Investigating Functional Properties of Depressive ... - SAGE Journals

Journal of Experimental Psychopathology JEP Volume 5 (2014), Issue 3, 244-258 ISSN 2043-8087 / DOI:10.5127/jep.038013

Investigating Functional Properties of Depressive Rumination: Insight and Avoidance Rosemary E. F. Kingstona, Edward R. Watkinsa,b, and Susan Nolen–Hoeksemac a

Mood Disorders Centre, Psychology, College of Life and Environmental Sciences, University of Exeter, UK

b

School of Psychology, University of Western Australia, Perth

c

Department of Psychology, Yale University, New Haven, CT

Abstract It remains unresolved why people keep ruminating even though it confers vulnerability to depression. It has been hypothesised that rumination is reinforced by (i) increasing insight and understanding into difficulties and/or (ii) providing a rationale for avoiding taking action, thereby avoiding aversive situations. To test this, we used an experimental analogue to rumination about threat: Participants were confronted with being assertive about a difficult interpersonal issue, and randomly allocated to repetitively think about this in an abstract style characteristic of depressive rumination (“Why?”) or a concrete style inconsistent with depressive rumination (“How?”). Relative to abstract rumination, concrete thinking significantly enhanced sense of confidence, control, and assertiveness self– efficacy, but not insight and understanding. In contrast, rumination increased justification for avoidance relative to concrete thinking. These findings suggest that rumination does not increase insight relative to other problem– focused thinking, but it may be reinforced by providing evidence that supports inactivity and avoidance. © Copyright 2014 Textrum Ltd. All rights reserved. Keywords: Rumination; Depression; Cognitive Processes, Metacognitive Beliefs; Avoidance Correspondence to: Rosemary Kingston, Psychology, College of Life and Environmental Sciences, University of Exeter, Washington Singer Building, Perry Road, Exeter, EX4 4QG, UK. E–mail: [email protected] Received 23–Aug–2013; received in revised form 11–Mar–2014; accepted 12–Mar–2014

Journal of Experimental Psychopathology, Volume 5 (2014), Issue 3, 244-258

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Table of Contents Introduction Method Design Participants Tasks Exposure to threatening situation: Confrontation with assertiveness task. Manipulation of processing mode: Abstract rumination / concrete thinking interview. Measures Response Styles Questionnaire – Ruminative Response Scale (RSQ–RRS, Nolen–Hoeksema & Morrow, 1991). Patient Health Questionnaire (PHQ–9, Kroenke, Spitzer, & Williams, 2001). Sense of understanding and insight. Sense of confidence and control. Assertiveness self–efficacy. State anxiety. Justification for avoidance. Interview coding of abstract / concreteness. Importance of understanding and insight. Ratings of the assertiveness issue. Procedure Results Preliminary Analyses Interview Manipulation Check Main Analyses Post–threat analyses. Post–manipulation analyses. Relationship with trait rumination. Relationship with current depression symptoms. Discussion Acknowledgements References

Introduction Depressive rumination refers to a passive and repetitive way of responding to low mood, which involves focusing on feelings of distress and the possible causes and consequences of those feelings (Nolen–Hoeksema, Wisco, & Lyubomirsky, 2008). Depressive rumination has robustly been found to contribute to the development and maintenance of depression and anxiety disorders (Nolen–Hoeksema et al., 2008; Watkins, 2008), indicating the importance of understanding its underlying processes, and identifying which factors contribute to individual differences in rumination. One potential paradox is that a subset of individuals (high ruminators) continue to ruminate frequently and persistently, despite its negative consequences. A key question in understanding its underlying mechanisms is therefore: “What makes it so difficult to break free of rumination once it has begun?” (Nolen–Hoeksema et al., 2008, p. 418). One hypothesis is that rumination may have functions that lead to outcomes that reinforce its further use. Rumination may be maintained for two reasons: (i) because of its perceived functions (i.e., conscious beliefs that it is helpful, which may be accurate or inaccurate), and/or (ii) because of actual reinforcement and procedural learning (Watkins, 2013). In particular, behavioural accounts of depression (e.g., Ferster, 1973; Martell, Addis, & Jacobson, 2001) underpin this hypothesis because they propose that depressive behaviours, including rumination, may have functional properties and consequences that reinforce their continued use. Parallels can also be drawn


