Rumination and worrying as possible mediators in the relation between neuroticism and symptoms of depression and anxiety in clinically depressed individuals
Introduction
Neuroticism has been considered one of the personality traits most relevant to predisposing individuals to psychopathology, in particular depression and anxiety (e.g., Akiskal et al., 1983, Widiger and Trull, 1992). There is good support for the associations between neuroticism and symptoms of depression and anxiety in clinical and non-clinical samples (e.g., Boyce et al., 1991, Duggan et al., 1990, Kendler et al., 1993, Muris et al., 2005, Ormel et al., 2001, Roberts and Gotlib, 1997, Saklofske et al., 1995, Surtees and Wainwright, 1996). A number of processes have been proposed that may account for the relation between neuroticism and symptoms of depression and anxiety. More specifically, neuroticism can lead to negative biases in attention (e.g., Derryberry & Reed, 1994) and memory (e.g., Martin, 1985), as well as to a cognitive and behavioural style of a ruminative focus on depressive symptoms (e.g., Roberts, Gilboa, & Gotlib, 1998).
There are a number of conceptualizations of rumination in the literature. For example, Martin and Tesser (1989) have defined rumination in terms of conscious thoughts around a theme that might help individuals to attain personal goals. In the context of depression, Nolen-Hoeksema (1991) has defined depressive rumination as responses that involve a pattern of behaviors and thoughts about symptoms of depression and the possible causes and consequences of these symptoms. There is evidence to suggest that depressive rumination (note that we will refer to ‘rumination’ from here) is related to neuroticism (e.g., Cox et al., 2001, Lam et al., 2003, Roberts et al., 1998), with some authors postulating that a ruminative response style might be considered one of the cognitive manifestations of neuroticism (e.g., Segerstrom, Tsao, Alden, & Craske, 2000). There is also good support for an association between rumination and symptoms of depression (see for reviews Lyubomirsky & Tkach, 2004 and Nolen-Hoeksema, 1998). Interestingly, recent research has shown that a ruminative response style might not only be characteristic for depression but is also related to anxiety (e.g., Fresco et al., 2002, Muris et al., 2004, Segerstrom et al., 2000). Thus, rumination seems to be a cognitive vulnerability factor for both depression and anxiety.
There has also been some research aimed at examining the specificity of various forms of negative thinking in psychopathology. More specifically, worry is another form of unproductive, negative, and repetitive thinking that bears strong resemblance to the construct of rumination. Worrying can be defined as an apprehensive expectation of possible negative outcomes in the future, and has traditionally been linked to anxiety (Borkovec, Robinson, Pruzinsky, & DePree, 1983). There is some debate as to whether rumination and worry are to be considered similar or different forms of repetitive thinking. Factor analytic studies have revealed that both constructs are distinctive (e.g., Fresco et al., 2002, Muris et al., 2004). However, it may also be the case that these findings reflect the wording of the materials used such that items with “worry” in their description tend to group together, whereas items with “depression” or “rumination” in their description tend to group together as well. Several other researchers have failed to find as much difference between rumination and worry (e.g., Segerstrom et al., 2000, Watkins et al., 2005), where the only difference found was temporal orientation, with rumination focused on the past and worry focused on the future. Despite this debate, there is evidence to suggest that worrying is related to depression (e.g., Fresco et al., 2002, Muris et al., in press, Muris et al., 2004, Muris et al., 2005, Starcevic, 1995) and to neuroticism (e.g., Davey and Tallis, 1994, Keogh et al., 1998, Muris et al., in press, Muris et al., 2005).
