Mindfulness - Its Use As A Psychological Treatment For Worry And Rumination

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In the last two decades, mindfulness has emerged as a key component of third-wave CBT and as a stand-alone treatment for psychological distress.

Worry and rumination are transdiagnostic cognitive processes that are thought to be central to the maintenance of anxiety disorders and depression. According to mindfulness theory, MBCT reduces ruminative thinking, which helps with depression.

The purpose of this article is to see if there is any evidence from medication or treatment studies to support the effects of mindfulness-based cognitive therapy (MBCT) or mindfulness-based stress reduction (MBSR) on clinical levels of worry or rumination. It also examine whether mindfulness interventions are ever contraindicated for people who experience excessive worry or rumination.

Mindfulness

Over the last 30 years, a simple form of meditation known as mindfulness has been translated from Buddhist practice to Western medicine. It asks people to pay attention to what is going on in the present moment, without passing judgment. Although mindfulness has been incorporated into a variety of third-wave CBT treatments (e.g., ACT, DBT, and meta-cognitive therapy), two manualised mindfulness-based psychological interventions have been extensively researched: mindfulness-based stress reduction (MBSR) and mindfulness-based cognitive therapy (MBCT).

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MBSR is an 8-week group-based program that focuses on teaching mindfulness skills and incorporating mindfulness into daily life, particularly in areas where people are experiencing physical or emotional distress. The structure and skills of MBSR are combined with cognitive behavioral techniques in MBCT. It is intended to keep people with recurrent depression from relapsing.

Mindfulness teaches people to be more aware of their thoughts and feelings and to relate to them as mental events rather than as true or false statements. It improves the relationship between thoughts and emotions in this way. Studies that showed that negative automatic thinking, such as rumination, catastrophizing, and self-criticism, was associated with depressive relapse, and that being able to detach from this thinking was likely to be beneficial in reducing depression, influenced the development of MBCT.

Rumination (psychology)

Worry And Rumination

Although worry and rumination are frequently mentioned as important processes in depression and anxiety disorders, there are a variety of definitions used. Rumination and worry, according to Brosschot, Gerin, and Thayer, are underpinned by the same cognitive process, perseverative cognition, which is a transdiagnostic factor that increases distress in both anxiety and depression. Cognitive activities that are (i) repetitive, (ii) uncontrolled, and (iii) negatively valenced are essential features of the various definitions of worry and rumination. The main distinction between the two is their focus: worry is concerned with the future, whereas rumination is concerned with the past.

Each aspect of worry or rumination (repetition, lack of control, or negative valence) is distressing in and of itself, causing the person to be concerned about both the symptoms and the content of worry or rumination. This self-perpetuating cycle of worrying about worrying explains why the distress persists. Worry or rumination are common clinical issues for people who present in a variety of diagnostic categories in clinical practice.

What Is The Relationship Between Mindfulness And Worry And Rumination?

The current evidence on mindfulness, worry, and rumination raises a number of important questions. In certain populations, there is strong evidence that MBSR and MBCT are effective in relieving distress and reducing the risk of depressive relapse. Although Teasdale et al. hypothesized that worry and rumination reductions were likely modes of change in anxiety and depression, it is unclear what effect MBCT and MBSR has on clinical presentations of worry and rumination.

Because of the severity of negative thinking, MBCT was considered unsuitable for acute depression. Because the length of time spent thinking is a key component of rumination, adding meditative time to each day may exacerbate rather than alleviate symptoms. It's crucial to figure out if MBCT isn't a good idea for people who have ruminative depressive symptoms.

We looked at trial data and mediation studies to see what the current best understanding of the effect of mindfulness interventions on worry and rumination is, and whether mindfulness interventions are contraindicated for people who have a lot of worry and rumination.

Materials And Methods

Few mindfulness treatment studies have been specifically designed to reduce worry and rumination; instead, worry and rumination measures have been used as secondary measures in depression and anxiety trials.

