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.

No description available.

The mood-as-input hypothesis was developed to explain perseverative worry. Based on this model, it is predicted that the amount of time individuals persist on tasks is based on their mood, and this hypothesis may explain the tendency for some individuals to engage in prolonged episodes of depressive rumination. However, surprisingly few studies have examined the applicability of the hypothesis to depressive rumination. Based on the mood-as-input hypothesis, it was predicted that persistence at a rumination task would be greatest in a "sad mood" condition paired with an "as many as can" (AMA) stop rule because individuals with depression have a difficult time assessing when to disengage from the rumination process. Participants were randomly assigned to one of three mood conditions (positive, negative, or neutral) through the use of movie clips from the Lion King and one of two stop rules conditions (as many as can or feel like stopping). Participants then completed the Catastrophic Interview Procedure (CIP), in which they were asked to recall a situation or event in their life that is associated with a depressed mood. More steps are indicative of greater rumination. Contrary to previous literature on the topic, there was no significant interaction between mood and stop rules on depressive steps; however the current study was the first to identify rumination as a predictor of variance after controlling for mood and stop rules indicating that the natural tendency to engage in rumination is an additional relevant variable in a basic perseveration task.

Les amis peuvent compter l'un sur l'autre lorsqu'ils sont confrontés à des problèmes, mais certaines discussions peuvent conduire à la co-rumination. La co-rumination apparaît tôt dans la vie et a été associée à diverses formes de symptômes anxieux et/ou à des désordres cliniques d’anxiété. Toutefois, peu d’études ont exploré l'association entre la co-rumination et les formes d'anxiété normative incluant l'anxiété d'état, de trait, de performance et la sensibilité à l'anxiété. Ce mémoire examine la relation entre la co-rumination et ces formes d'anxiété normative en tenant compte du sexe et de l'âge. Au total, 1204 enfants (âgés de 11 à 12 ans) et adolescents (âgés de 16 à 17 ans) ont été recrutés dans des écoles primaires et secondaires du Québec. Ils ont rempli des questionnaires mesurant la co-rumination et les quatre formes d'anxiété normative dans leurs classes. Les résultats ont révélé que la co-rumination était associée à une seule forme d'anxiété normative (sensibilité à l'anxiété) chez les enfants et à trois formes (trait, performance et sensibilité à l'anxiété) chez les adolescents. Ainsi, la co-rumination semble associée différemment à certaines formes d'anxiété normative en raison de facteurs développementaux. De futures études confirmatoires et longitudinales devraient examiner les hypothèses générées par les résultats de cette étude exploratoire. Au-delà des implications discutées dans l'article, ce mémoire présente des pistes de recherche potentielles et des considérations pour de futures études portant sur la relation entre la co-rumination et les différentes formes d'anxiété normative. / Friends can rely on each other when faced with problems, though these discussions may lead to co-rumination. Co-rumination occurs early in life and has been associated with various forms of anxiety symptoms and/or clinical anxiety disorders. However, a scarcity of literature has explored the association between co-rumination and forms of normative anxiety, including state anxiety, trait anxiety, test anxiety, and anxiety sensitivity. This thesis examined the relationship between co-rumination and these forms of normative anxiety while considering sex and age. In total, 1204 children (ages 11 to 12) and adolescents (ages 16 to 17) were recruited from elementary and high schools in Quebec. Participants completed questionnaires measuring co-rumination and the four forms of normative anxiety in their classrooms. The results revealed that co-rumination was associated with one form of normative anxiety (anxiety sensitivity) in children and three forms (trait anxiety, test anxiety, and anxiety sensitivity) in adolescents. Thus, co-rumination may be differentially associated with various forms of normative anxiety due to certain developmental factors. Future longitudinal confirmatory studies should test the hypotheses generated from the findings of this exploratory study. Beyond the implications discussed in the article, this thesis features potential research avenues and considerations for future studies investigating the relationship between co-rumination and different forms of normative anxiety.

