Emerging Trends in The Social and Behavioral Sciences

Rumination

Item

Title

Rumination

Author

Watkins, Edward R.

Research Area

Psychopathology

Topic

Mental Disorder Varieties

Abstract

Rumination is repetitive thinking about personal and self‐related concerns. Such rumination focused on symptoms and feelings has been implicated in the onset and maintenance of depression, through both experimental and longitudinal prospective studies, consistent with the Response Styles Theory. Rumination is also conceptualized within a control theory perspective, as an instrumental response to unresolved personal goals. Rumination acts to exacerbate existing mood states and elaborate preexisting cognition—in this way, it can act as a vulnerability factor for psychopathology. However, there is emerging cutting edge evidence that rumination can also have adaptive consequences, when it either focuses on positive information or involves a processing mode that is more concrete, focused on the specific details and mechanics of situations. Rumination is also being proposed as a strong candidate for a transdiagnostic process that contributes to multiple emotional disorders. New approaches to the treatment of rumination have recently been developed with preliminary encouraging data, although further large‐scale trials are required. Key issues for research into rumination going forward include more detailed unpacking of the underlying cognitive and attentional mechanisms determining individual differences in rumination and examining the contribution of rumination across physical and mental health.

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Identifier

etrds0294

extracted text

Rumination
EDWARD R. WATKINS

Abstract
Rumination is repetitive thinking about personal and self-related concerns. Such
rumination focused on symptoms and feelings has been implicated in the onset and
maintenance of depression, through both experimental and longitudinal prospective
studies, consistent with the Response Styles Theory. Rumination is also conceptualized within a control theory perspective, as an instrumental response to unresolved
personal goals. Rumination acts to exacerbate existing mood states and elaborate preexisting cognition—in this way, it can act as a vulnerability factor for psychopathology. However, there is emerging cutting edge evidence that rumination can also have
adaptive consequences, when it either focuses on positive information or involves a
processing mode that is more concrete, focused on the specific details and mechanics
of situations. Rumination is also being proposed as a strong candidate for a transdiagnostic process that contributes to multiple emotional disorders. New approaches to
the treatment of rumination have recently been developed with preliminary encouraging data, although further large-scale trials are required. Key issues for research
into rumination going forward include more detailed unpacking of the underlying
cognitive and attentional mechanisms determining individual differences in rumination and examining the contribution of rumination across physical and mental health.

INTRODUCTION
Rumination is repetitive, prolonged, and recurrent thinking about one’s
self, one’s personal concerns, and one’s experiences (Harvey, Watkins,
Mansell, & Shafran, 2004; Watkins, 2008). It bridges many topics: social
cognition, emotion, motivation, self-regulation, goal attainment, stress,
psychopathology, and mental health. Moreover, it is a process commonly
employed by all people.
Within clinical psychology, rumination has been principally conceptualized as a learnt response style characterized by repetitive thinking
about the symptoms, meanings, and consequences of depressed mood
(Nolen-Hoeksema, 1991), which is hypothesized to contribute to the onset
and maintenance of depression. This Response Styles Theory explains
increased vulnerability for depression, especially among women.
Emerging Trends in the Social and Behavioral Sciences. Edited by Robert Scott and Stephen Kosslyn.
© 2015 John Wiley & Sons, Inc. ISBN 978-1-118-90077-2.

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EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES

However, rumination has been conceptualized more broadly as recurrent
instrumental thinking about an unresolved goal within a Control Theory
account (Martin & Tesser, 1996). Such goal-discrepancy rumination can
have constructive or unconstructive consequences, depending on whether
it reduces the perceived discrepancy through active problem solving or
passively makes the unattained goal more salient.
This essay summarizes findings from both approaches, identifies the most
promising lines of inquiry to date, and identifies key issues that remain to be
addressed.
FOUNDATIONAL RESEARCH
CONTROL THEORY
This account proposes that rumination is triggered by a perceived discrepancy between the current state and the desired goal, focuses on the
unresolved goal, and persists until the unresolved goal is achieved or
abandoned (Martin & Tesser, 1996). Consistent with this account, unresolved
and blocked goals increase the priming and accessibility of goal-relevant
information. Thoughts relating to unresolved goals persist longer than those
associated with resolved goals (Zeigarnik, 1938). In naturalistic diary and
experience sampling studies, unresolved personally important goals are
associated with increased rumination (Moberly & Watkins, 2010; Gebhardt,
Van der Doef, Massey, Verhoeven, & Verkuil, 2010).
NEGATIVE CONSEQUENCES OF RUMINATION
The main consequences of rumination are (i) exacerbation of existing
emotional states such as sadness, anger, anxiety, and depression; (ii) elaborating and polarizing the thought content focused on during rumination
(Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008; Watkins, 2008). Rumination magnifies, prolongs, and exacerbates existing mood and elaborates
associated mood-congruent cognition. Rumination causes this effect by (i)
increasing self-focus and (ii) focusing attention on the discrepancy between
the desired goal and the actual situation, making the unresolved discrepancy
more salient. Experiments have used a standardized induction, in which
participants concentrate on sentences that focus on themselves, their current
feelings, and their causes and consequences (e.g., “Think about the way you
feel inside”; Lyubomirsky & Nolen-Hoeksema, 1995). As a control condition,
a distraction induction is typically used, in which participants concentrate
on sentences that involve imagining visual scenes unrelated to the self or to
feelings (e.g., “Think about a fire darting round a log in a fire place”).

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3

Compared to distraction, rumination is reliably found to exacerbate existing negative affect and increase existing negative cognition, although these
differential effects are only found when participants are already in a negative rather than a neutral mood (e.g., in depressed patients; after a sad mood
induction). For sad or depressed participants, compared to distraction, rumination exacerbates negative mood, increases negative thinking about the self,
past, and the future, impairs concentration and central executive functioning,
and impairs social problem solving (e.g., Lyubomirsky & Nolen-Hoeksema,
1995; Watkins & Brown, 2002). Magnifying effects of rumination have also
been found for anxiety and anger.
RESPONSE STYLES THEORY AND DEPRESSION
Consistent with Response Styles Theory (Nolen-Hoeksema, 1991), selfreported rumination prospectively predicts the onset of major depressive
episodes, depressive symptoms in nondepressed and currently depressed
individuals, and mediates the effects of other risk factors on depression in
large-scale longitudinal studies (e.g., Nolen-Hoeksema, 2000; Spasojevic
& Alloy, 2001; see meta-analysis by Mor & Winquist, 2002). Rumination
is elevated in women compared to men and partially explains the 2 : 1
female:male ratio of depression. The convergence of this longitudinal data
with the experimental evidence earlier suggests that rumination is a key
pathological process in the onset and maintenance of depression. Within
rumination, the brooding subtype, characterized by abstract, evaluative,
judgmental, and self-critical thinking about problems and difficulties is
implicated as most pathological.
CUTTING-EDGE RESEARCH
POSITIVE CONSEQUENCES
There is growing recognition that rumination can be adaptive and constructive as well as maladaptive and unconstructive. There is evidence
that rumination is associated with (i) successful cognitive processing and
recovery from upsetting and traumatic events, (ii) adaptive preparation and
planning for the future, (iii) recovery from depression, and (iv) uptake of
health-promoting behaviors (Watkins, 2008). These findings are consistent
with the Control Theory prediction that rumination can be an instrumental
functional process.
One factor influencing the consequences of rumination is the valence
of ruminative thought: thinking about positive information typically
results in adaptive consequences relative to focus on negative information,
for example, finding benefits when thinking about a difficult situation
(Watkins, 2008).

