increased
self-knowledge, which is assumed to facilitate psychological ad-
justment, and increased psychological distress and psychopathol-
ogy. Noting that private self-consciousness was correlated with
both Neuroticism and Openness to Experience, Trapnell and
Campbell (1999) hypothesized that the self-absorption paradox
could be explained if there was a neurotically motivated, threat-
avoidant form of chronic self-focus, labeled rumination, which
contributes to psychopathology, as well as a contrasting form of
chronic self-focus, motivated by epistemic curiosity, labeled re-
flection, which would be associated with increased self-
knowledge. The Rumination–Reflection Questionnaire (Trapnell
& Campbell, 1999) distinguishes between reflection (e.g., “I love
analyzing why I do things”) and rumination, defined as RT about
the self prompted by threats, losses, or injustices to the self.
Mind Wandering
Mind wandering has been defined as “a shift of attention from
a primary task toward internal information, such as memories”
(Smallwood & Schooler, 2006, p. 946). Mind wandering can be
persistent and repetitive, and as such fits within RT. Mind wan-
dering has unconstructive consequences in terms of reduced atten-
tion to external task-related information and interfering with per-
formance on tasks that require substantial controlled processing
(Smallwood, Davies, et al., 2004; Teasdale, Dritschel, et al., 1995).
However, it is hypothesized to facilitate problem solving by re-
peated working over unresolved current concerns (Smallwood &
Schooler, 2006).
Post-Event Rumination
Post-event rumination (also called “post-event processing” and
“post-mortem thinking”) has been defined as “repetitive thoughts
about subjective experiences during a recent social interaction,
including self-appraisals and external evaluations of partners and
other details involving the event” (Kashdan & Roberts, 2007, p.
286). Post-event rumination is hypothesized to contribute to the
development and maintenance of social anxiety (Clark & Wells,
1995; Rapee & Heimberg, 1997).
Positive Rumination
Positive rumination has been defined as “the tendency to re-
spond to positive affective states with thoughts about positive
self-qualities, positive affective experience, and one’s favorable
life circumstances that might amplify the positive affect” (S. L.
Johnson, McKenzie, & McMurrich, in press). Positive rumination
is hypothesized to be a process that may contribute to the dysregu-
lation of positive affect in individuals vulnerable to mania and
hypomania. The Responses to Positive Affect Questionnaire (Feld-
man, Joorman, & Johnson, in press) assesses how much an indi-
vidual ruminates in response to positive mood (e.g., “When you
feel happy, excited, or enthused how often do you: ‘Think about
how happy you feel’”).
Habitual Negative Self-Thinking
Habitual negative self-thinking is negative self-thinking that has
become a mental habit, defined as having “a history of repetition,
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CONSTRUCTIVE AND UNCONSTRUCTIVE REPETITIVE THOUGHT
characterized by a lack of awareness and conscious intent, men-
tally efficient, and sometimes difficult to control” (Verplanken,
Friborg, Wang, Trafimow, & Woolf, 2007, p. 526). The Habit
Index of Negative Thinking (Verplanken et al., 2007) assesses the
self-reported experience of the frequency, awareness, automaticity,
and control of negative thinking.
Overview
From this brief summary, it is clear that RT is a process common
to a number of important constructs in the realms of psychopa-
thology and self-regulation that has been hypothesized to have
both constructive and unconstructive consequences. Throughout
this article, I will use the construct RT as the generic label to
represent the constructs reviewed above, in preference to other
labels such as worry and rumination, because RT is (a) more
inclusive than other conceptualizations, encompassing the full
range of constructs reviewed above; (b) not wedded to a particular
theoretical viewpoint, unlike, say, rumination, which is typically
associated with RST; (c) less likely to cause confusion than other
terms that already have multiple conceptualizations and meanings
(e.g., rumination); (d) uncontaminated with prior assumptions as to
whether it is constructive or unconstructive, unlike rumination,
whose clinical usage typically reflects pathological processes; (e)
highly correlated with measures of worry and rumination, which in
turn are highly related to each other, suggesting the value of
examining more generic conceptualizations of thought process
(Feldman & Hayes, 2005; Fresco, Frankel, Mennin, Turk, &
Heimberg, 2002; Harrington & Blankenship, 2002; Hong, 2007;
Muris, Roelofs, Rassin, Franken, & Mayer, 2005; Segerstrom,
Tsao, Alden, & Craske, 2000; Verplanken et al., 2007; Watkins,
2004b; Watkins, Moulds, & Mackintosh, 2005).
Studies Included in the Review
A computerized search using keyword terms was conducted to
identify relevant publications for this review. The search, intended
to search for studies investigating RT, included the following
terms (using wild cards, such as ruminat* for ruminate, rumina-
tion, ruminator, ruminative): repetitive thought, worry, rumina-
tion, perseverative cognition, mental simulation, cognitive pro-
cessing, emotional processing, reflection, problem solving,
defensive pessimism, mind wandering, and counterfactual entered
into a number of academic databases (e.g., Web of Science—
Science Citation Index Extended and Social Science Citation In-
dex, PsycINFO, MEDLINE) from the beginning point of each
database through the middle of 2007. The Social Science Citation
Index was also searched for references citing seminal articles (e.g.,
Nolen-Hoeksema, 1991, 2000). In addition, reference lists of the
obtained articles as well as numerous review articles and chapters
(e.g., Martin & Tesser, 1989, 1996) were reviewed for relevant
articles.
Studies were included in this review if they reported either
constructive or unconstructive consequences associated with RT.
Constructive consequences were defined in terms of beneficial and
positive outcomes and products, including (but not limited to)
reduced negative affect, increased positive affect, decreases in
anxiety and depression, improved physical or mental health, im-
proved performance (e.g., better academic grades and exam re-
sults), helpful cognitions and behaviors (e.g., generating plans,
active behavioral problem solving, information seeking), and im-
proved cognitive functioning (e.g., improved memory recall, better
concentration), with unconstructive consequences defined in terms
of the reverse, detrimental and negative outcomes.
Three principal types of studies were considered: (a) cross-
sectional designs in which a measure of RT was found to be
correlated with a measure of positive or negative outcome; (b)
prospective longitudinal designs that assessed extent of RT at an
initial assessment point (T1) and examined whether it predicted a
dependent variable (e.g., depression) at a later date (T2), typically
controlling for the dependent variable at T1; and (c) experimental
designs that manipulated degree and/or nature of RT, and mea-
sured potential consequences, and, thus, could determine whether
RT had a causal effect on the measured dependent variable. The
latter two designs were given greater weight in the review because
they demonstrate that the dependent variable is a consequence of
RT, through indicating either a direct causal role of RT (experi-
mental) or a predictive function for RT antecedent to the depen-
dent variable (longitudinal). Throughout, the review will be orga-
nized by type of study, and, where appropriate, by whether the
consequences are main effects of RT or are moderated by inter-
actions with other factors. It is worth noting at the outset that the
literature on the unconstructive consequences of RT has been
better developed than the literature on the constructive conse-
quences of RT.
RT With Unconstructive Consequences
The main findings that emerged from reviewing this literature
are that RT is implicated in (a) vulnerability to depression, (b)
vulnerability to anxiety, and (c) difficulties in physical health.
Table 1 summarizes the relevant articles, reporting the design,
sample, measures, and main findings. The section on RT and
depression is the largest because of the extensive research on
depressive rumination.
RT and Vulnerability to Depression
Cross-Sectional Studies
In cross-sectional studies using the RSQ, depressive rumina-
tion is found to be (a) elevated in currently depressed patients,
formerly depressed patients, and women relative to men (Riso
et al., 2003; Roberts, Gilboa, & Gotlib, 1998) and (b) associated
with depressive symptoms in adults (Eshun, 2000; Ito et al.,
2003; Lam, Smith, Checkley, Rijsdijk, & Sham, 2003; Rich-
mond, Spring, Sommerfeld, & McChargue, 2001; see the re-
view by Thomsen, 2006), children (Abela, Vanderbilt, &
Rochon, 2004; Ziegert & Kistner, 2002), and adolescents
(Kuyken, Watkins, Holden, & Cook, 2006). Moreover, depres-
sive rumination partially accounts for the 2:1 rates of depres-
sion in women relative to men: Once statistically adjusted for,
there is no difference between men and women in rates of
depression (Butler & Nolen-Hoeksema, 1994; Grant et al.,
2004; Nolen-Hoeksema, Larson, & Grayson, 1999).
(text continues on page 175)
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WATKINS
Table 1
Studies Demonstrating Unconstructive Consequences of Repetitive Thought (RT)
Author Design and sample Measure Main finding
Cross-sectional studies
Abbott & Rapee
(2004)
54 socially anxious patients vs.
32 non-anxious controls
Post-event RT for 1 wk after
impromptu speech
Post-event RT: Socially phobic non-anxious
Abela et al. (2004) 260 3
rd
&7
th
grade children
RSQ, CDI RT positively correlated depression.
Borkovec et al.
(1983)
Study 1: 305 u/g’s STAI, BDI, % of day worrying Worry correlated anxiety, depression, social-evaluative
fears
Callander & Brown
(2007)
62 women at recurrent
miscarriage clinic
Thought listing, anxiety, depression Upward counterfactuals positively correlated anxiety
Clohessy & Ehlers
(1999)
56 ambulance service workers PSS, GHQ, responses to intrusions
(RT)
RT positively correlated with post-traumatic stress
symptoms
Conway et al.
(2000)
Study 2: 188 u/g’s RSS, distress about current
concern, BDI, NEO–FFI
Rumination on sadness significantly positively
correlated with BDI & neuroticism
Edwards et al.
(2003)
High vs. low social anxious Post-event RT for 1 wk after
impromptu speech
Negative rumination: High anxious low anxious
El Leithy et al.
(2006)
46 victims of physical assault IES–R, counterfactual fluency &
frequency
Frequency of counterfactual thinking positively
correlated with posttraumatic distress
Eshun (2000) 194 college students, USA &
Ghana
RSQ, suicidal ideation
questionnaire
Gender and rumination accounted for significant
variance in suicidal ideation
Feldman & Hayes
(2005)
Study 3; 325 u/g’s MMAP, RSQ, PSWQ, SPSI–R,
MASQ
Stagnant deliberation & outcome fantasy correlated
with increased depression & anxiety; problem
analysis correlated increased anxiety
Grant et al. (2004) 622 low-income, African
American adolescents
RSQ, depression, anxiety on YSR Depression: girlsboys. Rumination correlated
depression. Gender effect for depression mediated
by extent of rumination
Harrington &
Blakenship
(2002)
199 u/gs BDI, BAI, GRS Rumination significantly positively correlated with
depression and anxiety
Harvey (2000) 30 insomnia patients, 30 good
sleepers
Semi-structured interview Pre-sleep worry: Insomnia patients good sleepers
Ito et al. (2003) Retrospective, 106 parents
following death of a child
rumination, SCID, RSQ Ruminative coping after loss was significantly
associated with MDE
Johnson et al. (in
press)
28 Bipolar Disorder patients,
35 MDD patients; 44 no
mood disorder
RSQ, RPA Depressive rumination: Bipolar MDD no mood
disorder; positive rumination: Bipolar MDD
no mood disorder. Positive rumination positively
correlated hypomania
Joorman et al.
(2006)
64 MDD patients RSQ, emotional facial dot-probe Brooding significantly correlated with attentional bias
towards sad faces
Kocovski et al.
(2005)
55 high vs. 57 low socially
anxious u/g’s
Vignettes of public mistakes Report of rumination: High socially anxious low
socially anxious
Kuyken et al.
(2006)
High vs. low risk vs. MDD;
326 adolescents (age 14–18)
EPQ–N, BDI, RSQ, PHQ–A Rumination: MDD at risk (high N) not at risk
Rumination correlated depression in MDD group
Lam et al. (2003) 109 MDD patients RSQ, BDI, ASQ, DAS Rumination correlated depression scores, number of
past depression episodes
Lyubomirsky et al.
