Why Do People Worry And Ruminate

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In an earlier section of this chapter, the numerous negative consequences associated with worry and rumination were reviewed. Despite these consequences, it is puzzling to understand why people choose to engage in worry and rumination when stressors are encountered. Knowledge of the factors implicated in proneness to worry and rumination may contribute to our understanding of the mechanisms underlying the frequency and severity of worry and anxiety symptoms as well as rumination and depressive symptoms. Moreover, the modification of these factors may assist in reducing vulnerability to worry and rumination and maximising the efficacy of psychological interventions for anxiety and depression. A number of hypotheses have been advanced to account for the role of worry in anxiety and rumination in depression. Worry has been viewed as a form of avoidance (Borkovec & Inz, 1991; see Chapter 14), problem solving (Davey, 1994), coping strategy (Wells, 1994,1997), and intolerance of uncertainty (Dugas, Gagnon, Ladouceur & Freeston, 1998; see Chapter 12). Similarly, rumination has been conceptualised as resulting from a failure to achieve higher order goals (Martin & Tesser, 1989,1996), as a way of helping individuals to focus inwardly and evaluate their feelings and their problematic situation in order to gain insight (Nolen-Hoeksema, 1991) and as a primary coping activity (Papageorgiou & Wells, 2003, 2004). In particular, rumination can be viewed as a strategy used to understand one's problems, emotions and circumstances, and as a means of finding solutions to the problems precipitating depression (Papageorgiou & Wells, 2001a; Wells & Matthews, 1994, 1996).

A systematic account of worry and rumination should specify the mechanisms responsible for initiating and maintaining these activities and the factors contributing to the development of their pathological forms. The identification of the idiosyncratic nature and functions of worry and rumination within the context of information processing models may enhance our knowledge of the worrisome and ruminative processes involved in the onset, perpetuation and recurrence of anxiety and depression, respectively. Wells and Matthews' (1994,1996) S-REF model of emotional disorders accounts for the information processing mechanisms that initiate and maintain worry and rumination and the pathological consequences of these styles of thinking. In the S-REF model, a particular cognitive attentional 'syndrome' consisting of heightened self-focus, repetitive negative thinking, maladaptive coping behaviours and threat monitoring contributes to emotional disturbance. An important component of this syndrome is per-severative negative thinking in the form of worry or rumination. The S-REF model views these processes as coping strategies that have counterproductive effects of perpetuating emotional disorders. Selection and execution of worry or rumination is linked to particular metacognitive beliefs and processes. Metacognition refers to the aspect of the information processing system that monitors, interprets, evaluates, and regulates the contents and processes of its organisation (Flavell, 1979; Wells 2000). According to the S-REF model, perseverative negative thinking is problematic for emotional self-regulation because of multiple effects on low level and strategic cognitive operations required for restructuring self-knowledge and developing effective coping strategies. For example, worrying may focus appraisals on negative outcomes, hence preventing the processing of positive information that can change negative beliefs. Furthermore, the use of strategies such as thought suppression may activate low level automatic processing that increases the probability of intrusion of unwanted material into consciousness. Building on the generic S-REF model, two specific metacog-nitive models of worry in anxiety (Wells, 1995, 1997) and rumination in depression (Papageorgiou & Wells, 2003, 2004) have been developed and evaluated, and suggest specific ways in which both worry and rumination are initiated, maintained and become pathological. Descriptions of these models will now be considered.

Wells (1995,1997) proposed a metacognitive model of worry in GAD. This model is illustrated in Figure 2.2 (see Chapter 11). In this model, in response to a trigger (e.g., bad news, a negative intrusive thought or image, etc.), individuals with GAD select worry as a coping strategy. This selection is driven by the activation of positive beliefs about the benefits of worry (e.g., 'If I worry I can always be prepared'). Once Type I worries are set in motion, which are concerned with external daily events and non-cognitive internal events, negative appraisals about the process of worrying and accompanying emotion are activated. Negative appraisals of worry involve themes of uncontrollability and danger associated with this process (e.g., 'My worries are uncontrollable', 'Worrying is dangerous'). Table 2.1 lists additional examples of positive and negative appraisals of worry. According to Wells' (1995, 1997) model, it is Type II worry or meta-worry (i.e., worry about worry) that is associated with psychopathology. Indeed, in this model, pathological varieties of worry such as those found in GAD are linked to a high incidence of Type II worries. Once worry about worry has been established, three additional factors are then involved in the escalation and maintenance of the problem. These factors include behavioural responses, such as avoidance and reassurance seeking, thought control strategies, such as suppression and distraction, and emotional symptoms such as anxiety, tension, dissociation and even panic attacks and depression. Extensive

