The Role of Rumination in Depression Associate professor Michelle Moulds The unIVErsity of NSW

What is depression? The role of rumination in depression OVERVIEW What is depression? The role of rumination in depression

What is (clinical) depression? Combination of cognitive, physiological, behavioural symptoms Present for a specified period Clinically significant, cause functional impairment

Major Depressive Episode (MDE) 5 (or more) symptoms present during the same 2-week period; at least one of the symptoms is: 1. Depressed mood most of the day, nearly every day OR 2. Anhedonia:  interest or pleasure in activities 3. Significant weight loss or gain, or decrease or increase in appetite 4. Insomnia or hypersomnia

MDE (cont.) 5. Psychomotor retardation or agitation 6.  Energy 7. Worthlessness/guilt 8.  Concentration, indecisiveness 9. Thoughts of death, suicidal thoughts/plans Symptoms represent a change in previous functioning & are relatively persistent; i.e., they occur for most of the day, nearly every day, during the same 2 week period

Major Depressive Disorder (MDD) Characterised by one or more Major Depressive Episodes (MDE) MDE are ‘building blocks’ for MDD Either: Major Depressive Disorder, Single Episode Major Depressive Disorder, Recurrent (2 or more MDE)

Major Depressive Disorder (MDD) 19% of the population experience a mood disorder at some point in their lives Average age of onset – mid-20s, but recent epidemiological data suggest that age of onset is decreasing Gender ratio 2:1, female:male 1.5-3x more common among first-degree biological relatives than in general population 50-60% of people will have a 2nd episode (NB - some estimates as high as 85%); 2 episodes -->70% chance of a 3rd; 3 episodes --> 90% chance of a 4th

Major Depressive Disorder (MDD) Gender ratio 2:1, female:male Why?

Rumination Nolen-Hoeksema (1991) – ‘Depressive rumination’ - thoughts and behaviours that focus the attention on depressive symptoms and their possible causes, meanings and implications An extensive body of evidence demonstrates that individuals who engage in rumination when they feel sad are (i) more likely to become clinically depressed, and (ii) stay depressed for longer

Rumination Persistent, repetitive, passive thinking about the self, one’s emotional state, events in the past and current stressors Ongoing stream of thoughts that clients can become ‘stuck’ in, struggle to disengage from Tends to be abstract and evaluative: ‘why me?’ ‘why do I feel like this?’ Common themes – past losses, analysing past mistakes, social-evaluative judgements/comparisons Associated with procrastination, poor motivation, low mood, indecisiveness, prolonged emotional reactions

Prospective Evidence Rumination predicts: Likelihood of depressive episode over 18 months (Nolen-Hoeksema et al., 1993) Depression onset (Nolen-Hoeksema et al., 1995; Spasojevic & Alloy, 2002) and duration (Nolen-Hoeksema, 2000) Depressive symptoms in students 7 weeks post-earthquake (Nolen-Hoeksema & Morrow, 1991) Persistent depression in bereaved men (Nolen-Hoeksema et al., 1994) Maintenance of symptoms in clinically depressed participants (Kuehner & Weber, 1999; Nolen-Hoeksema, 2000)

Experimental Evidence Compared to distraction, a rumination manipulation: Exacerbates induced (Morrow & Nolen-Hoeksema, 1990) and naturally occurring (Nolen-Hoeksema & Morrow, 1993) depressed mood Increases global negative attributions, reduces judgements of likelihood of future positive events, reduces problem solving effectiveness (Lyubomirsky & Nolen-Hoeksema, 1995) Increases accessibility of negative autobiographical memories (Lyubomirsky et al., 1998) Maintains overgeneral autobiographical memory in depressed participants (Watkins & Teasdale, 2001)

So Why Study (or Treat) Rumination? Elevated in currently and formerly depressed individuals (Watkins & Moulds, 2007) Predicts subsequent dysphoria and depression in longitudinal studies (Spasojevic & Alloy, 2002) Thus important to address - implicated as both a risk factor and a maintaining factor in depression

The Role of Mode of Processing Cumulative evidence supports the role of rumination in the etiology and maintenance of depression BUT – why is recurrent thinking about the self, feelings, events sometimes adaptive, at other times dysfunctional? Processing style account of rumination – type/style of thinking adopted during rumination that determines whether it has adaptive or maladaptive consequences

The Role of Mode of Processing 2 components of rumination proposed: 1. Focus on self and symptoms 2. Abstract/analytical thinking about causes, meanings, consequences Distinction between abstract/analytical (why?) vs. experiential/concrete (how) thinking styles (Teasdale, 1999; Watkins, 2008)

Problem Solving Aim: To compare the relative effects of abstract and concrete modes on social problem solving 40 depressed, 40 never depressed participants Randomly allocated to: Abstract/analytical condition (causes, meanings and consequences – Think about physical sensations, the way you feel right now) Concrete/experiential condition (Focus your attention on your experience of physical sensations, the way you feel right now) Completed MEPS pre- and post-induction Watkins & Moulds, 2005, Emotion

Problem Solving Group x Condition X Time F (1,75) = 8.37, p < .005

Adopting an abstract/analytical mode of processing impeded problem solving Also experimental evidence that abstract processing results in a greater negative emotional response to a stressor (Watkins, Moberly, & Moulds, 2008) and increases the distress elicited by intrusive autobiographical memories (Williams & Moulds, 2010)

Summary Rumination predicts the onset of depression, and plays a role in its persistence Adopting an abstract mode of processing during rumination leads to poor outcomes Important for psychologists to assess the presence, extent and content of rumination in their clinical assessment of depressed individuals Psychological treatment and relapse prevention should teach adaptive ways of responding to problems other than engaging in rumination