(2006)
Retrospective, 70 breast cancer
survivors
RSQ, delay in seeking help Time to presentation: High ruminators low
ruminators (on average 39 days longer)
Markman & Miller
(2006)
58 u/gs divided into severe
depression, mild-to-moderate
depression, no depression,
generated counterfactuals
about recent negative
academic event
Coding of counterfactuals, rating of
negative event
Greater reduction in negative ratings following RT for
less depressed. Uncontrollable, characterological
counterfactuals: severe depression no depression
mild-to-moderate depression
Mellings & Alden
(2000)
58 socially anxious; 58 non-
anxious
Frequency of post-event RT
following social interaction
Frequency of post-event RT: Socially anxious non-
anxious. RT predicted recall of negative self-related
information, negative self-judgments when
anticipating a further social interaction
Meyer et al. (1990) Study 2: 405 u/g’s PSWQ, BDI, STAI Worry positively correlated anxiety and depression
Nolen-Hoeksema &
Jackson (2001)
740 community sample RSQ, beliefs recontrollability of
emotions, mastery of negative
events
Beliefs about controllability of emotions, mastery of
negative events mediated gender difference in
rumination
Papadakis et al.
(2006)
223 girls between 7
th
–12
th
grade
RSQ, discrepancy between actual
& ideal self, BDI
Rumination interacted with discrepancy to predict
concurrent depression
Perini et al. (2006) High vs. low socially anxious
groups
Post-event RT for 1 wk after
speech
Post-event rumination: Socially anxious low
anxious
(table continues)
167
CONSTRUCTIVE AND UNCONSTRUCTIVE REPETITIVE THOUGHT
Table 1 (continued)
Author Design and sample Measure Main finding
Cross-sectional studies
Rachman et al.
(2000)
130 u/g’s BDI, social anxiety inventory, post
event RT
Post-event RT significantly positively correlated with
social anxiety and depression
Richmond et al.
(2001)
145 u/g’s IDD, RSQ Increased rumination associated greater levels of
current and past depressive symptoms
Riso et al. (2003) Outpatients: 42 dysthymia; 27
nonchronic MDD; 24
control participant
SCID, DAS, ASQ, RSQ, IDS Ruminative response style: Dysthymia nonchronic
MDD never-ill controls
Roberts et al.
(1998)
Study 1: 13 CD; 13 PD; 19
ND; Study 2: 24 CD; 87
PPD; 149 BPD; 356 ND
RSQ, BDI, IDD, IDD–L Study 1: Rumination: currently dysphoric (CD)
previously dysphoric (PD) never-dysphoric (ND)
Study 2: Rumination: CD prolonged PD brief
PD ND. Rumination: females males.
Rumination mediates effects of gender & N on
dysphoria.
Rude et al. (2007) Study 1: 232 u/g’s. Study 2:
463 u/g’s
Study 1: RSQ, STAI, Self-rating
depression scale; Study 2: non-
judging RSQ, RSQ, BDI
Study1&2:both brooding & reflection positively
associated depression, anxiety. Study 2: non-judging
reflection not correlated with depression.
Schlotz et al.
(2004)
219 pts Worry & work overload, saliva on
awaking & at 30, 45, 60 mins
for 6 days
Increased worry associated greater increase and
elevated mean levels of cortisol on weekdays
Schwartz et al.
(2000)
Recovery after anger recall; 30
general population
Thoughts related to anger recall,
BP
Slower BP recovery after anger recall in women only
Segerstrom et al.
(2000)
Study 1: 110 u/g’s; 40 CBT
outpatients
Measure of RT, RSQ, PSWQ, BDI,
BAI
Study 1: RT correlated RSQ, PSWQ; anxiety &
depression
Smallwood,
O’Connor, et al.
(2004)
Study 1: 30 u/g’s. Examined
mind wandering via thought
probes during vigilance and
word encoding tasks
CES–D Mind wandering (task unrelated thought during
probes) positively correlated with depression
Smallwood et al.
(2007)
37 u/g’s split into high vs. low
dysphoric, thought probes
during word encoding vs.
word shadowing followed
by word fragment
completion recognition task
CES–D, RSQ During word encoding, high dysphoric group showed
an increase in mind wandering relative to low
dysphoric group. Mind wandering associated slower
reaction times, poorer recognition in the encoding
condition.
Steil & Ehlers
(2000)
2 Studies: 159 & 138 RTA
survivors
PSS, cognitive strategies incl.
rumination
Rumination positively correlated with PTSD severity
Suchday et al.
(2004)
40 male students Recovery of BP after provocation,
angry rumination
Angry rumination associated slower recovery of BP
Thomsen et al.
(2003)
126 students ECQ–R, POMS, PSQI RT positively correlated with depressive, anxious &
angry mood, poorer sleep quality, longer sleep-
onset.
Trapnell &
Campbell (1999)
3 samples u/g’s, n 441, n
570, n 710
RRQ, NEO-FFI, BDI Rumination scale significantly positively correlated
with depressive symptoms (r .38, r .36) and
neuroticism (r .64)
Verplanken et al.
(2007)
Study 2: 142 u/g’s; study 3: 97
u/g’s
HINT, ATQ, RSE Habitual negative self-thinking positively correlated
negative thoughts, low self-esteem (Study 2, 3)
Ziegert & Kistner
(2002)
201 adolescents RSQ, CDI Rumination elevated in girls relative to boys;
rumination associated with depressive symptoms
Longitudinal studies
Abela et al. (2002) T2 6 wks; 130 3
rd
& 184
7
th
grade children
RSQ, CDI RT at T1 predicted depressive symptoms at T2
Andrea et al.
(2004)
T2 10 mths; 253 low vs.
204 high fatigue pts
PSWQ, self-reported fatigue Worry & fatigue strongly positively correlated at T1.
Worry at T1 predicted fatigue at T2, but only for
low fatigue participants after controlling T1 fatigue
Broadbent et al.
(2003)
T2 1
st
20 hrs after hernia
surgery; 36 hernia patients
Pre-surgery worry, wound fluid Greater worry predicted lower levels of matrix
metalloproteinase-9 in wound fluid & self-reports of
painful, poorer, and slower recovery
Burwell & Shirk
(2007)
T1 spring of 8
th
grade, T2
fall of 9
th
grade, T3
spring of 9
th
grade (1 yr
later); 127 adolescents
(mean 14 yrs)
CDI, RSQ, CDRS-R Brooding predicted change in depression scores after
controlling for T1 depression, but reflection did not
168
WATKINS
Table 1 (continued)
Author Design and sample Measure Main finding
Longitudinal studies
Butler & Nolen-
Hoeksema
(1994)
T2 2 wks; 125 male, 74
female u/g’s
RSQ, BDI Rumination: female male. Rumination predicted T2
BDI, controlling T1 BDI. Once rumination
included, gender not predict depression.
Calmes & Roberts
(2007)
T2 6–8 wks; 451 u/g’s BAI, BDI, PSWQ, RSQ RT (worry & rumination) predicted T2 anxiety but not
T2 depression, controlling for T1 symptoms.
Symptom-focused rumination predicted T2
depression.
Ciesla & Roberts
(2007)
Study 4: T2 6 wks; 169
u/g’s
RSQ, BDI, RSE, LES Study 4: RT at T1 predicted depressive symptoms at
T2 only in pts with low self-esteem & high life
stress
Ehlers et al. (1998) T1 3 mths after RTA, T2
1 yr after; 967 consecutive
RTA patients
PSS, RT about RTA RT at T1 predicted PTSD symptoms at T2 after
controlling severity
Ehlers et al. (2003) T2 6 mths; 81 children age
5–16 after RTA
PTSD symptoms, RT rating Cognitive variables including RT at T1 predicted
PTSD symptoms at T2
Evers et al. (1998) T2 1 year; 91 arthritis
patients
Self-reported functional status, grip
strength, worry
Worry on PCI at T1 predicted functional status & grip
strength at T2, controlling for T1 scores
Feldman & Hayes
(2005)
Study 4. T1 start 1
st
semester;
T2 end 1
st
semester (13
wks); 110 1
st
year law
students
MMAP, RSQ, PSWQ, SPSI–R,
MASQ
Study 4: Stagnant deliberation & outcome fantasy at
T1 predicted depression at T2, controlling for T1
depression
Fortune et al.
(2003)
Duration of
photochemotherapy; 112
chronic psoriasis patients
PSWQ, HADS, psoriasis area &
severity index
Worry predicted time to clearance: psoriasis cleared
1.8 slower in high worriers vs. low worriers
Holeva et al.
(2001)
T2 6 mths; 265 RTA
patients
TCQ, PTS Use of worry to control thoughts at T1 predicted
PTSD at T2
Hong (2007) T2 1 mth; 241 u/g’s PSWQ, RSQ, MASQ, COPE T1 worry predicted T2 anxiety & depression;
controlling T1 symptoms. T1 rumination predicted
T2 depression, controlling T1 symptoms
Ito et al. (2005,
2006)
T2 8 mths; 191 u/g’s RSQ, DAS, depression Negative rumination was significant predictor of
depression
Just & Alloy
(1997)
Follow-ups every 6 weeks for
18 mths; 189 non-depressed
u/g’s at high & low risk for
MDE
RSQ, BDI, SADS–L, DAS, CSQ Rumination predicted onset of MDE & severity of
episode
Kubzansky et al.
(1997)
T2 20 years; 1759 men free
CHD
Trait worry Worry about social conditions predicts the onset of
CHD
Kuehner & Weber
(1999)
T2 4 wks, T3 4 mths
after discharge; 49 unipolar
MDD inpatients
PSE–10, IDD, RSQ Rumination at T2 predicted (a) levels of depressive
symptoms at T3; (b) MDE at T3 in those not
remitted at T2
Mayou et al.
(2001)
T1 after RTA, T2 3 mths,
T3 1 yr; 773 consecutive
RTA patients
HADS, PSS, cognitive variables
incl. rumination
Rumination at T2 predicted depression, general
anxiety and PTSD symptoms at T3, after
adjustment other predictors (severity, previous
mood)
Mayou et al.
(2002)
T2 3 yrs; 546 RTA patients PSS, emotional response;
rumination
Rumination at 3 mths&1yrpredicted PTSD severity
at 3 yrs, though not after controlling for PTSD at 3
mths
Michael et al.
(2005)
T1 12 wks post-assault, T2 6
mths; 73 assault survivors
PDS, BDI, intrusions incl.
rumination
Rumination about intrusive thoughts at T1 predicted
PTSD symptoms at T2
Moberly &
Watkins (in
press)
Between subsequent intervals
(1.5 hrs) in ESM design; 93
adults
ruminative self-focus, negative
affect 8 daily at random
intervals, RSQ
RSQ predicted momentary ruminative self-focus.
Ruminative self-focus predicted negative affect at
T2, controlling for negative affect at T1
Morrison &
O’Connor (2005)
T2 6 mths; 161 u/g’s RSQ, life events Rumination at T1 interacted with reported stress to
predict social dysfunction at T2
Murray et al.
