Rumination, distraction, and mindful self-focus in depressed patients
Silke Huffziger, Christine Kuehner *
Research Group Longitudinal and Intervention Research, Central Institute of Mental Health, Mannheim, Germany
a r t i c l e i n f o
Article history:
Received 18 July 2008
Received in revised form
15 December 2008
Accepted 16 December 2008
Depressive disorders
Cognitive vulnerability
Experimental study
a b s t r a c t
Rumination has been proposed as a cognitive risk factor for the onset and maintenance of depression. In
parallel, mindfulness interventions have shown to reduce the risk for recurrence of depressive episodes.
This study aimed to investigate effects of short periods of induced rumination, distraction, and mindful
self-focus on sad mood in depressed patients and to assess possible moderator effects of habitual vari-
ables on respective mood changes. Seventy-six depressed patients 3.5 years after discharge from inpa-
tient treatment were subjected to negative mood induction and subsequently randomly assigned to
a rumination, distraction, or mindful self-focus induction. Habitual aspects of rumination, distraction,
and mindfulness were assessed by questionnaires. Compared to rumination, the induction of a mindful
self-focus and of distraction showed clear beneficial effects on the course of negative mood. While
habitual distraction predicted better mood outcomes across all conditions, patients high in habitual
mindfulness tended to show stronger negative mood reduction specifically after the induction of
a mindful self-focus. This study indicates that – similar to distraction – an experimentally induced
mindful self-focus is able to reduce negative mood in depressed patients. Implications regarding possible
subgroups of patients who might particularly benefit from mindfulness-based interventions are
2009 Elsevier Ltd. All rights reserved.
Studies indicate lifetime prevalence rates of Major Depression
between 13 and 19% (Hasin, Goodwin, Stinson, & Grant, 2005) and
relapse rates of up to 80% in first episode patients (Judd, 1997). The
chronic relapsing condition of depressive disorders has been
addressed by cognitive and neurophysiological vulnerability
theories, and growing literature focuses on respective treatments
(Fava, Tomba, & Grandi, 2007; Kuehner, 2005; Segal, Williams, &
Teasdale, 2002).
The Response Styles Theory (RST) by Nolen-Hoeksema (1991;
Nolen-Hoeksema, Wisco, & Lyubomirsky, 2008) represents
a cognitive vulnerability theory for the onset, exacerbation, and
maintenance of depressive episodes. Two different coping styles,
namely rumination and distraction, address cognitive and behav-
ioural responses to depressive moods and symptoms. Ruminative
responses comprise passively focusing one’s attention on one’s
dysphoric symptoms and on their possible causes and conse-
quences. Distractive coping is defined as actively turning one’s
attention away from one’s depressive symptoms on to pleasant or
neutral thoughts and actions. The theory presumes that rumination
and distraction are purposeful trait-like styles of responding to or
trying to cope with negative mood (Nolen-Hoeksema, 1991).
According to RST, distraction should lead to mood repair through
refocusing on positive aspects, while rumination as a dysfunctional
mode of self-focused attention is supposed to activate negative
associative memory networks, to interfere with attention and
instrumental behaviour, and to impair problem solving. As
a consequence, rumination is supposed to maintain or to amplify
dysphoric and depressive states and to represent a cognitive
vulnerability factor for future depressive episodes (Nolen-Hoek-
sema, 1991; Nolen-Hoeksema et al., 2008).
Previous research has shown that ruminative and distractive
responses to depressed mood, as assessed by the Response Styles
Questionnaire (RSQ; Nolen-Hoeksema & Morrow, 1991), exhibited
reasonable temporal stability in clinical and nonclinical samples
(Bagby, Rector, Bacchiochi, & McBride, 2004; Kuehner & Weber,
1999), supporting the proposed trait-like characteristics of
response styles. Furthermore, observational studies reported
evidence for the predictive validity of rumination regarding
severity of depressive symptoms in nonclinical samples (Hong,
2007; Nolen-Hoeksema, Stice, Wade, & Bohon, 2007; Sarin, Abela, &
Auerbach, 2005), while respective results from clinical samples are
mixed (Arnow, Spangler, Klein, & Burns, 2004; Kuehner & Weber,
1999; Raes et al., 2006). All those studies controlled for concurrent
depression levels, suggesting that a ruminative response style does
* Corresponding author. Research Group Longitudinal and Intervention Research,
Central Institute of Mental Health, P.O. Box 122120, D-68072 Mannheim, Germany.
