The only times that I really enjoy life are when Im not ruminating: An initial investigation into th

1
The only times that I really enjoy life are when
Im not ruminating An initial investigation
into the nature and function of rumination in
chronic pain.
Melanie Edwards1, Anwen Wright1, Nicole K. Y.
Tang1, Paul Salkovskis1, Carolyne Timberlake2 1
Department of Psychology, Institute of
Psychiatry, Kings College London, 2 Princess
Royal University Hospital, Orpington, Kent,

• Background
• Rumination can be seen as a repetitive style of
  thinking where individuals go over and over the
  same thoughts in their mind
• It can be distinguished from worry by its
  tendency to be past-focused with an emphasis on
  searching for meanings and causes (Segerstrom et
  al, 2003)
• Rumination is an important cognitive process,
  which has been implicated in a number of
  disorders including depression, social phobia and
  post-traumatic stress disorder (e.g.
  Nolen-Hoeksema et al, 1993 Rachman et al, 2000
  Michael et al, 2007)
• However little is currently known about the
  nature or function of rumination in chronic pain

• Aims
• To explore the phenomenology of rumination in
  chronic pain patients in terms of 1) patterns of
  rumination, 2) perceived functions, and 3) its
  relationship with pain and mood
• The secondary aim of the study was to investigate
  the strategies used by non-ruminators to cope
  with pain to aid the development of interventions
  targeting rumination

• Method
• Participants were 20 chronic pain patients
  recruited from a specialist pain clinic (5 males,
  15 females, mean age 44 years, mean duration of
  pain 9 years)
• A semi-structured interview was used to explore
  participants experience of rumination generally
  and during a recent episode of pain
• Interviews were transcribed verbatim and thematic
  analysis was conducted by two independent
  reviewers who were familiar with the flow and
  context of the interviews in accordance with the
  principles and procedures set out by Braun and
  Clarke (2006)
• Extracted themes were scrutinised by two further
  researchers

Results
2) Functions of rumination Fourteen participants
held positive beliefs about the functions of
rumination, for example, that it helped them to
problem solve, prevent repeating past mistakes,
or find something positive in the situation.
it helps me to understand myself and accept the
situation that Im in. - Participant
17 However, all twenty participants reported at
least one disadvantage to rumination. A range of
negative emotional and non-emotional effects were
reported including effects on mood, increased
pain, problems sleeping, making it hard for them
to move on, and stopping them from enjoying
life. Trying to get to sleep at night and your
brains whizzing round. Or waking up early in the
morning and trying to get to get back to sleep
and your brains whizzing round. Participant 13

• 1) Patterns of rumination
• Sixty percent of participants reported ruminating
  either very often or almost always during the
  previous two weeks
• Besides pain, participants reported ruminating
  about a variety of topics including work,
  finances, health, relationships and family
• Analysis of ratings given during the interview
  suggested that pain-related rumination is
  difficult to control, distracting, intrusive,
  involuntary and accompanied by a high level of
  pain

3) Relationship between rumination, pain and
mood A reciprocal relationship was found between
rumination and pain. Nineteen participants
reported that pain triggered rumination. Twelve
participants reported that rumination increased
their pain, even during episodes of non-pain
related rumination. when you spend time
thinking about things that are not so great, then
the pain does feel worse Participant 12 A
reciprocal relationship was also found between
rumination and mood. Nine participants reported
that they ruminated when they felt low, anxious
or stressed. Eighteen reported that rumination
had negative effects on their mood including low
mood, anxiety and frustration. you go into a
bit of a spiral where everything just starts to
become terribly doom and gloom. Participant 2

• 4) Non-ruminators
• Five participants reported low levels of
  pain-related rumination
• These participants differed to the other
  participants by
• Reporting no benefits to rumination
• Generating more action-orientated alternatives to
  rumination e.g. taking action, using mentally
  engaging forms of distraction
• Reporting that rumination tends to be brief and
  they find it easy to move on
• Making a distinction between rumination and
  problem solving

• Discussion/Conclusion
• Chronic pain patients report frequent rumination
  about pain and other concerns
• All patients reported at least one disadvantage
  of rumination yet many also held positive beliefs
  about the functions of rumination
• However, a minority of patients report low levels
  of rumination and these patients report no
  benefits to rumination and can distinguish
  between problem solving and rumination
• Increasing self-awareness of rumination and
  challenging positive beliefs about rumination
  such as that it is a form of problem solving may
  be useful strategies for reducing excessive
  rumination in chronic pain patients
• Future research should experimentally investigate
  the impact of rumination on pain reports, mood,
  pain tolerance and performance

References Braun, V. Clarke, V. (2006).
Qualitative Research in Psychology, 3,
77-101. Michael, T., Halligan, S., Clark, D.
Ehlers, A. (2007). Depression and Anxiety, 24(5),
307-317 Nolen-Hoeksema, S., Morrow, J.
Fredrickson, B. (1993). Journal of Abnormal
Psychology, 102(1), 20-28 Rachman, S.,
Gruter-Andrew, J. Shafran, R. (2000). Behaviour
Research and Therapy, 38(6), 611-617 Segerstrom,
S., Stanton, A., Alden, L. Shortbridge, B.
(2003). Journal of Personality and Social
Psychology, 85(5), 909-921
Contact Melanie Edwards melanie.edwards_at_iop.kcl
.ac.uk