-
Clinical Psychology Review Dec 2020Initial models and empirical investigations of rumination in the clinical literature were predominantly in the domain of depression. However, rumination is now... (Review)
Review
Initial models and empirical investigations of rumination in the clinical literature were predominantly in the domain of depression. However, rumination is now well-established as a transdiagnostic cognitive process, including in the context of posttraumatic stress. To clarify the current understanding of rumination in posttraumatic stress, we conducted a systematic review of the empirical literature on rumination in posttraumatic stress disorder (PTSD). Six sub-groups of studies on this topic were identified; these addressed: (i) the frequency and nature of rumination, (ii) cross-sectional relationships between rumination and PTSD symptoms, (iii) the capacity of rumination to predict PTSD longitudinally, (iv) other processes associated with rumination, (v) neurobiological correlates of rumination, and (vi) whether treating PTSD reduces rumination. This review synthesizes these domains of research and identifies key methodological limitations which limit causal inferences, and points to important areas of future research to advance knowledge on rumination in PTSD.
Topics: Humans; Stress Disorders, Post-Traumatic
PubMed: 32971312
DOI: 10.1016/j.cpr.2020.101910 -
Psychological Medicine Dec 2023People with bipolar disorder (BD) often present emotion dysregulation (ED), a pattern of emotional expression interfering with goal-directed behavior. ED is a... (Meta-Analysis)
Meta-Analysis Review
People with bipolar disorder (BD) often present emotion dysregulation (ED), a pattern of emotional expression interfering with goal-directed behavior. ED is a transdiagnostic construct, and it is unclear whether it manifests itself similarly in other conditions, such as major depressive disorder (MDD) or borderline personality disorder (BPD), or has specific features in BD. The present systematic review and meta-analysis explored ED and adopted emotion regulation (ER) strategies in BD compared with other psychiatric conditions. PubMed/MEDLINE, EMBASE, Scopus, and PsycINFO databases were systematically searched from inception to April 28th, 2022. Studies implementing validated instruments assessing ED or ER strategies in BD and other psychiatric disorders were reviewed, and meta-analyses were conducted. Twenty-nine studies yielding multiple comparisons were included. BD was compared to MDD in 20 studies ( = 2451), to BPD in six studies ( = 1001), to attention deficit hyperactivity disorder in three studies ( = 232), to anxiety disorders in two studies ( = 320), to schizophrenia in one study ( = 223), and to post-traumatic stress disorder in one study ( = 31). BD patients did not differ from MDD patients in adopting most adaptive and maladaptive ER strategies. However, small-to-moderate differences in positive rumination and risk-taking behaviors were observed. In contrast, patients with BPD presented an overall higher degree of ED and more maladaptive ER strategies. There were insufficient data for a meta-analytic comparison with other psychiatric disorders. The present report further supports the idea that ED is a transdiagnostic construct spanning a continuum across different psychiatric disorders, outlining specific clinical features that could represent potential therapeutic targets.
Topics: Humans; Bipolar Disorder; Depressive Disorder, Major; Emotional Regulation; Attention Deficit Disorder with Hyperactivity; Borderline Personality Disorder; Emotions
PubMed: 37842774
DOI: 10.1017/S003329172300243X -
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 -
Behavior Therapy Jan 2021Prolonged grief disorder, characterized by severe, persistent, and disabling grief, has recently been included in the International Classification of Diseases-11... (Review)
Review
Prolonged grief disorder, characterized by severe, persistent, and disabling grief, has recently been included in the International Classification of Diseases-11 (ICD-11). Emotional disturbances are central to such complicated grief responses. Accordingly, emotion regulation is assumed critical in the development, persistence, and treatment of complicated grief. Yet, a comprehensive review on this topic is lacking. We conducted a systematic review (PROSPERO: CRD42017076061) searching PsycInfo, Web of Science, and PubMed to identify quantitative research examining relationships between emotion regulation and complicated grief. Sixty-four studies on 7,715 bereaved people were identified, focusing on a variety of emotion regulation strategies (i.e., experiential avoidance, behavioral avoidance, expressive suppression, rumination, worry, problem solving, cognitive reappraisal, positive thought, and mindfulness). Our synthesis showed strong evidence that experiential avoidance and rumination play a role in the persistence of complicated grief. More generally, surveys support positive associations between putative maladaptive emotion regulation strategies and complicated grief, and negative associations between putative adaptive emotion regulation strategies and complicated grief. Laboratory research yielded mixed results. Emotion regulation is critical in complicated grief, and in particular experiential avoidance and rumination form important targets in complicated grief treatments. We advise expanding current knowledge, by employing more advanced, intensive data collection methods and experiments across diverse samples. Increasing knowledge in this domain will improve clinical practice.
