Randomized Controlled Trial of a Mindfulness Mobile Application for Ruminative Adolescents.

OBJECTIVE: Rumination is a risk factor for the development of internalizing psychopathology that often emerges during adolescence. The goal of the present study was to test a mindfulness mobile app intervention designed to reduce rumination. METHOD: Ruminative adolescents (N = 152; 59% girls, 18% racial/ethnic minority, Mage = 13.72, SD = .89) were randomly assigned to use a mobile app 3 times per day for 3 weeks that delivered brief mindfulness exercises or a mood monitoring-only control. Participants reported on rumination, depressive symptoms and anxiety symptoms at baseline, post-intervention and at 3 follow-up timepoints: 6 weeks, 12 weeks, and 6 months post-intervention. Parents reported on internalizing symptoms. RESULTS: There was a significant Time X Condition effect at post-intervention for rumination, depressive symptoms, and anxiety symptoms, such that participants in the mindfulness intervention showed improvements relative to those in the control condition. The effect for rumination lasted through the 6-week follow-up period; however, group differences were generally not observed throughout the follow-up period, which may indicate that continued practice is needed for gains to be maintained. CONCLUSIONS: This intervention may have the potential to prevent the development of psychopathology and should be tested in a longitudinal study assessing affective disorder onset, especially in populations with limited access to conventional, in person mental health care.This study was registered with Clinicaltrials.gov (Identifier NCT03900416).

Psychological well-being of ruminative adolescents during the transition to COVID-19 school closures: An EMA study.

INTRODUCTION: Adolescents with moderate-to-severe levels of trait rumination are at heightened risk for psychopathology and may be particularly vulnerable to disruptions caused by the onset of the COVID-19 pandemic. As most past research documenting the impact of COVID-19 on adolescent well-being has been cross-sectional, it is unclear exactly how ruminative adolescents responded to the onset of the pandemic as it unfolded. METHODS: We used ecological momentary assessment (EMA) to explore changes in rumination among adolescents during the initial transition to distance learning in the United States. A subsample of 22 ruminative youth (Mage = 13.58; SD = 0.96; 54.5% male; 86.4% White) from a larger study provided EMA data throughout January-April 2020 (M responses per participant = 105.09, SD = 65.59). Following school closures, we hypothesized that adolescents would report greater rumination (i.e., focusing on emotions and problems) and depressive symptom level would moderate this effect. RESULTS: Surprisingly, rumination decreased, and this effect was moderated by depressive symptom level for emotion-focused rumination, i.e., those with average and below-average depressive symptoms experienced decreases in rumination. CONCLUSIONS: These results suggest that the first wave of stay-at-home orders and the transition to distance learning were not immediately distressing to vulnerable adolescents. However, more research is needed to determine whether the results from recent research are generalizable to other adolescents and to examine the long-term impact of the pandemic on adolescent well-being.

Depressive Symptoms, Rumination, and Emotion Reactivity Among Youth: Moderation by Gender.

The emotion context-insensitivity hypothesis (ECI; Rottenberg et al., 2005) posits that depressive symptoms are associated with blunted emotional reactivity and is supported by the results of a meta-analysis (Bylsma et al., 2008). Yet it remains unclear how strongly ECI holds across emotional response domains, whether ECI operates similarly in male and female individuals, and whether this pattern of underreactivity is observed in youth. In contrast, rumination, a cognitive style strongly associated with depressive symptoms, may be associated with heightened reactivity. We assessed the effects of youth's depressive symptoms and rumination on subjective and physiological emotion reactivity (N = 160; Mage = 12.67, SDage = 1.12; 48% female; 94% non-Hispanic). State sadness and respiratory sinus arrhythmia were assessed during a baseline activity (nature video) and a sad mood induction. As hypothesized, depressive symptoms predicted less subjective emotional reactivity, whereas rumination predicted more subjective reactivity. Exploratory analyses revealed that associations for physiological reactivity differed by child gender. ECI may be stronger in terms of subjective rather than physiological emotional reactivity.

