Hostname: page-component-8448b6f56d-c4f8m Total loading time: 0 Render date: 2024-04-17T06:37:19.357Z Has data issue: false hasContentIssue false
  • English
  • Français

Rumination in PTSD as well as in Traumatized and Non-Traumatized Depressed Patients: A Cross-Sectional Clinical Study

Published online by Cambridge University Press:  04 April 2011

Eva Birrer  and
Tanja Michael
Eva Birrer*
Affiliation:
Klinik fuer Schlafmedizin, Luzern, Switzerland
Tanja Michael
Affiliation:
Klinik fuer Schlafmedizin, Luzern, Switzerland
*
Reprint requests to Eva Birrer, Klinik fuer Schlafmedizin, St. Anna-Str. 32, 6006 Luzern, Switzerland. E-mail: birrer@ksm.ch
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Although rumination is a key process in the onset and maintenance of depressive symptoms and a powerful predictor of persistent posttraumatic stress disorder (PTSD), little is known about the differences and similarities of rumination in these conditions. Previous research has not always differentiated between rumination and intrusive images. Aims: We sought to systematically evaluate rumination and to gather more information about the content and associated emotions in three patient groups (PTSD, and depressed with and without trauma; n = 65). Furthermore, we examined the interaction between rumination and another predominant intrusive cognition, intrusive image. Method: A multi-method assessment for rumination, including a rumination questionnaire and a rumination log (kept for one week), was employed. Results: Rumination was found to be complex and composed of subcomponents that are similar across the diagnostic groups. Rumination rarely stopped intrusive images and it made the participants feel worse. There were, however, also important differences: in PTSD, rumination always or often triggered intrusive images and the traumatized individuals (PTSD and depressed with trauma) ruminated more than non-traumatized depressed patients. Conclusions: The results corroborate the assumption of rumination being a transdiagnostic process, with similarities but also with important differences across diagnostic groups. Moreover, the findings support recent research on the intricate relationship between different types of intrusive cognitions.

Keywords

Posttraumatic Stress Disorderdepression with and without traumaintrusive imagesruminationtriggers
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 39 , Issue 4 , July 2011 , pp. 381 - 397
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abramson, Y., Metalsky, G. I. and Alloy, L. B. (1989). Hopelessness depression: a theory-based subtype of depression. Psychological Review, 96, 358–372.CrossRefGoogle Scholar
Alloy, L. B., Abramson, L. Y., Hogan, M. E., Whitehouse, W. G., Rose, D. T., Robinson, M. S., et al. (2000). The Temple-Wisconsin cognitive vulnerability to depression (CVD) project: lifetime history of Axis I psychopathology in individuals at high and low cognitive vulnerability to depression. Journal of Abnormal Psychology, 109, 403–418.CrossRefGoogle Scholar
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: Author.Google Scholar
Backhaus, K., Erichson, B., Wulff, P. and Weiber, R. (2000). Multivariate Analysemethoden: eine anwendungsorientierte Einführung. Berlin: Springer.CrossRefGoogle Scholar
Beck, A. T., Steer, , Garbin, R. A., , M. G. (1988). Psychometric properties of the Beck depression inventory: twenty-five years of evaluation. Clinical Psychology Review, 8, 77–100.CrossRefGoogle Scholar
Beck, A. T., Ward, C. H., Mendelson, M., Mock, J. and Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.CrossRefGoogle ScholarPubMed
Behar, E., Zuellig, A. and Borkovec, T. D. (2005). Thought and imaginal activity during worry and trauma recall. Behavior Therapy, 36, 157–168.CrossRefGoogle Scholar
Birrer, E., Michael, T. and Munsch, S. (2007). Intrusive images in PTSD and in traumatised and non-traumatised depressed patients: a cross-sectional clinical study. Behaviour Research and Therapy, 45, 2053–2065.CrossRefGoogle ScholarPubMed