Tel.: þ49 621 1703 6057; fax: þ49 621 1703 1205.
E-mail address: (C. Kuehner).
Contents lists available at ScienceDirect
Behaviour Research and Therapy
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0005-7967/$ – see front matter 2009 Elsevier Ltd. All rights reserved.
doi:10.1016/j.brat.2008.12.005not merely reflect a cognitive epiphenomenon of depression. In
another line of research, a number of laboratory studies with
experimentally induced response styles reported detrimental
effects of rumination and beneficial effects of distraction on
depression-related emotional and cognitive processes (e.g.,
Donaldson & Lam, 2004; Kuehner, Holzhauer, & Huffziger, 2007;
Kuehner, Huffziger, & Liebsch, 2009; Lavender & Watkins,
2004; Lyubomirsky, Kasri, & Zehm, 2003; Rimes & Watkins, 2005;
Sutherland & Bryant, 2007). One study found that trait rumination
enhanced the negative impact of induced rumination in the labo-
ratory (Kuehner, Holzhauer, & Huffziger, 2007).
Originating from Buddhist philosophy, the core concept of
mindfulness includes receptive attention to and non-evaluative
and sustained moment-to-moment awareness of mental states and
processes. A mindful mode of processing involves a receptive state
of mind in which attention is kept to register internal and external
events as phenomena in a non-judgemental, accepting way
(Brown, Ryan, & Creswell, 2007a). In this context, even unpleasant
thoughts and feelings are openly accepted with the notion that they
are transient. According to Brown, Ryan, and Creswell (2007b)
mindfulness should be delineated from other modes of self-focused
attention due to the latter’s proneness to negative biased self-
centered thoughts. In contrast, the pure observant stance during
mindfulness is supposed to allow unbiased information processing
and therefore greater opportunities for adaptive self-regulation
(Brown et al., 2007b, p. 273).
The multidimensional concept of mindfulness has been inte-
grated into Western psychology, although with varying oper-
ationalizations and degrees of complexity (cf. Brown et al., 2007a).
One body of research has developed self-report scales to assess
momentary state mindfulness (e.g., Lau et al., 2006) or trait-like
aspects of mindfulness, the latter describing the tendency to
sustain mindful states over time (e.g., Walach, Buchheld, Butten-
mu¨ ller, Kleinknecht, & Schmidt, 2006). Psychometric evaluations
have found trait mindfulness scales to correlate negatively with
indicators of psychopathology and neuroticism, and positively with
extraversion, affect regulation, and acceptance of emotions
(cf. Brown et al., 2007a). Habitual mindfulness also predicted
emotional states and behavioural motivation in two longitudinal
studies (Brown & Ryan, 2003; Levesque & Brown, 2007). In a first
fMRI study, high mindfulness was linked to greater affect regulation
through enhanced prefrontal cortical inhibition of amygdalar
responses (Creswell, Way, Eisenberger, & Lieberman, 2007).
A second body of research has incorporated the concept of
mindfulness into therapeutic interventions to teach a more mindful
approach to mental problems. Usually, these interventions are
characterized by intensive training including mindful meditation
practice over several weeks. One of these interventions, Mindful-
ness-Based Cognitive Therapy for Depression (MBCT; Segal et al.,
2002), has been developed for relapse prevention in depression
and focuses on specific cognitive processes, including ruminative
tendencies. During MBCT, depressed patients are taught to develop
a non-judgemental and decentred awareness of their ruminative
state of mind to prevent the deleterious loop of negative thoughts
and moods. The capacity of mindfulness-based interventions to
reduce trait rumination has gained empirical support (Jain et al.,
2007; Ramel, Goldin, Carmona, & McQuaid, 2004; Shapiro, Brown,
& Biegel, 2007). Shapiro et al. (2007) found that an increase in
mindfulness during intervention predicted a drop in rumination,
and Jain et al. (2007) reported that the effects of a mindfulness
intervention on reducing distress were partially mediated by
reducing rumination.