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with the worry literature (cf. the avoidance theory of worry, Borkovec, 1994), in which worry is proposed to have functions that can be reinforced, such as helping people to anticipate and prepare for future events. There is some evidence supporting the notion that rumination may be maintained because of its perceived beneficial functions. People report beliefs that rumination helps them to gain insight into the meanings of their feelings and problems, and discern the reasons why things happen to them (Watkins & Baracaia, 2001; Kingston, Watkins, & O’Mahen, 2013). However, only one study has examined the effects of experimentally manipulating rumination on subjective sense of insight and understanding. Lyubomirsky and Nolen–Hoeksema (1993) found that relative to a distraction induction, dysphoric and nondysphoric participants undergoing a rumination induction rated themselves as more insightful. Based on this finding, Lyubomirsky and Nolen–Hoeksema (1993, p. 347) hypothesised that “the perception that one possesses insight (and not actual insight per se) may lead some dysphorics to continue ruminating”. However, this study was limited in that it did not examine the effect of rumination on a real–world problem. Furthermore, perceived insight was only assessed post–manipulation, so it was not possible to examine the change in perceived insightfulness resulting from rumination. Critically, this study only compared rumination to distraction, such that thinking about the self, feelings and problems (i.e., rumination) was compared with not thinking about feelings and problems. As such, it cannot be concluded that any observed differential effects are specific to rumination rather than the general benefit of thinking about and focusing on the problem, versus not thinking about the problem. One goal of the current study was to provide a more robust test of this insight hypothesis, by examining whether rumination specifically enhances feelings of insight relative to other ways of thinking about problems, as opposed to distraction. To address this, the current study ensured that all participants thought in detail about a personal problem, but with one condition thinking in a style analogous to depressive rumination (abstract processing), whereas the other condition involved thinking in a style phenomenologically inconsistent with rumination (concrete processing, see Watkins, 2008; Watkins, Moberly, & Moulds, 2008). Depressive rumination is characterised by abstract and evaluative processing, focused on analysing the causes, meanings, and implications of feelings and negative events (Watkins, 2008). In contrast, concrete thinking refers to a mode of processing which is experiential and focused on the contextual and specific details of a situation, which is uncharacteristic of naturally occurring depressive rumination, and found to have distinct constructive effects in contrast to rumination in experimental studies (Watkins, 2008; Watkins et al., 2008). Since both groups were matched for thinking about problems, any observed effects cannot be explained by the effect of thinking versus not thinking about a problem. A parallel account is that rumination is negatively reinforced because it is a passive behaviour that allows individuals to avoid directly engaging with their aversive environment (Ferster, 1973). Martell et al. (2001, p. 121) hypothesise that “although the rumination may be experienced as aversive to the individual, it is possible that it is maintained by the avoidance of even more aversive conditions”. Correlational evidence for this relationship comes from Giorgio et al. (2010), who found that trait rumination was significantly correlated with greater self–reported avoidance. Nolen–Hoeksema et al. (2008, p. 408) hypothesised that “rumination is reinforced by the reductions in distress that come from withdrawing from aversive situations, from being relieved of responsibility, and from a sense of certainty about one’s conclusions”. Hence, rumination may be maintained by acting as a means of avoiding aversive situations and responsibility. More specifically, Nolen–Hoeksema et al. (2008, p. 407) hypothesised that “rumination serves to build a case that the individual is facing a hopelessly uncontrollable situation and so he or she is not able to take action to overcome the situation”. If this avoidance hypothesis is correct, rumination would be predicted to increase the generation of reasons for not taking action and lead to negative predictions about the effectiveness of action, thereby reducing the likelihood of engaging in personally challenging or threatening behaviours. More speculatively, it may potentially avoid the increases in anxiety associated with such behaviours. Previous attempts to examine the putative avoidant functions of rumination (e.g., Giorgio et al., 2010) did not involve exposing participants to a challenging or threatening situation, which would afford the opportunity or necessity to avoid. In the absence of a situation that may motivate individuals towards avoidance, it is difficult to assess whether any behaviour functions as avoidance. To address this, the current study exposed participants to a


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potentially threatening situation, typical of those that trigger rumination: having to be assertive about an interpersonal problem. This approach therefore tested whether abstract rumination afforded more justification for avoiding assertiveness relative to concrete thinking. If the insight hypothesis is correct, then participants in the abstract condition (analogous to depressive rumination) will report a greater sense of understanding and insight relative to those in the concrete thinking condition. If the insight hypothesis is correct, we predict that this enhanced sense of insightfulness would also lead to a greater sense of confidence and control for participants in the abstract rumination condition relative to those in the concrete thinking condition. We use the term “confidence and control” to refer to a general sense of self–confidence and control over one’s life (e.g., feeling confident about one’s ability to handle difficulties, feeling in control of important personal issues). The insight hypothesis predicts that insightfulness may lead to an increased sense of confidence because having greater levels of personal insight and abstract understanding into causes of events will reduce perceived uncertainty and enable predictions for the future, making individuals feel more confident in themselves, their thoughts, their appraisals of situations, and their ability to manage difficulties. This prediction is consistent with evidence that individuals receiving an abstract meaning–making intervention designed to increase insightfulness following a stressful event report greater self–confidence, relative to those not receiving an intervention specifically designed to increase personal insight (Lee, Cohen, Edgar, Laizner, & Gagnon, 2006). In contrast, the processing mode theory (Watkins, 2008), which hypothesises that adopting concrete processing of difficulties is more constructive than abstract processing, predicts that sense of confidence and control will be greater for participants in the concrete condition relative to the abstract condition. If the avoidance hypothesis is correct, then participants in the abstract rumination condition are predicted to (a) generate more justifications for avoidance and (b) report less assertiveness self–efficacy, relative to participants in the concrete thinking condition. We also explored whether abstract rumination may also make the problem seem less proximal and thus reduce the activation of anxiety associated with confronting a problem, relative to concrete thinking. Lastly, functional accounts such as the insight and avoidance hypotheses tend to assume that the potential functions of behaviour (e.g., rumination) reflect general underlying processes that apply in a dimensional way across the spectrum from healthy to distressed individuals (i.e., ruminative thinking could increase sense of insight for all people). Therefore, we used an unselected sample to provide a proof–of–principle test of our primary hypothesis that rumination has functional effects. We propose that functional effects exist on a continuum and will apply to all people, whether healthy or with clinical symptoms, but such effects may be more extreme or exaggerated in clinical participants. Thus, it is therefore appropriate as a preliminary test of the hypotheses to initially utilise an unselected sample. However, because there may be quantitative differences in its functional effects (e.g., high ruminators may find abstract rumination more useful or have a greater need for it than low ruminators), we explored whether the effects of the experimental manipulation were moderated by the level of trait rumination using regression analyses (i.e., are the effects of the experimental manipulation similar for high and low ruminators?).

