Rumination

**Rumination** is the focused attention on the symptoms of one's distress, and on its possible causes and consequences, as opposed to its solutions, according to the Response Styles Theory proposed by Nolen-Hoeksema (1998). Because the Response Styles Theory has been empirically supported, this model of rumination is the most widely used conceptualization. Other theories, however, have proposed different definitions for rumination. For example, in the Goal Progress Theory, rumination is conceptualized not as a reaction to a mood state, but as a "response to failure to progress satisfactorily towards a goal". As such, both rumination and worry are associated with anxiety and other negative emotional states; however, its measures have not been unified.

## Source of the term

Ruminants are mammals that are able to acquire nutrients from plant-based food by fermenting it in a specialized stomach prior to digestion, principally through microbial actions. The process, which takes place in the front part of the digestive system and therefore is called foregut fermentation, typically requires the fermented ingesta (known as cud) to be regurgitated and chewed again. The process of rechewing the cud to further break down plant matter and stimulate digestion is called rumination.

## Theories

### Response styles theory

Response styles theory (RST) initially defined rumination as passively and repetitively focusing on one's symptoms of depression and the possible causes and consequences of these symptoms. As evidence for this definition, rumination has been implicated in the development, maintenance, and aggravation of both depressive symptoms as well as episodes of major depression. Recently, RST has expanded the definition of rumination beyond depression to include passive and repetitive focus on the causes, consequences, and symptoms of one's distress in general. This change was made because rumination has been implicated in a host of disorders, not just depression.

RST also contends that positive distraction is the healthy alternative to rumination, where focus is directed to positive stimuli instead of to distress. However, the literature suggests that positive distraction may not be as potent a tool as once thought.

### Self-regulatory executive function model

The self-regulatory executive function (S-REF) model of affective dysfunction (the contents of which lie beyond the scope of this article) contends that rumination can be explained most precisely within a multilevel model of self-regulation. Specifically, the S-REF model defines rumination as "repetitive thoughts generated by attempts to cope with self-discrepancy that are directed primarily toward processing the content of self-referent information and not toward immediate goal-directed action." Put more simply, when a person ruminates, he or she aims to answer questions such as:

* How do I feel about this event?
* How can I change my thoughts and feelings about the event?
* How can I prevent disturbing thoughts and feelings in the future?

However, in answering these questions, ruminators tend to focus on their emotions (i.e., "self-referent information") as opposed to problem solving (i.e., "goal-directed action").

Metacognition is also an important part of the S-REF model and helps to explain the link between rumination and depression. Specifically, those who hold positive metacognitive beliefs about the benefits of rumination (e.g., "I need to ruminate about the bad things that have happened in the past to make sense of them") are probably motivated to engage perseveratively in rumination. Once engagement in rumination has occurred, individuals' negative metacognitive beliefs about rumination are likely to be activated, seeing it as unpleasant (e.g., "Ruminating makes me physically ill"), uncontrollable (e.g., "Ruminating means I'm out of control"), and socially damaging. These negative metacognitive beliefs then contribute to the development and maintenance of depression.

### Goal progress theory

Goal progress theory (GPT) seeks to explain rumination as a function of goal progress. Specifically, GPT views rumination as an example of the Zeigarnik Effect, which suggests that individuals are more likely to remember information from unfinished tasks than from finished tasks. From this understanding, GPT defines rumination as "the tendency to think recurrently about important, higher order goals that have not yet been attained" or towards which sufficient progress has not been made.

GPT predicts that individuals for whom goal-related information is highly accessible should be more likely to ruminate. Various studies have provided support for this prediction.

## Pathology

Extensive research on the effects of rumination, or the tendency to self-reflect, shows that the negative form of rumination (associated with dysphoria) interferes with people's ability to focus on problem-solving and results in dwelling on negative thoughts about past failures. Evidence from studies suggests that the negative implications of rumination are due to cognitive biases, such as memory and attentional biases, which predispose ruminators to selectively devote attention to negative stimuli.

The tendency to negatively ruminate is a stable constant over time and serves as a significant risk factor for clinical depression. Not only are habitual ruminators more likely to become depressed, but experimental studies have demonstrated that people who are induced to ruminate experience greater depressed mood. There is also evidence that rumination is linked to general anxiety, post traumatic stress, binge drinking, eating disorders, and self-injurious behavior.

Rumination was originally believed to predict the duration of depressive symptoms. In other words, ruminating about problems was presumed to be a form of memory rehearsal which was believed to actually lengthen the experience of depression. The evidence now suggests that although rumination contributes to depression, it is not necessarily correlated with the duration of symptoms.

## Types and content of thoughts

Theories of rumination differ in their predictions regarding the content of ruminative thoughts based on their respective conceptualizations.
Some models propose that rumination is focused on negative feeling states and/or the circumstances surrounding that emotion (RST, rumination on sadness, Trapnell and Campbell, stress-reactive rumination, post-event processing models). Rumination in other models focuses on discrepancies between one's current and desired status (goal progress, conceptual evaluative model of rumination). Finally, other models propose that it is the negative themes of uncontrollability and harm in metacognitions that are most important. Some common thoughts that are characteristic of ruminative responses are questioning the well-being of oneself and focusing on the possible causes and consequences of one's depressive symptoms (Nolen-Hoeksema, 1991). For example, some ruminative thoughts include "why am I such a loser", "I'm in such a bad mood" or "I just don't feel like doing anything".

