Effect of ruminations on the saliva cortisol response to a social stressor.

Depression is generally precipitated by stressful life events, which suggests that there could be differences in response to stress in individuals at risk for depression compared to normal subjects. To test this hypothesis, we compared individuals who scored high on ruminative coping, a risk factor for depression, to individuals low on ruminative coping. We used the Trier Social Stress Test (TSST), a mock job interview in front of a panel of judges, and collected saliva cortisol to assess neuroendocrine response. While we observed a clear effect of the stressor on saliva cortisol secretion, we observed no differences in this response between high and low ruminators. However, the task itself failed to cause a significant increase in rumination in either group, suggesting the task itself may not be optimal for testing the hypothesis. Finally, a modified version of the TSST in which the subjects were allowed a longer preparatory period resulted in a markedly diminished saliva cortisol response to the TSST.

The role of rumination in depressive disorders and mixed anxiety/depressive symptoms.

Several studies have shown that people who engage in ruminative responses to depressive symptoms have higher levels of depressive symptoms over time, after accounting for baseline levels of depressive symptoms. The analyses reported here showed that rumination also predicted depressive disorders, including new onsets of depressive episodes. Rumination predicted chronicity of depressive disorders before accounting for the effects of baseline depressive symptoms but not after accounting for the effects of baseline depressive symptoms. Rumination also predicted anxiety symptoms and may be particularly characteristic of people with mixed anxiety/depressive symptoms.

Predictors of family members' satisfaction with hospice.

This large, long-term study of families served by hospice found that nearly 95 percent said hospice had been helpful. Still, about 30 percent of family members said there was something they wish hospice had done differently. Those who had some complaint were more likely than those who had no complaints to be women, to report the patient had needed a great deal of care, to have a history of depression and greater levels of distress before and after the patient's death, and to be dissatisfied with the support they received from family members and friends.

Explaining the gender difference in depressive symptoms.

It was hypothesized that women are more vulnerable to depressive symptoms than men because they are more likely to experience chronic negative circumstances (or strain), to have a low sense of mastery, and to engage in ruminative coping. The hypotheses were tested in a 2-wave study of approximately 1,100 community-based adults who were 25 to 75 years old. Chronic strain, low mastery, and rumination were each more common in women than in men and mediated the gender difference in depressive symptoms. Rumination amplified the effects of mastery and, to some extent, chronic strain on depressive symptoms. In addition, chronic strain and rumination had reciprocal effects on each other over time, and low mastery also contributed to more rumination. Finally, depressive symptoms contributed to more rumination and less mastery over time.

"Thanks for sharing that": ruminators and their social support networks.

Receiving positive social support after a trauma generally is related to better adjustment to the trauma. The personality of trauma survivors may affect the extent to which they seek social support, their perceived receipt of social support, and the extent to which they benefit from social support. The authors hypothesized that people with a ruminative coping style, who tended to focus excessively on their own emotional reactions to a trauma, compared to those without a ruminative coping style, would seek more social support, and would benefit more from social support, but would report receiving less social support. These hypotheses were confirmed in a longitudinal study of people who lost a loved one to a terminal illness.

Making sense of loss and benefiting from the experience: two construals of meaning.

Theoretical models of the adjustment process following loss and trauma have emphasized the critical role that finding meaning plays. Yet evidence in support of these models is meager, and definitions of meaning have been too broad to facilitate a clear understanding of the psychological process involved. Using a prospective and longitudinal study of people coping with the loss of a family member, we differentiate 2 construals of meaning--making sense of the event and finding benefit in the experience--and demonstrate that both independently play roles in the adjustment process following the loss. Results indicate that making sense of the loss is associated with less distress, but only in the 1st year postloss, whereas reports of benefit finding are most strongly associated with adjustment at interviews 13 and 18 months postloss.

Effects of ruminative and distracting responses to depressed mood on retrieval of autobiographical memories.

Four studies explored the effects of self-focused rumination vs. distraction on dysphoric and nondysphoric students' retrieval of autobiographical memories. Dysphorics induced to ruminate subsequently recalled more negatively biased autobiographical memories in free recall (Study 1) and in response to prompts for memories (Study 2) than either dysphorics who first distracted themselves from their mood or nondysphoric controls. In Study 3, dysphoric rumination led students to recall negative events as occurring relatively frequently in their lives and positive events as occurring relatively infrequently. In Study 4, judges scored transcripts of participants' thoughts as expressed aloud while engaging in rumination or distraction. Codings revealed that dysphoric ruminators spontaneously generated memories that were more negative than those of the other three groups. Implications of a ruminative response style for progress in therapy, as well as for enhancing dysphoria and negatively biased cognitive processes, are discussed.

Regulating responses to anger: effects of rumination and distraction on angry mood.