Si, lors d’une provocation, un individu ne réagit pas, il peut dans certains cas déplacer sa réaction agressive sur une autre personne, parfois plusieurs heures après cette provocation initiale. Certaines études ont identifié des caractéristiques spécifiques au processus d’agression déplacée. L’individu provoqué va ruminer entre la provocation initiale et l’agression qu’il va commettre. Il va ruminer sur la provocation ou sur lui-même. Il va ressentir de la honte, de la colère. Au moment où il va agresser sa victime, il sera dans un état émotionnel négatif élevé. Le but de cette thèse, composée de deux articles empiriques, était de démontrer les liens entre la honte, la colère et l’impulsivité dans la relation entre les ruminations centrées sur la provocation ou celles centrées sur soi et les comportements agressifs déplacés, au sein d’une population francophone. Le premier article présente les résultats de l’étude de validation d’une version française de l’unique instrument de mesure qui permette d’évaluer certaines caractéristiques individuelles associées à l’agression déplacée. Les analyses réalisées sur les données recueillies auprès de 191 adultes francophones suggèrent que cette version en langue française présente des bonnes qualités psychométriques et une structure en trois composantes similaires à celles de l’instrument de référence. Validé, il peut être utilisé et a été inclus dans l’étude du deuxième article. Les résultats de l’étude présentés dans le deuxième article soulignent les différences qui existent dans la relation entre le blâme d’autrui et le blâme de soi et les comportements agressifs déplacées selon que les ruminations sont centrées sur la provocation ou sur soi. En effet, des modèles de médiation en série suggèrent des effets spécifiques de la honte et de la colère au sein de chacune ces relations. Les résultats révèlent aussi que l’Urgence négative, la dimension de l’impulsivité qui réfère plus spécifiquement aux gestes posés dans un contexte émotionnel négatif intense, complète ces modèles de médiation en série. L’effet de la colère sur les comportements agressifs serait en partie expliqué par son effet indirect via l’urgence négative. Cette thèse permet de fournir un instrument de mesure du trait d’agression déplacée en langue française. Elle permet aussi de souligner la complexité des liens entres les ruminations, le blâme de soi et d’autrui, la colère, la honte, l’impulsivité et les comportements d’agression déplacée. Elle offre des pistes de réflexions sur les implications que ces résultats peuvent avoir au niveau théorique et empirique. De nouvelles études au devis expérimental seront nécessaires pour confirmer les voies causales que les modèles testés impliquent. / If, once provoked a person has not reacted, they can, in specific situations, displace their aggressive reaction to another person, sometimes several hours after the initial provocation. Some studies have identified specific features to the displaced aggression process. The person will ruminate between the provocation and the forthcoming aggression. They will ruminate about the provocation or about themselves. They will be feeling angry, ashamed. At the time they will be aggressive towards their victim their negative emotional state will be elevated. The aim of the following dissertation was to examine the roles of rumination, shame, anger and impulsivity in the relationship between self-centered rumination or rumination focused on provocation and displaced aggressive behaviors. The dissertation is composed of two articles presenting the studies’ results that were conducted within a French speaking population. The first article presents the results of the validation study of the French version of the only instrument that assesses personality differences in the tendency to displace aggression. Sample was composed of 191 adults. Analyses have suggested this French version of the questionnaire has good psychometric qualities and its three-dimension structure is similar to the structure of the original scale. Based on the validation results, this French questionnaire can be used and was included in the second study In the second article the results highlight the differences in the relationship between others or self-blame and displaced aggression behaviors whether provocation-centered rumination or self-centered rumination is concerned. Serial mediation models would suggest unique effects from anger and shame in each of these relationships (others or self-blame and aggressive behaviors). Results show negative Urgency (the tendency to act rashly when experiencing extremely negative emotion) can improve these serial mediation models. Indeed, anger effect on displaced aggressive behaviors would be partially explained by its indirect effect trough negative Urgency. This dissertation provides a French version of an instrument that assesses trait displaced aggression. It highlights the complex relationships between rumination, anger, shame, negative Urgency and displaced aggressive behaviors. Implications are discussed. As serial mediation models imply causal roles for shame and anger, further studies appear necessary to confirm these roles.

