Rumination in Depression: A Natural Coping Mechanism?

Liam Davenport

December 03, 2014

A novel questionnaire developed by Canadian researchers to better understand the role of analytic thinking in depression may lead to more focused therapeutic interventions for patients.

Developed by investigators at McMaster University in Hamilton, Ontario, the Analytical Rumination Questionnaire (ARQ) measures analytic rumination (AR), a response characterized by enhanced cognitive function thought to help depressed individuals focus on, analyze, and solve problems.

The questionnaire, which breaks down analytic rumination into four domains to better understand and, ultimately, solve apparently intractable problems, is aimed at understanding the mechanisms of depression and identifying how best to focus interventions.

Investigators found a meaningful connection between responses to the 20-question ARQ and AR.

"Depression has long been seen as nothing but a problem. We are asking whether it may actually be a natural adaptation that the brain uses to tackle certain problems. We are seeing more evidence that depression can be a necessary and beneficial adaptation to dealing with major, complex issues that defy easy understanding," lead researcher Paul Andrews, PhD, said in a release.

The research was published online November 14 in PLoS One.

High Reliability

Explaining the genesis of the study, Dr Andrews told Medscape Medical News: "Back in 2009, I published a large paper in Psychological Review reviewing the evidence that analytical thinking occurs in depressed or sad mood states, and suggesting they have evolved for that to promote that analytical thinking."

"Any clinician will tell you that depressed people face really complex problems in their lives. What we proposed in that early paper is that analytical processing style is evoked by this mood state precisely because it's useful in solving complicated problems that depressed people face," he added.

Building on these findings and research by other investigators, including Susan Nolen-Hoeksema's 1991 article on ruminative responses to depression, Dr Andrews and colleagues developed an instrument to determine whether depressive symptomatology was linked to this analytic processing style.

The team created a model of analytic rumination based on the hypothesis that depressed individuals analyze their problems in terms of four domains:

  • Understanding the cause

  • Understanding the aspects of their problems that need to be solved

  • Generating possible solutions and evaluating the advantages

  • Evaluating the advantages and disadvantages of possible solutions

From this, they generated 22 candidate items for the ARQ and scored them on a five-point Likert scale. This provided a score range of 22 to 110, with a higher score indicating a higher level of ruminating. It was assumed that individuals would seek to go through each domain in turn.

The questionnaire was administered to 579 university students. Of these, 140 completed it a second time. The findings were then compared with those obtained with other established instruments and examined using the Rasch measurement method.

Scores on the ARQ spanned the range of the scale and were not skewed, and there were few missing data. The instrument was found to have high reliability (Cronbach's alpha = 0.91); the mean inter-item correlation was 0.83, suggesting that the scale was reliable. Test-retest intraclass correlations were >0.81.

Crucially, mean ARQ scores were correlated with the reflective pondering subscale of the Rumination Response Scale, as well as with the Beck Depression Inventory and the Positive and Negative Affect Scale. Neither sex nor age had an effect on IRQ scores.

After further analysis, the team found that the concept of adaptive rumination was best captured by a 20-item scale with four-point response categories. This fitted the Rasch model (P = .07) with high reliability.

First Step

Discussing the study, Dr Andrews commented: "We've done that just as a first step, but obviously the larger piece at stake is for us to figure out, Is this also happening in clinical populations?"

"We haven't published these data yet, but we have a sample of 50 people from an outpatient clinic...and what we found there is that the relationship between depressive symptoms and our ARQ was even stronger, suggesting that it's even more appropriate or applicable in a clinical sample."

If that early signal in the clinical population is borne out, then the ARQ may allow more directed and effective management of patients with depression.

"Our questionnaire, in principle, may allow a potential researcher to ascertain where in this process a depressed person currently is, and are they still in the 'why did this happen' phase and, if so, if they're stuck there. That may be a potential focus for therapy in order to help them move on to the subsequent part," said Dr Andrews.

"You can see that we could potentially do that at different time points, too. If they are having trouble generating potential solutions, then they can't really go and evaluate them, and they'll need help with the generation of potential solutions as well," he added.

Dr Andrews also observed that there are a number of "talking therapies" that are consistent with an analytic processing style.

"The idea under our hypothesis is that depressed people often seem to be pessimistic because they are facing severe and complicated problems that they are having trouble solving, and that the analysis is the next stage in the attempt to try to solve it," he said.

"The depressed person is switching from quick, simple solutions to slower, effortful attempts to solve the problem [so] therapies that actually encourage the analytical processing should be particularly useful."

No Upside to Depression

Commenting on the principle underlying the research, that adaptive processing can be a positive aspect of depression, Philip R. Muskin, MD, professor of psychiatry at Columbia University Medical Center in New York City, told Medical Medical News: "I do think it's a good piece of research [but] I don't agree."

"I don't think they're wrong, but it takes away from the fact that depression is an illness, and there's nothing really positive about the illness of depression. It's unfortunate that people have the illness, and trying to make something positive out of an illness I don't think is a good approach."

Dr Muskin continued: "I don’t think there is good out of illness. There's suffering out of illness. Now, can people turn suffering into something good? I think people are remarkable in that they can do that.... Have artists great and not so great used their emotional turmoil to advance our culture? I think the answer is, 'Absolutely yes.' "

"But that doesn't mean that they were happy about being depressed. Depression often stifles creativity and causes people to withdraw in painful ways that they themselves can't control."

Discussing why it is important to recognize the gravity of depression in comparison with, for example, sadness, Dr Muskin said: "There may be times that [people] are sad. That's a normal emotion. I wouldn't want a life without sadness, and there may be times that we suffer a loss, we lose a friend, we lose a family member, we lose a pet, and that's poignant and sad."

"There are times when we have an illness called depression, which is unfortunately quite common, and that's not the same. People who are sad and deserve our support and our help are different from people who are depressed and who also deserve our support and help."

"But it's a different issue. They should be treated with talk therapy for people for whom that's appropriate, or pharmacotherapy for people for whom that's appropriate."

He concluded: "I wouldn’t want to make something like depression sound like, 'Oh well, you just have the bad version of rumination. Too bad you didn't get the good version of rumination.' "

The study program is funded by the Canadian Institutes of Health Research through the Social Aetiology of Mental Illness Funding Program at the Centre for Addiction and Mental Health in Toronto. The authors and Dr Muskin have disclosed no relevant financial relationships.

PLoS One. Published online November 14, 2014. Full article

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