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EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES

PROCESSING MODE
Another relevant factor is whether a more abstract or more concrete processing mode is adopted (Watkins, 2008). An abstract processing mode involves
focusing on general, superordinate, and decontextualized mental representations that convey the essential meaning, causes, and implications of goals
and events, including the “why” aspects of an action and the ends consequential to it. Such abstract thinking is characteristic of the phenomenology
of depressive rumination. In contrast, a concrete processing mode involves a
focus on the direct, specific, and contextualized experience of an event and on
the details of goals, events, and actions that denote the feasibility, mechanics,
and means of “how” to do the action.
The processing mode theory proposes that the consequences of abstract
versus concrete processing are determined by their relative sensitivity to contextual and situational detail. Relative to a concrete mode, an abstract mode
(i) insulates an individual from the specific context, (ii) makes the individual
less distractible, less impulsive, (iii) enables more consistency and stability
of goal pursuit across time, and (iv) allows gainful and unhelpful generalizations and inferences across different situations. However, it also (i) makes the
individual less responsive to the environment and to any situational change
and (ii) provides fewer specific and contextual guides to action and problem solving because of its distance from the mechanics of action (Watkins,
2011). When faced with difficulties and negative events, concrete processing will be adaptive relative to abstract processing because it will result in (i)
improved self-regulation focused on the immediate demands of the situation
rather than its evaluative implications; (ii) reduced negative overgeneralizations to emotional events, which contribute to increased emotional reactivity
and vulnerability to depression; and (iii) more effective problem solving.
Consistent with this theory, experimental studies have robustly found
abstract rumination causes negative consequences relative to concrete
rumination. The standardized rumination induction was adapted into two
variants that each retained the key original element of focus on self and
mood, but with distinct instructions to induce concrete (focus attention on the
experience of) versus abstract (think about the causes, meanings, and consequences
of) processing. In depressed patients, compared to abstract rumination, concrete rumination reduced negative global self-judgments (Rimes & Watkins,
2005), increased specificity of autobiographical memory recall (Watkins &
Teasdale, 2001), and improved social problem solving (Watkins & Moulds,
2005). Providing a conceptual replication to this finding, prompting abstract
rumination (questions such as “Why did this problem happen?”) impaired
social problem solving in a recovered depressed group, who performed
as well as never-depressed participants in a no-prompt control condition,

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5

whereas prompting concrete rumination (“How are you deciding what
to do next?”) ameliorated the problem-solving deficit found in currently
depressed patients (Watkins & Baracaia, 2002). Finally, repeated training to
think in a concrete mode reduced subsequent emotional reactivity to analog
loss and trauma events, relevant to training in an abstract mode (Watkins,
Moberly, & Moulds, 2008).
RUMINATION AS A TRANSDIAGNOSTIC PROCESS
Rumination has been proposed as a transdiagnostic process, that is, a process
present across multiple psychiatric diagnoses and that causally contributes
to those disorders, rather than only being implicated in depression (Ehring &
Watkins, 2008; Harvey et al., 2004; Nolen-Hoeksema & Watkins, 2011). Rumination prospectively predicts symptoms of anxiety and anxiety disorders
(e.g. post-traumatic stress) after controlling for baseline anxiety in numerous
longitudinal studies (Watkins, 2008). Rumination prospectively predicts
substance abuse, alcohol abuse, and eating disorders, after controlling for
initial symptoms (Ehring & Watkins, 2008; Nolen-Hoeksema & Watkins,
2011). A recent meta-analysis found that rumination was significantly
related to four distinct symptom types (depression, anxiety, eating, and
alcohol abuse; Aldao, Nolen-Hoeksema, & Schweizer, 2010). Two large-scale
longitudinal studies found that rumination explained the concurrent and
prospective associations between anxiety and depression (McLaughlin &
Nolen-Hoeksema, 2011).
TREATMENT INNOVATION
Because rumination has been identified as an important pathological process across multiple disorders, treatments that explicitly target rumination
are a priority. However, to date, little data has been collected on the effects of
cognitive behavioural therapy (CBT) or medication on rumination.
One recent treatment designed to explicitly target rumination is
Rumination-focused Cognitive Behavioral Therapy (RFCBT; Watkins
et al., 2007, 2011). RFCBT is a manualized treatment, theoretically informed
by processing mode and functional approaches to rumination, in which
patients are coached to shift from unconstructive rumination to constructive
rumination and to reduce avoidant behavior, through the use of functional
analysis, experiential/imagery exercises, and behavioral experiments.
Patients also use directed imagery to recreate previous mental states when
a more helpful thinking style was active, such as memories of being completely absorbed in an activity (e.g., “flow” experiences) and experiences
of increased compassion, which act directly counter to rumination. RFCBT

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EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES

significantly reduced rumination and depression in a multiple baseline
case series of patients with residual depression (Watkins et al., 2007) and
significantly outperformed continuation antidepressants in reducing rumination and depression in a Phase II randomized controlled trial (Watkins
et al., 2011).
Consistent with a causal relationship between processing mode and rumination, a proof-of-principle randomized controlled trial found that training
depressed individuals to be more concrete when faced with difficulties
reduced depression, anxiety, and rumination relative to a no-treatment
control (Watkins, Baeyens, & Read, 2009). The training involved repeated
practice at asking “How?” and focusing on specific details when thinking
about recent difficulties. In a Phase II randomized controlled trial, guided
self-help concreteness training was superior to treatment-as-usual in reducing rumination and depression in patients with major depression recruited
in primary care (Watkins et al., 2012).
KEY ISSUES FOR FUTURE RESEARCH
MECHANISMS UNDERPINNING RUMINATION
Despite well-developed theory and evidence regarding the consequences of
rumination, knowledge about its underlying mechanisms is less developed.
We do not know why some individuals engage in rumination more than
others. The critical question of “What makes it so difficult to break free of
rumination once it has begun?” (Nolen-Hoeksema et al., 2008, p. 418) remains
unanswered. Future research needs to delineate the mechanisms underpinning rumination.
Joormann (2010) proposed that rumination increases in those individuals
who are unable to inhibit now irrelevant but previously relevant information
in working memory. Consistent with this account, poor inhibitory control
indexed on different experimental tasks is correlated with rumination (e.g.,
Gotlib & Joormann, 2010; Joormann, Yoon, & Zetsche, 2007). Similarly,
Koster, De Lissnyder, Derakshan, and De Raedt (2011) proposed that individual differences in rumination arise from impairments in disengaging
attention from negative self-referent information. Consistent with this
account, self-reported rumination is correlated with selective attentional
bias toward sad faces (Joormann, Dkane, & Gotlib, 2006) and toward
negative words on the dot probe task (Donaldson, Lam, & Mathews, 2007).
Key next steps include (i) delineating whether rumination is associated with
biases in engaging and/or disengaging attention from negative information;
(ii) determining the causal direction of the relationship between these
deficits and the tendency toward rumination. If these biases and/or deficits

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7

cause rumination, then manipulating them (e.g., through cognitive bias
modification) should reduce rumination.
RUMINATION CO-MORBID WITH POOR PHYSICAL HEALTH
There is growing interest in rumination as a mechanism linking mental
and physical illness, accounting for their high co-morbidity (e.g., between
depression and cardiovascular disease). We coined the term “Worried
Unwell” to reflect individuals with chronic health conditions (e.g., cardiovascular disease, obesity, and chronic pain) who ruminate about the symptoms
and consequences of their ill-health. Such rumination may then contribute
to the maintenance of physical health symptoms and exacerbate depression
and anxiety.
Brosschot, Gerin, and Thayer (2006) noted that rumination involves the
repeated or chronic activation of the cognitive representation of psychological stressors, which is hypothesized to prolong psychological and
physiological responses to life events and daily stressors, resulting in body
systems associated with stress (e.g., cardiovascular, hypothalamic pituitary
adrenal, and immune systems) becoming chronically activated, and leading
to the development of disease. Consistent with this hypothesis, rumination
is elevated in patients with chronic illness and associated with dysregulated
physiological function (e.g., reduced heart rate variability, increased heart
rate, and increased blood pressure, all risk factors for hypertension and
cardiovascular disorders). Rumination prospectively predicts negative
health outcomes (Watkins, 2008), including increased heart disease over
a 20-year follow-up (Kubzansky et al., 1997) and increased depression in
patients with acute coronary syndrome (Denton, Rieckmann, Davidson &
Chaplin, 2012). Experimental induction of rumination about an upsetting or
angry event results in increased blood pressure and heart rate that maintains
over the next day (Ottaviani, Shapiro, & Fitzgerald, 2011).
However, experimental research has tended to be in healthy populations,
while most patient studies are cross sectional. Experimental and prospective studies are necessary to unpack whether rumination causally influences
symptoms in chronic illness and to determine its relative influence against
other vulnerabilities.
METHODOLOGICAL ADVANCES
Self-report remains central to the study of rumination because it is essentially
an experience of subjective consciousness. Nonetheless, development of
well-validated implicit, behavioral, and neuroimaging indices (e.g., attentional probe tasks and eye tracking), which provide analog proxies highly

