Syftet med den föreliggande studien var att undersöka rollen av prestationsångest och ältande mellan dispositionell mindfulness och självskattad prestation. Det var totalt 53 idrottare (22 kvinnor, 31 män; Målder = 29.32, SD = 12.28 år) från 18 olika idrotter som deltog i studien. Studien var av kvantitativ longitudinell design (tre tillfällen under en fyra veckors period) där den oberoende variabeln, den beroende variabeln och två möjliga mediatorer undersöktes med hjälp av Athletic Mindfulness Questionnaire, Sport Performance Questionnaire, Sport Anxiety Scale-2, och Rumination Reflection Questionnaire. Resultaten visade ingen signifikant indirekt effekt av dispositionell mindfulness på självskattad prestation genom varken ältande eller prestationsångest. Resultaten indikerar att ältande och prestationsångest inte medierar förhållandet mellan dispositionell mindfulness och självskattad prestation i det undersökta urvalet. Det diskuteras att mindfulness ändrar förhållandet idrottaren har med ångesten istället för att sänka den upplevda nivån av ångest. Forskning om ältande som en mediator mellan mindfulness och prestation diskuteras som sällsynt, vilket kan göra kunskapen om förhållandet otillräckligt för att göra några bestämda uttalanden. Resultaten bör tolkas med försiktighet med tanke på att undersökningen gjordes på en heterogen grupp av idrottare med en subjektiv mått av prestation. Vidare forskning bör fokusera på en bestämd grupp och använda mer objektiva mått på prestation, samt använda ett idrottsspecifik instrument för att mäta ältande. Nyckelord: prestationsångest, dispositionell mindfulness, idrottsprestation, idrottare / The purpose of this study was to examine the role of sport-trait anxiety and rumination in the relationship between dispositional mindfulness and self-assessed performance. A total of 53 athletes (22 women, 31 men; Mage = 29.32, SD = 12.28 years) from 18 different sports participated. A quantitative longitudinal design (three-time measures within a four-week period) was conducted wherein the independent and dependent variables, as well as the two potential mediators were measured using Athletic Mindfulness Questionnaire, Sport Performance Questionnaire, Sport Anxiety Scale-2, and Rumination Reflection Questionnaire. The results showed no significant indirect effect of dispositional mindfulness on self-assessed performance through neither sporttrait anxiety nor rumination. These findings indicate that sport-trait anxiety and rumination do not mediate the relationship between dispositional mindfulness and self-assessed performance in the examined sample. Mindfulness is discussed as altering the athlete’s relationship with anxiety rather than lowering the perceived levels of anxiety. Since research on rumination as a mediator between mindfulness and performance is very scarce, the knowledge about the relationship might be insufficient to make any decisive statements. Findings are to be taken with caution given the heterogeneous sample of athletes considered and the use of a subjective measure of performance. Further research should focus on a more targeted group and use a more objective performance measure, as well as a sport-specific rumination scale. Keywords: sport-specific anxiety, dispositional mindfulness, athletic performance, athlete

The purpose of this study was to examine the role of emotion regulation and rumination in the relationship between dispositional mindfulness and self-assessed performance. A total of 89 soccer players (72 male, 17 women; Mage = 28.75, SD =3.283 years) participated. A quantitative longitudinal design (three-time measures within a four-week period) was conducted where the independent and dependent variables, as well as the two potential mediators were measured using Rumination Reflection Questionnaire, Difficulties in Emotion Regulation Scale, Athlete Mindfulness Questionnaire and Sport Performance Questionnaire. The results showed a significant indirect effect of dispositional mindfulness on self-assessed performance through both emotion regulation and rumination. These findings indicate that emotion regulation and rumination mediate the relationship between dispositional mindfulness and self-assessed performance in the examined sample. Findings are to be taken with caution given the homogeneous sample of athletes considered and the use of a subjective measure of performance. Further research should focus on a more targeted group and use a more objective performance measure, as well as a sport specific rumination scale. / Syftet med den föreliggande studien var att undersöka rollen av emotionsreglering och ältande mellan dispositionell mindfulness and självskattad idrottsprestation. Totalt 89 fotbollsspelare (72 män, 17 kvinnor; Målder = 28.75, SD = 12.28 år) deltog i studien. Studien var av kvantitativ longitudinell design (tre mättillfällen under en fyra veckors period) där den oberoende variabeln, den beroende variabeln och två potentiella mediatorer undersöktes med hjälp av Rumination Reflection Questionnaire, Difficulties in Emotion Regulation Scale, Athlete Mindfulness Questionnaire och Sport Performance Questionnaire. Resultaten visade signifikant indirekt effekt av