Abstract
Distress tolerance has been implicated in the emergence of internalizing symptomatology, notably depressive symptoms. However, few studies have tested potential mechanisms underlying the relationship between distress tolerance and depressive symptoms, and further, this has not been tested among substance users, who commonly experience both low distress tolerance and elevated depressive symptoms. The current study focused on the construct of rumination, which has been suggested to be a coping response to stress associated with substance use and depression. Two forms of rumination, brooding and reflection, were tested as potential mediators of the relationship between distress tolerance and self-reported depressive symptoms among 128 individuals entering substance abuse treatment. Brooding (i.e., to overly focus on symptoms of distress) mediated the relationship between distress tolerance and depressive symptoms. However, reflection (i.e., to attempt to gain insight into problems) was unrelated to distress tolerance. Findings suggest the important role of brooding as a mechanism underlying the relationship between distress tolerance and depressive symptomatology.
Similar content being viewed by others
Notes
BDI scores were slightly positively skewed (skewness = 1.02, SE = 0.21). As such, we log transformed BDI scores, which improved skewness (skewness = −0.62, SE = 0.21). Transforming scores did not affect results across all analyses. To preserve the clinical significance of depression scores, the non-transformed data are reported here.
We conducted the same analyses with a contrast between the two indirect effects of brooding and reflection. In these analyses, there remained a significant indirect effect of brooding, but the indirect effect of reflection was non-significant (using both bias-corrected and percentile-based 95 % CIs).
References
Abela, J. Z., & Hankin, B. L. (2011). Rumination as a vulnerability factor to depression during the transition from early to middle adolescence: A multiwave longitudinal study. Journal of Abnormal Psychology, 120(2), 259–271. doi:10.1037/a0022796.
Abrantes, A. M., Strong, D. R., Lejuez, C. W., Kahler, C. W., Carpenter, L. L., Price, L. H, et al. (2008). The role of negative affect in risk for early lapse among low distress tolerance smokers. Addictive Behaviors, 33, 1394–1401.
Bagby, R., & Parker, J. A. (2001). Relation of rumination and distraction with neuroticism and extraversion in a sample of patients with major depression. Cognitive Therapy and Research, 25(1), 91–102. doi:10.1023/A:1026430900363.
Baker, T. B., Piper, M. E., McCarthy, D. E., Majeskie, M. R., & Fiore, M. C. (2004). Addiction motivation reformulated: An affective processing model of negative reinforcement. Psychological Review, 111(1), 33–51. doi:10.1037/0033-295X.111.1.33.
Baron, R., & Kenny, D. (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173–1182.
Beck, A. T., Steer, R. A., Ball, R., & Ranieri, W. F. (1996). Comparison of Beck Depression Inventories-IA and -II in psychiatric outpatients. Journal of Personality Assessment, 67(3), 588.
Bjornsson, A., Carey, G., Hauser, M., Karris, A., Kaufmann, V., Sheets, E., et al. (2010). The effects of experiential avoidance and rumination on depression among college students. International Journal of Cognitive Therapy, 3(4), 389–401. doi:10.1521/ijct.2010.3.4.389.
Borkovec, T. D. (1994). The nature, functions, and origins of worry. In G. L. Davey & F. Tallis (Eds.), Worrying: Perspectives on theory, assessment and treatment (pp. 5–33). Oxford England: Wiley.
Borkovec, T. D., Ray, W. J., & Stöber, J. (1998). Worry: A cognitive phenomenon intimately linked to affective, physiological, and interpersonal behavioral processes. Cognitive Therapy and Research, 22(6), 561–576. doi:10.1023/A:1018790003416.
Brown, R. A., Lejuez, C. W., Kahler, C. W., Strong, D. R., & Zvolensky, M. J. (2005). Distress tolerance and early smoking lapse. Clinical Psychology Review, 25(6), 713–733. doi:10.1016/j.cpr.2005.05.003.
