Ruminative Thinking Research Articles

Acute Emergence of Suicidal Thoughts Following Lemborexant Initiation: An Adverse Reaction Case Report

AbstractThis is a case report highlighting the side effect of suicidal ideation with lemborexant, a novel agent approved for the treatment of insomnia. A 22-year-old man received care at an outpatient psychiatrist for the treatment of major depressive disorder, persistent depressive disorder, generalized anxiety disorder, social phobia, and insomnia. The patient also has a diagnosis of Loeys-Dietz syndrome, a connective tissue disorder. Following numerous medication trials for both depression and insomnia that resulted in partial remission of mood symptoms without improvement in sleep, he was initiated on lemborexant to address insomnia. He was noted to be denying suicidal ideation at the appointment when lemborexant was prescribed. The patient did not take lemborexant until three days after the appointment, at which time he took the recommended dose of 5 mg at bedtime for insomnia. The patient experienced drowsiness immediately following taking this dose; however, he woke up two hours later with new-onset suicidal ideation. The patient was brought to the hospital for this complaint, and the following evening had attempted suicide by hanging in his hospital room. Laboratory investigations showed normal findings in blood chemistries, complete blood count, thyroid stimulating hormone, vitamin B12 level, vitamin D level, and urine illicit drug screening. Differential diagnosis includes acute reaction to insomnia, medication-induced side effect, and major depressive disorder. He had completed trials for insomnia with zolpidem, hydroxyzine, quetiapine, nortriptyline, and trazodone prior to beginning lemborexant. The patient had no history of suicide attempts in the past, but did experience suicidal ideation following a trial of nortriptyline. In the hospital, the lemborexant was discontinued, and clonidine and clonazepam were initiated at bedtime to address insomnia and ruminative thoughts. The patient was discharged with follow-up at his outpatient psychiatrist after his suicidal ideation was in remission, as well as noted improvement in insomnia. This case highlights new-onset suicidal ideation with subsequent suicide attempt after first use of lemborexant in a patient with major depressive disorder. This case is important given lemborexant is a new medication with limited information about its efficacy and safety in major psychiatric disorders.FundingNo Funding

Investigating the appraisal structure of spontaneous thoughts: evidence for differences among unexpected thought, involuntary autobiographical memories, and ruminative thought

Involuntary thinking occurs when mental states arise without intention. Such thoughts can take different forms, such as involuntary autobiographical memories (IAM), ruminative thoughts, and unexpected thoughts—all of which are popular areas of study, albeit in somewhat disparate literatures. Despite these mental states sharing a common thread of feeling involuntary in nature, it is nevertheless unclear what separates them phenomenologically. We conducted a set of exploratory and confirmatory experiments to elucidate the appraisal dimensions behind these forms of involuntary thought, with a particular interest in understanding the phenomenology behind unexpected thoughts that are predicted to violate expectations of both timing and content. Across two experiments, we found that unexpected thoughts had unique appraisal structures compared to the other two forms of involuntary thought: they were less identifiably cued, more surprising in content and timing, and offered new information (i.e., insight). We discuss how these distinctions support recent theories regarding the nature of unexpected thought and its relation to other forms of involuntary thinking, namely IAM and ruminative thought, which are the more commonly studied forms of involuntary thinking.

Questionnaires based on natural language processing elicit immersive ruminative thinking in ruminators: Evidence from behavioral responses and EEG data.

Rumination is closely related to mental disorders and can thus be used as a marker of their presence or a predictor of their development. The presence of masking and fabrication in psychological selection can lead to inaccurate detection of psychological disorders. Human language is considered crucial in eliciting specific conscious activities, and the use of natural language processing (NLP) in the development of questionnaires for psychological tests has the potential to elicit immersive ruminative thinking, leading to changes in neural activity. Electroencephalography (EEG) is commonly used to detect and record neural activity in the human brain and is sensitive to changes in brain activity. In this study, we used NLP to develop a questionnaire to induce ruminative thinking and then recorded the EEG signals in response to the questionnaire. The behavioral results revealed that ruminators exhibited higher arousal rates and longer reaction times, specifically in response to the ruminative items of the questionnaire. The EEG results showed no significant difference between the ruminators and the control group during the resting state; however, a significant alteration in the coherence of the entire brain of the ruminators existed while they were answering the ruminative items. No differences were found in the control participants while answering the two items. These behavioral and EEG results indicate that the questionnaire elicited immersive ruminative thinking, specifically in the ruminators. Therefore, the questionnaire designed using NLP is capable of eliciting ruminative thinking in ruminators, offering a promising approach for the early detection of mental disorders in psychological selection.