Can't Take My Eyes Off of You: Eye Tracking Reveals How Ruminating Young Adolescents Get Stuck.

Rumination, a cognitive process that involves passively, repetitively focusing on negative feelings and their meaning, is a transdiagnostic risk factor for psychopathology. Research with adults has suggested that attentional control difficulties may underlie rumination, but questions remain about the nature of these processes. Furthermore, the relationship between attentional control and rumination in youth has received little empirical examination. In the present study, 92 youth (ages 9-14; 72% girls; 74% Caucasian) reported on their trait rumination and internalizing symptoms. They also completed a 1,500 ms emotional-faces dot-probe task while their eye movements were measured to examine overt visual attention with high temporal precision. Youth's rumination was associated with greater dwell on emotional faces but not with initial orientation. These findings suggest that rumination is associated with increased attention to emotional information during the later stages of selective attention rather than earlier orienting to emotional cues. Implications for prevention and treatment of psychopathology are discussed.

Rumination and Moderators of Multifinality: Predicting Internalizing Symptoms and Alcohol Use During Adolescence.

Rumination, a perseverative cognitive process that involves repetitively and passively focusing on negative emotions, is a transdiagnostic risk factor for the development of psychopathology. Although rumination has been linked to various forms of psychopathology including depression, anxiety, and alcohol misuse, little is known about the conditions that lead to multifinality. Here, we test putative moderators (Nolen-Hoeksema & Watkins, 2011) of the association between rumination and subsequent internalizing symptoms and frequency of alcohol use during adolescence. Participants included 388 youth (52% girls; 90% Caucasian) in a longitudinal birth cohort study who completed questionnaires in Grades 9 and 11. Brooding, a maladaptive form of rumination measured in Grade 9, was associated with greater internalizing symptoms in Grade 11 and greater perceived peer rejection in Grade 9 amplified this association. Brooding was also associated with greater frequency of alcohol use among adolescents who reported having more friends who use alcohol. Gender differences were also examined. Findings provide support for some of the predictions regarding moderators of multifinality made by Nolen-Hoeksema and Watkins. Implications of understanding divergent trajectories in the prevention of psychopathology are discussed.

Daily and trait rumination: diurnal cortisol patterns in adolescent girls.

Rumination is a maladaptive form of emotion regulation associated with psychopathology. Research with adults suggests that rumination covaries with diurnal cortisol rhythms, yet this has not been examined among adolescents. Here, we examine the day-to-day covariation between rumination and cortisol, and explore whether trait rumination is associated with alterations in diurnal cortisol rhythms among adolescent girls. Participants (N = 122) provided saliva samples 3 times per day over 3 days, along with daily reports of stress and rumination, questionnaires assessing trait rumination related to peer stress, and diagnostic interviews assessing depression and anxiety. Greater rumination than usual during the day was associated with lower cortisol awakening responses the following morning, but this effect was not significant after accounting for wake time and an objective measure of adherence to the saliva sampling protocol. Trait rumination was associated with lower average cortisol levels at waking and flatter diurnal slopes, accounting for wake time, protocol compliance, and other factors. These patterns may help to explain why rumination is related to the development of psychopathology.

Maltreated youth display a blunted blood pressure response to an acute interpersonal stressor.

Although there is much evidence of hypothalamic-pituitary-adrenal axis dysfunction among individuals who have experienced child maltreatment, dysregulation of the autonomic nervous system (ANS) has received less attention. Understanding the role of the ANS in maltreated children may help clarify how these children respond to subsequent life stress. We explored ANS reactivity among 111 youth (ages 9-14), 34 of whom had experienced verified child maltreatment. ANS activity was assessed via blood pressure-a convenient, noninvasive physiological index-while youth underwent a social stress task. Blood pressure and subjective mood ratings were obtained prior to and following the task. Nonmaltreated youth experienced an increase in systolic blood pressure following the stressor, whereas maltreated youth did not. Self-reported subjective mood worsened for both groups. The current data suggest that children who experienced early stress exposure demonstrate blunted ANS reactivity. Results are discussed in terms of children's healthy adaptations to transient social stressors. In addition, we discuss the cost-effectiveness and benefits of physiological measures such as blood pressure for understanding risk for psychopathology.