(2002)
T2 4 wks, T3 6 mths; 27
inpatient, 176 outpatient
RTA patients
PDS, cognitive factors incl.
rumination
Rumination at T1 predicted PTSD symptoms at T2
and T3
Rumination at T2 predicted PTSD symptoms at T3,
even controlling for dissociation and injury severity
Nolan et al. (1998) T2 8–10 wks; 135 u/g’s EPQ–N, IDD, RSQ N & rumination predicted T2 depression controlling
T1 depression, with this effect moderated T1
depression
Nolen-Hoeksema
(2000)
T2 1 year; 1,109 community
sample
RSQ, HRSD, BDI, SCID, BAI Rumination predicted: (a) onset of MDE in never-
depressed; (b) levels of anxiety and depression at
T2, controlling T1 symptoms
(table continues)
169
CONSTRUCTIVE AND UNCONSTRUCTIVE REPETITIVE THOUGHT
Table 1 (continued)
Author Design and sample Measure Main finding
Longitudinal studies
Nolen-Hoeksema et
al. (1997)
T2 1 year; 30 gay men,
whose partners died from
AIDS
Rumination from interview
transcripts, IES, CES–D
Rumination predicted increased distress (intrusive &
avoidant thoughts) but not depression, although not
after controlling T1 IES
Nolen-Hoeksema et
al. (1999)
T2 1 year later; 1,132
community adults
BDI, HRSD, RSQ, chronic strain,
mastery
Rumination, chronic strain, & mastery mediated
gender difference in depression
Nolen-Hoeksema &
Morrow (1991)
T2 10 days after quake (n
137), T3 7 wks after
quake (n 41); 250 u/g’s 2
wks before 1989 Lomo
Prieta earthquake
RSQ, IDD Rumination at T1 predicted depression and PTSD
stress symptoms at T2 and T3, controlling for T1
symptoms. Rumination about earthquake at T2
predicted stress symptoms at T3
Nolen-Hoeksema et
al. (1993)
79 u/g’s 30 day diary of mood &
rumination
More ruminative responses predicted increased
duration of depressed mood, after controlling for
initial severity of mood
Nolen-Hoeksema et
al. (1994)
T2 6 mths; 253 adults, 1
mth after death of loved one
RSQ, HRSD, BDI, Social support Rumination at T1 predicted level of depressive
symptoms at T2 controlling T1 depression
Nolen-Hoeksema et
al. (2007)
Annually for 4 yrs; 496 female
adolescents, 11–15 yrs old
RSQ, SADS for Children, Eating
Disorder Examination, substance
abuse
Rumination predicted increases in depression, bulimia
symptoms & substance abuse over following yr;
controlling for 1 year lag of symptoms. Depression
and bulimic symptoms predicted increases in
rumination over yr
Raes, Hermans,
Williams,
Beyers, et al.
(2006)
T2 7 mths; 28 MDD
patients
RSS, BDI, HRSD, AMT Rumination on sadness at T1 predicted BDI at T2 &
mediated relationship between memory specificity
& BDI
Rector & Roger
(1996)
T1 start of term, T2 8 wks
later, 121 1
st
year u/g’s
ECQ–R, GHC, York self-esteem
inventory
Anxiety, depression, insomnia on GHC at T2
predicted by rehearsal at T1
Robinson & Alloy
(2003)
T2 2.5 yrs; 148 u/g’s at
high and low cognitive risk
Stress-reactive rumination, RSQ,
BDI, DAS, CSQ, SADS–L
Stress-reactive rumination at T1 predicted future MDE
at T2 in individuals with high DAS, CSQ but not
low DAS, CSQ
Roelofs et al.
(2006)
T2 6 mths; 331 at T1, 73 at
T2 u/g’s
RSQ, RRQ, Zung depression scale,
STAI
Joint factor “rumination on causes of sadness”
interacted with T1 depression to predict T2
depression, after controlling T1 rumination &
depression
Roger & Najarian
(1998)
T1 immediately after exam,
T2 3 wks later; 51
student nurses
ECO–R, urinary cortisol Increases in cortisol T1 to T2 associated with
increased RT
Rohan et al. (2003) T1 Oct–Nov, T2 Jan–
Feb; 20 SAD women; 20
controls
RSQ, BDI, SCID, HRSD In SAD, RT assessed at T1 predicted depressive
symptoms during winter at T2, after controlling for
T1 depression
Sakamoto et al.
(2001)
T2 2 mths; 98 u/g’s RSQ, Self-Rating Depression Scale Rumination at T1 predicts ruminative responses and
cognitive symptoms of depression at T2
Sarin et al. (2005) T1 grading of difficult
midterm exam; T2 4–8
hrs later, T3 4 days later;
87 u/g’s
RSQ, MASQ Rumination at T1 predicts increases in anxiety at T2
and increases in both depression & anxiety at T3
Schmaling et al.
(2002)
Course of treatment; 96
dysthymia / minor
depression
RSQ, BDI, HRSD Rumination predicts more depression/poor treatment
response across all 3 treatment conditions: PST,
paroxetine or placebo
Schwartz & Koenig
(1996)
T2 6 wks; 397 adolescents RSQ, ASQ, CDI Rumination at T1 predicted depression at T2
Segerstrom et al.
(1998)
2, 8, 15 weeks after Northridge
earthquake 1994; 47 hospital
workers
PSWQ, IES, POMS, NK cells NK cells: Low worriers high worriers
Intrusive thoughts: High worriers low worriers
Segerstrom et al.
(2000)
Study 2: T1 prior midterm
exam; T2 1wk
post-exam; 90 u/g’s
Measure of RT, RSQ, PSWQ, BDI,
BAI
Shared variance between RSQ & PSWQ (repetitive
thought) predicted maintenance of anxiety, after
controlling for T1 anxiety (p .07)
Siegle et al. (1999) Treatment outcome; 53 MDD
or dysthymia patients
RSQ, weekly BDI during CBT Rumination was associated with slower recovery from
depression, in part mediated by initial depression
Smith et al. (2006) T2 2.5 yrs; 137 u/g’s with
high vs. low cognitive risk
RSQ, BDI, DAS, CSQ,
hopelessness, suicidal ideation
Presence & duration of suicidal ideation at T2
predicted by rumination at T1, with this effect
partially mediated by hopelessness
Spasojevic & Alloy
(2001)
Assessed every 6 weeks for
2.5 years; 137 u/g’s with
high vs. low cognitive risk
RSQ, BDI, DAS, CSQ, SADS–L Rumination mediated effects of dysfunctional
attitudes, past depression, self-criticism on onset of
MDE
170
WATKINS
Table 1 (continued)
Author Design and sample Measure Main finding
Longitudinal studies
Stanton, Danoff-
Burg, et al.
(2000)
T1 20 wks after treatment,
T2 3 mths later; 92
female breast cancer patients
COPE, emotional processing &
expression, POMS
Emotional processing at T1 predicted higher distress
scores at T2, after controlling T1 distress and
emotional expression
Thomson, Mehlsen,
Hokland, et al.
(2004)
T2 1 year; 96 20–35 yr
olds, 110 70–85 yr olds
ECQ–R, self-reported physical
problems
RT significantly predicted self-reported physical health
only for 20–35 yr olds
Thomsen, Mehlsen,
Olesen, et al.
(2004)
Immunological measures 7–14
days after T1, follow-up 1
yr; 196 20–35 yr olds; 314
70–85 yr olds
ECO–R, POMS, MMSE, sleep
quality. Health care use
RT associated sad mood & poor sleep quality
In 70–85 yr olds, RT predicted numbers of leukocytes
and lymphocytes, and increased health care
utilization, esp. telephone consultation
Treynor et al.
(2003)
T2 1 yr; 1130 community
sample
RSQ, BDI Brooding subscale at T1 predicted more depression at
T2 controlling for depression at T1
Verplanken et al.
(2007)
T2 9 mths; 1,102
Norwegian citizens
HINT, HADS, DAS, life events Controlling for T1 symptoms, dysfunctional attitudes
& life events, habitual negative self-thinking
predicted anxiety & depression at T2
Young & Azam
(2003)
Sept to Nov (T1); Jan to
March (T2); 18 SAD
patients
14 day diary of mood &
rumination, BDI
Diary measure of rumination in the fall (T1) predicted
winter depression at T2, after controlling for T1
BDI
Experimental studies
Andrews &
Borkovec (1988)
Velten inductions: worry vs.
depression vs. somatic
anxiety vs. neutral;
128 u/g’s
MAACL For MAACL depression: Depression Worry
Somatic anxiety neutral. For MAACL anxiety:
Somatic anxiety worry depression neutral
Behar et al. (2005) 5-min counterbalanced worry
vs. trauma recall vs.
relaxation; u/g’s Study 1:
78; Study 2: 43 / GAD,
PTSD symptoms
depression & anxiety ratings Study 1, 2: Worry verbal thought, trauma recall
imagery. For anxiety: worry ⬎⫽ trauma recall
relaxation. For depression: trauma recall worry
relaxation.
Blagden & Craske
(1996)
Anxious mood induction then
RUM vs. DIS, activity vs.
passivity; 44 u/g’s
POMS Anxious mood: Rumination Distraction
Borkovec et al.
(1993)
30s relaxation vs. general-
worry vs. thought-worry vs.
image-worry vs. affect-
worry, then public speaking
image 10; 75 female high
speech anxious u/g’s
HR, fear rating HR during threat image: Relaxation Thought-worry:
other 3 conditions between but ns difference. Fear
rating during public speaking image: All Worry
conditions Relaxation
Borkovec & Hu
(1990)
Day 1: Neutral vs. relaxation
vs. worry, day 2: imagine
public speaking 10 trials;
45 female high speech
anxious u/g’s
HR, fear rating HR increase to imagery: Relaxation neutral
worry. Fear report to images: Worry neutral
Borkovec et al.
(1983)
Study 3: 0 vs. 15-min vs. 30-
min worry periods, with pre-
& post-manipulation focus-
breathing tasks; 60 u/g
worriers vs. nonworriers
MAACL, HR Anxiety, depression, hostility: Worriers nonworriers
Negative distracting thoughts: Increase in 15-min
worry, decrease in 0-min, 30-min worry
Brosschot & van
der Doef (2006)
Postpone worry to 30-min
period daily vs. no
intervention; 171 high
school students
6 day log of worry, somatic
symptoms for 3 days pre-/post-
intervention
Postponers fewer somatic complaints than control
group, controlling for baseline complaints, with
worry duration acting as mediator
Bushman (2002) Anger induction (insult from
other pt), then hitting
punchbag thinking about
other (rumination) vs.
thinking about getting fit
(distraction) vs. control; 602
u/g’s
MAACL-anger, PANAS,
Aggression measure: noise
directed to other
Anger: rumination distraction control
Aggression: rumination control
(table continues)
171
CONSTRUCTIVE AND UNCONSTRUCTIVE REPETITIVE THOUGHT
Table 1 (continued)
Author Design and sample Measure Main finding
Experimental studies
Bushman et al.
(2005)
Study 1 Provocation, then
RUM vs. DIS vs. positive
mood, then trigger vs. no
trigger for irritation (poor
vs. good performance of
research assistant); 42 u/g’s
Study 2: Provocation vs. no
provocation, RUM vs. DIS,
trigger vs. no trigger
(positive vs. negative
evaluations from other pt);
385 u/g’s. Study 3:
provocation then RUM vs.
no-rumination, then 8 hr
later trigger vs. no trigger;
93 u/g’s
anger ratings, aggression measure
(evaluation research assistant/hot
sauce allocated to confederate/
noise directed at other)
Anger: rumination distraction in all 3 studies
Study 1: After trigger, aggression in RUM DIS
positive mood; no difference after no trigger
condition
Study 2: Provocation Rumination Trigger
interaction: for provoked participants, in the
presence of trigger, more hot sauce allocated in
RUM than DIS, with this effect mediated by
negative affect in response to trigger.
Study 3: After trigger, aggression in RUM no rum,
no difference if no trigger
Ciesla & Roberts
(2007)
Study 1: negative mood
induction, followed by no-
task delay period; 126 u/g’s;
Study 2: negative mood
induction, then RUM vs.
DIS; 132 u/g’s
BDI, MAACL, RSQ, RSS, RSE,
DAS, ASQ
Study 1: RT predicted post-delay dysphoria,
controlling for post-induction dysphoria but only in
low self-esteem/high DAS pts. Study 2: lower self-
esteem/higher DAS associated higher levels of
dysphoria, this effect stronger in RUM vs. DIS.
Conway et al.