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EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES

correlated with rumination, will enable us to overcome the limitations of
self-report and enable fine-tuned investigation of underlying cognitive
mechanisms.
To date, most rumination manipulations ask participants to voluntarily
and deliberately ruminate, introducing potential demand effects. Further,
this approach is not ecologically valid because rumination is typically
experienced as passive, involuntary, and uncontrollable. New induction
methods are required that indirectly engage involuntary rumination such
as prompting personally important unresolved goals or training an abstract
processing mode before failure feedback.
CONCLUSION
Rumination is a universal cognitive process triggered in response to poor
progress on personally relevant goals. Rumination tends to amplify existing
affect and elaborate mood-congruent cognitions. As such, it is implicated in
the onset and maintenance of depression, anxiety, emotional disorders, and
potentially chronic illness. Nonetheless, rumination can be adaptive when it
is focused on positive content or when it involves concrete processing.
DEDICATION
This essay is dedicated to the memory of Susan Nolen-Hoeksema (1960–
2013), following her premature death. Susan single-handedly initiated the
clinical study of rumination and inspired us all through her rigor, clarity, and
humanity. She will be much missed.
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Brosschot, J. F., Gerin, W., & Thayer, J. F. (2006). The perseverative cognition hypothesis: A review of worry, prolonged stress-related physiological activation, and
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Gebhardt, W. A., Van der Deof, M. P., Massey, E. K., Verhoeven, C. J., & Verkuil, B.
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Behavior Therapy, 37, 269–281.
Joorman, J., Yoon, K. L., & Zetsche, U. (2007). Cognitive inhibition in depression.
Applied and Preventive Psychology:, 12, 128–139.
Koster, E. H. W., De Lissnyder, E., Derakshan, N., & De Raedt, R. (2011). Understanding depressive rumination from an affective neuroscience perspective: The
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(1997). Is worrying bad for your heart? A prospective study of worry and coronary
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Lyubomirsky, S., & Nolen-Hoeksema, S. (1995). Effects of self-focused rumination
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Social Psychology, 69, 176–190.
Martin, L. L., & Tesser, A. (1996). Some ruminative thoughts. In R. S. Wyer (Ed.),
Ruminative thoughts: Advances in social cognition (Vol. 9, pp. 1–47). Hillsdale, NJ:
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McLaughlin, K. A., & Nolen-Hoeksema, S. (2011). Rumination as a transdiagnostic
factor in depression and anxiety. Behaviour Research and Therapy, 3, 186–193.
Moberly, N. J., & Watkins, E. R. (2010). Negative affect and ruminative self-focus
during everyday goal pursuit. Cognition and Emotion, 24(4), 729–739.
Mor, N., & Winquist, J. (2002). Self-focused attention and negative affect: A metaanalysis. Psychological Bulletin, 128, 638–662.
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Nolen-Hoeksema, S. (2000). The role of rumination in depressive disorders and
mixed anxiety/depressive symptoms. Journal of Abnormal Psychology, 109, 504–511.
Nolen-Hoeksema, S., & Watkins, E. R. (2011). A heuristic for transdiagnostic models
of psychopathology: Explaining multifinality and divergent trajectories. Perspectives in Psychological Science, 6, 589–609.
Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008). Rethinking rumination.
Perspectives on Psychological Science, 3, 400–424.
Ottaviani, C., Shapiro, D., & Fitzgerald, L. (2011). Rumination in the laboratory: What
happens when you go back to everyday life? Psychophysiology, 48, 453–461.

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Rimes, K. A., & Watkins, E. (2005). The effects of self-focused rumination on
global negative self-judgements in depression. Behaviour Research and Therapy, 43,
1673–1681.
Spasojevic, J., & Alloy, L. B. (2001). Rumination as a common mechanism relating
depressive risk factors to depression. Emotion, 1, 25–37.
Watkins, E. (2008). Constructive and unconstructive repetitive thought. Psychological
Bulletin, 134, 163–206.
Watkins, E. R. (2011). Dysregulation in level of goal and action identification across
psychological disorders. Clinical Psychology Review, 31, 260–278.
Watkins, E., & Baracaia, S. (2002). Rumination and social problem-solving in depression. Behaviour Research and Therapy, 40, 1179–1189.
Watkins, E. R., Baeyens, C. B., & Read, R. (2009). Concreteness training reduces dysphoria: Proof-of-principle for repeated cognitive bias modification in depression.
Journal of Abnormal Psychology, 118, 55–65.
Watkins, E., & Brown, R. G. (2002). Rumination and executive function in depression: an experimental study. Journal of Neurology Neurosurgery and Psychiatry, 72,
400–402.
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… , Scott, J. (2011). Rumination-focused cognitive behaviour therapy for residual
depression: Phase II randomized controlled trial. British Journal of Psychiatry, 199,
317–322.
Watkins, E. R., Moberly, N. J., & Moulds, M. (2008). Processing mode causally influences emotional reactivity: Distinct effects of abstract versus concrete construal on
emotional response. Emotion, 8, 364–378.
Watkins, E. R., & Moulds, M. (2005). Distinct modes of ruminative self-focus: Impact
of abstract versus concrete rumination on problem solving in depression. Emotion,
5, 319–328.
Watkins, E. R., Scott, J., Wingrove, J., Rimes, K. A., Bathurst, N., Steiner, H., … ,
Malliaris, Y. (2007). Rumination-focused cognitive behaviour therapy for residual
depression: A case series. Behaviour Research and Therapy, 45, 2144–2154.
Watkins, E. R., Taylor, R. S., Byng, R., Baeyens, C. B., Read, R., Pearson, K., & Watson, L. (2012). Guided self-help concreteness training as an intervention for major
depression in primary care: A phase II randomized controlled trial. Psychological
Medicine, 42, 1359–1373.
Watkins, E., & Teasdale, J. D. (2001). Rumination and overgeneral memory in depression: Effects of self-focus and analytic thinking. Journal of Abnormal Psychology, 110,
353–357.
Zeigarnik, B. (1938). On finished and unfinished tasks. In W. D. Ellis (Ed.), A source
book of gestalt psychology (pp. 300–314). New York, NY: Harcourt, Brace, & World.

FURTHER READING
Harvey, A., Watkins, E., Mansell, W., & Shafran, R. (2004). Cognitive behavioural processes across psychological disorders: A transdiagnostic approach to research and treatment. Oxford, UK: Oxford University Press.

Rumination

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Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008). Rethinking rumination.
Perspectives on Psychological Science, 3, 400–424.
Watkins, E. (2008). Constructive and unconstructive repetitive thought. Psychological
Bulletin, 134, 163–206.

EDWARD R. WATKINS SHORT BIOGRAPHY
Edward R. Watkins is Director of the Sir Henry Wellcome Mood Disorders
Centre and Professor of Experimental and Applied Clinical Psychology at
the University of Exeter. His research programme investigates the interactions between thoughts and feeling that underpin psychopathology, focuses
on rumination in depression, and translates this knowledge into improved
psychological interventions. He has published over 70 articles in leading psychology and psychiatry journals and has held major funding from NARSAD,
Medical Research Council-UK, the Wellcome Trust, and National Institute for
Health Research. He has coauthored and coedited books on the transdiagnostic approach (Cognitive Behavioural processes across the psychological disorders),
depression (Depression, 2nd edition), and cognition and emotion (Handbook of
Cognition and Emotion).
Personal webpage: http://www.exeter.mooddisorderscentre.
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et al.
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Problems Attract Problems: A Network Perspective on Mental Disorders
(Psychology), Angélique Cramer and Denny Borsboom
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Patrick S. Forscher and Patricia G. Devine
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Insomnia and Sleep Disorders (Psychology), Elizabeth C. Mason and Allison
G. Harvey
Mental Imagery in Psychological Disorders (Psychology), Emily A. Holmes
et al.