Rumination and multi-modal emotional reactivity.

Rumination, a cognitive process that involves passively and repetitively focusing on negative feelings and their consequences, has been linked to negative emotional outcomes. Previous research suggests that rumination may lead to deleterious outcomes through prolonging emotional reactivity; however, evidence supporting the link between rumination and reactivity has been mixed. In the present study, we examined the relationship between state and trait rumination and multi-modal emotional reactivity (i.e., hypothalamic-pituitary-adrenal axis, autonomic nervous system, subjective experience). Fifty undergraduates participated in a social evaluative laboratory stressor. They also reported on their general tendency to ruminate and their use of rumination in response to this particular laboratory stressor. State, but not trait, rumination was associated with increases in cortisol and negative affect. Findings underscore the importance of multi-modal assessment of emotional reactivity and suggest important implications for rumination following a stressor.

School-aged children's depressive rumination is associated with their reactivity to sadness but not fear.

It is well documented that a ruminative response style is associated with greater risk for depression in children and adults. Less is known about the association between rumination and stress reactivity, particularly among children. Similarly, the extent to which depressive rumination is associated with general reactivity to negative emotion, or more specifically to sadness, has not received sufficient attention. The current study examines the association between depressive rumination and stress reactivity in response to a mild laboratory stressor in school-aged children. A diverse sample of 94 children between the ages of 8 and 12 participated in this 2-session study in which they reported on their tendency to engage in depressive rumination. Children's cardiovascular reactivity (operationalized as respiratory sinus arrhythmia) was assessed while they completed a task in which they read vignettes depicting children experiencing sadness and fear. Children also reported on their emotional reaction to the sad and fear vignettes, and we assessed the length of time it took them to respond to these questions (reaction time). Rumination was associated with greater decreases in respiratory sinus arrhythmia and greater increases in self-reported negative emotion in response to the sad but not the fear vignettes, suggesting that children higher in depressive rumination experienced more subjective arousal and showed evidence of greater regulatory effort when contemplating sadness. Rumination was associated with slower reaction time to both types of vignettes in one condition of the paradigm only. Results are discussed in terms of their implications for rumination and stress reactivity.

Characterizing the ruminative process in young adolescents.

Rumination involves repeatedly and passively dwelling on negative feelings and brooding about their causes and consequences. Prior work has found that rumination predicts many forms of psychopathology including anxiety, binge eating, binge drinking, self-injury, and especially depression (Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008 ). In the present study, we attempt to characterize the ruminative process in real time in young adolescents, specifically by examining factors that predict rumination following an interpersonal stressor. A community sample of 105 youth ages 9 to 14 (70% girls; 66% Caucasian) completed questionnaires regarding depressive symptoms and trait rumination along with an assessment of selective attention using an emotional faces dot-probe task. Participants then underwent an interpersonal stressor and audio rumination induction in the laboratory during which time thoughts were sampled regularly and coded. Results indicate that negative self-referential thought is a common response to the stressor and is predicted by trait rumination scores. Although most participants were able to disengage from this type of thinking, 10.5% persisted through (i.e., ruminated) until the end of the study. These individuals were characterized by higher depressive symptoms and an attentional bias away from happy (relative to neutral) faces. Differences in attentional processes may characterize rumination in youth. Implications for the measurement of rumination as well as treatment are discussed.

Rumination mediates the relationship between peer alienation and eating pathology in young adolescent girls.

PURPOSE: This study examined whether rumination, the tendency to passively and repeatedly dwell on negative events, mediated the relationship between peer alienation and eating disorder symptoms among adolescent girls. METHODS: Participants included 101 girls (ages 10-14; 47% Hispanic, 24% African American) who completed questionnaires regarding peer relationships, symptoms of eating pathology, rumination, and depressive symptoms. RESULTS: Girls who reported experiencing more peer alienation reported a higher degree of pathological eating symptoms. The relationship between peer alienation and eating pathology was mediated by rumination, even after controlling for depressive symptoms. CONCLUSIONS: This study extends previous work indicating that rumination is a cognitive mechanism that may contribute to the development and/or maintenance of eating pathology. The findings suggest that adolescents who feel alienated by their peers might be particularly susceptible to engaging in ruminative thinking that can lead to or exacerbate eating problems.

