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01-02-2019 | Original Article

Rumination and Its Relationship with Thought Suppression in Unipolar Depression and Comorbid PTSD

Authors: Laina E. Rosebrock, Kimberly A. Arditte Hall, Alora Rando, Suzanne L. Pineles, Gabrielle I. Liverant

Published in: Cognitive Therapy and Research | Issue 1/2019

Abstract

Despite research suggesting that rumination may function as a cognitive avoidance strategy, few studies have examined the presence of rumination or its relationship with other cognitive avoidance strategies (e.g., thought suppression) in individuals with comorbid posttraumatic stress disorder (PTSD) and depression. In the current study, 80 veterans with unipolar depression were categorized into two groups: those with and without a comorbid PTSD diagnosis (PTSD+ and PTSD− groups, respectively). Participants completed a clinician-administered diagnostic interview and measures of clinical symptoms, rumination (brooding, reflection, depressive rumination), and thought suppression. No group differences emerged for the measures of rumination, though the PTSD+ group did report greater use of thought suppression. Diagnostic status moderated the associations between thought suppression and brooding and reflection. Specifically, thought suppression was significantly associated with brooding and reflection for individuals with comorbid depression and PTSD, but not for those with depression alone. Though the presence of rumination did not differ between the two groups, results suggest that the function of rumination may differ across depressed individuals with comorbid PTSD compared to those with depression alone.

Abramowitz, J. S., Tolin, D. F., & Street, G. P. (2001). Paradoxical effects of thought suppression: A meta-analysis of controlled studies. Clinical Psychology Review, 21(5), 683–703. https://doi.org/10.1016/S0272-7358(00)00057-X.PubMedCrossRef

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington: American Psychiatric Association.CrossRef

Arditte, K. A., & Joormann, J. (2011). Emotion regulation in depression: Reflection predicts recovery from a major depressive episode. Cognitive Therapy and Research, 35(6), 536–543. https://doi.org/10.1007/s10608-011-9389-4.CrossRef

Bagby, R. M., Rector, N. A., Bacchiochi, J. R., & McBride, C. (2004). The stability of the Response Styles Questionnaire Rumination Scale in a sample of patients with major depression. Cognitive Therapy and Research, 28(4), 527–538. https://doi.org/10.1023/B:COTR.0000045562.17228.29.CrossRef

Beck, A. T., Steer, R. A., Ball, R., & Ranieri, W. (1996). Comparison of Beck Depression Inventories -IA and -II in psychiatric outpatients. Journal of Personality Assessment, 67(3), 588–597. https://doi.org/10.1207/s15327752jpa6703_13.PubMedCrossRef

Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck Depression Inventory—second edition (BDI-II). San Antonio: The Psychological Corporation.

Birrer, E., & Michael, T. (2011). Rumination in PTSD as well as in traumatized and non-traumatized depressed patients: A cross-sectional clinical study. Behavioural and Cognitive Psychotherapy, 39(4), 381–397. https://doi.org/10.1017/S1352465811000087.PubMedCrossRef

Birrer, E., Michael, T., & Munsch, S. (2007). Intrusive images in PTSD and in traumatised and non-traumatised depressed patients: A cross-sectional clinical study. Behaviour Research and Therapy, 45(9), 2053–2065. https://doi.org/10.1016/j.brat.2007.03.005.PubMedCrossRef

Breslau, N., Davis, G. C., Peterson, E. L., & Schultz, L. (1997). Psychiatric sequelae of posttraumatic stress disorder in women. Archives of General Psychiatry, 54(1), 81–87. https://doi.org/10.1001/archpsyc.1997.01830130087016.PubMedCrossRef

Butler, G., Wells, A., & Dewick, H. (1995). Differential effects of worry and imagery after exposure to a stressful stimulus: A pilot study. Behavioural and Cognitive Psychotherapy, 23(1), 45–56. https://doi.org/10.1017/S1352465800017628.CrossRef

Campbell, D. G., Felker, B. L., Liu, C. F., Yano, E. M., Kirchner, J. E., Chan, D., … Chaney, E. F. (2007). Prevalence of depression-PTSD comorbidity: Implications for clinical practice guidelines and primary care-based interventions. Journal of General Internal Medicine, 22(6), 711–718. https://doi.org/10.1007/s11606-006-0101-4.PubMedPubMedCentralCrossRef

Cooper, A. A., Clifton, E. G., & Feeny, N. C. (2017). An empirical review of potential mediators and mechanisms of prolonged exposure therapy. Clinical Psychology Review, 56, 106–121. https://doi.org/10.1016/j.cpr.2017.07.003.PubMedPubMedCentralCrossRef

Cribb, G., Moulds, M. L., & Carter, S. (2006). Rumination and experiential avoidance in depression. Behaviour Change, 23(3), 165–176. https://doi.org/10.1375/bech.23.3.165.CrossRef