Buckner, J. D., Keough, M. E., & Schmidt, N. B. (2007). Problematic alcohol and cannabis use among young adults: The roles of depression and discomfort and distress tolerance. Addictive Behaviors, 32(9), 1957–1963. doi:10.1016/j.addbeh.2006.12.019.
Burwell, R. A., & Shirk, S. R. (2007). Subtypes of rumination in adolescence: Associations between brooding, reflection, depressive symptoms, and coping. Journal of Clinical Child and Adolescent Psychology, 36(1), 56–65. doi:10.1207/s15374424jccp3601_6.
Caselli, G., Bortolai, C., Leoni, M., Rovetto, F., & Spada, M. M. (2008). Rumination in problem drinkers. Addiction Research & Theory, 16(6), 564–571. doi:10.1080/16066350802100822.
Conway, M., Csank, P. R., Holm, S. L., & Blake, C. K. (2000). On assessing individual differences in rumination on sadness. Journal of Personality Assessment, 75(3), 404–425.
Cox, B. J., Enns, M. W., & Taylor, S. (2001). The effect of rumination as a mediator of elevated anxiety sensitivity in major depression. Cognitive Therapy and Research, 25(5), 525–534. doi:10.1023/A:1005580518671.
Daughters, S. B., Lejuez, C. W., Bornovalova, M. A., Kahler, C. W., Strong, D. R., & Brown, R. A. (2005). Distress tolerance as a predictor of early treatment dropout in a residential substance abuse treatment facility. Journal of Abnormal Psychology, 114, 728–734. doi:10.1037/0021-843X.114.4.729.
Daughters, S. B., Reynolds, E. K., MacPherson, L., Kahler, C. W., Danielson, C. K., Zvolensky, M., et al. (2009). Distress tolerance and early adolescent externalizing and internalizing symptoms: The moderating role of gender and ethnicity. Behaviour Research and Therapy, 47(3), 198–205. doi:10.1016/j.brat.2008.12.001.
Dennhardt, A. A., & Murphy, J. G. (2011). Associations between depression, distress tolerance, delay discounting, and alcohol-related problems in European American and African American college students. Psychology of Addictive Behaviors, 25(4), 595–604. doi:10.1037/a0025807.
Deyo, M., Wilson, K. A., Ong, J., & Koopman, C. (2009). Mindfulness and rumination: Does mindfulness training lead to reductions in the ruminative thinking associated with depression? Patient Education and Counseling, 5, 265–271.
Ellis, A. J., Fischer, K. M., & Beevers, C. G. (2010). Is dysphoria about being red and blue? Potentiation of anger and reduced distress tolerance among dysphoric individuals. Cognition and Emotion, 24(4), 596–608. doi:10.1080/13803390902851176.
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (2002). Structured clinical interview for DSM-IV-TR Axis I disorders, research version, patient edition with psychotic screen. New York: Biometrics Research, New York State Psychiatric Institute.
Glick, D. M., & Orsillo, S. M. (2011). Relationships among social anxiety, self-focused attention, and experiential distress and avoidance. Journal of Cognitive and Behavioral Psychotherapies, 11(1), 1–12.
Gorka, S. M., Ali, B., & Daughters, S. B. (2012). The role of distress tolerance in the relationship between depressive symptoms and problematic alcohol use. Psychology of Addictive Behaviors, 26(3), 621–626. doi:10.1037/a0026386.
Harley, R., Sprich, S., Safren, S., Jacobo, M., & Fava, M. (2008). Adaptation of dialectical behavior therapy skills training group for treatment-resistant depression. Journal of Nervous and Mental Disease, 196(2), 136–143. doi:10.1097/NMD.0b013e318162aa3f.
Harrington, N. (2006). Frustration intolerance beliefs: Their relationship with depression, anxiety, and anger in a clinical population. Cognitive Therapy and Research, 30(6), 699–709. doi:10.1007/s10608-006-9061-6.
