From Threat to Rumination

Presentation First Author: 
Young Chul Chung

The perception of threat is a central feature of paranoia. There is considerable evidence that paranoid individuals often experienced an abnormal frequency of adverse events such as bullying, discrimination and victimization. These precipitants may cause state of hyperarousal or induce anomalous perceptual experience. Combined with emotional distress, negative beliefs about the self, others and the world, and reasoning bias, hypervigilant individuals may try to make sense of internal unusual experience in negative and malicious way leading to the formation of threat belief. This threat anticipation cognitive model put forward by Freeman and Garety (2004) is supported by recent brain imaging studies that neural response of amygdale in response to fearful face or threat-related facial expressions has been found altered in patients with schizophrenia. However, there are different theoretical approaches to the understanding of delusion formation such as deficits in self-monitoring and 'theory of mind, externalizing attribution style or lower social rank. We would like to suggest rumination as another novel and crucial factor triggering and maintaining paranoid thinking. Nolen-Hoeksema (1987) developed the depressive rumination construct, defined as repetitive thought focused particularly on depressive feelings and symptoms. Rumination has been associated with elevated and prolonged sad mood, vulnerability to and maintenance of depression and metacognitive aspects of depression as well as negative health outcomes such as delayed recovery from coronary incidents. Recently, benefits of rumination-focused cognitive-behavioral therapy in persistent depression have been reported. With regard to psychosis, Halari et al (2009) reported negative symptoms are associated with rumination. Patients family in China reported too much thinking as cause for schizophrenia. Freeman and Garety (1999) suggested that almost two-thirds of individuals with persecutory delusions have a worry thinking style even about matters unrelated to paranoia which is, though, a little different concept from rumination. Cognitive slowing, one of the side effects caused by antipsychotic medication, could be a therapeutic benefit to subgroup of psychotic patients with high levels of rumination. We developed a new Rumination Scale (RS) consisting of three subdomains, frustration, anger, and foolishness, based on the teachings of Buddhism (three mind poisons). We recruited patients with anxiety disorder (n=74), depression (n=148) and psychosis (n=65), and normal volunteer (n=124) to compare psychological aspects using RS and other tools. The RS score in patients with psychosis was between the scores of patients with depression, and patients with anxiety disorder or normal volunteer though no significant differences between subgroups. Interestingly, there were significant positive correlations between the P3 (hallucinatory behavior) and P4 (excitement) of PANSS and total score of RS in patients with psychosis. These results may point to contributing role of rumination in the genesis of positive symptoms. Further studies are needed to explore relationships between rumination and paranoia and to refine the definition of rumination with regard to psychosis. Lastly, therapeutic implications for cognitive therapy will be discussed.

Conference Name: 
Presentation Date: 
January, 2015
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