The Effect of Mindfulness-Based Cognitive Therapy On Rumination and Intrusive Thoughts in Patients With Bipolar Disorder: Secondary Analyses From a Randomized Controlled Trial

Background: Preliminary evidence suggests that Mindfulness-Based Cognitive Therapy (MBCT) is a promising treatment for bipolar disorder (BD). One of the proposed working mechanisms of MBCT in attenuating depressive symptoms is through the reduction of depressive rumination. In BD the effect of MBCT on rumination is less well studied. The primary aim of this study was to investigate the effect of MBCT on self-reported trait depressive rumination and an experimental state measure of negative intrusive thoughts. On an exploratory note, we investigated the effect of MBCT on positive rumination and positive intrusive thoughts.Methods: The study population consisted of a subsample of bipolar type I or II patients participating in a multicenter randomized controlled trial comparing MBCT + treatment as usual (TAU) (N = 25) to TAU alone (N = 24). Trait depressive rumination (RRS brooding subscale) and negative intrusive thoughts (breathing focus task (BFT)) were assessed at baseline and post-treatment. During the BFT, participants were asked to report negative, positive and neutral intrusive thoughts while focusing on their breathing. Results: Compared to TAU alone, MBCT + TAU resulted in a significant pre- to post-treatment reduction of trait depressive rumination (R2 = 0.16, F(1, 28) = 5.30, p = .029; medium effect size (f2 = 0.19)) and negative intrusive thoughts on the BFT (R2 = .15, F(1, 28) = 4.88, p = .036; medium effect size (f2 = 0.17)). MBCT did not significantly change positive rumination or positive intrusive thoughts on the BFT.Conclusions: MBCT might be a helpful additional intervention to reduce depressive rumination in BD which might reduce risk of depressive relapse or recurrence. Future research is required to replicate our findings and to explore whether this reduction in rumination following MBCT indeed mediates a reduction in depressive symptoms and leads to relapse prevention in BD.

Oversampled and undersolved: Depressive rumination from a predictive coding perspective

Rumination is a widely recognized cognitive deviation in depression. An integrative view that combines clinical findings on rumination with theories of mental simulation and cognitive problem-solving could help explain the development and maintenance of rumination in a computationally and biologically plausible framework. In this review, we connect insights from neuroscience and computational psychiatry to elucidate rumination as repetitive but unsuccessful attempts at mental problem-solving. Appealing to a predictive processing account, we suggest that problem-solving is based on an algorithm that generates candidate behavior (policy primitives for problem solutions) using a Bayesian sampling approach, evaluates resulting policies for action, and then engages in instrumental learning to reduce prediction errors. We present evidence suggesting that this problem-solving algorithm is distorted in depression: Specifically, depressive rumination is regarded as excessive Bayesian sampling of candidates that is associated with high prediction errors without activation of the successive steps (policy evaluation, instrumental learning) of the algorithm. Thus, prediction errors cannot be decreased, and excessive resampling of the same problems occur. This then leads to reduced precision weighting attributed to external, “online” stimuli, low behavioral output and high opportunity costs due to the time-consuming nature of the sampling process itself. We review different computational reasons that make the proposed Bayesian sampling algorithm vulnerable to a ruminative „halting problem”. We also identify neurophysiological correlates of these deviations in pathological connectivity patterns of different brain networks. We conclude by suggesting future directions for research into behavioral and neurophysiological features of the model and point to clinical implications.

Perceived stress in the time of COVID-19: the association with brooding and COVID-related rumination in adults with and without migraine

