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

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

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

4. 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

5. 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

6. 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)

7. 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

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

9. 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

10. 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

11. 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)

12. 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)

13. 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

14. 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

15. 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)

16. 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

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

18. 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)

19. 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