Hostname: page-component-cd4964975-8tfrx Total loading time: 0 Render date: 2023-03-29T13:13:27.040Z Has data issue: true Feature Flags: { "useRatesEcommerce": false } hasContentIssue true
  • English

Rumination, Depressive Symptoms and Awareness of Illness in Schizophrenia

Published online by Cambridge University Press:  09 November 2012

Neil Thomas ,
Darryl Ribaux  and
Lisa J. Phillips
Neil Thomas*
Affiliation:
Monash Alfred Psychiatry Research Centre and Swinburne University, Melbourne, Australia
Darryl Ribaux
Affiliation:
University of Melbourne, Australia
Lisa J. Phillips
Affiliation:
University of Melbourne, Australia
*
Reprint requests to Neil Thomas, Monash Alfred Psychiatry Research Centre, 607 St Kilda Road, Melbourne, Victoria 3004, Australia. E-mail: neilthomas@swin.edu.au
Get access Rights & Permissions[Opens in a new window]

Abstract

Background: Depressive symptoms are common in schizophrenia. Previous studies have observed that depressive symptoms are associated with both insight and negative appraisals of illness, suggesting that the way in which the person thinks about their illness may influence the occurrence of depressive responses. In affective disorders, one of the most well-established cognitive processes associated with depressive symptoms is rumination, a pattern of perseverative, self-focused negative thinking. Aims: This study examined whether rumination focused on mental illness was predictive of depressive symptoms during the subacute phase of schizophrenia. Method: Forty participants with a diagnosis of schizophrenia and in a stable phase of illness completed measures of rumination, depressive symptoms, awareness of illness, and positive and negative symptoms. Results: Depressive symptoms were correlated with rumination, including when controlling for positive and negative symptoms. The content of rumination frequently focused on mental illness and its causes and consequences, in particular social disability and disadvantage. Depressive symptoms were predicted by awareness of the social consequences of mental illness, an effect that was mediated by rumination. Conclusions: Results suggest that a process of perseveratively dwelling upon mental illness and its social consequences may be a factor contributing to depressive symptoms in people with chronic schizophrenia.

