Randomized Controlled Trial of a Mindfulness Mobile Application for Ruminative Adolescents.

OBJECTIVE: Rumination is a risk factor for the development of internalizing psychopathology that often emerges during adolescence. The goal of the present study was to test a mindfulness mobile app intervention designed to reduce rumination. METHOD: Ruminative adolescents (N = 152; 59% girls, 18% racial/ethnic minority, Mage = 13.72, SD = .89) were randomly assigned to use a mobile app 3 times per day for 3 weeks that delivered brief mindfulness exercises or a mood monitoring-only control. Participants reported on rumination, depressive symptoms and anxiety symptoms at baseline, post-intervention and at 3 follow-up timepoints: 6 weeks, 12 weeks, and 6 months post-intervention. Parents reported on internalizing symptoms. RESULTS: There was a significant Time X Condition effect at post-intervention for rumination, depressive symptoms, and anxiety symptoms, such that participants in the mindfulness intervention showed improvements relative to those in the control condition. The effect for rumination lasted through the 6-week follow-up period; however, group differences were generally not observed throughout the follow-up period, which may indicate that continued practice is needed for gains to be maintained. CONCLUSIONS: This intervention may have the potential to prevent the development of psychopathology and should be tested in a longitudinal study assessing affective disorder onset, especially in populations with limited access to conventional, in person mental health care.This study was registered with Clinicaltrials.gov (Identifier NCT03900416).

Which adolescents are well-suited to app-based mindfulness training? A randomized clinical trial and data-driven approach for personalized recommendations.

OBJECTIVE: Rumination heightens risk for depression and anxiety, which increase substantially during adolescence. Smartphone apps offer a convenient and cost-effective means for adolescents to access mindfulness training, which may reduce rumination. Despite their increasing popularity, it is unclear which adolescents benefit from mindfulness apps. METHOD: Adolescents (n = 152) with elevated trait rumination were randomly assigned to 3 weeks of app-based mindfulness training or a mood-monitoring control. Multilevel models tested group differences in state rumination change, assessed via ecological momentary assessment. Baseline adolescent characteristics were submitted to elastic net regularization models to develop a "Personalized Advantage Index" indicating an individual's expected outcome from the mindfulness app relative to the mood-monitoring control. Finally, we translated a predictive model (developed in an external sample) for personalized recommendations of expected benefit from the mindfulness app. RESULTS: Adolescents in the mindfulness app condition reported significantly greater reductions in rumination than adolescents in the control condition. Individuals predicted to have better outcomes from the mindfulness app relative to mood monitoring had significantly greater reductions in rumination if randomly assigned to the mindfulness condition. In contrast, between-condition differences in outcome were not significant for adolescents predicted to have better outcomes in the mood-monitoring condition. CONCLUSIONS: Findings support the efficacy of a mindfulness app to reduce state rumination in adolescents, particularly among adolescents high in trait rumination. A predictive model is put forth, which could be used to objectively communicate expected mindfulness app outcomes to adolescents prior to engagement in app-based mindfulness training. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Acceptability and Preliminary Effects of a Mindfulness Mobile Application for Ruminative Adolescents.

Rumination is a transdiagnostic risk factor that appears to be reduced through mindfulness interventions. However, mindfulness mobile apps have not been tested for their effects on rumination, especially among adolescents. Thus, we aimed to test the acceptability and effects of a mindfulness mobile intervention among ruminative adolescents using a within-subjects pretest/posttest design. Participants were 80 adolescents ages 12-15, selected for moderate-to-high rumination (M age = 14.01, SD = .99; 46.2% girls; 86.25% White; 3.75% Hispanic). We asked adolescents to use our mindfulness app 3 times per day for 3 weeks. Participants and parents completed questionnaires at baseline, post-intervention, and 6 and 12 weeks later. Acceptability was assessed by tracking app use and asking adolescents and parents to report on their experiences post-intervention. We assessed repetitive negative thinking (i.e., rumination and worry) and internalizing symptoms via self- and parent-report. The intervention demonstrated acceptability, and there were significant reductions in rumination, worry, anxiety and parent-reported internalizing symptoms post-intervention. Effects on rumination, anxiety and internalizing symptoms persisted throughout the 12-week follow-up with large effect sizes using an intention-to-treat approach. Thus, a brief mindfulness mobile app intervention appeared to be both engaging and helpful in reducing negative repetitive thinking and internalizing symptoms among ruminative adolescents. It will be important to test this intervention in a randomized controlled trial to control for effects of time and attention.