12

EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES

Normal Negative Emotions and Mental Disorders (Sociology), Allan V.
Horwitz
Dissociation and Dissociative Identity Disorder (DID) (Psychology), Rafaële
J. C. Huntjens and Martin J. Dorahy
Computer Technology and Children’s Mental Health (Psychology), Philip C.
Kendall et al.
Cultural Neuroscience: Connecting Culture, Brain, and Genes (Psychology),
Shinobu Kitayama and Sarah Huff
Mechanisms of Fear Reducation (Psychology), Cynthia L. Lancaster and
Marie-H. Monfils
Understanding Risk-Taking Behavior: Insights from Evolutionary Psychology (Psychology), Karin Machluf and David F. Bjorklund
Evolutionary Perspectives on Animal and Human Personality (Anthropology), Joseph H. Manson and Lynn A. Fairbanks
Disorders of Consciousness (Psychology), Martin M. Monti
Cognitive Remediation in Schizophrenia (Psychology), Clare Reeder and Til
Wykes
Cognitive Bias Modification in Mental (Psychology), Meg M. Reuland et al.
Born This Way: Thinking Sociologically about Essentialism (Sociology),
Kristen Schilt
Clarifying the Nature and Structure of Personality Disorder (Psychology),
Takakuni Suzuki and Douglas B. Samuel
Taking Personality to the Next Level: What Does It Mean to Know a Person?
(Psychology), Simine Vazire and Robert Wilson
A Gene-Environment Approach to Understanding Youth Antisocial Behavior (Psychology), Rebecca Waller et al.
Emotion Regulation (Psychology), Paree Zarolia et al.



Rumination
EDWARD R. WATKINS

Abstract
Rumination is repetitive thinking about personal and self-related concerns. Such
rumination focused on symptoms and feelings has been implicated in the onset and
maintenance of depression, through both experimental and longitudinal prospective
studies, consistent with the Response Styles Theory. Rumination is also conceptualized within a control theory perspective, as an instrumental response to unresolved
personal goals. Rumination acts to exacerbate existing mood states and elaborate preexisting cognition—in this way, it can act as a vulnerability factor for psychopathology. However, there is emerging cutting edge evidence that rumination can also have
adaptive consequences, when it either focuses on positive information or involves a
processing mode that is more concrete, focused on the specific details and mechanics
of situations. Rumination is also being proposed as a strong candidate for a transdiagnostic process that contributes to multiple emotional disorders. New approaches to
the treatment of rumination have recently been developed with preliminary encouraging data, although further large-scale trials are required. Key issues for research
into rumination going forward include more detailed unpacking of the underlying
cognitive and attentional mechanisms determining individual differences in rumination and examining the contribution of rumination across physical and mental health.

INTRODUCTION
Rumination is repetitive, prolonged, and recurrent thinking about one’s
self, one’s personal concerns, and one’s experiences (Harvey, Watkins,
Mansell, & Shafran, 2004; Watkins, 2008). It bridges many topics: social
cognition, emotion, motivation, self-regulation, goal attainment, stress,
psychopathology, and mental health. Moreover, it is a process commonly
employed by all people.
Within clinical psychology, rumination has been principally conceptualized as a learnt response style characterized by repetitive thinking
about the symptoms, meanings, and consequences of depressed mood
(Nolen-Hoeksema, 1991), which is hypothesized to contribute to the onset
and maintenance of depression. This Response Styles Theory explains
increased vulnerability for depression, especially among women.
Emerging Trends in the Social and Behavioral Sciences. Edited by Robert Scott and Stephen Kosslyn.
© 2015 John Wiley & Sons, Inc. ISBN 978-1-118-90077-2.

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EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES

However, rumination has been conceptualized more broadly as recurrent
instrumental thinking about an unresolved goal within a Control Theory
account (Martin & Tesser, 1996). Such goal-discrepancy rumination can
have constructive or unconstructive consequences, depending on whether
it reduces the perceived discrepancy through active problem solving or
passively makes the unattained goal more salient.
This essay summarizes findings from both approaches, identifies the most
promising lines of inquiry to date, and identifies key issues that remain to be
addressed.
FOUNDATIONAL RESEARCH
CONTROL THEORY
This account proposes that rumination is triggered by a perceived discrepancy between the current state and the desired goal, focuses on the
unresolved goal, and persists until the unresolved goal is achieved or
abandoned (Martin & Tesser, 1996). Consistent with this account, unresolved
and blocked goals increase the priming and accessibility of goal-relevant
information. Thoughts relating to unresolved goals persist longer than those
associated with resolved goals (Zeigarnik, 1938). In naturalistic diary and
experience sampling studies, unresolved personally important goals are
associated with increased rumination (Moberly & Watkins, 2010; Gebhardt,
Van der Doef, Massey, Verhoeven, & Verkuil, 2010).
NEGATIVE CONSEQUENCES OF RUMINATION
The main consequences of rumination are (i) exacerbation of existing
emotional states such as sadness, anger, anxiety, and depression; (ii) elaborating and polarizing the thought content focused on during rumination
(Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008; Watkins, 2008). Rumination magnifies, prolongs, and exacerbates existing mood and elaborates
associated mood-congruent cognition. Rumination causes this effect by (i)
increasing self-focus and (ii) focusing attention on the discrepancy between
the desired goal and the actual situation, making the unresolved discrepancy
more salient. Experiments have used a standardized induction, in which
participants concentrate on sentences that focus on themselves, their current
feelings, and their causes and consequences (e.g., “Think about the way you
feel inside”; Lyubomirsky & Nolen-Hoeksema, 1995). As a control condition,
a distraction induction is typically used, in which participants concentrate
on sentences that involve imagining visual scenes unrelated to the self or to
feelings (e.g., “Think about a fire darting round a log in a fire place”).

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3

Compared to distraction, rumination is reliably found to exacerbate existing negative affect and increase existing negative cognition, although these
differential effects are only found when participants are already in a negative rather than a neutral mood (e.g., in depressed patients; after a sad mood
induction). For sad or depressed participants, compared to distraction, rumination exacerbates negative mood, increases negative thinking about the self,
past, and the future, impairs concentration and central executive functioning,
and impairs social problem solving (e.g., Lyubomirsky & Nolen-Hoeksema,
1995; Watkins & Brown, 2002). Magnifying effects of rumination have also
been found for anxiety and anger.
RESPONSE STYLES THEORY AND DEPRESSION
Consistent with Response Styles Theory (Nolen-Hoeksema, 1991), selfreported rumination prospectively predicts the onset of major depressive
episodes, depressive symptoms in nondepressed and currently depressed
individuals, and mediates the effects of other risk factors on depression in
large-scale longitudinal studies (e.g., Nolen-Hoeksema, 2000; Spasojevic
& Alloy, 2001; see meta-analysis by Mor & Winquist, 2002). Rumination
is elevated in women compared to men and partially explains the 2 : 1
female:male ratio of depression. The convergence of this longitudinal data
with the experimental evidence earlier suggests that rumination is a key
pathological process in the onset and maintenance of depression. Within
rumination, the brooding subtype, characterized by abstract, evaluative,
judgmental, and self-critical thinking about problems and difficulties is
implicated as most pathological.
CUTTING-EDGE RESEARCH
POSITIVE CONSEQUENCES
There is growing recognition that rumination can be adaptive and constructive as well as maladaptive and unconstructive. There is evidence
that rumination is associated with (i) successful cognitive processing and
recovery from upsetting and traumatic events, (ii) adaptive preparation and
planning for the future, (iii) recovery from depression, and (iv) uptake of
health-promoting behaviors (Watkins, 2008). These findings are consistent
with the Control Theory prediction that rumination can be an instrumental
functional process.
One factor influencing the consequences of rumination is the valence
of ruminative thought: thinking about positive information typically
results in adaptive consequences relative to focus on negative information,
for example, finding benefits when thinking about a difficult situation
(Watkins, 2008).