Trigger

Positive meta-beliefs activated ** \ (Strategy selection) „ '

Metacognitive Therapy Type Worry

Figure 2.2 A cognitive model of generalised anxiety disorder Source: Papageorgiou, C. & Wells, A. (1995, 1997) An empirical test of a clinical metacognitive model of rumination and depression. Cognitive Therapy and Research, 27, 261-273; (2004) Nature, functions, and beliefs about depressive rumination. In C. Papageorgiou & A. Wells, (Eds), Depressive Rumination: Nature, Theory and Treatment. Chichester, UK; John Wiley & Sons, Ltd.

Figure 2.2 A cognitive model of generalised anxiety disorder Source: Papageorgiou, C. & Wells, A. (1995, 1997) An empirical test of a clinical metacognitive model of rumination and depression. Cognitive Therapy and Research, 27, 261-273; (2004) Nature, functions, and beliefs about depressive rumination. In C. Papageorgiou & A. Wells, (Eds), Depressive Rumination: Nature, Theory and Treatment. Chichester, UK; John Wiley & Sons, Ltd.

empirical evidence supports the metacognitive model of worry and GAD (see Chapter 11).

Figure 2.3 shows the basic components and structure of a clinical metacognitive model of rumination and depression (Papageorgiou & Wells, 2003, 2004). According to this model, following a specific trigger (e.g., a negative intrusive thought or image, a memory of loss or failure, or an external non-cognitive event), positive metacognitive beliefs about the benefits and advantages of rumination motivate individuals with depression to

Table 2.1 Examples of positive and negative metacognitive beliefs about worry

Positive Beliefs about Worry

Worrying helps me to avoid problems in the future I need to worry in order to remain organised Worrying helps me to get things sorted out in my mind

Worrying helps me to avoid disastrous situations People who do not worry, have no depth

Worrying helps me cope If I did not worry, I would make more mistakes

Negative Beliefs about Worry

My worrying is dangerous for me

I could make myself sick with worrying

If I let my worrying thoughts get out of control, they will end up controlling me

My worrying thoughts persist, no matter how I try to stop them I cannot ignore my worrying thoughts

My worrying could make me go mad Worry can stop me from seeing a situation clearly

Source: Cartwright-Hatton, S. & Wells, A. (1997). Beliefs about worry and intrusions: The Metacognitions Questionnaire and its correlates. Journal of Anxiety Disorders, 11, 279-296.

engage in sustained ruminative thinking. Depressed individuals may believe that 'ruminating about my depression helps me to understand past mistakes and failures'. Once rumination is activated, and because of the numerous negative consequences associated with this process, individuals then appraise rumination as both uncontrollable and harmful (i.e., negative

Ruminate Danger

Figure 2.3 Basic components and structure of a clinical metacognitive model of rumination and depression

Source: Papageorgiou, C. & Wells, A. (2003). An empirical test of a clinical metacognitive model of rumination and depression. Cognitive Therapy and Research, 27, 261-273; (2004) Nature, functions, and beliefs about depressive rumination. In C. Papageorgiou & A. Wells, (Eds), Depressive Rumination: Nature, Theory and Treatment. Chichester, UK; John Wiley & Sons, Ltd.

Figure 2.3 Basic components and structure of a clinical metacognitive model of rumination and depression

Source: Papageorgiou, C. & Wells, A. (2003). An empirical test of a clinical metacognitive model of rumination and depression. Cognitive Therapy and Research, 27, 261-273; (2004) Nature, functions, and beliefs about depressive rumination. In C. Papageorgiou & A. Wells, (Eds), Depressive Rumination: Nature, Theory and Treatment. Chichester, UK; John Wiley & Sons, Ltd.