Keywords

schizophreniapsychosisruminationpost-psychotic depressioninsight
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 42 , Issue 2 , March 2014 , pp. 143 - 155
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2012 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Addington, D., Addington, J. and Atkinson, M. (1996). Psychometric comparison of the Calgary Depression Scale for Schizophrenia and the Hamilton Depression Rating Scale. Schizophrenia Research, 19, 205–212.CrossRefGoogle ScholarPubMed
Addington, D., Addington, J. and Maticka-Tyndale, E. (1993). Assessing depression in schizophrenia: the Calgary Depression Scale. British Journal of Psychiatry 163, 39–44.Google Scholar
Amador, X. F., Strauss, D. H., Yale, S. A., Flaum, M. M., Endicott, J. and Gorman, J. M. (1993). The assessment of insight in psychosis. American Journal of Psychiatry, 150, 873–879.Google ScholarPubMed
an der Heiden, W., Könnecke, R., Maurer, K., Ropeter, D. and Häfner, H. (2005). Depression in the long-term course of schizophrenia. European Archives of Psychiatry and Clinical Neuroscience, 255, 174–184.CrossRefGoogle ScholarPubMed
Bach, P. and Hayes, S. C. (2002). The use of Acceptance and Commitment Therapy to prevent the rehospitalization of psychotic patients: a randomized controlled trial. Journal of Consulting and Clinical Psychology, 70, 1129–1139.CrossRefGoogle Scholar
Badcock, J. C., Paulik, G. and Maybery, M. T. (2011). The role of emotion regulation in auditory hallucinations. Psychiatry Research, 185, 303–308.CrossRefGoogle ScholarPubMed
Baron, R. M. and Kenny, D. A. (1986). The moderator–mediator variable distinction in social psychological research: conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51, 1173–1182.CrossRefGoogle ScholarPubMed
Bell, M., Milstein, R., Beam-Goulet, J., Lysaker, P. and Cicchetti, D. (1992). The Positive and Negative Syndrome Scale and the Brief Psychiatric Rating Scale: reliability, comparability, and predictive validity. Journal of Nervous and Mental Disease, 180, 723–728.CrossRefGoogle ScholarPubMed
Birchwood, M. (2003). Pathways to emotional dysfunction in psychosis. British Journal of Psychiatry, 182, 373–375 CrossRefGoogle ScholarPubMed
Birchwood, M., Iqbal, Z., Chadwick, P. and Trower, P. (2000). Cognitive approach to depression and suicidal thinking in psychosis: I. ontogeny of post-psychotic depression. British Journal of Psychiatry, 177, 516–528.CrossRefGoogle ScholarPubMed
Birchwood, M., Mason, R., MacMillan, F. and Healey, J. (1993). Depression, demoralization and control over illness: a comparison of depressed and non-depressed patients with a chronic psychosis. Psychological Medicine, 23, 387–395.CrossRefGoogle ScholarPubMed
Carroll, A., Fattah, S., Clyde, Z., Coffey, I., Owens, D. G. and Johnstone, E. C. (1999). Correlates of insight and insight change in schizophrenia. Schizophrenia Research, 35, 247–253.CrossRefGoogle Scholar
Crumlish, N., Whitty, P., Kamali, M., Clarke, M., Browne, S., McTigue, O., et al. (2005). Early insight predicts depression and attempted suicide after 4 years in first-episode schizophrenia and schizophreniform disorder. Acta Psychiatrica Scandinavica, 112, 449–455.CrossRefGoogle ScholarPubMed
Drake, R. J., Pickles, A., Bentall, R. P., Kinderman, P., Haddock, G., Tarrier, N., et al. (2004). The evolution of insight, paranoia and depression during early schizophrenia. Psychological Medicine, 34, 285–292.CrossRefGoogle ScholarPubMed
First, M. B., Gibbon, M., Spitzer, R. L. and Williams, J. B. W. (1997). Structured Clinical Interview for DSM-IV Axis I Disorders: research version (SCID-I). New York: Biometrics Research.Google Scholar
Foster, C., Startup, H., Potts, L. and Freeman, D. (2010). A randomized controlled trial of a worry intervention for individuals with persistent persecutory delusions. Journal of Behavior Therapy and Experimental Psychiatry, 41, 45–51.CrossRefGoogle ScholarPubMed
Gaudiano, B. A. and Herbert, J. D. (2006). Acute treatment of inpatients with psychotic symptoms using acceptance and commitment therapy: pilot results. Behaviour Research and Therapy, 44, 415–437.CrossRefGoogle ScholarPubMed
Harvey, A. G., Watkins, E., Mansell, W. and Shafran, R. (2004). Cognitive Behavioural Processes Across Psychological Disorders: a transdiagnostic approach to research and treatment. Oxford: Oxford University Press.CrossRefGoogle Scholar
Hayes, S. C., Strosahl, K. D. and Wilson, K. G. (1999). Acceptance and Commitment Therapy: an experiential approach to behavior change. New York: Guilford.Google Scholar
Iqbal, Z., Birchwood, M., Chadwick, P., Trower, P. (2000). Cognitive approach to depression and suicidal thinking in psychosis: 2. testing the validity of a social ranking model. British Journal of Psychiatry, 177, 522–528.Google ScholarPubMed
Kay, S., Opler, L. and Lindenmayer, J. P. (1987). The Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Schizophrenia Bulletin, 13, 261–275.CrossRefGoogle Scholar
Kay, S., Opler, L. and Lindenmayer, J. P. (1988). Reliability and validity of the positive and negative syndrome scale for schizophrenics. Psychiatry Research, 23, 99–110.CrossRefGoogle ScholarPubMed
Lincoln, T., Lüllmann, E. and Rief, W. (2007). Correlates and long-term consequences of poor insight in patients with schizophrenia: a systematic review. Schizophrenia Bulletin, 33, 1324–1342.CrossRefGoogle ScholarPubMed
Lo, C. S. L., Ho, S. M. Y. and Hollon, S. D. (2008). The effects of rumination and negative cognitive styles on depression: a mediation analysis. Behaviour Research and Therapy, 46, 487–495.CrossRefGoogle ScholarPubMed
