How ruminative thinking styles lead to dysfunctional cognitions: evidence from a mediation model

Background and Objectives

Dysfunctional attitudes and a ruminative thinking style are of utmost clinical importance because they are found to be crucially implicated in depression vulnerability. In this study, based on the Diathesis-Stress model (Beck, 1967) and the Differential Activation Hypothesis (Teasdale, 1988), we investigated whether inter-individual differences in a ruminative thinking style would be related to the development of depressive symptoms, leading to the activation of dysfunctional attitudes under stress.

Methods

Seventy-six never depressed undergraduate students completed internet questionnaires measuring rumination, depressive symptoms and dysfunctional attitudes at 4 fixed moments in time (T1, T2, T3, T4): T1 was performed six weeks before their exams (considered as a low stress period); T2, T3 and T4 were performed during three consecutive weeks in their final exams (considered as life stress event).

Results

As expected, results revealed that the relationship between rumination, measured both out of (T1) and in (T2) a stressful period, and dysfunctional attitudes (measured at T4) was mediated by increased depressive symptoms (measured at T3).

Limitations

Because the questionnaire for rumination was developed in the context of understanding responses to depressive symptoms, there might be a construct overlap between the predictor and the mediator of the models that were tested. Moreover, because only healthy undergraduates were included, our results demonstrate a decreased generalizability.

Conclusions

These findings indicate that rumination can be conceived as a stable and underlying mechanism leading to depressed mood and dysfunctional attitudes under stress. Moreover, our findings highlight that clinical interventions should not only target dysfunctional schemas and attitudes, but might also benefit from the use of procedures aimed at changing processes such as a ruminative thinking style.     

Dysfunctional cognitions of depressive inpatients and their relationship with treatment outcome

BackgroundDysfunctional cognitions can contribute to depression and its maintenance. They may be related to a higher relapse rate and a longer duration of the depressive episode. The relevance of dysfunctional cognitions for acute inpatient treatment of unipolar depression is examined in this study and its variability by cognitive behavioural therapy (CBT).Methods222 patients suffering from Major Depressive Disorder (MDD) were evaluated during their inpatient treatment by assessing admission and discharge depression scores and their relationship to dysfunctional cognitions, using the Dysfunctional Attitude Scale (DAS). The relationship between dysfunctional cognitions and treatment outcome was examined. Primary outcome measures were the Hamilton-Rating-Scale (HRSD) and the Beck Depression Inventory (BDI).ResultsHigher age, depression severity at admission, comorbid personality disorders and recurrent depressive disorders are related with higher DAS-scores at admission. DAS-Scores declined during treatment but to a lower extend than depressive symptom scales (effect size d_{DAS-G t1-t2} = .31; d_{HRSD t1-t2} = 2.88; d_{BDI t1-t2} = 1.38). Higher DAS-scores at admission correlated negatively with the improvement of depressive symptoms during treatment (HRSD: r = −.62; p < .01; BDI: r = −.54; p < .01) and remission rates (HRSD: r = −.65; p < .01; BDI: r = −.48; p < .01). CBT did not additionally reduce DAS-scores compared to pharmacotherapy only.ConclusionDysfunctional cognitions are relatively stable compared to other depressive symptoms and are associated with poorer treatment outcome even in combined treatment of antidepressant medication and CBT during inpatient treatment. Changes of dysfunctional cognitions seem to be a long-term treatment goal, especially because of their association with comorbid personality disorders and recurrent depressive disorders.     

Traumatic stress symptoms after the November 13th 2015 Terrorist Attacks among Young Adults: The relation to media and emotion regulation

ObjectiveA major terror attack occurred in the Paris region on 13th November 2015. This event was widely showed, described, and commented in the media. Media consumption may lead to a widespread diffusion of trauma-related symptoms following a collective trauma. These effects may depend on the type of media and emotion regulation strategies used by the media consumer.MethodTrauma history, traumatic symptoms, media consumption, psychological distress, and emotion regulation strategies of 451 young adults were assessed by an online survey.ResultsFindings reveal the joint role of social networks use and dysfunctional emotion regulation strategies on anxiety, depression, and somatization symptoms and also on cognitive and emotional alteration among traumatic symptoms.DiscussionConsistent with the emotional contagion hypothesis, individuals who reported spending more time on social networks were also those who were experiencing more psychological distress.     