A third research strategy aims at investigating effects of an
experimentally induced mindful self-focus on emotional and
cognitive processes (e.g., Arch & Craske, 2006; Broderick, 2005;
Kuehner et al., 2009; Singer & Dobson, 2007). In contrast to the
above described mindfulness intervention programs, these exper-
imental manipulations include only short induction periods of
selected mindfulness elements (e.g., non-judgemental state of
mind, awareness of the breath), therefore allowing comparisons
with other forms of induced attention focusing. Importantly, these
studies do not claim to capture the complex processes involved in
therapeutic mindfulness interventions. Three studies compared the
effects of an induced mindful self-focus with induced rumination
and distraction and provided ambiguous results. While Broderick
(2005) identified even higher mood improvement after induced
mindfulness than after distraction, the study by Kuehner et al.
(2009) showed the magnitude of mood change after a mindful self-
focus induction to be between the effects achieved after rumination
and distraction. Finally, in the study by Singer and Dobson (2007)
induced mindfulness and distraction caused similar mood
improvements in a sample of remitted depressed patients.
Clearly, these studies differ in the extent of identified mood
changes following the induction of a mindful self-focus. Two
aspects may account for this: First, the available studies imple-
mented methodologically different induction procedures and,
secondly, different populations possibly show distinct reactions
towards the induction of a mindful self-focus. It may be hypothe-
sized, for example, that especially individuals with a history of
depression might benefit from a mindful attention focus induced in
the laboratory. Compared to healthy subjects, they have experi-
enced negative mood shifts that seem uncontrollable and dis-
tressing and might therefore feel a particular need for strategies to
prevent such mood disturbances.
Aims of the present study were to assess the effects of experi-
mentally induced rumination, distraction, and mindful self-focus
on the course of mood after negative mood induction in a clinical
sample of depressed patients 3.5 years after discharge from inpa-
tient treatment. These patients underwent an induction paradigm
that was already used in a previous nonclinical study (Kuehner
et al., 2009). We expected that the induction of a mindful self-focus
– similar to distraction and in contrast to rumination – would
improve previously induced negative mood in the present patient
sample. Furthermore, we assessed the impact of habitual rumina-
tion, distraction, and mindfulness on the course of mood during
response induction to check for possible moderator effects of these
Within the context of a 3.5 year follow-up assessment of a larger
longitudinal study, we investigated 76 depressed patients originally
recruited during their inpatient treatment at the Central Institute of
Mental Health in Mannheim, Germany (cf. Kuehner & Buerger,
2005). Diagnostic inclusion criteria were Major Depression, single
(F32) or recurrent (F33) episode, and Dysthymic Disorder (F34)
according to ICD-10 (WHO,1992) at index admission. At the present
3.5-year follow-up examination after index discharge, the patients’
current diagnostic status was assessed using the Structured Clinical
Interview for DSM-IV Axis I (SCID-I; Wittchen, Wunderlich,
Gruschwitz, & Zaudig, 1997). In all, 58 patients (76.3%) were
While the term ‘‘trait’’ is used commonly in the literature to assess habitual
aspects of rumination, distraction, and mindfulness, we acknowledge that these
characteristics most closely reflect enduring cognitive styles, i.e., preferred ways of
thinking, placed at the interface between cognition and personality (Sternberg,
S. Huffziger, C. Kuehner / Behaviour Research and Therapy 47
(2009) 224–230 225remitted from their previous Major Depressive Episode (less than 3
MDE criterion symptoms in the previous month) or from their
Dysthymic Disorder, five patients (6.6%) displayed significant
residual depressive symptoms (3 or 4 MDE criterion symptoms in
the previous month, including two patients with a current Dys-
thymic Disorder), and 13 patients (17.1%) fulfilled criteria for
a current MDE according to DSM-IV.
Study design
The present examination was mainly composed of an experi-
mental session lasting about 35 min. The study was conducted in
accordance with the declaration of Helsinki and had been approved
by the local ethics committee of the University of Heidelberg,
Before the start of the experimental session, the SCID-I and
interviewer- and self-rated questionnaires were completed (for
a full description of instruments see measures section). At the
beginning of the experimental session, all patients underwent
a baseline mood assessment (T1) followed by a sad mood induction
(for a detailed description see experimental inductions section
below). A second mood measure (T2) controlled for mood changes
caused by the sad mood induction. Subsequently, each participant
was assigned to one of three response induction groups (rumina-
tion, distraction, or mindful self-focus, for a detailed description of
the experimental conditions see section below) in a blocked
randomized manner, additionally stratifying for gender. Randomi-
zation lists were developed using a computer random number
generator to select random permuted blocks for both genders. This
procedure ensured an approximately equal number of male and
female patients per condition. Following the response induction,
a third mood measure (T3) was applied. The experimental session
was terminated by a manipulation check and a detailed debriefing.
