رابطه بین نشخوار فکری، اجتناب و افسردگی در نمونه غیر بالینی

Recent commentaries have proposed conceptualizations of rumination in terms of both cognitive and behavioral avoidance. This study examined the relationship between rumination, avoidance and depression using a newly developed self-report measure of avoidance in depression, the Cognitive-Behavioral Avoidance Scale (CBAS) [Ottenbreit, N.D., & Dobson, K.S. (2004). Avoidance and depression: The construction of the cognitive-behavioral avoidance scale. Behaviour Research and Therapy, 42, 293–313]. A non-clinical sample (N=104) of undergraduate students completed self-report measures of depression, anxiety, rumination and avoidance. Rumination, avoidance and depression were all significantly correlated. Rumination and behavioral avoidance remained intercorrelated when anxiety was controlled, confirming an association that is independent of anxiety. By contrast, the relationship between cognitive avoidance and rumination disappeared when anxiety was partialled out. Notably, avoidance predicted unique variance in depression scores, over and above anxiety and rumination. Consistent with the proposal of Ottenbreit and Dobson [Avoidance and depression: The construction of the cognitive-behavioral avoidance scale. Behaviour Research and Therapy, 42, 293–313], our findings support the value of clinicians and psychopathologists giving consideration to avoidance in their conceptualization of depression.

Avoidance, in an array of forms, is central to the conceptualization and diagnostic criteria of DSM-IV Axis I anxiety disorders (American Psychiatric Association (APA), 1994). For example, in posttraumatic stress disorder (PTSD), an individual may avoid situational and contextual reminders of a traumatic event, may use strategies such as thought suppression to cognitively avoid trauma-related content, and may engage in behaviors (e.g., abuse drugs or alcohol) in order to avoid emotional and affective responses to the trauma. In the short term, avoidance functions to reduce distress; in the long term, avoidance contributes to the maintenance of anxiety. Accordingly, cognitive-behavioral treatment protocols for anxiety disorders emphasize exposure-based approaches to counter cognitive and behavioral avoidance. The construct of avoidance has received less consideration in the context of depression. As noted in recent commentaries (Ottenbreit & Dobson, 2004; Martell, Addis, & Jacobson, 2001), Ferster (1973) outlined the role of avoidance in a functional analysis of depression. The thesis of Ferster's model is that depressed individuals engage in avoidance and escape behaviors (e.g., making complaints, withdrawing), in addition to reduced frequency of positively reinforced behavior. As noted by Ottenbreit and Dobson (2004), the literature has only recently seen renewed theoretical and clinical interest in the role of avoidance in the clinical conceptualization of depression. The development of Behavioral Activation as a treatment for depression (BA; Jacobson, Martell, & Dimidjian, 2001; Martell et al., 2001) reflects this revived interest. The theoretical basis of BA is that depression is characterized by dysfunctional patterns of avoidance, withdrawal and inactivity. Driven by this model, the emphasis of BA intervention is on teaching clients strategies to counter their problematic behavioral patterns. This approach represents a notable departure from traditional cognitive therapy for depression (e.g., Beck, Rush, Shaw, & Emery, 1979), in which depressogenic thought content and maladaptive patterns of thinking are the central focus of treatment. The BA model acknowledges the role of ruminative thinking in depression. Rumination is conceptualized as ‘ … an escape or avoidance behavior. It keeps the individual separated from others and prevents true problem solving’ (Martell et al., 2001, p. 121). Although rumination is distinctive in form from other (perhaps more obvious) types of avoidant behaviour (e.g., social withdrawal), the BA framework proposes that the function of both may be the same. That is, rumination similarly functions to avoid active engagement with the environment, and to avoid engaging in active problem solving. Proponents of the BA framework propose that rumination is potentially reinforced in two main ways; first, complaints about life circumstances may be reinforced by others in the depressed person's environment, and/or second, by operating as an alternative to actively addressing problems, thereby avoiding dealing with difficult circumstances and the distress that may be associated with doing so (Martell et al., 2001). Arguably the most influential and most-researched model of rumination is the response styles theory of depression (Nolen-Hoeksema, 1991; Just & Alloy, 1997). This model posits that the duration, severity and course of depressive illness are a consequence of how one responds to depressive symptoms; specifically, individuals who ruminate about the causes and implications of symptoms are more likely to become depressed and remain depressed for longer. Prospective studies support the role of depressive rumination in the onset (Nolen-Hoeksema, Morrow, & Fredrickson, 1993) and maintenance (Nolen-Hoeksema, 2000) of depression. Experimental studies have linked rumination to a range of cognitive correlates of depression, including impoverished problem solving (Lyubomirsky & Nolen-Hoeksema, 1995; Watkins & Moulds, 2005) overgeneral autobiographical memory (Watkins & Teasdale, 2004; Watkins, Teasdale, & Williams, 2000) and negative cognition (Lavender & Watkins, 2004). These studies found impaired performance in these domains in dysphoric and clinically depressed participants who received a rumination induction compared to a distraction induction prior to the completion of the experimental tasks, confirming a role of rumination in the maintenance of depression-related deficits. A recent development in the rumination field is the attempt to dismantle the rumination