Lobban, F., Barrowclough, C. and Jones, S. (2004). The impact of beliefs about mental health problems and coping on outcome in schizophrenia. Psychological Medicine, 34, 1165–1176.CrossRefGoogle Scholar
Lobban, F., Barrowclough, C. and Jones, S. (2005). Assessing cognitive representations of mental health problems: I. the illness perception questionnaire for schizophrenia. British Journal of Clinical Psychology, 44, 147–162.CrossRefGoogle Scholar
Lysaker, P. H., Roe, D. and Yanos, P. T. (2007). Toward understanding the insight paradox: internalized stigma moderates the association between insight and social functioning, hope, and self-esteem among people with schizophrenia spectrum disorders. Schizophrenia Bulletin, 33, 192–197.CrossRefGoogle ScholarPubMed
Martell, C. R., Dimidjian, S. and Herman-Dunn, R. (2010). Behavioural Activation for Depression: a clinician's guide. New York: Guilford.Google Scholar
Martin, L. L. and Tesser, A. (1996). Some ruminative thoughts. In Wyer, R. S. (Ed.), Ruminative Thoughts. Hillside, NJ: Erlbaum.Google Scholar
Mintz, A. R., Dobson, K. S. and Romney, D. M. (2003). Insight in schizophrenia: meta-analysis. Schizophrenia Research, 6, 75–88.CrossRefGoogle Scholar
Moore, O., Cassidy, E., Carr, A. and Callaghan, E. O. (1999). Unawareness of illness and its relationship with depression and self deception in schizophrenia. European Journal of Psychiatry, 14, 264–269.CrossRefGoogle Scholar
Morrison, A. P. and Wells, , , A. (2007). Relationships between worry, psychotic experiences and emotional distress in patients with schizophrenia spectrum diagnoses and comparisons with anxious and non-patient groups. Behaviour Research and Therapy, 45, 1593–1600.CrossRefGoogle ScholarPubMed
Nolen-Hoeksema, S. (1991). Responses to depression and their effects on the duration of depressive episodes. Journal of Abnormal Psychology, 100, 569–582.CrossRefGoogle ScholarPubMed
Nolen-Hoeksema, S., Wisco, B. E. and Lyubomirsky, S. (2008). Rethinking rumination. Perspectives on Psychological Science, 3, 400–424.CrossRefGoogle ScholarPubMed
Preacher, K. J. and Hayes, A. F. (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instruments, and Computers, 36, 717–731.CrossRefGoogle ScholarPubMed
Preacher, K. J. and Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 879–891.CrossRefGoogle ScholarPubMed
Pyszczynski, T. and Greenberg, J. (1987). Self-regulatory perseveration and the depressive self-focusing style: a self-awareness theory of reactive depression. Psychological Bulletin, 102, 122–138.CrossRefGoogle ScholarPubMed
Robinson, M. S. and Alloy, L. B. (2003). Negative cognitive styles and stress-reactive rumination interact to predict depression: a prospective study. Cognitive Therapy and Research, 27, 275–292.CrossRefGoogle Scholar
Rooke, O. and Birchwood, M. (1998). Loss, humiliation and entrapment as appraisals of schizophrenic illness: a prospective study of depressed and non-depressed patients. British Journal of Clinical Psychology, 37, 259–268.CrossRefGoogle Scholar
Segal, Z., Williams, J. M. G. and Teasdale, J. D. (2002). Mindfulness-Based Cognitive Therapy for Depression: a new approach to preventing relapse. New York: Guilford.Google Scholar
Siegle, G. J., Moore, P. M. and Thase, M. E. (2004). Rumination: one construct, many features in healthy individuals, depressed individuals, and individuals with lupus. Cognitive Therapy and Research, 28, 645–668.CrossRefGoogle Scholar
Simon, A. E., Berger, G. E., Giacomini, V., Ferrero, F. and Mohr, S. (2006). Insight, symptoms and executive functions in schizophrenia. Cognitive Neuropsychiatry, 11, 437–451.CrossRefGoogle Scholar
Sobel, M. E. (1982). Asymptotic confidence intervals for indirect effects in structural equations models. In Leinhart, S. (Ed.), Sociological Methodology 1982. San Francisco: Jossey-Bass.Google Scholar
Soo, H., Burney, S. and Basten, C. (2009). The role of rumination in affective distress in people with chronic physical illness: a review of the literature and theoretical formulation. Journal of Health Psychology, 14, 956–966.CrossRefGoogle ScholarPubMed
Spasojevic, J. and Alloy, L. B. (2001). Rumination as a common mechanism relating depressive risk factors to depression. Emotion, 1, 25–37.CrossRefGoogle ScholarPubMed
Startup, H., Freeman, D. and Garety, P. A. (2007). Persecutory delusions and catastrophic worry in psychosis: developing the understanding of delusion distress and persistence. Behaviour Research and Therapy, 45, 523–537.CrossRefGoogle ScholarPubMed
Trapnell, P. D. and Campbell, J. D. (1999). Private self-consciousness and the five-factor model of personality: distinguishing rumination from reflection. Journal of Personality and Social Psychology, 76, 284–304.CrossRefGoogle ScholarPubMed
Watkins, E. R. (2008). Constructive and unconstructive repetitive thought. Psychological Bulletin, 134, 163–206.CrossRefGoogle ScholarPubMed
Watkins, E., Scott, J., Wingrove, J., Rimes, K., Bathurst, N., Steiner, H., et al. (2007). Rumination-focused cognitive behaviour therapy for residual depression: a case series. Behaviour Research and Therapy, 45, 2144–2154.CrossRefGoogle ScholarPubMed
Watson, P. W. B., Garety, P. A., Weinman, J., Dunn, G., Bebbington, P. E., Fowler, D., et al. (2006). Emotional dysfunction in schizophrenia spectrum psychosis: the role of illness perceptions. Psychological Medicine, 36, 761–770.CrossRefGoogle ScholarPubMed
Wells, A. and Papageorgiou, C. (2003). Metacognitive therapy for depressive rumination. In Papageorgiou, C. and Wells, A. (Eds.), Depressive Rumination: nature, theory and treatment. Chichester: Wiley.Google Scholar
Submit a response

Comments

No Comments have been published for this article.