dispositionell mindfulness på självskattad idrottsprestation genom både ältande och emotionsreglering. Resultaten indikerar att ältande och emotionsreglering medierar förhållandet mellan dispositionell mindfulness och självskattad idrottsprestation i det undersökta urvalet. Det diskuteras att atleter med karaktärsdrag att vara medvetna dagligen är mer benägna att effektivt reglera deras negativa emotioner. Det diskuteras dessutom att atleter med en högre grad av ältande tankar har mer negativ idrottsprestation än atleter med lägre grad av ältande tankar. Resultaten bör tolkas med försiktighet med tanke på att undersökningen gjordes på en homogen grupp av fotbollsspelare med ett subjektivt mått av prestation. Framtida forskning bör fokusera på en mer bestämd grupp för att öka reliabiliteten och använda mer objektiva mått på prestation, samt använda ett idrottsspecifikt instrument för att mäta ältande.

Using action orientation after failure as a measure of individual differences in emotion regulation abilities (ERA), this thesis’ studies investigated the impact of ERA on cognition, behavior, and own versus imposed goals differentiation. The first study used cortisol as a physiological stress marker to replicate the link between ERA and the ability to make intuitive judgments under stress. High ERA were associated with increased performance in an intuition task under stress. In contrast, when feeling no stress, low ERA were associated with increased performance in an intuition task. The second study showed that ERA can compensate for depression-associated biased processing of negative stimuli. This effect was present even at mild to moderate depression levels. Replicating earlier findings, the third study showed that ERA are associated with an increased ability to distinguish self-chosen from imposed goals. Most importantly, the study identified activation in the right medial prefrontal cortex as a neural correlate of identifying self-chosen goals, and activation in the anterior cingulate cortex, as a correlate of falsely identifying imposed goals as self-chosen ones. Altogether, these studies show the necessity to consider individual differences in ERA in stress, clinical, and motivational research. The findings are discussed with respect to three theories that relate to motivation and personality from behavioral and neurobiological perspectives, namely, Personality Systems Interaction Theory, Predictive and Reactive Control Systems Theory, and Self-Determination Theory.

No description available.

No description available.

[pt] A ruminação é um tipo de pensamento repetitivo, caracterizado pelo foco nos sintomas e nas suas possíveis consequências. Esse padrão de pensamento se relaciona com diversas consequências danosas para a vida do sujeito. Considerando a relevância desses prejuízos, o objetivo desta dissertação foi investigar esse construto em relação com outras variáveis, e avaliar as formas de tratamento que já estão sendo utilizadas para diminuir os pensamentos ruminativos. Para isso, foi feita uma pesquisa empírica que avaliou o papel preditor da ruminação na agressividade, em vítimas de maus-tratos infantis. O artigo 1 descreve essa pesquisa, e os resultados apontam a ocorrência de maus-tratos infantis como preditores da ruminação e da agressividade na idade adulta, enquanto a ruminação também aparece como um preditor da agressividade. Esses dados evidenciam o impacto negativo da ruminação, o que indica a necessidade de intervenções capazes de diminuir esses pensamentos. Nesse contexto, o artigo 2 compreendeu uma revisão sistemática e uma metanálise com estudos clínicos randomizados que avaliaram intervenções psicológicas para diminuir a ruminação em uma amostra de crianças e adolescentes. Os resultados indicam, no geral, a eficácia das intervenções, mas apontam algumas limitações. Assim sendo, trabalhos futuros devem buscar aprimorar os protocolos de tratamentos focados na ruminação. / [en] Rumination is a type of repetitive thinking, characterized by a focus on symptoms and their possible consequences. This pattern of thinking is related to several harmful consequences for the individual s life. Considering the relevance of these impairments, the aim of this dissertation was to investigate this construct in relation to other variables, and to evaluate the forms of treatment that are already being used to reduce ruminative thoughts. To this en aggressiveness in victims of child maltreatment. Article 1 describes this research, and the results point to the occurrence of child maltreatment as predictors of rumination and aggression in adulthood, while rumination also appears as a predictor of aggressiveness. These data show the negative impact of rumination, which indicates the need for interventions capable of reducing these thoughts. In this context, article 2 comprised a systematic review and a meta-analysis with randomized clinical trials that assessed psychological interventions to reduce rumination in a sample of children and adolescents. The results indicate, in general, the effectiveness of the interventions, but point out some limitations. Therefore, future studies should seek to improve treatment protocols focused on rumination.