Psychological well-being of ruminative adolescents during the transition to COVID-19 school closures: An EMA study.

INTRODUCTION: Adolescents with moderate-to-severe levels of trait rumination are at heightened risk for psychopathology and may be particularly vulnerable to disruptions caused by the onset of the COVID-19 pandemic. As most past research documenting the impact of COVID-19 on adolescent well-being has been cross-sectional, it is unclear exactly how ruminative adolescents responded to the onset of the pandemic as it unfolded. METHODS: We used ecological momentary assessment (EMA) to explore changes in rumination among adolescents during the initial transition to distance learning in the United States. A subsample of 22 ruminative youth (Mage = 13.58; SD = 0.96; 54.5% male; 86.4% White) from a larger study provided EMA data throughout January-April 2020 (M responses per participant = 105.09, SD = 65.59). Following school closures, we hypothesized that adolescents would report greater rumination (i.e., focusing on emotions and problems) and depressive symptom level would moderate this effect. RESULTS: Surprisingly, rumination decreased, and this effect was moderated by depressive symptom level for emotion-focused rumination, i.e., those with average and below-average depressive symptoms experienced decreases in rumination. CONCLUSIONS: These results suggest that the first wave of stay-at-home orders and the transition to distance learning were not immediately distressing to vulnerable adolescents. However, more research is needed to determine whether the results from recent research are generalizable to other adolescents and to examine the long-term impact of the pandemic on adolescent well-being.

Dopaminergic Genetic Variation in Young Adolescents: Associations with Sensation-Seeking.

Deficient reward functioning, including reward-related personality, is implicated in depression's etiology. A dopaminergic genetic multilocus genetic profile score (MGPS) has previously been associated with neural reward responsivity but, despite theoretical basis, has not been studied with reward-related personality. Such research is needed to elucidate associations between genetic variation and reward-related personality in a developmentally sensitive population. In the present study, we examined associations between dopaminergic MGPS's and self-report reward-related personality in two young adolescent samples aged 10-15 years old (Sample 1: N = 100 girls, 82% White, 18% Other; Sample 2: N = 141, 65 girls, 76 boys, 89.36% White, 10.64% Other) using an established MGPS and an augmented MGPS. A "mini" meta-analysis synthesized results across samples. In Sample 1, an exploratory mediation analysis intended to gauge effect size for future work tested a path between the MGPS and depression through significant reward traits. In each independent sample, both MGPS's showed significant associations with sensation-seeking but not social drive, a pattern that persisted following correction. Effect sizes of novel variants were at least as robust as established variants, suggesting their added utility. Additionally, the exploratory mediation analysis suggested no noteworthy indirect effect, but a small (R2 = 0.022), statistically non-significant direct effect of the MGPS predicting prospective depressive symptoms. Results suggest that dopaminergic genetic variation is associated with the reward-related personality trait of sensation seeking but not social drive. Additional work is needed to probe whether sensation seeking may be a path through which this genetic variation confers depression risk.

App-based Mindfulness Training for Adolescent Rumination: Predictors of Immediate and Cumulative Benefit.

