Rumination causes and maintains depression. Rumination is activated in response to negative thoughts, sadness, and loss experiences and people ruminate to understand the reasons for feeling depressed and work out ways to deal with depressive thoughts.
Rumination contains why-questions, for example, “Why do I feel like this?“. When people ruminate for extended periods of time, they get to negative conclusions and feelings of hopelessness.
Rumination is controlled by metacognitive beliefs (which are beliefs about thinking):
“Thinking about the causes of sadness will help me prevent it”
“I have no control over my mind and mood”
In addition to rumination, depressed patients activate several other CAS strategies (the cognitive attentional syndrome):
Worrying about the reoccurrence of depressive symptoms
Monitoring for signs of depression and mood changes
Avoiding activities and social contact to rest more
Using substances to regulate mood
Self-harming to manage negative feelings
These strategies preserve rumination and depressive mood.
MCT focuses on reducing rumination (along with other CAS strategies) by helping the patient relate differently to depressive thoughts. MCT also changes metacognitive beliefs about rumination.
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