Previous research has found that self-focused rumination maintains or increases depressed mood, whereas distraction decreases depressed mood (S. Nolen-Hoeksema & J. Morrow, 1993; S. Nolen-Hoeksema, J. Morrow, & B. L. Fredrickson, 1993). The present series of experiments examined these mood regulation strategies in the context of an angry mood. In Experiments 1 and 3, rumination increased anger, whereas distraction decreased or had no effect on anger. In Experiments 2 and 4, women were more likely to choose to ruminate when in a neutral mood but to distract themselves following induction of an angry mood. Men were equally likely to choose rumination or distraction, regardless of mood condition. The results are interpreted and discussed within the framework of an associative-network model of anger.

Are two interventions worse than none? Joint primary and secondary prevention of eating disorders in college females.

Prevention programs for eating disorders attempt to simultaneously prevent new cases from arising (primary prevention) and encourage students who already have symptoms to seek early treatment (secondary prevention), even though ideal strategies for these 2 types of prevention may be incompatible with each other. In the present study, an eating disorder prevention program was evaluated in a simple of female college freshmen. In the intervention, classmates who had recovered from eating disorders described their experiences and provided information about eating disorders. At follow-up, intervention participants had slightly more symptoms of eating disorders than did controls. The program may have been ineffective in preventing eating disorders because by reducing the stigma of these disorders (to encourage students with problems to seek help), the program may have inadvertently normalized them.

Rumination and psychological distress among bereaved partners.

Recently bereaved men who evidenced more negative ruminative thoughts in free-response interviews showed greater psychological distress on several outcome measures both 1 month and 12 months after their loss and less increase in positive morale over this 12-month period. Men who engaged in more analysis of themselves and the meaning of their loss reported greater positive morale 1 month after their loss but showed more persistent depression and absence of positive states of mind over the 12 months following their loss. Finally, men who reported more social friction also evidenced more enduring depressive symptoms over the year than did men who reported less social friction. These results are generally consistent with other studies that have shown that self-reflective, ruminative coping with negative emotions and social friction are associated with longer and more severe periods of depressed mood following stressful events.

Effects of self-focused rumination on negative thinking and interpersonal problem solving.

Hypotheses about the effects of self-focused rumination on interpretations of events and interpersonal problem solving were tested in 3 studies with dysphoric and nondysphoric participants. Study 1 supported the hypothesis that dysphoric participants induced to ruminatively self-focus on their feelings and personal characteristics would endorse more negative, biased interpretations of hypothetical situations than dysphoric participants induced to distract themselves from their mood, or nondysphoric participants. Study 2 showed that dysphoric participants who ruminated were more pessimistic about positive events in their future than the other 3 groups. Study 3 showed that dysphoric ruminating participants generated less effective solutions to interpersonal problems than the other 3 groups. In Studies 1 and 3, dysphoric ruminating participants also offered the most pessimistic explanations for interpersonal problems and hypothetical negative events. In all 3 studies, dysphoric participants who distracted were as optimistic and effective in solving problems as non-dysphoric participants.

Ruminative coping with depressed mood following loss.

In a longitudinal study of 253 bereaved adults, people with poorer social support, more concurrent stressors, and higher levels of postloss depression reported more rumination than people with better social support, fewer stressors, and lower initial depression levels. Women reported more rumination than men. People with a ruminative style at 1 month were more likely to have a pessimistic outlook at 1 month, which was associated with higher depression levels at 6 months. People with a more ruminative style were more depressed at 6 months, even after controlling for initial depression levels, social support, concurrent stressors, gender, and pessimism. Additional stressors and high depression scores at 1 month were also associated with higher levels of depression at 6 months.

The emergence of gender differences in depression during adolescence.

There are no gender differences in depression rates in prepubescent children, but, after the age of 15, girls and women are about twice as likely to be depressed as boys and men. In this article, three models for how gender differences in depression might develop in early adolescence are described and evaluated. According to Model 1, the causes of depression are the same for girls and boys, but these causes become more prevalent in girls than in boys in early adolescence. According to Model 2, there are different causes of depression in girls and boys, and the causes of girls' depression become more prevalent than the causes of boys' depression in early adolescence. According to Model 3, girls are more likely than boys to carry risk factors for depression even before early adolescence, but these risk factors lead to depression only in the face of challenges that increase in prevalence in early adolescence. Most studies of gender differences in depression have focused on the effects of individual variables on depression in girls and boys rather than on testing models of how these differences develop. Evidence for the variables most commonly thought to contribute to gender differences in depression in children and adolescents is reviewed, and this evidence is related to the three models for how these differences develop. It is concluded that Model 3 is best supported by the available data, although much more research is needed. Before adolescence, girls appear to develop more risk factors for depression than boys; girls also apparently face more new challenges in early adolescence than boys. It is argued that these factors combine, as specified in Model 3, to generate gender differences in depression beginning in early adolescence.

Self-perpetuating properties of dysphoric rumination.