Objectives: Rumination is a transdiagnostic risk factor for depression and anxiety, which surge during the adolescent years. Mindfulness training - with its emphasis on metacognitive awareness and present-moment attention - may be effective at reducing rumination. Mindfulness apps offer a convenient, engaging, and cost-effective means for accessing mindfulness training for teens. Despite their increasing popularity among adolescents, no study to date has investigated which teens are well-suited to app-based mindfulness training. Methods: Eighty adolescents (M age = 14.01 years, 45% girls) with elevated rumination were enrolled in a 3-week trial of app-based mindfulness training. Repeated daily ecological momentary assessment (EMA) surveys assessed problem-focused and emotion-focused rumination immediately prior to and following each mindfulness exercise. Elastic net regularization (ENR) models tested baseline predictors of "immediate" (post-mindfulness exercise) and "cumulative" (post-3-week intervention) benefit from app-based mindfulness training. Results: Ninety percent (72/80) of adolescents completed the 3-week trial, and the mean number of mindfulness exercises completed was 28.7. Baseline adolescent characteristics accounted for 14%-25% of the variance in outcomes (i.e., reduction in problem-focused or emotion-focused rumination). Higher baseline rumination, and lower emotional suppression, predicted better immediate and cumulative outcomes. In contrast, female gender and older age predicted better immediate, but not cumulative, outcomes. Differences in results across outcome timeframes (immediate vs. cumulative) are discussed. Conclusions: Findings from this study highlight the potential of data-driven approaches to inform which adolescent characteristics may predict benefit from engaging with an app-based mindfulness training program. Additional research is needed to test these predictive models against a comparison (non-mindfulness) condition.

The Link between Discrimination and Worst Point Suicidal Ideation among Sexual and Gender Minority Adults.

OBJECTIVE: Sexual and gender minority (SGM) adults often report a disproportionately high rate of suicidal ideation compared to their heterosexual and cisgender counterparts. The current study aimed to understand the relationship between discrimination for one's sexual orientation or gender identity and suicidal ideation. We hypothesized that discrimination would be associated with suicidal ideation at one's worst point through the indirect effects of hopelessness regarding thwarted belongingness and perceived burdensomeness. METHOD: A sample of 178 SGM adults (M age = 30.34, range 18-69; 76% white) completed an online questionnaire assessing minority-specific stressors and suicide-related thoughts and behaviors. RESULTS: A mediation model with bootstrapping indicated that greater discrimination was associated with more frequent suicidal ideation at one's worst point through the indirect effect of hopelessness regarding thwarted belongingness. CONCLUSIONS: The current study provides evidence that the pathway between discrimination and worst point suicidal ideation may be partially explained by the perception that one will never belong. These findings support the utility of an understudied Interpersonal Theory of Suicide hypothesis for research among SGM adults.

Depressive Symptoms, Rumination, and Emotion Reactivity Among Youth: Moderation by Gender.

The emotion context-insensitivity hypothesis (ECI; Rottenberg et al., 2005) posits that depressive symptoms are associated with blunted emotional reactivity and is supported by the results of a meta-analysis (Bylsma et al., 2008). Yet it remains unclear how strongly ECI holds across emotional response domains, whether ECI operates similarly in male and female individuals, and whether this pattern of underreactivity is observed in youth. In contrast, rumination, a cognitive style strongly associated with depressive symptoms, may be associated with heightened reactivity. We assessed the effects of youth's depressive symptoms and rumination on subjective and physiological emotion reactivity (N = 160; Mage = 12.67, SDage = 1.12; 48% female; 94% non-Hispanic). State sadness and respiratory sinus arrhythmia were assessed during a baseline activity (nature video) and a sad mood induction. As hypothesized, depressive symptoms predicted less subjective emotional reactivity, whereas rumination predicted more subjective reactivity. Exploratory analyses revealed that associations for physiological reactivity differed by child gender. ECI may be stronger in terms of subjective rather than physiological emotional reactivity.

The developmental origins of ruminative response style: An integrative review.

Rumination has been conceptualized as a stable, trait-level response style involving repetitive and passive focus on the symptoms of distress and the possible causes and consequences of those symptoms. This theoretical review examines developmental risk factors of ruminative response style, incorporating a developmental psychopathology perspective. A model integrating these developmental factors within a conceptual framework is proposed, wherein risk factors for distress (i.e., temperamental negative affectivity, stressful environments, parenting, and genetic vulnerability) lead to engagement in rumination. We propose that when rumination is well-practiced, it will consolidate into a trait-like response style, especially among adolescents who experience cognitive control deficits. Reciprocal relationships and moderators that may contribute to the formation of a ruminative response style are also included. To understand how these factors converge and influence the formation of ruminative response styles, we review patterns of stability and change in physical and cognitive development to demonstrate that individual differences in rumination may emerge and consolidate into enduring, trait-level response styles during early adolescence.