Method Design This was an experimental study with participants randomly allocated to one of two conditions: Abstract Rumination versus Concrete Thinking, manipulating the independent variable (IV) of processing mode. The five dependent variables (DVs) were: (i) sense of understanding and insight, (ii) sense of confidence and control, (iii) assertiveness self–efficacy, (iv) justification for avoidance, and (v) state anxiety.

Participants The sample consisted of 95 undergraduate students (84.20% female; age range 18 – 42 years, M = 20.17, SD = 4.40; 91.58% identified as White, 4.26% identified as Asian, 4.21% identified as Mixed Ethnicity). Whilst


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participants were not excluded as a result of depression or dysphoria status, levels of depression in the sample were generally low (PHQ–9 mean score = 3.86, SD = 3.10).

Tasks Exposure to threatening situation: Confrontation with assertiveness task. Participants were asked to identify and describe an issue that they wanted to be assertive about with someone close to them. The experimenter read the following instructions aloud to the participants: “Now, we need to identify something that you want to be assertive about with someone close to you. Typically, this will be something that the other person does (for example, telling you what to do, some annoying habit they have, making you feel bad about yourself), or something the other person does not do (for example, not asking your opinion about things, not following through with commitments). It needs to be something that bothers you, and that you would like to change, but haven’t yet spoken to the person about, or resolved properly with them.” The experimenter emphasised to the participant that the issue had to be unresolved, personally significant rather than trivial, and something not previously raised. Participants then verbally described the issue they were having with another person, such that the experimenter could check it met the criteria outlined above. To ensure a clear focus on the assertiveness issue and to make the idea of confronting the issue seem more real and threatening, participants were told to focus on what they would like to express to the close person, in order to make them more ready to be assertive. They were left alone in the room to do this for two minutes.

Manipulation of processing mode: Abstract rumination / concrete thinking interview. Processing mode was manipulated by means of a detailed structured interview about the assertiveness issue. We adopted an interview method so that the experimenter could ensure that participants were using the appropriate processing mode for their condition. Participants in the Abstract Rumination condition, designed to be an analogue of depressive rumination, were interviewed with questions that were abstract and focused on the “why” of the situation, with a focus on the meanings, causes, and implications of the issue (e.g., “why is this issue important to you?”, “what consequences does this issue have on your relationship with this close person?”). Participants in the Concrete Thinking condition, designed to be uncharacteristic of depressive rumination, were interviewed with questions that were focused on the contextual, sensory, and sequential details of “how” the situation may occur (e.g., “what exactly do you want to say?”, “where will you discuss this?”). Each interview contained seven questions delivered in the same order for all participants. Participants were asked to try and spend approximately one minute responding to each question. If answers were brief or unelaborated, set prompts were used (e.g., “can you tell me more about that?”). Critically, both sets of interviews equally focused on the assertiveness concern and did not differ in emotional content.

Measures Response Styles Questionnaire – Ruminative Response Scale (RSQ–RRS, Nolen– Hoeksema & Morrow, 1991). The RSQ–RRS is a 22–item questionnaire that assesses ruminative responses focused on the self, symptoms, and possible causes and consequences of low mood. Total scores range from 22–88, with higher scores indicating greater trait rumination. Internal consistency in our sample was excellent (α = .92). The RSQ–RRS can also be used to assess brooding and reflection components of rumination, with the items comprising these subscales being uncontaminated with symptoms of depression (Treynor, Gonzalez, & Nolen–Hoeksema, 2003). The brooding and reflection subscales each contain 5 items, with scores on each subscale ranging from 5–20, with higher scores indicating greater brooding and reflection. In our sample, internal consistency for these subscales was acceptable to good (brooding α = .80; reflection α = .79).


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Patient Health Questionnaire (PHQ–9, Kroenke, Spitzer, & Williams, 2001). The PHQ–9 is a nine–item measure designed to assess the severity of depression symptoms over the past two weeks. Scores range from 0 to 27, with greater scores indicating more severe symptoms of depression. It has good internal consistency and construct validity (Kroenke et al., 2001).

Sense of understanding and insight. A 16–item measure was created for this study, adapted from Lyubomirsky and Nolen–Hoeksema (1993), to assess current perceived understanding and insight (e.g., “Right now, how much do you understand yourself?”, “Right now, how much insight do you have into other people?”; see Appendix for full measure). Responses for each item were given on a scale from 1 (“Very slightly or not at all”) to 5 (“Very strongly”). A mean score was calculated, with scores ranging from 1 to 5, with higher scores indicating a greater sense of understanding and insight. Internal consistency was good (α = .86).

