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International Journal of Environmental... Dec 2022Objective: To systematically evaluate the effectiveness of mindfulness-based interventions (MBIs) on rumination among patients with depression and their efficacy across... (Meta-Analysis)
Meta-Analysis Review
Objective: To systematically evaluate the effectiveness of mindfulness-based interventions (MBIs) on rumination among patients with depression and their efficacy across countries and year of publication and control conditions. Methods: Web of Science Core Collection, Medline, BIOSIS Citation Index, KCI-Korean Journal Database, SciELO Citation Index, PubMed, Cochrane Library, and Embase were searched to include randomized controlled trials of MBIs for depressive rumination that met the criteria. The Rumination Scale was used as the primary outcome indicator; Depression, mindfulness, and anxiety indexes were selected as the secondary outcome indicators. An evaluation of bias risk was conducted to identify possible sources of bias based on methodological and clinical factors. RevMan5.3 software was used to perform a meta-analysis of the extracted data. Results: Nineteen studies with 1138 patients were included. Meta-analysis showed that MBIs could significantly reduce rumination levels in patients with depression (standardized mean difference (SMD) = −0.46; 95% confidence interval (CI): −0.58, −0.34; p < 0.001), notably improve depression (SMD = −0.58; 95% CI: −0.83, −0.32; p < 0.001), enhance mindfulness ability (SMD = 0.95; 95% CI: 0.57, 1.32; p < 0.001), and reduce the anxiety of patients with depression (SMD = −0.45, 95% CI: −0.62, −0.27; p < 0.001). MBIs conducted in Asia improved rumination better than studies in Europe and North America (SMD = −2.05 95% CI: −4.08, −0.01; p < 0.001) but had no greater effect than behavior activation on depression. The interventions carried out in the past 5 years were significantly better than earlier studies in improving mindfulness levels (SMD = 2.74; 95% CI: 0.81, 4.66; p = 0.005). Conclusions: MBIs are effective in the treatment of depression as they produce pleasant improvement in rumination and depression, decrease the degree of anxiety, and enhance mindfulness levels compared to controls. In newer forms of MBIs, regional differences need to be considered when designing the intervention program. More large, high-quality randomized controlled studies are needed to confirm the conclusion that the effectiveness of MBIs has differences in terms of the trial area and year of publication.
Topics: Humans; Randomized Controlled Trials as Topic; Mindfulness; Anxiety; Anxiety Disorders; Depressive Disorder
PubMed: 36498174
DOI: 10.3390/ijerph192316101 -
Nature Communications Jun 2023Rumination is a cognitive style characterized by repetitive thoughts about one's negative internal states and is a common symptom of depression. Previous studies have...
Rumination is a cognitive style characterized by repetitive thoughts about one's negative internal states and is a common symptom of depression. Previous studies have linked trait rumination to alterations in the default mode network, but predictive brain markers of rumination are lacking. Here, we adopt a predictive modeling approach to develop a neuroimaging marker of rumination based on the variance of dynamic resting-state functional connectivity and test it across 5 diverse subclinical and clinical samples (total n = 288). A whole-brain marker based on dynamic connectivity with the dorsomedial prefrontal cortex (dmPFC) emerges as generalizable across the subclinical datasets. A refined marker consisting of the most important features from a virtual lesion analysis further predicts depression scores of adults with major depressive disorder (n = 35). This study highlights the role of the dmPFC in trait rumination and provides a dynamic functional connectivity marker for rumination.
Topics: Adult; Humans; Depressive Disorder, Major; Magnetic Resonance Imaging; Prefrontal Cortex; Brain; Brain Mapping
PubMed: 37321986
DOI: 10.1038/s41467-023-39142-9 -
Cognition & Emotion Nov 2018Rumination and worry are two perseverative, negatively valenced thought processes that characterise depressive and anxiety disorders. Despite significant research...
