Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
European Archives of Psychiatry and Clinical Neuroscience
Published in: European Archives of Psychiatry and Clinical Neuroscience 8/2007

01-12-2007 | SPECIAL ISSUE

Ruminative coping as avoidance

A reinterpretation of its function in adjustment to bereavement

Authors: Margaret Stroebe, Paul A. Boelen, Marcel van den Hout, Wolfgang Stroebe, Elske Salemink, Jan van den Bout

Published in: European Archives of Psychiatry and Clinical Neuroscience | Issue 8/2007

Login to get access

Abstract

The paper argues for a reconceptualization of ruminative coping with the death of a loved one as an avoidant rather than a confrontational strategy. Ruminative coping has been characterized within the bereavement field as persistent, repetitive and passive focus on negative emotions and symptoms. It has been theoretically described and empirically shown to be a maladaptive process, being conceptually related to complicated/chronic/prolonged grief. Furthermore, it has been contrasted with denial and suppression processes—which, too, have been understood to be maladaptive and associated with major complications following bereavement. Here evidence is reviewed and the case made that rumination is not an opposite form of coping from suppression or denial, but that it is a similar phenomenon to these, and different from the types of confrontation that take place in so-called “grief work”. Implications with respect to intervention for complicated grief are discussed.
Footnotes
1
We use the term “complicated” in preference to “prolonged” grief, since the former term is still more familiar and more frequently used in the current scientific literature.
 
2
There have been few methodologically sound empirical studies investigating the notion that grief work leads to adaptation to bereavement [9, 67]. Thus, the link with good adaptation is based more on theoretical than empirical research.
 
3
See Treynor et al. [71] for discussion of issues to do with the potential conceptual overlap between rumination and depression.
 
4
Scott and McIntosh [61] developed the so-called Scott-McIntosh rumination inventory, about people’s tendency to ruminate about failed goal pursuits. We do not describe this scale here, since it focuses, like Martin and Tesser [40], on engaging in thoughts about progress toward goals. Other rumination scales that are similar in some respects to the RSQ are the Negative Rumination Scale [33] and the more specific Anger Rumination Scale [68]—it is beyond current scope to describe these.
 
5
Worden’s [77] Task Model of Mourning, notably the 1st 2 tasks.
 
6
Although we have categorized rumination as an avoidance process, it must be remembered that there are also non-ruminative avoidance (suppression, denial, etc.) processes which may sometimes be related to poor mental health, sometimes not (see [28], for a scholarly analysis of the relationship of types of avoidance to complicated grief).
 
