نشخوار فکری، نگرانی،اجتناب شناختی واجتناب رفتاری : بررسی اثرات زمانی

Recently, cross-sectional research has demonstrated that depressive rumination is significantly associated with the tendency to engage in cognitive and behavioral avoidance. This evidence suggests that rumination may be the result of attempts to avoid personally threatening thoughts, in a manner suggested by multiple contemporary theories of worry. This investigation examined the temporal relationship among daily levels of cognitive avoidance, behavioral avoidance, rumination, worry, and negative affect. Seventy-eight adolescents completed baseline questionnaires and then electronically completed daily measures of rumination, worry, behavioral avoidance, and cognitive avoidance, as well as sad and anxious affect for 7 days. Lagged-effect multilevel models indicated that increases in daily sadness were predicted by greater daily rumination and cognitive avoidance. Increases in daily anxiety were predicted by greater daily rumination, worry, and both cognitive and behavioral avoidance. Further, both daily rumination and worry were positively predicted by daily cognitive, but not behavioral, avoidance. Mediation analyses suggested that rumination mediated the effect of cognitive avoidance on both sadness and anxiety. Also, worry mediated the effect of cognitive avoidance on anxiety. Implications for models of avoidance, rumination, and worry are discussed.

The response styles theory (Nolen-Hoeksema, 1991) posits that the propensity to respond to feelings of sadness by ruminating, or passively and repetitively thinking about causes and consequences of problems, is a risk factor for depression. Research supports the notion that rumination leads to several negative outcomes, most notably depression (see Nolen-Hoeksema, Wisco, & Lyubormirsky, 2008, for a review). This work also suggests that individuals continue to ruminate despite the resulting negative consequences. Thus, it is important to further explore the function and motivations driving ruminative thought in order to inform prevention and treatment efforts that target this vulnerability. Recent research has drawn parallels between rumination and worry in order to further understand the persistence of rumination (Fresco et al., 2002 and Segerstrom et al., 2000). Furthermore, research has demonstrated that worry serves to exacerbate anxiety and, as is the case with rumination, worriers continue to worry despite the negative repercussions. Borrowing from avoidance theories of worry (Borkovec, 1994), researchers have begun to question whether avoidance is also central to the maintenance of rumination. The current study sought to investigate the temporal associations among rumination, behavioral avoidance, cognitive avoidance, and dysphoric affect. Further, this investigation sought to examine whether the associations among avoidance, rumination, and sadness differ from the associations among avoidance, worry, and anxiety. With respect to rumination, Nolen-Hoeksema (1991) proposed the response styles theory of depression, which posits that the tendency to engage in ruminative thought represents a stable risk factor for depressive disorder. This theory has received a great deal of support in empirical tests. Experimental studies have repeatedly demonstrated that ruminative tasks, as opposed to distracting tasks, maintain dysphoric affect (Butler and Nolen-Hoeksema, 1994 and Nolen-Hoeksema and Morrow, 1993). Further, prospective research has shown that the tendency to ruminate is predictive of depressive symptoms and new onsets of major depressive episodes (Nolen-Hoeksema, 2000 and Robinson and Alloy, 2003). Prospective investigations have also supported the stability of individual tendencies to ruminate (Just and Alloy, 1997 and Roberts et al., 1998). Researchers have also extended the response styles theory to the study of depression among adolescents. Overall, this work has demonstrated an association between rumination and depression both concurrently and prospectively (Abela et al., 2002 and Abela et al., 2004). Evidence also suggests that the use of ruminative coping increases from pre- to late adolescence (Hampell & Petermann, 2005) and that higher levels of rumination are associated with more severe levels of depressive symptoms among depressed adolescents (Kuyken, Watkins, Holden, & Cook, 2006). This research demonstrates that ruminative adolescents experience the same negative outcomes, including the development of depressive symptoms and increased severity, as ruminative adults. Given the longitudinal continuity of depression and the marked increase in risk associated with adolescence, understanding the origin and maintenance of rumination in this developmental period is essential. Furthermore, a normative adolescent sample provides particular advantages in the examination of avoidance models of depression. First, a normative sample avoids the potential restriction of range on vulnerability measures that could be encountered with a universally depressed sample. Second, in order to study the vulnerabilities that ultimately lead to depression, it is important to utilize young, high-risk samples that have not yet experienced repeated major depressive episodes. Given the deleterious effects that result, why do some adolescents persist with engaging in ruminative thought? Differing explanations for the motivations maintaining ruminative responses have been offered since the