Hasin, D., Liu, X., Nunes, E., McCloud, S., Samet, S., & Endicott, J. (2002). Effects of major depression on remission and relapse of substance dependence. Archives of General Psychiatry, 59(4), 375–380. doi:10.1001/archpsyc.59.4.375.
Hayes, A. F. (2009). Beyond Baron and Kenny: Statistical mediation analysis in the new millennium. Communication Monographs, 76(4), 408–420. doi:10.1080/03637750903310360.
Johnson, M. E., Neal, D. B., Brems, C., & Fisher, D. G. (2006). Depression as measured by the Beck Depression Inventory-II among injecting drug users. Assessment, 13(2), 168–177. doi:10.1177/1073191106286951.
Just, N., & Alloy, L. B. (1997). The response styles theory of depression: Tests and an extension of the theory. Journal of Abnormal Psychology, 106(2), 221–229. doi:10.1037/0021-843X.106.2.221.
Katz, E. J., & Bertelson, A. D. (1993). Effects of gender and response style on depressed mood. Sex Roles, 29(7–8), 509–514. doi:10.1007/BF00289324.
Kross, E., Ayduk, O., & Mischel, W. (2005). When asking ‘why’ does not hurt: Distinguishing rumination from reflective processing of negative emotions. Psychological Science, 16(9), 709–715. doi:10.1111/j.1467-9280.2005.01600.x.
Kuehner, C., & Weber, I. (1999). Responses to depression in unipolar depressed patients: An investigation of Nolen-Hoeksema's response styles theory. Psychological Medicine, 29(6), 1323–1333. doi:10.1017/S0033291799001282.
Lejuez, C., Bornovalova, M., Daughters, S., & Curtin, J. (2005). Differences in impulsivity and sexual risk behavior among inner-city crack/cocaine users and heroin users. Drug and Alcohol Dependence, 77(2), 169–175.
Leyro, T. M., Zvolensky, M. J., & Bernstein, A. (2010). Distress tolerance and psychopathological symptoms and disorders: A review of the empirical literature among adults. Psychological Bulletin, 136(4), 576–600.
Linehan, M. M., Schmidt, H., Dimeff, L. A., Craft, J., Kanter, J., & Comtois, K. A. (1999). Dialectical behavior therapy for patients with borderline personality disorder and drug-dependence. The American Journal on Addictions, 8(4), 279–292. doi:10.1080/105504999305686.
MacPherson, L., Reynolds, E. K., Daughters, S. B., Wang, F., Cassidy, J., Mayes, L., et al. (2010). Positive and negative reinforcement underlying risk behavior in early adolescents. Prevention Science, 11(3), 331–342. doi:10.1007/s11121-010-0172-7.
Martin, L. L., & Tesser, A. (1996). Some ruminative thoughts. In R. S. Wyer (Ed.), Ruminative thoughts (pp. 1–47). Hillsdale, NJ: Lawrence Erlbaum Associates, Inc.
Mayer, J. D., & Salovey, P. (1997). What is emotional intelligence? In P. Salovey & D. J. Sluyter (Eds.), Emotional development and emotional intelligence: Educational implications (pp. 3–34). New York, NY: Basic Books.
McIntosh, E., Gillanders, D., & Rodgers, S. (2010). Rumination, goal linking, daily hassles and life events in major depression. Clinical Psychology & Psychotherapy, 17(1), 33–43.
McKay, J. R., Donovan, D. M., McLellan, T., Krupski, A., Hansten, M., Stark, K. D., et al. (2002). Evaluation of full vs. partial continuum of care in the treatment of publicly funded substance abusers in Washington State. The American Journal of Drug and Alcohol Abuse, 28(2), 307–338. doi:10.1081/ADA-120002976.
McLaughlin, K. A., & Nolen-Hoeksema, S. (2011). Rumination as a transdiagnostic factor in depression and anxiety. Behaviour Research and Therapy, 49(3), 186–193. doi:10.1016/j.brat.2010.12.006.