Literature
1.
American Psychiatric Association (1987) Diagnostic and statistical manual of mental disorders, 3rd edn. rev. Author, Washington, DC
2.
American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. Author, Washington, DC
3.
Bagby R, Rector N, Bacchiochi J, McBride C (2004) The stability of the Response Style Questionnaire Rumination Scale in a sample of patients with major depression. Cognitive Therapy Res 28:527–538CrossRef
4.
Boelen PA (2006) Cognitive behavioral therapy for complicated grief: theoretical underpinnings and case description. J Loss Trauma 11:1–31CrossRef
5.
Boelen PA, van den Bout J, van den Hout MA (2006b) Negative cognitions and avoidance in emotional problems after bereavement: a prospective study. Behav Res Therapy 44:1657–1672
6.
Boelen PA, van den Bout J, van den Hout MA (2003) The role of negative interpretations of grief reactions in emotional problems after bereavement. J Behav Therapy Exp Psychiatry 34:225–238CrossRef
7.
Boelen PA, van den Hout MA, van den Bout J (2006a) A cognitive-behavioral conceptualization of complicated grief. Clin Psychol: Sci Prac 13:109–128CrossRef
8.
Boelen PA, de Keijser J, van den Hout MA, van den Bout J (in press) Treatment of complicated grief: a comparison between cognitive behavioral therapy and supportive counseling. J Consult Clin Psychol
9.
Bonanno G (2001) Grief and emotion: a social-functional perspective. In: Stroebe M, Hansson RO, Stroebe W, Schut H (eds) Handbook of bereavement research: consequences, coping, and care. APA, Washington, DC, pp 493–515CrossRef
10.
Bonanno G, Papa A, O’Neill K (2001) Loss and human resilience. Appl Prevent Psychol 10:193–206CrossRef
11.
Bonanno G, Papa A, Lalande L, Zhang N, Noll J (2006) Grief processing and deliberate grief avoidance: a prospective comparison of bereaved spouses and parents in the United States and the People’s Republic of China. J Consult Clin Psychol 73:86–98
12.
Bonanno G, Keltner D, Holen A, Horowitz M (1995) When avoiding unpleasant emotions may not be such a bad thing: verbal-automatic response dissociation and midlife conjugal bereavement. J Person Soc Psychol 69:975–989CrossRef
13.
Borkovec T (1985) Worry: a potentially valuable concept. Behav Res Therapy 4:481–482CrossRef
14.
Borkovec TD, Alcaine O, Behar E (2004) Avoidance theory of worry and generalized anxiety disorder. In: Heimberg RG, Turk CL, Mennin DS (eds) Generalized anxiety disorder: advances in research and practice. Guilford Press, New York, pp 77–108
15.
Borkovec TD, Lyonfields JD (1993) Worry: thought suppression of emotional processing. In: Krohne HW (ed) Attention and avoidance: strategies in coping with aversiveness. Hogrefe Huber Publishers, Göttingen, pp 101–118
16.
Borkovec T, Roemer L (1995) Perceived functions of worry among generalized anxiety disorder subjects: distraction from more emotionally distressing topics? J Behav Therapy Exp Psychiatry 26:25–30CrossRef
17.
Borkovec T, Robinson E, Pruzinsky T, DePree J (1983) Preliminary exploration of worry: some characteristics and processes. Behav Res Therapy 21:9–16CrossRef
18.
Borkovec T, Ray W, Stöber J (1998) Worry: a cognitive phenomenon intimately linked to affective, physiological, and interpersonal behavioral processes. Cognitive Therapy Res 22:561–576CrossRef
19.
Bower J, Kemeny M, Taylor S, Fahey J (1998) Cognitive processing, discovery of meaning, CD4 decline, and AIDS-related mortality among bereaved HIV-seropositive men. J Consult Clin Psychol 66:979–986PubMedCrossRef
20.
Bowlby J (1980) Attachment and loss: vol 3: loss: sadness and depression. Hogarth Press, London
21.
Brosschot J, Gerin W, Thayer J (2006) The perseverative cognition hypothesis: a review of worry, prolonged stress-related physiological activation, and health. J Psychosom Res 60:113–124PubMedCrossRef
22.
Davey G, Tallis F (1994) Worrying: perspectives on theory, assessment and treatment. Wiley, Chichester
23.
Davey G, Hampton J, Farrell J, Davidson S (1992) Some characteristics of worrying: evidence for worrying and anxiety as separate constructs. Person Individ Differ 13:133–147CrossRef
24.
Davis C, Nolen-Hoeksema S, Larson J (1998) Making sense of loss and benefiting from the experience: two construals of meaning. J Person Soc Psychol 75:561–574CrossRef
25.
Ehlers A, Clark D (2000) A cognitive model of posttraumatic stress disorder. Behav Res Therapy 38:319–345CrossRef
26.
Ehlers A, Mayou RA, Bryant B (1998) Psychological predictors of chronic posttraumatic stress disorder after motor vehicle accidents. J Abnormal Psychol 107:508–519CrossRef
27.
Ehlers A, Steil R (1995) Maintenance of intrusive memories in posttraumatic stress disorder: a cognitive approach. Behav Cognitive Psychotherapy 23:217–249