Rumination and worry are two perseverative, negatively valenced thought processes that characterise depressive and anxiety disorders. Despite significant research interest, little is known about the everyday precipitants and consequences of rumination and worry. Using an experience sampling methodology, we examined and compared rumination and worry with respect to their relations to daily events and affective experience. Participants diagnosed with Major Depressive Disorder (MDD), Generalized Anxiety Disorder (GAD), co-occurring MDD-GAD, or no diagnosis carried an electronic device for one week and reported on rumination, worry, significant events, positive affect (PA), and negative affect (NA). Across the clinical groups, occurrences of everyday events predicted subsequent increases in rumination, but not worry. Further, higher momentary levels of rumination, but not worry, predicted subsequent decreases in PA and increases in NA. Thus, in these clinical groups, rumination was more susceptible to daily events and produced stronger affective changes over time. We discuss implications for theory and clinical intervention.
Topics: Adolescent; Adult; Anxiety; Anxiety Disorders; Case-Control Studies; Depressive Disorder, Major; Female; Humans; Middle Aged; Rumination, Cognitive; Young Adult
PubMed: 28103761
DOI: 10.1080/02699931.2017.1278679 -
Biological Psychiatry Aug 2015The intuitive association between self-focused rumination in major depressive disorder (MDD) and the self-referential operations performed by the brain's default-mode... (Review)
Review
The intuitive association between self-focused rumination in major depressive disorder (MDD) and the self-referential operations performed by the brain's default-mode network (DMN) has prompted interest in examining the role of the DMN in MDD. In this article, we present meta-analytic findings showing reliably increased functional connectivity between the DMN and subgenual prefrontal cortex (sgPFC)-connectivity that often predicts levels of depressive rumination. We also present meta-analytic findings that, while there is reliably increased regional cerebral blood flow in sgPFC in MDD, no such abnormality has been reliably observed in nodes of the DMN. We then detail a model that integrates the body of research presented. In this model, we propose that increased functional connectivity between sgPFC and the DMN in MDD represents an integration of the self-referential processes supported by the DMN with the affectively laden, behavioral withdrawal processes associated with sgPFC-an integration that produces a functional neural ensemble well suited for depressive rumination and that, in MDD, abnormally taxes only sgPFC and not the DMN. This synthesis explains a broad array of existing data concerning the neural substrates of depressive rumination and provides an explicit account of functional abnormalities in sgPFC in MDD.
Topics: Adult; Aged; Brain; Brain Mapping; Depressive Disorder, Major; Female; Humans; Magnetic Resonance Imaging; Male; Models, Neurological; Nerve Net; Neurosciences; Prefrontal Cortex; Thinking; Young Adult
PubMed: 25861700
DOI: 10.1016/j.biopsych.2015.02.020 -
PloS One 2022Brooding rumination is positively associated with symptoms of both depression and posttraumatic stress disorder (PTSD). However, non-clinical cross-cultural research...
Brooding rumination is positively associated with symptoms of both depression and posttraumatic stress disorder (PTSD). However, non-clinical cross-cultural research indicates that culture may influence these associations. This study aimed to examine the moderating effect of cultural group (Australian versus Malaysian) on the associations between brooding rumination and symptoms of depression and PTSD. European Australians (n = 109) and Malaysians of varying Asian heritages (n = 144) completed an online questionnaire containing the Hospital Anxiety and Depression Scale, PTSD checklist for DSM-5 and the Ruminative Response Scale-Short Form. First, Malaysian participants had higher brooding rumination than Australian participants. Second, higher levels of brooding rumination were positively associated with depression and PTSD symptom severity. Third, contrary to our expectations, cultural group did not moderate the relationships between brooding rumination and symptoms of depression and PTSD. If replicable, these results suggest that existing assessment and treatment approaches that target brooding rumination may apply to Malaysian individuals with depression and PTSD.