The traumatic impact of the COVID-19 pandemic: the possible role of rumination and uncertainty.

The COVID-19 pandemic has caused some traumatic injuries to individuals due to the isolation, loneliness, and uncertainty it has created. Ruminative thoughts and uncertain situations are known to affect trauma. It aimed to evaluate the traumatic effect of the pandemic based on the ruminative thoughts and intolerance of uncertainty in the study. The sample for the descriptive and cross-sectional study consisted of 402 participants. Data were collected by using the questionnaire form, the Post Traumatic Stress Disorder Scale (PTSD), the Ruminative Reactions Scale (RRS), and the Intolerance of Uncertainty Scale (IUS). A positive correlation was discovered between the PTSD mean scores of the study participants and their RRS and IUS scores (p < .05). Furthermore, RRS (β = 0.280) was identified as a variable that primarily affected PTSD (p < .05). It was concluded that both ruminative thoughts and intolerance of uncertainty were predictors of post-traumatic stress disorder in the COVID-19 pandemic. Considering the possible effects of the pandemic, it is recommended to reduce the intolerance to uncertainty, to rework the ruminative thought content with appropriate and effective methods, and to create some programs for gaining problem-solving skills.

The relationships among ruminative thoughts, Gestalt contact disturbances and unfinished business

The relationships among ruminative thoughts, Gestalt contact disturbances and unfinished business

Clinical and Psychological Features of Patients With Poisoning By Antihypertensive and Antiarrhythmic Drugs as a Result of Suicidal Actions

The effective care for patients with self-poisoning with antihypertensive and antiarrhythmic drugs is associated with taking into account both clinical and adverse social, psychological and environmental stress factors. To identify their specifics, a retrospective analysis of 120 medical records and a clinical and psychological examination of 20 patients with antihypertensive and antiarrhythmic drugs self-poisoning and a comparison group of 34 patients with selfpoisoning with psychotropic drugs were carried out. It has been shown that the risk group for re-suicide in self-poisoning with antihypertensive and antiarrhythmic drugs is about 30% of patients. Risk factors are depressive symptoms that persist before discharge from the hospital, as well as dysfunctional personality traits (perfectionism in the form of increased preoccupation with the assessments of other people and frequent unfavorable comparisons with them, experiencing loneliness and isolation, increased impulsivity and a feeling of hostility from others) and unproductive ways of coping with stress (ruminative thinking or repetitive unpleasant and unproductive thoughts about anergy, lack of strength and loneliness). The results of the study and the developed psychodiagnostic complex can be used to identify targets for urgent psychological assistance and screening for the risk of re-suicide.

IL-6, homocysteine, and autism spectrum phenotypes: an investigation among adults with autism spectrum disorder and their first-degree relatives.

The importance of recognizing different kinds of autism spectrum presentations among adults, including subthreshold forms and the broad autism phenotype (BAP), has been increasingly highlighted in recent studies. Meanwhile, the possible involvement of immune system deregulation and altered methylation/trans-sulfuration processes in autism spectrum disorder (ASD) is gaining growing attention, but studies in this field are mainly focused on children. In this framework, the aim of this study was to compare plasmatic concentrations of IL-6 and homocysteine (HCY) among adults with ASD, their first-degree relatives, and healthy controls (CTLs), investigating also possible correlations with specific autism symptoms. Plasma concentrations of IL-6 and HCY were measured in a group of adult subjects with ASD, their first-degree relatives (BAP group), and healthy controls (CTL). All participants were also evaluated with psychometric instruments. IL-6 and HCY concentrations were significantly higher in the ASD group than in CTLs, while BAP subjects reported intermediate results. Significant correlations were reported between biochemical parameters and psychometric scales, particularly for the dimension of ruminative thinking. These findings support the hypothesis of a key involvement of HCY-related metabolism and immune system alteration in autism spectrum pathophysiology. HCY and IL-6 seem to show different associations with specific autism dimensions.