28.
Fraley RC, Shaver P (1999) Loss and bereavement: attachment theory and recent controversies concerning “grief work” and the nature of detachment. In: Cassidy J Shaver P (eds) Handbook of attachment: theory, research, and clinical applications. Guilford, New York, pp 735–759
29.
Fresco D, Frankel A, Mennin D, Turk C, Heimberg R (2002) Distinct and overlapping features of rumination and worry: the relationship of cognitive production to negative affective states. Cognitive Therapy Res 26:179–188CrossRef
30.
Freud S (1917/1957) Mourning and melancholia. In: Strachey J (ed) Standard edition of the complete works of Sigmund Freud. Hogarth, London
31.
Gosselin P, Langlois F, Freeston MH, Ladouceur R, Laberge M, Lemay D (2007) Cognitive variables related to worry among adolescents: avoidance strategies and faulty beliefs about worry. Behav Res Therapy 45:225–233CrossRef
32.
Horowitz M, Siegel B, Holen A, Bonanno G, Milbrath C, Stinson C (1997) Diagnostic criteria for complicated grief disorder. Am J Psychiatry 154:904–910PubMed
33.
Ito T, Agari I (2001) Development of the negative rumination scale and its relationship with depression. Jpn J Counsel Sci 34:31–42
34.
Jaycox LH, Foa EB (1996) Obstacles in implementing exposure therapy for PTSD: case discussions and practical solutions. Clin Psychol Psychotherapy 3:176–184CrossRef
35.
Kasch K, Klein D, Lara M (2001) A construct validation study of the Response Styles Questionnaire Rumination scale in participants with a recent-onset major depressive episode. Psychol Assess 13:375–383PubMedCrossRef
36.
Landman J (1987) Regret: a theoretical and conceptual analysis. J Theory Soc Behav 17:135–160CrossRef
37.
Lindemann E (1944) Symptomatology and management of acute grief. Am J Psychiatry 101:141–148
38.
Lyubomirsky S, Nolen-Hoeksema S (1995) Effects of self-focused rumination on negative thinking and interpersonal problem solving. J Person Soc Psychol 69:176–190CrossRef
39.
Lyubomirsky S, Tucker K, Caldwell N, Berg K (1999) Why ruminators are poor problem solvers: clues from the phenomenology of dysphoric rumination. J Person Soc Pscyhol 77:1041–1060CrossRef
40.
Martin L, Tesser A (1996) Some ruminative thoughts. In: Wyer R (ed) Advances in social cognition. Erlbaum, Hillsdale, NJ, pp 1–47
41.
Mathews A (1990) Why worry? The cognitive function of anxiety. Behav Res Therapy 28:455–468CrossRef
42.
Michael S, Snyder C (2005) Getting unstuck: the roles of hope, finding meaning, and rumination in the adjustment to bereavement among college students. Death Studies 29:435–458PubMedCrossRef
43.
Nolen-Hoeksema S (1987) Sex differences in unipolar depression: evidence and theory. Psychol Bull 101:259–282PubMedCrossRef
44.
Nolen-Hoeksema S (1991) Responses to depression and their effects on the duration of depressive episodes. J Abnormal Psychol 100:569–582CrossRef
45.
Nolen-Hoeksema S (1996) Chewing the cud and other ruminations. In: Wyer R (ed) Advances in social cognition. Erlbaum, Hillsdale, NJ, pp 135–144
46.
Nolen-Hoeksema S (2001) Ruminative coping and adjustment to bereavement. In: Stroebe M, Hansson RO, Stroebe W, Schut H (eds) Handbook of bereavement research: consequences, coping, and care. American Psychological Association Press, Washington, DC, pp 545–562CrossRef
47.
Nolen-Hoeksema S (2005) Lost in thought: rumination and depression. Paper presented at the Annual Conference of the American Psychological Association, Washington DC, August 18–21
48.
Nolen-Hoeksema S, Davis C (1999) “Thanks for sharing that”: ruminators and their social support networks. J Person Soc Psychol 77:801–814CrossRef
49.
Nolen-Hoeksema S, Harrell Z (2002) Rumination, depression, and alcohol use: tests of gender differences. J Cognitive Psychotherapy 16:3911–404
50.
Nolen-Hoeksema S, Larson J (1999) Coping with loss. Erlbaum, Mahwah, NJ
51.
Nolen-Hoeksema S, Jackson B, (2001) Mediators of the gender difference in rumination. Psychol Women Quarter 25:37–47CrossRef
52.
Nolen-Hoeksema S, McBride A, Larson J (1997) Rumination and psychological distress among bereaved partners. J Person Soc Psychol 72:855–862CrossRef
53.
Nolen-Hoeksema S, Parker L, Larson J (1994) Ruminative coping with depressed mood following loss. J Person Soc Psychol 67:92–104CrossRef
54.
Ong A, Bergemen C, Bisconti T (2005) Unique effects of perceived daily control on anxiety symptomatology during conjugal bereavement. Person Individ Differ 38:1057–1067CrossRef
55.
Parkes C (1996) Bereavement: studies of grief in adult life, 3rd edn. Tavistock/Routledge, London
56.