Borkovec, T. D., Ray, W. J. and Stober, J. (1998). Worry: a cognitive phenomenon intimately linked to affective, physiological, and interpersonal behavioral processes. Cognitive Therapy and Research, 22, 561–576.CrossRefGoogle Scholar
Brewin, C. R. (1998). Intrusive autobiographical memories in depression and post-traumatic stress disorder. Applied Cognitive Psychology, 12, 359–370.3.0.CO;2-5>CrossRefGoogle Scholar
Brewin, C. R., Dalgleish, T. and Joseph, S. (1996). A dual representation theory of posttraumatic stress disorder and its treatment. Behaviour Research and Therapy, 39, 373–393.CrossRefGoogle Scholar
Brewin, C. R., Gregory, J. D., Lipton, M. and Burgess, N. (2010). Intrusive images in psychological disorders: characteristics, neural mechanisms, and treatment implications. Psychological Review, 117, 210–232.CrossRefGoogle ScholarPubMed
Brewin, C. R., Hunter, E., Carroll, F. and Tata, P. (1996). Intrusive memories in depression. Psychological Medicine, 26, 1271–1276.CrossRefGoogle ScholarPubMed
Bywaters, M., Andrade, J. and Turpin, G. (2004a). Determinants of the vividness of visual imagery: the effects of delayed recall, stimulus affect and individual differences. Memory, 12, 479–488.CrossRefGoogle ScholarPubMed
Bywaters, M., Andrade, J. and Turpin, G. (2004b). Intrusive and non-intrusive memories in a non-clinical sample: the effects of mood and affect on imagery vividness. Memory, 12, 467–478.CrossRefGoogle Scholar
Carlier, I. V., Voerman, B. E. and Gersons, B. P. (2000). Intrusive traumatic recollections and comorbid posttraumatic stress disorder in depressed patients. Psychosomatic Medicine, 62, 26–32.CrossRefGoogle ScholarPubMed
Carver, C. S. and Scheier, M. F. (1981). Attention and Self-Regulation: a control-theory approach to human behavior. New York: Springer.CrossRefGoogle Scholar
Clark, D. A. (Ed.) (2005). Intrusive Thoughts in Clinical Disorders: theory, research, treatment. New York: The Guilford Press.Google Scholar
Clark, D. A. and Rhyno, S. (2005). Unwanted intrusive thoughts in nonclinical individuals: implications for clinical disorders. In Clark, D. A. (Ed.), Intrusive Thoughts in Clinical Disorders: theory, research, treatment (pp. 1–29). New York: The Guilford Press.Google Scholar
Clohessy, S. and Ehlers, A. (1999). PTSD symptoms, response to intrusive memories and coping in ambulance service workers. British Journal of Clinical Psychology, 38, 251–265.CrossRefGoogle ScholarPubMed
Davey, G. C. L. (1994). Pathological worrying as exacerbated problem-solving. In Davey, G. and Tallis, F. (Eds.), Worrying: perspectives on theory, assessment and treatment (pp. 35–59). Chichester, UK: John Wiley and Sons Ltd.Google Scholar
David, D., Mellman, T. A., Mendoza, L. M., Kulick-Bell, R., Ironson, G. and Schneiderman, N. (1996). Psychiatric morbidity following Hurricane Andrew. Journal of Traumatic Stress, 9, 607–612.CrossRefGoogle ScholarPubMed
Donaldson, C. and Lam, D. (2004). Rumination, mood and social problem-solving in major depression. Psychological Medicine, 34, 1309–1318.CrossRefGoogle ScholarPubMed
Ehlers, A. and Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38, 319–345.CrossRefGoogle ScholarPubMed
Ehlers, A., Hackmann, A. and Michael, T. (2004). Intrusive re-experiencing in post-traumatic stress disorder: phenomenology, theory, and therapy. Memory, 12, 403–415.CrossRefGoogle ScholarPubMed
Ehlers, A., Mayou, R. A. and Bryant, B. (1998). Psychological predictors of chronic posttraumatic stress disorder after motor vehicle accidents. Journal of Abnormal Psychology, 107, 508–519.CrossRefGoogle ScholarPubMed
Foa, E. B. (1995). The Posttraumatic Diagnostic Scale (PDS) manual. Minneapolis, MN: National Computer Systems.Google Scholar
