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Rumination, Reflection and Distress: An 8-Month Prospective Study of Colon-Cancer Patients

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Abstract

Self-focused thoughts may be both adaptive and maladaptive. We asked 67 patients who had received a colon-cancer diagnosis within the past 1–7 months to complete measures of rumination, reflection, intrusive and avoidance symptoms and depressive symptoms. At 8 months follow-up they completed the same measures. Higher rumination at time 1 was associated with more symptoms at both times 1 and 2. Reflection at time 1 did not show any associations with symptoms at time 1 and 2. However, time 1 reflection predicted higher time 2 avoidance symptoms, while controlling for time 1 avoidance symptoms. This suggests that while reflection may not be as maladaptive as rumination, it may still under some circumstances be associated with increased symptoms.

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Notes

  1. RRQ, rumination: At T1, 8 participants had missing data with an average of 1.38 missing items (range 1–2). RRQ, reflection: At T1, 5 participants had missing data with 2 participants having all items missing (and thus were not included in analyses) and the remaining 3 participants all having 1 missing item. At T2, no participants had missing data for the rumination or the reflection subscale of the RRQ. IES, intrusion subscale: At T1, 5 participants had missing data for the IES intrusion subscale with an average of 4 missing items (range 1–7; 3 participants were not included in analyses because of too many missing items). IES, avoidance subscale: At T1, 7 participants had missing data with an average of 4 missing items (range 1–8; 3 participants were not included in the analyses because of too many missing items). At T2, 1 participant had 1 missing item for the IES intrusion subscale and 1 participant had 1 missing data point for the IES avoidance subscale. BDI-II: At T1, 6 participants had missing data with 1 participant missing 11 items (and thus not included in analyses) and the remaining 5 participants missing between 1 and 6 items (average 2.8 items). At T2, 4 participants had missing data for the BDI-II with an average of 3.75 missing items (range 1–10). Thus, more replacement of missing values was needed for the T1 data.

  2. Because the results for reflection were in disagreement with expectations, we examined the relation between reflection and an alternative measure of distress. As a part of the study participants described the event where they received the cancer diagnosis at both T1 and T2. We counted positive and negative affect words in the descriptions the participants made of the event where they received the diagnosis. We coded this as “0” for no mentioning of positive/negative affect words and “1” for the mentioning of positive/negative affect words. The agreement between the two independent co-raters was high (κ = 0.80). We analyzed these data in two regression analyses using reflection at T1 to predict mentioning of positive or negative affect words in T2 descriptions while controlling for mentioning of positive or negative affect words in T1 descriptions. For negative affect words, the overall model was significant (F(2, 48) = 8.84, p < 0.05). However, reflection did not reach significance, although the direction of the relationship indicated that more reflection was associated with higher likelihood of mentioning negative affect words (β = 0.16, p > 0.05). For positive affect words, the overall model was significant (F(2, 48) = 6.38, p < 0.05). Reflection was associated with less likelihood of mentioning positive affect words at T2, while controlling for T1 positive affect words (β = −0.26, p = 0.05). We believe that these additional analyses further support the idea that reflection is associated with reduced well-being over time in the present study.

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Acknowledgments

Thanks to Margith Grøn and the nurses at the Department of Oncology, Aarhus University Hospital as well as the student assistants for their help with the data collection and coding.

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The authors have no conflict of interest.

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Authors and Affiliations

  1. Center on Autobiographical Memory Research (CON AMORE), Aarhus University, Aarhus C, Denmark

    Dorthe Kirkegaard Thomsen

  2. Department of Oncology, Aarhus University Hospital, Aarhus C, Denmark

    Anders Bonde Jensen & Robert Zachariae

  3. Department of Psychology and Behavioral Sciences, Aarhus University, Bartholins Allé 9, 8000, Aarhus C, Denmark

    Dorthe Kirkegaard Thomsen, Thomas Jensen, Mimi Yung Mehlsen, Christina Gundgaard Pedersen & Robert Zachariae

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  1. Dorthe Kirkegaard Thomsen
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Correspondence to Dorthe Kirkegaard Thomsen.

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Thomsen, D.K., Jensen, A.B., Jensen, T. et al. Rumination, Reflection and Distress: An 8-Month Prospective Study of Colon-Cancer Patients. Cogn Ther Res 37, 1262–1268 (2013). https://doi.org/10.1007/s10608-013-9556-x

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