Sense of confidence and control. A 9–item measure was created for this study to assess current perceived control and confidence (e.g., “Right now, how much do you feel that you are in control of your life?”, “Right now, how confident do you feel about your ability to handle your personal problems?”; see Appendix for full measure). Responses for each item were given on a scale from 1 (“Very slightly or not at all”) to 5 (“Very strongly”). A mean score was calculated, with scores ranging from 1 to 5, with higher scores indicating a greater sense of confidence and control. Internal consistency was good (α = .82).

Assertiveness self–efficacy. A 6–item measure was created to assess participants’ self–efficacy regarding being assertive (e.g., “Right now, how confident are you that it would go well if you were to be assertive?”, “Right now, how risky does being assertive feel to you?”; see Appendix for full measure). Responses for each item were given on a scale from 1 (“Very slightly or not at all”) to 5 (“Very strongly”). A mean score was calculated, with scores ranging from 1 to 5, with higher scores indicating greater assertiveness self–efficacy. Internal consistency was acceptable (α = .77).

State anxiety. State anxiety was assessed by using the 4 items from the “activated unpleasant” subscale of the Circumplex Measure of Affect (Larsen & Diener, 1992; Russell, 1980). This measure comprises emotion words (“anxious”, “nervous”, “fearful”, “annoyed”) that are rated according to the extent to which participants feel this emotion “right now”, on a scale from 1 (“very slightly or not at all”) to 5 (“extremely”). The whole measure was delivered so as to conceal our interest in the anxiety items. A mean score was calculated, with scores ranging from 1 to 5, with higher scores indicating greater trait anxiety. Internal consistency in our sample for this scale was acceptable (α = .77).

Justification for avoidance. Degree of justification for avoidance was assessed by coding of interview transcripts by a rater blind to participant condition, with a second rater blind to condition rating a randomly selected 10% of transcripts to check the reliability of coding. A coding scheme was developed for the current study where three types of avoidance were coded: (i) avoidance because of perceived lack of control (i.e., avoiding the issue because of a perceived certainty that efforts will be fruitless, that the individual has no control over the problem, and that nothing he/she could do would work); (ii) avoidance because of a reduced sense of responsibility (i.e., avoiding the issue because of a perception that he/she is not responsible for the situation itself or for resolving the situation), and (iii) avoidance because of a wish to avoid distress (i.e., avoiding the issue because he/she wants to avoid a negative, unpleasant or uncomfortable outcome, either in terms of his/her own emotions or the emotions of others). Each of these three dimensions were rated on a scale ranging from 1 (“not demonstrated at all”) to 4 (“demonstrated a lot”), giving each participant three


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scores for avoidance, with higher scores indicating greater justification for avoidance. Inter–rater reliability for 10% of the items was substantial (mean Cohen’s kappa = .67).

Interview coding of abstract / concreteness. Interview transcripts were coded by a rater blind to the aims of the experiment and the participant condition, with a second rater blind to condition rating a randomly selected 10% of transcripts to check the reliability of coding, as a means of assessing whether the manipulation was successful (i.e., whether participants in the Abstract Rumination condition were more abstract than those in the Concrete Thinking condition). Ratings were made using the abstract and concreteness rating scale outlined in Stöber and Borkovec (2002), which comprises a 5–point scale: 1 (abstract, defined as “indistinct, cross–situational, equivocal, unclear, aggregated”), 2 (somewhat abstract), 3 (neither–nor), 4 (somewhat concrete), 5 (concrete, defined as “distinct, situationally specific, unequivocal, clear, singular”). Inter–rater reliability for 10% of the items was substantial (mean Cohen’s kappa = .61).

Importance of understanding and insight. Two single–item measures were created for the current study to assess the perceived importance of having insight into the self and others (“How important to you is it to understand and have insight into yourself?”, “How important to you is it to understand and have insight into other people?”). Responses to each item were made on a scale from 1 (“Not at all”) to 10 (“Extremely”).

Ratings of the assertiveness issue. A series of 7 items were created for the current study to explore various aspects of the situation participants wanted to be assertive about, to check that there were no differences between conditions on the qualities of the situation raised (e.g., “How important is this concern to you?”, “How risky does it feel to raise this concern with this person?”; see Appendix for all items). Responses to each item were made on a scale from 1 (“Not at all”) to 10 (“Extremely”).

Procedure Prior to the experiment, participants completed the RSQ–RRS and PHQ–9 online. A small number of additional measures not analysed in the current study were also administered. The experiment comprised three phases. In Phase 1, participants were told that the study was examining assertiveness and whether certain ways of thinking about interpersonal problems can encourage assertiveness. They were told that they would be asked to identify an important current interpersonal problem that they wanted to be assertive about, and that they would be followed up in two weeks to see if they had been assertive, and were further told, “whilst you are free to decide what to do, we are very keen for you to try and be assertive about this issue, and would strongly encourage you to speak to the other person about your concern”. Participants then completed the importance of understanding and insight measure, as well as a battery of state measures (Baseline) comprising sense of understanding and insight, sense of confidence and control, assertiveness self–efficacy, and state anxiety. Next, participants were exposed to the threatening situation by completing the confrontation with assertiveness task. Afterwards, participants completed the ratings of the assertiveness issue measure, and the battery of state measures again (Post–Threat). In Phase 2, processing mode was manipulated by giving participants either the Abstract Rumination or the Concrete Thinking interview, which was audio recorded. In Phase 3, participants completed the battery of state questionnaires for a third time (Post–Manipulation). Participants were debriefed and told that they would not be followed up after the session to check whether they had been assertive.