Foa, E. B., Cashman, L., Jaycox, L. and Perry, K. (1997). The validation of a self-report measure of posttraumatic stress disorder: the posttraumatic diagnostic scale. Psychological Assessment, 9, 445–451.CrossRefGoogle Scholar
Foa, E. B. and Kozak, M. J. (1986). Emotional processing and fear: exposure to corrective information. Psychological Bulletin, 99, 20–35.CrossRefGoogle ScholarPubMed
Foa, E. B., Steketee, G. and Rothbaum, B. O. (1989). Behavioural/cognitive conceptualisation of post-traumatic stress disorder. Behaviour Therapy, 20, 155–176.CrossRefGoogle Scholar
Fresco, D. M., Frankel, A. N., Mennin, D. S., Turk, C. L and Heimberg, R. G. (2002). Distinct and overlapping features of rumination and worry: the relationship of cognitive production to negative affect states. Cognitive Therapy and Research, 26, 179–188.CrossRefGoogle Scholar
Harvey, A. G. (2001a). I can't sleep, my mind is racing! An investigation of strategies of thought control in insomnia. Behavioural and Cognitive Psychotherapy, 29, 3–12.CrossRefGoogle Scholar
Harvey, A. G. (2001b). Insomnia: symptom or diagnosis? Clinical Psychology Review, 21, 1037–1059.CrossRefGoogle ScholarPubMed
Harvey, A. G., Watkins, E., Mansell, W. and Shafran, R. (2004). Cognitive Behavioural Processes Across Psychological Disorders: a transdiagnostic approach to research and treatment. Oxford: Oxford University Press.CrossRefGoogle Scholar
Hayes, S. C., Luoma, J. B., Bond, F. W., Masuda, A. and Lillis, J. (2006). Acceptance and commitment therapy: model, processes and outcomes. Behaviour Research and Therapy, 44, 1–25.CrossRefGoogle ScholarPubMed
Hayes, S. C., Strosahl, K. and Wilson, K. G. (1999). Acceptance and Commitment Therapy: an experiential approach to behaviour change. New York: Guilford.Google Scholar
Holmes, E. A. and Hackmann, A. (Eds.) (2004). Special issue on mental imagery and memory in psychopathology. Memory, 12.Google Scholar
Hong, R. Y. (2007). Worry and rumination: differential associations with anxious and depressive symptoms and coping behaviour. Behaviour Research and Therapy, 45, 277–290.CrossRefGoogle Scholar
Kolk, B. A., Van, Der and Fisler, R. (1995). Dissociation and the fragmentary nature of traumatic memories: overview and exploratory study. Journal of Traumatic Stress, 8, 505–525.CrossRefGoogle ScholarPubMed
Krakow, B., Johnston, L., Melendrez, D., Hollifield, M., Warner, T. D., Chavez-Kennedy, D. et al. . (2001). An open-label trial of evidence-based cognitive behavior therapy for nightmares and insomnia in crime victims with PTSD. American Journal of Psychiatry, 158, 2043–2047.CrossRefGoogle ScholarPubMed
Kuehner, C. and Weber, I. (1999). Responses to depression in unipolar depressed patients: an investigation of Nolen-Hoeksema's response styles. Theory Psychological Medicine, 29, 1323–1333.CrossRefGoogle ScholarPubMed
Kuyken, W. and Brewin, C. R. (1994). Intrusive memories of childhood abuse during depressive episodes. Behaviour Research and Therapy, 32, 525–528.CrossRefGoogle ScholarPubMed
Lavender, A. and Watkins, E. (2004). Rumination and future thinking in depression. British Journal of Clinical Psychology, 43, 129–142.CrossRefGoogle ScholarPubMed
Lehmann, E. L. (1998). Nonparametrics: statistical methods based on ranks. Englewood Cliffs, NJ: Prentice Hall.Google Scholar
Maercker, A., Michael, T., Fehm, L., Becker, E. S. and Margraf, J. (2004). Age of traumatisation as a predictor of post-traumatic stress disorder or major depression in young women. British Journal of Psychiatry, 184, 482–487.CrossRefGoogle ScholarPubMed
Maes, M., Mylle, J., Delmeire, L. and Altamura, C. (2000). Psychiatric morbidity and comorbidity following accidental man-made traumatic events: incidence and risk factors. European Archives of Psychiatry and Clinical Neuroscience, 250, 156–162.CrossRefGoogle ScholarPubMed
Mansell, W. and Lam, D. (2004). A preliminary study of autobiographical memory in remitted bipolar and unipolar depression. Memory, 12, 437–446.CrossRefGoogle ScholarPubMed
