Adaptive and maladaptive rumination in alexithymia and their relation with depressive symptoms
Introduction
A considerable amount of research indicates that some people are more vulnerable to depression than others; such people possess stable ways to react or to process negative emotional events and information. Among others, alexithymia and ruminative thinking style are two dispositions typically associated with depression (Luminet et al., 2001, Nolen-Hoeksema et al., 2008). In the present paper, we investigated the association between alexithymia, rumination and depression, to explore reciprocal inter-relations among their dimensions. The relation between depression and alexithymia on one hand, and between depression and rumination on the other hand, have been already researched for decades. These streams will be summarized in the next two paragraphs, and then hypotheses about the combined contribution that alexithymia and rumination can give to depression will be stated in the third paragraph.
Alexithymia is a personality trait characterised by a deficit in the processing of emotional information (Taylor, Bagby, & Parker, 1997). It is traditionally defined by the following salient features: difficulty identifying feelings (DIF), difficulty describing feelings (DDF) and externally oriented thinking (EOT). In the late 1980s, preliminary studies based on self-report measures provided evidence about an association between alexithymia and depression (Haviland, Mac Murray, & Cummings, 1988). Since then, a large amount of cross-sectional (Grabe et al., 2004, Honkalampi et al., 2000) and longitudinal studies on clinical populations (Honkalampi et al., 2000, Luminet et al., 2007, Luminet et al., 2001) have provided further support for this association. Consequently, alexithymia has gained increasing attention as a possible vulnerability factor for depression. These studies also showed that alexithymia measures are relatively stable over time, compared with measures of depression. This observation suggests that alexithymia represents a stable risk factor, and that depression and alexithymia are different constructs (Honkalampi et al., 2000, Luminet et al., 2001, Luminet et al., 2007). However, mechanisms underlying the association between alexithymia and depression are not clear yet.
Moreover, given the multi-faceted nature of alexithymia, differential effects of its dimensions have been generally highlighted: in some studies, an association with depression was found only for DIF and DDF, but not for EOT (Haviland et al., 1988, Hendryx et al., 1991). In other studies, only an association between DIF and depression or negative affect has been found (cf. Bailey and Henry, 2007, De Berardis et al., 2008, Grabe et al., 2004), whereas the association between DDF and depression turned out to be much more unstable (Bailey & Henry, 2007). Taken together, this body of evidence suggests that the association between alexithymia and depression needs to be further specified, so as to comprehend which could be the process responsible of higher risk for depression in association with some dimensions of alexithymia and not with others. In the present paper, we suggest that different rumination modes are a possible path of investigation.
It is well known that depressed individuals have a typical mind-set, which consists of repetitively thinking about one’s own condition, its causes and consequences, defined as rumination (Nolen-Hoeksema, 1991). Numerous studies have shown that rumination rather maintains depressive symptoms, impairs one’s ability to solve problems and ushers in a host of negative consequences that exacerbate negative mood and cognition (for a review, see Nolen-Hoeksema et al. (2008)).
Originally, the depressive effect of rumination was attributed to the fact that ruminators dwell on negative contents more than other people, and thereby experience negative emotions more frequently (Lyubomirsky & Tkach, 2003). This perspective was put forward by Nolen-Hoeksema and her co-workers: It implied that rumination could only be maladaptive and consistently the phenomenon was labelled as “depressive rumination”. However, recent conceptualizations have proposed a distinction between different modes of rumination, which could be either adaptive or maladaptive.
Watkins (2008), for example, distinguished two modes of rumination: abstract-analytic and concrete-experiential. The abstract-analytic mode is focused on evaluating the higher-level causes, meanings and implications of self-experience. By contrast, the concrete-experiential mode is focused on lower-level, specific, contextual and concrete moment-by-moment details of how does self-experience unfold.
This dichotomy parallels other theories such as the one proposed by Kross and colleagues (Kross, Ayduk, & Mischel, 2005), who distinguished between the “why” and the “what” focus’ cognitive processes, and the one proposed by Trope, Liberman, and Wakslak (2007), who distinguished between “high level of construal” and “low level of construal” cognitive processes. Notwithstanding differences in labels, these distinctions correspond to similar processes: the one consists in generalizing across different events and gives global representations, focused on the general meaning of the situation, whereas the other goes deeply into objective and subjective details of a specific event and gives representations that are more concrete, detailed and imaginative. However, investigation relationship between these two modes and rumination was mainly put forward by Watkins (2008), for which reason his distinction will be the one we will refer to in the following of this paper.
According to his definitions, individuals in an abstract-analytic mode of rumination may experience thoughts such as “what does this mean for my life?”, ‘‘why do I react this way?’’, or ‘‘I just can’t cope with anything’’. On the contrary, in the concrete-experiential mode one may experience thoughts such as: “how did this happen?”, “how could I intervene to fix this problem?”, “what are my feelings here and now?”.
Research shows that the experimental induction of abstract-analytic and concrete-experiential modes of processing results in significant variations in emotional regulation (for a review, see Philippot, Neumann, and Vrielynck (2007)). The abstract-analytic variant increases negative global self-evaluations (Rimes & Watkins, 2005), impairs social problem solving (Watkins & Moulds, 2005), leads to problems in emotional recovery from prior failure and increases emotional vulnerability to subsequent failure (Moberly & Watkins, 2006). Conversely, it has been found that experimental induction of a concrete-experiential mode through specific training reduces emotional reactivity to stressors (Watkins, Moberly, & Moulds, 2008), depressive symptoms and negative self-judgment (Watkins, Baeyens, & Read, 2009). Based on this evidence, the abstract-analytic mode is considered to be maladaptive, whereas the concrete-experiential mode is considered to be adaptive, regardless the positive or negative valence of contents they apply to.