Finally, the experimenter (S.H.) initiated a positive refocusing on
personal resources of the participants at the end of the session to
ensure that they left the experiment in a neutral mood state.
Experimental inductions
The sad mood induction included a combination of mood-
suggestive music (extract from the Adagio in g-minor by Tomaso
Albinoni, arranged for strings and organ by Remo Giazotto) and
negative autobiographic recall. In this recall task, participants were
asked to remember three specific life events during which they had
felt lonely, sad, rejected, or hurt. The events were then listed in
ascending order in terms of subjectively perceived sadness. For the
subsequent mood induction phase, which lasted 6 min, participants
were instructed to concentrate on the listed events and on their
thoughts and feelings at that time, each for 2 min, while listening to
the sad music. The efficacy of this procedure to induce transient sad
mood has previously been demonstrated (Kuehner et al., 2009;
Westermann, Spies, Stahl, & Hesse, 1996). Three participants of the
original cohort refused participation in the sad mood induction and
were excluded from the experiment.
For the response induction, we used an internationally adopted
paradigm for rumination and distraction induction (Lyubomirsky
et al., 2003) and developed a new, comparable protocol for the
induction of a mindful self-focus (cf. Kuehner et al., 2009). The
paradigm for rumination and distraction induction requires
participants to focus their attention and think about a series of
items presented on cards (28 cards per condition). In the rumina-
tion condition, participants are asked to focus on emotion-focused,
symptom-focused, and self-focused thoughts (e.g., ‘‘think about
. your current level of energy, . the physical sensations in your
body, . what your feelings might mean’’). Participants in the
distraction condition are asked to concentrate their attention on
thoughts that are focused externally and not related to symptoms,
emotions, or the self (examples: ‘‘think about . a boat slowly
crossing the Atlantic, . the expression on the face of the Mona Lisa’’
etc.). While participants have to spend exactly 8 min focusing on
the cards, they are free to decide how many cards they focus on and
how long they focus on individual cards during the allotted time.
For the induction of a mindful self-focus, we adopted identical
instructions with items presented on cards. Twenty-eight items
reflecting prompts to a mindful approach were constructed based
on mindfulness literature (Heidenreich & Michalak, 2004; Segal
et al., 2002; Singer & Dobson, 2007). Items focused on the attitude
of non-judgemental acceptance (e.g., ‘‘realize that all feelings, also
negative feelings, are part of human experience’’, ‘‘take note of your
thoughts and feelings without judging them’’) and on moment-
to-moment awareness (the item ‘‘consciously attend to your breath
for some seconds’’ was repeated on every seventh card). Content
validity of the mindful self-focus items was determined by expert
ratings. Identical to the rumination and distraction inductions,
participants were asked to focus on the cards for 8 min.
Current diagnostic depression status was assessed using SCID-I
(Wittchen et al., 1997), a semi-structured interview for mental
disorders with adequate interrater-reliability. To measure inter-
viewer-rated severity of depressive symptoms during the week
prior to follow-up, the 10-item Montgomery Asberg Depression
Rating Scale (MADRS; Montgomery & Asberg, 1979) was applied,
which has shown adequate psychometric properties (e.g., Muller,
Himmerich, Kienzle, & Szegedi, 2003). In the present sample,
internal consistency (Cronbach’s a) amounted to .87.