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EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES

PROCESSING MODE
Another relevant factor is whether a more abstract or more concrete processing mode is adopted (Watkins, 2008). An abstract processing mode involves
focusing on general, superordinate, and decontextualized mental representations that convey the essential meaning, causes, and implications of goals
and events, including the “why” aspects of an action and the ends consequential to it. Such abstract thinking is characteristic of the phenomenology
of depressive rumination. In contrast, a concrete processing mode involves a
focus on the direct, specific, and contextualized experience of an event and on
the details of goals, events, and actions that denote the feasibility, mechanics,
and means of “how” to do the action.
The processing mode theory proposes that the consequences of abstract
versus concrete processing are determined by their relative sensitivity to contextual and situational detail. Relative to a concrete mode, an abstract mode
(i) insulates an individual from the specific context, (ii) makes the individual
less distractible, less impulsive, (iii) enables more consistency and stability
of goal pursuit across time, and (iv) allows gainful and unhelpful generalizations and inferences across different situations. However, it also (i) makes the
individual less responsive to the environment and to any situational change
and (ii) provides fewer specific and contextual guides to action and problem solving because of its distance from the mechanics of action (Watkins,
2011). When faced with difficulties and negative events, concrete processing will be adaptive relative to abstract processing because it will result in (i)
improved self-regulation focused on the immediate demands of the situation
rather than its evaluative implications; (ii) reduced negative overgeneralizations to emotional events, which contribute to increased emotional reactivity
and vulnerability to depression; and (iii) more effective problem solving.
Consistent with this theory, experimental studies have robustly found
abstract rumination causes negative consequences relative to concrete
rumination. The standardized rumination induction was adapted into two
variants that each retained the key original element of focus on self and
mood, but with distinct instructions to induce concrete (focus attention on the
experience of) versus abstract (think about the causes, meanings, and consequences
of) processing. In depressed patients, compared to abstract rumination, concrete rumination reduced negative global self-judgments (Rimes & Watkins,
2005), increased specificity of autobiographical memory recall (Watkins &
Teasdale, 2001), and improved social problem solving (Watkins & Moulds,
2005). Providing a conceptual replication to this finding, prompting abstract
rumination (questions such as “Why did this problem happen?”) impaired
social problem solving in a recovered depressed group, who performed
as well as never-depressed participants in a no-prompt control condition,

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5

whereas prompting concrete rumination (“How are you deciding what
to do next?”) ameliorated the problem-solving deficit found in currently
depressed patients (Watkins & Baracaia, 2002). Finally, repeated training to
think in a concrete mode reduced subsequent emotional reactivity to analog
loss and trauma events, relevant to training in an abstract mode (Watkins,
Moberly, & Moulds, 2008).
RUMINATION AS A TRANSDIAGNOSTIC PROCESS
Rumination has been proposed as a transdiagnostic process, that is, a process
present across multiple psychiatric diagnoses and that causally contributes
to those disorders, rather than only being implicated in depression (Ehring &
Watkins, 2008; Harvey et al., 2004; Nolen-Hoeksema & Watkins, 2011). Rumination prospectively predicts symptoms of anxiety and anxiety disorders
(e.g. post-traumatic stress) after controlling for baseline anxiety in numerous
longitudinal studies (Watkins, 2008). Rumination prospectively predicts
substance abuse, alcohol abuse, and eating disorders, after controlling for
initial symptoms (Ehring & Watkins, 2008; Nolen-Hoeksema & Watkins,
2011). A recent meta-analysis found that rumination was significantly
related to four distinct symptom types (depression, anxiety, eating, and
alcohol abuse; Aldao, Nolen-Hoeksema, & Schweizer, 2010). Two large-scale
longitudinal studies found that rumination explained the concurrent and
prospective associations between anxiety and depression (McLaughlin &
Nolen-Hoeksema, 2011).
TREATMENT INNOVATION
Because rumination has been identified as an important pathological process across multiple disorders, treatments that explicitly target rumination
are a priority. However, to date, little data has been collected on the effects of
cognitive behavioural therapy (CBT) or medication on rumination.
One recent treatment designed to explicitly target rumination is
Rumination-focused Cognitive Behavioral Therapy (RFCBT; Watkins
et al., 2007, 2011). RFCBT is a manualized treatment, theoretically informed
by processing mode and functional approaches to rumination, in which
patients are coached to shift from unconstructive rumination to constructive
rumination and to reduce avoidant behavior, through the use of functional
analysis, experiential/imagery exercises, and behavioral experiments.
Patients also use directed imagery to recreate previous mental states when
a more helpful thinking style was active, such as memories of being completely absorbed in an activity (e.g., “flow” experiences) and experiences
of increased compassion, which act directly counter to rumination. RFCBT

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EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES

significantly reduced rumination and depression in a multiple baseline
case series of patients with residual depression (Watkins et al., 2007) and
significantly outperformed continuation antidepressants in reducing rumination and depression in a Phase II randomized controlled trial (Watkins
et al., 2011).
Consistent with a causal relationship between processing mode and rumination, a proof-of-principle randomized controlled trial found that training
depressed individuals to be more concrete when faced with difficulties
reduced depression, anxiety, and rumination relative to a no-treatment
control (Watkins, Baeyens, & Read, 2009). The training involved repeated
practice at asking “How?” and focusing on specific details when thinking
about recent difficulties. In a Phase II randomized controlled trial, guided
self-help concreteness training was superior to treatment-as-usual in reducing rumination and depression in patients with major depression recruited
in primary care (Watkins et al., 2012).
KEY ISSUES FOR FUTURE RESEARCH
MECHANISMS UNDERPINNING RUMINATION
Despite well-developed theory and evidence regarding the consequences of
rumination, knowledge about its underlying mechanisms is less developed.
We do not know why some individuals engage in rumination more than
others. The critical question of “What makes it so difficult to break free of
rumination once it has begun?” (Nolen-Hoeksema et al., 2008, p. 418) remains
unanswered. Future research needs to delineate the mechanisms underpinning rumination.
Joormann (2010) proposed that rumination increases in those individuals
who are unable to inhibit now irrelevant but previously relevant information
in working memory. Consistent with this account, poor inhibitory control
indexed on different experimental tasks is correlated with rumination (e.g.,
Gotlib & Joormann, 2010; Joormann, Yoon, & Zetsche, 2007). Similarly,
Koster, De Lissnyder, Derakshan, and De Raedt (2011) proposed that individual differences in rumination arise from impairments in disengaging
attention from negative self-referent information. Consistent with this
account, self-reported rumination is correlated with selective attentional
bias toward sad faces (Joormann, Dkane, & Gotlib, 2006) and toward
negative words on the dot probe task (Donaldson, Lam, & Mathews, 2007).
Key next steps include (i) delineating whether rumination is associated with
biases in engaging and/or disengaging attention from negative information;
(ii) determining the causal direction of the relationship between these
deficits and the tendency toward rumination. If these biases and/or deficits

Rumination

7

cause rumination, then manipulating them (e.g., through cognitive bias
modification) should reduce rumination.
RUMINATION CO-MORBID WITH POOR PHYSICAL HEALTH
There is growing interest in rumination as a mechanism linking mental
and physical illness, accounting for their high co-morbidity (e.g., between
depression and cardiovascular disease). We coined the term “Worried
Unwell” to reflect individuals with chronic health conditions (e.g., cardiovascular disease, obesity, and chronic pain) who ruminate about the symptoms
and consequences of their ill-health. Such rumination may then contribute
to the maintenance of physical health symptoms and exacerbate depression
and anxiety.
Brosschot, Gerin, and Thayer (2006) noted that rumination involves the
repeated or chronic activation of the cognitive representation of psychological stressors, which is hypothesized to prolong psychological and
physiological responses to life events and daily stressors, resulting in body
systems associated with stress (e.g., cardiovascular, hypothalamic pituitary
adrenal, and immune systems) becoming chronically activated, and leading
to the development of disease. Consistent with this hypothesis, rumination
is elevated in patients with chronic illness and associated with dysregulated
physiological function (e.g., reduced heart rate variability, increased heart
rate, and increased blood pressure, all risk factors for hypertension and
cardiovascular disorders). Rumination prospectively predicts negative
health outcomes (Watkins, 2008), including increased heart disease over
a 20-year follow-up (Kubzansky et al., 1997) and increased depression in
patients with acute coronary syndrome (Denton, Rieckmann, Davidson &
Chaplin, 2012). Experimental induction of rumination about an upsetting or
angry event results in increased blood pressure and heart rate that maintains
over the next day (Ottaviani, Shapiro, & Fitzgerald, 2011).
However, experimental research has tended to be in healthy populations,
while most patient studies are cross sectional. Experimental and prospective studies are necessary to unpack whether rumination causally influences
symptoms in chronic illness and to determine its relative influence against
other vulnerabilities.
METHODOLOGICAL ADVANCES
Self-report remains central to the study of rumination because it is essentially
an experience of subjective consciousness. Nonetheless, development of
well-validated implicit, behavioral, and neuroimaging indices (e.g., attentional probe tasks and eye tracking), which provide analog proxies highly