In the present paper, we explore rumination modes associated with alexithymia, suggesting that high alexithymia scorers might be more prone to develop depressive symptoms, as long as they engage more easily in dysfunctional rumination processes. This hypothesis relies on the assumption that alexithymics have less information available to guide their behaviour in an emotional context because of their deficit in the identification and elaboration of their internal emotional state. Therefore, they are supposed to engage in more repetitive and analytic thinking towards external emotional targets as a strategy to obtain the information that is lacking from their emotions.
However, the few studies conducted so far on this topic displayed unclear results. For instance, Luminet et al., 2000, Luminet et al., 2004 investigated emotional responding in alexithymia by examining cognitive, social and physiological responses to emotional events. In these studies, cognitive and social responses consisted of rumination and social sharing of emotions, respectively. It was found that alexithymia did not predict the amount of rumination after the most negative personal emotional event in the last 3 or 6 months (Luminet, Zech, Rimé, Wagner, 2000) or an experimentally induced emotional episode (Luminet, Rimé, Bagby, Taylor, 2004); only a significant negative effect was found of DDF on the amount of social sharing. Such results are surprising if we consider that both alexithymia and rumination contribute to depression. However, we consider these findings as just preliminary since rumination measures only consisted of self-rated frequency of thoughts, degree of intrusion and search for meaning; these measures were not theoretically driven and did not distinguish between adaptive and maladaptive dimensions of rumination.
The present study investigated the relation between alexithymia, rumination and depression, looking at the relationships between sub-dimensions of the first two constructs, before and after controlling for depressive symptoms as captured by self-reported measures. It was assumed that a multidimensional investigation should enable one to disentangle which dimensions of alexithymia are associated with which dimensions of rumination.
Concerning the hypotheses, at a general level we expected to replicate earlier results, which are an association between depressive symptoms and alexithymia on the one hand, and an association between depressive symptoms and rumination modes on the other hand, positive for abstract-analytic and negative for concrete-experiential rumination. Second, alexithymia being a deficit in the identification and elaboration of internal emotional states, it was also expected to be associated with a dysfunctional rumination pattern, that is more abstract-analytic and less concrete-experiential. However, after controlling for depressive symptoms, there were theoretical reasons to expect the sole association between DIF and abstract-analytic rumination to remain significant. Indeed the sole DIF dimension explicitly refers to the inability in taking one’s internal state as a guide for judgment, decision making and action; therefore an abstract-analytic thinking is supposed to be the reflection of an attempt to gain this lacking information throughout conceptualization. Such a result would also be consistent with previous evidence showing that the association between depression and alexithymia is mainly due to the DIF dimension (Bailey and Henry, 2007, De Berardis et al., 2008, Grabe et al., 2004, Haviland et al., 1988, Hendryx et al., 1991). In contrast, no specific association with any rumination dimension was expected for DDF, other than the association due to the common variance of depression, since this dimension has rather to do with a lack of words for emotional states and events. Accordingly, previous evidence already showed that this aspect of alexithymia rather impairs other emotion regulation strategies, more related to verbal aspects (Bailey & Henry, 2007). Finally, EOT was not expected to be associated with any rumination dimension either, because a relation with depression was never found at this level. Nevertheless, EOT was included in the study for the reason that, similarly to DIF, it is also very much related to thinking aspects of alexithymia.
Section snippets
Participants
One hundred and seventy-four undergraduates at the Université catholique de Louvain (43 males and 131 females, Mage = 21.40, SD = 3.44) completed self-report measures of depression, alexithymia and rumination. Participants were recruited via the student panel of the Faculty of Psychology and completed questionnaires on line.
Materials
The Zung self-rating depression scale (Zung, Richards, & Short, 1965), which was back translated following Brislin (1970), was used to assess the presence of depressive
Results
The average level of depression was 40.60 (SD = 9.14). Means and standard deviations of alexithymia, its three dimensions and the two rumination dimensions are shown in Table 1, together with the correlations of these dimensions with depression.
Concerning distributional proprieties, all of the considered variables displayed skewness and kurtosis values between −1 and +1. Therefore, no transformation was applied to data.
Given the elevated number of correlations considered, the critical p value was
Discussion
The results of the present study confirm what has been already observed in the literature, and also suggests new patterns of association deserving further attention. First, our findings replicated the association between alexithymia and depression (Honkalampi et al., 2000, Luminet et al., 2001, Luminet et al., 2007) as they also showed that this association was mainly accounted for by DIF, less so by DDF, but not by EOT (cf. Bailey and Henry, 2007, De Berardis et al., 2008, Grabe et al., 2004,
Acknowledgements
The authors appreciated helpful comments of Betty Chang on earlier drafts of this paper. This research has been facilitated by Grants from the “Action de Recherche Concertée” (ARC) 06/11, and by the “Fonds de la Recherche Scientifique” (FNRS) 1.5.148.10., at the Université catholique de Louvain, Louvain-la-Neuve, Belgium.
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