Coping styles
Coping styles based on the Response Styles Theory by Nolen-
Hoeksema (1991) were assessed with the 23-item German version
of the Response Styles Questionnaire (Kuehner, Huffziger, & Nolen-
Hoeksema, 2007). The RSQ asks participants how they generally
respond to depressed mood, thereby aiming at assessing habitual
aspects of rumination and distraction. Factor analyses of the
German version revealed three subscales, namely symptom-
focused rumination (RSQ-SYM, rumination about one’s depressive
symptoms, their causes, and consequences, e.g., ‘‘think about how
hard it is to concentrate’’), self-focused rumination (RSQ-SELF,
items primarily related to self-analysis/introspection and self-
isolation, e.g., ‘‘analyze my personality and try to understand why I
am depressed’’; cf. also Bagby & Parker, 2001; Cox, Enns, & Taylor,
2001) and distraction (RSQ-DIS, e.g., ‘‘think I’ll concentrate on
something other than how I feel’’). The three subscales show good
psychometric properties, including internal consistency, temporal
stability, and concurrent, discriminant, and predictive validity
(Kuehner, Huffziger, & Nolen-Hoeksema, 2007). In the present
sample, internal consistencies (Cronbach’s a) of the subscales were
as follows: RSQ-SYM .90, RSQ-SELF .75, and RSQ-DIS .81. Further-
more, the subscales showed moderate and statistically significant
retest correlations over a period of six months (RSQ-SYM .54, RSQ-
SELF .48, RSQ-DIS .62) and 3.5 years (RSQ-SYM .44, RSQ-SELF .39,
RSQ-DIS .59; unpublished data from the larger longitudinal study).
Habitual mindfulness
Habitual aspects of mindfulness were measured using the
14-item short form of the Freiburg Mindfulness Inventory (FMI-14),
German version (Walach et al., 2006). Participants are asked to
characterize their general experience of mindfulness without
S. Huffziger, C. Kuehner / Behaviour Research and Therapy 47
(2009) 224–230 226considering a specific time frame (e.g., ‘‘I watch my feelings without
getting lost in them’’). The instrument represents one global factor;
in the present sample, it yielded an internal consistency of .86.
Importantly, the items of the short form of the FMI (FMI-14) have
shown to be semantically independent from a Buddhist or medi-
tation context, and the short form is recommended for use with
clinical and nonclinical samples without previous meditation
experience (Walach et al., 2006). In a previous sample of healthy
young adults without meditation experience (n ¼ 56, cf. Kuehner
et al., 2009), we found a moderate retest correlation of r ¼.52
(p < .001) of FMI-14 scores over a one-year period.
Positive and negative affect
To measure the course of mood during the experimental session,
we used the Positive and Negative Affect Schedule (PANAS; Watson,
Clark, & Tellegen, 1988). The PANAS consists of two 10-item scales
for positive affect (PA; examples: ‘‘active’’, ‘‘alert’’, ‘‘interested’’) and
negative affect (NA; examples: ‘‘distressed’’, ‘‘nervous’’, ‘‘guilty’’).
The instrument has proven a reliable and valid measure of the
constructs of positive and negative affect for different time frames
(Crawford & Henry, 2004). In the present study, the PANAS served
as a state measure of mood at the three measuring points T1, T2,
and T3 during the experimental session (instruction: ‘‘how do you
feel at the moment’’).
Statistical analyses
To test for possible pretest differences between the three
response induction groups, analyses of variance (ANOVAs) were
used for continuous and Chi-square tests for categorical variables.
The effects of mood induction on positive (PA) and negative (NA)
PANAS scores were investigated by separate repeated measures
analyses of variance (RM ANOVAs) with PANAS PA and NA scores at
T1 and T2 as repeated measures. In additional RM ANOVAs, we
included the baseline MADRS depression scores as a covariate to
test for its possible effect on mood deterioration. To analyse the
effects of response induction on PANAS PA and NA scores, analyses
of covariance (ANCOVAs) were conducted with PANAS PA and NA
scores at T3 as dependent variables, PANAS PA and NA scores at T2
as covariates (thus allowing to analyse respective mood changes),
and response induction as fixed factor. In these ANCOVAs, we also
controlled for baseline MADRS depression scores. Post-hoc pair-
wise analyses were performed to compare the effects across
groups, and separate RM ANOVAs to assess the direction of change
within each group.
To investigate the influence of habitual variables (RSQ-SYM,
RSQ-SELF, RSQ-DIS, FMI-14) on the course of mood after response
induction (T2–T3), we repeated the above described ANCOVAs and
separately included the habitual variables as additional covariates.
Simultaneous inclusion of baseline MADRS scores as a covariate
allowed to examine net effects of the habitual variables on
respective outcomes. When a significant effect of a habitual vari-
able on PANAS T3 scores was determined, we further tested its
interaction with group status to determine its potential differential
effect on mood change in the three response induction groups.
Directness of these associations was finally illustrated by partial
correlations between PANAS T3 scores and habitual variable,
controlling for PANAS T2 and MADRS baseline scores.
