Depressive Rumination Research Articles

Multi-ethnic variation in the ties that bind rumination and heart rate variability: Implications for health disparities.

Higher self-reported rumination, a common form of trait perseverative cognition, is linked with lower resting heart rate variability (HRV), which indicates poorer cardiac function and greater disease risk. A meta-analysis and systematic review indicated that in samples with fewer European Americans, the association of rumination with both heart rate and blood pressure was stronger. Thus, trait rumination may be more strongly associated with resting HRV among ethnically minoritized populations. The current study investigated whether differences in the association of self-reported rumination with resting HRV varied by ethnicity in a sample (N=513; Mage=19.41; 226 Women) of self-identified African Americans (n=110), Asian Americans (n=84), and European Americans (n=319). Participants completed a five-minute baseline period to assess resting HRV, followed by the Ruminative Responses Scale, which contains three facets of rumination including brooding, depressive, and reflective rumination. On average, Asian Americans reported higher levels of rumination relative to European Americans. African Americans had higher resting HRV than Asian Americans. Adjusting for covariates, higher self-reported rumination was significantly associated with lower resting HRV in both African and Asian Americans, but not significantly so in European Americans. This finding was consistent for brooding and reflective, but not depressive rumination. Overall, this study lends insight into a psychological mechanism-rumination-that may impact health disparities among ethnically minoritized individuals, contributing to an understanding of how stress gets under the skin among such minoritized populations.

“Always Look on the Bright Side of Life”

Abstract: Most research on depressive rumination is generally related to performance deterioration. Rumination, however, may be adaptive if it is associated with reflection, improving task performance. The mechanisms responsible for improved task performance related to rumination are not well-known. Thus, this study investigated the role of effort in understanding how people, high on reflection, engage in task performance. We argue that high reflectors would be more sensitive to “effort congruent” cues than low reflectors and would, therefore, take that extra step to invest more effort, which would then be translated into improved task performance. We manipulated motivational states of effort investment (effort enhancing vs. effort minimizing) and tested the effect of individual differences in reflection on the performance of the multiple-goal task. Results showed that high reflectors (vs. low) performed better when asked to focus on tasks requiring more effort. These new insights make a meaningful contribution to the dual model theory of rumination.

Effects of Inappropriate Nurturing Experiences, Depressive Rumination, and Trait Anxiety on Depressive Symptoms.

Prior research has shown that inappropriate childhood nurturing experiences (low care and high overprotection), trait anxiety, and depressive rumination are risk factors for depression. However, no studies to date have analyzed the overall association between these factors and depressive symptoms. In the present study, we hypothesized that depressive rumination mediates the impacts of inappropriate childhood nurturing experiences on depressive symptoms, and that these mediating effects are moderated by trait anxiety, and tested these hypotheses in adult volunteers. The subjects were adult volunteers who were investigated between April 2017 and April 2018. A self-report questionnaire on demographic data, childhood nurturing experiences, trait anxiety, depressive rumination, and depressive symptoms was distributed to conduct the survey, and written informed consent and valid responses were obtained from 585 subjects. Mediation and moderated-mediation analyses were performed by SPSS 28 and macro PROCESS 4.0 software. This study was approved by the Ethics Committee of Tokyo Medical University. Parental care showed a significant negative indirect effect on depressive symptoms via its effect on depressive rumination (p < 0.01), whereas parental overprotection showed the opposite effect (p < 0.01). Furthermore, the mediation effect of depressive rumination on depressive symptoms was increased by trait anxiety (p < 0.05). Our present study demonstrated that the main factor affecting depressive symptoms is inappropriate childhood nurturing experiences, which indirectly enhance depression by intensifying depressive rumination, and that depressive rumination and trait anxiety mutually reinforce each other to enhance depressive symptoms. These findings may be useful for the prevention of depressive symptoms. Large-scale prospective studies are needed to confirm the causal associations among these factors in the future.