Early family context and development of adolescent ruminative style: moderation by temperament.

We know very little about the development of rumination, the tendency to passively brood about negative feelings. Because rumination is a risk factor for many forms of psychopathology, especially depression, such knowledge could prove important for preventing negative mental health outcomes in youth. This study examined developmental origins of rumination in a longitudinal sample (N=337; 51% girls) studied in preschool (ages 3½ and 4½ years) and early adolescence (ages 13 and 15 years). Results indicated that family context and child temperament, assessed during the preschool period, were risk factors for a ruminative style in adolescence. Specifically, early family contexts characterised by over-controlling parenting and a family style of negative-submissive expressivity predicted higher levels of later rumination. These associations were moderated by children's temperamental characteristics of negative affect and effortful control. Further, the interaction of these temperament factors exerted an additional influence on later rumination. Implications for prevention and intervention efforts are discussed.

Which adolescents are well-suited to app-based mindfulness training? A randomized clinical trial and data-driven approach for personalized recommendations.

OBJECTIVE: Rumination heightens risk for depression and anxiety, which increase substantially during adolescence. Smartphone apps offer a convenient and cost-effective means for adolescents to access mindfulness training, which may reduce rumination. Despite their increasing popularity, it is unclear which adolescents benefit from mindfulness apps. METHOD: Adolescents (n = 152) with elevated trait rumination were randomly assigned to 3 weeks of app-based mindfulness training or a mood-monitoring control. Multilevel models tested group differences in state rumination change, assessed via ecological momentary assessment. Baseline adolescent characteristics were submitted to elastic net regularization models to develop a "Personalized Advantage Index" indicating an individual's expected outcome from the mindfulness app relative to the mood-monitoring control. Finally, we translated a predictive model (developed in an external sample) for personalized recommendations of expected benefit from the mindfulness app. RESULTS: Adolescents in the mindfulness app condition reported significantly greater reductions in rumination than adolescents in the control condition. Individuals predicted to have better outcomes from the mindfulness app relative to mood monitoring had significantly greater reductions in rumination if randomly assigned to the mindfulness condition. In contrast, between-condition differences in outcome were not significant for adolescents predicted to have better outcomes in the mood-monitoring condition. CONCLUSIONS: Findings support the efficacy of a mindfulness app to reduce state rumination in adolescents, particularly among adolescents high in trait rumination. A predictive model is put forth, which could be used to objectively communicate expected mindfulness app outcomes to adolescents prior to engagement in app-based mindfulness training. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Acceptability and Preliminary Effects of a Mindfulness Mobile Application for Ruminative Adolescents.

Rumination is a transdiagnostic risk factor that appears to be reduced through mindfulness interventions. However, mindfulness mobile apps have not been tested for their effects on rumination, especially among adolescents. Thus, we aimed to test the acceptability and effects of a mindfulness mobile intervention among ruminative adolescents using a within-subjects pretest/posttest design. Participants were 80 adolescents ages 12-15, selected for moderate-to-high rumination (M age = 14.01, SD = .99; 46.2% girls; 86.25% White; 3.75% Hispanic). We asked adolescents to use our mindfulness app 3 times per day for 3 weeks. Participants and parents completed questionnaires at baseline, post-intervention, and 6 and 12 weeks later. Acceptability was assessed by tracking app use and asking adolescents and parents to report on their experiences post-intervention. We assessed repetitive negative thinking (i.e., rumination and worry) and internalizing symptoms via self- and parent-report. The intervention demonstrated acceptability, and there were significant reductions in rumination, worry, anxiety and parent-reported internalizing symptoms post-intervention. Effects on rumination, anxiety and internalizing symptoms persisted throughout the 12-week follow-up with large effect sizes using an intention-to-treat approach. Thus, a brief mindfulness mobile app intervention appeared to be both engaging and helpful in reducing negative repetitive thinking and internalizing symptoms among ruminative adolescents. It will be important to test this intervention in a randomized controlled trial to control for effects of time and attention.

