Science Brief

The structure and consequences of repetitive thought

How what’s on your mind, and how, and how much, affects your health.

By Suzanne Segerstrom

Suzanne Segerstrom, PhDSuzanne Segerstrom is Professor of Psychology at the University of Kentucky in Lexington.  Her research focuses on how individual differences and self-regulatory processes – including regulation of repetitive thought – affect physiology and health.  She received her PhD in clinical psychology from the University of California, Los Angeles, in 1997. She and her work have been honored with awards including the 2002 Templeton Positive Psychology Prize, the 2004 Outstanding Young Alumna Award from Lewis and Clark College, and the 2007 Robert Ader New Investigator Award from the Psychoneuroimmunology Research Society. She is also the author of the 2006 trade book Breaking Murphy’s Law.

 


Repetitive thought – colloquially, what’s been on your mind – plays an important role in people’s subjective lives and consequently their well-being.  Among the many potential effects of repetitive thought, getting mentally lost in your depressed mood could prevent you from taking actions that could cheer you (Nolen-Hoeksema, 1991), and getting mentally stuck over an argument could prevent your blood pressure from recovering afterward (Gerin, Davidson, Christenfeld, Goyal, & Schwartz, 2006).  On the other hand, mentally re-living a happy time from the past could make you feel happier in the present (Bryant, 2003), and planning an effective course of action ahead of time could avert later stress (Taylor, Pham, Rivkin, & Armor, 1998).

Research on repetitive thought has tended to focus on one or another single, discrete type, such as rumination, worry, planning, reflection, processing, or reminiscing, to name a few.  I have been interested in the relationships among all of these types:  for example, how is worry the same or different from rumination, and are there consequences of any such differences (Segerstrom, Tsao, Alden, & Craske, 2000)?  Together with my collaborators and students, I have discovered a multidimensional structure for repetitive thought that is helpful in understanding how discrete types of repetitive thought may arise and why they have the effects that they do.

Dimensions of Repetitive Thought

We have used multidimensional scaling to characterize the differences among various types of repetitive thought.  Multidimensional scaling arrays the types according to their similarities to each other.  Types that are very similar, such as rumination and worry, appear close to each other; those that are less similar, such as self-analysis and self-reproach, appear far away from each other.   Figure 1 shows the multidimensional result from older adults using correlations to judge similarity (Segerstrom, Roach, Evans, Schipper, & Darville, 2010). The horizontal dimension reflects a quality we call valence, that is, whether the content of the thoughts is largely positive or negative.  The vertical dimension reflects a quality we call purpose, that is, whether the tone of the thoughts is largely searching, questioning, and/or uncertain or largely solving, planning, and/or certain.  We have found the same dimensional structure in younger adults using correlations to judge similarity and when we gathered free descriptions of repetitive thought and had young adult judges sort them based on their similarity (Evans & Segerstrom, in press; Segerstrom, Stanton, Alden, & Shortridge, 2003).

Multidimensional scaling of trait repetitive thought for older adults

Figure 1. Multidimensional scaling of trait repetitive thought for older adults. Self-analysis, symptom focus, and self-reproach refer to factors of the Response Style Questionnaire—Rumination Scale. Lack of control refers to a factor of the Rumination Scale. Savoring, reminiscing, and anticipating refer to factors of the Savoring Beliefs Scale.

In addition to the qualitative dimensions of valence and purpose, we also consider a third dimension, total repetitive thought.  Note that in the description of the multidimensional scaling results above, I characterized repetitive thought types as more or less similar.  Despite their qualitative differences, we typically find that all types of repetitive thought correlate positively with each other (Evans & Segerstrom, in press; Segerstrom et al., 2003; Segerstrom, Roach, et al., 2010).  Therefore, even types that are opposite each other in the multidimensional space are positively correlated, but to a lesser degree than types that are close to each other.  This global positive correlation means that some people are just more prone to repetitive thought than others.  Whereas one person’s thoughts might sometimes resemble a broken record, a woman I interviewed who experienced a major life event told me she effectively deals with thoughts of the event by just “rubbing it away” (as she rubbed a small circle on her forehead.)

Too Much Thought, or the Wrong Kind?