Electroconvulsive therapy enhances degree centrality in the orbitofrontal cortex in depressive rumination

Depressive rumination has been implicated in the onset, duration, and treatment response of refractory depression. Electroconvulsive therapy (ECT) is remarkably effective in treatment of refractory depression by modulating the functional coordination between brain hubs. However, the mechanisms by which ECT regulates depressive rumination remain unsolved. We investigated degree centrality (DC) in 32 pre- and post-ECT depression patients as well as 38 matched healthy controls. An identified brain region was defined as the seed to calculate functional connectivity (FC) in whole brains. Rumination was measured by the Ruminative Response Scale (RRS) and its relationships with identified DC and FC alterations were examined. We found a significant negative correlation between DC of the right orbitofrontal cortex (rOFC) before ECT and brooding level before and after treatment. Moreover, rOFC DC increased after ECT. DC of the left superior temporal gyrus (lSTG) was positively correlated with reflective level before intervention, while lSTG DC decreased after ECT. Patients showed elevated FC in the rOFC with default mode network. No significant association was found between decreased RRS scores and changes in DC and FC. Our findings suggest that functional changes in rOFC and lSTG may be associated with the beneficial effects of ECT on depressive rumination.

Identifying the insomnia-related psychological issues associated with hyperarousal: A network perspective

Hyperarousal, recognized as a fundamental characteristic of insomnia for decades, has yielded limited evidence concerning its direct psychological associations. This study aimed to explore the psychological factors linked to hyperarousal within the framework of interrelated variables. Two independent samples, comprising n = 917 and n = 652 young adults, were included in the study. Employing the first dataset as a discovery sample and the second dataset as a replication sample, network analyses were conducted using 26 variables derived from 17 scales. The objective was to estimate the direct and indirect associations between psychological issues, including hyperarousal and insomnia. Additionally, linear regression analysis was employed to assess the convergence of findings obtained from the network analysis. Network analyses in both samples converged to reveal direct associations between insomnia severity and several psychological factors, including negative sleep beliefs, physical fatigue, insomnia response to stress, hyperarousal, self-reported depression, and mental fatigue. Notably, the nodes with relative importance within the network include trait anxiety, depressive rumination, hyperarousal, perfectionism sub-dimension of concern over mistakes, and private self-consciousness. Hyperarousal is one of the key factors linking insomnia with a variety of psychological issues, including emotion-related factors (rumination, perveived stress), sleep-related factors (dysfunctional sleep beliefs and attitudes, insomnia response to stress, fatigue, chronotype), and self-related factors (self-consciousness, perfectionism). The results suggest that forthcoming strategies for enhancing the treatment efficacy of insomnia could consider supplementary interventions that specifically address hyperarousal, other factors directly linked to insomnia, or the hub nodes within the network.

Study protocol for a feasibility study of microinterventions in smartphone-based assessments to reduce depressive rumination

IntroductionDepression as well as suicidal ideation and behaviours share several precipitating and maintaining factors and are subject to the influence of overlapping constructs. One of these transdiagnostic constructs is rumination....

Rumination-Focused Cognitive Behavioral Therapy Reduces Rumination and Targeted Cross-network Connectivity in Youth With a History of Depression: Replication in a Preregistered Randomized Clinical Trial

BackgroundRumination-focused cognitive behavioral therapy (RF-CBT) is designed to reduce depressive rumination or the habitual tendency to dwell on experiences in a repetitive, negative, passive, and global manner. RF-CBT uses functional analysis, experiential exercises, and repeated practice to identify and change the ruminative habit. This preregistered randomized clinical trial (NCT03859297, R61) is a preregistered replication of initial work. We hypothesized a concurrent reduction of both self-reported rumination and cross-network connectivity between the left posterior cingulate cortex and right inferior frontal and inferior temporal gyri. MethodsSeventy-six youths with a history of depression and elevated rumination were randomized to 10 to 14 sessions of RF-CBT (n = 39; 34 completers) or treatment as usual (n = 37; 28 completers). Intent-to-treat analyses assessed pre-post change in rumination response scale and in functional connectivity assessed using two 5 minute, 12 second runs of resting-state functional magnetic resonance imaging. ResultsWe replicated previous findings: a significant reduction in rumination response scale and a reduction in left posterior cingulate cortex to right inferior frontal gyrus/inferior temporal gyrus connectivity in participants who received RF-CBT compared with those who received treatment as usual. Reductions were large (z change = 0.84; 0.73, respectively [ps < .05]). ConclusionsThis adolescent clinical trial further demonstrates that depressive rumination is a brain-based mechanism that is modifiable via RF-CBT. Here, we replicated that RF-CBT reduces cross-network connectivity, a possible mechanism by which rumination becomes less frequent, intense, and automatic. This National Institute of Mental Health-funded fast-fail study continues to the R33 phase during which treatment-specific effects of RF-CBT will be compared with relaxation therapy.