Exposure to negative socio-emotional events induces sustained alteration of resting-state brain networks in older adults.

Basic emotional functions seem well preserved in older adults. However, their reactivity to and recovery from socially negative events remain poorly characterized. To address this, we designed a 'task-rest' paradigm in which 182 participants from two independent experiments underwent functional magnetic resonance imaging while exposed to socio-emotional videos. Experiment 1 (N = 55) validated the task in young and older participants and unveiled age-dependent effects on brain activity and connectivity that predominated in resting periods after (rather than during) negative social scenes. Crucially, emotional elicitation potentiated subsequent resting-state connectivity between default mode network and amygdala exclusively in older adults. Experiment 2 replicated these results in a large older adult cohort (N = 127) and additionally showed that emotion-driven changes in posterior default mode network-amygdala connectivity were associated with anxiety, rumination and negative thoughts. These findings uncover the neural dynamics of empathy-related functions in older adults and help understand its relationship to poor social stress recovery.

The Effects of Group Based Cognitive Behavioral Therapy on Self-Compassion, Social Anxiety and Ruminative Thought Style of Turkish Youth Transitional Age: A Controlled Study on University Students

Abstract Background: Social anxiety disorder (SAD) occurs in social environment or performance conditions, is characterized by the fear of being negatively evaluated or showing symptoms of anxiety and usually causes avoidance behavior. It is known that that changing negative thoughts and producing alternative thoughts have an important place in the treatment of social anxiety disorder. In Cognitive Behavioral Therapy, the focus is mainly on the person's negative thoughts about himself. Group Based Cognitive Behavioral Therapy (CBGT) is frequently used therapy model in anxiety disorders, including social anxiety. The aim of this study is to examine the effect of CBGT on the social anxiety levels of university students with SAD, as well as on their ruminative thinking and self-compassion. Methods: Liebowitz Social Anxiety Scale was applied to 1200 students. 30 university students who had highest social anxiety levels were selected. The selected students were assigned to the experimental and placebo groups. CBGT was applied to the experimental group, and communication-based group therapy was applied to the placebo group. Results: There is a significant difference between pretest and posttest of the LSF and rumination levels of the experimental group. In addition, LFS and rumination post-test levels were found to differ significantly according to the group. There was no significant difference in self-compassion levels. Conclusion: The social anxiety and ruminative thinking levels of the students with social anxiety disorder who were applied cognitive behavioral group therapy decreased. No change was observed in the self-compassion levels of the individuals.

In situ fNIRS measurements during cognitive behavioral emotion regulation training in rumination-focused therapy: A randomized-controlled trial

Repetitive negative thinking (RNT), including rumination, plays a key role in various psychopathologies. Although several psychotherapeutic treatments have been developed to reduce RNT, the neural correlates of those specific treatments and of psychotherapy in general are largely unknown. Functional near-infrared spectroscopy (fNIRS) offers the potential to investigate the neural correlates of psychotherapeutic techniques in situ. Therefore, in this study we investigated the efficacy and neural correlates of a fNIRS adapted Mindfulness-based Emotion Regulation Training (MBERT) for the treatment of depressive rumination in 42 subjects with major depressive disorder (MDD) in a cross-over designed randomized controlled trial. Using psychometric measures, subjective ratings and fNIRS, we analyzed in situ changes in depressive symptom severity, ruminative thoughts and cortical activity in the Cognitive Control Network (CCN). Our results show that MBERT is effective in treating depressive symptoms and rumination. On a neural level, we found consistently higher cortical activation during emotion regulation training compared to control trials in the bilateral inferior frontal gyrus (IFG) and dorsolateral prefrontal cortex (DLPFC). Furthermore, cortical oxygenation decreased from session to session in the bilateral DLPFC. The relevance of the results for the psychotherapeutic treatment of MDD as well as further necessary investigations are discussed.

Rumination Thinking and Adolescent Depression: the Moderating Role of Coping Styles and Gender

Rumination Thinking and Adolescent Depression: the Moderating Role of Coping Styles and Gender

Mindfulness for the self-management of negative coping, rumination and fears of compassion in people with cancer: An exploratory study.