Socially oriented thinking and the biological stress response: Thinking of friends and family predicts trajectories of salivary cortisol decline.

The cortisol stress response has been related to perceived social support, but previous studies rely on self-reported social support variables. The cortisol recovery phase in particular has been theorized to serve a social coping function, but individual differences in recovery slope have not yet been examined in relation to social coping-relevant indices. This study addressed these gaps by examining the relationship of cortisol trajectories after a socioevaluative task to individual differences in covertly assessed cognitions related to close social relationships. We examined trajectories of cortisol change related to socially oriented thinking, the semi-implicit activation of cognitive representations of friends or family. Young adults (N = 64) gave salivary cortisol samples before and for 45 min after a speech task. Participants' thoughts were sampled repeatedly; the frequency of words related to friends or family was assessed to index socially oriented thinking. A free curve slope intercept latent growth curve model showed excellent fit with the cortisol data. Socially oriented thinking was unrelated to overall magnitude of cortisol response to the task (latent intercept) but predicted the latent cortisol trajectory, independently of cortisol intercept and baseline cortisol levels. Socially oriented thinkers showed more gradual cortisol declines, whereas nonsocially oriented thinkers showed a steeper downslope driven primarily by cortisol changes 45 min after the task. Individual differences in socially oriented thinking may manifest in different rates of biological changes following a performance task.

Can't Take My Eyes Off of You: Eye Tracking Reveals How Ruminating Young Adolescents Get Stuck.

Rumination, a cognitive process that involves passively, repetitively focusing on negative feelings and their meaning, is a transdiagnostic risk factor for psychopathology. Research with adults has suggested that attentional control difficulties may underlie rumination, but questions remain about the nature of these processes. Furthermore, the relationship between attentional control and rumination in youth has received little empirical examination. In the present study, 92 youth (ages 9-14; 72% girls; 74% Caucasian) reported on their trait rumination and internalizing symptoms. They also completed a 1,500 ms emotional-faces dot-probe task while their eye movements were measured to examine overt visual attention with high temporal precision. Youth's rumination was associated with greater dwell on emotional faces but not with initial orientation. These findings suggest that rumination is associated with increased attention to emotional information during the later stages of selective attention rather than earlier orienting to emotional cues. Implications for prevention and treatment of psychopathology are discussed.

Rumination and Moderators of Multifinality: Predicting Internalizing Symptoms and Alcohol Use During Adolescence.

Rumination, a perseverative cognitive process that involves repetitively and passively focusing on negative emotions, is a transdiagnostic risk factor for the development of psychopathology. Although rumination has been linked to various forms of psychopathology including depression, anxiety, and alcohol misuse, little is known about the conditions that lead to multifinality. Here, we test putative moderators (Nolen-Hoeksema & Watkins, 2011) of the association between rumination and subsequent internalizing symptoms and frequency of alcohol use during adolescence. Participants included 388 youth (52% girls; 90% Caucasian) in a longitudinal birth cohort study who completed questionnaires in Grades 9 and 11. Brooding, a maladaptive form of rumination measured in Grade 9, was associated with greater internalizing symptoms in Grade 11 and greater perceived peer rejection in Grade 9 amplified this association. Brooding was also associated with greater frequency of alcohol use among adolescents who reported having more friends who use alcohol. Gender differences were also examined. Findings provide support for some of the predictions regarding moderators of multifinality made by Nolen-Hoeksema and Watkins. Implications of understanding divergent trajectories in the prevention of psychopathology are discussed.

Daily and trait rumination: diurnal cortisol patterns in adolescent girls.

Rumination is a maladaptive form of emotion regulation associated with psychopathology. Research with adults suggests that rumination covaries with diurnal cortisol rhythms, yet this has not been examined among adolescents. Here, we examine the day-to-day covariation between rumination and cortisol, and explore whether trait rumination is associated with alterations in diurnal cortisol rhythms among adolescent girls. Participants (N = 122) provided saliva samples 3 times per day over 3 days, along with daily reports of stress and rumination, questionnaires assessing trait rumination related to peer stress, and diagnostic interviews assessing depression and anxiety. Greater rumination than usual during the day was associated with lower cortisol awakening responses the following morning, but this effect was not significant after accounting for wake time and an objective measure of adherence to the saliva sampling protocol. Trait rumination was associated with lower average cortisol levels at waking and flatter diurnal slopes, accounting for wake time, protocol compliance, and other factors. These patterns may help to explain why rumination is related to the development of psychopathology.