Michalak, J., Hölz, A., & Teismann, T. (2011). Rumination as a predictor of relapse in mindfulness-based cognitive therapy for depression. Psychology and Psychotherapy: Theory, Research and Practice, 84(2), 230–236. doi:10.1348/147608310X520166.
Moulds, M. L., Kandris, E., Starr, S., & Wong, A. M. (2007). The relationship between rumination, avoidance and depression in a non-clinical sample. Behaviour Research and Therapy, 45(2), 251–261. doi:10.1016/j.brat.2006.03.003.
Nezu, A. M., Ronan, G. F., Meadows, E. A., & McClure, K. S. (2000). Practitioner’s guide to empirically based measures of depression. Dordrecht Netherlands: Kluwer Academic Publishers.
Nolen-Hoeksema, S. (1991). Responses to depression and their effects on the duration of depressive episodes. Journal of Abnormal Psychology, 100(4), 569–582. doi:10.1037/0021-843X.100.4.569.
Nolen-Hoeksema, S., & Girgus, J. S. (1994). The emergence of gender differences in depression during adolescence. Psychological Bulletin, 115(3), 424–443. doi:10.1037/0033-2909.115.3.424.
Nolen-Hoeksema, S., & Harrell, Z. A. (2002). Rumination, depression, and alcohol use: Tests of gender differences. Journal of Cognitive Psychotherapy, 16(4), 391–403. doi:10.1891/jcop.16.4.391.52526.
Nolen-Hoeksema, S., & Morrow, J. (1991). A prospective study of depression and posttraumatic stress symptoms after a natural disaster: The 1989 Loma Prieta earthquake. Journal of Personality and Social Psychology, 61(1), 115–121. doi:10.1037/0022-3514.61.1.115.
Nolen-Hoeksema, S., Stice, E., Wade, E., & Bohon, C. (2007). Reciprocal relations between rumination and bulimic, substance abuse, and depressive symptoms in female adolescents. Journal of Abnormal Psychology, 116(1), 198–207. doi:10.1037/0021-843X.116.1.198.
Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008). Rethinking rumination. Perspectives on Psychological Science, 3(5), 400–424. doi:10.1111/j.1745-6924.2008.00088.x.
O’Cleirigh, C., Ironson, G., & Smits, J. J. (2007). Does distress tolerance moderate the impact of major life events on psychosocial variables and behaviors important in the management of HIV? Behavior Therapy, 38(3), 314–323. doi:10.1016/j.beth.2006.11.001.
Preacher, K. J., & Hayes, A. F. (2004). SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, 36, 717–731.
Preacher, K. J., & Hayes, A. F. (2008). Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 40, 879–891.
Raes, F. (2010). Ruminating and worrying as mediators of the relationship between self-compassion and anxiety and depression. Personality and Individual Differences, 48, 757–761.
Raes, F., & Hermans, D. (2008). On the mediating role of subtypes of rumination in the relationship between childhood emotional abuse and depressed mood: Brooding vs. Reflection. Depression & Anxiety, 25, 787–792.
Roberts, J. E., Gilboa, E., & Gotlib, I. H. (1998). Ruminative response style and vulnerability to episodes of dysphoria: Gender, neuroticism, and episode duration. Cognitive Therapy and Research, 22(4), 401–423. doi:10.1023/A:1018713313894.
Roelofs, J., Muris, P., Huibers, M., Peeters, F., & Arntz, A. (2006). On the measurement of rumination: A psychometric evaluation of the ruminative response scale and the rumination on sadness scale in undergraduates. Journal of Behavior Therapy and Experimental Psychiatry, 37(4), 299–313. doi:10.1016/j.jbtep.2006.03.002.
Sauer, S. E., & Baer, R. A. (2011). Ruminative and mindful self-focused attention in borderline personality disorder. Personality Disorders: Theory, Research, and Treatment. doi:10.1037/a0025465.