A - 67 Does Cognitive Set-Shifting in Multilinguals Serve as a Protective Factor against Depressive Rumination?

The purpose of this study is to assess whether multilinguals' advantage in cognitive flexibility serves as a protective factor against ruminative tendencies common in depressed mood. We compared monolinguals and multilinguals in a backward inhibition task during negative and neutral moods. It was hypothesized that monolinguals compared with multilinguals would perform worse on inhibition trials compared to control when induced into a negative mood. 96 undergraduates from Queens College, a population with high linguistic diversity, were recruited from Psychology 101 courses. Participants were monolingual (n = 47) or multilingual (2+ languages; n = 49). Participants responded to questions about their language and social background before undergoing mood induction to either neutral or negative (sad) affective states. They then completed a computerized cognitive set-shifting task measuring reaction time (RT) and accuracy. A two-way ANOVA was conducted examining the effect of mood condition and mono/multilingualism status on RT and accuracy on the set-switching task for backward inhibition trials. There was a statistically significant interaction between the effects of mood condition and mono/multilingualism on RT, F(1, 92) =6.062, p = 0.002, such that multilinguals had a higher RT compared to monolinguals when induced into a negative mood. The main effects of mono/multilingualism and mood condition were not statistically significant. Difference in accuracy between groups was not statistically significant. Contrary to our hypothesis, bilinguals took longer to respond than monolinguals in a sad mood, specifically for lag inhibition trials. Additional research is needed to determine how sociocultural factors may explain multilinguals' slowed response in a negative mood.

Depressive rumination and political engagement

ABSTRACT Rumination, or negative repetitive thinking, is a significant risk factor for depression and a common and pervasive habit of thought. Using original data from two online surveys of British adults conducted in March 2021 and February 2022, we examine associations between measures of political engagement and the two types of depressive rumination computed from Nolen-Hoeksema’s Response Styles Theory: brooding (the maladaptive component that assesses negative aspects of self-reflection) and reflective pondering (the adaptive component focused on problem-solving). We show that (1) higher brooding is associated with lower internal political efficacy and voting; (2) higher reflective pondering is associated with higher external political efficacy; and (3) reflective pondering increases voting propensity for nonpartisans but not for partisans. Thus, while maladaptive rumination is detrimental to political engagement, adaptive rumination appears to be beneficial. Our findings advance our understanding of the role of reflection in democratic citizenship.

Trait anxiety and depressive rumination mediate the effect of perceived childhood rearing on adulthood presenteeism.

Productivity loss in the workplace due to physical or mental health problems, which is called presenteeism, leads to large financial losses. Personal and work environment factors, as well as physical and mental illnesses are associated with presenteeism, but the detailed underlying mechanism remains unclear. In this study, we analyzed the effects of perceived childhood rearing on the presenteeism of adult workers, and the mediating effects of trait anxiety and depressive rumination. In 2017 and 2018, a cross-sectional paper-based survey was conducted, and written consent from 447 adult workers was obtained. Demographic information and results from the Parental Bonding Instrument, trait anxiety of State-Trait Anxiety Inventory Form Y, Ruminative Responses Scale, and Work Limitations Questionnaire were surveyed. Multiple regression analyses and structural equation modeling were conducted. The low perceived quality of rearing from parents in childhood, i.e., low care and high overprotection, indirectly worsened current presenteeism via trait anxiety and depressive rumination. Presenteeism was directly worsened by trait anxiety and depressive rumination, and the low perceived quality of rearing from parents directly affected trait anxiety and depressive rumination, and trait anxiety affected depressive rumination. The results of this study clarified the long-term influences of the low perceived quality of rearing experienced in childhood on adulthood presenteeism via trait anxiety and depressive rumination. Therefore, assessing the quality of childhood rearing, trait anxiety, and depressive rumination of individuals may help to elucidate the causes of presenteeism in the workplace, and how to manage it effectively.

Rumination as a Transdiagnostic Phenomenon in the 21st Century: The Flow Model of Rumination.