Topics: Humans; Stress Disorders, Post-Traumatic; Depression; Australia; Diagnostic and Statistical Manual of Mental Disorders; Checklist
PubMed: 36445879
DOI: 10.1371/journal.pone.0278328 -
Frontiers in Pediatrics 2021Rumination syndrome involves recurrent regurgitation of food and is believed to be underdiagnosed with patients experiencing long delays in diagnosis. It can be... (Review)
Review
Rumination syndrome involves recurrent regurgitation of food and is believed to be underdiagnosed with patients experiencing long delays in diagnosis. It can be associated with significant social consequences, high rates of school absenteeism, and medical complications such as weight loss. The primary aims of the current review are to assess the literature regarding prevalence, pathophysiology, and treatment outcomes with a focus on neurotypical children and adolescents. Population studies in children/adolescents, 5 years of age or older, range from 0 to 5.1%. There are fewer studies in clinical settings, but the prevalence appears to be higher in patients with other gastrointestinal symptoms, particularly chronic vomiting. While physiologic changes that occur during a rumination episode are well-described, the underlying cause is less well-defined. In general, rumination appears to have similarities to other functional gastrointestinal disorders including dysmotility, possibly inflammation, and an interaction with psychologic function. While diaphragmatic breathing is considered the mainstay of treatment, pediatric data demonstrating efficacy is lacking, especially as an isolated treatment. Pediatric rumination syndrome remains greatly understudied, particularly regarding treatment. There is a need to better define prevalence in both the primary care and subspecialty clinical settings, especially in patients presenting with vomiting or apparent gastroesophageal reflux. There is a need to determine whether treatment of co-morbid conditions results in improvement of rumination. Diaphragmatic breathing needs to be studied and compared to other competing responses.
PubMed: 34490165
DOI: 10.3389/fped.2021.709326 -
Frontiers in Psychiatry 2022Previous theoretical models and reviews have documented a strong connection between emotion dysregulation eating disorder (ED) psychopathology among the general and...
BACKGROUND
Previous theoretical models and reviews have documented a strong connection between emotion dysregulation eating disorder (ED) psychopathology among the general and clinical populations. The aim of this review was to build on this previous work by conducting a network meta-analysis to explore associations between adaptive and maladaptive emotion regulation strategies and ED psychopathology trans-diagnostically across the ED spectrum to identify areas of emotion dysregulation that have the strongest association with symptomatology.
METHODOLOGY
A total of 104 studies were included in the meta-analysis and correlation coefficient representing the associations between specific emotion regulation strategies and ED symptomatology were extracted. We ran a Bayesian random effects network meta-analysis and the initial network was well-connected with each emotion regulation strategy being linked to at least one other strategy. We also conducted a network meta-regression to explore whether between-study differences in body mass index (BMI), age, and whether the sample consisted of solely female participants explained any possible network inconsistency.
RESULTS
The network meta-analysis revealed that ruminations and non-acceptance of emotions were most closely associated with ED psychopathology. There was no significant network inconsistency but two comparisons approached significance and thus meta-regressions were conducted. The meta-regressions revealed a significant effect of BMI such that the associations between different emotion regulation strategies and ED symptomatology were weaker among those with low BMI.
DISCUSSION
The present findings build on previous work and highlight the role of rumination and difficulties with accepting emotions as key emotion regulation difficulties in EDs. Additionally, the finding that the associations were weaker among ED patients with low BMI may point toward a complex relationship between ED behaviors and emotion regulation. Taken together, our findings call for interventions that target emotion regulation, specifically rumination and difficulties accepting emotions, in the treatment of EDs.
SYSTEMATIC REVIEW REGISTRATION
https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021249996, PROSPERO, identifier: CRD42021249996.
PubMed: 35280172
DOI: 10.3389/fpsyt.2022.793094 -
Turk Psikiyatri Dergisi = Turkish... 2022The aim of this study was to test the metacognitive model of depression in individuals diagnosed with major depressive disorder (MDD) and to investigate the relative...
OBJECTIVE
The aim of this study was to test the metacognitive model of depression in individuals diagnosed with major depressive disorder (MDD) and to investigate the relative contributions of cognitions and metacognitions about rumination to the explanation of depressive symptoms.
METHOD
The participants of the study consisted of 180 MDD patients not meeting the diagnostic criteria for other psychiatric disorders. The obtained data were analyzed through structural equation modelling (SEM) and hierarchical regression analyses.
RESULTS
SEM results showed that positive beliefs about rumination increased the rumination level, and the higher levels of rumination significantly predicted the increase in depressive symptoms partly through the mediating effect of negative metacognitive beliefs about rumination regarding interpersonal and social consequences. However, negative metacognitive beliefs about the uncontrollability and danger of rumination were not found to be associated with symptoms of depression in the participants of this study. The power of dysfunctional attitudes for predicting depression was lost when hierarchical regression analysis was carried out by controlling the metacognitions about negative interpersonal and social consequences of rumination.
CONCLUSION
The results are consistent with the metacognitive model of depression, which was originally developed for better understanding of MDD, and point to the usefulness of considering positive and negative metacognitions about rumination in the processes of clinical evaluation and intervention for MDD.