(2000)
Study 3: mood induction, then
no delay vs. 5-min delay; 37
high vs. 24 low RSS scorers
RSS, distress about current
concern, BDI
High RSS scorers more distressed in delay condition
than no-delay condition
Donaldson & Lam
(2004)
RUM vs. DIS; 36 MDD, 36
controls
mood, MEPS In MDD (not controls), more negative mood and
poorer problem solutions in RUM DIS
Glynn et al. (2002) Study 1: emotional vs.
nonemotional stressor, high
vs. low reactivity task,
followed by rumination (
recall stressor vividly); 72
u/g’s. Study 2: mental
arithmetic task, then 10 mins
delay (potential rumination)
vs. DIS; 20 u/g’s
Study 1: BP, HR. Study 2. BP, HR Study 1: Elevated BP during rumination and slower
BP recovery following the emotional stressor
conditions (mental arithmetic, shock avoidance) but
not following non-emotional stressors (physical
exercise, cold-pressor)
Study 2: Speed of BP recovery: Distraction RT
Guastella &
Moulds (2007)
Evening after mid-session
exam RUM vs. DIS; 59 high
vs. 55 low trait ruminators
RSQ, IES, Sleep-Disturbance Pre-sleep intrusive thoughts: High-trait ruminators
low-trait ruminators, RUM DIS; Sleep quality:
high-trait ruminators in RUM condition other 3
groups
Hazlett-Stevens &
Borkovec (2001)
Relaxation vs. control vs.
worry prior to speech; 42
speech-anxious u/g’s
Anxiety, HR, MSD of IBI Anxiety before and during first speech: worry
control relaxation. HR, MSD of IBI no
difference across conditions
Hertel (1998) RUM vs. DIS vs. waiting
condition; 36 Dys vs. 54
Non-dys u/g’s
BDI, stem-completion memory test Controlled retrieval of target words: In Dys, DIS
waiting RUM; no difference in Non-dys
Joorman & Siemer
(2004)
(Study 1): Positive vs. negative
mood induction, then RUM
vs. DIS; 119 u/g’s, Dys vs.
Non-Dys on CES-D
mood ratings, time to recall
memories to / cues
After negative induction, Non-Dys (not Dys) who
ruminated recalled mood-incongruent (positive)
memories faster. After positive induction, Dys who
ruminated recalled mood-congruent (positive)
memories slower than Non-Dys
Kao et al. (2006) RUM vs. DIS; 33 Dys u/g’s
(BDI 14); 33 Non-dys
u/g’s (BDI 6)
mood, MEPS, memory recall
during MEPS
Post-manipulation dysphoria: Dys ruminators other
3 groups. Effectiveness of problem solving: Dys
ruminators other 3 groups. Categoric memories:
Dys ruminators Dys distractors other 2 groups
Kashdan & Roberts
(2007)
Personal self-disclosure vs.
small talk; 83 u/g’s
Social anxiety, post-event
rumination; BDI, PANAS
At higher levels of social anxiety, post-event
rumination associated with increases in negative
affect following personal disclosure, but decreases
in negative affect following small talk
Lavender &
Watkins (2004)
RUM vs. DIS; 30 MDD vs. 30
control participants
Future thinking task, SCID Within MDD patients, no. of negative future events
generated, RUM DIS; no effect in controls
172
WATKINS
Table 1 (continued)
Author Design and sample Measure Main finding
Experimental studies
Lyonfields et al.
(1995)
Within-subject, baseline vs.
worry imagery vs. verbal
worry; 15 GAD vs. 15
controls
HR, MSD of IBI, anxiety ratings Vagal (parasympathetic) tone (MSD of IBI): GAD
controls. Little change in vagal tone across tasks in
GAD group, but decline in vagal tone across tasks
in controls
Anxiety: verbal worry worry imagery
Lyubomirsky et al.
(2003)
Study 1: RUM vs. DIS vs.
planning, 45 Dys (BDI
15) vs. 46 Non-Dys (BDI
3)
Study 1: CIQ, reading task, Study 1: dysphoric mood, time spend reading passage,
interfering thoughts in Dys-ruminative group
other 4 groups. Study 2: dysphoric mood, time
answering questions in Dys-ruminative group
other 3 groups
Study 2: RUM vs. DIS, 28
Dys vs. 26 Non-Dys. Study
3: RUM vs. DIS, 33 Dys vs.
32 Non-Dys
Study 2: questions on videotaped
lecture. Study 3, COQ during
puzzle, proof-reading
Study 3: dysphoric mood, interfering thoughts, poorer
proof-reading in Dys-ruminative group other 3
groups
Lyubomirsky &
Nolen-Hoeksema
(1995)
RUM vs. DIS, Dys (BDI–SF
7) vs. Non-Dys (BDI–SF
3); Dys vs. Non-Dys u/
g’s - Study 1: 33 vs. 36;
Study 2: 36 vs. 37; Study 3:
36 vs. 33
Mood ratings. Study 1: CBQ.
Study 2: future predictions.
Study 3: MEPS
All studies - dysphoric mood: Dys-ruminative group
other 3 groups. Study 1: depressed-distorted
thoughts, pessimistic attributions: Dys-ruminative
group other 3 groups. Study 2: likelihood of
positive future events: Dys-ruminative group
other 3 conditions. Study 3: problem-solving
effectiveness: Dys-ruminative group other 3
groups
Lyubomirsky et al.
(1998)
RUM vs. DIS, Dys vs. Non-
Dys then (Study 1) free
recall memory task; (Study
2) cued memory task;
(Study 3) frequency ratings
for events; (Study 4) think
aloud during manipulation.
Dys vs. Non-Dys u/g’s -
Study 1: 38 vs. 34; Study 2:
25 vs. 24; Study 3: 39 vs.
33; Study 4: 20 vs. 20
Mood ratings
Memory measures
Study 1, 2, 4: dysphoria, negativity of
autobiographical memories in Dys-ruminative group
other 3 groups
Study 3: dysphoria, reported frequency of negative
events in Dys-ruminative group other 3 groups
McLaughlin et al.
(2007)
Within-subject, worry vs.
rumination counterbalanced
Study 1: 60 u/g’s. Study 2: 34
worrier / ruminator, 40
ruminator, 35 control
BDI, PSWQ, MASQ, PANAS,
anxiety & depression ratings
In Study1&2,both worry & rumination increased
negative affect, anxiety, depression & reduced
positive affect. Both involve a predominance of
thought (versus imagery)
Moberly &
Watkins (2006)
Repeated focus on emotional
scenarios, abstract vs.
concrete, prior to failure; 61
u/g’s
PANAS, ACS–P, BDI After failure, higher levels of trait RT were associated
with lower levels of positive affect, but only in
abstract condition, not in concrete condition
Morrow & Nolen-
Hoeksema
(1990)
Sad mood induction then RUM
vs. DIS, active vs. passive
task; 35 male, 34 female
u/g’s
sadness, hostility & anxiety ratings Reduction in sadness post-induction to post-task:
Distracting–active distracting-passive
ruminative-active ruminative–passive
Nelson & Harvey
(2002)
Speech threat prior to bed,
think about speech verbally
(worry) vs. imagery; 31
insomnia pts
Distress, sleep-onset latency Initial distress: Imagery Verbal worry Sleep-onset
latency: Imagery verbal worry. Depressed mood
increased for Dys participants who ruminated, but
decreased in other 3 groups
Nolen-Hoeksema &
Morrow (1993)
RUM vs. DIS; 24 Dys vs. 24
Non-Dys u/g’s
Mood ratings Depressed mood increased for Dys participants who
ruminated, but decreased in other 3 groups
Park et al. (2004) RUM vs. DIS: Adolescents: 75
1
st
episode MDD; 26 non-
depressed psychiatric pts; 33
controls
Despondency, AMT In MDD group, negative mood and categoric
autobiographical memories: RUM DIS
Peasley-Miklus &
Vrana (2000)
Worry vs. relaxation then
feared imagery for 24 trials;
51 Fearful female u/g’s
HR, facial EMG During 1
st
phase for HR: worry relaxation. During
imagery phase for HR: relaxation worry
Rusting & Nolen-
Hoeksema
(1998)
Study 1: angry mood
induction, then RUM vs.
DIS; 41 u/g’s. Study 3:
anger induction then RUM
vs. DIS vs. thought-listing;
60 u/g’s
anger, depression, anxiety ratings Study 1: RUM increased anger, DIS no change in
anger
Study 3 for anger: rumination control (thought-
listing) distraction
(table continues)
173
CONSTRUCTIVE AND UNCONSTRUCTIVE REPETITIVE THOUGHT
Table 1 (continued)
Author Design and sample Measure Main finding
Experimental studies
Segerstrom et al.
(1999)
Exposure to phobic stimulus
vs. no exposure;
Snake/spider fearful: 7
worriers, 8 non-worriers: 6
controls
PSWQ, SCL, HR, immune function Increased SCL, HR both worry groups; increase in
NK cells in response to fear only in normal worry
group
Thayer et al.
(1996)
Baseline vs. relaxation vs.
worry; 34 GAD patients, 32
controls
HR, IBIs, MSD of IBIs Cardiac IBIs: GAD controls. Worry baseline
relaxation. Worry associated lower cardiac vagal
control
Thomsen,
Jorgensen, et al.
(2004)
Mood induction; 56 u/g’s ECQ–R, mood ratings Trait RT positively correlated with post-induction
stress, anxiety, anger & helplessness, controlling
pre-induction mood
Watkins (2004a) Failure then 3 expressive
writing, abstract (why?) vs.
concrete (how?); 69
community sample
ACS–P, BDI, MAACL, IES Higher levels of trait RT associated with higher levels
of negative mood 12 hr after failure in the abstract
but not the concrete writing condition
Watkins & Brown
(2002)
Within subject, RUM vs. DIS
counterbalanced; 14 MDD,
14 controls
Random number generation task For count score (index of less randomness), MDD
ruminators other 3 conditions, i.e., DIS improved
randomness in MDD
Watkins &
Teasdale (2001)
Analytical RUM vs.
experiential RUM vs. DIS
vs. abstraction; 36 MDD
patients
despondency, AMT pre-, post-
manipulation
Post manipulation despondency: Analytical,
Experiential RUM (high self-focus) DIS,
abstraction (low self-focus). Increase in specificity
of autobiographical memory: Experiential RUM,
DIS (low analytical) analytical RUM, abstraction
(high analytical)
Watkins &
Teasdale (2004)
Analytical RUM vs.
experiential RUM; 28 MDD
patients
despondency, AMT Increase in specificity of autobiographical memory
pre-to-post manipulation: Experiential RUM
Analytical RUM
Watkins et al.