Taken together, the available research suggests a mediational model in which neuroticism is associated with rumination, which in turn is related to symptoms of depression and anxiety. To date, there is indeed some evidence for this mediational model in undergraduates (Muris et al., 2005, Roelofs et al., 2008) and in adolescents at risk for depression (Kuyken et al., 2006, Muris et al., in press). Muris et al. (2005) also found evidence for worry as a mediator in the relation between neuroticism and symptoms of anxiety and depression. However, to the authors' best knowledge, the mediation model has hitherto not been tested in clinically depressed individuals. The present study was aimed to fill this gap by investigating the mediational effects of rumination and worry in the relation between neuroticism and symptoms of depression and anxiety in clinically depressed individuals. We applied a stepwise approach to the mediational analyses, first investigating the effects of rumination and worry in separate analyses, followed by a model in which rumination and worry were entered simultaneously as mediators. We hypothesized that (1) neuroticism would correlate positively with symptoms of depression and anxiety, (2) neuroticism would be positively associated with rumination and worry; (3) rumination and worry would be associated with symptoms of depression and anxiety, and (4) the associations between neuroticism and symptoms of depression and anxiety would be reduced or eliminated when controlling for the mediating variables of rumination and worry.
With respect to predictions of the mediation model, it is important to view rumination and worry as forms of repetitive thinking, which can have constructive and unconstructive consequences (Watkins, 2008). Rumination is characterized by negatively valenced thought content (thoughts about depressive mood), a negative intrapersonal context (i.e., depressed mood, negative self-beliefs), and an abstract level of construal (i.e., thinking about meanings and implications). Worry might have both unconstructive and constructive consequences. More specifically, worry characterized by an abstract level of construal and negative interpersonal context is unconstructive, whereas a concrete level of construal is considered constructive (see Watkins, 2008). In the current study, rumination and worry are operationalized at an abstract level of construal and are, therefore, considered to be positively associated with symptoms of anxiety and depression in the mediation analyses.
As rumination is considered a multi-component process (e.g., Siegle, 2000), we also examined the effects of two components of rumination (i.e., reflection and brooding) that have been proposed (Treynor, Gonzales, & Nolen-Hoeksema, 2003). Although there is some support from previous research that reflection might have beneficial effects on depressed mood (e.g., Joormann et al., 2006, Roelofs et al., 2008, Treynor et al., 2003), other studies have failed to find beneficial effects of reflection. For example, Burwell and Shirk (2007) found evidence to suggest that brooding but not reflective pondering predicted the development of depressive symptoms over time in adolescents and Rude, Maestas, and Neff (2007) have shown that changing the negative judgmental quality of items indicative of reflection resulted in a reduced relationship of reflection and depression, suggesting that reflection may have negative consequences. In accounting for the effects of reflection, Trapnell and Campbell (1999) have identified a neurotically motivated, threat-avoidant form of chronic self-focus that they labeled rumination, and an contrasting form of chronic self-focus motivated by epistemic curiosity which they referred to as reflection. The former would contribute to symptoms of psychopathology, whereas the latter form of self-focus would be associated with increased self-knowledge. The Interacting Cognitive Subsystems Theory (Teasdale and Barnard, 1993, Teasdale et al., 1995) makes a difference between an analytic ruminative self-focus and an experiential form of self-focus, with the former considered to be detrimental and depressogenic and the latter to be more beneficial. Taken together, we consider both brooding and reflection as analytical forms of ruminative self-focus that involve an abstract level of construal resulting in unconstructive consequences. Therefore, we hypothesize both brooding and reflection to be positively associated with symptoms of depression and anxiety in the mediational analyses.
Section snippets
Participants and procedure
Participants comprised a consecutive sample of 198 clinically depressed patients (56% females) who were seeking treatment at the mood disorders treatment program of the Maastricht community mental health center (RIAGG Maastricht). The center is a secondary care setting where individuals with a variety of psychiatric disorders are treated after referral by the general practitioner or other health professionals. The inclusion criterion was a primary diagnosis of major depressive disorder (MDD) as
General findings
Before addressing the main results, four general remarks are in order. First, descriptive statistics of the self-report measures for the total sample as well as for females and males separately are presented in Table 1. All variables were approximately normally distributed (skewness range: −0.86 to 0.59; kurtosis range: −0.52 to 0.39). Independent samples t-tests did not reveal significant gender differences on the self-report measures (see Table 1), except for the anxiety scale of the SCL-90-R
Discussion
The current study sought to investigate the mediational effects of rumination and worry in the relation between neuroticism and symptoms of depression and anxiety. Results can be summarized as follows. In line with our expectation, substantial and significant associations were found between neuroticism, rumination (i.e., total score, brooding, reflection), worry, and symptoms of depression and anxiety. With respect to the mediational analyses, when analyzed separately, rumination and worry
Acknowledgements
We would like to express our gratitude to the members of the mood disorders program of the community mental health center Maastricht (RIAGG Maastricht), The Netherlands.