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EMERGING TRENDS IN THE SOCIAL AND BEHAVIORAL SCIENCES

correlated with rumination, will enable us to overcome the limitations of
self-report and enable fine-tuned investigation of underlying cognitive
mechanisms.
To date, most rumination manipulations ask participants to voluntarily
and deliberately ruminate, introducing potential demand effects. Further,
this approach is not ecologically valid because rumination is typically
experienced as passive, involuntary, and uncontrollable. New induction
methods are required that indirectly engage involuntary rumination such
as prompting personally important unresolved goals or training an abstract
processing mode before failure feedback.
CONCLUSION
Rumination is a universal cognitive process triggered in response to poor
progress on personally relevant goals. Rumination tends to amplify existing
affect and elaborate mood-congruent cognitions. As such, it is implicated in
the onset and maintenance of depression, anxiety, emotional disorders, and
potentially chronic illness. Nonetheless, rumination can be adaptive when it
is focused on positive content or when it involves concrete processing.
DEDICATION
This essay is dedicated to the memory of Susan Nolen-Hoeksema (1960–
2013), following her premature death. Susan single-handedly initiated the
clinical study of rumination and inspired us all through her rigor, clarity, and
humanity. She will be much missed.
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(1997). Is worrying bad for your heart? A prospective study of worry and coronary
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Moberly, N. J., & Watkins, E. R. (2010). Negative affect and ruminative self-focus
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Mor, N., & Winquist, J. (2002). Self-focused attention and negative affect: A metaanalysis. Psychological Bulletin, 128, 638–662.
Nolen-Hoeksema, S. (1991). Responses to depression and their effects on the duration
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Nolen-Hoeksema, S. (2000). The role of rumination in depressive disorders and
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Nolen-Hoeksema, S., & Watkins, E. R. (2011). A heuristic for transdiagnostic models
of psychopathology: Explaining multifinality and divergent trajectories. Perspectives in Psychological Science, 6, 589–609.
Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008). Rethinking rumination.
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Ottaviani, C., Shapiro, D., & Fitzgerald, L. (2011). Rumination in the laboratory: What
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Rimes, K. A., & Watkins, E. (2005). The effects of self-focused rumination on
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Watkins, E., & Baracaia, S. (2002). Rumination and social problem-solving in depression. Behaviour Research and Therapy, 40, 1179–1189.
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… , Scott, J. (2011). Rumination-focused cognitive behaviour therapy for residual
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FURTHER READING
Harvey, A., Watkins, E., Mansell, W., & Shafran, R. (2004). Cognitive behavioural processes across psychological disorders: A transdiagnostic approach to research and treatment. Oxford, UK: Oxford University Press.

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Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008). Rethinking rumination.
Perspectives on Psychological Science, 3, 400–424.
Watkins, E. (2008). Constructive and unconstructive repetitive thought. Psychological
Bulletin, 134, 163–206.

EDWARD R. WATKINS SHORT BIOGRAPHY
Edward R. Watkins is Director of the Sir Henry Wellcome Mood Disorders
Centre and Professor of Experimental and Applied Clinical Psychology at
the University of Exeter. His research programme investigates the interactions between thoughts and feeling that underpin psychopathology, focuses
on rumination in depression, and translates this knowledge into improved
psychological interventions. He has published over 70 articles in leading psychology and psychiatry journals and has held major funding from NARSAD,
Medical Research Council-UK, the Wellcome Trust, and National Institute for
Health Research. He has coauthored and coedited books on the transdiagnostic approach (Cognitive Behavioural processes across the psychological disorders),
depression (Depression, 2nd edition), and cognition and emotion (Handbook of
Cognition and Emotion).
Personal webpage: http://www.exeter.mooddisorderscentre.
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Rumination
EDWARD R. WATKINS

Abstract
Rumination is repetitive thinking about personal and self-related concerns. Such
rumination focused on symptoms and feelings has been implicated in the onset and
maintenance of depression, through both experimental and longitudinal prospective
studies, consistent with the Response Styles Theory. Rumination is also conceptualized within a control theory perspective, as an instrumental response to unresolved
personal goals. Rumination acts to exacerbate existing mood states and elaborate preexisting cognition—in this way, it can act as a vulnerability factor for psychopathology. However, there is emerging cutting edge evidence that rumination can also have
adaptive consequences, when it either focuses on positive information or involves a
processing mode that is more concrete, focused on the specific details and mechanics
of situations. Rumination is also being proposed as a strong candidate for a transdiagnostic process that contributes to multiple emotional disorders. New approaches to
the treatment of rumination have recently been developed with preliminary encouraging data, although further large-scale trials are required. Key issues for research
into rumination going forward include more detailed unpacking of the underlying
cognitive and attentional mechanisms determining individual differences in rumination and examining the contribution of rumination across physical and mental health.

INTRODUCTION
Rumination is repetitive, prolonged, and recurrent thinking about one’s
self, one’s personal concerns, and one’s experiences (Harvey, Watkins,
Mansell, & Shafran, 2004; Watkins, 2008). It bridges many topics: social
cognition, emotion, motivation, self-regulation, goal attainment, stress,
psychopathology, and mental health. Moreover, it is a process commonly
employed by all people.
Within clinical psychology, rumination has been principally conceptualized as a learnt response style characterized by repetitive thinking
about the symptoms, meanings, and consequences of depressed mood
(Nolen-Hoeksema, 1991), which is hypothesized to contribute to the onset
and maintenance of depression. This Response Styles Theory explains
increased vulnerability for depression, especially among women.
Emerging Trends in the Social and Behavioral Sciences. Edited by Robert Scott and Stephen Kosslyn.
© 2015 John Wiley & Sons, Inc. ISBN 978-1-118-90077-2.

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However, rumination has been conceptualized more broadly as recurrent
instrumental thinking about an unresolved goal within a Control Theory
account (Martin & Tesser, 1996). Such goal-discrepancy rumination can
have constructive or unconstructive consequences, depending on whether
it reduces the perceived discrepancy through active problem solving or
passively makes the unattained goal more salient.
This essay summarizes findings from both approaches, identifies the most
promising lines of inquiry to date, and identifies key issues that remain to be
addressed.
FOUNDATIONAL RESEARCH
CONTROL THEORY
This account proposes that rumination is triggered by a perceived discrepancy between the current state and the desired goal, focuses on the
unresolved goal, and persists until the unresolved goal is achieved or
abandoned (Martin & Tesser, 1996). Consistent with this account, unresolved
and blocked goals increase the priming and accessibility of goal-relevant
information. Thoughts relating to unresolved goals persist longer than those
associated with resolved goals (Zeigarnik, 1938). In naturalistic diary and
experience sampling studies, unresolved personally important goals are
associated with increased rumination (Moberly & Watkins, 2010; Gebhardt,
Van der Doef, Massey, Verhoeven, & Verkuil, 2010).
NEGATIVE CONSEQUENCES OF RUMINATION
The main consequences of rumination are (i) exacerbation of existing
emotional states such as sadness, anger, anxiety, and depression; (ii) elaborating and polarizing the thought content focused on during rumination
(Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008; Watkins, 2008). Rumination magnifies, prolongs, and exacerbates existing mood and elaborates
associated mood-congruent cognition. Rumination causes this effect by (i)
increasing self-focus and (ii) focusing attention on the discrepancy between
the desired goal and the actual situation, making the unresolved discrepancy
more salient. Experiments have used a standardized induction, in which
participants concentrate on sentences that focus on themselves, their current
feelings, and their causes and consequences (e.g., “Think about the way you
feel inside”; Lyubomirsky & Nolen-Hoeksema, 1995). As a control condition,
a distraction induction is typically used, in which participants concentrate
on sentences that involve imagining visual scenes unrelated to the self or to
feelings (e.g., “Think about a fire darting round a log in a fire place”).

