Eisma Maarten C, Schut Henk A W, Stroebe Maggie S, Boelen Paul A, van den Bout Jan, Stroebe Wolfgang
Department of Clinical and Health Psychology, Utrecht University, The Netherlands.
Br J Clin Psychol. 2015 Jun;54(2):163-80. doi: 10.1111/bjc.12067. Epub 2014 Sep 17.
Rumination is a risk factor after bereavement, predicting higher concurrent and prospective symptom levels of complicated grief and depression in mourners. Research has shown that rumination may consist of adaptive and maladaptive subtypes, but there has been a paucity of research in this topic in the bereavement area. Therefore, we aimed to clarify whether functional and dysfunctional forms of rumination can be distinguished after loss.
Two-hundred and forty-two adults, who lost a first-degree family member on average 10 months previously, filled out questionnaires at three time points with 6 months between each time point.
Multiple regression analyses, controlled for loss-related variables, neuroticism, and baseline symptoms, were run to examine associations of subtypes of depressive rumination (brooding, reflection) and grief rumination (rumination about injustice, meaning, reactions, relationships and counterfactual thinking) with concurrent and prospective symptom levels of complicated grief and depression.
Overall, grief rumination explained more variance in symptom levels than depressive rumination. Other major findings were that grief rumination about injustice predicted higher concurrent and prospective symptom levels of complicated grief and higher prospective symptom levels of depression. In contrast, grief rumination about emotional reactions was related to prospective reductions in symptoms of complicated grief. Reflection was also associated with prospective reductions of complicated grief and depressive symptom levels.
Results indicate that adaptive and maladaptive forms of ruminative thinking can be distinguished in bereaved individuals. Therapeutic interventions for complicated grief could potentially be improved by including techniques aimed at reducing maladaptive rumination and increasing adaptive rumination.
Clinical implications: Adaptive and maladaptive components of rumination after loss can be distinguished. They are differentially associated with concurrent and prospective symptom levels of complicated grief and depression in mourners. Adaptive rumination after bereavement is characterized by repetitive, self-focused thinking aimed at understanding one's depressive and loss-related emotional reactions. Maladaptive rumination is characterized by repetitive, self-focused thinking about injustice to the self and making passive comparisons between the current situation (in which one has experienced a loss) and unrealized alternatives. Psychological interventions for complicated grief may be improved by adding therapeutic techniques aimed at reducing maladaptive rumination and increasing adaptive rumination. Cautions and limitations: This investigation relied exclusively on self-report measures. Conjugally bereaved women were overrepresented in the current sample. Complicated grief and depression levels in the current sample ranged from non-clinical to clinical. Effects may be more pronounced in a clinical sample.
沉思是丧亲后的一个风险因素，预示着哀悼者中复杂性悲伤和抑郁的当前及未来症状水平会更高。研究表明，沉思可能由适应性和适应不良性亚型组成，但在丧亲领域，关于这一主题的研究很少。因此，我们旨在明确在经历丧失后，功能性和功能失调性的沉思形式是否可以区分。
242名成年人，平均在10个月前失去了一位一级亲属，在三个时间点填写问卷，每个时间点间隔6个月。
进行多元回归分析，控制与丧失相关的变量、神经质和基线症状，以检验抑郁性沉思（沉思、反思）和悲伤性沉思（关于不公正、意义、反应、关系和反事实思维的沉思）的亚型与复杂性悲伤和抑郁的当前及未来症状水平之间的关联。
总体而言，悲伤性沉思比抑郁性沉思能解释更多症状水平的变异。其他主要发现是，关于不公正的悲伤性沉思预示着复杂性悲伤的当前及未来症状水平更高，以及抑郁的未来症状水平更高。相比之下，关于情绪反应的悲伤性沉思与复杂性悲伤症状的未来减轻有关。反思也与复杂性悲伤和抑郁症状水平的未来减轻有关。
结果表明，在丧亲个体中可以区分适应性和适应不良性的沉思思维形式。针对复杂性悲伤的治疗干预可能通过纳入旨在减少适应不良性沉思和增加适应性沉思的技术而得到改善。
临床意义：丧失后沉思的适应性和适应不良性成分可以区分。它们与哀悼者中复杂性悲伤和抑郁的当前及未来症状水平存在不同的关联。丧亲后的适应性沉思的特点是反复的、自我聚焦的思维，旨在理解自己的抑郁和与丧失相关的情绪反应。适应不良性沉思的特点是反复的、自我聚焦的思维，思考对自己的不公正，并在当前状况（经历了丧失）与未实现的选择之间进行消极比较。通过增加旨在减少适应不良性沉思和增加适应性沉思的治疗技术，可能会改善针对复杂性悲伤的心理干预。注意事项和局限性：本调查完全依赖自我报告测量。当前样本中丧偶女性的比例过高。当前样本中复杂性悲伤和抑郁水平从非临床到临床不等。在临床样本中，效果可能更明显。
