Rumination in PTSD as well as in Traumatized and Non-Traumatized Depressed Patients: A Cross-Sectional Clinical Study

Abstract

Background:Although rumination is a key process in the onset and maintenance of depressive symptoms and a powerful predictor of persistent posttraumatic stress disorder (PTSD), little is known about the differences and similarities of rumination in these conditions. Previous research has not always differentiated between rumination and intrusive images. Aims: We sought to systematically evaluate rumination and to gather more information about the content and associated emotions in three patient groups (PTSD, and depressed with and without trauma; n = 65). Furthermore, we examined the interaction between rumination and another predominant intrusive cognition, intrusive image. Method: A multimethod assessment for rumination, including a rumination questionnaire and a rumination log (kept for one week), was employed. Results: Rumination was found to be complex and composed of subcomponents that are similar across the diagnostic groups. Rumination rarely stopped intrusive images and it made the participants feel worse. There were, however, also important differences: in PTSD, rumination always or often triggered intrusive images and the traumatized individuals (PTSD and depressed with trauma) ruminated more than non-traumatized depressed patients. Conclusions: The results corroborate the assumption of rumination being a transdiagnostic process, with similarities but also with important differences across diagnostic groups. Moreover, the findings support recent research on the intricate relationship between different types of intrusive cognitions.Keywords: Posttraumatic Stress Disorder, depression with and without trauma, intrusive images, rumination, triggers. IntroductionThe human mind is capable of sustaining intense focus and shifting thoughts, and yet we can be disturbed by unintended and unwanted intrusive cognitions, such as thoughts and E. Birrer and T. Michaelimages, which interrupt our ongoing activities and redirect attentional resources. Previous research has shown that unwanted intrusive cognitions are a prominent feature of many clinical disorders, including posttraumatic stress disorder (PTSD) and depression, and has suggested these cognitions are transdiagnostic phenomena (e.g. Brewin, Gregory, Lipton and Burgess, 2010;Michael, Halligan, Clark and Ehlers, 2007;Michael, Ehlers and Halligan, 2005a; Clark, 2005). Harvey, Watkins, Mansell and Shafran (2004) showed the feasibility and benefits of shifting the perspective away from a "disorder focus" and towards elucidating the common mechanisms, for example, in memory and cognition that appear across disorders -that is, towards a transdiagnostic perspective. Yet research on intrusive thoughts has not always differentiated between the different forms of intrusive cognitive activities, which prevents a clear identification and comparison of these cognitions across diagnostic groups. Furthermore, as cognitive therapy is developing in new directions by emphasizing metacognitive interventions (which try to change an individual's relationship to the intrusive...

Constructive and Unproductive Processing of Traumatic Experiences in Trauma-Focused Cognitive-Behavioral Therapy for Youth

“…Recurrent and repetitive negative thinking about traumatic experiences and their consequences is associated with intrusions, re-experiencing, and prolonged distress, which maintain PTSD and related symptoms (Ball & Brewin, 2012; Birrer & Michael, 2011; Brewin et al, 2010; Ehlers & Clark, 2000; Michael, Halligan, Clark, & Ehlers, 2007). Anger and emotional venting can also loop in ruminative cycles that predict and perpetuate PTSD symptoms (e.g., Ehlers, Mayou, & Bryant, 1998; Germain, Kangas, Taylor, & Forbes, 2015; Kunst, Winkel, & Bogaerts, 2011; Orth, Cahill, Foa, & Maercker, 2008).…”

Reliving and Disorganization in Posttraumatic Stress Disorder and Panic Disorder Memories

“…Moreover, transdiagnostic research in general might explain whether we should see anxiety syndromes as discrete classes of psychopathology or whether symptoms indicate more continuous dimensions (e.g., Krueger et al, 2005). Interestingly, the very few transdiagnostic studies showed intrusion-associated emotions were equally intense in PTSD and depressive patients (Reynolds and Brewin, 1998), although PTSD intrusions had a higher here-and-now quality (Birrer et al, 2007).…”

The Comparison of Experimental Avoidance, Mindfulness and Rumination in Trauma-Exposed Individuals With and Without Posttraumatic Stress Disorder (PTSD) in an Iranian Sample

“…Depression in those with PTSD is a confirmation on rumination in people with PTSD (Hayes et al, 2004). Previous studies have also shown that intrusive memories are common in PTSD as well as depression (Birrer & Michael, 2011). Although rumination is a key process in initiation and maintenance of depression symptoms, it is also as a basic principle in predicting the durability of post-traumatic stress disorder.…”

“…Although rumination is a key process in initiation and maintenance of depression symptoms, it is also as a basic principle in predicting the durability of post-traumatic stress disorder. Researchers most agree that rumination is a form of cognitive activity which penetrates in individual consciousness and plays an important role in both depression and PTSD (Birrer & Michael, 2011). Certain features of rumination like compulsion to continue rumination, the occurrence of unproductive thoughts, argument and status of questions and also feelings before and after rumination are considerably along with PTSD symptoms (Michael, Ehlers, Halligan, & Clark, 2005).…”