Hypotheses about the self-perpetuating properties of ruminative responses to depressed mood were tested in 2 laboratory studies and 2 questionnaire studies with dysphoric and nondysphoric Ss. Studies 1 and 2 supported the hypothesis that dysphorics induced to engage in self-focused rumination would report reduced willingness to engage in pleasant, distracting activities that could lift their moods, even if they believed they would enjoy such activities. Studies 3 and 4 confirmed the hypothesis that dysphorics induced to ruminate in response to their moods would feel they were gaining insight into their problems and their emotions. Therefore, they might have avoided distraction because they believed it would interfere with their efforts to understand themselves. Depressed mood alone, in the absence of rumination, was not associated with either lower willingness to participate in distractions or an enhanced sense of insightfulness.

Response styles and the duration of episodes of depressed mood.

We examined the relationship between ruminative and distracting styles of responding to depressed mood and the duration of mood. Seventy-nine subjects kept accounts of their moods and responses to their moods for 30 consecutive days. The majority of subjects (83%) showed consistent styles of responding to depressed mood. Regression analyses suggested that the more ruminative responses subjects engaged in, the longer their periods of depressed mood, even after taking into account the initial severity of the mood. In addition, women were more likely than men to have a ruminative response style and on some measures to have more severe and long-lasting periods of depression.

Predictors and consequences of childhood depressive symptoms: a 5-year longitudinal study.

A 5-year longitudinal study investigated the interrelationships among children's experiences of depressive symptoms, negative life events, explanatory style, and helplessness behaviors in social and achievement situations. The results revealed that early in childhood, negative events, but not explanatory style, predicted depressive symptoms; later in childhood, a pessimistic explanatory style emerged as a significant predictor of depressive symptoms, alone and in conjunction with negative events. When children suffered periods of depression, their explanatory styles not only deteriorated but remained pessimistic even after their depression subsided, presumably putting them at risk for future episodes of depression. Some children seem repeatedly prone to depressive symptoms over periods of at least 2 years. Depressed children consistently showed helpless behaviors in social and achievement settings.

Therapeutic empathy and recovery from depression in cognitive-behavioral therapy: a structural equation model.

This study demonstrated that therapeutic empathy has a moderate-to-large causal effect on recovery from depression in a group of 185 patients treated with cognitive-behavioral therapy (CBT). The authors simultaneously estimated the reciprocal effect of depression severity on therapeutic empathy and found that this effect was quite small. In addition, homework compliance had a separate effect on clinical recovery, over and above the effect of therapeutic empathy. The patients of novice therapists improved significantly less than did the patients of more experienced therapists, when controlling for therapeutic empathy and homework compliance. Ss who terminated therapy prematurely were less likely to complete the self-help assignments between sessions, rated their therapists as significantly less empathic, and improved significantly less. Ss with borderline personality disorder improved significantly less, but they rated their therapists as just as empathic and caring as other patients. The significance of these findings for psychotherapy research, treatment, and clinical training is discussed.

Effects of the 1989 San Francisco earthquake on frequency and content of nightmares.

In a systematic evaluation of the effects of a natural disaster on nightmares, nightmare frequency was found to be about twice as high among 92 San Francisco Bay area college students as among 97 control subjects in Tucson, Arizona, after the 1989 Loma Prieta earthquake. Subjects in California had not only more nightmares in general but substantially more nightmares about earthquakes. Over a 3-week period, about 40% of those in the San Francisco Bay area reported one or more nightmares about an earthquake, as compared with only 5% of those in Arizona. However, nightmares about earthquakes were not more emotionally intense than other nightmares. These findings support the long-held view that the experience of a potentially traumatic event can result in more frequent nightmares, particularly about the event itself, but contradict the common opinion that nightmares about such events are unusually intense.

Responses to depression and their effects on the duration of depressive episodes.

I propose that the ways people respond to their own symptoms of depression influence the duration of these symptoms. People who engage in ruminative responses to depression, focusing on their symptoms and the possible causes and consequences of their symptoms, will show longer depressions than people who take action to distract themselves from their symptoms. Ruminative responses prolong depression because they allow the depressed mood to negatively bias thinking and interfere with instrumental behavior and problem-solving. Laboratory and field studies directly testing this theory have supported its predictions. I discuss how response styles can explain the greater likelihood of depression in women than men. Then I intergrate this response styles theory with studies of coping with discrete events. The response styles theory is compared to other theories of the duration of depression. Finally, I suggest what may help a depressed person to stop engaging in ruminative responses and how response styles for depression may develop.

A prospective study of depression and posttraumatic stress symptoms after a natural disaster: the 1989 Loma Prieta Earthquake.

Measures of emotional health and styles of responding to negative moods were obtained for 137 students 14 days before the Loma Prieta earthquake. A follow-up was done 10 days again 7 weeks after the earthquake to test predictions about which of the students would show the most enduring symptoms of depression and posttraumatic stress. Regression analysis showed that students who, before the earthquake, already had elevated levels of depression and stress symptoms and a ruminative style of responding to their symptoms had more depression and stress symptoms for both follow-ups. Students who were exposed to more dangerous or difficult circumstances because of the earthquake also had elevated symptom levels 10 days after the earthquake. Similarly, students who, during the 10 days after the earthquake, had more ruminations about the earthquake were still more likely to have high levels of depressive and stress symptoms 7 weeks after the earthquake.