construct (e.g., Treynor, Gonzalez, & Nolen-Hoeksema, 2003; see also Watkins, 2004; Watkins & Moulds, 2005) in an attempt to specify the maladaptive component of this cognitive process. For example, a recent factor analysis (Treynor et al., 2003) of the gold standard measure of rumination, the Ruminative Response Scale (RRS; Nolen-Hoeksema & Morrow, 1991) identified that this measure indexes two distinct factors, labeled by the authors as brooding and reflection. Treynor et al. (2003) proposed that the items that comprise the brooding factor index a tendency toward moody pondering (e.g., Think about a recent situation, wishing it had gone better), while the reflection factor captures a tendency to contemplate and reflect (e.g., Go someplace alone to think about your feelings). Interestingly, these factors appear to have differential relationships with depression. Treynor et al. (2003) found that brooding was associated with greater depression concurrently and longitudinally, while reflection was associated with greater concurrent depression but less depression over time. Although preliminary, this finding suggests that the brooding factor may be most closely linked to the maladaptive outcomes of rumination. In accord with the BA model, the proposal that rumination serves an avoidance function has also been advanced from a cognitive perspective. On the basis that rumination and worry share overlapping features (Segerstrom, Tsao, Alden, & Craske, 2000; Watkins, Moulds, & Mackintosh, 2005), Watkins and Moulds (2004) drew on Borkovec and colleagues’ avoidance theory of worry (Borkovec, Ray, & Stober, 1998; Stober & Borkovec, 2002) to account for the maintenance of rumination. This model contends that ‘the function of worry is to escape aversive imagery’ (Stober, 1998, p. 753). On the grounds that worrisome thought is predominantly verbal (rather than image-based), this model proposes that, by avoiding aversive imagery, worry limits somatic and physiological arousal associated with problem content. Further, Stober (1998) and Borkovec et al. (1998) specify that it is the reduced concreteness of this imagery that impedes the activation of associated physiological responses. That is, if worries are more abstract and less concrete and specific in nature, they are less likely to evoke distressing imagery, and, in turn, to evoke corresponding somatic responses. As a result, problems remain unresolved, and worry persists. The utility of this model in accounting for the maintenance of rumination in depression has been proposed (Watkins & Moulds, 2004). Rumination has similarly been conceptualized as a cognitive avoidance strategy in the context of posttraumatic stress, such that individuals engage in rumination to avoid processing their anxiety-eliciting trauma memories (Ehlers & Steil, 1995). Although the proposal here is that rumination promotes cognitive and affective avoidance, this suggestion concurs with the BA conceptualization of rumination as serving an avoidant function. A related line of recent research has examined the role of avoidance in depression by exploring whether differential motivational systems (i.e., approach versus avoidance goals) underlie anxiety and depression (Dickson & MacLeod (2004a) and Dickson & MacLeod (2004b)). The theoretical basis for this work was Gray's (1982) suggestion of two affect-motivational systems—the behavioral inhibition (aversive, or punishment-driven) system, and behavioral activation (appetitive, or reward-driven) system. Employing this framework, Fowles (1994) proposed that depression and anxiety are characterised by high behavioral inhibition but low behavioral activation. Dickson & MacLeod (2004a) and Dickson & MacLeod (2004b) tested this proposal in adolescent samples. Counter to prediction, in both studies anxiety (but not depression) was correlated with avoidance goals. The authors concluded that depression and anxiety are characterized by distinctive patterns of goal motivation. The finding that avoidance goals were not a feature of the motivational underpinnings of depression is inconsistent with the proposal that depression is associated with avoidance (e.g., Martell et al., 2001). Thus, the association between avoidance and depression remains unclear. Further research is needed to clarify the theorized role that avoidance plays in depression. In accord with the renewed focus on avoidance in depression, Ottenbreit and Dobson (2004) developed and validated the Cognitive-Behavioral Avoidance Scale (CBAS). This self-report instrument indexes avoidance across four factors: behavioral-social, behavioral-nonsocial, cognitive-social, and cognitive-nonsocial. This measure provides clinicians and researchers working in the field of depression with a useful self-report instrument that taps avoidance across these four key domains. To our knowledge, apart from the original validation study, the CBAS has not been employed in any studies in the published literature. In their 2004 paper, Ottenbreit and Dobson (2004) called for follow-up research to examine the interrelationship of avoidance and other established cognitive correlates of depression, such as rumination. Accordingly, our objective in this study was to conduct a preliminary investigation of the association between rumination and avoidance in a non-clinical sample. On the premise that rumination functions as a form of cognitive avoidance (Watkins & Moulds, 2004), we predicted that rumination would correlate positively with the cognitive avoidance subscales of the CBAS. Given preliminary evidence that the brooding component of rumination is most strongly associated with depression (Treynor et al., 2003), we further hypothesized that brooding would be more strongly correlated with avoidance than would reflection. Similarly, a positive correlation between rumination (and in particular, brooding) and the behavioral subscales of the CBAS was hypothesized, in line with the conceptualization of rumination as an avoidance response (Martell et al., 2001).