Cancer and its treatments have the potential to significantly impact mental health, provoking feelings of anxiety, depression, and distress, which can last long after treatment is over. One of the most rapidly emerging influences in the healthcare field is mindfulness-based interventions (MBIs), which are designed to cultivate present moment awareness, attentional flexibility, compassion and acceptance, to reduce physical and psychological distress. However, there is limited research into the efficacy of MBIs or disease specific MBIs in shifting negative coping, ruminative thinking and fears of compassion as primary outcomes in individuals with cancer. This exploratory study was designed to evaluate inter- and intra-individual change in the management of negative coping, rumination and fears of compassion, following a cancer-specific mindfulness-based intervention. A single group, non-experimental, repeated measures study of 22 participants across six cancer care centres explored the efficacy of an 8-week Mindfulness-Based Cognitive Therapy for Cancer (MBCT-Ca) course. The Reliable Change Index (RCI) examined reliable clinical improvement, deterioration, or no change in individuals on the Mental Adjustment to Cancer Scale (MACS), the Ruminative Responses Scale (RRS) and the Fears of Compassion Scale (FCS). About 82% of participants (n=18) saw an improvement in at least one measure. A significant decrease in primary outcome scores was observed in negative coping, ruminating and fears of self-compassion. There were significant correlations between the fear of self-compassion and depressive ruminating, fear of accepting compassion from others and showing it to others pre and post intervention. Our findings indicate that the MBCT-Ca programme may significantly reduce negative coping, ruminating and fears of self-compassion improving psychological health and wellbeing in cancer survivors.

Alteration of whole-brain amplitude of low-frequency fluctuation and degree centrality in patients with mild to moderate depression: A resting-state functional magnetic resonance imaging study.

Mild to moderate depressive disorder has a high risk of progressing to major depressive disorder. Low-frequency amplitude and degree centrality were calculated to compare 49 patients with mild to moderate depression and 21 matched healthy controls. Correlation analysis was conducted to explore the correlation between the amplitude of low-frequency fluctuation (ALFF) and the degree centrality (DC) of altered brain region and the scores of clinical scale. Receiver operating characteristic (ROC) curves were further analyzed to evaluate the predictive value of above altered ALFF and DC areas as image markers for mild to moderate depression. Compared with healthy controls, patients with mild to moderate depression had lower ALFF values in the left precuneus and posterior cingulate gyrus [voxel p < 0.005, cluster p < 0.05, Gaussian random field correction (GRF) corrected] and lower DC values in the left insula (voxel p < 0.005, cluster p < 0.05, GRF corrected). There was a significant negative correlation between DC in the left insula and scale scores of Zung's Depression Scale (ZungSDS), Beck Self-Rating Depression Scale (BDI), Toronto Alexithymia Scale (TAS26), and Ruminative Thinking Response Scale (RRS_SUM, RRS_REFLECTION, RRS_DEPR). Finally, ROC analysis showed that the ALFF of the left precuneus and posterior cingulate gyrus had a sensitivity of 61.9% and a specificity of 79.6%, and the DC of the left insula had a sensitivity of 81% and a specificity of 85.7% in differentiating mild to moderate depression from healthy controls. Intrinsic abnormality of the brain was mainly located in the precuneus and insular in patients with mild to moderate depression, which provides insight into potential neurological mechanisms.

The portuguese version of the Emotion Regulation of Others and Self (EROS) in a clinical sample: psychometric properties and measurement invariance across sex

The Emotion Regulation of Others and Self Scale (EROS) is commonly used to measure individual differences in the use of strategies to regulate one’s own and other people’s emotions. This study aimed to examine its psychometric properties and measurement invariance across sex in a Portuguese clinical sample. For this purpose, we tested the factorial structure of the EROS in a sample of 390 adults (259 women; Mage = 34.33; SD = 9.99) undergoing active psychotherapy in a private clinic. The confirmatory factor analysis showed that the four-factor solution proposed by the original authors (intrinsic affect-improving, intrinsic affect-worsening, extrinsic affect-improving and extrinsic affect-worsening) fitted well to our data. Invariance across sex was determined by using multi-group analyses. Additionally, reliability analysis indicated good coefficients for all the dimensions. The pattern of associations of the EROS subscales with dispositional mindfulness, ruminative thinking, psychological inflexibility, emotional intelligence, and psychopathological symptoms were examined. As expected, small to moderate correlations were found evidencing the convergent construct validity of the EROS. Findings suggest that the EROS is a psychometrically sound approach for assessing individual differences in emotion regulation in clinical samples.