Submitted by Caroline Xavier (caroline.xavier@pucrs.br) on 2017-06-30T17:24:36Z No. of bitstreams: 1 DIS_JULIA_LUIZA_SCHAFER_PARCIAL.pdf: 1950516 bytes, checksum: d087e3b380f5026a78af786f693a37b3 (MD5) / Made available in DSpace on 2017-06-30T17:24:36Z (GMT). No. of bitstreams: 1 DIS_JULIA_LUIZA_SCHAFER_PARCIAL.pdf: 1950516 bytes, checksum: d087e3b380f5026a78af786f693a37b3 (MD5) Previous issue date: 2017-03-08 / Conselho Nacional de Pesquisa e Desenvolvimento Cient?fico e Tecnol?gico - CNPq / Introdu??o: A literatura sugere que respostas emocionais est?o associadas ao desenvolvimento e manuten??o de sintomas do Transtorno de Estresse P?s-Traum?tico (TEPT). A capacidade de influenciar a experi?ncia e express?o emocional, conhecida como regula??o emocional (RE), pode ser cr?tica ao lidar com n?veis significativos de estresse. Especificamente, a RE atrav?s de cogni??es, ou pensamentos (ou seja, Regula??o Emocional Cognitiva, REC), ajuda os indiv?duos a manter o controle sobre sua experi?ncia emocional durante, ou depois de serem expostos a eventos estressores, ou traum?ticos. O Question?rio de Regula??o Emocional Cognitiva (CERQ), foi desenvolvido para medir nove diferentes estrat?gias de REC que se referem ? maneira consciente e atencional de lidar com eventos de vida amea?adores, ou negativos. Objetivos: Os objetivos gerais desta disserta??o foram desenvolver e investigar as evid?ncias de validade da vers?o brasileira do CERQ (Estudo 1) e investigar a rela??o entre a exposi??o a traumas, estrat?gias cognitivas de RE, afeto e Sintomas de Estresse P?s-Traum?tico (SEPT) atrav?s de um modelo de media??o dupla (Estudo 2). M?todo: Uma amostra de 445 estudantes universit?rios completou um Question?rio S?cio-Demogr?fico, a Life of Events Checklist (LEC-5), a vers?o brasileira do CERQ, a Positive and Negative Affect Schedule (PANAS) e a Posttraumatic Symptoms Checklist (PCL-5) em uma plataforma de pesquisa on-line. Para o Estudo 1, o processo de adapta??o da vers?o brasileira do CERQ incluiu tradu??o, retro-tradu??o, avalia??o de ju?zes e teste em 30 participantes da popula??o-alvo. As evid?ncias de validade de construto foram avaliadas atrav?s de an?lise fatorial confirmat?ria, da consist?ncia interna atrav?s dos alfas de Cronbach e de correla??es com as vari?veis afetivas mensuradas pelo PANAS. Para o Estudo 2 foram realizadas an?lises preliminares de correla??o e de regress?o linear m?ltipla para investigar associa??es entre tipo de trauma, estrat?gias cognitivas de regula??o emocional, afeto e severidade de SEPT. Em seguida, um modelo com rumina??o e afeto negativo como mediadores do efeito da exposi??o ao trauma les?o moral causada por outros sobre os SEPT foi testado usando o macro PROCESS para o SPSS. Resultados: As an?lises de validade mostraram que a estrutura original do CERQ possui boa validade fatorial na amostra e alta confiabilidade, com ? de Cronbach variando entre .71 e .88. An?lises preliminares de associa??o entre tipo de trauma, estrat?gias de regula??o emocional cognitiva, afeto e SEPT mostraram que o tipo de trauma de les?o moral causada por outros, rumina??o e afeto negativo s?o preditores significativos da gravidade de SEPT. Ao testar o modelo de media??o dupla, os resultados sugerem que a rumina??o ? um mediador forte e independente entre o tipo de trauma de les?o moral causada por outros e SEPT, enquanto afeto negativo ? um mediador apenas quando a rumina??o est? presente no modelo. Discuss?o: Nossos resultados indicam que a vers?o brasileira do CERQ ? uma ferramenta v?lida e confi?vel para avaliar as estrat?gias cognitivas de regula??o emocional e que os indiv?duos expostos ao tipo de trauma de les?o moral causada pelos outros utilizam rumina??o como uma estrat?gia de regula??o emocional