(2000)
RUM vs. DIS; 48 Dys sample despondency, AMT Post-manipulation despondency: RUM DIS
Increases in specificity of autobiographical memory
pre to post-manipulation: DIS RUM
Wells &
Papageorgiou
(1995)
Watch upsetting film, then
control vs. imagery vs.
distraction vs. worry about
film vs. worry usual
concerns; 70 u/g’s
PSWQ, STAI, anxiety VAS,
intrusive image diary next 3 days
Number of intrusive images: worry about film
control, all other groups not significantly different
York et al. (1987) Velten inductions worry vs.
somatic anxiety vs. neutral,
then breathing-focus task; 36
u/g’s
Negative intrusions, MAACL, HR Increases in negative intrusions during
breathing-focus: Worry Neutral, Somatic anxiety
ns different from both. Increase in HR: Worry
Somatic Anxiety Neutral
Note. ACS–P Action Control Scale—Preoccupation; AMT Autobiographical Memory Test; ASQ Attributional Style Questionnaire; ATQ
Automatic Thoughts Questionnaire; BAI Beck Anxiety Inventory; BDI Beck Depression Inventory; BP blood pressure; BPD brief previous
dysphoric group; CBQ Cognitive Biases Questionnaire; CBT cognitive-behavioral therapy; CD currently dysphoric group; CDI Childrens
Depression Inventory; CDRS–R Children’s Depression Rating Scale—Revised; CES–D Centre for Epidemiological Survey—Depression; CHD
coronary heart disease; CIQ Cognitive Interference Questionnaire; COPE the COPE scale; CSQ Cognitive Styles Questionnaire; DAS
Dysfunctional Attitudes Scale; DIS distraction manipulation; Dys dysphoric participants; ECO–R Emotional Control Questionnaire—Rehearsal;
EPQ–N Eysenck Personality Questionnaire—Neuroticism scale; ESM Experience Sampling Methodology; GAD generalized anxiety disorder;
GHC general health checklist; GHQ General Health questionnaire; GRS Global Rumination Scale; HADS Hospital Anxiety and Depression
Scale; HINT Habit Index of Negative Thinking; HR heart rate; HRSD Hamilton Rating Scale for Depression; IDD Inventory to Diagnose
Depression; IDD–L Inventory to Diagnose Depression—Lifetime; IDS Inventory of Depressive Symptoms; IES Impact of Event Scale; IES–R
Impact of Event Scale—Revised; LES Life Experiences Survey; MAACL Multiple Affect Adjective Checklist; MASQ Mood and Anxiety
Symptom Questionnaire; MDE major depressive episode; MDD patients with major depressive disorder; MEPS Means Ends Problem Solving task;
MMAP Measure of Mental Anticipatory Processes; MMSE Mini-Mental State Examination; MSD of IBI Mean Successive Differences of Heart
Interbeat Intervals; N Neuroticism; ND never-dysphoric group; NEO–FFI NEO-five factor inventory of personality; NK natural killer cells;
Non-Dys non-dysphoric participants; PANAS Positive and Negative Affect Schedule; PCI Pain Control Inventory; PD previously dysphoric;
PDS Posttraumatic Diagnostic Scale; PHQ–A Patient Health Questionnaire—Adolescent; POMS Profile of Mood States scale; PPD prolonged
previously dysphoric group; PSE–10 Present State Examination—10; PSS post-traumatic stress symptom scale; PST problem-solving therapy;
PSQI Pittsburgh Sleep Quality Index; PSWQ Penn State Worry Questionnaire; pts participants; PTS posttraumatic symptoms; PTSD
posttraumatic stress disorder; RPA Responses to Positive Affect; RRQ Rumination & Reflection Questionnaire; RSE Rosenberg Self-Esteem
questionnaire; RSQ Response Styles Questionnaire; RSS Rumination on Sadness Scale; RTAs road traffic accidents; RUM rumination
manipulation; SAD seasonal affective disorder; SADS–L Schedule for Affective Disorders and Schizophrenia—Lifetime; SCID Structured Clinical
Interview for Diagnostic and Statistical Manual of Mental Disorders; SCL skin conductance; SPSI–R Social Problem Solving Inventory—revised;
STAI State Trait Anxiety Inventory; TCQ Thought Control Questionnaire; T1 initial baseline assessment, T2 follow-up assessment, u/g’s
undergraduates; VAS visual analogue scale; YSR Youth Self Report.
174
WATKINS
Measures of forms of RT other than depressive rumination are also
positively and significantly correlated with depression, including a
general tendency toward RT (e.g., global rumination scale, Harrington
& Blankenship, 2002; W. D. McIntosh & Martin, 1992; Segerstrom
et al., 2000, Study 1), worry (PSWQ, Meyer et al., 1990; Segerstrom
et al., 2000; or self-rating, Borkovec et al., 1983), rumination on
sadness (Conway et al., 2000), rumination as operationalized by
Trapnell and Campbell (1999), content-independent perseverative
thinking (Ehring, 2007), or RT measured on the Measure of Mental
Anticipatory Processes (MMAP; Feldman & Hayes, 2005). The
MMAP assesses trait disposition to respond with various forms of RT
when faced with an “important, difficult and stressful problem” (p.
492), including Stagnant Deliberation (e.g., “Whenever I think about
the problem, I often wind up getting stuck”), Problem Analysis (e.g.,
“I think about why this problem is happening”), Plan Rehearsal (e.g.,
“I mentally visualize the steps involved in solving the problem”), and
Outcome Fantasy (e.g., “I fantasize about it all just going away”)
subscales. Both Stagnant Deliberation and Outcome Fantasy were
positively correlated with worry (PSWQ), depressive rumination
(RSQ), and depression symptoms. Likewise, mind wandering, as
measured by thought sampling during a task, is consistently associ-
ated with self-reported dysphoria across a wide range of tasks, includ-
ing word learning (Smallwood et al., 2003; Smallwood, O’Connor,
Sudberry, Haskell, & Ballantyne, 2004; Smallwood, O’Connor, Sud-
berry, & Obonsawin, 2007), sustained attention (Smallwood, Davies,
et al., 2004), and word fragment completion (Smallwood, O’Connor,
& Heim, 2005).
Prospective Longitudinal Studies
Main effect of RT. Prospective longitudinal studies have found
that the RSQ predicts (a) the future onset of a major depressive
episode across a range of follow-up periods in initially ND individuals
(Just & Alloy, 1997; Nolen-Hoeksema, 2000; and Spasojevic &
Alloy, 2001, by using the same sample as Just & Alloy, 1997, found
that rumination mediated the effect of other risk factors on onset of
depression); (b) depressive symptoms across a range of follow-up
periods in initially ND individuals, after controlling for baseline
symptoms (Abela, Brozina, & Haigh, 2002; Butler & Nolen-
Hoeksema, 1994; Hong, 2007; Nolen-Hoeksema, 2000; Nolen-
Hoeksema & Morrow, 1991; Nolen-Hoeksema, Parker, & Larson,
1994; Nolen-Hoeksema, Stice, Wade, & Bohon, 2007; Sakamoto,
Kambara, & Tanno, 2001; J. A. J. Schwartz & Koenig, 1996; J. M.
Smith, Alloy, & Abramson, 2006); (c) depressive symptoms in pa-
tients with clinical depression, after controlling for baseline depres-
sion (Kuehner & Weber, 1999; Nolen-Hoeksema, 2000; Rohan, Sig-
mon, & Dorhofer, 2003), although one non-replication should be
noted (88 college students with recent onset major depressive episode,
follow-up after 6 months; reported in both Kasch, Klein, & Lara,
2001; Lara, Klein, & Kasch, 2000).
It is worth noting one limitation of the RSQ: RSQ items are
multidimensional, such that rumination assessed on the RSQ over-
laps conceptually with a number of other constructs including
depressive symptoms (Roberts et al., 1998; Treynor, Gonzalez, &
Nolen-Hoeksema, 2003), negative affectivity–neuroticism (Kasch
et al., 2001; Watson & Clark, 1984), and cognitive reactivity
(Scher, Ingram, & Segal, 2005; Segal, Gemar, & Williams, 1999;
Segal et al., 2006; Van der Does, 2002), each of which could
potentially account for the RSQ predicting prospective depression.
However, this concern has been offset by convergent evidence that
other measures of RT predict depression. First, other measures of
depressive rumination predicted future depressive mood: (a) diary
studies in which participants recorded their moods and responses
to their moods every day for at least 2 weeks, for both undergrad-
uates (Nolen-Hoeksema, Morrow, & Fredrickson, 1993) and pa-
tients with seasonal affective disorder (Young & Azam, 2003); (b)
rumination ratings of interview transcripts about a gay male part-
ner’s recent death from AIDS (Nolen-Hoeksema et al., 1997); and
(c) experience sampling methodology in which momentary rumi-
native self-focus reported in response to randomly timed beeps on
an electronic watch predicted negative affect at the subsequent
recording point (on average 1.5 hr later), after controlling for T1
negative affect (Moberly & Watkins, in press).
Second, forms of RT other than depressive rumination predict
future levels of depression in prospective longitudinal studies includ-
ing (a) the Rumination to Sadness Scale in depressed patients with
7-month follow-up (Raes et al., 2006); (b) the Emotion Control
Questionnaire—Rehearsal subscale with 8-week follow-up (Rector &
Roger, 1996); (c) Stagnant Deliberation and Outcome Fantasy sub-
scales on the MMAP predicted depression symptoms 13 weeks later
in 1st year law students, after controlling for initial levels of depres-
sion (Feldman & Hayes, 2005); (d) habitual negative self-thinking
predicted depressive symptoms 9 months later, after controlling for
baseline depression, negative life events, and dysfunctional attitudes
in 1,102 Norwegian citizens (Verplanken et al., 2007); and (e) with an
8-month follow-up, rumination about negative content predicted fu-
ture depression and mediated the effects of depressive rumination in
predicting depression (Ito, Takenaka, & Agari, 2005; Ito, Takenaka,
Tomita, & Agari, 2006).
Effect of RT moderated by context. Several studies reported
moderating relationships between depressive rumination and in-
trapersonal variables in predicting future depression. First, within
the Temple–Wisconsin Cognitive Vulnerability to Depression
project, in which undergraduates selected for high and low risk on
negative cognitive style were followed up for 2.5 years, an inter-
action of negative cognitive style and stress-reactive rumination
significantly predicted the rate, number, and duration of major
depressive episodes, even after controlling for level of depression
at T1 (Just & Alloy, 1997; Robinson & Alloy, 2003; for other
Cognitive Vulnerability to Depression studies, see J. M. Smith et
al., 2006; Spasojevic & Alloy, 2001). Stress-reactive rumination
assessed the tendency to ruminate about negative inferences fol-
lowing stressful events by adapting the RSQ (e.g., “Think about
how the stressful event was all your fault,” Robinson & Alloy,
2003). Negative cognitive style was assessed by the Dysfunctional
Attitudes Scale (Weissman & Beck, 1978), which indexes the
endorsement of maladaptive, perfectionistic beliefs about the con-
tingencies necessary to demonstrate self-worth (e.g., “If I do not do
well all the time people will not respect me”) and by the Cognitive
Style Questionnaire, which assesses attributions about the inter-
nality, stability, and globality of events and inferences about the
consequences of events for self-worth. Stress-reactive rumination
predicted future episodes of major depression in individuals with
high levels of negative cognitive style, but not in individuals with
low levels of negative cognitive style.
Second, trait depressive rumination, self-esteem, and stressful
life events interacted in predicting maintenance of depression over
a 6-week period in mildly depressed undergraduates (Ciesla &
175
CONSTRUCTIVE AND UNCONSTRUCTIVE REPETITIVE THOUGHT
Roberts, 2007). Depressive rumination predicted depression at
follow-up only among participants with both low self-esteem and
a high level of stressful life events. Third, depressive rumination
interacted with baseline depression symptoms to predict future
depression (Nolan, Roberts, & Gotlib, 1998; Roelofs, Muris, Hul-
bers, Peeters, & Arntz, 2006). Moreover, one study found that
depressive rumination interacted with stressful life events to pre-
dict future depression, indicating that situational context can mod-
erate the effects of rumination (Morrison & O’Connor, 2005).
Thus, across these studies, the unconstructive consequences of
depressive rumination occurred only in individuals with more
negative self-beliefs, more pessimistic attributions, more de-
pressed mood, or negative life events.
Effect of RT moderated by thought content. Factor analyses of
the RSQ have identified distinct subtypes of depressive rumina-
tion: Brooding versus Reflective Pondering (Treynor et al., 2003),
Dwelling on the Negative versus Active Cognitive Appraisal
(Fresco et al., 2002), and Symptom-Focused Rumination versus
Introspection versus Self-Blame (Roberts et al., 1998). Across
these distinctions, the subtypes linked to more unconstructive
consequences (Brooding, Dwelling on the Negative, Self-Blame)
all share a common theme as reflected in scale items, that is,
negative, self-critical, evaluative (e.g., “Why can’t I handle things
better?”), judgmental, and comparative thinking about the self
(e.g., “Why do I have problems other people don’t have?”; Nolen-
Hoeksema & Morrow, 1991). The evidence is strongest for the
distinction between Brooding and Reflective Pondering, which
was found when the RSQ was factor analyzed once the items
referring to symptoms of depression were removed. Brooding is
characterized by “moody pondering” (Treynor et al., 2003, p. 251),
whereas Reflective Pondering is characterized by items such as
“Analyze recent events to understand why you are depressed” and
was interpreted “as a purposeful turning inward to engage in
cognitive problem solving to alleviate one’s depressive symptoms”
(Treynor et al., 2003, p. 256). Brooding measured at T1 predicted
both increased concurrent depression and increased future depres-
sion assessed 1 year later, even after controlling for depression
levels at T1, whereas Reflective Pondering measured at T1 pre-
dicted increased concurrent depression but reduced future depres-
sion assessed 1 year later (Treynor et al., 2003). In adolescents,
Brooding but not Reflective Pondering predicted the development
of depressive symptoms over time (Burwell & Shirk, 2007). Fur-
thermore, in patients with major depression, Brooding but not
Reflective Pondering was significantly correlated with an atten-
tional bias toward sad facial expressions relative to neutral facial
expressions, as assessed on a facial dot-probe task, after control-
ling for level of depressive symptoms (Joormann, Dkane, & Got-
lib, 2006). These results suggest that thought valence and content
during RT may moderate its consequences, with the negative,
self-critical thinking typical of brooding being more maladaptive.