Rumination and its related mental phenomena share associated impairments in cognition, such as executive functions and attentional processes across different clinical conditions (e.g., in psychotic disorders). In recent decades, however, the notion of rumination has been increasingly narrowed to the "self-focused" type in depressive disorders. A closer review of the literature shows that rumination may be construed as a broader process characterized by repetitive thoughts about certain mental contents that interfere with one's daily activities, not only limited to those related to "self". A further examination of the construct of rumination beyond the narrowly focused depressive rumination would help expand intervention opportunities for mental disorders in today's context. We first review the development of the clinical construct of rumination with regard to its historical roots and its roles in psychopathology. This builds the foundation for the introduction of the "Flow Model of Rumination (FMR)", which conceptualizes rumination as a disruption of a smooth flow of mental contents in conscious experience that depends on the coordinated interactions between intention, memory, affect, and external events. The conceptual review concludes with a discussion of the impact of rapid technological advances (such as smartphones) on rumination. Particularly in contemporary societies today, a broader consideration of rumination not only from a cognition viewpoint, but also incorporating a human-device interaction perspective, is necessitated. The implications of the FMR in contemporary mental health practice are discussed.

Do savoring beliefs predict posttraumatic stress symptoms following stressful life events?

ABSTRACT Background and objectives Savoring beliefs refer to people’s beliefs about their ability to generate, increase, and prolong enjoyment from positive experiences. The role of these beliefs in affecting responses to negative events is largely unexplored. This study aimed to increase knowledge about the role of savoring beliefs in symptoms of posttraumatic stress (PTS) following negative life events and the incremental role of these beliefs beyond the impact of worry, depressive rumination, and neuroticism. Design A two-wave longitudinal survey. Methods Two-hundred and five students completed the Savoring Beliefs Inventory, measuring one’s ability to generate pleasure from past, present, and anticipated experiences at Time 1 (T1). Six months later (at T2), they rated adverse life-events experienced between T1 and T2 and completed measures of PTS (associated with the most distressing event experienced in this time-frame) and depression. Results Savoring beliefs at T1 were correlated with PTS total scores and PTS clusters and depression at T2. Regression analyses indicated that savoring beliefs regarding present and future (but not past) events were associated with some, but not all T2-outcomes, above and beyond worry, depressive rumination, and neuroticism. Conclusions This study confirms that increased savoring beliefs could mitigate the impact of confrontation with adverse events.

The influence of childhood emotional maltreatment on cognitive symptoms, rumination, and hopelessness in adulthood depression.

Childhood emotional maltreatment (CEM) is a risk factor for the pathogenesis of depressive disorders. However, it is not clear whether CEM is more strongly related to specific symptoms of depression and whether specific traits or cognitive states may mediate the association between CEM and depressive symptoms. In our cross-sectional study, including 72 patients with a current depressive episode, we investigated if CEM is specifically related to cognitive symptoms of depression. In addition, we evaluated whether CEM also influences the extent of rumination and hopelessness in adult depression. Using multiple regression analyses, we tested if CEM and rumination could predict cognitive symptoms and hopelessness. A structural equation model (SEM) was used to examine if rumination mediates the relationship between CEM and cognitive symptoms. Correlational analyses revealed that CEM was related to cognitive symptoms, rumination, and hopelessness. The regression analyses showed that only rumination was a significant predictor for cognitive symptoms and hopelessness, whereas CEM could not significantly predict the two constructs. SEM revealed that the association between CEM and cognitive symptoms in adult depression was mediated by rumination. Our results thereby suggest that CEM is a risk factor particularly for the development of cognitive symptoms as well as rumination and hopelessness in adult depression. However, the influence on cognitive symptomatology seems to be indirectly regulated by rumination. These findings may contribute to a better understanding of processes that promote depression, as well as provide guidance for more targeted treatment options.

The effect of biofeedback on depressive rumination and its functional correlates in the brain

The effect of biofeedback on depressive rumination and its functional correlates in the brain

Depressive rumination and trait anxiety mediate the effects of childhood victimization on adulthood depressive symptoms in adult volunteers.

