Exploring depression
Exploring depression

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Exploring depression

3.5 Models of rumination

People differ in the extent to which they ruminate when they are feeling sad. Excessive introspection and self-preoccupied thinking, however, are rarely effective ‘mood-management’ strategies, and are often associated with depression. Nolen-Hoeksema and others have studied aspects of rumination in depression and how this may differ between men and women (Smith and Alloy, 2009). The Responses to Depression Questionnaire is a scale that can be used to measure individual differences in ‘ruminative coping styles’. Rumination in this respect does not involve a focus on the causes of depression (which is active and ‘problem-focused’), but rather a preoccupation with the state of ‘being depressed’ (dwelling on negative mood states).

Individual differences in rumination have been found to relate to the duration and severity of depression. Nolen-Hoeksema (2012) has posed the notion that women are more likely to show a ruminative coping style compared to men. In addition to social, cultural and biological differences, differences in ruminative coping style may therefore represent another relevant factor which may contribute to susceptibility to depression, and to influence the duration and severity of a depressive episode.

People who are depressed find it difficult to consciously suppress (or unconsciously repress) negative thoughts, and to keep these from coming to mind. Negative thinking tends to resurge. Learning to replace negative biases and negative thoughts with more positive ones, however, is a key element in the recovery from depression, and a main goal for treatment (cognitive therapy in particular), the idea being that if negative thinking is eliminated, other symptoms of depression (intense sadness, loss of interest in activities, sleep disturbances, etc.) will also abate, allowing the individual to ‘gain control’ once more.

It is important to note, however, that there is no single unifying definition for rumination, and various theories and models have been proposed (Smith and Alloy, 2009). Among these are the ‘Response Styles Theory’ and ‘Rumination on Sadness’. Nolen-Hoeksema’s (1991) Response Styles Theory (RST) considers rumination to consist of repetitive thinking about the causes, consequences and symptoms of one’s negative mood. The Response Styles Questionnaire (RSQ), although widely used and empirically supported, has been criticised however, for overlap with positive forms of repetitive thoughts (reflection) and worry, and the RST does not address how rumination fits with biological or cognitive processes such as attention or metacognitive beliefs (Smith and Alloy, 2009). Conway et al.’s (2000) ‘Rumination on Sadness’ defines rumination as thinking about sadness, and the circumstances related to one’s sadness – proposed as a model for ‘predicting’ sadness. However, the Rumination on Sadness Scale is not widely used, so its specificity for use in depression remains unclear. Other models include the Stress-Reactive model (rumination on negative, event-related inferences), Goal Progress Theory (which views rumination as a response to failure to progress satisfactorily towards a goal), and Self-Regulatory Executive Function (S-REF) theory (which considers rumination to be a multi-faceted construct and attempts to integrate attention, cognition regulation, beliefs about emotion regulation strategies and interaction between various levels of cognitive processing as part of an overall conceptualisation of rumination).

An important issue to consider would be clarifying the extent to which models of rumination relate to and overlap with other psychological constructs that may be similar conceptually, including negative-automatic thoughts, private self-consciousness, self-focused attention, repetitive thought, intrusive thoughts and obsessions, worry, emotion regulation and coping, neuroticism, social and emotional competence and emotional intelligence (Smith and Alloy, 2009). It has also been proposed that ‘rumination’ should be differentiated from ‘reflection’. The picture that emerges is therefore a complex one, in which rumination is a multifaceted, multidimensional construct. Although rumination is important in the context of depression, it can be difficult to determine how it can be best measured and used to predict a clinical outcome.

Theoretical models continue to evolve, and it has been argued that new models are needed that take into account not only psychological constructs and life events but socio-cultural and environmental factors (such as poverty, conflict and violence), as well as genetic and biological predisposition which influence ‘vulnerability’ and ‘resilience’, and that importantly such models should be validated experimentally (empirically supported), including in suitable animal models where feasible, while recognising the inherent limitations.

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