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Compared to distraction, rumination is reliably found to exacerbate existing negative affect and increase existing negative cognition, although these
differential effects are only found when participants are already in a negative rather than a neutral mood (e.g., in depressed patients; after a sad mood
induction). For sad or depressed participants, compared to distraction, rumination exacerbates negative mood, increases negative thinking about the self,
past, and the future, impairs concentration and central executive functioning,
and impairs social problem solving (e.g., Lyubomirsky & Nolen-Hoeksema,
1995; Watkins & Brown, 2002). Magnifying effects of rumination have also
been found for anxiety and anger.
RESPONSE STYLES THEORY AND DEPRESSION
Consistent with Response Styles Theory (Nolen-Hoeksema, 1991), selfreported rumination prospectively predicts the onset of major depressive
episodes, depressive symptoms in nondepressed and currently depressed
individuals, and mediates the effects of other risk factors on depression in
large-scale longitudinal studies (e.g., Nolen-Hoeksema, 2000; Spasojevic
& Alloy, 2001; see meta-analysis by Mor & Winquist, 2002). Rumination
is elevated in women compared to men and partially explains the 2 : 1
female:male ratio of depression. The convergence of this longitudinal data
with the experimental evidence earlier suggests that rumination is a key
pathological process in the onset and maintenance of depression. Within
rumination, the brooding subtype, characterized by abstract, evaluative,
judgmental, and self-critical thinking about problems and difficulties is
implicated as most pathological.
CUTTING-EDGE RESEARCH
POSITIVE CONSEQUENCES
There is growing recognition that rumination can be adaptive and constructive as well as maladaptive and unconstructive. There is evidence
that rumination is associated with (i) successful cognitive processing and
recovery from upsetting and traumatic events, (ii) adaptive preparation and
planning for the future, (iii) recovery from depression, and (iv) uptake of
health-promoting behaviors (Watkins, 2008). These findings are consistent
with the Control Theory prediction that rumination can be an instrumental
functional process.
One factor influencing the consequences of rumination is the valence
of ruminative thought: thinking about positive information typically
results in adaptive consequences relative to focus on negative information,
for example, finding benefits when thinking about a difficult situation
(Watkins, 2008).

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PROCESSING MODE
Another relevant factor is whether a more abstract or more concrete processing mode is adopted (Watkins, 2008). An abstract processing mode involves
focusing on general, superordinate, and decontextualized mental representations that convey the essential meaning, causes, and implications of goals
and events, including the “why” aspects of an action and the ends consequential to it. Such abstract thinking is characteristic of the phenomenology
of depressive rumination. In contrast, a concrete processing mode involves a
focus on the direct, specific, and contextualized experience of an event and on
the details of goals, events, and actions that denote the feasibility, mechanics,
and means of “how” to do the action.
The processing mode theory proposes that the consequences of abstract
versus concrete processing are determined by their relative sensitivity to contextual and situational detail. Relative to a concrete mode, an abstract mode
(i) insulates an individual from the specific context, (ii) makes the individual
less distractible, less impulsive, (iii) enables more consistency and stability
of goal pursuit across time, and (iv) allows gainful and unhelpful generalizations and inferences across different situations. However, it also (i) makes the
individual less responsive to the environment and to any situational change
and (ii) provides fewer specific and contextual guides to action and problem solving because of its distance from the mechanics of action (Watkins,
2011). When faced with difficulties and negative events, concrete processing will be adaptive relative to abstract processing because it will result in (i)
improved self-regulation focused on the immediate demands of the situation
rather than its evaluative implications; (ii) reduced negative overgeneralizations to emotional events, which contribute to increased emotional reactivity
and vulnerability to depression; and (iii) more effective problem solving.
Consistent with this theory, experimental studies have robustly found
abstract rumination causes negative consequences relative to concrete
rumination. The standardized rumination induction was adapted into two
variants that each retained the key original element of focus on self and
mood, but with distinct instructions to induce concrete (focus attention on the
experience of) versus abstract (think about the causes, meanings, and consequences
of) processing. In depressed patients, compared to abstract rumination, concrete rumination reduced negative global self-judgments (Rimes & Watkins,
2005), increased specificity of autobiographical memory recall (Watkins &
Teasdale, 2001), and improved social problem solving (Watkins & Moulds,
2005). Providing a conceptual replication to this finding, prompting abstract
rumination (questions such as “Why did this problem happen?”) impaired
social problem solving in a recovered depressed group, who performed
as well as never-depressed participants in a no-prompt control condition,

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whereas prompting concrete rumination (“How are you deciding what
to do next?”) ameliorated the problem-solving deficit found in currently
depressed patients (Watkins & Baracaia, 2002). Finally, repeated training to
think in a concrete mode reduced subsequent emotional reactivity to analog
loss and trauma events, relevant to training in an abstract mode (Watkins,
Moberly, & Moulds, 2008).
RUMINATION AS A TRANSDIAGNOSTIC PROCESS
Rumination has been proposed as a transdiagnostic process, that is, a process
present across multiple psychiatric diagnoses and that causally contributes
to those disorders, rather than only being implicated in depression (Ehring &
Watkins, 2008; Harvey et al., 2004; Nolen-Hoeksema & Watkins, 2011). Rumination prospectively predicts symptoms of anxiety and anxiety disorders
(e.g. post-traumatic stress) after controlling for baseline anxiety in numerous
longitudinal studies (Watkins, 2008). Rumination prospectively predicts
substance abuse, alcohol abuse, and eating disorders, after controlling for
initial symptoms (Ehring & Watkins, 2008; Nolen-Hoeksema & Watkins,
2011). A recent meta-analysis found that rumination was significantly
related to four distinct symptom types (depression, anxiety, eating, and
alcohol abuse; Aldao, Nolen-Hoeksema, & Schweizer, 2010). Two large-scale
longitudinal studies found that rumination explained the concurrent and
prospective associations between anxiety and depression (McLaughlin &
Nolen-Hoeksema, 2011).
TREATMENT INNOVATION
Because rumination has been identified as an important pathological process across multiple disorders, treatments that explicitly target rumination
are a priority. However, to date, little data has been collected on the effects of
cognitive behavioural therapy (CBT) or medication on rumination.
One recent treatment designed to explicitly target rumination is
Rumination-focused Cognitive Behavioral Therapy (RFCBT; Watkins
et al., 2007, 2011). RFCBT is a manualized treatment, theoretically informed
by processing mode and functional approaches to rumination, in which
patients are coached to shift from unconstructive rumination to constructive
rumination and to reduce avoidant behavior, through the use of functional
analysis, experiential/imagery exercises, and behavioral experiments.
Patients also use directed imagery to recreate previous mental states when
a more helpful thinking style was active, such as memories of being completely absorbed in an activity (e.g., “flow” experiences) and experiences
of increased compassion, which act directly counter to rumination. RFCBT

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significantly reduced rumination and depression in a multiple baseline
case series of patients with residual depression (Watkins et al., 2007) and
significantly outperformed continuation antidepressants in reducing rumination and depression in a Phase II randomized controlled trial (Watkins
et al., 2011).
Consistent with a causal relationship between processing mode and rumination, a proof-of-principle randomized controlled trial found that training
depressed individuals to be more concrete when faced with difficulties
reduced depression, anxiety, and rumination relative to a no-treatment
control (Watkins, Baeyens, & Read, 2009). The training involved repeated
practice at asking “How?” and focusing on specific details when thinking
about recent difficulties. In a Phase II randomized controlled trial, guided
self-help concreteness training was superior to treatment-as-usual in reducing rumination and depression in patients with major depression recruited
in primary care (Watkins et al., 2012).
KEY ISSUES FOR FUTURE RESEARCH
MECHANISMS UNDERPINNING RUMINATION
Despite well-developed theory and evidence regarding the consequences of
rumination, knowledge about its underlying mechanisms is less developed.
We do not know why some individuals engage in rumination more than
others. The critical question of “What makes it so difficult to break free of
rumination once it has begun?” (Nolen-Hoeksema et al., 2008, p. 418) remains
unanswered. Future research needs to delineate the mechanisms underpinning rumination.
Joormann (2010) proposed that rumination increases in those individuals
who are unable to inhibit now irrelevant but previously relevant information
in working memory. Consistent with this account, poor inhibitory control
indexed on different experimental tasks is correlated with rumination (e.g.,
Gotlib & Joormann, 2010; Joormann, Yoon, & Zetsche, 2007). Similarly,
Koster, De Lissnyder, Derakshan, and De Raedt (2011) proposed that individual differences in rumination arise from impairments in disengaging
attention from negative self-referent information. Consistent with this
account, self-reported rumination is correlated with selective attentional
bias toward sad faces (Joormann, Dkane, & Gotlib, 2006) and toward
negative words on the dot probe task (Donaldson, Lam, & Mathews, 2007).
Key next steps include (i) delineating whether rumination is associated with
biases in engaging and/or disengaging attention from negative information;
(ii) determining the causal direction of the relationship between these
deficits and the tendency toward rumination. If these biases and/or deficits