Table 2.2 Examples of positive and negative metacognitive beliefs about rumination

Positive Beliefs about Rumination

In order to understand my feelings of depression, I need to ruminate about my problems I need to ruminate about the bad things that have happened in the past to make sense of them I need to ruminate about my problems to find the causes of my depression Ruminating about my problems helps me to focus on the most important things

Ruminating about the past helps me to prevent future mistakes and failures Ruminating about my feelings helps me to recognise the triggers for my depression Ruminating about the past helps me to work out how things could have been done better

Negative Beliefs about Rumination Ruminating makes me physically ill

When I ruminate, I can't do anything else

Ruminating means I'm out of control Ruminating will turn me into a failure

Ruminating means I'm a bad person

It is impossible not to ruminate about the bad things that have happened in the past Only weak people ruminate

Source: Papageorgiou, C. & Wells, A. (2001) Metacognitive beliefs about rumination in recurrent major depression. Cognitive and Behavioral Practice, 8,160-164; (2001) Positive beliefs about depressive rumination: Development and preliminary validation of a self-report scale.

Behavior Therapy, 32,13-26.

beliefs 1, e.g., 'It is impossible not to ruminate about the bad things that have happened in the past') and likely to produce detrimental interpersonal and social consequences (i.e., negative beliefs 2, e.g., 'Everyone would desert me if they knew how much I ruminate about myself'). Additional examples of positive and negative metacognitive beliefs about rumination are presented in Table 2.2. This model asserts that the activation of negative beliefs about rumination contributes to depression. Therefore, a number of vicious cycles of rumination and metacognition are hypothesised to be responsible for the perpetuation of depression. Evidence supporting some of the hypotheses postulated by this model is reviewed next.

Several cross-sectional, prospective and experimental studies provide initial support for the clinical metacognitive model of rumination and depression (Papageorgiou & Wells, 2003, 2004). In a preliminary study, Papageorgiou and Wells (2001a) conducted a number of semi-structured qualitative interviews with patients with DSM-IV recurrent major depression and found that they all reported positive and negative metacogni-tive beliefs about rumination. Some examples of these beliefs are shown in Table 2.2. Using these beliefs, the Positive Beliefs about Rumination

Scale (PBRS; Papageorgiou & Wells, 2001b) and the Negative Beliefs about Rumination Scale (NBRS; Papageorgiou, Wells & Meina, in preparation) were developed. Both the PBRS and NBRS have been shown to have good psychometric properties of reliability and validity (for a review, see Luminet, 2004). Studies have shown that the PBRS is significantly and positively associated with rumination and depression in both non-clinical samples (Papageorgiou & Wells, 2001a, Study 4; 2001c; 2003, Study 2) and patients with depression (Papageorgiou & Wells, 2003, Study 1; Papageorgiou et al., in preparation). In addition, both subtypes of negative metacog-nitive beliefs about rumination (i.e., beliefs concerning uncontrollability and harm, and the interpersonal and social consequences of rumination), as measured by NBRS1 and NBRS2 respectively, have been shown to be significantly and positively correlated with rumination and depression in non-clinical samples (Papageorgiou & Wells, 2001c; 2003, Study 2) and patients with depression (Papageorgiou & Wells, 2003, Study 1; Papageor-giou et al., in preparation). Studies have also shown that both positive and negative metacognitive beliefs about rumination significantly distinguish patients with recurrent major depression from patients with panic disorder and agoraphobia, and patients with social phobia (Papageorgiou & Wells, 2001a, Study 5; Papageorgiou et al., in preparation), suggesting specificity associated with such metacognitive beliefs. In another study, Sanderson and Papageorgiou (in preparation) found that positive and negative beliefs about rumination did not discriminate between currently and previously recurrently depressed individuals, suggesting that these beliefs may act or persist as a vulnerability factor. Indeed, Papageorgiou and Wells (2001c) conducted a prospective study to examine the causal status of the relationships between rumination, negative metacognitive beliefs about rumination and depression in a non-clinical sample. The results showed that negative metacognitive beliefs about the uncontrollability and harm associated with rumination predicted depression prospectively even after controlling statistically for initial levels of depression and rumination. Finally, using structural equation modelling, a good statistical model fit has been found for the clinical metacognitive model of rumination and depression in a depressed sample (Papageorgiou & Wells, 2003, Study 1).

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  • noah kelly
    Why do people worry,according to well?
    4 years ago

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