Cukor, J., Spitalnick, J., Difede, J., Rizzo, A., & Rothbaum, B. O. (2009). Emerging treatments for PTSD. Clinical Psychology Review, 29(8), 715–726. https://doi.org/10.1016/j.cpr.2009.09.001.PubMedCrossRef

Dozois, D. J. A., Dobson, K. S., & Ahnberg, J. L. (1998). A psychometric evaluation of the Beck Depression Inventory-II. Psychological Assessment, 10(2), 83–89. https://doi.org/10.1037/1040-3590.10.2.83.CrossRef

Ehlers, A., & Clark, D. M. (2000). A cognitive model of posttraumatic stress disorder. Behaviour Research and Therapy, 38(4), 319–345. https://doi.org/10.1016/S0005-7967(99)00123-0.PubMedCrossRef

Ehring, T., Frank, S., & Ehlers, A. (2008). The role of rumination and reduced concreteness in the maintenance of posttraumatic stress disorder and depression following trauma. Cognitive Therapy and Research, 32(4), 488–506. https://doi.org/10.1007/s10608-006-9089-7.PubMedCrossRef

Ehring, T., Fuchs, N., & Klasener, I. (2009). The effects of experimentally induced rumination versus distraction on analogue posttraumatic stress symptoms. Behavior Therapy, 40(4), 403–413. https://doi.org/10.1016/j.beth.2008.10.001.PubMedCrossRef

Ehring, T., & Watkins, E. R. (2008). Repetitive negative thinking as a transdiagnostic process. International Journal of Cognitive Therapy, 1(3), 192–205. https://doi.org/10.1521/ijct.2008.1.3.192.CrossRef

First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (2002). Structured clinical interview for DSM-IV TR axis I disorders, research version, patient edition with psychotic screen (SCID-I/P W/PSY SCREEN). New York: Biometrics Research, New York State Psychiatric Institute.

Flack, W. F. Jr., Litz, B. T., Hsieh, F. Y., Kaloupek, D. G., & Keane, T. M. (2000). Predictors of emotional numbing, revisited: A replication and extension. Journal of Traumatic Stress, 13(4), 611–618. https://doi.org/10.1023/A:1007806132319.PubMedCrossRef

Flory, J. D., & Yehuda, R. (2015). Comorbidity between post-traumatic stress disorder and major depressive disorder: Alternative explanations and treatment considerations. Dialogues in Clinical Neuroscience, 17(2), 141–150.PubMedPubMedCentral

Foa, E. B., Keane, T. M., Friedman, M. J., & Cohen, J. A. (2008). Effective treatments for PTSD: Practice guidelines from the International Society for Traumatic Stress Studies (2nd ed.). New York: Guilford Press.

Friedman, M. J., Resick, P. A., Bryant, R. A., & Brewin, C. R. (2011). Considering PTSD for DSM-5. Depression and Anxiety, 28(9), 750–769. https://doi.org/10.1002/da.20767.PubMedCrossRef

Garnefski, N., & Kraaij, V. (2007). The cognitive emotion regulation questionnaire. European Journal of Psychological Assessment, 23, 141–149. https://doi.org/10.1027/1015-5759.23.3.141.CrossRef

Giorgio, J. M., Sanflippo, J., Kleiman, E., Reilly, D., Bender, R. E., Wagner, C. A., … Alloy, L. B. (2010). An experiential avoidance conceptualization of depressive rumination: Three tests of the model. Behaviour Research and Therapy, 48(10), 1021–1031. https://doi.org/10.1016/j.brat.2010.07.004.PubMedPubMedCentralCrossRef

Gold, D. B., & Wegner, D. M. (1995). Origins of ruminative thought: Trauma, incompleteness, nondisclosure, and suppression. Journal of Applied Social Psychology, 25(14), 1245–1261. https://doi.org/10.1111/j.1559-1816.1995.tb02617.x.CrossRef

Harvey, A. G., & Bryant, R. A. (1998). The effect of attempted thought suppression in acute stress disorder. Behaviour Research and Therapy, 36(6), 583–590. https://doi.org/10.1016/S0005-7967(98)00052-7.PubMedCrossRef

Holmbeck, G. N. (2002). Post-hoc probing of significant moderational and mediational effects in studies of pediatric populations. Journal of Pediatric Psychology, 27(1), 87–96. https://doi.org/10.1093/jpepsy/27.1.87.PubMedCrossRef

Johnson, D. P., & Whisman, M. A. (2013). Gender differences in rumination: A meta-analysis. Personality and Individual Differences, 55(4), 367–374. https://doi.org/10.1016/j.paid.2013.03.019.PubMedPubMedCentralCrossRef