Prior studies have reported that childhood victimization experiences substantially augment the risk of depression and suicide in adulthood. Several of our previous studies suggested that childhood experiences of victimization interact with the quality of parenting experienced in childhood, childhood experiences of abuse, neuroticism, and other factors to influence depressive symptoms in adulthood. In this study, it was hypothesized that "childhood victimization" worsens "trait anxiety" and "depressive rumination", and that "trait anxiety" and "depressive rumination" are mediators that worsen "depressive symptoms in adulthood". The following self-administered questionnaires were completed by 576 adult volunteers: Patient Health Questionnaire-9, State-Trait Anxiety Inventory form Y, Ruminative Responses Scale, and Childhood Victimization Rating Scale. Statistical analyses were performed by Pearson correlation coefficient analysis, t-test, multiple regression analysis, path analysis, and covariance structure analysis. Path analysis demonstrated that the direct effect was statistically significant for the paths from childhood victimization to trait anxiety, depressive rumination, and depressive symptom severity. Moreover, the indirect effect of childhood victimization on depressive rumination mediated by trait anxiety was statistically significant. The indirect effects of childhood victimization on depressive symptom severity mediated by trait anxiety and depressive rumination were statistically significant. Furthermore, the indirect effect of childhood victimization on depressive symptom severity mediated by both trait anxiety and depressive rumination was statistically significant. We found that childhood victimization directly and adversely influenced each of the above factors, and indirectly worsened adulthood depressive symptoms with trait anxiety and depressive ruminations as mediating factors. The present study is the first to clarify these mediation effects. Therefore, the results of this study suggest the importance of preventing childhood victimization and the importance of identifying and addressing childhood victimization in patients with clinical depression.

Effect of the emotional valence of autobiographical memory and parental bonding on depressive symptoms in a community sample

Retrospective perceptions of parental bonding may be a protective factor for emotional health. These perceptions are grounded in autobiographical memory, which plays a key role in the onset and maintenance of depressive symptomatology. The aim of the present study was to explore whether the emotional valence of autobiographical memories (positive and negative) and the dimensions of parental bonding (care and protection) have an impact on depressive symptomatology, examining the role of depressive rumination and possible age-related differences. A total of 139 young adults (18–28 years) and 124 older adults (65–88 years) completed the Parental Bonding Instrument, the Beck Depression Inventory (BDI-II), the Autobiographical Memory Test and the Short Depressive Rumination Scale. Our results show that positive autobiographical memories serve as a protective factor for depressive symptoms in both young and older adults. Additionally, in young adults, high paternal care and protection scores are associated with increased negative autobiographical memories, although this association has no effect on depressive symptomatology. In older adults, high maternal protection scores are directly related to greater depressive symptomatology. Depressive rumination significantly increases depressive symptoms in both young and older adults, with an increase in negative autobiographical memories in young adults, and a decrease in such memories in older adults. Our findings progress the understanding of the relationships between parental bonding and autobiographical memory with respect to emotional disorders, which, in turn, will help in the design of effective prevention measures.

Emotion dysregulation, impulsivity and anger rumination in borderline personality disorder: the role of amygdala and insula

Borderline Personality Disorder (BPD) is a severe mental disorder, characterized by deficits in emotion regulation, interpersonal dysfunctions, dissociation and impulsivity. Brain abnormalities have been generally explored; however, the specific contribution of different limbic structures to BPD symptomatology is not described. The aim of this study is to cover this gap, exploring functional and structural alterations of amygdala and insula and to highlight their contribution to neuropsychiatric symptoms. Twenty-eight BPD patients (23.7 ± 3.42years; 6M/22F) and twenty-eight matched healthy controls underwent a brain MR protocol (1.5T, including a 3D T1-weighted sequence and resting-state fMRI) and a complete neuropsychiatric assessment. Volumetry, cortical thickness and functional connectivity of amygdala and insula were evaluated, along with correlations with the neuropsychiatric scales. BPD patients showed a lower cortical thickness of the left insula (p = 0.027) that negatively correlated with the Anger Rumination Scale (p = 0.019; r = -0.450). A focused analysis on female patients showed a significant reduction of right amygdala volumes in BPD (p = 0.037), that correlate with Difficulties in Emotion Regulation Scale (p = 0.031; r = - 0.415), Beck Depression Inventory (p = 0.009; r = - 0.50) and Ruminative Response Scale (p = 0.045; r = - 0.389). Reduced functional connectivity was found in BPD between amygdala and frontal pole, precuneus and temporal pole. This functional connectivity alterations correlated with Anger Rumination Scale (p = .009; r = -0.491) and Barratt Impulsiveness Scale (p = 0.020; r = -0.447). Amygdala and insula are altered in BPD patients, and these two limbic structures are implicated in specific neuropsychiatric symptoms, such as difficulty in emotion regulation, depression, anger and depressive rumination.