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Results Preliminary Analyses No outliers were detected in the sample on any variables, and thus all participants’ data were retained. To detect univariate outliers, variables were transformed into standardised scores (z–scores), to see if any standardised scores were greater than or equal to 3 (i.e., whether there were any outliers that were more than 3 standard deviations from the mean). To detect multivariate outliers, Mahalanobis distances (D2) were calculated between the variables, to see if any values were greater than the critical value at p < .001 (in this case, 40.790). Moreover, no problematic multicollinearity was detected in the sample after examining VIF and tolerance statistics. Independent samples t tests revealed that there were no differences between the conditions on any of the baseline measures of rumination (full RSQ–RRS: t(93) = –.20, p = .839; RSQ–RRS Brooding subscale: t(93) = –.07, p = .944; RSQ–RRS Reflection subscale: t(93) = .15, p = .884), depression (t(93) = –.10, p = .918), understanding and insight (t(93) = – .60, p = .551), confidence and control (t(93) = –.49, p = .626), assertiveness self–efficacy (t(93) = .19, p = .850), and state anxiety (t(93) = .65, p = .515); see Table 1 for means and standard deviations. Moreover, to examine whether there were any differences between groups on ratings of the assertiveness issue (e.g., “How important is this concern to you?”), independent samples t tests for each of the items (see Appendix for all items) revealed there were no significant differences between groups on any of these items, indicating that the randomisation was successful (t range = –.13 to –1.81, p range = .073 to .895). Therefore, these findings indicate that there was no difference in the qualities of the assertiveness issue (e.g., importance, severity, etc.) between conditions.

Interview Manipulation Check A t test was conducted to see whether the two conditions differed on level of concreteness. There was a significant difference between the groups, indicating that the manipulation was successful, as interview responses from participants in the abstract rumination condition were rated as more abstract (M = 2.39, SD = .34) than those in the concrete thinking condition (M = 2.81, SD = .29), t(93) = 6.40, p < .001.

Main Analyses In order to examine the differential effects of rumination versus concrete thinking on our dependent variables of interest, a series of two–way repeated measures Analyses of Variance (ANOVAs) and independent samples t tests were conducted (see Table 1 for means and standard deviations).

Post–threat analyses. We did not expect any differential effect of exposing participants to the assertiveness threat prior to the manipulations of rumination versus concrete processing. We conducted 2 (Condition: Abstract Rumination versus Concrete Thinking) by 2 (Time: Baseline versus Post–Threat) ANOVAs respectively on the dependent variables of understanding and insight, confidence and control, assertiveness self–efficacy, and anxiety. There was a main effect of Time on anxiety (F(1, 93) = 29.06, p < .001): all participants became more anxious after exposure to the threatening situation. There were no other main effects of Time (F range .06 – .23, p range .632 – .813), and as predicted, there were no main effects of Condition (F range .01 – .26, p range .612 – .938) or interaction effects of Time X Condition (F range .00 – 1.66, p range .199 – .956) on any of the dependent variables (see Table 1).


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Table 1: Means (and standard deviations) for the dependent variables across time and condition. Abstract Rumination (n = 48) Baseline RSQ-RRS

Post-Threat

Post-Manipulation

Concrete Thinking (n = 47) Baseline

Post-Threat

Post-Manipulation

37.98 (10.15)

37.53 (11.23)

RSQ-RRS Brooding subscale

8.87 (3.09)

8.92 (3.08)

RSQ-RRS Reflection subscale

8.26 (2.97)

8.17 (2.92)

PHQ-9

3.90 (2.95)

3.83 (3.28)

Sense of Understanding and Insight

3.24 (.50)

3.21 (.61)

3.37 (.60)

3.18 (.47)

3.17 (.46)

3.45 (.48)

Sense of Confidence and Control

3.15 (.54)

3.14 (.63)

3.21 (.64)

3.09 (.57)

3.08 (.65)

3.43 (.61)

Assertiveness Self-Efficacy

2.92 (.68)

2.97 (.72)

3.17 (.73)

2.95 (.69)

2.93 (.71)

3.45 (.61)

State anxiety

1.72 (.60)

2.09 (.72)

1.84 (.75)

1.81 (.74)

2.04 (.83)

1.79 (.83)

Avoidance: No Control

1.73 (.84)

1.17 (.48)

Avoidance: Not Responsible

1.42 (.08)

1.13 (.05)

Avoidance: Avoid Distress

2.17 (.12)

1.11 (.05)

Note. RSQ-RRS = Response Styles Questionnaire – Ruminative Response Scale; PHQ-9 = Patient Health Questionnaire.