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cause rumination, then manipulating them (e.g., through cognitive bias
modification) should reduce rumination.
RUMINATION CO-MORBID WITH POOR PHYSICAL HEALTH
There is growing interest in rumination as a mechanism linking mental
and physical illness, accounting for their high co-morbidity (e.g., between
depression and cardiovascular disease). We coined the term “Worried
Unwell” to reflect individuals with chronic health conditions (e.g., cardiovascular disease, obesity, and chronic pain) who ruminate about the symptoms
and consequences of their ill-health. Such rumination may then contribute
to the maintenance of physical health symptoms and exacerbate depression
and anxiety.
Brosschot, Gerin, and Thayer (2006) noted that rumination involves the
repeated or chronic activation of the cognitive representation of psychological stressors, which is hypothesized to prolong psychological and
physiological responses to life events and daily stressors, resulting in body
systems associated with stress (e.g., cardiovascular, hypothalamic pituitary
adrenal, and immune systems) becoming chronically activated, and leading
to the development of disease. Consistent with this hypothesis, rumination
is elevated in patients with chronic illness and associated with dysregulated
physiological function (e.g., reduced heart rate variability, increased heart
rate, and increased blood pressure, all risk factors for hypertension and
cardiovascular disorders). Rumination prospectively predicts negative
health outcomes (Watkins, 2008), including increased heart disease over
a 20-year follow-up (Kubzansky et al., 1997) and increased depression in
patients with acute coronary syndrome (Denton, Rieckmann, Davidson &
Chaplin, 2012). Experimental induction of rumination about an upsetting or
angry event results in increased blood pressure and heart rate that maintains
over the next day (Ottaviani, Shapiro, & Fitzgerald, 2011).
However, experimental research has tended to be in healthy populations,
while most patient studies are cross sectional. Experimental and prospective studies are necessary to unpack whether rumination causally influences
symptoms in chronic illness and to determine its relative influence against
other vulnerabilities.
METHODOLOGICAL ADVANCES
Self-report remains central to the study of rumination because it is essentially
an experience of subjective consciousness. Nonetheless, development of
well-validated implicit, behavioral, and neuroimaging indices (e.g., attentional probe tasks and eye tracking), which provide analog proxies highly

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correlated with rumination, will enable us to overcome the limitations of
self-report and enable fine-tuned investigation of underlying cognitive
mechanisms.
To date, most rumination manipulations ask participants to voluntarily
and deliberately ruminate, introducing potential demand effects. Further,
this approach is not ecologically valid because rumination is typically
experienced as passive, involuntary, and uncontrollable. New induction
methods are required that indirectly engage involuntary rumination such
as prompting personally important unresolved goals or training an abstract
processing mode before failure feedback.
CONCLUSION
Rumination is a universal cognitive process triggered in response to poor
progress on personally relevant goals. Rumination tends to amplify existing
affect and elaborate mood-congruent cognitions. As such, it is implicated in
the onset and maintenance of depression, anxiety, emotional disorders, and
potentially chronic illness. Nonetheless, rumination can be adaptive when it
is focused on positive content or when it involves concrete processing.
DEDICATION
This essay is dedicated to the memory of Susan Nolen-Hoeksema (1960–
2013), following her premature death. Susan single-handedly initiated the
clinical study of rumination and inspired us all through her rigor, clarity, and
humanity. She will be much missed.
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Gebhardt, W. A., Van der Deof, M. P., Massey, E. K., Verhoeven, C. J., & Verkuil, B.
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Kubzansky, L. D., Kawachi, I., Spiro, A., Weiss, S. T., Vokonas, P. S., & Sparrow, D.
(1997). Is worrying bad for your heart? A prospective study of worry and coronary
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Lyubomirsky, S., & Nolen-Hoeksema, S. (1995). Effects of self-focused rumination
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Social Psychology, 69, 176–190.
Martin, L. L., & Tesser, A. (1996). Some ruminative thoughts. In R. S. Wyer (Ed.),
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McLaughlin, K. A., & Nolen-Hoeksema, S. (2011). Rumination as a transdiagnostic
factor in depression and anxiety. Behaviour Research and Therapy, 3, 186–193.
Moberly, N. J., & Watkins, E. R. (2010). Negative affect and ruminative self-focus
during everyday goal pursuit. Cognition and Emotion, 24(4), 729–739.
Mor, N., & Winquist, J. (2002). Self-focused attention and negative affect: A metaanalysis. Psychological Bulletin, 128, 638–662.
Nolen-Hoeksema, S. (1991). Responses to depression and their effects on the duration
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Nolen-Hoeksema, S. (2000). The role of rumination in depressive disorders and
mixed anxiety/depressive symptoms. Journal of Abnormal Psychology, 109, 504–511.
Nolen-Hoeksema, S., & Watkins, E. R. (2011). A heuristic for transdiagnostic models
of psychopathology: Explaining multifinality and divergent trajectories. Perspectives in Psychological Science, 6, 589–609.
Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008). Rethinking rumination.
Perspectives on Psychological Science, 3, 400–424.
Ottaviani, C., Shapiro, D., & Fitzgerald, L. (2011). Rumination in the laboratory: What
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Rimes, K. A., & Watkins, E. (2005). The effects of self-focused rumination on
global negative self-judgements in depression. Behaviour Research and Therapy, 43,
1673–1681.
Spasojevic, J., & Alloy, L. B. (2001). Rumination as a common mechanism relating
depressive risk factors to depression. Emotion, 1, 25–37.
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Bulletin, 134, 163–206.
Watkins, E. R. (2011). Dysregulation in level of goal and action identification across
psychological disorders. Clinical Psychology Review, 31, 260–278.
Watkins, E., & Baracaia, S. (2002). Rumination and social problem-solving in depression. Behaviour Research and Therapy, 40, 1179–1189.
Watkins, E. R., Baeyens, C. B., & Read, R. (2009). Concreteness training reduces dysphoria: Proof-of-principle for repeated cognitive bias modification in depression.
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400–402.
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… , Scott, J. (2011). Rumination-focused cognitive behaviour therapy for residual
depression: Phase II randomized controlled trial. British Journal of Psychiatry, 199,
317–322.
Watkins, E. R., Moberly, N. J., & Moulds, M. (2008). Processing mode causally influences emotional reactivity: Distinct effects of abstract versus concrete construal on
emotional response. Emotion, 8, 364–378.
Watkins, E. R., & Moulds, M. (2005). Distinct modes of ruminative self-focus: Impact
of abstract versus concrete rumination on problem solving in depression. Emotion,
5, 319–328.
Watkins, E. R., Scott, J., Wingrove, J., Rimes, K. A., Bathurst, N., Steiner, H., … ,
Malliaris, Y. (2007). Rumination-focused cognitive behaviour therapy for residual
depression: A case series. Behaviour Research and Therapy, 45, 2144–2154.
Watkins, E. R., Taylor, R. S., Byng, R., Baeyens, C. B., Read, R., Pearson, K., & Watson, L. (2012). Guided self-help concreteness training as an intervention for major
depression in primary care: A phase II randomized controlled trial. Psychological
Medicine, 42, 1359–1373.
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353–357.
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book of gestalt psychology (pp. 300–314). New York, NY: Harcourt, Brace, & World.

FURTHER READING
Harvey, A., Watkins, E., Mansell, W., & Shafran, R. (2004). Cognitive behavioural processes across psychological disorders: A transdiagnostic approach to research and treatment. Oxford, UK: Oxford University Press.

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Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008). Rethinking rumination.
Perspectives on Psychological Science, 3, 400–424.
Watkins, E. (2008). Constructive and unconstructive repetitive thought. Psychological
Bulletin, 134, 163–206.

EDWARD R. WATKINS SHORT BIOGRAPHY
Edward R. Watkins is Director of the Sir Henry Wellcome Mood Disorders
Centre and Professor of Experimental and Applied Clinical Psychology at
the University of Exeter. His research programme investigates the interactions between thoughts and feeling that underpin psychopathology, focuses
on rumination in depression, and translates this knowledge into improved
psychological interventions. He has published over 70 articles in leading psychology and psychiatry journals and has held major funding from NARSAD,
Medical Research Council-UK, the Wellcome Trust, and National Institute for
Health Research. He has coauthored and coedited books on the transdiagnostic approach (Cognitive Behavioural processes across the psychological disorders),
depression (Depression, 2nd edition), and cognition and emotion (Handbook of
Cognition and Emotion).
Personal webpage: http://www.exeter.mooddisorderscentre.
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