Kuo, J. R., Edge, I. G., Ramel, W., Edge, M. D., Drabant, E. M., Dayton, W. M., & Gross, J. J. (2012). Trait rumination is associated with enhanced recollection of negative words. Cognitive Therapy and Research, 36(6), 722–730. https://doi.org/10.1007/s10608-011-9430-7.PubMedCrossRef

Liverant, G. I., Kamholz, B. W., Sloan, D. M., & Brown, T. A. (2011). Rumination in clinical depression: A type of emotional suppression? Cognitive Therapy and Research, 35(3), 253–265. https://doi.org/10.1007/s10608-010-9304-4.CrossRef

Marroquin, B. M., Fontes, M., Scilletta, A., & Miranda, R. (2010). Ruminative subtypes and coping responses: Active and passive pathways to depressive symptoms. Cognition and Emotion, 24(8), 1446–1455. https://doi.org/10.1080/02699930903510212.CrossRef

Michael, T., Halligan, S. L., Clark, D. M., & Ehlers, A. (2007). Rumination in posttraumatic stress disorder. Depression and Anxiety, 24(5), 307–317. https://doi.org/10.1002/da.20228.PubMedCrossRef

Moulds, M. L., Kandris, E., Starr, S., & Wong, A. C. (2007). The relationship between rumination, avoidance and depression in a non-clinical sample. Behaviour Research and Therapy, 45(2), 251–261. https://doi.org/10.1016/j.brat.2006.03.003.PubMedCrossRef

Nolen-Hoeksema, S. (1991). Responses to depression and their effects on the duration of depressive episodes. Journal of Abnormal Psychology, 100(4), 569–582. https://doi.org/10.1037/0021-843X.100.4.569.PubMedCrossRef

Nolen-Hoeksema, S., & Morrow, J. (1991). A prospective study of depression and posttraumatic stress symptoms after a natural disaster: The 1989 Loma Prieta Earthquake. Journal of Personality and Social Psychology, 61(1), 115–121. https://doi.org/10.1521/pedi.2010.24.5.651.PubMedCrossRef

Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008). Rethinking rumination. Perspectives on Psychological Science, 3(5), 400–424. https://doi.org/10.1111/j.1745-6924.2008.00088.x.PubMedCrossRef

O’Donnell, M. L., Creamer, M., & Pattison, P. (2004). Posttraumatic stress disorder and depression following trauma: Understanding comorbidity. American Journal of Psychiatry, 161(8), 1390–1396. https://doi.org/10.1176/appi.ajp.161.8.1390.PubMedCrossRef

Pietrzak, R. H., Harpaz-Rotem, I., & Southwick, S. M. (2011). Cognitive-behavioral coping strategies associated with combat-related PTSD in treatment-seeking OEF-OIF Veterans. Psychiatry Research, 189(2), 251–258. https://doi.org/10.1016/j.psychres.2011.07.019.PubMedCrossRef

Robichaud, M., Dugas, M. J., & Conway, M. (2003). Gender differences in worry and associated cognitive-behavioral variables. Journal of Anxiety Disorders, 17(5), 501–516. https://doi.org/10.1016/S0887-6185(02)00237-2.PubMedCrossRef

Schoofs, H., Hermans, D., & Raes, F. (2010). Brooding and reflection as subtypes of rumination: Evidence from confirmatory factor analysis in nonclinical samples using the Dutch Ruminative Response Scale. Journal of Psychopathology and Behavioral Assessment, 32(4), 609–617. https://doi.org/10.1007/s10862-010-9182-9.CrossRef

Seligowski, A. V., Lee, D. J., Bardeen, J. R., & Orcutt, H. K. (2015). Emotion regulation and posttraumatic stress symptoms: A meta-analysis. Cognitive Behaviour Therapy, 44(2), 87–102. https://doi.org/10.1080/16506073.2014.980753.PubMedCrossRef

Shipherd, J. C., & Beck, J. G. (1999). The effects of suppressing trauma-related thoughts on women with rape-related posttraumatic stress disorder. Behaviour Research and Therapy, 37(2), 99–112. https://doi.org/10.1016/S0005-7967(98)00136-3.PubMedCrossRef

Shipherd, J. C., & Beck, J. G. (2005). The role of thought suppression in posttraumatic stress disorder. Behavior Therapy, 36(3), 277–287. https://doi.org/10.1016/S0005-7894(05)80076-0.CrossRef

Skre, I., Onstad, S., Torgersen, S., & Kringlen, E. (1991). High interrater reliability for the Structured Clinical Interview for DSM-III-R Axis I (SCID-I). Acta Psychiatrica Scandinavica, 84(2), 167–173. https://doi.org/10.1111/j.1600-0447.1991.tb03123.x.PubMedCrossRef

Spinhoven, P., Drost, J., de Rooij, M., van Hemert, A. M., & Penninx, B. W. (2014). A longitudinal study of experiential avoidance in emotional disorders. Behavior Therapy, 45(6), 840–850. https://doi.org/10.1016/j.beth.2014.07.001.PubMedCrossRef