Limitations. A general limitation of these longitudinal pro-
spective studies is that many studies have not factored prior
episodes of the relevant disorder (e.g., prior major depression as
opposed to depressive symptoms) into the analyses. As such, the
possibility that past major depressive episodes is a common factor
linking RT and prospective depression cannot be ruled out. For
example, if RT is the result of “scarring” from a previous episode,
then this relationship could explain why RT is associated with
increased risk for future depression.
Experimental Studies
Main effect of RT. Studies that experimentally manipulated RT
in the form of worry, by asking participants to briefly worry about
a self-chosen concern, found that worry increases depressed mood
in normal participants (Andrews & Borkovec, 1988; Behar, Zuel-
lig, & Borkovec, 2005; Borkovec et al., 1983; McLaughlin, Bork-
ovec, & Sibrava, 2007; see the review in Borkovec et al., 1998)
and produces a short-term increase in negative intrusive thoughts,
relative to relaxation or visual imagery or no instruction conditions
(Borkovec et al., 1983; Wells & Papageorgiou, 1995; York, Bork-
ovec, Vasey, & Stern, 1987). Experimental studies have also
demonstrated that trait predisposition toward RT increases emo-
tional reactivity to negative mood inductions and mood challenges,
particularly when participants are provided with a delay period that
allows the opportunity to ruminate (Conway et al., 2000; Thomsen,
Jorgensen, Mehlsen, & Zachariae, 2004).
Effect of RT moderated by intrapersonal context. Moreover, a
series of studies provided convergent evidence that RT in the form
of depressive rumination plays a causal role in a range of uncon-
structive outcomes associated with depression, including exacer-
bating negative affect and increasing negative cognition (for fur-
ther details, see Table 1). These studies used a standardized
rumination induction, in which participants are instructed to spend
8 minutes concentrating on a series of sentences that involve
rumination about themselves, their current feelings and physical
state, and the causes and consequences of their feelings (e.g.,
“Think about the way you feel inside”; Lyubomirsky & Nolen-
Hoeksema, 1995; Nolen-Hoeksema & Morrow, 1993). As a con-
trol condition, a distraction induction is typically used in which
participants are instructed to spend 8 minutes concentrating on a
series of sentences that involve imagining visual scenes that are
unrelated to the self or to current feelings (e.g., “Think about a fire
darting round a log in a fire place”).
Compared with the distraction induction, the rumination induc-
tion is reliably found to have negative consequences on mood and
cognition. Critically, the differential effects of these manipulations
are found only when participants are already in a dysphoric mood
before the manipulations, indicating a moderating role for intrap-
ersonal context. Under these conditions, compared with distrac-
tion, rumination exacerbates negative mood (Lavender & Watkins,
2004; Lyubomirsky & Nolen-Hoeksema, 1995; Morrow & Nolen-
Hoeksema, 1990; Nolen-Hoeksema & Morrow, 1993; Watkins &
Teasdale, 2001), increases negative thinking (Lyubomirsky &
Nolen-Hoeksema, 1995), increases negative autobiographical
memory recall (Lyubomirsky, Caldwell, & Nolen-Hoeksema,
1998), reduces the specificity of autobiographical memory re-
trieval (Kao, Dritschel, & Astell, 2006; Park, Goodyer, & Teas-
dale, 2004; Watkins & Teasdale, 2001; Watkins, Teasdale, &
Williams, 2000; see Williams et al., 2007, for a discussion),
increases negative thinking about the future (Lavender & Watkins,
2004), impairs concentration and central executive functioning
(Lyubomirsky, Kasri, & Zehm, 2003; Watkins & Brown, 2002),
impairs controlled memory retrieval (Hertel, 1998), and impairs
social problem solving (Donaldson & Lam, 2004; Lyubomirsky &
Nolen-Hoeksema, 1995; Lyubomirsky, Tucker, Caldwell, & Berg,
1999). Likewise, when they ruminated after a negative mood
induction, dysphoric individuals recalled more negative memories,
whereas non-dysphoric individuals recalled more positive memo-
176
WATKINS
ries (Joormann & Siemer, 2004). This pattern of results has been
found for both dysphoric, non-clinical participants and for de-
pressed patients (e.g., Donaldson & Lam, 2004; Lavender &
Watkins, 2004; Park et al., 2004; Rimes & Watkins, 2005; Watkins
& Brown, 2002; Watkins & Teasdale, 2001), suggesting that the
effects generalize to clinical samples.
Extending the role of intrapersonal context, Ciesla and Roberts
(2007) found that the effect of trait predisposition toward depres-
sive rumination (RSQ) on subsequent emotional response was
moderated by dysfunctional attitudes and self-esteem, such that
following a negative mood induction, higher levels of trait rumi-
nation were associated with higher levels of dysphoric affect after
an 8-minute no-task delay period in participants with low self-
esteem or high dysfunctional attitudes but not in participants with
high self-esteem or low dysfunctional attitudes. Moreover, self-
esteem and dysfunctional attitudes interacted with the rumination
versus distraction manipulations after a sad mood induction to
predict later levels of dysphoria, such that individuals with lower
self-esteem and more dysfunctional attitudes had elevated dyspho-
ric mood, with this effect stronger in the rumination condition than
in the distraction condition (Ciesla & Roberts, 2007).
Markman and Miller (2006) further extended the moderating
effect of level of depression on the consequences of RT to forms
of RT other than depressive rumination. A sample of students with
a range of depressive symptoms (non-depressed, ND; mild-to-
moderately depressed, MD; severely depressed, SD) generated
upward counterfactuals about a recent negative academic outcome
(Markman & Miller, 2006). There was a greater reduction in
negative evaluation of the event following RT for the ND and MD
participants than for the SD participants. Further, MD participants
generated a greater proportion of counterfactuals focusing on spe-
cific controllable behaviors relative to uncontrollable, enduring
qualities of the self than did the ND and SD participants. In turn,
the SD participants generated more counterfactuals involving char-
acterological self-blame than did the ND and MD participants.
Thus, RT was unconstructive in the SD group but constructive in
the MD depressed group.
Effect of RT moderated by concrete versus abstract processing
during RT. The effect of trait predisposition toward RT on emo-
tional reactivity is moderated by the thinking style adopted by
participants. Increasing trait predisposition toward RT (as assessed
on the Action Control Scale—Preoccupation; Kuhl, 1994; sample
item “When I am in a competition and have lost every time, the
thought that I lost keeps running through my mind”) was corre-
lated with slower emotional recovery following a prior failure
experience (Watkins, 2004a) and greater emotional reactivity to a
subsequent failure experience (Moberly & Watkins, 2006), but
only in participants manipulated into adopting an abstract, evalu-
ative mindset focused on the causes, meanings, and implications of
events. Watkins (2004a) randomly allocated participants to expres-
sive writing about a previously induced failure in either an ab-
stract, evaluative way (e.g., “Why did you feel this way?”) or a
concrete, experiential way (e.g., “How did you feel moment-by-
moment?”). At higher levels of preoccupation, levels of negative
mood 12 hours after the failure were greater, but only in individ-
uals who wrote in the abstract, evaluative way and not in individ-
uals who wrote in the more concrete, experiential way. Moberly
and Watkins (2006) trained participants to repetitively think about
emotional scenarios, either imagining the concrete details of what
is happening in each scenario or evaluating the causes, meanings,
and implications of each scenario, prior to an unanticipated failure
experience. After the failure experience, higher levels of trait
preoccupation were significantly correlated with lower levels of
positive affect, but only for participants in the evaluative condition
and not for participants in the concrete condition.
Limitations. A limitation of many experimental studies com-
paring rumination versus distraction is the lack of a no-
intervention control making it impossible to determine whether the
distinct consequences are due to active negative effects of rumi-
nation and/or active positive effects of distraction. However, se-
lecting an appropriate control condition is difficult in dysphoric
participants: A passive control condition that involves “doing
nothing” may simply allow naturally occurring rumination to
continue (e.g., Hertel, 1998), whereas any active control condition
may act as a distraction. Nonetheless, a number of other experi-
mental manipulations of RT, for example, of worry, also included
a no-intervention control and replicated the finding that RT in-
creased depression, consistent with RT having an active detrimen-
tal effect.
Summary of RT and Vulnerability to Depression
This review reveals that there is an extensive body of findings
suggesting that RT is involved in the onset and maintenance of
depression, with both depressive rumination and a range of other
types of RT predicting future depression in longitudinal prospec-
tive studies as well as increasing negative affect when experimen-
tally induced. Thus, there is convergent evidence across numerous
studies utilizing different populations, different measures (RSQ,
interview, self-report), different study designs, and different forms
of RT, all of which are consistent with the hypothesis that RT is a
process underpinning the onset and development of depression.
RT and Vulnerability to Anxiety
Cross-Sectional Studies
In non-clinical samples, RT is significantly and positively cor-
related with increased levels of concurrent trait and state anxiety,
whether assessed as worry (e.g., Davey, Hampton, Farrell, &
Davidson, 1992; Meyer et al., 1990; Siddique, LaSalle-Ricci,
Glass, Arnkoff, & Diaz, 2006), Stagnant Deliberation, Outcome
Fantasy, Problem Analysis (Feldman & Hayes, 2005), global ru-
mination (Harrington & Blakenship, 2002), rumination about a
traumatic event (Steil & Ehlers, 2000), or emotional processing
(Stanton, Danoff-Burg, et al., 2000).
Moreover, RT is a key element of a number of anxiety disorders
(Chelminski & Zimmerman, 2003; Harvey et al., 2004): general-
ized anxiety disorder, social anxiety, and posttraumatic stress
disorder (PTSD). Chronic worry is a central and defining charac-
teristic of generalized anxiety disorder (American Psychiatric As-
sociation, 1994; Hoyer, Becker, & Margraf, 2002). Within social
anxiety, post-event rumination has been identified as an important
process: Compared with low-anxious control participants, individ-
uals with high social anxiety and patients with a diagnosis of social
anxiety demonstrate significantly more post-event RT following
social interactions, performing mental “post-mortems” on how the
interaction went and how they performed (Abbott & Rapee, 2004;
177
CONSTRUCTIVE AND UNCONSTRUCTIVE REPETITIVE THOUGHT
Edwards, Rapee, & Franklin, 2003; Kocovski, Endler, Rector, &
Flett, 2005; Mellings & Alden, 2000; Perini, Abbott, & Rapee,
2006; Rachman, Gruter-Andrew, & Shafran, 2000; Rapee &
Heimberg, 1997).
RT has also been implicated as an important process in the
development of PTSD. Ehlers and colleagues have conceptualized
RT about a traumatic event as a causal mechanism in the devel-
opment of PTSD. By using brief self-report measures of RT about
an identified traumatic event (e.g., “Do you go over and over what
happened again and again?”), they have found RT to be elevated
in patients with PTSD compared with RT in non-clinical control
participants (e.g., Ehlers, Mayou & Bryant, 1998). Likewise, in
survivors of physical assault, the frequency of counterfactual
thoughts was positively correlated with PTSD symptoms such as
intrusions about the negative event (El Leithy, Brown, & Robbins,
2006), and for women who had experienced recurrent miscarriage,
upward counterfactual thinking was positively correlated with
anxiety (Callander & Brown, 2007). Similarly, counterfactual
thinking following uncontrollable and traumatic events, such as
sudden infant death, is associated with a greater level of distress
(C. G. Davis, Lehman, Wortman, Silver, & Thompson, 1995).