Nonsuicidal self-injury in sexual minority college students: a test of theoretical integration.

BACKGROUND: Individuals identifying as a sexual minority report engaging in nonsuicidal self-injury (NSSI) at substantially higher rates compared to their heterosexual peers. Given that NSSI is a known risk factor for suicide, it is important to understand the processes unique to being a sexual minority that increases risk for NSSI so that adequate prevention efforts can be established. The current study integrated Minority Stress Theory and the Interpersonal Theory of Suicide to test a model of NSSI and suicide risk. METHODS: A total of 137 college students who identified as a sexual minority completed an anonymous on-line study assessing NSSI, suicidal thoughts/behaviors, and constructs of the minority stress and interpersonal theories. Two linear regressions using bootstrapping analyses were conducted to test our hypotheses. RESULTS: Minority stress was directly associated with NSSI and via perceived burdensomeness, explaining 27 % of the variance. NSSI was associated with increased risk for suicide thoughts/behaviors directly, and through acquired capability, explaining 45 % of the variance. CONCLUSIONS: These findings provide evidence that unique stressors individuals face as a result of their sexual minority status increases risk for self-harm by influencing cognitive and emotional processes such as burdensomeness and acquired capability. Implications for prevention, intervention, and future research are briefly discussed.

Affective neural responses modulated by serotonin transporter genotype in clinical anxiety and depression.

Serotonin transporter gene variants are known to interact with stressful life experiences to increase chances of developing affective symptoms, and these same variants have been shown to influence amygdala reactivity to affective stimuli in non-psychiatric populations. The impact of these gene variants on affective neurocircuitry in anxiety and mood disorders has been studied less extensively. Utilizing a triallelic assay (5-HTTLPR and rs25531) to assess genetic variation linked with altered serotonin signaling, this fMRI study investigated genetic influences on amygdala and anterior insula activity in 50 generalized anxiety disorder patients, 26 of whom also met DSM-IV criteria for social anxiety disorder and/or major depressive disorder, and 39 healthy comparison subjects. A Group x Genotype interaction was observed for both the amygdala and anterior insula in a paradigm designed to elicit responses in these brain areas during the anticipation of and response to aversive pictures. Patients who are S/L(G) carriers showed less activity than their L(A)/L(A) counterparts in both regions and less activity than S/L(G) healthy comparison subjects in the amygdala. Moreover, patients with greater insula responses reported higher levels of intolerance of uncertainty, an association that was particularly pronounced for patients with two LA alleles. A genotype effect was not established in healthy controls. These findings link the serotonin transporter gene to affective circuitry findings in anxiety and depression psychopathology and further suggest that its impact on patients may be different from effects typically observed in healthy populations.

Psychophysiological Correlates of Attention to Emotional Information in Youth.

Attention to emotional stimuli has been associated with psychological health among adults and youth. In this study, we examined 2 putative functional psychophysiological correlates of attention to emotional information in a community sample of 135 youth (M age=12 years, 7 months; SD age=1 year, 1 month; 50% girls). After measuring resting respiratory sinus arrhythmia (RSA), participants completed a 1,500 ms emotional faces dot probe task with eye tracking. We examined pupil dilation during angry, sad, and happy trials and predicted that lower resting RSA and greater pupil dilation would be associated with relatively greater attention to negative stimuli. Results partially confirmed our hypothesis. Lower resting RSA was associated with relatively greater attention to sad faces. Lower resting RSA was also associated with relatively greater attention to angry faces when pupil dilation was lower. RSA may be an important functional correlate of attention that should be explored further in future research.

Rumination and multi-modal emotional reactivity.