cognitiva com mais frequ?ncia. O uso aumentado dessa estrat?gia amplifica os n?veis de afeto negativo que acaba levando a n?veis mais elevados de SEPT. Em geral, esses resultados podem influenciar pesquisas e auxiliar no desenvolvimento e melhoria de interven??es cognitivas para indiv?duos expostos a eventos traum?ticos. / Background: Literature suggests that emotional responses are associated to the development and maintenance of Posttraumatic Stress Disorder (PTSD) symptoms. The ability to influence emotional experience and expression, known as emotion regulation (ER), can be critical when dealing with significant levels of stress. Specifically, ER through cognitions, or thoughts (i.e. Cognitive Emotion Regulation; CER), helps individuals to maintain control over their emotional experience during, or after being exposed to stressful, or traumatic events. The Cognitive Emotion Regulation Questionnaire (CERQ) was developed to measure nine different CER strategies that refer to the conscious and attentional way people deal with threatening, or negative life events. Objectives: Therefore, the general purposes of this thesis were to develop and evaluate validity evidences of the Brazilian version of the CERQ (Study 1) and to investigate the relationship between trauma exposure, cognitive emotion regulation strategies, affect and Posttraumatic Stress Symptoms (PTSS) testing for a double mediation model (Study2). Method: A sample of 445 university students completed a Socio-Demographic Questionnaire, the Life of Events Checklist (LEC-5), the Brazilian version of the CERQ, the Positive and Negative Affect Schedule (PANAS) and the Posttraumatic Symptoms Checklist (PCL-5) on an on-line research platform. For Study 1, adaptation process of the Brazilian version of the CERQ included translation, backtranslation, expert committee?s evaluation, and testing on 30 participants from the target population. Validity evidence was assessed through confirmatory factor analysis, internal consistency through the Cronbach?s alpha analysis, and correlations with the affective variables measured by the PANAS. For Study 2, preliminary correlation and multiple linear regression analyses were conducted to investigate associations among trauma type exposure, cognitive emotion regulation strategies, affect and PTSS severity. Next, a model positing rumination and negative affect as double mediators of the effect of trauma type of moral injury by others on PTSS was tested using the PROCESS macro for SPSS. Results: Validity analyses showed that the original structure of the CERQ has good factorial validity in the sample and high reliabilities, with Cronbach?s ? ranging between .71 and .88. Preliminary analyses of the association among trauma type, cognitive emotion regulation strategies, affect and PTSS showed that trauma type of moral injury, rumination and negative affect were significant predictors of PTSS severity. When testing for the double mediation model, results suggested that rumination is a strong and independent mediator between trauma type moral injury by others and PTSS, while negative affect is a mediator only when rumination is also included. Discussion: Our results indicate that the Brazilian version of the CERQ is a valid and reliable tool for assessing cognitive emotion regulation strategies, and that individuals who are exposed to trauma type of moral injury by others engage more frequently in rumination as a cognitive emotion regulation strategy, which in turn amplifies levels of negative effect that ends up leading to higher levels of PTSS. Overall, these results can influence further researches and aid the development and improvement of cognitive treatment interventions for individuals exposed to traumatic events.