All analyses were performed using the SPSS version 15 software
(SPSS Inc., Illinois).
Preliminary analyses
Demographic characteristics, clinical variables, treatment
history, and baseline positive and negative mood (PANAS PA and NA
at T1) for the three induction groups are displayed in Table 1.
Participants randomly assigned to the rumination, distraction, and
mindful self-focus induction following negative mood induction
did not differ regarding any of the baseline variables displayed in
Table 1, all ps > .10. Partial correlations among the assessed habitual
variables, controlling for MADRS depression scores, are reported in
Table 2. Moderate associations were found between symptom-
focused and self-focused rumination and between distraction and
mindfulness, while all other intercorrelations were negligible.
Mood induction
RM ANOVAs revealed highly significant mood deteriorations
from T1 (before) to T2 (after mood induction). Positive affect
(PANAS PA) decreased from 30.7 (SD ¼ 7.1) to 24.6 (SD ¼ 7.7),
F(1,74) ¼ 82.30, p < .001. In parallel, negative affect (PANAS NA)
increased from 13.7 (SD ¼ 5.0) to 16.6 (SD ¼ 6.8), F(1,74) ¼ 20.21,
p < .001. Additional RM ANOVAs revealed that baseline MADRS
scores did not significantly influence the course of positive affect,
F(1,73) ¼ 1.92, ns, while it marginally significantly affected the
course of negative affect, F(1,73) ¼ 3.09, p ¼ .08. A further set of
analyses indicated that the three response induction groups did not
Table 1
Relevant baseline characteristics in the three induction groups.
Induction groups
Rumination (n ¼ 24) Distraction (n ¼ 27) Mindful self-focus (n ¼ 25)
M/% SD M/% SD M/% SD
Age 51.37 11.82 45.95 12.96 44.85 10.38
Female 50% 52% 48%
Age at first depressive episode 35.67 15.12 31.22 14.81 31.32 13.63
3 anamnestic depressive episodes 70.8% 76% 75%
Age at first inpatient treatment 42.21 13.00 37.30 13.66 36.56 11.94
N of inpatient treatments 3.29 2.88 2.44 1.80 3.28 3.30
Current psychopharmacological treatment 54.2% 55.5% 64%
Current psychotherapy 16.7% 22.2% 24%
Current MDE according to SCID-I 25% 14.8% 12%
Depression score (MADRS) 7.67 7.55 8.70 7.59 8.56 6.45
PANAS PA T1 32.27 7.58 28.54 5.91 31.32 7.59
PANAS NA T1 13.50 6.02 13.81 4.83 13.80 4.42
Note: MADRS ¼ Montgomery Asberg Depression Rating Scale; SCID-I ¼ Structured Clinical Interview for DSM-IV Axis I; PANAS PA T1 ¼ Positive and negative affect schedule –
positive affect at T1 (before mood induction); PANAS NA T1 ¼ Positive and negative affect schedule – negative affect at T1 (before mood induction).
S. Huffziger, C. Kuehner / Behaviour Research and Therapy 47 (2009) 224–230 227differ with regard to change in positive, F(2,72) ¼ 2.00, ns, or in
negative affect, F(2,72) ¼ 0.73, ns, from T1 to T2.
Response induction
Fig. 1 shows the course of positive (PANAS PA) and negative
affect (PANAS NA) from T2 (before response induction) to T3 (after
response induction) in the three response induction groups.
