Is there a relationship between depression and rumination?

¿There is a relationship between depression and psychological rumination (the tendency to have recurring thoughts that we can't get out of our heads)? Various studies have attempted to reveal the answer to this question. In this article we bring you a theory that explains in detail the relationship between depression and a ruminative style, the Susan Nolen-Hoeksema theory.

In addition, we turned to a review that analyzes the conclusions of 59 functional neuroimaging studies, and we specify the results they reached on this issue.

• Related article: "Types of depression: its symptoms, causes and characteristics"

Relationship between depression and rumination: the Nolen-Hoeksema theory

If we investigate within the group of explanatory theories of depression, we find one of them that establishes a relationship between depression and rumination. This is the theory of response styles, proposed by Susan Nolen-Hoeksema (1959 - 2013) in the year 1991. Nolen-Hoeksema was an American professor of psychology at Yale University (United States).

Specifically, what Nolen-Hoeksema says in her theory of response styles is that there are certain factors that determine the course of depression; These factors have to do with the way in which the subject responds to the first symptoms of depression. This response, also called "ruminative style," influences how long the depression lasts and how severe it is.

Thus, specifying even more, the author explains that a ruminative response style in depression maintains or exacerbates its symptoms.

That is, according to this author, the relationship between depression and rumination is as follows: rumination of depressive symptoms makes depression chronic, in addition to exacerbating its symptoms on certain occasions. The opposite occurs with an active style based on distraction or problem solving.

Ruminative response style

But what is a ruminative response style? It consists of the mental process of focusing our attention on the symptoms of the disorder and their implications in our person, without doing anything to alleviate said symptoms.

In other words, it is a process from which coping strategies are not implemented; in simpler words, it is about “thinking about” things, without stopping thinking about them, worrying about them, without taking care of them or doing anything to change them. It would be like “entering a loop”.

On the other hand, the author of the theory that postulates a relationship between depression and rumination, attributes the origin of the ruminative style to childhood learning by modeling (through models, for example parents, who also show a ruminative style), added to practices of socialization that do not provide the person with a repertoire of more adaptive behaviors, necessary to face the depression. Thus, these two factors would explain the origin of the ruminative style.

• You may be interested in: "Rumination: the annoying vicious circle of thought"

How does rumination influence depression?

S. Nolen-Hoeksema goes further with his theory to understand the relationship between depression and rumination, and he proposes a series of mechanisms that would explain the negative effects of the ruminative style on the depression. What are these mechanisms? There are four:

1. vicious circles

The first mechanism that explains why a ruminative style in depression leads to negative effects for the person has to do with vicious cycles, which occur between depressed mood and negative cognitions.

Thus, we enter a "loop" in the following way: our state of mind is depressed, which affects our thinking with more negative cognitions; in turn, these cognitions increase depressed mood (and both feed off each other).

2. No generation of effective solutions

On the other hand, another of the mechanisms that explains the relationship between depression and rumination is the decrease in effective solutions to day-to-day problems.

That is, we generate fewer effective solutions to problems (or even none at all), since instead of thinking about these solutions, we think about the problems (ruminative style).

3. Interference

The fourth of the mechanisms that allows us to understand the relationship between depression and rumination is the interference that occurs with instrumental behaviors that would provide us with positive reinforcementas well as a feeling of control.

That is, the ruminative style makes it difficult for these behaviors to appear (or interferes with their functioning), in addition to prevent the sense of control necessary in depressive disorders and that would allow us to advance within the disorder.

4. Weakening of social support

Finally, there is a weakening of social support, which translates into rejection by others, or even criticism of oneself.

This is logical to understand since, when our interpretation of reality and our coping mechanism in the face of life are based on a constant ruminative style, in the end the people around us get tired of these behaviors and move away, because they see that we do nothing to deal with depression (neither seeking help, nor relativizing things or giving them the importance they deserve, nor recognizing that we have a problem…).

Research and results

Following Susan Nolen-Hoeksema's theory, which supports a relationship between depression and rumination, a series of experimental studies on ruminative responses were carried out. Their results were as follows.

1. Type of attributions

People with a ruminative style make a greater number of negative and global attributions to everything that happens to them (that is, causal attributions).

• You may be interested in: "Theories of causal attribution: definition and authors"

2. accessibility to memories

The accessibility to negative memories in this type of people is greater than in people without a ruminative style.

3. Pessimism

There is pessimism and a negative interpretation of biased reality, in people with a ruminative style in the context of depression.

4. Poor interpersonal solutions

Finally, these people generate poorer interpersonal solutions, which are less effective (for example, in the face of a conflict with another person).

Scientific review: what does the neuroscience say?

Beyond the theory of the ruminative style of S. Nolen-Hoeksema, to understand a little more the relationship between depression and rumination, we have turned to a scientific review carried out in 2016 by Rayner, Jackson and Wilson, which analyzes the findings of up to 59 functional neuroimaging studies in adults with unipolar depression.

This review also analyzes the relationship between the brain networks involved in cognitive processes during a depressive disorder and the symptoms of the disorder. Specifically, analyzes the relationship between abnormal functioning of these brain structures and depressive symptoms.

Results

The results of this review suggest that there are two different neurocognitive networks, which may largely explain the symptoms of depression. These two networks are: the autobiographical memory network (AMN), and the cognitive control network (CCN).

Specifically, what was found through this review is that the hyperactivity of the first network, the autobiographical memory network is related to three types of symptoms in depressive patients: rumination, self-blame and pathological parenting.

On the other hand, it was found that hypoactivation or abnormal functioning of the other network, the cognitive control network, is related to the following symptoms in this type of patients: automatic negative thoughts (the famous "PAN's" of Aaron Beck), cognitive distortions and low concentration.

Furthermore, it should be noted that the configuration of these networks can change over time in people; this is also related to a variation in depressive symptoms over time (ie, a fluctuating course of depression).

Neurocognitive networks and depression

According to this review, we can say that depression, in addition to being a multifactorial disorder, where biological, social, psychological… it could also be framed as a neurocognitive network disorder, which links neurobiology to practice psychiatric.

This can be of great help to researchers, doctors, psychologists, etc., and open a path from neuroscience perspective, to help us understand and treat this and other mental disorders in a future.

Bibliographic references:

• American Psychiatric Association –APA- (2014). DSM-5. Diagnostic and Statistical Manual of Mental Disorders. Madrid: Pan American.
• Belloch, A., Sandin, B. and Ramos, F. (2010). Manual of Psychopathology. Volume I and II. Madrid: McGraw-Hill.
• García Cruz, R, Valencia Ortiz, A.I., Hernández-Martínez, A. and Rocha Sánchez, T.E. (2017). Ruminative thinking and depression among university students: rethinking the impact of gender. Interamerican Journal of Psychology, 51(3): 406-416.
• Rayner, G., Jackson, G. & Wilson, S. (2016). Cognition-related brain networks underpin the symptoms of unipolar depression: Evidence from a systematic review. Neuroscience & Biobehavioral Reviews, 61: 53-65.