Eisma Maarten C, Rinck Mike, Stroebe Margaret S, Schut Henk A W, Boelen Paul A, Stroebe Wolfgang, van den Bout Jan
Department of Clinical and Health Psychology, Utrecht University, Netherlands.
Behavioural Science Institute, Radboud University Nijmegen, Netherlands.
J Behav Ther Exp Psychiatry. 2015 Jun;47:84-91. doi: 10.1016/j.jbtep.2014.11.010. Epub 2014 Nov 25.
Rumination, a risk factor in adjustment to bereavement, has often been considered a confrontation process. However, building on research on worry in generalized anxiety disorder (GAD) and rumination in post-traumatic stress disorder (PTSD), researchers recently developed the Rumination as Avoidance Hypothesis (RAH), which states that rumination after bereavement serves to avoid the reality of the loss. In the present study, RAH was tested by investigating if rumination is associated with implicit loss avoidance.
An Approach Avoidance Task (AAT) was used to assess automatic behavior tendencies. Using a joystick, 71 persons who recently lost a first-degree relative (90.1% women), pulled stimuli toward themselves or pushed them away from themselves. Stimuli represented the loss (picture deceased + loss word), were loss-related but ambiguous (picture deceased + neutral word; picture stranger + loss word), or were non-loss-related (picture stranger + neutral word; puzzle picture + X's).
Participants who ruminated more were relatively faster in pushing loss stimuli away from themselves and slower in pulling loss stimuli towards themselves, implying more rumination was associated with stronger implicit loss avoidance. Effects were maintained after controlling for depressive or post-traumatic stress symptom levels, but not when controlling for prolonged grief symptom levels.
Conjugally bereaved women were overrepresented in the sample, which limits generalizability of results. The study was correlational, precluding causal inferences.
In line with RAH, rumination was positively associated with loss avoidance. This may indicate that the application of exposure-based techniques can reduce rumination and loss-related psychopathology.
反复思考是适应丧亲之痛的一个风险因素，通常被视为一个对抗过程。然而，基于对广泛性焦虑障碍（GAD）中的担忧和创伤后应激障碍（PTSD）中的反复思考的研究，研究人员最近提出了反复思考即回避假说（RAH），该假说认为丧亲后的反复思考是为了回避失去亲人的现实。在本研究中，通过调查反复思考是否与隐性损失回避相关来检验RAH。
使用趋近-回避任务（AAT）来评估自动行为倾向。71名最近失去一级亲属的人（90.1%为女性）使用操纵杆将刺激物拉向自己或推离自己。刺激物代表损失（已故亲人照片+损失相关词汇）、与损失相关但含义模糊（已故亲人照片+中性词汇；陌生人照片+损失相关词汇）或与损失无关（陌生人照片+中性词汇；拼图照片+X）。
反复思考较多的参与者将损失刺激物推离自己的速度相对较快，而将损失刺激物拉向自己的速度较慢，这意味着更多的反复思考与更强的隐性损失回避相关。在控制抑郁或创伤后应激症状水平后，这种效应仍然存在，但在控制持续性悲伤症状水平后则不存在。
样本中丧偶女性的比例过高，这限制了结果的普遍性。该研究是相关性研究，无法进行因果推断。
与RAH一致，反复思考与损失回避呈正相关。这可能表明应用基于暴露的技术可以减少反复思考和与损失相关的精神病理学症状。