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Post–manipulation analyses. Further ANOVAs were conducted to examine the effect of Condition (Abstract Rumination versus Concrete Thinking) and Time (Post–Threat to Post–Manipulation) on the dependent variables identified above. There was a main effect of Time (F(1, 93) = 35.25, p < .001) on understanding and insight: All participants reported a greater sense of understanding and insight after the manipulation. However, there was no main effect of Condition (F(1, 93) = .05, p = .833) or interaction of Time X Condition (F(1, 93) = 2.52, p = .116) on understanding and insight, inconsistent with the insight hypothesis: Participants in the Abstract Rumination condition did not have a greater increase in understanding and insight than participants in the Concrete Thinking condition (see Table 1). There was a significant main effect of Time (F(1, 93) = 26.52, p < .001) but not Condition (F(1, 93) = .43, p = .516) on sense of confidence and control, which was secondary to a significant interaction effect of Time X Condition (F(1, 93) = 11.67, p = .001): participants in the Concrete Thinking condition reported a significantly greater increase in confidence and control relative to participants in the Abstract Rumination condition (see Table 1). Consistent with the avoidance hypothesis, there was a significant effect of Time (F(1, 93) = 40.41, p < .001) but not Condition (F(1, 93) = .83, p = .366) on assertiveness self–efficacy, which was secondary to a significant interaction effect of Time X Condition (F (1, 93) = 1.30, p = .005): Participants in the Concrete Thinking condition reported a greater increase in assertiveness self–efficacy after the manipulation relative to participants in the Abstract Rumination condition (see Table 1). There was a main effect of Time (F(1, 93) = 21.96, p < .001) on state anxiety: All participants became less anxious after the manipulation. However, there was no main effect of Condition (F(1, 93) = .11, p = .737) or interaction of Time X Condition (F(1, 93) = .00, p = 1.00) on anxiety: Participants in the Abstract Rumination condition did not show a greater decrease in anxiety relative to participants in the Concrete Thinking condition. Three independent samples t tests were conducted to examine the effect of condition on the three types of justification for avoidance. Consistent with the avoidance hypothesis, participants in the Abstract Rumination condition were significantly more likely than those in the Concrete Thinking condition to report that they were avoiding assertiveness because they perceived that they had no control over outcomes (t(93) = –4.00, p < .001), that they were not responsible for resolving the situation (t(93) = –2.97, p = .004), and because they wanted to avoid distress (t(93) = –8.41, p < .001). Abstract Rumination therefore afforded more justification for avoiding a threatening situation relative to Concrete Thinking about being assertive (see Table 1).

Relationship with trait rumination. To investigate whether the potential functional effects of rumination are consistent across different levels of trait rumination (e.g., do high ruminators find abstract rumination more useful than low ruminators?), distinct hierarchical multiple regression analyses were conducted that included an interaction term between trait rumination and experimental condition. The dependent variables for each separate regression were respectively, post– manipulation understanding and insight; confidence and control; assertiveness self–efficacy; anxiety. The concomitant variable assessed at post–threat was entered at Step 1 in the regression analysis to control for the prior level of that variable, enabling estimation of change in the dependent variable across the manipulation. Trait rumination was then entered at Step 2 and Condition entered at Step 3, to assess main effects, before the interaction between Condition X trait rumination was entered at Step 4. If the effect of the manipulation is moderated by level of trait rumination, this final step should be a significant predictor of post–manipulation dependent variables, controlling for post–threat scores and above and beyond main effects. There was no significant effect of Condition X trait rumination in any of the analyses (β range = –.04 to –.09, p range = .336 to .655), indicating that the observed effects are consistent across the whole spectrum of trait rumination: The effect of the experimental manipulation was not significantly different at low or high levels of trait rumination. Consistent with previous research (Watkins & Baracaia, 2001), there was a positive correlation between trait rumination and participants reporting that it is important to have insight into the self (r(93) = .26, p = .010) and other people (r(93) = .23, p = .020), as assessed with the importance of understanding and insight measure, completed at baseline. There was also a negative correlation between trait rumination and baseline sense of understanding


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and insight (r(93) = –.33, p = .001). As such, participants high on trait rumination believed that it was more important to be insightful, but at the same time, reported feeling less insightful than those lower on trait rumination.

Relationship with current depression symptoms. To investigate whether the effects of the experimental manipulations were consistent across different levels of current depression symptoms, a series of hierarchical multiple regression analyses were conducted, using the same steps and dependent variables as previously reported for examining the interaction of condition with trait rumination, but replacing trait rumination with level of depression symptoms (PHQ–9) in both main effect and interaction terms. There was no significant effect of Condition X depression in any of the analyses (β range = –.17 to .03, p range = .062 to .746), indicating that the observed effects are consistent across the symptoms of depression reported in this sample.