Prigerson H, Jacobs S (2001) Traumatic grief as a distinct disorder: a rationale, consensus criteria, and a preliminary empirical test. In: Stroebe M, Hansson RO, Stroebe W, Schut H (eds) Handbook of bereavement research: consequences, coping, and care. American Psychological Association Press, Washington, DC, pp 613–645CrossRef
57.
Prigerson H, Vanderwerker L, Maciejewski P (in press) Prolonged grief disorder: a case for inclusion in DSM. In: Stroebe M, Hansson RO, Schut H, Stroebe W (eds) Handbook of bereavement research: 21st century perspectives. Washington, DC
58.
Ramsay R (1977) Behavioural approaches to bereavement. Behav Res Therapy 15:131–135CrossRef
59.
Roemer L, Borkovec T (1993) Worry: unwanted cognitive activity that controls unwanted somatic experience. In: Wegner D, Pennebaker J (eds) Handbook of mental control. Prentice-Hall, Englewood Cliffs, NJ, pp 220–238
60.
Rosenblatt P (1983) Bitter, bitter tears: nineteenth century diarists and twentieth century grief theories. University of Minnesota Press, Minneapolis
61.
Scott V, McIntosh W (1999) The development of a trait measure of ruminative thought. Person Individ Differ 26:1045–1056CrossRef
62.
Segerstrom S, Stanton A, Alden L, Shortridge B (2003) A multidimensional structure for repetitive thought: what’s on your mind, and how, and how much? J Person Soc Psychol 85:909–921CrossRef
63.
Shear M, Frank E, Foa E, Cherry C, Reynolds III C, VanderBilt J, Masters S (2001) Traumatic grief treatment: a pilot study. Am J Psychiatry 158:1506–1508PubMedCrossRef
64.
Shuchter S, Zisook S (1993) The course of normal grief. In: Stroebe M, Hansson RO, Stroebe W (eds) Handbook of bereavement: theory, research, and intervention. Cambridge, New York, pp 23–43
65.
Stein N, Folkman S, Trabasso T, Richards T (1997) Appraisal and goal processes as predictors of psychological wellbeing in bereaved caregivers. J Person Soc Psychol 72:872–884CrossRef
66.
Stroebe M (1992) Coping with bereavement: a review of the grief work hypothesis. Omega. J Death Dying 26:19–42CrossRef
67.
Stroebe W, Schut H, Stroebe M (2005) Grief work, disclosure and counseling: do they help the bereaved? Clin Psychol Rev 25:395–314PubMedCrossRef
68.
Sukhodolsky D, Golub A, Cromwell E (2001) Development and validation of the anger rumination scale. Person Individ Differ 31:689–700CrossRef
69.
Tait R, Silver R (1989) Coming to terms with major negative life events. In: Uleman J, Bargh J (eds) Unintended thought. Guilford, New York, pp 351–382
70.
Tallis F, Davey GCL, Bond A (1994) The worry domains questionnaire. In: Davey G, Tallis F (eds) Worrying: perspectives on theory, assessment and treatment. Wiley, New York, pp 286–297
71.
Treynor W, Gonzalez R, Nolen-Hoeksema S (2003) Rumination reconsidered: a psychometric analysis. Cognitive Therapy Res 27:247–259CrossRef
72.
Wagner B, Knaevelsrud C, Maercker A (2006) Internet-based cognitive-behavioural therapy for complicated grief: a randomized controlled trial. Death Stud 30:429–453PubMedCrossRef
73.
Watkins E (2004) Appraisals and strategies associated with rumination and worry. Person Individ Differ 37:679–694CrossRef
74.
Watkins E, Moulds M, Mackintosh B (2005) Comparisons between ruminations and worry in a non-clinical population. Behav Res Therapy 43:1577–1585CrossRef
75.
Wells A (1995) Meta-cognition and worry: a cognitive model of generalized anxiety disorder. Behav Cognitive Psychotherapy 23:301–320CrossRef
76.
Wells A (1999) A metacognitive model and therapy for generalized anxiety disorder. Clin Psychol Psychotherapy 6:86–95CrossRef
77.
Worden JW (2002) Grief counseling and grief therapy: a handbook for the mental health practitioner, 3rd edn. Springer, New York
78.
Metadata
Title
Ruminative coping as avoidance
A reinterpretation of its function in adjustment to bereavement
Authors
Margaret Stroebe
Paul A. Boelen
Marcel van den Hout
Wolfgang Stroebe
Elske Salemink
Jan van den Bout
Publication date
01-12-2007
Publisher
D. Steinkopff-Verlag
Published in
European Archives of Psychiatry and Clinical Neuroscience / Issue 8/2007
Print ISSN: 0940-1334
Electronic ISSN: 1433-8491
DOI
https://doi.org/10.1007/s00406-007-0746-y

Other articles of this Issue 8/2007

European Archives of Psychiatry and Clinical Neuroscience 8/2007 Go to the issue

SPECIAL ISSUE

An attachment-based model of complicated grief including the role of avoidance

SPECIAL ISSUE

The influence of symptoms of prolonged grief disorder, depression, and anxiety on quality of life among bereaved adults

ORIGINAL PAPER

Insular volume reduction in schizophrenia

SPECIAL ISSUE

Complicated grief after traumatic loss

EDITORIAL-SPECIAL ISSUE

When grief becomes a disorder

ORIGINAL PAPER

Suicide victims’ contacts with physicians during the year before death