Another difference emerged in the content of rumination concerns the time period of ruminative thinking, with several theories supposing that rumination can vacillate between past, current, and future focus, and others assuming that ruminative content is focused on the past or present. It is consistently reported that rumination, in comparison to worry, contains past-related thoughts. However, a more recent study found that time orientation changes over the course of rumination, such that individuals begin with a past focus, but increase in present and future related thoughts over the course of ruminating. Thus, rumination may be more complicated than previously thought, and not necessarily wholly past focused.

Three forms of rumination have been proposed:

* **State rumination**, which involves dwelling on the consequences and feelings associated with the failure. State rumination is more common in people who are pessimistic, neurotic, and who have negative attributional styles.
* **Action rumination**, which consists of task-oriented thought processes focused on goal-achievement and correction of mistakes.
* **Task-irrelevant rumination**, which utilizes events or people unassociated with the blocked goal to distract a person from the failure.

## Measurement

The tendency to ruminate can be assessed with the Ruminative Responses Scale of the Response Styles Questionnaire. On this measure, people are asked to indicate how often they engage in 22 ruminative thoughts or behaviors when they feel sad or blue.

## Sex differences

According to Susan Nolen-Hoeksema, women tend to ruminate when they are depressed, whereas men tend to distract themselves. This difference in response style was proposed to explain the higher rates of depression in women compared to men. Researchers have confirmed the greater likelihood of rumination in women, though the prediction that men are more likely to distract themselves has not been consistently supported.

## Healthy self-disclosure

Although rumination is generally unhealthy and associated with depression, thinking and talking about one's feelings can be beneficial under the right conditions. According to Pennebaker, healthy self-disclosure can reduce distress and rumination when it leads to greater insight and understanding about the source of one's problems. Thus, when people share their feelings with others in the context of supportive relationships, they are likely to experience growth. In contrast, when people repetitively ruminate and dwell on the same problem without making progress, they are likely to experience depression.
Co-rumination is a process defined as "excessively discussing personal problems within a dyadic relationship" (Rose, 2002), a construct that is relatively understudied in both its negative and positive trade-offs.

## Relationship to other related constructs

Rumination has been confounded with other similar constructs that may overlap with it. Worry and negative automatic thoughts are two of them.

### Worry

Rumination appears closely related to worry. Worry has been identified as "a chain of thoughts and images, negatively affect-laden and relatively uncontrollable; it 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." (Borkovec)

Rumination has also been compared to worry, and in some models, is considered a type of worry (S-REF). Many researchers have noted the high comorbidity of generalized anxiety disorder (GAD) and depression; over 60% of clients who present with symptoms of GAD also qualify for a diagnosis of major depressive disorder. This significant concurrence has led to an increasing literature on the overlap between rumination, which is often studied in the context of depression, and worry, which is often studied in the context of GAD.

Measures of rumination and worry have also demonstrated high correlations, above and beyond that of symptom measures of anxiety and depression (r=.66; Beck & Perkins, 2001). Rumination and worry overlap in their relationships to anxiety and depression, although some studies do indicate specificity of rumination to depression and worry to anxiety. Rumination has been found to predict changes in both depression and anxiety symptoms and individuals with major depression have been reported to engage in levels of worry similar to individuals with GAD. As a whole, these studies suggest that rumination and worry are related not only to each other, but also each is related to symptoms of both depression and anxiety.

Other studies have demonstrated that the content of worry and rumination are distinct; worry thoughts are often focused on problem-solving and have a future orientation, whereas ruminative thoughts concern themes of loss and are more focused on the past. Rumination, as compared to worry, has also been associated with less effort and less confidence in problem solving (Papageorgiou & Wells, 2004). It has also been suggested that rumination and worry serve different purposes, namely that rumination is associated with greater belief in the personal relevance of a situation and a larger need to understand it, whereas worry is associated with a desire to avoid worry thoughts (Watkins 2004b). Worry has also been hypothesized to contain more imagery than rumination; however, support for this has been mixed.

Overall, these studies suggest that worry and rumination are related constructs that both lead to depression and anxiety. It is likely that rumination and worry, as with rumination and reflection, are related types of repetitive thinking that may be better captured as subtypes of some larger construct, such as avoidant coping strategies.

### Negative automatic thoughts

Rumination has been compared to negative automatic thoughts, defined as repetitive thoughts that contain themes of personal loss or failure.
Nolen-Hoeksema (2004) contends that rumination (as defined in RST) is distinct from negative automatic thoughts in that while negative automatic thoughts are relatively shorthand appraisals of loss and depression in depression, rumination consists of longer chains of repetitive, recyclic, negative and self-focused thinking that may occur as a response to initial negative thoughts. Nolen also suggests that rumination may, in addition to analysis of symptoms, causes, and consequences, contain negative themes like those in automatic thoughts. Similarly, Papageorgiou and Wells (2004) have provided supports to this conclusion when they found that rumination can predict depression even when negative cognitions are controlled, suggesting that these constructs do not wholly overlap and have different predictive value.
Despite Nolen-Hoeksema's (2004) argument that rumination and negative automatic thoughts are distinct phenomena, the Response Style Questionnaire has been criticized for its conceptual overlap with negative automatic thoughts.