Construct validity and psychometric properties of the Responses to Positive Affect (RPA) questionnaire

Previous studies confirm the role of depressive rumination in the exacerbation of negative mood. However, less is known about rumination in relation to positive affect. We present the construct validity and psychometric properties of the Responses to Positive Affect (RAP) questionnaire in a sample of 302 people from the general population (55.2% female), aged 18-68 years (M= 28.6, SD= 12.0). Exploratory and confirmatory factor analyses indicate a two-factor structure: emotion- and person-centered positive rumination (α= .88) and buffering (α= .83), both with adequate configural, metric and scalar invariance by sex. The two factors present adequate convergent, discriminant and incremental validity with constructs related to negative and positive affect. The results are discussed according to the studies reviewed and the RAP is proposed as an assessment instrument in therapeutic procedures that seek to enhance positive affect and psychological well-being.

Moderating roles of grit and locus of control on rumination and suicidality

Cognitive factors constitute an important risk factor to the development of suicidal thoughts and behaviors (STBs). Engaging in depressive and anger rumination are uniquely associated with elevated vulnerabilities to STBs. Variations in attentional focus and control may further modify the impacts of rumination. For one, grit resembles the inflexible thinking patterns inherent in rumination, potentially contributing to one's capability of persisting in carrying out suicidal behaviors despite fears of pain or death. In the context of rumination, locus of control may alter the perspectives to which individuals attribute negative experiences. The current study examines the moderating roles of grit and locus of control on the impact of depressive and anger rumination on suicidality. Participants (N = 322) completed a battery of self-report questionnaires measuring depressive rumination, anger rumination, grit, locus of control, and suicidal history (a history of suicidal ideation, history of suicidal attempts, or neither). Using hierarchical multinomial logistic regression in R, results revealed that, as opposed to working together, the proposed variables are more independently informative in distinguishing those with a history of suicidal ideation, suicidal attempts, or neither. Findings provide unique contribution to the suicide literature pertaining to how individuals may perceive of their own internal locus of control and grit following suicidal thoughts and beliefs. Clinical implications and future directions are provided as recommendations in line with current findings.

Psychological Inflexibility in Depression with Psychotic Features: A Case Report

IntroductionMajor depressive disorder (MDD) is a mood disorder that can last for weeks or even months, in which there is a depressed mood accompanied by anxiety, in addition to negative changes in cognitive functions, psychomotor movement and vegetative functions. Depression with psychotic features is a psychiatric syndrome that progresses with delusions as well as severe symptoms such as psychomotor retardation or agitation, depressive ruminations, deterioration in cognitive functions, and confusion. Compared to the subtypes without psychotic features, the symptoms are more severe, the age of onset is earlier, and the duration of the disease is longer. Feelings of guilt, worthlessness and suicidal thoughts and attempts at suicide are more common. The risk of exacerbation is greater. Diagnosis of bipolar disorder and schizophrenia is more common in first-degree relatives of these patients.ObjectivesAn 18-year-old female patient with somatic delusions and psychotic persistence that started after a sexual trauma and persisted for 1 month was consulted after organic exclusions were made. It is understood from the anamnesis that the patient had a manic episode about 6 months ago and that his mother was followed up with a diagnosis of bipolar disorder. The patient’s current clinical picture was evaluated as depression with psychotic features, and after hospitalization, the treatment was adjusted as fluoxetine 20 mg/g, olanzapine 5 mg/g, and lithium 900 mg/g. Self as context, cognitive defusion and acceptance interventions were applied to the patient.MethodsWhen the Cognitive Fusion Questionnaire(CFQ), Self-as-Context Scale(SACS), Acceptance and Action Questionnaire(AAQ-II) completed by the patient during hospitalization and in remission periods were compared, it was observed that there was a significant regression in the patient’s psychological inflexibility during the period of remission. Written informed consent was obtained from the patient whose clinical picture was presented in order to contribute to the scientific literature.ResultsDepression with psychotic features is another clinical picture in which psychological inflexibility increases, and it has been observed that interviews to increase psychological flexibility during the treatment process contribute positively to the treatment process. For this reason, the contribution to the healing process can be better clarified in further studies on interventions to increase psychological flexibility applied in addition to pharmacological treatments.Image:ConclusionsPsychological inflexibility is an effort to control a person’s emotion, thought, behavior or experience in a dysfunctional way in the face of an undesired experience. It has been seen in studies conducted in recent years that; There is a significant positive correlation between high psychological inflexibility and somatization, depression, anxiety and other psychological disorders.Disclosure of InterestNone Declared