Repetitive Thought in Psychopathology: The Relation of Rumination and Worry to Depression and Anxiety Symptoms

The relation between repetitive thought and depression and anxiety symptoms was examined in an undergraduate sample. Individuals completed self-report measures of rumination, worry, depression, and anxiety as well as other related constructs including private self-consciousness, looming maladaptive style, cognitive style, cognitive content, and future outlook. Regression analyses and tests for significant differences between partial correlations were utilized to assess the study hypotheses. The results indicated that rumination and worry overlap in their association with depression and anxiety symptoms, and that rumination may be an especially important component of this overlap. Secondary analyses demonstrated that rumination and worry are two distinct constructs, as their patterns of associations with related constructs were different. Keywords: cognitive processes; comorbidity; mood; self-focused attention Researchers have long been interested in the comorbidity between generalized anxiety disorder (GAD) and major depressive disorder (MDD; Kendall & Watson, 1989; Kessler, Chiu, Demler, & Walters, 2005). Some researchers have suggested that the two disorders share a similar underlying cognitive process. For example, Ingram (1990) proposed that self-focused attention is a cognitive process that is present in a variety of mental disorders, including anxiety and depression. Ingram (1990) put forward a model in which pathological-level self-focused attention exists in many disorders and is distinguished by its disorder-specific content. More recently, two specific types of repetitive self-focused attention, rumination and worry, have come under increasing scrutiny for their potential role in maintaining and exacerbating depression and anxiety pathology. Similarities noted between rumination and worry might be a key to understanding the overlap between depression and anxiety and lead to more efficient, combined interventions for these disorders. DEFINING THE CONSTRUCTS Nolen-Hoeksema's (1987) response-style theory of depression (RST) introduced the concept of depressive rumination, repetitive thinking about the causes and consequences of one's negative mood. Research in clinical samples (Ciesla & Roberts, 2002; Kuehner & Weber, 1999 ) and evidence from studies of laboratory-induced negative mood suggest that engaging in rumination maintains dysphoric mood (Morrow & Nolen-Hoeksema, 1990). Rumination has also been found to prospectively predict onsets of major depression episodes (Just & Alloy, 1997; Nolen- Hoeksema, 2000; Spasojevic & Alloy, 2001). Laboratory studies have revealed rumination's ability to disrupt healthy cognition and behavior. For example, dysphoric individuals who engaged in a rumination task were more impaired in concentration (Lyubomirsky, Kasri, & Zehm, 2003), memory tasks (Hertel, 1998; Park, Goodyer, & Teasdale, 2004), and problem-solving skills (Donaldson & Lam, 2004; Lyubomirsky & Nolen-Hoeksema, 1995) and rated themselves as less likely to engage in pleasant activities than did dysphoric individuals who engaged in distraction (Lyubomirsky & Nolen-Hoeksema, 1993). Together, these findings support the theory that rumination exacerbates depressed mood. Borkovec, Robinson, Pruzinsky and DePree (1983) defined the construct of worry as "a chain of thoughts and images, negatively affect-laden and relatively uncontrollable. The worry process represents an attempt to engage in mental problem-solving on an issue whose outcome is uncertain but contains the possibility of one or more negative outcomes" (p. 10). Worry is a diagnostic criterion symptom of GAD and thus is present in all diagnosed GAD cases (American Psychiatric Association, 2000). Worry is associated with intolerance of uncertainty (e.g., Ladouceur, Gosselin, & Dugas, 2000) and poor problem orientation and elaboration (Stober, Tepperwien, & Staak, 2000). The separate literatures on rumination and worry suggest that the constructs share some common characteristics. …