Prospective Longitudinal Studies
In non-clinical samples, RT has been found to predict (a) ele-
vated levels of self-reported anxiety in undergraduates following
their midterm exams, after controlling for baseline anxiety (Sarin,
Abela, & Auerbach, 2005; Segerstrom et al., 2000); (b) prospec-
tive increases in anxiety for law students before and after their first
semester final exams (Siddique et al., 2006); (c) prospective in-
creases in anxiety over 1 month (Hong, 2007), over 6 8 weeks
(Calmes & Roberts, 2007), and over 9 months (Verplanken et al.,
2007); and (d) the onset and severity of posttraumatic stress
symptoms following traumatic events such as the Lomo Prieta
earthquake of 1989 (Nolen-Hoeksema & Morrow, 1991). Further-
more, following traumatic events, RT about the trauma predicts the
persistence of PTSD in prospective longitudinal studies from 6
months to 3 years later, for road accidents (Ehlers, Mayou, &
Bryant, 1998, 2003; Holeva, Tarrier, & Wells, 2001; Mayou,
Bryant, & Ehlers, 2001; Mayou, Ehlers, & Bryant, 2002; Murray,
Ehlers, & Mayou, 2002), assaults (Halligan, Michael, Clark, &
Ehlers, 2003; Michael, Ehlers, Halligan, & Clark, 2005), and in
ambulance workers (Clohessy & Ehlers, 1999).
Experimental Studies
Main effects of RT. In experimental studies, RT has been
found to increase anxiety, whether the RT consists of brief periods
of worry about self-chosen concerns (Andrews & Borkovec, 1988;
Behar et al., 2005; Borkovec et al., 1983; McLaughlin et al., 2007)
or a rumination manipulation that exacerbates pre-existing anxious
mood (Blagden & Craske, 1996). When university students were
asked to describe a distressing event that occurred in the last 2
years and then randomly allocated to rumination (prompts like
“Why has this event happened to me?”) or distraction (a word
generation task), rumination resulted in a greater increase in neg-
ative affect and higher levels of intrusive memories than did
distraction (Ehring, Szeimies, & Schaffrick, 2007), suggesting a
potential causal role for rumination in the development of post-
traumatic symptoms.
Effect of RT moderated by interpersonal and situational context.
Kashdan and Roberts (2007) found that there was an interactive
effect of intrapersonal and situational context on the consequences
of post-event rumination for next-day negative affect following a
social situation. Unacquainted undergraduates engaged in 45-
minute interactions with randomly paired opposite-sex partners,
working through questions structured to induce either personal
self-disclosure (e.g., “What is your most treasured memory?”) or
to mimic small talk (“What is the best TV show you’ve seen?”).
For individuals with higher levels of trait social anxiety, post-event
rumination for the 24 hours post-event was associated with in-
creases in negative affect following personal disclosure but asso-
ciated with decreases in negative affect following small talk
(Kashdan & Roberts, 2007). There was no interaction between
rumination and situation in predicting negative affect for individ-
uals with lower levels of social anxiety. Thus, in a situational
context that was more personally revealing and, presumably, more
meaningful and threatening for individuals high in social anxiety,
post-event rumination had more negative consequences.
Effect of RT moderated by concrete versus abstract processing
during RT. In an analogue study of posttraumatic stress symp-
toms, undergraduates watched a distressing film showing the af-
termath of motor vehicle accidents, known to induce negative
affect and intrusions, and were then randomly allocated to abstract
rumination, concrete rumination, or distraction (Ehring et al.,
2007). Across time, abstract rumination resulted in slower recov-
ery from negative affect than did concrete rumination or distrac-
tion. Moreover, concrete rumination resulted in fewer negative
intrusions than did abstract rumination and distraction, which did
not differ from each other. Thus, these results suggest that abstract
rumination may be particularly unconstructive following exposure
to a distressing event.
RT and Impaired Physical Health
Consistent with the perseverative cognition hypothesis
(Brosschot et al., 2006), RT correlates with indices of poor phys-
ical health and prospectively predicts health-related outcomes.
Cross-Sectional Studies
First, RT is associated with increases in cortisol secretion, which
is an index of activation of the hypothalamic–pituitary–adrenal
axis, whether assessed as worry (Schlotz, Hellhammer, Schulz, &
Stone, 2004) or Rehearsal (Roger & Najarian, 1998). Second,
high-trait worry is associated with suppression of the expected
increase in natural killer immune cells when experimentally ex-
posed to a fearful situation (Segerstrom, Glover, Craske, & Fahey,
1999) and with reduced natural killer immune cells in response to
a naturally occurring trauma (Segerstrom, Solomon, Kemeny, &
Fahey, 1998). Third, RT is associated with dysregulated cardio-
vascular function: Worry is associated with reduced heart rate
variability and increased heart rate (Borkovec & Hu, 1990; Bork-
ovec, Lyonfields, Wiser, & Deihl, 1993; Brosschot & Thayer,
2003; Lyonfields, Borkovec, & Thayer, 1995); RT (Rehearsal) is
associated with delayed heart rate recovery following a challeng-
ing task (Roger & Jamieson, 1988; Roger & Najarian, 1989).
178
WATKINS
Reduced heart rate variability is an index of parasympathetic
activity and a risk factor for increased mortality, specifically
associated with hypertension and cardiovascular disorders (P. K.
Stein & Kleiger, 1999). Fourth, high levels of depressive rumina-
tion are associated with delay in presenting the symptoms of breast
cancer to a healthcare professional (Lyubomirsky, Kasri, Chang, &
Chung, 2006), and RT is associated with more physical symptoms
in women undergoing a breast cancer prevention trial (Segerstrom
et al., 2003). Fifth, RT has also been implicated in the development
of insomnia (Gross & Borkovec, 1982; Harvey, 2000; Nelson &
Harvey, 2002). Insomnia is associated with increased pre-sleep
worry (Harvey, 2000), and RT is associated with poorer sleep
quality and longer time to fall asleep (Thomsen, Mehlsen, Chris-
tensen, & Zachariae, 2003).
Prospective Longitudinal Studies
Increased RT prospectively predicts (a) increased heart disease
over a 20-year follow-up doubling the risk for high worriers
compared with low worriers (Kubzansky et al., 1997); (b) in-
creased somatic health complaints in high school students, with the
use of a controlled worry period reducing subsequent somatic
complaints (Brosschot & van der Doef, 2006); (c) higher levels of
fatigue over a 10-month follow-up (Andrea et al., 2004); (d)
slower recovery and impaired wound healing following surgery for
hernias (E. Broadbent, Petrie, Alley, & Booth, 2003); (e) fewer
natural killer cells in the months after the Northridge earthquake
(Segerstrom et al., 1998); (f) slower clearing of psoriasis in re-
sponse to psoralen-UV-A photochemotherapy (Fortune et al.,
2003); (g) reduced functional status and reduced grip strength 1
year after the diagnosis of rheumatoid arthritis (Evers, Kraaimaat,
Geenen, & Bijlsma, 1998); and (h) self-reported physical health
problems 1 year later in 20–35-year-olds and increased health care
utilization over the subsequent year in 70 85-year-olds (Thomsen,
Mehlsen, Hokland, et al., 2004, Thomsen, Mehlsen, Olesen, et al.,
2004).
Experimental Studies
Consistent with the hypothesis that RT plays a causal role in
poor physical health, experimental manipulations of RT have been
shown to influence health-related indices. First, experimental in-
duction of rumination about a previous emotionally stressful task
results in increased blood pressure (BP) and delayed recovery of
BP, whereas distraction facilitates BP recovery (Glynn, Christen-
feld, & Gerin, 2002). Second, trait anger rumination predicts
prolonged elevated BP after recalling an angry event (A. R.
Schwartz et al., 2000) or after an anger provocation (Suchday,
Carter, Ewart, Larkin, & Desiderato, 2004). High sustained BP is
a risk factor for many diseases including cardiovascular disease
and diabetes. Third, compared with distraction, rumination about a
mid-session exam resulted in more pre-sleep intrusive thoughts
and poorer ratings of sleep quality for high-trait ruminators but not
for low-trait ruminators (Guastella & Moulds, 2007). Fourth, Nel-
son and Harvey (2002) gave patients with insomnia a speech threat
just prior to bedtime. Thinking about giving the speech in images
produced more initial distress and self-reported arousal but shorter
sleep onset latency than did worrying about the speech verbally.
RT With Constructive Consequences
There is also a growing literature indicating how RT can be
adaptive, functional, and beneficial, although, as noted earlier, the
constructive consequences of RT have been less investigated than
the unconstructive consequences of RT. The relevant studies are
summarized in Table 2. The main emergent findings are that RT is
implicated in (a) successful cognitive processing and recovery
from upsetting and traumatic events, (b) adaptive preparation and
planning for the future, (c) recovery from depression, and (d)
uptake of health-promoting behaviors.
RT and Successful Cognitive Processing of Stress, Loss,
and Trauma
Cross-Sectional Studies
Main effects of RT. A number of studies have found that,
following stressful or traumatic events, RT in the form of cognitive
processing is associated with acceptance and recovery. People who
actively think about the trauma and its implications are more likely
to find meaning or to experience growth than people who do not
dwell on the trauma (J. E. Bower et al., 1998; Calhoun et al., 2000;
Tedeschi & Calhoun, 2004; Ullrich & Lutgendorf, 2002). Extent of
RT after a traumatic or stressful event was positively associated
with more posttraumatic growth, as indexed by self-reported in-
creases in relating to others, discovering new possibilities, discov-
ering personal strength, and increased appreciation of life (Cal-
houn et al., 2000). For example, RT immediately after a child’s
death was associated with posttraumatic growth in bereaved par-
ents, whereas more recent RT was not, and, in older adults, growth
attributed to the struggle with their most stressful events was
associated with frequency of rumination across all traumatic
events (Calhoun, Tedeschi, Fulmer, & Harlan, 2000; and Tedeschi,
Calhoun, & Cooper, 2000; both cited in Tedeschi et al., 2004).
Similarly, RT, which was defined as recurrent event-related
thoughts that help one understand, resolve, and make sense of
trauma-related events, was correlated with competency beliefs
about ability to handle problems arising from the trauma in chil-
dren evacuated because of Hurricane Floyd (Cryder, Kilmer, Te-
deschi, & Calhoun, 2006).
Effects of RT moderated by thought content. Segerstrom and
colleagues (2003) examined the nature of RT and its role in
adjustment in women who were exposed to a stressful situation
through being identified at high risk for breast cancer. In previous
undergraduate studies, (Segerstrom et al., 2003, Studies 1 and 2),
multidimensional scaling across large samples of structured mea-
sures of ruminative thinking and sampled thoughts concerning
rumination had revealed that RT could be described on two inde-
pendent structural dimensions: valence of content (negative vs.
positive) and purpose. As thought content became more negative,
affect was rated as more negative. The purpose dimension re-
flected the goals motivating rumination, with two extremes of
purpose: searching for new ideas and experiences versus solving
problems and improving certainty and predictability. Solving was
defined as “trying to narrow down, to make sure, to make plans or
to declare knowledge” (Segerstrom et al., 2003, p. 916). Examples
included causal statements, summary statements, statements of
definite consequences, and planning. Searching was defined as
179
CONSTRUCTIVE AND UNCONSTRUCTIVE REPETITIVE THOUGHT
Table 2
Studies Demonstrating Constructive Consequences of Repetitive Thought
Author Design and sample Measure Main finding
Cross-sectional studies
Belzer et al. (2002) 353 u/g’s PSWQ, Catastrophic worry
questionnaire, STAI,
SPSI–R
Rational problem solving (constructive) & impulsiveness/
carelessness (unconstructive) positively correlated with
worry, after controlling trait anxiety & problem
orientation
Calhoun et al. (2000) 54 u/g’s with traumatic event in
past 3 yrs
PTGI, rumination (items
derived existing
measures)
Early event-related rumination after trauma positively
correlated with post-traumatic growth
Cryder et al. (2006) 46 children evacuated for
Hurricane Floyd
Rumination, competency
beliefs, PTGI
Rumination correlated positively with competency beliefs
but not with post-traumatic growth, although
competency beliefs correlated with post-traumatic
growth
Davey et al. (1992) Study 1: 105 u/g’s; Study 2:
108 u/g’s; Study 3: 94 u/g’s
& p/g’s
All studies: STAI, Student
Worry Scale. Study 1, 2:
Coping with stress,
Study 3: Miller
Behavioral Style scale-
monitoring
Study 1, 2: Worry correlated with trait anxiety. When
trait anxiety controlled, worry positively correlated
self-reported strategies of active behavioral coping,
information-seeking, affective regulation. Study 3:
When trait anxiety held constant, worry positively
correlated monitoring.