Emotion coping strategies and dysfunctional sleep-related beliefs are associated with objective sleep problems in young adults with insomnia

BackgroundThough insomnia is associated with affected emotion regulation and dysfunctional ideas about sleep, little is known about the relation of these problems with objective sleep disruption. We aimed to explore this relationship in young adults with and without insomnia.MethodsTwenty young adults with diagnosed insomnia disorder (aged 27.7 ± 8.6 years) and twenty age-matched individuals without insomnia (26.7 ± 7.0 years) completed questionnaires, measuring sleep-related thoughts and emotions and emotion regulation. Objective sleep measurements were collected through 10-days actigraphy as a representative sample of nights, and analyzed for sleep onset latency, sleep efficiency total sleep time. T-tests and multivariate analyses of variance (MANOVA) were conducted for sample characterization and analysis of the association of sleep-related thoughts and emotions and emotion regulation with objective sleep data.ResultsAs expected, young people showed more dysfunctional sleep-related thoughts and emotions (all ps ≤ 0.025) and dysfunctional emotion regulation strategies (all ps ≤ 0.040). Surprisingly, MANOVA results showed that only emotion coping strategies after a stressful event (p = 0.017) and dysfunctional beliefs about sleep (p = 0.012), but not other factors of arousal or sleep reactivity, were associated with overall worse sleep, especially sleep onset latency (all ps ≤ 0.012) and sleep efficiency (all ps ≤ 0.010).ConclusionsMaladaptive emotion coping strategies after a stressful event and dysfunctional sleep-related beliefs and attitudes affect objective sleep onset latency and sleep efficiency in young adults, highlighting the importance of targeting these features in the prevention and treatment of chronic insomnia and improving actual sleep quality.     

Emotion categories and patterns of change in experiential therapy for depression

Objective: This investigation examined the relationship between in-session types of emotional experience operationalized by the emotion category coding system and the reduction of depressive symptoms in emotion-focused therapy (EFT). Method: Segments of videotaped sessions were coded and the different emotion categories were related to reduction in depressive symptoms in a sample of 30 clients who received EFT for depression. Results: Both fewer secondary and more primary adaptive emotions, in the working phases of therapy, were found to significantly predict outcome. Moderate levels of primary maladaptive emotion in the middle working session were associated with outcome and the frequency with which clients moved from primary maladaptive to primary adaptive emotions in this session-predicted outcome. Conclusions: Results of this study support a transformational model of changing emotion with emotion.     

Determinism, “Freedom,” and Psychotherapy†

Objective: Childhood abuse is associated with a wide range of negative outcomes, including increased risk for development of emotion dysregulation and psychopathology, such as posttraumatic stress disorder (PTSD). The goal of the present study was to examine associations between child abuse, PTSD symptoms, and performance on an emotional conflict regulation task that assesses implicit emotion regulation abilities. Method: The sample consisted of 67 (94% African American) females recruited from a public, urban hospital. Childhood abuse was measured using the Childhood Trauma Questionnaire, and PTSD was measured using the modified PTSD Symptom Scale. Task accuracy and implicit emotion regulation were measured through an emotional conflict regulation behavioral task. Results: A multivariate analysis of covariance showed that exposure to moderate to severe childhood abuse was significantly related to worse emotional conflict regulation scores independent of current PTSD symptoms, depressive symptoms, and adult trauma exposure, suggesting a deficit in implicit emotion regulation. We also found an interaction between PTSD symptoms and abuse exposure in predicting accuracy on the behavioral task; high levels of PTSD symptoms were associated with poorer task accuracy among individuals who reported moderate to severe exposure to childhood abuse. However, no relationship between implicit emotion regulation abilities and overall PTSD symptom severity was found. Conclusions: This study provides preliminary evidence of an implicit emotion regulation deficit for individuals exposed to significant childhood abuse and further supports the growing evidence that addressing various aspects of emotion dysregulation, such as awareness of emotions and strategies to manage strong emotions, in the context of treatment would be valuable.     