App-based Mindfulness Training for Adolescent Rumination: Predictors of Immediate and Cumulative Benefit.

Objectives: Rumination is a transdiagnostic risk factor for depression and anxiety, which surge during the adolescent years. Mindfulness training - with its emphasis on metacognitive awareness and present-moment attention - may be effective at reducing rumination. Mindfulness apps offer a convenient, engaging, and cost-effective means for accessing mindfulness training for teens. Despite their increasing popularity among adolescents, no study to date has investigated which teens are well-suited to app-based mindfulness training. Methods: Eighty adolescents (M age = 14.01 years, 45% girls) with elevated rumination were enrolled in a 3-week trial of app-based mindfulness training. Repeated daily ecological momentary assessment (EMA) surveys assessed problem-focused and emotion-focused rumination immediately prior to and following each mindfulness exercise. Elastic net regularization (ENR) models tested baseline predictors of "immediate" (post-mindfulness exercise) and "cumulative" (post-3-week intervention) benefit from app-based mindfulness training. Results: Ninety percent (72/80) of adolescents completed the 3-week trial, and the mean number of mindfulness exercises completed was 28.7. Baseline adolescent characteristics accounted for 14%-25% of the variance in outcomes (i.e., reduction in problem-focused or emotion-focused rumination). Higher baseline rumination, and lower emotional suppression, predicted better immediate and cumulative outcomes. In contrast, female gender and older age predicted better immediate, but not cumulative, outcomes. Differences in results across outcome timeframes (immediate vs. cumulative) are discussed. Conclusions: Findings from this study highlight the potential of data-driven approaches to inform which adolescent characteristics may predict benefit from engaging with an app-based mindfulness training program. Additional research is needed to test these predictive models against a comparison (non-mindfulness) condition.

Dopaminergic Genetic Variation in Young Adolescents: Associations with Sensation-Seeking.

Deficient reward functioning, including reward-related personality, is implicated in depression's etiology. A dopaminergic genetic multilocus genetic profile score (MGPS) has previously been associated with neural reward responsivity but, despite theoretical basis, has not been studied with reward-related personality. Such research is needed to elucidate associations between genetic variation and reward-related personality in a developmentally sensitive population. In the present study, we examined associations between dopaminergic MGPS's and self-report reward-related personality in two young adolescent samples aged 10-15 years old (Sample 1: N = 100 girls, 82% White, 18% Other; Sample 2: N = 141, 65 girls, 76 boys, 89.36% White, 10.64% Other) using an established MGPS and an augmented MGPS. A "mini" meta-analysis synthesized results across samples. In Sample 1, an exploratory mediation analysis intended to gauge effect size for future work tested a path between the MGPS and depression through significant reward traits. In each independent sample, both MGPS's showed significant associations with sensation-seeking but not social drive, a pattern that persisted following correction. Effect sizes of novel variants were at least as robust as established variants, suggesting their added utility. Additionally, the exploratory mediation analysis suggested no noteworthy indirect effect, but a small (R2 = 0.022), statistically non-significant direct effect of the MGPS predicting prospective depressive symptoms. Results suggest that dopaminergic genetic variation is associated with the reward-related personality trait of sensation seeking but not social drive. Additional work is needed to probe whether sensation seeking may be a path through which this genetic variation confers depression risk.

The Link between Discrimination and Worst Point Suicidal Ideation among Sexual and Gender Minority Adults.