This anecdote brings up an important question about repetitive thought:  Is repetition bad per se?  Is it better to be a broken record, or to “rub it away”?  Should people who ruminate think less, or think differently?  By separating out the qualitative and quantitative aspects of repetitive thought, we have provided data that begin to answer this question. 

Some people equate repetitive thought (i.e., thought characterized by repetition) with repetitious thought (i.e., thought characterized by unnecessary and tedious repetition), but there are many forms of repetitive thought that are not tedious and are perhaps even necessary.  Mental simulation or planning, for example, can help people be more effective and more successfully meet their goals. There are a number of types of repetitive thought that have positive valence.  In the Figure, different flavors of savoring (reminiscing, savoring, and anticipating) reflect positively valenced repetitive thought about the past, present, and future, respectively.  Emotional processing – taking time to think about one’s feelings – is also positively valenced.  Contemplating oneself in reflection or self-analysis is neutrally rather than negatively valenced.  Therefore, it may not necessarily be bad to be a repetitive thinker, if one is prone to these neutral or positively valenced types of repetitive thought.

Unfortunately, it is impossible to tell from a single score – for example, one’s score on a worry scale – one’s repetitive thought profile.  A high worry score might derive from a propensity to think repetitively in general (high total), a propensity to think about negative topics (negative valence), or even a propensity to turn problems over in one’s mind or to try to gain certainty about the future – qualities that are associated with worry (solving purpose).  One person’s repetitive thought profile might incorporate the high worry with high anticipation of positive events, resulting in a high total but balanced, neutral valence.  Another person’s profile might incorporate high worry with high rumination but not other types of repetitive thought, resulting in a moderate total but highly negative valence.  Those two people could have the same score on a type of repetitive thought (worry), but the larger pictures of their mental lives would be quite different.

It is clear that negatively valenced repetitive thought has bad consequences for mental and physical health (see Watkins, 2008, for a review).  To continue with worry as an example, worry is associated with anxiety (e.g., as a criterion for generalized anxiety disorder; American Psychiatric Association, 1994), but it also correlates just as highly with depression (Segerstrom et al., 2000).  People who were more prone to worry had more abnormal immune responses to both acute, laboratory and chronic, naturalistic stress (Segerstrom, Solomon, Kemeny, & Fahey, 1998; Segerstrom, Glover, Craske, & Fahey, 1999).  Worry is also a risk factor for cardiovascular disease (Kubzansky et al., 1997).

But are the negative effects of worry due to valence or total?  When we applied the dimensional model, valence is clearly the main factor that promotes better well-being.  Young adults who described more positively valenced repetitive thought (with valence judged by objective raters) also reported more positive emotions during the thoughts.  For the older adults, we weighted their standardized type scores by the multidimensional weights to give us dimension scores for valence and purpose and summed the scores to give us total. More positively valenced repetitive thought was associated with higher psychological well-being, lower depression, less stress, and better subjective cognitive and physical health. 

In contrast, more total repetitive thought was associated with higher stress, but not other differences in well-being (Segerstrom et al., 2003; Segerstrom, Eisenlohr-Moul, & Evans 2010).  One possibility is that stress provokes repetitive thought about one’s emotions, but it is the valence of those thoughts that determines whether one subsequently feels well or ill.  Consistent with this possibility, among dementia caregivers, a composite of negative repetitive thought (e.g., rumination, worry) was associated with poorer antibody response to influenza vaccination, whereas a composite of neutral repetitive thought (e.g., reflection, emotional processing) was associated with a better antibody response (Segerstrom, Schipper, & Greenberg, 2008).