Dysfunctional attitudes and perceived stress predict depressive symptoms severity following antidepressant treatment in patients with chronic depression

Many patients continue to experience depressive symptoms after optimal pharmacological treatment. The aim of this study was to investigate whether Beck's cognitive diathesis stress model of depression would help predict the degree of improvement in the depressive symptoms of patients with chronic depression receiving antidepressant treatment. The study investigated the dysfunctional attitudes, perceived stress, and depressive symptoms of 117 patients with chronic depression before and after they were treated with an 8-week course of fluoxetine. A hierarchical multiple regression analysis showed a significant effect for the interaction between dysfunctional attitudes and perceived stress explaining severity of depressive symptom following antidepressant treatment. Patients with both high perceived stress and high dysfunctional attitudes prior to treatment reported more depressive symptoms at the end of treatment than patients with high perceived stress and lower dysfunctional attitudes. Surprisingly, in the presence of low perceived stress, patients with higher dysfunctional attitudes experienced less depressive symptoms at the end of treatment than patients with lower dysfunctional attitudes. Results suggest the value of taking into consideration both patients' perceived stress and dysfunctional attitudes when assessing treatment for depressive symptoms.     

Correlation between emotion dysregulation and mood symptoms of bipolar disorder: A systematic review and meta-analysis

Background

Emotion dysregulation (ED) is a transdiagnostic construct characterized by difficulties regulating intense emotions. People with bipolar disorder (BD) are more likely to show ED and use maladaptive emotion regulation strategies than adaptive ones. However, little is known about whether ED in BD is a trait or it is rather an epiphenomenon of mood symptoms.

Methods

We conducted a systematic review and meta-analysis of the evidence across major literature databases reporting correlations between measures of emotion regulation (overall ED and different emotion regulation strategies) and measures of depressive and (hypo)manic symptoms in BD from inception until April 12th, 2022.

Results

Fourteen studies involving 1371 individuals with BD were included in the qualitative synthesis, of which 11 reported quantitative information and were included in the meta-analysis. ED and maladaptive strategies were significantly higher during periods with more severe mood symptoms, especially depressive ones, while adaptive strategies were lower.

Conclusion

ED significantly correlates with BD symptomatology, and it mainly occurs during mood alterations. ED may be a target for specific psychotherapeutic and pharmacological treatments, according to precision psychiatry. However, further studies are needed, including patients with mood episodes and longitudinal design, to provide more robust evidence and explore the causal direction of the associations.     

A self-report version of the Ways of Responding: Reliability and validity in a clinical sample

Objective: The Ways of Responding (WOR) instrument measures compensatory skills, a central construct in some theories of the mechanism of cognitive therapy for depression. However, the instrument is time-consuming and expensive to use in community settings, because it requires trained independent judges to rate subjects’ open-ended written responses to depressogenic scenarios. The present study evaluated the reliability and validity of a self-report version of the WOR (WOR-SR) in a community mental health sample with depressive symptoms (N?=?467). Method: Subjects completed the WOR-SR, a modified version of the original WOR, and other measures of depressive symptoms, dysfunctional cognitions, functioning, quality of life, and interpersonal problems at multiple time points. Results: An exploratory factor analysis confirmed the two-factor structure of the WOR-SR. The positive and negative subscales both demonstrated excellent internal consistency (Cronbach’s alphas?=?.91) and moderate convergent validity with other measures. Conclusion: The WOR-SR is a reliable and valid measure of compensatory skills in patients receiving treatment for depression at community mental health centers.     