El Leithy et al.
(2006)
46 victims of physical assault IES–R, fluency &
frequency of
counterfactuals
Fluency of counterfactual thinking positively correlated
with generation of behavioral plans
Feldman & Hayes
(2005)
Study 3; 325 u/g’s MMAP, Reflection, SPSI–
R, MASQ
Study 3: Plan rehearsal negatively correlated depression,
positively correlated well-being
Perkins & Corr
(2005)
68 salespeople PSWQ, ability, job perfor-
mance
Worry correlated with better job performance but only in
high ability individuals
Schorr & Roemer
(2002)
141 students reporting trauma/
loss
PTGI, “searching for a
way to make sense of
experience”
Attempts to make sense (RT) associated post-traumatic
growth
Segerstrom et al.
(2003)
Study 1: 978 u/g’s; Study 2: 25
u/g’s
Study 3: 62 women in breast
cancer prevention trial
Study 1: Emotional
processing, IES, PSWQ,
RSQ, RRQ, NEO–FFI
Study 2, 3: self-
generated descriptions of
RT, ratings of affect
Study 3, CES–D, quality
of life, IES, STAI
Study 1: Multidimensional scaling revealed Valence
dimension (positive vs. negative), Purpose dimension
(openness to experience vs. clarity & worry). Study 2:
Independent sorting of descriptions resulted in
dimensions of Valence (positive vs. negative), Content
(achievement vs. interpersonal), Purpose (searching vs.
solving). Valence dimension associated affect ratings.
Study 3: More negative RT associated more negativity,
worse mental health, more anxiety, more physical
symptoms. When thought valence positive, searching
decreased ratings of physical health and positivity;
when thought valence negative, searching increased
ratings of physical health and positivity
Szabo & Lovibond
(2006)
39 u/g’s 7 day diary of worry
episodes
A large % of worry involved problem-solving attempts,
sometimes leading to satisfying solutions
Trapnell & Campbell
(1999)
u/g’s: n 441, n 570, n
710
RRQ, NEO–FF, BDI Reflection scale not correlated with depressive symptoms
(r .04, r .08) but correlated with openness to
experience (r .61)
Verhaegen et al.
(2005)
99 u/g’s Reflection from RSQ,
CES–D
Reflective pondering related to current depression, self-
rated creative interests & creative fluency originality
and elaboration
Longitudinal studies
Bower et al. (1998) Bereavement interview at T1,
then blood samples every 6
mths for 2–3 years. 40 HIV
seropositive men after AIDS-
related bereavement
Interview transcripts:
cognitive processing,
discovery of meaning,
CES–D, CD4 T-cells,
mortality
Cognitive processing significantly associated with
discovery of meaning. Discovery of meaning at T1
associated decrease in rate of CD4 decline T1 to T2
and decreased rate of AIDS-related mortality
Cantor et al. (1987) Transition to college. T1 1
st
semester, T2 2
nd
semester;
147 u/g’s
DPQ, GPA, reflectivity
no. of ideas generated
for coping plans
Reflectivity at T1 positively associated GPA at T2;
higher reflectivity predicted higher GPA in DP but
lower GPA in OP
Ciesla & Roberts
(2002)
Response to group treatment;
32 MDD patients
RSQ, DAS, RSE, BDI Rumination interacted with cognitive style to predict
change in depression: in high self-esteem, low DAS
group, rumination predicted better outcome
180
WATKINS
Table 2 (continued)
Author Design and sample Measure Main finding
Longitudinal studies
Dijkstra & Brosschot
(2003)
T2 8 mths; 380 smokers, 324
ex-smokers
T1: worry about health,
self-efficacy,
disengagement beliefs.
T2 smoking behavior
In smokers, increased worry at T1 predicted more quit
attempts T1 to T2, more so in group with high
self-efficacy
In ex-smokers, worry predicted relapse, especially in low
self-efficacy, high disengagement beliefs group
Feldman & Hayes
(2005)
Study 4. T1 start of 1
st
semester; T2 end of 1
st
semester after 13 weeks; 110
1
st
year law students
MMAP, Reflection, SPSI–
R, MASQ
Study 4: plan rehearsal at T1 predicted reduced
depression at T2, although no longer sign when
controlling T1 depression
Hay et al. (2006) Meta-analysis of 12 prospective
studies; 3,342 high-risk &
general population women
Breast cancer worry at T1,
T2 breast examination,
mammography use
Breast cancer worry has small but reliable (r 0.12)
positive correlation with breast cancer
screening-behavior; greater worry predicts greater
likelihood of screening
Siddique et al.
(2006)
T1 law school orientation;
T2 1 mth prior to 1
st
semester final exam, T3
post 1
st
semester final exam;
T4 1 mth prior oral
argument; T5 oral
argument, 2
nd
semester; 184
1
st
year law students
PSWQ, self-efficacy,
STAI, final exam scores,
performance rating for
oral argument
After controlling for trait anxiety, T1 worry significantly
predicted better T3 exam performance & better T5 oral
argument performance, & higher state anxiety at T2,
T3, T4
Treynor et al. (2003) T2 1 yr; 1,130 community
sample
RSQ, BDI Reflective pondering subscale at T1 predicted less
depression at T2 controlling for depression at T1
Yamada et al. (2003) T2 6 mths after
pharmacotherapy; 105 MDD
patients
HRSD, rumination
questionnaire
Rumination at T1 predicted reduced depression at T2
Experimental studies
Lyubomirsky et al.
(2003)
(Study 1): RUM vs. DIS vs.
planning, 45 Dys u/g’s (BDI
15) vs. 46 Non-dys (BDI
3) u/g’s
Ratings sadness &
depression, reading task,
interfering thoughts
(CIQ)
Study 1: dysphoric mood, time spend reading passage,
interfering thoughts in dysphoric: Repetitive planning
distraction rumination
Moberly & Watkins
(2006)
Training to focus on emotional
scenarios, abstract vs.
concrete, prior to failure; 61
u/g’s
PANAS, ACS–P, BDI After failure, higher levels of trait RT were associated
with lower levels of positive affect, but only in
abstract condition, not in concrete condition
Norem & Illingworth
(1993)
Study 1: thought-listing re
positive & negative outcomes
(reflection) vs. distraction; 26
DP vs. 30 OP. Study 2: Rate
goal progress vs. no progress;
nursing students, 13 DP vs.
11 OP
DPQ. Study 1: POMS,
STAI, mental arithmetic
task. Study 2: ESM 4
times a day for 7 days,
rating affect
Study 1: Negative mood & anxiety: For DP, distraction
thought-listing; for OP, thought-listing distraction
Math performance - for DP, thought-listing distraction
Study 2: DP who rated progress felt more positive and
rated situations as easier than those who did not; OP
who rated progress felt made less progress than those
who did not
Pham & Taylor
(1999)
Process vs. outcome vs.
combined simulation vs.
control, all daily for 1 wk.
101 u/g’s 1 wk before
midterm exam
No. of study hours,
planning, worry,
confidence, grades
Negative emotion: Process-simulation no-process-
simulation. Planning, number of hours of study, exam
grades: Process-simulation no process-simulation.
Exam grades: Outcome simulation no-outcome
simulation
Rimes & Watkins
(2005)
Experiential RUM vs. analytical
RUM; 30 MDD patients, 30
controls
BDI, RSQ, VAS ratings of
mood & global negative
self-judgments
In MDD patients, analytical RUM increased post-
manipulation global judgments of worthlessness
relative to experiential RUM. No effect of condition in
controls
Rivkin & Taylor
(1999)
Process-simulation on how
problem arose and unfolded
vs. outcome simulation vs.
control; 77 u/g’s designate
ongoing stressful event
Emotional self-ratings,
COPE immediately after
and 1 wk later
Immediate positive affect: Process outcome control
One week later, positive reinterpretation, use of social
support: Process outcome control
Showers (1992) Concrete positive-outcome-
focus vs. concrete negative-
outcome-focus on upcoming
conversation Study 1: 40 OPs
vs. 38 DPs in social
situations. Study 2: 27 OPs,
31 DPs
Study 1: Time talking
during conversation,
confederate &
participant ratings. Study
2: thought listing as
anticipate conversation
Study 1: Negative-focus DP talked more, rated more
positively by confederate than positive-focus DP, no
effect of focus on Ops Study 2: negative-focus DPs
reported more positive self-relevant thoughts than
positive-focus DPs, no effect of focus on OPs
(table continues)
181
CONSTRUCTIVE AND UNCONSTRUCTIVE REPETITIVE THOUGHT
“exploring, considering possibilities, or expressing confusion”
(Segerstrom et al., 2003, p. 916). Examples included expressions
of uncertainty, generating options, indecision or confusion, listing
multiple possibilities, and learning new perspectives or ways. In
the breast cancer study, the valence of thought content during RT
predicted concurrent affect and well-being: Less negative content
during RT was associated with less negative affect, more positive
affect, better overall mental health, less anxiety, and fewer phys-
ical symptoms (Segerstrom et al., 2003). Furthermore, there were
also interactions between valence and purpose on affect and rat-
ings of physical health: When the valence of RT content was
positive, a searching purpose was associated with decreased pos-
itive affect and decreased ratings of physical health, but when the
valence of thought content was negative, a searching purpose was
Table 2 (continued)
Author Design and sample Measure Main finding
Experimental studies
Spencer & Norem
(1996)
Coping imagery vs. mastery
imagery vs. relaxation 97
u/g’s, DP vs. OP
DPQ, performance on darts Dart performance - for DPs: Coping imagery mastery
imagery relaxation; for OPs: Relaxation mastery
imagery coping imagery
Taylor et al. (1998) Study 1, 3 Process-simulation
vs. outcome simulation vs.
control for 5–7 days. Study
1; 77 u/g’s 1 wk before 1st
midterm exam. Study 3, 84
u/g’s with project to
complete next wk. Study 4:
process-simulation on how
problem arose and unfolded
vs. outcome simulation vs.
control; 77 u/g’s with
ongoing stressful event
Study 1: Anxiety, time
spent studying, exam
grades. Study 3:
planning fallacy (project
began on time, finished
on time). Study 4:
emotional self-ratings,
COPE immediately after
and 1 wk later
Study 1: Hours of study, exam grades: Process-
simulation outcome-simulation control. Study 2:
% began on time: Process-simulation outcome-
simulation control; % finish on time: process
outcome control. Study 4: Immediate positive
affect: Process outcome control; One week later,
positive reinterpretation, use of social support: Process
outcome control
Ulrich & Lutgendorf
(2002)
Writing about stressful event
(cognitions & emotions vs.
emotions alone) vs. non-
expressive writing; 122 u/g’s
completed journals for 1 mth
Ratings of post-traumatic
growth
Reported post-traumatic growth: Writing cognition &
emotion emotions alone non-expressive writing
Watkins (2004a) Failure then 3 expressive
writing, abstract-evaluative
(why?) vs. concrete (how?);
69 community sample
ACS–P, BDI, MAACL,
IES
Higher