研究目的：在現今高壓力與忙碌的社會中，失眠是很常見的問題。在國外的失眠的相關調查結果顯示，失眠的盛行率會受對於失眠定義之嚴謹程度影響，而有大範圍的變異，其範圍約落在6~48%。當定義符合臨床上之診斷標準時，失眠盛行率約降至6~15%。因此，受失眠之苦的個體中，有一大部分可能未達診斷標準，而為暫時性或急性失眠之患者。然而過去的研究大多將重點聚焦在符合失眠疾患診斷的失眠族群上，針對剩下雖未符合失眠疾患診斷標準，但又飽受失眠症狀困擾之群體，卻是缺乏探討。此外，失眠的縱貫研究中也發現，暫時性失眠個體到最後會有一部份會發展成為慢性失眠。因此，針對這群為數不少，且容易經歷暫時性失眠之個體，若能更加了解其暫時性失眠發生的成因與相關機制，便能及早介入，協助個體不落入慢性失眠的惡性循環中。過去研究發現，暫時性失眠的發生，最常見的促發因素為壓力事件。Drake、Richardson、Roehrs、Scofield與Roth（2004）便發展出福特壓力失眠反應量表（Ford Insomnia Response to Stress Test, FIRST）來測量個體特質上遭遇壓力情境的睡眠脆弱程度；且研究結果也發現個體身心激發程度是和睡眠脆弱特質息息相關的因素之一。由於過去在失眠的相關研究中，少有研究探討暫時性失眠的相關機制，因此，本研究從和暫時性失眠相關的壓力下睡眠脆弱特質出發，探討此脆弱特質與過度激發的關聯性，並欲探討其他會提升激發程度的相關認知與情緒因子，如：失功能信念、情緒反應性、反芻特質、情緒遲惰特質和此特質間的關係。本研究假設個體對於睡眠的失功能信念與對負向事件的情緒反應性可能會透過提高睡前身心的激發程度，而使個體容易經歷壓力下的急性失眠，增加睡眠的脆弱性；即睡前身心激發程度在睡眠的失功能信念與情緒反應性對睡眠脆弱性的關係間扮演一中介作用之角色。另外，也假設睡眠的失功能信念與情緒反應性與睡前身心激發程度間的關係，會分別受反芻特質與情緒遲惰特質調節，即具有高反芻特質與高情緒遲惰特質者，其睡眠的失功能信念與情緒反應性與睡前身心激發程度間的關係更強烈，因此在壓力下，其有較高的睡眠脆弱性，容易經歷暫時性失眠。 研究方法：本研究於大學中招募60位20~35歲之受試者（男：22位；女：38位），經晤談以確認受試者符合收案標準後，將請受試者填寫研究相關問卷（包含：壓力下失眠反應量表、反芻型反應風格短版量表、睡前激發程度量表、睡眠失功能信念及態度簡式量表、情緒反應量表、失眠嚴重度量表、貝克憂鬱量表第二版與貝克焦慮量表）；並在詳細解釋情緒經驗取樣流程後，請受試者回到日常生活環境中進行連續三天的情緒遲惰經驗取樣紀錄。 研究結果：根據執行檢驗中介效果步驟的階層迴歸與Sobel test的分析結果，睡前認知激發程度對擔憂的失功能信念與情緒持續性和睡眠脆弱性間的關係具中介的作用；即對睡眠有過度擔憂的失功能信念、情緒持續性較久皆可能會提高睡前認知激發程度而增加壓力下的睡眠脆弱性。其他失功能信念之向度，如：知覺失眠造成的影響、對睡眠的期待、藥物使用，以及情緒反應性之其他向度，如：情緒敏感度與情緒激發度對睡前認知過度激發狀態無顯著的預測力。另外，根據執行檢驗調節效果步驟的階層迴歸分析結果，反芻特質與情緒遲惰特質分別在失功能信念與情緒反應性對認知激發程度的關係上，皆未有顯著的調節效果。 研究結論：研究結果部分支持身心激發程度為對睡眠的失功能信念與情緒反應性影響壓力下睡眠脆弱性的中介因子之假設。本研究發現過度擔憂睡眠的信念以及情緒持續度較久這兩個因子會分別獨立地提高睡前認知激發程度，顯示睡前認知激發程度分別受認知與情緒因素影響；且相較與睡前的生理激發狀態，睡前的認知激發對於壓力下的失眠反應之影響具有顯著的預測力，顯示認知激發在失眠的前置因子中可能扮演較重要的角色。另外，反芻特質與情緒遲惰特質分別在失功能信念與情緒反應性對認知激發程度的關係上，皆未有顯著的調節效果，此部份不符合研究預期。基於本研究結果，在臨床上對於容易經歷失眠之個體，若能及早調整對於睡眠的擔憂相關的信念，並學習有效調節情緒的方式，皆可有效降低個體睡前的認知激發活動，減少失眠的發生率與改善失眠症狀，避免使其落入失眠慢性化的惡性循環中。

Though a major illness in modern society, depression is still not completely understood. A number of empirical observations point to the importance of basic cognitive processes as well as personality variables as antecedents of a depressive disorder. In this work it is argued that “state orientation”, a personality style characterized by the inability to actively influence one’s focus of thought, plays an important role in the development of at least some forms of major depressive disorder. In the present work, it is suggested that (1) state-oriented cognitions are equivalent to sustained information processing, that (2) depressed individuals are characterized in particular by state-oriented cognitions related to prior failure experiences, that (3) sustained processing of affective information will interfere with normal executive cognitive functioning in depressed individuals resulting in impairments of normal behavior, and that (4) both sustained information processing and “affective interference” will be associated with specific dysfunctional patterns of brain activity in depressed individuals. In the first chapter of this thesis, theorizing pertaining to “action control” and the relationship between action control and state orientation are reviewed. After having established the potential functional significance of state-oriented cognitions, their possible link to depression is