Cognitive change processes in a group cognitive behavior therapy of depression

The present study attempted to examine the causal relationships among changes in automatic thoughts, dysfunctional attitudes, and depressive symptoms in a 12-week group cognitive behavior therapy (GCBT) program for depression. In all, 35 depressed patients attending the GCBT program were monitored with the Automatic Thoughts Questionnaire, Dysfunctional Attitudes Scale, and Beck Depression Inventory at the pre-treatment, 4th and 8th sessions, and post-treatment. The results were as follows: (1). GCBT reduces negative cognitions; (2). changes in automatic thoughts and dysfunctional attitudes lead to change in depressive symptoms; and (3). automatic thoughts play a mediating role between dysfunctional attitudes and depression. The findings taken as a whole support the Causal Cognition Model of depression.     

未治疗抑郁障碍患者自杀风险与认知情绪调节策略的关系

目的探讨具有自杀风险的抑郁障碍患者在认知情绪调节策略方面的特征及其影响因素,以早期识别具有自杀风险的患者,有针对性地给予干预。方法选取117例来自北京回龙观医院门诊、经简明国际神经精神访谈(MINI)5. 0中文版筛查符合抑郁障碍诊断标准的未治疗抑郁障碍患者,根据MINI 5. 0中文版自杀模块的访谈结果,将患者分为自杀风险组(n=52)和无自杀风险组(n=65)。采用认知情绪调节问卷(CERQ-C)进行认知调节策略的测评,采用汉密尔顿抑郁量表17项版(HAMD-17)评定抑郁症状的严重程度。结果抑郁障碍患者自杀风险发生率为44. 4%(52/117)。与无自杀风险组相比,自杀风险组患者更多见于女性、未婚、平均年龄更小、发病年龄更早、HAMD-17总评分更高、伴精神病性症状率较高,自杀风险组自我责难、接受、沉思、灾难化4个认知调节策略维度及消极认知情绪调节评分均高于无自杀风险组(P均<0. 05)。Logistic回归分析显示,女性(OR=3. 539,95%CI:1. 383~9. 057)、发病年龄(OR=0. 931,95%CI:0. 895~0. 968)、HAMD-17总评分(OR=1. 207,95%CI:1. 063~1. 370)和灾难化(OR=1. 143,95%CI:1. 002~1. 305)与抑郁障碍患者自杀风险相关(P均<0. 05)。结论女性、发病年龄早、抑郁症状严重和灾难化可能为未治疗抑郁障碍患者自杀风险的危险因素。     

Psychometric Properties of the Korean version of the Emotion Regulation Questionnaire (K-ERQ) in a Clinical Sample

ObjectiveThe Emotion Regulation Questionnaire (ERQ) is one of the widely used instruments to assess emotion regulation skills in many countries, including Korea. However, its psychometric properties have not been validated within this population. Also, the ERQ has increasingly been used in studies with psychiatric patients despite a general lack of validation in clinical settings. Therefore, the present study aimed to investigate the psychometric properties of the Korean version of the ERQ (K-ERQ) using a clinical sample in Korea. MethodsOne hundred and ninety-three psychiatric patients completed a packet of self-report measures, including K-ERQ, K-BDI-II, K-ASI-3, PCL-5-K, AUDIT-K. Confirmatory factor analysis (CFA) was administered to investigate the factor structure of the K-ERQ, and internal reliability and validity were examined. ResultsResults of the CFA supported the two-factor structure, but only after the removal of one item. The K-ERQ showed good internal consistency reliability, and its concurrent validity was also confirmed. Cognitive reappraisal was negatively correlated with depression and alcohol use disorder-related symptoms, and expressive suppression was positively correlated with depression, anxiety sensitivity, posttraumatic stress disorder (PTSD)-related symptoms and alcohol use disorder-related symptoms. Significant group differences were found in the use of emotion regulation strategies; patients with PTSD reported the higher level of cognitive reappraisal than patients with depressive disorders, bipolar disorders, and attention-deficit hyperactivity disorder. Conclusion The 9-itemed K-ERQ is a reliable and valid tool to assess the emotion regulation strategies in a Korean clinical sample. Our study also adds preliminary evidence on the usefulness of the ERQ in clinical settings.     