McLaughlin, K. A., Borkovec, T. D. and Sibrava, N. (2007). The effects of worry and rumination on affect states and cognitive activity. Behavior Therapy, 38, 23–38.CrossRefGoogle ScholarPubMed
Michael, T. and Ehlers, A. (2007). Enhanced priming for trauma-related stimuli and posttraumatic stress disorder symptoms: two experimental investigations. Behaviour Research and Therapy, 45, 341–358. 77CrossRefGoogle Scholar
Michael, T., Ehlers, A. and Halligan, S. L. (2005a). Enhanced priming for trauma-related material in posttraumatic stress disorder. Emotion, 5, 103–112CrossRefGoogle ScholarPubMed
Michael, T., Ehlers, A., Halligan, S. L. and Clark, D. M. (2005b). Unwanted memories of assault: what intrusion characteristics are associated with PTSD? Behaviour Research and Therapy, 43, 613–628.CrossRefGoogle ScholarPubMed
Michael, T., Halligan, S. L., Clark, D. M. and Ehlers, A. (2007). Rumination in posttraumatic stress disorder. Depression and Anxiety, 24, 307–317.CrossRefGoogle ScholarPubMed
Morin, C. M. and Espie, C. A. (2004). Insomnia: psychological assessment and management. New York: Guilford Press.Google Scholar
Muris, P., Roelofs, J., Meesters, C. and Boomsma, P. (2004). Rumination and worry in nonclinical adolescents. Cognitive Therapy and Research, 28, 539–554.CrossRefGoogle Scholar
Murray, J., Ehlers, A. and Mayou, R. A. (2002). Dissociation and post-traumatic stress disorder: two prospective studies of road traffic accident survivors. British Journal of Psychiatry, 180, 363–368.CrossRefGoogle ScholarPubMed
Nolen-Hoeksema, S. (1991). Responses to depression and their effects on the duration of depressive episodes. Journal of Abnormal Psychology, 100, 569–582.CrossRefGoogle ScholarPubMed
Nolen-Hoeksema, S. (2000). The role of rumination in depressive disorders and mixed anxiety/depressive symptoms. Journal of Abnormal Psychology, 109, 504–511.CrossRefGoogle ScholarPubMed
Nolen-Hoeksema, S., Parker, L. E. and Larson, J. (1994). Ruminative coping with depressed mood following loss. Journal of Personality and Social Psychology, 67, 92–104.CrossRefGoogle ScholarPubMed
Papageorgiou, C. and Wells, A. (2001). Metacognitive beliefs about rumination in recurrent major depression. Cognitive and Behavioral Practice, 8, 160–164.CrossRefGoogle Scholar
Papageorgiou, C. and Wells, A. (2003). An empirical test of a clinical meta-cognitive model of rumination and depression. Cognitive Therapy and Research, 27, 261–273.CrossRefGoogle Scholar
Papageorgiou, C. and Wells, A. (2004). Nature, functions, and beliefs about depressive rumination. In Papageorgiou, C. and Wells, A. (Eds.), Depressive Rumination: nature, theory and treatment (pp. 3–20). Chichester: Wiley.Google Scholar
Reynolds, M. and Brewin, C. R. (1999). Intrusive memories in depression and posttraumatic stress disorder. Behaviour Research and Therapy, 37, 201–215.CrossRefGoogle ScholarPubMed
Robinson, S. M. and Alloy, L. B. (2003). Negative cognitive styles and stress-reactive rumination interact to predict depression: a prospective study. Cognitive Therapy and Research, 27, 275–291.CrossRefGoogle Scholar
Roemer, L. and Borkovec, T. D. (1993). Worry: unwanted cognitive activity that controls unwanted somatic experience. In Wegner, D. M. and Pennebaker, J. W. (Eds.), Handbook of Mental Control. Englewood Cliffs, NJ: Prentice Hall.Google Scholar
Schwarzer, R. and Schulz, U. (2002). The role of stressful life events. In Nezu, A. M., Nezu, C. M. and Geller, P. A. (Eds.), Comprehensive Handbook of Psychology, Vol. 9: health psychology (pp. 27–49). New York: Wiley.Google Scholar
Segal, Z. V., Williams, J. M. G. and Teasdale, J. D. (2002). Mindfulness-Based Cognitive Therapy Depression. New York: Guilford.Google Scholar
Segerstrom, S. C., Tsao, J. C., Alden, L. E. and Craske, M. G. (2000). Worry and rumination: repetitive thought as a concomitant and predictor of negative mood. Cognitive Therapy and Research, 24, 671–688.CrossRefGoogle Scholar