developed by introducing the “degenerated-intention hypothesis”. Afterwards, the role of state orientation in the advent of the depressive state is discussed against the background of the “functional helplessness” model of depression. Next, recent empirical findings related to executive dysfunction associated with state-oriented cognitions in major depressive disorder and related dysfunctional patterns of brain activity are reviewed. By considering evidence from studies on executive functioning, brain imaging, and neurophysiological studies, support is found for a possible frontocingulate dysfunction associated with a state-oriented cognitive style underlying a major depressive disorder. Consistent with the proposed link between depression and state orientation, in the second chapter of the thesis, Studies 1a – 1c demonstrate that subclinically and clinically depressed individuals are specifically characterized by failure-related state orientation. Moreover, the results of Study 2, described in Chapter 3, reveal that sustained processing of affectively valenced information may indeed interfere with subsequent executive cognitive functioning, especially in individuals demonstrating relatively high levels of depression. Finally, in line with the idea that sustained information processing and affective interference will be related to an individual’s level of state orientation and will be reflected in specific patterns of neural activity, Study 3, presented in Chapter 4, provides considerable evidence for disturbed brain function in clinically depressed individuals during processing of affective information as well as subsequent executive cognitive functioning and its relation to state-oriented thought. The current research supports the idea that state orientation, in particular its failure-focused form, is a crucial process involved in the development and maintenance of a depressive disorder. Specifically, the present findings suggest that certain forms of major depressive disorder are associated with sustained processing of affective information and with the resulting affective interference with executive cognitive functioning. Findings further suggest that sustained information processing is experienced by affected individuals as ruminative, state-oriented thought on past aversive experiences, and that both sustained information processing and affective interference are associated with distinct patterns of brain activity, which are related to early stimulus evaluation, conflict monitoring, and conflict resolution. The processes possibly underlying some forms of depression, as proposed in this thesis, comprise what may be called “the spinning mind”, whose important functional significance is to hinder an individual from adaptive behavior by impairing the ability to direct thought. Although state orientation may therefore appear to be maladaptive per se, it may be argued instead that this mode of action control is also an adaptive process as long as critical limits of certain parameters are met and the spinning mind is prevented. These and similar considerations are addressed in the concluding discussion in Chapter 5.