initial proposition of the response styles theory. Nolen-Hoeksema (1991) initially conceived of ruminative responses as “purposeful styles of responding to or trying to cope with negative mood in the perpetuation of that mood” (p. 570). Thus, rumination may be considered volitional or a coping process where people purposefully and cognitively engage their problems and feelings of distress, possibly out of a mistaken belief that rumination promotes greater insight and adjustment ( Lyubomirsky & Nolen-Hoeksema, 1993). However, recent research has challenged the suggestion that rumination is motivated by a desire to engage one's feelings of distress. In fact, repetitive thought that more directly and concretely engages such concerns appears less likely to result in depression when compared to rumination that is more abstract and removed ( Watkins & Moulds, 2005). Such concrete rumination on stressful thoughts may even be adaptive (see Watkins, 2008, for a review). It is possible that rumination may be better thought of as a maladaptive style of cognitive disengagement or avoidance of one's specific troubles. From this perspective, rumination may be functionally similar to worry, another form of unconstructive repetitive thought. Akin to rumination, worry tends to be passive, vague, and does not involve active problem solving or coping (Borkovec, Ray, & Stöber, 1998). However, despite their similarities, research has demonstrated that worry and rumination are distinct constructs (e.g., Watkins, Moulds, & Mackintosh, 2005). Generally, worry tends to be future oriented in anticipation of possible threats or problems, whereas rumination tends to focus on past events, feelings of sadness, or problems. Such worries can become debilitating and give rise to generalized anxiety disorder. In his highly influential theory of this disorder, Borkovec (1994) emphasized understanding worry as being driven by avoidance. That is, individuals may engage in excessive worry in order to prepare for threat and suppress the psychological and physiological experiences of anxiety. Since then, several theories examining the relationship between emotional dysfunction and the use of worry have conceptualized worry as an avoidance strategy (see Newman & Llera, 2011, for a review). Though the precise role of avoidance in worry has yet to be fully delineated, these theories each recognize avoidance as central to the prediction and maintenance of worry. This avoidance perspective on worry is now playing an influential role on current theories of rumination. In contrast to earlier writings emphasizing coping or active attempts to think about one's problems, Nolen-Hoeksema and colleagues (2008, p. 410) recently characterized rumination as a process that people may utilize “to escape from aversive self-focus by suppressing negative feelings and thoughts cognitively or by engaging in behaviors to avoid self-awareness.” Thus, this perspective proposes that a primary motivator of rumination is avoidance or escape. However, Nolen-Hoeksema and colleagues hypothesized that rumination and worry serve different avoidant functions. Whereas worry is associated with cognitive avoidance of negative thoughts, rumination may be associated with cognitive focus on these thoughts. The authors speculated that rumination's function may be to motivate behavioral withdrawal and behavioral avoidance, rather than the cognitive avoidance of worry. Moulds, Kandris, Starr, and Wong (2007) examined the association among avoidance, rumination, and depression. This cross-sectional study revealed significant correlations among cognitive avoidance (similar to thought suppression), behavioral avoidance (similar to behavioral withdrawal), rumination, and depressive symptoms. Similar cross-sectional results were found in an examination of rumination, depression, and experiential avoidance (Cribb, Moulds, & Carter, 2006), an avoidance of unwanted internal events. Although these results suggest that avoidance is an important aspect of both depression and rumination, the correlational designs preclude causal inference. The prospective design employed in the present study allows examination of whether cognitive or behavioral avoidance predicts rumination or whether avoidance is predicted by prior levels of rumination. Further, the use of daily measurements in this study permitted examining the potential interplay between rumination and both cognitive and behavioral avoidance that has yet to be examined in previous studies. Recent research has also examined the temporal relationship between rumination and depression. In a longitudinal investigation, Spasojevic and Alloy (2001) found that rumination mediated the relationship between depression-related vulnerabilities and subsequent depressive episodes. The authors argued that the tendency to engage in rumination was a proximal mechanism through which common depression-related risk factors affect depression. As such, this study examines rumination as a possible mediator of the temporal relationship between avoidance and sadness. Furthermore, Moberly and Watkins (2008) examined the relationship between dispositional rumination and experiences of negative affect, measured several times per day over the course of 1 week. Their results demonstrated that rumination predicted subsequent increases in negative affect. From this work, we examine the possibility that rumination predicts subsequent increases in sadness and anxiety.