The impact of rumination on life satisfaction of hotel employees during the COVID-19 pandemic: the mediating role of fear of COVID-19 and the moderating role of sedentary lifestyle.

It is important to determine the individual factors that cause the differentiation of negative reactions of individuals due to epidemics. The purpose of this study is to investigate the moderating role of a sedentary lifestyle and the mediating role of fear of COVID-19 on the relationship between rumination and life satisfaction. Intense rumination is known to have a negative impact on individuals' life satisfaction levels. Very little is known about variables that may mediate and moderate this relationship. The study was conducted with staff members of five-star accommodation establishments in Turkey. Data were collected with a quantitative research method via questionnaires, completed by 386 full-time employees. The results show that rumination negatively affects life satisfaction, and fear of COVID-19 has a mediating role between rumination and life satisfaction. In addition, the study concluded that a sedentary lifestyle moderated the indirect effect of rumination on life satisfaction through fear of COVID-19. This finding indicates that the negative impact of rumination on life satisfaction, mediated by fear of COVID-19, decreased, as the active lifestyle level of employees increased. The results indicate the importance of active lifestyles in reducing negative impacts of the fear of being infected with a disease during times of crisis such as outbreaks and ruminative thoughts on lifestyle. The findings of this study provide substantial contributions with respect to how outbreak-related negative reactions occur and differ.

Relationships Among Rumination, Resilience, Mindfulness, and Perceived PTSD Symptoms in Military Veterans Returning to College: A Cross-Sectional Study.

The influx of military Veterans with posttraumatic stress disorder (PTSD) returning to college following active military service presents an unmanageable trend for many secondary educational institutions in the United States. The current study aimed to determine relationships among rumination, resilience, mindfulness, and perceived PTSD symptoms in college student Veterans. To this end, 133 college student military Veterans registered in a U.S. university responded to an online survey. Results revealed that rumination has a direct effect on perceived PTSD symptoms and mediates the relationship between mindfulness and perceived PTSD symptoms, and that resilience moderates the relationship between mindfulness and perceived PTSD symptoms through rumination as the mediator. These findings imply that designing and developing mindfulness-based interventions for college student Veterans with PTSD requires concerted efforts targeted at improving ruminative thinking and enhancing resilience. [Journal of Psychosocial Nursing and Mental Health Services, 61(6), 43-50.].

The Relationship between Depressive Symptoms, Rumination, and Suicide Ideation in Patients with Depression.

A cross-sectional study of 95 subjects with depression recruited intentionally from the psychiatric ward of Tzu Chi Hospital. The questionnaire included demographic data, the Beck Depression Inventory-II, the Ruminative Response Scale, and the Beck Scale for Suicide Ideation. Independent sample t-test, Pearson product difference correlation, and the stepwise regression test were adopted for data analysis. Age (r = -0.41, p &lt; 0.01), age at diagnosis (r = -0.34, p &lt; 0.01), and sleep duration (r = -0.25, p &lt; 0.05) were negatively correlated with rumination-reflection. The depressive symptoms (r = 0.72, p &lt; 0.01) were positively correlated with rumination, whereas rumination (r = 0.57, p &lt; 0.01) and suicide ideation were positively correlated. Depressive symptoms and rumination could predict suicide ideation, and the effective explanatory power reached 60%. If the patient with depression was younger or the patient was diagnosed at a younger age, the depressive symptoms of the reflection subscale of rumination thinking and suicide ideation were more serious. Our results indicate that clinicians who care for patients with depression should be aware of rumination and its impact on suicide ideation, specifically in younger patients.

When Thoughts Have No Off Switch: The Cost of Telepressure and Message-based Communication behaviour within Boundary-crossing Contexts.