Saunders, J. B., Aasland, O. G., Babor, T. F., De La Fuente, J. R., & Grant, M. (1993). Development of the Alcohol Use Disorders Identification Test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption–II. Addiction, 88(6), 791–804.
Schmidt, N. B., Richey, J. A., Cromer, K. R., & Buckner, J. D. (2007). Discomfort intolerance: Evaluation of a potential risk factor for anxiety psychopathology. Behavior Therapy, 38, 247–255.
Schmidt, N. B., Richey, J., & Fitzpatrick, K. (2006). Discomfort intolerance: Development of a construct and measure relevant to panic disorder. Journal of Anxiety Disorders, 20(3), 263–280. doi:10.1016/j.janxdis.2005.02.002.
Simons, J. S., & Gaher, R. M. (2005). The distress tolerance scale: Development and validation of a self-report measure. Motivation & Emotion, 29(2), 83–102. doi:10.1007/s11031-005-7955-3.
Tate, S. R., Brown, S. A., Unrod, M., & Ramo, D. E. (2004). Context of relapse for substance-dependent adults with and without comorbid psychiatric disorders. Addictive Behaviors, 29(9), 1707–1724. doi:10.1016/j.addbeh.2004.03.037.
Thase, M. E., Salloum, I. M., & Cornelius, J. D. (2001). Comorbid alcoholism and depression: Treatment issues. Journal of Clinical Psychiatry, 62(S20), 32–41.
Trapnell, P. D., & Campbell, J. D. (1999). Private self-consciousness and the five-factor model of personality: Distinguishing rumination from reflection. Journal of Personality and Social Psychology, 76(2), 284–304. doi:10.1037/0022-3514.76.2.284.
Treynor, W., Gonzalez, R., & Nolen-Hoeksema, S. (2003). Rumination reconsidered: A psychometric analysis. Cognitive Therapy and Research, 27(3), 247–259. doi:10.1023/A:1023910315561.
Watkins, E. (2004). Adaptive and maladaptive ruminative self-focus during emotional processing. Behaviour Research and Therapy, 42(9), 1037–1052. doi:10.1016/j.brat.2004.01.009.
Watkins, E. R. (2008). Constructive and unconstructive repetitive thought. Psychological Bulletin, 134(2), 163–206. doi:10.1037/0033-2909.134.2.163.
Watkins, E., Scott, J., Wingrove, J., Rimes, K., Bathurst, N., Steiner, H., et al. (2007). Rumination-focused cognitive behaviour therapy for residual depression: A case series. Behaviour Research and Therapy, 45(9), 2144–2154. doi:10.1016/j.brat.2006.09.018.
Willem, L., Bijttebier, P., Claes, L., & Raes, F. (2011). Rumination subtypes in relation to problematic substance use in adolescence. Personality and Individual Differences, 50(5), 695–699. doi:10.1016/j.paid.2010.12.020.
Zvolensky, M. J., Marshall, E. C., Johnson, K., Hogan, J., Bernstein, A., & Bonn-Miller, M. O. (2009). Relations between anxiety sensitivity, distress tolerance, and fear reactivity to bodily sensations to coping and conformity marijuana use motives among young adult marijuana users. Experimental and Clinical Psychopharmacology, 17(1), 31–42. doi:10.1037/a0014961.
Acknowledgments
This work was supported by National Institute of Drug Abuse Grants R01 DA026424 and R01 DA022974 (PI: Daughters).
Author information
Authors and Affiliations
Corresponding authors
Rights and permissions
About this article
Cite this article
Magidson, J.F., Listhaus, A.R., Seitz-Brown, C.J. et al. Rumination Mediates the Relationship Between Distress Tolerance and Depressive Symptoms Among Substance Users. Cogn Ther Res 37, 456–465 (2013). https://doi.org/10.1007/s10608-012-9488-x
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10608-012-9488-x