Introdução: Ruminação é a perseveração mal-adaptativa de pensamentos auto-centrados. Evidências sinalizam que ela está associada com início e manutenção de episódios depressivos, e ocorre em múltiplos transtornos mentais. A ruminação está associada com marcadores de desenvolvimento psicopatológico, como volumetria cerebral, memória, genes do BDNF e serotonina. É necessário aprofundar o conhecimento da ruminação enquanto traço dimensional, e conhecer melhor sua associação com variáveis sóciodemográficas, biológicas e clínicas para entender quando passa a ser um sintoma. Entretanto, aferi-la é um desafio, considerando que só existem escalas psicométricas. A mais utilizada, Ruminative Response Scale (RRS), foi validada em amostras não-clínicas. Objetivos: Avaliar ruminação transdiagnosticamente e determinar a validade de constructo da RRS em amostra clínica, buscando determinar fatores sócio-demográficos, clínicos e neurobiológicos associados a maiores escores de ruminação. Métodos: Estudo transversal, amostra não-probabilística. Foram convidados a participar 944 pacientes em atendimento psiquiátrico ambulatorial no HCPA entre março/2015 e junho/2016, maiores de 18 anos, que soubessem ler e escrever, e portadores de transtornos bipolares, depressão, esquizofrenia, esquizoafetivo, ansiedade generalizada, pânico, fobia específica e obsessivocompulsivo. Foram excluídos 373 com doenças que alteram resposta inflamatória, dependência química, gravidez, lactação, doenças neurológicas, vasculares e degenerativas. Recusaram-se a participar 254. Foram incluídos 317 pacientes, e 200 completaram a coleta de dados, que foi realizada em 4 etapas: 1) perfil sócio-demográfico e escalas auto-aplicáveis: ruminação, preocupação e funcionalidade; 2) amostras de sangue e entrevista clínica para aplicação das escalas de sintomas: depressão, mania, ansiedade e gravidade; 3) confirmação diagnóstica; e 4) processamento, armazenamento e análises bioquímicas das amostras de sangue. No primeiro artigo, revisamos sistematicamente a literatura sobre ruminação nos transtornos bipolares. No segundo, determinamos as validades de construto e externa da RRS. No terceiro, usamos machine learning para encontrar padrões de ruminação e determinar quais variáveis associadas preveem ruminação. Resultados: Ruminação está presente em todas as fases do transtorno bipolar, e é um sintoma estável independente do estado de humor, apesar de ter relação estreia com ele. Verificou-se também que mulheres ruminam mais que homens. Os escores de ruminação foram menores nos portadores de esquizofrenia que nos com depressão maior, bipolaridade e ansiedade. RRS apresentou boa confiabilidade, com 2-fatores correlacionados, brooding e ponderação, que apresentaram similaridade nas correlações com medidas clínicas, confirmando a validade externa transdiagnóstica. Por fim, encontrou-se que as variáveis associadas aos pacientes que mais ruminam são preocupação, sintomas de ansiedade generalizada e depressão, gravidade, nível socioeconômico e diagnóstico atual de pânico, sinalizando que ruminação pode ser um marcador de maior sensibilidade à ansiedade. Discussão: Ruminação parece ser um sintoma transdiagnóstico marcador de sofrimento. Os resultados desta tese contribuem para ampliar a discussão sobre diagnóstico psiquiátrico, agregando evidências para aprimorar as definições de limites e sobreposições diagnósticas entre as doenças mentais em que a ruminação ocorre. Por fim, conhecer melhor os mecanismos bioquímicos e clínicos envolvidos na ruminação contribuem na compreensão sobre quando ela deixa de ser um traço normal e vira um sintoma que necessita de tratamento. / Introduction: Rumination has been described as maladaptive perseveration of self-centered thoughts. Evidence indicates that rumination is associated with onset and maintenance of depressive episodes, it’s present in several mental disorders. Rumination is associated with markers of development of psychopathology, such as cerebral volumetry, memory, BDNF and serotonin genes. Measuring rumination is a challenge, considering that are available only psychometric scales. The most used, the Ruminative Responses Scale (RRS), was validated on non-clinical samples. Objectives: To evaluate transdiagnostically the rumination and to determine construct validity of the RRS in outpatients, in order to determine which associated factors lead the patients to ruminate. Methods: Cross-sectional study, non-probabilistic sample. A total of 944 patients in psychiatric outpatient treatment at HCPA between March / 2015 and June / 2016, major than 18 years old, knowing read and write, presenting bipolar disorder, schizophrenia, schizoaffective disorder, generalized anxiety disorder, panic disorder, phobia specific and obsessive-compulsive disorder were invited to participate. We excluded 373 patients with diseases that alter inflammatory response, chemical dependence, pregnancy, lactation, neurological, vascular and degenerative diseases. Two hundred fifty four refused to participate, 317 were included, and 200 completed the data collection, which was performed in 4 stages: 1) socio-demographic profile and self-applicable scales: rumination, worry and functionality; 2) blood samples and clinical interview for the application of symptom scales: depression, mania, anxiety and severity; 3) diagnostic confirmation; and 4) processing, storage and biochemical analyzes of blood samples. In the first article, we systematically reviewed the literature on rumination in bipolar disorders. In the second, we evaluated construct and external validity of RRS. In the third, we used machine learning algorithms to find patterns of rumination and to determine which associated variables predict rumination. Results: Rumination is present in all phases of bipolar disorder, it is a stable symptom, independent of mood, despite it has close relationship with it. It has also been found that women ruminate more than men. Rumination scores were lower in patients with schizophrenia than in major depression, bipolarity and anxiety patients. RRS presented good reliability, with correlated 2-factors, brooding and pondering, which presented similar correlations with clinical measures, confirming the external transdiagnostic validity. Finally, it was found that the variables associated with the greater scores of rumination are worry, symptoms of generalized anxiety and depression, severity of symptoms, socioeconomic level and current diagnosis of panic, signaling that rumination may be a marker of greater sensitivity to anxiety. Discussion: Rumination seems to be a transdiagnostic symptom of suffering. The results of this thesis contribute to broadening the discussion about psychiatric diagnostic, adding evidence to improve the definitions of limits and diagnostic overlaps between mental illnesses in which rumination occurs. Finally, a better understanding of the biochemical and clinical mechanisms involved in rumination may contribute to understanding of when rumination ceases to be a normal trait and becomes a symptom that requires treatment.

過去的研究顯示，反芻為憂鬱的危險因子，對憂鬱的發展與維持扮演重要的角色。然而，並不是所有反芻型態都會對個體帶來不利的影響。Treynor, Gonzalez與Nolen-Hoeksema（2003）從反芻反應風格量表中抽取出兩個因素結構：苦惱自責式反芻與深思反省式反芻。苦惱自責式反芻能正向預測憂鬱症狀，而深思反省式則是負向預測憂鬱症狀，為較具適應性的反芻型態。然而，過去文獻在深思反省式反芻上未能獲得一致的結論，可能與研究方法及受到苦惱自責式反芻污染的影響。為釐清深思反省式反芻對乳癌患者而言是否具適應性，本研究欲探討兩類反芻與憂鬱之關聯性，並在控制初始的憂鬱症狀後，檢驗兩類反芻對一年後憂鬱症狀的預測力，最後修正Takano與Tanno（2009）的模型探索兩類反芻之路徑關係如何影響憂鬱。 　　本研究以立意取樣的方式，追蹤283名乳癌患者，分別於受術後一年（T1）與手術後兩年（T2）進行問卷評量。每位參與者皆需完成知情同意書、背景資料、短版反芻反應風格量表、醫院憂鬱量表。根據研究目的，以相關分析、階層迴歸分析與路徑分析進行假設考驗。 　　研究結果顯示，苦惱自責式反芻、深思反省式反芻與憂鬱具有同時的正向關聯性。然而，在控制時間點一的憂鬱症狀後，深思反省式反芻則會預測一年後較低的憂鬱症狀，顯示其會帶來適應性的結果，與Treynor, Gonzalez與Nolen-Hoe ksema（2003）的研究結果一致。路徑分析結果發現，苦惱自責式反芻能預測一年後較低的深思反省式反芻與增加憂鬱症狀，但能同時增加深思反省式反芻；深思反省式反芻則能抑制苦惱自責式反芻，無法預測憂鬱症狀。 　　本研究發現與過去研究結果一致，在乳癌患者樣本上亦能發現兩類反芻具有不同的適應性功能，尤其深思反省式反芻可能透過抑制苦惱自責式反芻來降低一年後的憂鬱症狀，進一步支持反芻反應風格應區分為兩構念進行探討。建議在臨床上可針對乳癌患者進行反芻反應篩檢，以協助判斷患者在憂鬱症狀之預後，並針對高自責式反芻的患者進行心理介入。 / Literature review has shown that rumination is one of risk factors of depression. It plays a crucial rule of developing and sustaining depressive symptoms. However, the different types of rumination may not all lead to depression. Treynor, Gonzalez and Nolen-Hoeksema (2003) have extracted two factors from Ruminative Respon -ses Scale, brooding and reflective pondering. In their study, brooding positively pre -dicts depressive symptoms, but reflective pondering negatively predicts depressive symptoms, depicting that reflective pondering is an adaptive repetitive thinking. Yet, past studies haven’t reached a consensus on reflective pondering. It is probably due to research method and not taking the contamination of brooding into account. For clarifying the possible adaptive characteristic of reflective pondering, the present study examines the relationship between reflective pondering and depression. Furthermore, after controlling T1 depression, the present study explores the prediction of rumination to T2 depression. Last, we examine the predictive paths between brooding and reflective pondering to depression. 　　