Disrupted amygdala-prefrontal connectivity during emotion regulation links stress-reactive rumination and adolescent depressive symptoms

Rumination in response to stress (stress-reactive rumination) has been linked to higher levels of depressive symptoms in adolescents. However, no work to date has examined the neural mechanisms connecting stress-reactive rumination and adolescent depressive symptoms. The present work attempted to bridge this gap through an fMRI study of 41 adolescent girls (M_age = 15.42, SD = 0.33) – a population in whom elevated levels of depressive symptoms, rumination, and social stress sensitivity are displayed. During the scan, participants completed two tasks: an emotion regulation task and a social stress task. Using psychophysiological interaction (PPI) analyses, we found that positive functional connectivity between the amygdala and ventrolateral prefrontal cortex (VLPFC) during the emotion regulation task mediated the association between stress-reactive rumination and depressive symptoms. These results suggest that stress-reactive rumination may interfere with the expression and development of neural connectivity patterns associated with effective emotion regulation, which may contribute, in turn, to heightened depressive symptoms.     

Development of emotion regulation across the first two years of college

IntroductionEmotion regulation is thought to develop substantially from late adolescence into early adulthood; further, the rate of development purportedly varies based on personal and contextual characteristics. However, little research has explicitly documented this maturation in young adulthood or identified its determinants. We aimed to (1) characterize how adaptive (positive reappraisal, emotional social support-seeking) and maladaptive (suppression, substance use coping) emotion regulation strategies changed over time and (2) predict change in each strategy based on baseline personal, social, and motivational characteristics.MethodsWe followed a sample of 1578 students entering university in the northeastern United States across their first two years, assessing them four times.ResultsAs expected, social support-seeking increased and suppression decreased. However, contrary to expectations, cognitive reappraisal declined over time while substance use coping increased. Women generally used more adaptive emotion regulation strategies than did men; social engagement and connection and eudaimonic well-being were generally predictive of using more adaptive coping over time.ConclusionsOverall, students did not consistently demonstrate maturation to more adaptive emotion regulation and in fact exhibited decrements over the first two years of college. Students’ baseline characteristics accounted for substantial degrees of change in emotion regulation. These findings suggest potentially fruitful directions for interventions to assist college students in developing more adaptive emotion regulation skills.     

Dysfunctional Attitudes and Perfectionism and Their Relationship to Anxious and Depressive Symptoms in Boys with Autism Spectrum Disorders

In spite of increasing interest in cognitive behaviour therapy for emotional disorders in children with autism spectrum disorders (ASD), little research has explored the relevance of the cognitive model in this population. This study explores dysfunctional attitudes and perfectionism in boys with ASD and the relationship with anxious and depressive symptoms. Compared to a typically developing group (n = 42), boys with ASD (n = 41) endorsed more dysfunctional attitudes and reported higher emotional symptoms. The relationship between emotional and cognitive variables was weak in both groups, although in the ASD group dysfunctional attitudes were significantly associated with reported obsessive–compulsive symptoms. Reasons for elevated dysfunctional attitudes in the ASD group are discussed and the roles of cognitive inflexibility and social impairments are explored.     

Depressive and anxiety symptoms, dysfunctional attitudes and social aspects in irritable bowel syndrome and inflammatory bowel disease