The controlled trials and mediation studies that were looked at were those that were published on Pubmed between December 2012 and December 2013, Psychoinfo, Cochrane Library and Medline databases, using combinations of search terms: mindfulness, MBCT, MBSR, rumination, worry, PSWQ, meditation, anxiety, depression, RSS, Rumination on Sadness Scale, RRQ, Rumination Reflection Questionnaire, CERTS, Cambridge-Exeter Repetitive Thought Scale, RSQ Rumination Style Questionnaire.

Studies that used primary or secondary measures of worry and rumination, such as the Ruminative Response Scale or the Penn State Worry Questionnaire, were eligible for inclusion. Only clinical and non-clinical adult participants were included in our analysis. There were no uncontrolled trials included in our study. The review did not include studies that included people with learning disabilities, psychotic disorders, or Axis II disorders.

Two Things You Can Do To Stop Ruminating

Results

The researchers looked at 11 trials that looked at mindfulness–based interventions and used self–report measures to see if they reduced worry or rumination.

The studies were mostly of moderate quality, and they were all graded by hand. Several had control conditions, though they weren't always active controls, and they used measures that were easily replicable. However, there was little or no follow-up. In most cases, no intention-to-treat analysis was performed, so attrition could be a significant factor that was overlooked in the statistical analysis.

The only MBCT trial specifically targeting rumination was published by Heeren and Philippot. There was a significant decrease from pre to post, as well as between MBCT and the waiting list control group.

The mindfulness intervention was found to be effective in all ten studies that looked at rumination, providing preliminary support for mindfulness interventions as a treatment for rumination.

All four studies that looked at worry found that mindfulness interventions had a positive effect, providing another layer of support for mindfulness as a worry treatment.

While there is some evidence that mindfulness interventions can reduce worry and rumination, there are a few things to consider.

There is virtually no replication of studies, with the exception of van Aalderen et al. and Batink et al., so any findings should be interpreted with caution.
Generalization is difficult due to the heterogeneity of the samples, as well as the severity of the presentations and formats. It would be useless to conduct a meta-analysis of the data.
Other approaches, such as cognitive behavior therapy, have been shown to reduce worry and rumination. It's important to figure out whether the effect was caused by the mindfulness or cognitive therapy components of the intervention.
Because few of the studies used active controls, the effect could have been caused by non-specific group effects or psychoeducation.
Only one of the studies focused solely on worry and rumination, and any effects observed in the other studies could be a side effect of changes in the primary outcome, such as anxiety or depression.

Contraindications For Mindfulness

Neither MBSR or MBCT were found to have any negative side effects in any of the studies. "It is well known that participants can experience an increase in symptoms as a result of the awareness training," Fjorback et al. cautioned. According to anecdotal evidence, those who struggle the most at first are those who have a high level of rumination as they transition to a situation with more thinking time and less distraction. Crane and Williams discovered that those who quit MBCT had higher rumination levels. In general, the dropout rate in the trials was comparable to that of other psychological treatments. However, it's crucial to figure out what causes dropout and whether it's caused by rumination-related anxiety.

A Caucasian woman wearing a white t-shirt and a green beaded necklace looking worried and holding both sides of her head with her hands

Conclusion

Despite the fact that it is a cornerstone of the theoretical understanding of mindfulness's effect on depression, there has been very little direct research on mindfulness and worry and rumination. Despite the fact that all of the interventions studied had positive results, the heterogeneity of the studies made it difficult to recommend mindfulness-based interventions as a treatment for clinical worry or rumination due to a lack of evidence. There is a link between MBCT and changes in worry and rumination, according to studies. Evidence suggests that affective and cognitive variables interact in a complex way, necessitating the inclusion of these variables in mediation models. Although some commentators have claimed that mindfulness causes increased distress, there is no evidence that MBCT and MBSR is harmful or ineffective.

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