Dimensional distinctions can enlighten us about why certain types of repetitive thought have good or ill effects.  They are also important to a better understanding of other psychological states, such as mindfulness.  Mindfulness is a quality characterized by high conscious attention to one’s inner and outer environment, without judging or reacting to what one observes. People who are mindful ruminate less, which may account for their generally higher well-being (Chambers, Lo, & Allen, 2008).  However, as in the worry example above, if one only measures rumination, it is impossible to tell who gets a high score because of high total and who gets a high score because of negative valence.  Models of mindfulness could support either possibility. One aspect of mindfulness emphasizes letting thoughts pass freely through one’s mind without holding on to them, an ability that would reduce total repetitive thought.  Another aspect emphasizes not being critical or judgmental of one’s thoughts or experiences, a stance that would reduce negative valence in repetitive thought.  We (Evans & Segerstrom, in press) administered a battery of repetitive thought measures to young adults, derived dimension scores (valence, purpose, and total), and correlated the dimensions with mindfulness.  The relationship of total repetitive thought was mixed, with some aspects of mindfulness correlating negatively with total and another aspect correlating positively.  As a result, total mindfulness was unrelated to total repetitive thought.  The results were more consistent for valence.  More positively valenced repetitive thought was associated with total mindfulness as well as several individual aspects.

It is not bad to be a broken record, if the record is positively valenced. The propensity to engage in repetitive thought may be an important amplifier of both events and other thought qualities.  In our older adult sample, more negatively valenced repetitive thought was associated with subjective physical health (above and beyond the presence and severity of chronic disease).  This effect was larger when total repetitive thought was also high (Segerstrom, Roach, et al., 2010).  We have recently found in the same sample that the prospective, negative effect of stressful life events on well-being was present only in those people who had high total repetitive thought (Segerstrom, Eisenlohr-Moul, & Evans, 2010).  Therefore, it seems that being a “broken record” – a repetitive thinker – is bad for health and well-being in the context of negative events and thoughts, but conversely may be good for health and well-being in the context of positive events and thoughts.

Are There Missing Dimensions?

Valence, purpose, and total are the dimensions that arise from questionnaire measures of trait repetitive thought. Are they the only dimensions?  Probably not.  When we had judges sort free descriptions of repetitive thought, a fourth dimension emerged:  interpersonal versus intrapersonal content.  This “missing” dimension from trait measures may nonetheless be important.  For example, self-focused thought may be more characteristic of depression than other-focused thought (Smith, Ingram, & Roth, 1985).  The variability of repetitive thought represents another possible missing dimension.  For example, purpose both has more subtle effects on well-being and is more variable over time than the other dimensions, and the ability to switch between searching forms of repetitive thought such as reflection and solving forms of repetitive thought such as planning may be more important than favoring one purpose or the other (Roach, Salt, & Segerstrom, 2010; Segerstrom et al., 2003).

Where Does Repetitive Thought Come From?

Why do some people think a lot, or think negatively, or search?  Some tendencies may be part of personality:  for example, neuroticism is correlated with more negative repetitive thought, and openness to experience is correlated with more searching repetitive thought (Segerstrom et al., 2003).  The positive correlation between stress and total repetitive thought suggests that people might think more when they are under stress (Segerstrom, Roach, et al., 2010).  Another possibility is that basic cognitive strengths or weaknesses predispose people to particular kinds or amounts of repetitive thought.  Most of the studies that address this possibility have focused on executive cognitive function, which encompasses the abilities to inhibit dominant responses or impulses, switch between cognitive sets, and hold information in working memory.  These studies, using discrete repetitive thought types, have found that people with poorer cognitive function are also more prone to negative repetitive thought types such as depressive rumination and worry (e.g., Davis & Nolen-Hoeksema, 2000; Crowe et al., 2007).

Davis and Nolen-Hoeksema (2000) concluded from their data that “Ruminators therefore have trouble inhibiting perseverative tendencies and maintaining adaptive tendencies” (p. 708).  But is executive function more important to one’s ability to inhibit repetitive thought (i.e., to have less total) or to maintain adaptive repetitive thought (i.e., to have more positive valence)?  We found that executive function (as measured by the Trail-Making Test) was associated with more positively valenced repetitive thought, but not less total.  There was a neuropsychological correlate of total repetitive thought, however, which was IQ (estimated from the North American Adult Reading Test).  Higher IQ associated with more total repetitive thought (Segerstrom, Roach, et al., 2010). The basic cognitive strengths and weaknesses that contribute to the various dimensions of repetitive thought is an important direction for future research.

Acknowledgements

The research described here was supported by the National Institutes of Health (AG026307and MH16531), the Dana Foundation, and the Templeton Foundation, and would not have been possible without the contributions of the many colleagues and students who collaborated on this work.

References

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