This is called the cognitive attentional syndrome (CAS), and includes cognitive processes such as persistent worry and rumination, focussing of attention on threat, and maladaptive coping strategies (e.g. avoidance or thought suppression).
Depression patients often suffer from rumination and persistent thoughts associated with decreased hippocampal volume [ 115], disturbed activation of the mPFC [ 116], and disconnection of the cognitive control network involving the hippocampus and PFC [ 117].
In responding to distressing events, they may experience empathic distress fatigue, compassion fatigue, stress, burnout, and self-criticism, which in turn can alter their ability to provide compassion to both self and others, and can create persistent self-criticism and negative rumination.
The absence of any direct effect of the Negative Beliefs About Worry subscale on depression may reflect the wording of this measure, which focuses specifically on beliefs about worry as opposed to other forms of persistent thinking (i.e., rumination) that are more closely associated with depression.
Whilst diverging views on the construction of rumination abound, it represents persistent, cyclical often depressive thinking [ 40], and it has been documented as an important cognitive element of affective disorders [ 41- 44].
The theory proposes that individuals have dispositional differences in the way they react to negative mood states and those who respond to a depressed mood by consistently engaging in rumination tend to have more persistent and severe depressive episodes.
Pain unpleasantness endured over time engages prefrontal cortical areas involved in reflection and rumination over the future implications of a persistent pain condition [95].
Pain unpleasantness endured over time engages prefrontal cortical areas involved in reflection and rumination over the future implications of a persistent pain condition [ 95].
Brain scans of people with persistent high-functioning depression also show that regions associated with inward thinking or rumination are hyperactive.
In the latter study [ 9], rumination was highly correlated with depressive symptoms, and rumination predicted a persistent as opposed to a remitting major depressive episode, but not a remitting episode compared to no episode, when depressive symptoms were controlled for [ 10].
