Department of Clinical and Health Psychology, Utrecht University.
Department of Social and Organizational Psychology, Utrecht University.
J Abnorm Psychol. 2013 Nov;122(4):961-70. doi: 10.1037/a0034051.
Ruminative coping has been associated with negative outcomes in bereavement. Rather than assuming it to be a problematic confrontation process, researchers have recently suggested rumination to be maladaptive through its links with avoidance processes. The main aim of this study was to examine, for the first time, whether the relationship between ruminative coping and symptoms of complicated grief and depression is mediated by avoidance processes (suppression, memory/experiential avoidance, behavioral avoidance, loss-reality avoidance). A sample of 282 adults (88% female, 12% male), bereaved on average 18 months previously, filled out three questionnaires at 6-month intervals. We assessed symptom levels, grief rumination, and trait rumination at baseline; avoidance processes after 6 months; and symptom levels after 12 months. When controlling for initial symptom levels, experiential avoidance mediated the link between grief rumination and complicated grief, and experiential avoidance and behavioral avoidance mediated the link between grief rumination and depression. Post hoc analyses showed suppression may also mediate the link between grief rumination and symptoms of complicated grief, but not depression. Loss-reality avoidance was no significant mediator of these relationships. This study provides initial evidence that rumination during bereavement increases and perpetuates symptoms of psychopathology, because it is linked with specific avoidance processes. Bereaved individuals with problematic grief and (chronic) rumination may benefit from therapy focused on countering avoidance tendencies.
反刍应对与丧亲后的负面结果有关。研究人员最近提出，与其将反刍视为一个有问题的应对过程，不如将其与回避过程联系起来，认为反刍是适应不良的。本研究的主要目的是首次检验，反刍应对与复杂悲痛和抑郁症状之间的关系是否通过回避过程（抑制、记忆/体验回避、行为回避、丧失现实回避）来介导。一项由 282 名成年人（88%为女性，12%为男性）组成的样本，平均在 18 个月前经历了丧亲之痛，在 6 个月的时间间隔内填写了三份问卷。我们在基线时评估了症状水平、悲伤反刍和特质反刍；6 个月后评估回避过程；12 个月后评估症状水平。在控制初始症状水平的情况下，体验回避中介了悲伤反刍与复杂悲痛之间的关系，体验回避和行为回避中介了悲伤反刍与抑郁之间的关系。事后分析表明，抑制也可能中介悲伤反刍与复杂悲痛症状之间的关系，但不能中介抑郁症状。丧失现实回避不是这些关系的显著中介。本研究初步提供了证据，表明丧亲期间的反刍会增加和延续精神病理学症状，因为它与特定的回避过程有关。有问题的悲伤和（慢性）反刍的丧亲者可能会从针对回避倾向的治疗中受益。