Controlling for baseline MADRS scores, ANCOVAs revealed highly
significant group effects on changes in positive, F(2,70) ¼ 4.37,
p ¼ .016, and negative mood, F(2,70) ¼ 7.86, p ¼ .001, while MADRS
scores did not predict change in positive, F(1,70) ¼ 0.65, ns, or
negative mood, F(1,70) ¼ 0.12, ns. Post-hoc pair-wise comparisons
indicated similar effects of induced mindful self-focus and
distraction on change in positive and negative mood, PANAS PA:
F(1,47) < 1, PANAS NA: F(1,47) < 1. In contrast, significant differ-
ences emerged between induced rumination and mindful self-
focus, PANAS PA: F(1,44) ¼ 8.33, p ¼ .006, PANAS NA:
F(1,44) ¼ 10.52, p ¼ .002, and between induced rumination and
distraction, PANAS PA: F(1,47) ¼ 6.32, p ¼ .015, PANAS NA:
F(1,47) ¼ 11.43, p ¼ .001. Separate RM ANOVAs for the three
induction groups identified significant mood improvements from
T2 to T3 in the mindful self-focus group, PANAS PA: F(1,23) ¼ 27.87,
p < .001, PANAS NA: F(1,23) ¼ 24.67, p < .001, and in the distraction
group, PANAS PA: F(1,26) ¼ 21.70, p < .001, PANAS NA:
F(1,26) ¼ 17.67, p < .001, while no mood changes were seen in the
rumination group, PANAS PA: F(1,23) ¼ 1.47, ns, PANAS NA:
F(1,23) ¼ 1.58, ns. Thus, in contrast to induced rumination, induced
distraction and mindful self-focus demonstrated clear positive
effects on the course of positive and negative mood (cf. Fig. 1).
Next, we investigated the impact of habitual variables on mood
changes after response induction. Controlling for baseline MADRS
scores and PANAS at T2, ANCOVAs revealed no significant effects for
RSQ-SYM and RSQ-SELF, all ps > .10. In contrast, RSQ-DIS showed
a significant predictive effect on change in positive, F(1,68) ¼ 4.32,
p ¼ .041, and a marginally significant effect on change in negative
mood, F(1,68) ¼ 3.96, p ¼ .051, from T2 to T3. Partial correlation
coefficients indicated that higher RSQ-DIS scores were significantly
associated with higher PANAS PA scores at T3, r ¼ .25, p ¼ .037, and
marginally significantly with lower PANAS NA scores at T3, r ¼ .22,
p ¼ .066. It is important to note, however, that Bonferroni adjust-
ment would require a significance level of p ¼ .0125 (.05/4) for the
predictive effects of habitual distraction. Since the effects of RSQ-
DIS did not reach this level, a cautious interpretation seems
In additional analyses, we included the interaction of RSQ-DIS
and response induction into the respective models, thereby
assessing a possible differential impact of RSQ-DIS in the three
response induction groups. The interaction terms regarding posi-
tive, F(2,66) < 1, and negative mood, F(2,66) ¼ 1.22, ns, were non-
significant, indicating that the predictive effects of RSQ-DIS did not
vary across groups.
Furthermore, the effect of habitual mindfulness (FMI-14) on the
course of positive mood from T2 to T3 was non-significant,
F(1,69) ¼ 2.19, ns. However, FMI-14 had a highly significant effect on
the change of negative mood from T2 to T3, F(1,69) ¼ 9.17, p ¼ .003,
even after Bonferroni adjustment (p < .0125). Controlling for
baseline MADRS and PANAS NA at T2, the partial correlation coef-
ficient indicated that higher FMI-14 scores were linked to lower
PANAS NA scores at T3, r ¼ .30, p ¼ .011. In a further step, we
included the interaction of FMI-14 and response induction into the
model and noted a significant interaction term, F(2,67) ¼ 4.68,
p ¼ .013. Separate analyses for the three response induction groups
revealed that in the mindful self-focus group, FMI-14 had
a marginally significant effect on PANAS NA at T3, F(1,20) ¼ 3.25,
p ¼ .086, whereas in the rumination and distraction groups, no
significant effects of FMI-14 were identified (rumination group:
F(1,20) ¼ 2.30, p ¼ .145, distraction group: F(1,23) ¼ 2.93, p ¼ .101).
The partial correlation coefficient, again adjusted for PANAS NA at
T2 and baseline MADRS scores, revealed that in the mindful self-
focus group elevated habitual mindfulness tended to be associated
with lower PANAS NA scores after mindful self-focus induction,
r ¼ .37, p ¼ .086.
In the present study, we investigated effects of experimentally
induced rumination, distraction, and mindful self-focus (response
induction) on the course of mood after negative mood induction in
a clinical sample of depressed patients 3.5 years after discharge
from index inpatient treatment. We also examined whether
habitual rumination, distraction, and mindfulness moderated
mood changes following the response induction.
Table 2
Intercorrelations among habitual variables controlling for MADRS depression scores.