Discussion Because individuals persist in rumination despite it being detrimental to wellbeing, the current study sought to understand why people continue to ruminate, by assessing whether rumination has any beneficial outcomes that might be reinforcing. One hypothesis was that depressive rumination, by focusing on meanings and implications, increases sense of insight into problems (the insight hypothesis). Another hypothesis is that rumination serves as a form of avoidance by allowing people to generate reasons for not taking action (the avoidance hypothesis). To test these hypotheses, we conducted the first experimental study to compare rumination focusing on meanings and implications versus thinking focused on concrete behaviour in the context of a situation that afforded avoidance – being confronted with being assertive. Inconsistent with the insight hypothesis, abstract rumination, analogous to depressive rumination, about a challenging assertiveness concern did not differ from concrete thinking in terms of increasing sense of understanding and insight. Moreover, concrete thinking led to an increased sense of confidence and control relative to abstract rumination, at odds with the insight hypothesis, but consistent with processing mode theory (Watkins, 2008), which hypothesises that concrete processing of difficulties leads to more constructive outcomes than abstract processing. However, our results are broadly consistent with the avoidance hypothesis: abstract rumination lead to greater justification for avoiding taking action (e.g., because of the perception of having no control over the situation), relative to concrete thinking. Moreover, abstract rumination lead to significantly less assertiveness self–efficacy relative to concrete thinking. However, there were no differences between conditions on anxiety, contrary to the speculative prediction that abstract rumination may reduce anxiety. Finally, through examining the interaction between condition and trait rumination, we found that these effects were maintained at all levels of trait rumination. Our findings indicate that when applied to a real–world situation and compared with an appropriate control matched for thinking about a problem, rumination does not differentially increase self–reported insight and understanding. When we used this more ecologically valid control and assessed change in sense of insight over time, we did not replicate the findings of Lyubomirsky and Nolen–Hoeksema (1993). We interpret this pattern of findings as indicating that rumination does not genuinely lead to enhanced feelings of insight, relative to any other form of thinking, even though the abstract rumination involved a focus on meanings and implications. We suggest that the Lyubomirsky and Nolen–Hoeksema (1993) finding may be a consequence of the methodological design that compared thinking versus not thinking (i.e., the process of thinking caused the increased sense of insight, rather than ruminative thinking per se). Our findings suggest that beliefs that rumination increases insight and understanding (e.g., Kingston et al., 2013; Papageorgiou & Wells, 2003) may be misplaced. Despite involving a focus on meanings and implications, depressive rumination does not specifically increase sense of insight relative to another form of thinking. We note that there has been some debate as to whether rumination leads to actual or perceived insight. For example, Lyubomirsky and Nolen–Hoeksema (1993), (p. 347) noted that “given that dysphoric people who ruminate appear to be less successful at interpersonal problem solving, rumination may lead to enhanced feelings of insightfulness but to less actual insight”. Our findings suggest that this debate may be moot, as rumination does not differentially increase subjective insight relative to an appropriate control.


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We found that rumination was significantly less helpful than concrete thinking for sense of confidence and control: Thinking concretely about a difficulty led to significantly greater improvements in confidence and control, relative to rumination. This is consistent with processing mode theory (Watkins, 2008). Processing mode theory has demonstrated the benefits of concrete processing on actual problem–solving behaviour and emotional reactivity relative to abstract processing (e.g., Watkins et al., 2008; Watkins & Moulds, 2005). This study provides preliminary evidence that processing style also has benefits in terms of subjective confidence and control. Regarding the avoidance hypothesis, our findings suggest that rumination provides reasons for avoiding confronting a threatening situation by affording the accumulation of evidence against taking action, relative to more concrete thinking. However, it is not known whether this avoidance directly reinforces rumination. The wider model proposed by Nolen–Hoeksema et al. (2008) predicts that rumination leads to avoidance by generating reasons not to take action. In turn, this is negatively reinforced because it avoids negative emotions, thereby reinforcing and maintaining rumination. This study examined the first part of this model by demonstrating that rumination gives people reasons not to take action with threatening situations, by making negative predictions about the effectiveness of action. Whilst this is consistent with the possibility that rumination may have an avoidant function, this study did not test the second part of the model relating to reinforcement because we did not measure whether avoidance behaviour actually reinforces rumination. Whilst the reasons people give for avoiding taking action are likely to be a good proxy for actual avoidance behaviour, the next step is to test the second part of the model by manipulating or assessing avoidance post–rumination, and measuring the effects on subsequent rumination. This would make it possible to draw conclusions about whether rumination is maintained because it is being reinforced. Because previous literature has found that increasing abstract processing also increases temporal distance and vice versa (Liberman, Sagristano, & Trope, 2002), we speculated that the abstract processing mode adopted in the rumination condition might lead to the assertiveness issue appearing more distal, and, thereby, temporarily reduce anxiety, relative to the concrete condition. However, the findings were not consistent with this, as there was no difference in anxiety between the abstract rumination and concrete thinking conditions. We speculate that the combination of avoiding the actual situation (which may reduce anxiety) and dwelling on the situation (which may increase anxiety) might result in the effects on overall anxiety being balanced out, explaining the observed pattern of findings. We note that the current study examined the effects of abstract rumination, as an exemplar of a broader transdiagnostic process of repetitive negative thought (cf. Ehring & Watkins, 2008; Nolen–Hoeksema & Watkins, 2011; Watkins, 2008). Another form of repetitive negative thought, worry, has been hypothesised to share the same four common processes as rumination; specifically, that it is (i) repetitive; (ii) passive and/or relatively uncontrollable; (iii) characterised by an abstract style of processing; and (iv) focused on negative content (Ehring & Watkins, 2008). Whilst rumination and worry may differ in content (e.g., rumination may focus more in depressive symptoms, past events, and failures, whereas worry may focus more on future uncertainty and anxious feelings) they both reflect a tendency towards unhelpful, abstract, and repetitive focus on negative content, despite these differences in content. Therefore, given the commonality between ruminative and worrisome thinking, we would expect the effects observed in the current study to apply to both rumination and worry. Nonetheless, it would be of theoretical interest to repeat a modified version of this study with the addition of a condition in which participants are manipulated to think in a worrisome manner. Moreover, such a study could also measure some additional outcomes identified in the worry literature (cf. Borkovec, 1994) that would have specific relevance for worrisome thinking (e.g., that worrying may help people to feel more prepared and better able to cope with future negative events). The study had a number of strengths. To the best of our knowledge, it is the first experimental study to examine the consequences of abstract rumination about a threatening situation relative to another form of thinking, uncharacteristic of rumination. Since both conditions involved thinking in detail about the threatening issue, it is possible to conclude that any observed differences between conditions are due to the mode of thinking (i.e., abstract rumination or concrete thinking), whereas in previous studies that have used non–thinking control groups (e.g., distraction), this has not been possible. Second, we examined the avoidance hypothesis with reference to an example of a threatening situation that each participant might want to avoid. This enhanced ecological validity, and


