Elsevier

Comprehensive Psychiatry

Volume 55, Issue 7, October 2014, Pages 1556-1560
Comprehensive Psychiatry

The mediator role of ruminative thinking style in the relationship between dysfunctional attitudes and depression

https://doi.org/10.1016/j.comppsych.2014.05.017Get rights and content

Abstract

Background

The main aim of the present study was to examine whether ruminative thinking styles (brooding and reflection) mediate the effects of dysfunctional attitudes on depressive symptoms.

Methods

120 psychotropic drug-naive first episode depression patients recruited from Bulent Ecevit University School of Medicine psychiatry department and Zonguldak State Hospital psychiatry department outpatient clinics were involved in the study. Participants completed the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Beck Depression Inventory (BDI), Dysfunctional Attitude Scale (DAS) and Ruminative Responses Scale (RRS-short version). Regression analyses together with the Sobel tests were performed for testing the mediator hypothesis.

Results

According to the path model, the level of brooding fully mediated the relationship between dysfunctional attitudes and depressive symptomatology but reflection did not play a mediator role in the relationship between dysfunctional attitudes and depressive symptoms.

Conclusions

Assessment of brooding with both mental status examination and specific measurements and focusing on brooding as an intervention strategy would be beneficial components for an effective treatment of depression.

Introduction

According to traditional cognitive theory of depression, individual’s cognitions and beliefs, which are based on attitudes or assumptions (schemas), have an important role in the development of depression [1]. In particular, dysfunctional attitudes influenced by early life experiences are latent in the periods of euthymia. However, these schemas can be activated by specific stressful circumstances that correspond to the initial experiences responsible for embedding these negative attitudes, which ultimately serve to precipitate depression [2]. In other words, interactions between negative life events and dysfunctional attitudes trigger individual’s negative thoughts about the self, world and future [3], which is known as cognitive reactivity phenomenon [1]. A number of researchers have reported that dysfunctional attitudes increase the risk for depression [4], [5], [6], [7].

Not only dysfunctional attitudes but also ruminative response styles have been accepted as important vulnerability factors to depression [8], [9]. Response styles theory considers the processing of thought, rather than the content of the thought. According to this theory, rumination is the repetitive and passive thinking of the possible causes and consequences of depression symptoms [10]. In prospective studies, it has been found that ruminative response style plays an important role in the development and maintenance of depression [11], [12], [13], [14].

Treynor et al. (2003) have reported two components of ruminative response style in terms of depression. Brooding is a passive comparison of unmet expectations with the current situation and related to thinking anxiously and gloomily about things. On the other hand, reflective pondering is a purposeful turning inward to engage in mental efforts to solve depressive symptoms cognitively [13]. Indicating the need for examining these two response styles separately, both factors evidenced different relationships patterns with depression. To illustrate, while brooding revealed long term associations with depression, reflection was associated less with depression over time, and with improvement in negative moods [15], [16]. It has been suggested that reflection is eventually adaptive in reducing negative affect, perhaps because it prompts the use of adaptive cognitive strategies [13], [17], [18]. These findings suggest in general that while brooding represents the maladaptive form rumination, reflection symbolizes an adaptive form of rumination.

In recent years, the relationship between negative cognitive content and rumination has been examined using prospective designs. In the general sense, rumination, negative cognitive styles, and depression were found to be closely related. In particular, rumination was reported to be more related with depression for participants who have higher levels of negative cognitive content [19], [20]. Vanderhasselt and Raedt (2012) studied how rumination activates dysfunctional attitudes in the times of stress. They investigated a group of students prospectively and found that rumination was an underlying mechanism leading to depressed mood and dysfunctional attitudes under stress [9]. Lo et al. (2008) focused on the relationship patterns among negative cognitive styles, ruminative response styles, and depression both in a college sample and depressive patients who have past depression history. Their findings demonstrated that it was brooding but not reflection that mediates the relationship between negative attributional styles and depression [21].

However, much uncertainty still exists about the underlying mechanism of dysfunctional attitudes in conjunction with separate rumination styles in psychotropic drug-naive patients with first episode depression. Thus, the present study seeks to examine whether the both ruminative thinking styles, namely brooding and reflection, would mediate the effects of dysfunctional attitudes on depressive symptoms. By focusing on such an analysis unit, we attempted to eliminate the effect of previous depressive episodes that may cause cognitive reactivity. We also aimed to avoid from the effect of psychotropic drugs on cognitions in patients with depression.

Section snippets

Participants

The sample of the present study consisted of 120 depression patients comprising 83 (69.2%) women and 37 (30.8%) men. The age of the sample ranged from 18 to 63 years, with a mean of 31.57 (SD = 11.52).

The study was conducted at Bulent Ecevit University School of Medicine psychiatry department and Zonguldak State Hospital psychiatry department between August 2013 and March 2014. Participants were informed about the study and their consent was taken. Scales were administered in a single session,

Correlational analyses and descriptive statistics

Prior to conducting mediation analyses, Pearson intercorrelations, means and standard deviations of the variables used in the study as predictor (independent), mediator and criterion (dependent) variables were computed (Table 1). As can be seen, all correlations among the variables were significant and positive.

In addition, we performed a one way variance analysis (ANOVA) to test whether there were any differences between women and men on study variables. Results indicated no significant

Discussion

This study set out to determine the mediator role of ruminative thinking style in the relationship between dysfunctional attitudes and depression. Since previous depressive episodes are strong predictors of increased cognitive reactivity [28], the present study was specifically designed to minimize the effect of cognitive reactivity by using a sample of psychotropic drug-naive patients with first episode depression. Moreover, considering the need for differentiate the ruminative thinking

References (33)

  • L.J. Olinger et al.

    Dysfunctional attitudes and stressful life events: an interactive model of depression

    Cogn Ther Res

    (1987)
  • S. Kwon et al.

    Differential causal roles of dysfunctional attitudes and automatic thoughts in depression

    Cogn Ther Res

    (1992)
  • L.B. Alloy et al.

    Prospective incidence of first onsets and recurrences of depression in individuals at high and low cognitive risk for depression

    J Abnorm Psychol

    (2006)
  • Z.V. Segal et al.

    Differential cognitive response to a mood challenge following successful cognitive therapy or pharmacotherapy for unipolar depression

    J Abnorm Psychol

    (1999)
  • S. Nolen-Hoeksema

    Responses to depression and their effects on the duration of depressed mood

    J Abnorm Psychol

    (1991)
  • S. Nolen-Hoeksema et al.

    Rethinking rumination

    Perspect Psychol Sci

    (2008)
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    Author Disclosure Statement: No competing financial interests exist.

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