OBJECTIVE: Sexual and gender minority (SGM) adults often report a disproportionately high rate of suicidal ideation compared to their heterosexual and cisgender counterparts. The current study aimed to understand the relationship between discrimination for one's sexual orientation or gender identity and suicidal ideation. We hypothesized that discrimination would be associated with suicidal ideation at one's worst point through the indirect effects of hopelessness regarding thwarted belongingness and perceived burdensomeness. METHOD: A sample of 178 SGM adults (M age = 30.34, range 18-69; 76% white) completed an online questionnaire assessing minority-specific stressors and suicide-related thoughts and behaviors. RESULTS: A mediation model with bootstrapping indicated that greater discrimination was associated with more frequent suicidal ideation at one's worst point through the indirect effect of hopelessness regarding thwarted belongingness. CONCLUSIONS: The current study provides evidence that the pathway between discrimination and worst point suicidal ideation may be partially explained by the perception that one will never belong. These findings support the utility of an understudied Interpersonal Theory of Suicide hypothesis for research among SGM adults.

Socially oriented thinking and the biological stress response: Thinking of friends and family predicts trajectories of salivary cortisol decline.

The cortisol stress response has been related to perceived social support, but previous studies rely on self-reported social support variables. The cortisol recovery phase in particular has been theorized to serve a social coping function, but individual differences in recovery slope have not yet been examined in relation to social coping-relevant indices. This study addressed these gaps by examining the relationship of cortisol trajectories after a socioevaluative task to individual differences in covertly assessed cognitions related to close social relationships. We examined trajectories of cortisol change related to socially oriented thinking, the semi-implicit activation of cognitive representations of friends or family. Young adults (N = 64) gave salivary cortisol samples before and for 45 min after a speech task. Participants' thoughts were sampled repeatedly; the frequency of words related to friends or family was assessed to index socially oriented thinking. A free curve slope intercept latent growth curve model showed excellent fit with the cortisol data. Socially oriented thinking was unrelated to overall magnitude of cortisol response to the task (latent intercept) but predicted the latent cortisol trajectory, independently of cortisol intercept and baseline cortisol levels. Socially oriented thinkers showed more gradual cortisol declines, whereas nonsocially oriented thinkers showed a steeper downslope driven primarily by cortisol changes 45 min after the task. Individual differences in socially oriented thinking may manifest in different rates of biological changes following a performance task.

The developmental origins of ruminative response style: An integrative review.

Rumination has been conceptualized as a stable, trait-level response style involving repetitive and passive focus on the symptoms of distress and the possible causes and consequences of those symptoms. This theoretical review examines developmental risk factors of ruminative response style, incorporating a developmental psychopathology perspective. A model integrating these developmental factors within a conceptual framework is proposed, wherein risk factors for distress (i.e., temperamental negative affectivity, stressful environments, parenting, and genetic vulnerability) lead to engagement in rumination. We propose that when rumination is well-practiced, it will consolidate into a trait-like response style, especially among adolescents who experience cognitive control deficits. Reciprocal relationships and moderators that may contribute to the formation of a ruminative response style are also included. To understand how these factors converge and influence the formation of ruminative response styles, we review patterns of stability and change in physical and cognitive development to demonstrate that individual differences in rumination may emerge and consolidate into enduring, trait-level response styles during early adolescence.

Nonsuicidal self-injury in young adolescent girls: moderators of the distress-function relationship.

This study examined nonsuicidal self-injury (NSSI) in a community sample of young adolescent girls. Potential moderators of the relationships between different types of distress (internal and interpersonal) and particular functions of NSSI (emotion-regulation and interpersonal) were explored. Participants included 94 girls (49% Hispanic; 25% African American) ages 10-14 years who completed questionnaires regarding self-injurious behavior and other constructs of interest. Fifty-six percent of girls (n = 53) reported engaging in NSSI during their lifetime, including 36% (n = 34) in the past year. Internal distress (depressive symptoms) was associated with engaging in NSSI for emotion-regulation functions, and rumination moderated the relationship between depressive symptoms and engaging in NSSI for automatic positive reinforcement. Interpersonal distress (peer victimization) was associated with engaging in NSSI for social reinforcement, and quality of peer communication moderated this relationship. The clinical implications of these findings include designing preventions that address the particular contexts of self-injurious behavior.