Communication technology enables employees to be constantly connected at the cost of potentially blurring the boundaries between work and private life, which can be detrimental to their well-being. The present study utilised a quantitative diary approach (N = 269 employees, N = 1256 data points) to provide further evidence on the association between telepressure and ruminative thoughts within boundary-crossing contexts (i.e., including work-related behaviour and cognitions during leisure time as well as private-related behaviour and cognitions at work). On a day-to-day level, we examined if context-incongruent telepressure had a positive effect on context-incongruent affective rumination through context-incongruent message-based communication behaviour. Multilevel analyses supported our hypothesised mediation models. Altogether, findings reveal that quickly replying towards messages or its related cognition (i.e., telepressure) may result in a resource-draining experience in terms of affective rumination within both boundary-crossing contexts. Theoretical and practical implications as well as future research avenues are discussed.

Positivity and Post-Traumatic Stress Disorder (PTSD) in COVID-19 Survivors: Mediating Role of Rumination and Fear of COVID-19.

COVID-19 pandemic, which still continues to affect the whole world, has led to an increase in PTSD symptoms in societies, especially individuals who have been diagnosed with the disease and recovered are at significant risk for PTSD have been reported. Although it has been observed that PTSD symptoms of individuals who were infected in the past epidemics such as SARS and Ebola continued for a long time even after the epidemic, it is noteworthy that the studies conducted during the COVID-19 process do not focus enough on people who survived the COVID-19 disease. The purpose of this study is to determine the direct and indirect impact of positivity on PTSD symptoms of individuals who have recovered from COVID-19 and the role of rumination and fear of COVID-19 as potential mediators in this effect. In the study, the Impact of Event Scale-Revised, Ruminative Response Scale, Positivity Scale, and Fear of COVID-19 Scale were applied to 551 Turkish participants, who survived the COVID-19 disease. SEM-based mediation analysis was used to test hypothesized relationships. Mediating roles of fear of COVID-19 and rumination between positivity and PTSD were tested. Results indicated that rumination and fear of COVID-19 had a full mediating role in the relationship between positivity and PTSD. These findings pointed out that positivity might be an indirect protective disposition against COVID-19-related PTSD and might reduce risk factors associated with PTSD among COVID-19 survivors. Mental health practices for COVID-19 patients should aim to increase positive thinking, since they have ruminative thoughts about transmission of the virus and hospitalization process and these thoughts may lead to negative mental health conditions. In this sense, positive psychology-focused implementations can be organized for COVID-19 patients and survivors.

Impact of caregiver burden on caregiver mental health in patients with esophageal cancer: chain mediating effects of benefit finding and rumination, a cross-sectional study.

Cancer caregivers are the main supporter for the tumor patients, they not only need to provide daily nursing to the patients, but also suffering the pressure from economy, emotion and even family members. The mental health of tumor patient is mostly noticed, while not caregivers. The mental health of caregiver greatly affected the nursing quality and even the treatment outcomes. In the current study, the mechanisms underlying the links between caregiver burden, benefit finding, mental health, and rumination in those caring for people with esophageal cancer were examined. The study was using a convenience sampling, 166 esophageal cancer patients in 2 general hospitals in Jiangsu Province, China, and caregivers of patients were included after excluded the non-conforming patients. Data were collected using investigator-developed questionnaires, the Benefit Finding Scale (BFS), the Event-Related Rumination Inventory (ERRI), the Zarit Burden Interview (ZBI), and the Hospital Anxiety and Depression Scale (HADS) during May 2020 to December 2020. The results were analyzed by SPSS, and the chain mediating effect was analyzed by the the SPSS PROCESS Macro Model. The study comprised 166 caregivers with an average age of (59.96±11.48) years, most of them were female (85.5%). The ZBI was positive correlated with HADS (r=0.882, P<0.01), and negative correlated with BFS (r=-0.873, P<0.01). Intrusive rumination and deliberate rumination in caregivers were negatively correlated (r=-0.901, P<0.01) and positive correlated (r=0.904, P<0.01) with BFS scores, respectively. Furthermore, research have discovered a chain mediation impact of benefit finding and rumination between caregiver burden and psychological well-being among carers of esophageal cancer patients. The findings of this study imply that benefit finding and rumination are crucial components of the coping strategy used to buffer against negative emotion (such as anxiety and depression). Therefore, the mental health of caregivers should also be noticed, and health care professionals should provide targeted interventions to increase the caregiver's level of benefit finding and promote deliberate ruminative thinking.