title: Rumination and implicit avoidance following bereavement: an approach avoidance task investigation.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  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).
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  Conjugally bereaved women were overrepresented in the sample, which limits generalizability of results. The study was correlational, precluding causal inferences.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Clinical and Health Psychology, Utrecht University, Netherlands. Electronic address: m.c.eisma@uu.nl.
authors.forename: Maarten C
authors.initials: MC
authors.lastname: Eisma
authors.affiliation: Behavioural Science Institute, Radboud University Nijmegen, Netherlands.
authors.forename: Mike
authors.initials: M
authors.lastname: Rinck
authors.affiliation: Department of Clinical and Health Psychology, Utrecht University, Netherlands; Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Netherlands.
authors.forename: Margaret S
authors.initials: MS
authors.lastname: Stroebe
authors.affiliation: Department of Clinical and Health Psychology, Utrecht University, Netherlands.
authors.forename: Henk A W
authors.initials: HA
authors.lastname: Schut
authors.affiliation: Department of Clinical and Health Psychology, Utrecht University, Netherlands.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Boelen
authors.affiliation: Department of Social and Organizational Psychology, Utrecht University, Netherlands; Department of Social Psychology, University of Groningen, Netherlands.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Stroebe
authors.affiliation: Department of Clinical and Health Psychology, Utrecht University, Netherlands.
authors.forename: Jan
authors.initials: J
authors.lastname: van den Bout
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001362:Avoidance Learning; D001601:Bereavement; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010775:Photic Stimulation / Q000379:methods; D011930:Reaction Time; D013647:Task Performance and Analysis; D013850:Thinking; D014796:Visual Perception; D055815:Young Adult
keywords: Approach avoidance task; Avoidance; Prolonged grief; Rumination; Worry