Siegle, G. J., Steinhauer, S., Carter, C. S. and Thase, M. E. (2000). Convergence and Divergence in Measures of Rumination. Paper presented at the 34th annual convention of the Association for Advancement of Behaviour Therapy, New Orleans. Retrieved on 21 January 2007 from http://kraepelin.wpic.pitt.edu/~siegle/gregweb/aabt00/Google Scholar
Singer, A. R. and Dobson, K. S. (2007). An experimental investigation of the cognitive vulnerability to depression. Behaviour Research and Therapy, 45, 563–575.CrossRefGoogle ScholarPubMed
Steil, R. and Ehlers, A. (2000). Dysfunctional meaning of posttraumatic intrusions in chronic PTSD. Behaviour Research and Therapy, 38, 537–558.CrossRefGoogle ScholarPubMed
Teasdale, D. T. (1999). Emotional processing, three modes of mind and the prevention of relapse in depression. Behaviour Research and Therapy, 37, 53–77.CrossRefGoogle ScholarPubMed
Trapnell, P. D. and Campbell, J. D. (1999). Private self-consciousness and the five-factor model of personality: distinguishing rumination from reflection. Journal of Personality and Social Psychology, 76, 284–304.CrossRefGoogle ScholarPubMed
Treynor, W., Gonzalez, R. and Nolen-Hoeksema, S. (2003). Rumination reconsidered: a psychometric analysis. Cognitive Therapy and Research, 27, 247–259.CrossRefGoogle Scholar
Watkins, E. (2004). Appraisals and strategies associated with rumination and worry. Personality and Individual Differences, 37, 679–694.CrossRefGoogle Scholar
Watkins, E. and Moulds, , , M. (2005). Distinct modes of ruminative self-focus: impact of abstract versus concrete rumination on problem solving in depression. Emotion, 5, 319–328.CrossRefGoogle ScholarPubMed
Watkins, E. and Teasdale, , , J. D. (2001). Rumination and overgeneral memory in depression: effects of self-focus and analytical thinking. Journal of Abnormal Psychology, 110, 353–357.CrossRefGoogle Scholar
Watkins, E., Teasdale, , Williams, J. D., , R. M. (2000). Decentring and distraction reduce overgeneral autobiographical memory in depression. Psychological Medicine, 30, 911–920.CrossRefGoogle ScholarPubMed
Wells, A. (2000). Emotional Disorders and Metacognition: innovative cognitive therapy. Chichester, UK: Wiley.Google Scholar
Wells, A. and Papageorgiou, C. (2004). Metacognitive therapy for depressive rumination. In Papageorgiou, C. and Wells, A. (Eds.), Depressive Rumination: nature, theory and treatment (pp. 259–273). Chichester, UK: Wiley.Google Scholar
Wells, A. and Sembi, S. (2004). Metacognitive therapy for PTSD: a core treatment manual. Cognitive and Behavioural Practice, 11, 365–377.CrossRefGoogle Scholar
Zetsche, U., Ehring, T. and Ehlers, A. (2009). The effects of rumination on mood and intrusive memories after exposures to traumatic material: an experimental study. Journal of Behavior Therapy and Experimental Psychiatry, 40, 499–514.CrossRefGoogle ScholarPubMed
Zimmerman, M. and Coryell, W. (1987a). The inventory to diagnose depression: lifetime version. Acta Psychiatrica Scandinavica, 75, 495–499.CrossRefGoogle ScholarPubMed
Zimmerman, M. and Coryell, W. (1987b). The inventory to diagnose depression (IDD): a self-report scale to diagnose major depressive disorder. Journal of Consulting and Clinical Psychology, 55, 55–59.CrossRefGoogle Scholar
Zimmerman, M. and Coryell, W. (1988). The validity of a self report questionnaire for diagnosing major depressive disorder. Archives of General Psychiatry, 45, 738–740.CrossRefGoogle ScholarPubMed
Zimmermann, M., Coryell, W., Corenthal, C. and Wilson, S. (1986). A self-report scale to diagnose major depressive disorder. Archives of General Psychiatry, 43, 1076–1081.CrossRefGoogle Scholar
Zimmerman, M., Sheeran, T. and Young, D. (2004). The diagnostic inventory for depression: a self-report scale to diagnose DSM-IV major depressive disorder. Journal of Clinical Psychology, 60, 87–110.CrossRefGoogle ScholarPubMed
Submit a response

Comments

No Comments have been published for this article.