Topics: Anxiety; Bereavement; Emotional Regulation; Grief; Humans; Surveys and Questionnaires
PubMed: 33483120
DOI: 10.1016/j.beth.2020.04.004 -
BMC Complementary Medicine and Therapies Sep 2023Mindfulness yoga is a type of exercise that emphasizes the integration of mindfulness or meditation into yoga. The aim of this study was to determine the effectiveness... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Mindfulness yoga is a type of exercise that emphasizes the integration of mindfulness or meditation into yoga. The aim of this study was to determine the effectiveness of mindfulness yoga intervention on major depressive disorder (MDD) patients.
METHODS
A systematic review and meta-analysis of randomized controlled trials (RCTs) was conducted by searching nine databases, including PubMed, EMBASE, Web of Science, The Cochrane Library, MEDLINE, China National Knowledge Infrastructure (CNKI), Wanfang Data knowledge service platform, Chinese Biomedical Literature Database (CBM), and China Science and Technology Journal Database (VIP) from inception to April 2023. Primary outcomes included the severity of depression. Secondary outcomes included anxiety and rumination.
RESULTS
Nine RCTs met our inclusion criteria (n = 581). The meta-analysis showed that mindfulness yoga significantly has a significant effect on depression (SMD = -0.53; 95%CI = -0.96 to -0.11; P < 0.05) among MDD patients. The only two RCTs involved also showed that mindfulness yoga could alleviate the anxiety level of MDD patients after intervention (SMD = -1.08; 95%CI = -1.64 to -0.52; P < 0.05). Meta-analysis did not reveal positive effects of the mindfulness yoga groups on rumination after intervention based on three RCTs (SMD = -0.33; 95%CI = -0.89 to 0.23; P > 0.05), but found a significant difference in the follow-up period based on two RCTs (MD = -7.42; 95%CI = -11.27 to -3.56; P < 0.05), compared with the control groups.
CONCLUSION
Although we were unable to provide conclusive evidence to support the effectiveness of mindfulness yoga in improving symptoms in MDD patients, we found the literature included in this study indicated that mindfulness yoga might have a potential benefit for MDD patients and should be a feasible, acceptable, and promising intervention.
Topics: Humans; Depressive Disorder, Major; Yoga; Meditation; Mindfulness; Randomized Controlled Trials as Topic
PubMed: 37684609
DOI: 10.1186/s12906-023-04141-2 -
Eating Behaviors Apr 2022While maladaptive interpersonal behaviors have been implicated in models of psychopathology, particularly depression, maladaptive interpersonal behaviors have received... (Review)
Review
While maladaptive interpersonal behaviors have been implicated in models of psychopathology, particularly depression, maladaptive interpersonal behaviors have received limited attention in the eating disorder (ED) literature. Further, the extant literature on maladaptive interpersonal behaviors in relation to ED psychopathology has yet to be synthesized. Therefore, the aim of this systematic review was to characterize the literature on maladaptive interpersonal behaviors and ED psychopathology. Inclusion criteria for the review were: availability of the study in English, empirical journal article, inclusion of human subjects, and reporting an association between at least one maladaptive interpersonal behavior and one measure of ED psychopathology. Databases searched were PsycInfo and PubMed across all dates (up to September 2020). Data was extracted from articles, and main findings were synthesized; quality scores were provided using a modified version of the Newcastle Ottawa Scale. There were 35 studies with 36 independent samples included in the review. Most studies evidenced significant bivariate associations between maladaptive interpersonal behaviors and ED psychopathology. That is, higher levels of maladaptive interpersonal behaviors were generally associated with greater disordered eating, bulimic symptoms, and body image concerns. Although limited to a minority of studies, some studies identified prospective associations and significant mediators and moderators of associations. This systematic review supports further research on maladaptive interpersonal behaviors and ED psychopathology. Given a number of significant limitations in the literature identified in this review, there are an array of avenues for future research on maladaptive interpersonal behaviors and ED psychopathology.