Topics: Anxiety; Cognition; Depression; Depressive Disorder, Major; Humans; Metacognition
PubMed: 35730508
DOI: 10.5080/u26082 -
Frontiers in Human Neuroscience 2017Despite the success of available medical and psychosocial treatments, a sizable subgroup of individuals with commonly co-occurring disorders, generalized anxiety... (Review)
Review
Despite the success of available medical and psychosocial treatments, a sizable subgroup of individuals with commonly co-occurring disorders, generalized anxiety disorder (GAD) and major depressive disorder (MDD), fail to make sufficient treatment gains thereby prolonging their deficits in life functioning and satisfaction. Clinically, these patients often display temperamental features reflecting heightened sensitivity to underlying motivational systems related to threat/safety and reward/loss (e.g., somatic anxiety) as well as inordinate negative self-referential processing (e.g., worry, rumination). This profile may reflect disruption in two important neural networks associated with emotional/motivational salience (e.g., salience network) and self-referentiality (e.g., default network, DN). Emotion Regulation Therapy (ERT) was developed to target this hypothesized profile and its neurobehavioral markers. In the present study, 22 GAD patients (with and without MDD) completed resting state MRI scans before receiving 16 sessions of ERT. To test study these hypotheses, we examined the associations between baseline patterns of intrinsic functional connectivity (iFC) of the insula and of hubs within the DN (anterior and dorsal medial prefrontal cortex [MPFC] and posterior cingulate cortex [PCC]) and treatment-related changes in worry, somatic anxiety symptoms and decentering. Results suggest that greater treatment linked reductions in worry were associated with iFC clusters in both the insular and parietal cortices. Greater treatment linked gains in decentering, a metacognitive process that involves the capacity to observe items that arise in the mind with healthy psychological distance that is targeted by ERT, was associated with iFC clusters in the anterior and posterior DN. The current study adds to the growing body of research implicating disruptions in the default and salience networks as promising targets of treatment for GAD with and without co-occurring MDD.
PubMed: 28316567
DOI: 10.3389/fnhum.2017.00086 -
Journal of Psychosomatic Research Dec 2023Cognitive behavioural therapy (CBT) is increasingly used to manage Disorders of Gut-Brain Interaction (DGBIs). This systematic review aimed to review the evidence for... (Review)
Review
OBJECTIVE
Cognitive behavioural therapy (CBT) is increasingly used to manage Disorders of Gut-Brain Interaction (DGBIs). This systematic review aimed to review the evidence for the effectiveness of CBT-based interventions for patients with gastroduodenal DGBIs.
METHODS
Medline, Embase, PubMed, Cochrane Central, and Scopus were searched in July 2022. Studies were included if they investigated the effects of a CBT-based intervention on gastrointestinal symptoms and/or psychological outcomes pre- and post-intervention in patients with gastroduodenal DGBIs. Case studies, studies not in English, and studies with patients under 18 years were excluded. Results were synthesised narratively, and standardised effect sizes were calculated where possible.
RESULTS
Nine studies (seven RCTs and two pre/post studies) were identified, with data reported in 10 articles (total N = 602). The studies investigated patients with functional dyspepsia (n = 7), rumination syndrome (n = 1), and supragastric belching (n = 1). The studies had heterogeneous interventions, methodologies, and outcomes, precluding meta-analysis, as well as a moderate-high risk of bias and high drop-outs rates. Findings demonstrated decreased gastrointestinal symptoms and improved anxiety, depression, and quality of life, from pre- to post-intervention, with medium to large effect sizes for symptoms and small to large effect sizes for psychological outcomes. Efficacy was maintained at follow-up, up to one year later.
CONCLUSIONS
This review suggests promising evidence that CBT effectively improves gastrointestinal symptoms and psychological outcomes in patients with gastroduodenal DGBIs. However, heterogeneity, risk of bias, and lack of statistical reporting were noted, indicating the need for more robust research and standardisation.
Topics: Adolescent; Humans; Anxiety Disorders; Brain; Cognitive Behavioral Therapy; Psychotherapy; Quality of Life
PubMed: 37832277
DOI: 10.1016/j.jpsychores.2023.111516