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also allowed us to examine the consequences of rumination in response to a genuinely threatening personal problem, rather than an artificial threatening situation created in the laboratory. The study had a number of limitations. Since the sample was limited to undergraduate students, we cannot be sure that findings would generalise to clinical populations. Whilst we did test for interactions between condition and trait rumination and condition and depression symptoms to check whether the effects of manipulation were moderated by these individual differences, finding no such interaction, this was not a clinical sample. We therefore do not know whether the observed effects would generalise to patients with depression. It is possible, although we believe unlikely, that rumination increases insightfulness in dysphorics but not in nondysphorics. Repeating this design in a clinically depressed sample would resolve this question. A further limitation is the reliance on self–report measures, although we note that certain constructs (e.g., sense of insight, sense of confidence) are inherently subjective and require self–report assessment. Moreover, with respect to the question of what maintains rumination, subjective sense of insight or confidence and control would be potentially sufficient to maintain rumination. Nonetheless, future research would benefit from behavioural and observational assessments, particularly of avoidance. We also note that some of the outcome variables (i.e., assertiveness self–efficacy) focused specifically on the assertiveness issue, whereas other outcome variables (e.g., sense of understanding and insight) had a more general focus. Whilst we do not believe that this is a serious limitation because the phrasing of all self–report items meant that participants were focusing on their feelings immediately after considering the assertiveness situation (i.e., all items began with the words “right now”), the fact that some outcome variables were specific to the assertiveness issue and others were more general introduces a source of unintentional variation. In addition, whilst the design of the study afforded comparison of the effects of abstract rumination relative to concrete thinking, consistent with our primary question, there was not a control no–manipulation condition that would have allowed us to determine the default mode of processing adopted (i.e., what individuals do when left to their own devices, are they abstract or concrete?), and hence whether the observed effects were due to abstract rumination increasing justification for avoidance or concrete thinking reducing justification for avoidance, or both. Lastly, the experimenter was not blind to the hypotheses or condition, which may have influenced the results. However, even though experimenter effects cannot be ruled out, effort was made to minimise possible influences by adhering to a standardised script. Whilst it is important to attempt to replicate these findings in participants with clinical levels of depression and rumination, these findings have some potential clinical implications. First, these findings suggest that metacognitive beliefs that rumination increases sense of insightfulness may be inaccurate, because rumination did not increase understanding and insight relative to concrete thinking. Whilst we did not assess metacognitive beliefs in the current study, we measured outcomes (e.g., insightfulness) that are highly relevant to the beliefs that ruminators often report (e.g., that rumination increases insight). Therefore, these findings suggest that rumination may not have some of the positive properties and functions that some individuals believe it has, relative to concrete thinking. It may be important for such beliefs about the utility of rumination to be tackled therapeutically, with therapists challenging the accuracy of these beliefs, as a means to reduce motivation to engage in rumination. Second, the study demonstrates the advantages of thinking in a concrete, rather than abstract ruminative way, when faced with difficulties, since concrete thinking lead to a greater sense of confidence, control, and assertiveness self–efficacy. Psychoeducation interventions for people at risk for rumination could emphasise the advantages of this way of thinking, rather than informing individuals not to dwell on problems at all, and to instead think about the situation in a more constructive, solution–focused way (see Watkins et al., 2011, 2012). However, as outlined previously, further studies are required to test whether concrete thinking has benefits relative to a control condition prior to making clinical recommendations. In sum, because of rumination’s deleterious outcomes for mood and mental health, it is important to have a clearer understanding of the factors that cause people to ruminate. This study demonstrates that beliefs about the utility of rumination may not be accurate, since it does not have advantageous outcomes relating to insightfulness, and confidence and control, relative to other non–ruminative ways of thinking about a problem. However, the findings suggest that rumination may have an avoidant function as it allows people to generate justifications for not taking action.


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Acknowledgements The authors are grateful for the assistance of Hannah Smith in blind coding the interview transcripts for this study. This paper is written as a tribute to Susan Nolen-Hoeksema and her seminal work that initiated the study of depressive rumination. Susan was an irreplaceable scientist, collaborator, mentor, and teacher. Her loss is felt keenly by the whole clinical psychology community. Despite establishing the key findings for depressive rumination, Susan did not rest on her laurels and was always asking the next critical questions at the forefront of the field. This work arose from such questions and discussions when EW visited Susan on sabbatical and then translated into experimental designs in collaboration with RK within her PhD. RK conceived and designed the experiment, conducted the data collection and analysis, and wrote the manuscript. EW and SN-H made significant contributions to the conception and study design. EW had substantial involvement in the drafting of the manuscript.

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