Patients were eligible if they have been diagnosed with breast cancer. We survey 283 patients after they had completed operation for a year, and follow-up at one year later. All patients complete the informed consent, the demographic survey, the short version of Ruminative Responses Scale, the Hospital Depression Scale. Analysis are conducted using Pearson correlation analysis, multiple regression analysis and path analysis. 　　The result revealed that brooding and reflective pondering are positively related to depression at T1. However, after controlling T1 depression, reflective pondering negatively predicted T2 depression. This result indicates that reflective pondering may be an adaptive form of rumination, matched the result of Treynor, Gonzalez and Nolen-Hoeksema (2003). In the result of path analysis, we also found brooding predicts less reflective pondering and more depression after one year, but it concurrently predicts more reflective pondering. On the other hand, reflective pondering predicts less brooding and has no significant impact on depression. The present study supports the finding of Treynor, Gonzalez and Nolen-Hoeksema (2003). In patients with breast cancer, reflective pondering negatively predicts depressive symptoms through reducing brooding. Brooding and reflective pondering are different forms of rumination, the former is more maladaptive and latter is adaptive. According to the study result, we suggest that clinicians screen for the high-brooder, and practice psychological interventions.

Introdução: Ruminação é a perseveração mal-adaptativa de pensamentos auto-centrados. Evidências sinalizam que ela está associada com início e manutenção de episódios depressivos, e ocorre em múltiplos transtornos mentais. A ruminação está associada com marcadores de desenvolvimento psicopatológico, como volumetria cerebral, memória, genes do BDNF e serotonina. É necessário aprofundar o conhecimento da ruminação enquanto traço dimensional, e conhecer melhor sua associação com variáveis sóciodemográficas, biológicas e clínicas para entender quando passa a ser um sintoma. Entretanto, aferi-la é um desafio, considerando que só existem escalas psicométricas. A mais utilizada, Ruminative Response Scale (RRS), foi validada em amostras não-clínicas. Objetivos: Avaliar ruminação transdiagnosticamente e determinar a validade de constructo da RRS em amostra clínica, buscando determinar fatores sócio-demográficos, clínicos e neurobiológicos associados a maiores escores de ruminação. Métodos: Estudo transversal, amostra não-probabilística. Foram convidados a participar 944 pacientes em atendimento psiquiátrico ambulatorial no HCPA entre março/2015 e junho/2016, maiores de 18 anos, que soubessem ler e escrever, e portadores de transtornos bipolares, depressão, esquizofrenia, esquizoafetivo, ansiedade generalizada, pânico, fobia específica e obsessivocompulsivo. Foram excluídos 373 com doenças que alteram resposta inflamatória, dependência química, gravidez, lactação, doenças neurológicas, vasculares e degenerativas. Recusaram-se a participar 254. Foram incluídos 317 pacientes, e 200 completaram a coleta de dados, que foi realizada em 4 etapas: 1) perfil sócio-demográfico e escalas auto-aplicáveis: ruminação, preocupação e funcionalidade; 2) amostras de sangue e entrevista clínica para aplicação das escalas de sintomas: depressão, mania, ansiedade e gravidade; 3) confirmação diagnóstica; e 4) processamento, armazenamento e análises bioquímicas das amostras de sangue. No primeiro artigo, revisamos sistematicamente a literatura sobre ruminação nos transtornos bipolares. No segundo, determinamos as validades de construto e externa da RRS. No terceiro, usamos machine learning para encontrar padrões de ruminação e determinar quais variáveis associadas preveem ruminação. Resultados: Ruminação está presente em todas as fases do transtorno bipolar, e é um sintoma estável independente do estado de humor, apesar de ter relação estreia com ele. Verificou-se também que mulheres ruminam mais que homens. Os escores de ruminação foram menores nos portadores de esquizofrenia que nos com depressão maior, bipolaridade e ansiedade. RRS apresentou boa confiabilidade, com 