title: Adaptive and maladaptive rumination after loss: A three-wave longitudinal study.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Clinical and Health Psychology, Utrecht University, The Netherlands.
authors.forename: Maarten C
authors.initials: MC
authors.lastname: Eisma
authors.forename: Henk A W
authors.initials: HA
authors.lastname: Schut
authors.forename: Maggie S
authors.initials: MS
authors.lastname: Stroebe
authors.forename: Paul A
authors.initials: PA
authors.lastname: Boelen
authors.forename: Jan
authors.initials: J
authors.lastname: van den Bout
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Stroebe
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D001601:Bereavement; D003863:Depression / Q000523:psychology*; D003866:Depressive Disorder / Q000523:psychology*; D005260:Female; D006117:Grief; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D012044:Regression Analysis; D055500:Resilience, Psychological; D012307:Risk Factors; D057566:Self Report; D011795:Surveys and Questionnaires; D013850:Thinking
keywords: bereavement; brooding; depression; prolonged grief; reflection; repetitive thinking; rumination