References (68)
- et al.
Psychometric properties of Eysenck Personality Questionnaire-Revised (EPQ-R) short scale in Greece
Personality and Individual Differences
(2004) - et al.
Preliminary exploration of worry: some characteristics and processes
Behaviour Research and Therapy
(1983) - et al.
Psychological vulnerabilities in patients with major depression vs. panic disorder
Behaviour Research and Therapy
(2001) - et al.
Adaptive and maladaptive components of rumination? Diagnostic specificity and relation to depressive biases
Behavior Therapy
(2006) - et al.
Rumination in adolescents at risk for depression
Journal of Affective Disorders
(2006) Neuroticism as predisposition to depression: a cognitive mechanism
Personality and Individual Differences
(1985)- et al.
Development and validation of the Penn State Worry Questionnaire
Behaviour Research and Therapy
(1990) - et al.
Brooding and reflection: rumination predicts suicidal ideation at 1-year follow-up in a community sample
Behaviour Research and Therapy
(2007) - et al.
Mediating effects of rumination and worry on the links between neuroticism, anxiety and depression
Personality and Individual Differences
(2005) - et al.
Personality and cognitive processes: self-criticism and different types of rumination as predictors of suicidal ideation
Behaviour Research and Therapy
(2008)
Treatment of recurrent major depression with attention training
Cognitive and Behavioral Practice
Effects of neuroticism on depression and anxiety: rumination as a possible mediator
Personality and Individual Differences
On the measurement of rumination: a psychometric evaluation of the ruminative response scale and the rumination on sadness scale in undergraduates
Journal of Behavior Therapy and Experimental Psychiatry
Neuroticism, depression, and depression proneness
Personality and Individual Differences
Pathological worry in major depression: a preliminary report
Behaviour Research and Therapy
How does cognitive therapy prevent depressive relapse and why should attentional control (mindfulness) training help?
Behaviour Research and Therapy
Comparisons between rumination and worry in a non-clinical population
Behaviour Research and Therapy
Rumination-focused cognitive behaviour therapy for residual depression: a case series
Behaviour Research and Therapy
Ending depression one step at a time: The new behavioral activation approach to getting your life back
The relationship of personality to affective disorders
Archives of General Psychiatry
SCL-90. Handleiding bij een multidimensionele psychopathologie indicator
Personality as a vulnerability factor to depression
British Journal of Psychiatry
Subtypes of rumination in adolescence: associations between brooding, reflection, depressive symptoms, and coping
Journal of Clinical Child and Adolescent Psychology
Applied multiple regression/correlation analysis for the behavioral sciences
Reflection, brooding and suicidality: a preliminary study of different types of rumination in individuals with a history of major depression
British Journal of Clinical Psychology
Worrying: Perspectives on theory, assessment, and treatment
Symptom Checklist-90-R [SCL-90-R] administration, scoring, and procedures manual
The SCL-90 and the MMPI: a step in the validation of a new self-report scale
British Journal of Psychiatry
Temperament and attention: orienting toward and away from positive and negative signals
Journal of Personality and Social Psychology
Discriminant and convergent validity of the SCL-90 in psychiatric inpatients
Journal of Personality Assessment
Does personality predict long-term outcome in depression?
British Journal of Psychiatry
Manual of the Eysenck Personality Scales (EPS adult)
Structured clinical interview for DSM-IV axis I disorders – Clinician version, SCID-CV
Distinct and overlapping features of rumination and worry: the relationship of cognitive production to negative affective states
Cognitive Therapy and Research
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