Depressive rumination, defined as “behavior and thoughts that focus one’s attention on one’s depressive symptoms and on the implications of these symptoms”  has been identified as a core process in the onset and maintenance of depression. Rumination is elevated in both currently and formerly depressed patients and tends to be elevated in women relative to men, i.e., in groups known to be at increased risk for depression. Prospective longitudinal studies have found that self-reported depressive rumination predicts the onset and maintenance of major depression and depressive symptoms. Furthermore, there is evidence that increased rumination is associated with less therapeutic responsiveness to both antidepressant and cognitive-behavioral interventions. This article will highlight key issues in understanding depressive rumination and review state-of-the-art treatment approaches.

The Phenomenology of Depressive Rumination

A typical presentation of depressive rumination involves repeated and recurrent thinking about the self, past upsetting events, unresolved concerns, and depressed symptoms. Depressive rumination is often characterized by evaluative thinking, with patients making negative comparisons between themselves and others (“Why do I have problems other people don’t have?”), between their current state and desired state (“Why can’t I get better?”) and between the current self and past self (“Why can’t I work as well as before?”). The common reported consequences of rumination are increased sadness, distress and anxiety, reduced motivation, insomnia, and increased tiredness, self-criticism, pessimism and hopelessness. 

Understanding Depressive Rumination

 It is important to recognize that rumination is a common, normal, and sometimes functional response, not just limited to people with psychological disorders. We have all had the  experience of ruminating about personal losses such as bereavements or break-ups, trying to  understand why it happened to us. However, for most people, the rumination is relatively brief. 

Current theoretical models hypothesize that unresolved concerns or unattained goals  initiate recurrent thinking about the unresolved issue or goal in order to facilitate effective self- regulation towards the goal. Thus, rumination is conceptualized as an  attempt to make sense of an upsetting event or to solve a problem. Importantly, recent  experimental research suggests that there are distinct styles of rumination, with distinct functional  properties and consequences: a helpful style characterized by concrete, process-focused and  specific thinking versus an unhelpful, maladaptive style characterized by abstract, evaluative  thinking. This  research suggests that when a depressed patient dwells on his symptoms and difficulties,  analyzing and evaluating the meanings and implications of his experiences (e.g., “What does this  failure mean about me?”) increases overgeneralization (e.g., “I can never get it right”), impairs  problem-solving, and exacerbates depressed mood. However, dwelling on symptoms and  difficulties in a more concrete and specific way, reflecting on how to do something about the difficulties, improves problem solving and reduces depression. This difference between thinking  styles appears to be one factor determining the duration and usefulness of rumination since  individuals prone to pathological rumination tend to be more abstract and evaluative.