Worry is a mental activity in both clinical and non-clinical populations. Worry is a connection of thoughts and images, negatively affect-laden and relatively uncontrollable.Worry is a cardinal diagnostic feature of DSM-IV generalised anxiety disorder (GAD) and it is predominantly experienced in verbal rather than imaginal form. Normal and GAD worries differ little in their content, but people with GAD perceive them as subjectively less controllable and less successfully reduced by corrective attempts compared to normal worries.
The content of worrisome thinking is associated with a number of themes including health, social and intimate relationships, finances and work/academic performance. Certain people, particularly those with GAD, worry about worry itself.
Chronic worrying may be initiated by an involuntary intrusive thought. However, it can also be triggered and maintained in a volitional way on the basis of its perceived functions. Once triggered, chains of worrisome thinking involve 'What if . . . ?' type questions about anticipated threat or danger to oneself or others. For example, 'What if I fail my test?', 'What if I do not get a promotion?', and 'What if I become ill?'.
Although chronic worry is a clinical feature that characterises GAD, it is also a common cognitive process in other psychological disorders. People with panic disorder worry about the physical or mental catastrophic consequences of having a panic attack; those with social phobia worry about embarrassing or humiliating themselves in public; people with obsessive-compulsive disorder may worry about being contaminated by germs; those with post-traumatic stress disorder worry about re-experiencing the trauma; and people with anorexia nervosa worry about gaining weight. Therefore, chronic worry, although central to GAD, is also prevalent in other disorders as well as non-clinical populations.
Rumination is a relatively common response to negative moods and a salient cognitive feature of dysphoria and DSM-IV major depressive disorder. Although rumination may be symptomatic of dysphoria or clinical depression, it may also be perceived as serving a function. The content of rumination is experienced in both verbal and imaginal form and it is similar in depressed and non-depressed people. The content of ruminative thinking involves themes about past personal loss and failure. Like worry, rumination may also be activated initially as a response to an intrusive thought, and it can be perpetuated depending on its perceived functions.
Chains of ruminative thought are characterised by 'Why' type questions. For example, 'Why did it happen to me?', 'Why do I feel so depressed?', and 'Why don't I feel like doing anything?'. Rumination refers to several types of recurrent thinking or the entire class of thought that has a tendency to recur. Clearly, this view of rumination is also intimately linked to worry but it could form the basis for a non-specific framework for understanding different varieties of perseverative thinking, albeit negative or positive in content.
The response styles theory of depression (Nolen-Hoeksema, 1991) views rumination as repetitive and passive thinking about symptoms of depression and the possible causes and consequences of these symptoms. According to this theory, rumination consists of 'repetitively focusing on the fact that one is depressed; on one's symptoms of depression; and on the causes, meanings, and consequences of depressive symptoms'.
The concept of stress-reactive rumination was developed in order to refer to the tendency to ruminate on negative inferences following stressful life events. Stress-reactive rumination is thought to occur prior to the onset of depressed mood, whereas emotion-focused rumination is thought to occur in response to depressed mood. Stress-reactive rumination has been shown to play a key role in depression.
The interaction between negative cognitive styles and stress-reactive rumination predicted the retrospective lifetime rate of major depressive episodes as well as hopelessness depressive episodes. The same interaction predicted the prospective onset, number and duration of both major depressive and hopelessness depressive episodes.
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