Rumination, a cognitive process that involves passively and repetitively focusing on negative feelings and their consequences, has been linked to negative emotional outcomes. Previous research suggests that rumination may lead to deleterious outcomes through prolonging emotional reactivity; however, evidence supporting the link between rumination and reactivity has been mixed. In the present study, we examined the relationship between state and trait rumination and multi-modal emotional reactivity (i.e., hypothalamic-pituitary-adrenal axis, autonomic nervous system, subjective experience). Fifty undergraduates participated in a social evaluative laboratory stressor. They also reported on their general tendency to ruminate and their use of rumination in response to this particular laboratory stressor. State, but not trait, rumination was associated with increases in cortisol and negative affect. Findings underscore the importance of multi-modal assessment of emotional reactivity and suggest important implications for rumination following a stressor.

Maltreated youth display a blunted blood pressure response to an acute interpersonal stressor.

Although there is much evidence of hypothalamic-pituitary-adrenal axis dysfunction among individuals who have experienced child maltreatment, dysregulation of the autonomic nervous system (ANS) has received less attention. Understanding the role of the ANS in maltreated children may help clarify how these children respond to subsequent life stress. We explored ANS reactivity among 111 youth (ages 9-14), 34 of whom had experienced verified child maltreatment. ANS activity was assessed via blood pressure-a convenient, noninvasive physiological index-while youth underwent a social stress task. Blood pressure and subjective mood ratings were obtained prior to and following the task. Nonmaltreated youth experienced an increase in systolic blood pressure following the stressor, whereas maltreated youth did not. Self-reported subjective mood worsened for both groups. The current data suggest that children who experienced early stress exposure demonstrate blunted ANS reactivity. Results are discussed in terms of children's healthy adaptations to transient social stressors. In addition, we discuss the cost-effectiveness and benefits of physiological measures such as blood pressure for understanding risk for psychopathology.

Transmission of parental neuroticism to offspring's depression: the mediating role of rumination.

Rumination is a cognitive process that involves repetitively focusing on the causes, situational factors and consequences of one's negative emotion, and it is a potent risk factor for depression. Parental depression and neuroticism may exert an influence on offspring's development of rumination, which may increase offspring's risk for depression. The current study included 375 biological parent-offspring dyads. Parents were assessed for depressive symptoms and neuroticism; adult offspring were assessed for depressive symptoms and rumination. Structural equation modelling was used to examine the effects of parental depressive symptoms and parental neuroticism on adult offspring's depression, and to determine whether offspring's rumination mediated this relationship. Results provided evidence that offspring's rumination fully mediated the relationship between parental neuroticism and offspring's depressive symptoms. Parental depressive symptoms and neuroticism may contribute a genetic predisposition for depressive symptoms in offspring, but it also may promote an environment in which maladaptive cognitive processes, such as rumination, are learned. Given the role that rumination plays in mediating the association between neuroticism and depressive symptoms-targeting rumination in the treatment of high risk individuals would be important in reducing onset of depressive disorders.

Rumination as a transdiagnostic factor underlying transitions between internalizing symptoms and aggressive behavior in early adolescents.

The high degree of comorbidity among mental disorders has generated interest in identifying transdiagnostic processes associated with multiple types of psychopathology. Susan Nolen-Hoeksema conceptualized rumination as one such transdiagnostic process associated with depression, anxiety, substance abuse, binge eating, and self-injurious behavior. The degree to which rumination accounts for the co-occurrence of internalizing and externalizing psychopathology, however, has never been tested. We used a sample of early adolescents (N = 1,065) assessed at 3 time points spanning 7 months to examine (a) the reciprocal prospective associations between rumination and aggressive behavior in adolescents, (b) whether rumination explained the longitudinal associations of aggressive behavior with depression and anxiety symptoms, and (c) gender differences in these associations. Rumination predicted increases over time in aggressive behavior, and aggression was associated with increases in rumination over time only for boys. Rumination fully mediated the longitudinal association of aggression with subsequent anxiety symptoms and of both depression and anxiety symptoms with subsequent aggression in boys but not girls. Rumination did not explain the association between aggression and subsequent depressive symptoms for either boys or girls. These findings provide novel evidence for the role of rumination as a transdiagnostic factor underlying transitions between internalizing and externalizing symptoms among males during early adolescence. Interventions aimed at reducing rumination may have beneficial influences on multiple forms of psychopathology and on the development of comorbidity. (PsycINFO Database Record (c) 2014 APA, all rights reserved).