Topics: Body Image; Feeding and Eating Disorders; Humans; Psychopathology
PubMed: 35221209
DOI: 10.1016/j.eatbeh.2022.101601 -
Neurogastroenterology and Motility Jul 2024Rumination is characterized by the repeated regurgitation of food. Rumination syndrome is a disorder of gut-brain interaction diagnosed by Rome criteria, whereas... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Rumination is characterized by the repeated regurgitation of food. Rumination syndrome is a disorder of gut-brain interaction diagnosed by Rome criteria, whereas rumination disorder is a feeding and eating disorder diagnosed by DSM-5 criteria. We aimed to determine the global prevalence of rumination according to these criteria across all age groups.
METHODS
We performed a systematic review and meta-analysis of studies reporting the prevalence of rumination syndrome according to Rome III and Rome IV and rumination disorder according to the following validated DSM-5 assessments: PARDI, EDA-5, EDY-Q, STEP, and STEP-CHILD. We searched MEDLINE, EMBASE, and PsychINFO (from January 1, 2006, to June 1, 2023) to identify studies reporting the prevalence of rumination in community settings in participants of any age. We did a meta-analysis to estimate the pooled prevalence and odds ratio (OR) of rumination according to diagnostic criteria, country, and characteristics such as age and sex.
KEY RESULTS
The search strategy generated 1243 studies, of which 147 studies appeared to be relevant. Thirty studies were included, with a total of 114,228 participants, of whom 61,534 of these were adults and 52,694 were children. The pooled prevalence of rumination syndrome in children of all ages according to Rome III criteria was 1.0% (95% CI 0.3-1.6; I 91.1%), but no data were available for adults. According to Rome IV criteria, the pooled prevalence of rumination syndrome in children of all ages was 0.4% (95% CI 0.2-0.6; I 56.4%) and 3.7% in adults (95% CI 2.3-5.1; I 91.4%). The pooled prevalence of rumination disorder in children of all ages according to EDY-Q was 2.1% (95% CI 0.9-3.4; I = 78.1%), but only one study utilizing EDY-Q in adults was included (0.7% [95% CI 0.4-1.0]). No data were available for children or adults using any other validated DSM-5 assessments for rumination disorder. Irrespective of diagnostic criteria, the pooled prevalence of rumination was higher in adults compared to children and adolescents (3.0% [95% CI 1.4-4.7; I = 98.1%] vs. 0.8% [95% CI 0.4-1.3; I = 90.8%]), but higher in adolescents than in children (1.1% [95% CI 0.3-2.0; I = 92.8%] vs. 0.1% [95% CI 0.0-0.2; I = 24.5%]). In adults, factors independently associated with rumination were female gender (OR 1.4 [95% CI 1.0-2.0]), anxiety (OR 2.3 [95% CI 2.1-2.6]), and depression (OR 1.8 [95% CI 1.2-2.9]). No association between gender and rumination was seen in children.
CONCLUSIONS AND INFERENCES
The prevalence of rumination is more common in adults than in children. In adults, rumination is associated with female gender, anxiety, and depression. Future population studies should aim to better understand why this behavior is more common in adults and also compare validated DSM-5 assessments for rumination disorder with Rome criteria for rumination syndrome as prevalence may differ.
Topics: Humans; Prevalence; Rumination Syndrome; Feeding and Eating Disorders; Child; Adult
PubMed: 38563201
DOI: 10.1111/nmo.14793 -
The British Journal of Clinical... Mar 2023Due to rumination and self-criticism over unwanted obsessions and repetitive rituals, shame is a common emotion experienced by individuals with obsessive-compulsive... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Due to rumination and self-criticism over unwanted obsessions and repetitive rituals, shame is a common emotion experienced by individuals with obsessive-compulsive disorder (OCD). Shame is also theorized to have relevance to unacceptable thoughts in OCD. However, empirical research looking at the relationship between OCD and shame is still emerging and findings have been mixed.
OBJECTIVES
Our review systematically examines the association of shame with OCD and unacceptable thoughts.