2-fatores correlacionados, brooding e ponderação, que apresentaram similaridade nas correlações com medidas clínicas, confirmando a validade externa transdiagnóstica. Por fim, encontrou-se que as variáveis associadas aos pacientes que mais ruminam são preocupação, sintomas de ansiedade generalizada e depressão, gravidade, nível socioeconômico e diagnóstico atual de pânico, sinalizando que ruminação pode ser um marcador de maior sensibilidade à ansiedade. Discussão: Ruminação parece ser um sintoma transdiagnóstico marcador de sofrimento. Os resultados desta tese contribuem para ampliar a discussão sobre diagnóstico psiquiátrico, agregando evidências para aprimorar as definições de limites e sobreposições diagnósticas entre as doenças mentais em que a ruminação ocorre. Por fim, conhecer melhor os mecanismos bioquímicos e clínicos envolvidos na ruminação contribuem na compreensão sobre quando ela deixa de ser um traço normal e vira um sintoma que necessita de tratamento. / Introduction: Rumination has been described as maladaptive perseveration of self-centered thoughts. Evidence indicates that rumination is associated with onset and maintenance of depressive episodes, it’s present in several mental disorders. Rumination is associated with markers of development of psychopathology, such as cerebral volumetry, memory, BDNF and serotonin genes. Measuring rumination is a challenge, considering that are available only psychometric scales. The most used, the Ruminative Responses Scale (RRS), was validated on non-clinical samples. Objectives: To evaluate transdiagnostically the rumination and to determine construct validity of the RRS in outpatients, in order to determine which associated factors lead the patients to ruminate. Methods: Cross-sectional study, non-probabilistic sample. A total of 944 patients in psychiatric outpatient treatment at HCPA between March / 2015 and June / 2016, major than 18 years old, knowing read and write, presenting bipolar disorder, schizophrenia, schizoaffective disorder, generalized anxiety disorder, panic disorder, phobia specific and obsessive-compulsive disorder were invited to participate. We excluded 373 patients with diseases that alter inflammatory response, chemical dependence, pregnancy, lactation, neurological, vascular and degenerative diseases. Two hundred fifty four refused to participate, 317 were included, and 200 completed the data collection, which was performed in 4 stages: 1) socio-demographic profile and self-applicable scales: rumination, worry and functionality; 2) blood samples and clinical interview for the application of symptom scales: depression, mania, anxiety and severity; 3) diagnostic confirmation; and 4) processing, storage and biochemical analyzes of blood samples. In the first article, we systematically reviewed the literature on rumination in bipolar disorders. In the second, we evaluated construct and external validity of RRS. In the third, we used machine learning algorithms to find patterns of rumination and to determine which associated variables predict rumination. Results: Rumination is present in all phases of bipolar disorder, it is a stable symptom, independent of mood, despite it has close relationship with it. It has also been found that women ruminate more than men. Rumination scores were lower in patients with schizophrenia than in major depression, bipolarity and anxiety patients. RRS presented good reliability, with correlated 2-factors, brooding and pondering, which presented similar correlations with clinical measures, confirming the external transdiagnostic validity. Finally, it was found that the variables associated with the greater scores of rumination are worry, symptoms of generalized anxiety and depression, severity of symptoms, socioeconomic level and current diagnosis of panic, signaling that rumination may be a marker of greater sensitivity to anxiety. Discussion: Rumination seems to be a transdiagnostic symptom of suffering. The results of this thesis contribute to broadening the discussion about psychiatric diagnostic, adding evidence to improve the definitions of limits and diagnostic overlaps between mental illnesses in which rumination occurs. Finally, a better understanding of the biochemical and clinical mechanisms involved in rumination may contribute to understanding of when rumination ceases to be a normal trait and becomes a symptom that requires treatment.