Spinhoven, P., Penninx, B. W., Krempeniou, A., van Hemert, A. M., & Elzinga, B. (2015). Trait rumination predicts onset of Post-Traumatic Stress Disorder through trauma-related cognitive appraisals: A 4-year longitudinal study. Behaviour Research and Therapy, 71, 101–109. https://doi.org/10.1016/j.brat.2015.06.004.PubMedCrossRef

Stroebe, M., Boelen, P. A., van den Hout, M., Stroebe, W., Salemink, E., & van den Bout, J. (2007). Ruminative coping as avoidance: A reinterpretation of its function in adjustment to bereavement. European Archives of Psychiatry and Clinical Neuroscience, 257(8), 462–472. https://doi.org/10.1007/s00406-007-0746-y.PubMedCrossRef

Surrence, K., Miranda, R., Marroquin, B. M., & Chan, S. (2009). Brooding and reflective rumination among suicide attempters: Cognitive vulnerability to suicidal ideation. Behaviour Research and Therapy, 47(9), 803–808. https://doi.org/10.1016/j.brat.2009.06.001.PubMedCrossRef

Szabo, Y. Z., Warnecke, A. J., Newton, T. L., & Valentine, J. C. (2017). Rumination and posttraumatic stress symptoms in trauma-exposed adults: A systematic review and meta-analysis. Anxiety Stress and Coping, 30(4), 396–414. https://doi.org/10.1080/10615806.2017.1313835.CrossRef

Treynor, W., Gonzalez, R., & Nolen-Hoeksema, S. (2003). Rumination reconsidered: A psychometric analysis. Cognitive Therapy and Research, 27(3), 247–259. https://doi.org/10.1023/A:1023910315561.CrossRef

Watkins, E., & Moulds, M. L. (2007). Reduced concreteness of rumination in depression: A pilot study. Personality and Individual Differences, 43(6), 1386–1395. https://doi.org/10.1016/j.paid.2007.04.007.CrossRef

Watkins, E. R. (2016). Rumination-focused cognitive-behavioral therapy for depression. New York: Guilford Press.

Watkins, E. R., & Moulds, M. L. (2009). Thought control strategies, thought suppression, and rumination in depression. International Journal of Cognitive Therapy, 2(3), 235–251. https://doi.org/10.1521/ijct.2009.2.3.235.CrossRef

Watson, D., Weber, K., Assenheimer, J. S., Clark, L. A., Strauss, M. E., & McCormick, R. A. (1995). Testing a tripartite model: I. Evaluating the convergent and discriminant validity of anxiety and depression symptom scales. Journal of Abnormal Psychology, 104(1), 3–14. https://doi.org/10.1037/0021-843X.104.1.3.PubMedCrossRef

Weathers, F. W., Litz, B. T., Herman, D., Huska, J., & Keane, T. M. (1994). The PTSD checklist—civilian version (PCL-C). Boston: National Center for PTSD.

Wegner, D. M. (1989). White bears and other unwanted thoughts: Suppression, obsession, and the psychology of mental control. New York: Penguin Press.

Wegner, D. M., & Zanakos, S. (1994). Chronic thought suppression. Journal of Personality, 62(4), 616–640. https://doi.org/10.1111/j.1467-6494.1994.tb00311.x.PubMedCrossRef

Wenzlaff, R. M., & Luxton, D. D. (2003). The role of thought suppression in depressive rumination. Cognitive Therapy and Research, 27(3), 293–308. https://doi.org/10.1023/A:1023966400540.CrossRef

Wilkins, K. C., Lang, A. J., & Norman, S. B. (2011). Synthesis of the psychometric properties of the PTSD checklist (PCL) military, civilian, and specific versions. Depression and Anxiety, 28(7), 596–606. https://doi.org/10.1002/da.20837.PubMedPubMedCentralCrossRef

Zanarini, M. C., & Frankenburg, F. R. (2001). Attainment and maintenance of reliability of axis I and II disorders over the course of a longitudinal study. Comprehensive Psychiatry, 42(5), 369–374. https://doi.org/10.1053/comp.2001.24556.PubMedCrossRef

Title: Rumination and Its Relationship with Thought Suppression in Unipolar Depression and Comorbid PTSD
Authors: Laina E. Rosebrock
Kimberly A. Arditte Hall
Alora Rando
Suzanne L. Pineles
Gabrielle I. Liverant
Publication date: 01-02-2019
Publisher: Springer US
Published in: Cognitive Therapy and Research / Issue 1/2019
Print ISSN: 0147-5916
Electronic ISSN: 1573-2819
DOI: https://doi.org/10.1007/s10608-018-9935-4

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Rumination and Its Relationship with Thought Suppression in Unipolar Depression and Comorbid PTSD

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