Background The main goal of this research was to explore whether migraineurs had a higher level of perceived stress than healthy controls during the times of the coronavirus and related restrictive measures, and to examine the relationship between different subtypes of rumination and perceived stress in these groups. We measured two facets of depressive rumination, brooding and reflection, along with rumination about the current COVID-19 situation to see whether these different subtypes of rumination explained perceived stress among migraineurs and healthy controls. Methods Healthy adults (n = 64) and migraine patients (n = 73) filled out self-report questionnaires online. A multiple linear regression model was used to test whether depressive rumination (i.e. brooding and reflection) and COVID-related rumination explained perceived stress among adults with and without migraine during the times of COVID-19, after controlling for gender, age, migraine/control group status and migraine disability. Results Although we did not find any difference in the level of perceived stress among migraineurs and the control group, perceived stress was more strongly associated with brooding as well as COVID-related rumination among migraineurs than healthy controls. COVID-related rumination and brooding (but not reflection) explained the level of perceived stress after controlling for gender, age, migraine/control group status and migraine disability. Conclusions The similar degree of perceived stress among migraineurs and the control group may imply that there is great variation in the personal experience of people regarding the pandemic, that may be determined by numerous other factors. Our results demonstrate that ruminating about the pandemic and related difficulties, as well as brooding (but not reflection) appear to be associated with higher level of perceived stress during the times of the coronavirus. This association was slightly stronger among migraineurs, hinting at the increased vulnerability of this patient group in stressful situations like the COVID-19 pandemic. Our results also suggest that ruminating about the pandemic and its consequences is weakly associated with trait-level depressive rumination, thus may be more contingent on specific factors.

Mechanisms of rumination change in adolescent depression (RuMeChange): study protocol for a randomised controlled trial of rumination-focused cognitive behavioural therapy to reduce ruminative habit and risk of depressive relapse in high-ruminating adolescents

Background Adolescent-onset depression often results in a chronic and recurrent course, and is associated with worse outcomes relative to adult-onset depression. Targeting habitual depressive rumination, a specific known risk factor for relapse, may improve clinical outcomes for adolescents who have experienced a depressive episode. Randomized controlled trials (RCTs) thus far have demonstrated that rumination-focused cognitive behavioral therapy (RFCBT) reduces depressive symptoms and relapse rates in patients with residual depression and adolescents and young adults with elevated rumination. This was also observed in a pilot RCT of adolescents at risk for depressive relapse. Rumination can be measured at the self-report, behavioral, and neural levels- using patterns of connectivity between the Default Mode Network (DMN) and Cognitive Control Network (CCN). Disrupted connectivity is a putative important mechanism for understanding reduced rumination via RFCBT. A feasibility trial in adolescents found that reductions in connectivity between DMN and CCN regions following RFCBT were correlated with change in rumination and depressive symptoms. Method This is a phase III two-arm, two-stage, RCT of depression prevention. The trial tests whether RFCBT reduces identified risk factors for depressive relapse (rumination, patterns of neural connectivity, and depressive symptoms) in adolescents with partially or fully remitted depression and elevated rumination. In the first stage, RFCBT is compared to treatment as usual within the community. In the second stage, the comparator condition is relaxation therapy. Primary outcomes will be (a) reductions in depressive rumination, assessed using the Rumination Response Scale, and (b) reductions in resting state functional magnetic resonance imaging connectivity of DMN (posterior cingulate cortex) to CCN (inferior frontal gyrus), at 16 weeks post-randomization. Secondary outcomes include change in symptoms of depression following treatment, recurrence of depression over 12 months post-intervention period, and whether engagement with therapy homework (as a dose measure) is related to changes in the primary outcomes. Discussion RFCBT will be evaluated as a putative preventive therapy to reduce the risk of depressive relapse in adolescents, and influence the identified self-report, behavioral, and neural mechanisms of change. Understanding mechanisms that underlie change in rumination is necessary to improve and further disseminate preventive interventions. Trial registration ClinicalTrials.gov Identifier: NCT03859297, registered 01 March 2019.

Anger Rumination and Mindfulness: Mediating Effects on Forgiveness

(1) Background: Different investigations relate mindfulness practice as a strategy to cope with and improve negative repetitive thinking states and forgiveness. (2) Methods: The aim is to analyze the mediating processes of mindfulness as a trait and the changes in the anger rumination on forgiveness. This sample comprised 264 undergraduate students (M = 24.13 years, SD = 11.39). The instruments used were the Anger Rumination Scale (ARS), the Five Facet Mindfulness Questionnaire (FFMQ) and the Heartland Forgiveness Scale (HFS). For data analysis, the spillover effect was calculated using 10,000 bootstrap samples for the bootstrap confidence intervals (CI). (3) Conclusions: The results confirm that the relationship between mindfulness practice and forgiveness is mediated by changes in mindfulness trait and anger rumination. Given the results obtained, it is considered appropriate to extend the study to samples from other countries, as well as to contexts of depressive rumination or anxiety.