METHODS
The last updated search was conducted across five databases between 27 and 29 February 2022. The final selection included 20 papers, 18 of which were used in the primary meta-analysis to calculate pooled effect sizes between OCD and shame measures using a random effects model. In a separate analysis, three papers were used to calculate pooled effect sizes between shame and OCD symptom dimensions also using a random effects model.
RESULTS
The meta-analyses identified a significant, moderate and positive correlation between total OCD and shame scores r = .352, 95% CI [0.260, 0.438]. In addition, significant, weak and positive relationships were found between shame and three OCD symptom dimensions: unacceptable thoughts r = .252, 95% CI [-0.467, 0.9708], harm obsessions r = .224, CI [-0.190, 0.638] and symmetry concerns r = .200, CI [-0.108, 0.509].
LIMITATIONS
Shame measures in the reviewed studies were not specific to OCD, and between-study variance in the analyses examining unacceptable thoughts was significant.
CONCLUSIONS
Our findings support a medium positive relationship between shame and OCD. As shame in OCD can be a barrier to seeking treatment and impair quality of life, it is imperative to address this emotion through psychoeducation, assessment and treatment.
Topics: Humans; Quality of Life; Obsessive-Compulsive Disorder; Shame; Psychiatric Status Rating Scales; Psychometrics
PubMed: 36300990
DOI: 10.1111/bjc.12392 -
Clinical Psychology & Psychotherapy May 2021It has been proposed that repetitive negative thinking (worry and rumination) may be more common among adults who have been exposed to childhood adverse experiences,... (Review)
Review
BACKGROUND
It has been proposed that repetitive negative thinking (worry and rumination) may be more common among adults who have been exposed to childhood adverse experiences, leading to emotional disorders and other adverse outcomes. The current study aims to present a comprehensive evaluation of the literature examining the relationship between the exposure to childhood adversities, repetitive negative thinking and clinical outcomes in adulthood.
METHODS
In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, a search was conducted on PubMed and Ebsco. A manual search of reference lists was also run. Search terms were 'childhood adversity/childhood abuse/childhood neglect/early loss event AND worry or rumination'.
RESULTS
A total of 18 studies met the inclusion criteria. In both non-clinical and clinical populations, worry and rumination seem to be common among adults exposed to childhood abuse or childhood neglect. Among adults who have been exposed to childhood adversities, rumination seems to be associated with worse clinical outcomes such as severe psychiatric symptoms, depression, dysphoria, suicidal ideation, cognitive complaints, post-traumatic stress symptoms and aggression.
CONCLUSION
Early experiences of abuse and neglect may be associated with a tendency to engage in repetitive negative thinking, such as worry and rumination, in adulthood. Among adults, with a history of childhood adversities, tailored treatment to reduce repetitive negative thinking should be considered.
Topics: Adult; Adverse Childhood Experiences; Anxiety; Child; Depressive Disorder, Major; Humans; Pessimism; Suicidal Ideation
PubMed: 33861493
DOI: 10.1002/cpp.2590 -
Neuroscience and Biobehavioral Reviews Nov 2022Emotion dysregulation (ED) is characterized by rigid and frequent use of maladaptive emotion regulation (ER) strategies. Conceptualized as a transdiagnostic feature, ED... (Meta-Analysis)
Meta-Analysis Review
Emotion dysregulation (ED) is characterized by rigid and frequent use of maladaptive emotion regulation (ER) strategies. Conceptualized as a transdiagnostic feature, ED may occur in both clinical and non-clinical populations, including people diagnosed with bipolar disorder (BD) and their first-degree relatives (FDRs), though expected to manifest with differential clinical features. To this end, we conducted a systematic review and meta-analysis of the literature comparing people with BD to healthy controls (HCs) or FDRs, from inception up to November 25, 2021, across major databases. Random-effects meta-analyses considered twenty-eight studies assessing ER/ED with a validated scale. Patients with BD differed from HCs in adopting more maladaptive ER strategies, such as rumination, risk-taking behaviors, negative focus, and less adaptive ones. Unaffected FDRs differed from people with BD, yet to a lower extent, suggesting that ED may span a continuum. ED in BD should be widely explored to better understand its course and management, with specific interventions aimed at reducing its burden on both high-risk and full-threshold populations.
Topics: Humans; Bipolar Disorder; Emotional Regulation
PubMed: 36243194
DOI: 10.1016/j.neubiorev.2022.104914