OBJECTIVE: Biopsychosocial models for both organic and functional gastrointestinal (GI) disorders have been described in the recent literature. The objective of this study was to give further data to this model by assessing stressful life events, social support, psychopathological symptoms, and dysfunctional attitudes in irritable bowel syndrome (IBS), inflammatory bowel disease (IBD) and healthy subjects. METHOD: Age- and gender-matched IBS and IBD patients presenting at a tertiary care gastroenterological center completed self-reported questionnaires on stressful life events, social support, depressive and anxiety symptoms and dysfunctional attitudes. For comparative purposes, data from an age- and gender-matched healthy control group were obtained. RESULTS: No significant differences were found between the groups regarding stressful life events and social support. Both patient groups had higher depressive and anxiety symptoms compared to healthy subjects, and IBS patients had higher depressive scores compared to IBD patients. IBS patients had more dysfunctional attitudes compared to both IBD and healthy subjects, while IBD and healthy subjects did not differ on dysfunctional attitudes. CONCLUSIONS: GI patient status is associated with depressive and anxiety symptoms, in addition IBS patients have more severe depressive symptoms and depressogenic dysfunctional attitudes. The fact that functional GI patients are characterized by more severe psychological, but not social parameters, supports the hypothesis that IBS might be related to the range of depressive disorders.     

Socialization of emotion regulation strategies through friends

This study examines the effects of best friends' emotion regulation strategies (regarding the emotions anger, fear, and sadness) on the development of adolescents' emotion regulation strategies and subsequent depressive symptoms. Based on a two-wave longitudinal sample of 238 German adolescents, true change analyses showed positive effects of best friends' adaptive strategies (T1) on the change of adolescents' adaptive strategies (T2 − T1) for anger and fear. Best friends' adaptive strategies (T1) indirectly influence the development of maladaptive strategies (T2 − T1) through the change of adaptive strategies (T2 − T1) and, in turn, the development of depressive symptoms (T2 − T1; two-step mediation). Best friends' adaptive strategies for sadness did not have an effect on adolescents' adaptive strategies. In contrast to adaptive strategies, none of the friends' maladaptive strategies affected adolescents' maladaptive strategies. The results are discussed in terms of peer influences on the development of emotion regulation strategies and psychosocial adjustment.     

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

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.     

Mindfulness and emotion regulation in older and young adults

Objectives: Research shows that dispositional mindfulness is associated with metrics of overall well-being, with enhanced emotion regulation potentially underlying these salutary effects. However, the role of regulation strategy use remains poorly understood. In this study, we examined age-variant associations between dispositional mindfulness, emotion regulation strategies, and emotion dysregulation.

Method: Self-report data were collected from 50 older and 50 young adults on mindfulness, emotion dysregulation, and recent strategy use. For the current study, we examined if cognitive reappraisal, experiential suppression, and thought avoidance use mediated the association between mindfulness and emotion dysregulation.

Results: Thought avoidance, but not reappraisal or suppression strategies, partially mediated the association between mindfulness and emotion dysregulation. Age group moderated the observed mediation, such that for young adults, lower mindfulness was associated with greater use of thought avoidance, and in turn with greater emotion dysregulation (e.g., difficulties engaging in goal-directed behavior in the face of strong emotions).

Conclusion: The current cross-sectional study suggests that reduced avoidance of thoughts may partially explain the relationship between trait mindfulness and enhanced emotion regulation, with this mediational pathway being stronger for young compared with older adults.     

Attachment to Parents and Peers as a Risk Factor for Adolescent Depressive Disorders: The Mediating Role of Emotion Regulation

This study examined emotion regulation as a mediator in the relationship of attachment and depression in adolescents. Participants (N girls = 127; M age = 14.50; N boys = 121; M age = 14.31) completed self-report questionnaires of attachment to parents and peers, emotion regulation and depression. Models with dysfunctional emotion regulation as a mediation variable were tested via hierarchical multiple regression analyses and bootstrapping procedure. Results revealed significant relations between attachment to parents and peers, dysfunctional emotion regulation and depression. For girls, internal-dysfunctional emotion regulation was a mediator in the relation of attachment to parents and depression and partly mediated the association of attachment to peers. For boys, internal- and external-dysfunctional emotion regulation acted as partly mediators in association of attachment to parents and depression. Results indicate important mechanisms that contribute to the refinement of conceptual models and provide indications for gender specific prevention and intervention for depressive disorders.