RSQ-SYM – .50** .17 .17
RSQ-SELF – .02 .08
RSQ-DIS – .37**
Note: ** p .001; RSQ-SYM ¼ Response Styles Questionnaire – subscale symptom-
focused rumination, RSQ-SELF ¼ subscale self-focused rumination, RSQ-
DIS ¼ subscale distraction; FMI-14 ¼ Freiburg Mindfulness inventory – short form.
Fig. 1. Course of positive (PANAS PA) and negative mood (PANAS NA) from T2 to T3 in the three response induction groups. T2, before response induction; T3, after response induction.
S. Huffziger, C. Kuehner / Behaviour Research and Therapy 47 (2009) 224–230 228The following main findings emerged in this study. After nega-
tive mood induction, patients showed significant mood deteriora-
tions. A subsequently induced mindful self-focus led to significant
mood improvement, which was comparable to the effect produced
by induced distraction. In contrast, induced rumination led to
extended depressive mood. Higher levels of habitual distractive
coping predicted less negative and more positive mood after
response induction across all groups. In contrast, elevated habitual
mindfulness tended to enhance improvement of negative mood
specifically after mindful self-focus induction. The identified
moderating effects of habitual distraction and mindfulness were
independent of the impact of concurrent depression levels, indi-
cating that we did not merely assess irrelevant epiphenomena of
depressive symptomatology.
For the sad mood induction, we used a combination of mood-
suggestive music and negative autobiographical recall. This
procedure resulted in highly significant changes regarding positive
and negative affect, confirming prior findings on its efficacy for
negative mood induction (Kuehner et al., 2009; Westermann et al.,
1996). To induce rumination and distraction, we used a paradigm
by Lyubomirsky et al. (2003), which was expanded for the induc-
tion of a mindful self-focus (cf. Kuehner et al., 2009). The latter
condition was identical to the former ones with regard to procedure
and instructions, thus ensuring that differences between condi-
tions were not attributable to methodological issues.
Our study provides further evidence that after negative mood
induction, induced rumination has a negative impact on the course
of depressed mood in depressed patients while induced distraction
causes immediate mood improvement (cf. Donaldson & Lam, 2004;
Lavender & Watkins, 2004). Consistent with a number of previous
studies, we observed that induced rumination maintained rather
than exacerbated negative affect (e.g., Joormann & Siemer, 2004;
Kuehner, Holzhauer, & Huffziger, 2007; Singer & Dobson, 2007).
This is in accordance with assumptions of the RST, whereby rumi-
nation may both prolong and exacerbate periods of negative mood
(Nolen-Hoeksema, 1991; Nolen-Hoeksema et al., 2008). Of interest,
studies reporting clear exacerbation of negative mood following
induced rumination have mostly used naturally occurring mood
states as reference baseline (Donaldson & Lam, 2004; Lyubomirsky
et al., 2003). It is conceivable that this discrepancy is partly due to
ceiling effects for negative mood in studies using active negative
mood priming procedures immediately before response induction.
Furthermore, we noted that a habitual distractive coping style in
response to depressed mood showed general beneficial effects on
the course of mood after response induction. In particular,
distractive coping appeared to facilitate the immediate experience
of positive affect. This finding emphasizes the capacity of habitual
distraction to support overall adaptive mood-regulative processes
in depressed individuals. However, the observed mood-improving
effects of habitual distraction in our study were small, and repli-
cation studies are required to confirm our findings.
Our results suggesting mood-improving effects of an induced
mindful self-focus parallel findings by Singer and Dobson (2007). It
seems that a short mindful self-focus induction is able to elicit
marked immediate mood improvements, comparable to those
achieved by induced distraction. However, beneficial effects of an
induced mindful self-focus appear to vary across different groups.
First, while we identified clear mood-enhancing effects in the
present patient sample, we previously found healthy young adults
to show less pronounced mood improvements after mindful self-
focus induction (Kuehner et al., 2009). Consequently, it seems
possible that individuals with a history of depression might benefit
more from an experimentally induced mindful self-focus than
nonclinical samples who lack the experience of seemingly uncon-
trollable depressive states.
Second, our results showed that participants with high levels of
habitual mindfulness tended to exhibit more pronounced mood
improvements after the induction of a mindful self-focus. Accord-
ingly, one could speculate that dispositional mindfulness may
‘‘predispose’’ individuals for effective mindfulness-based inter-
ventions – either in experimental or even therapeutic settings. It
has previously been pointed out that future research should iden-
tify possible moderators for the effects of mindfulness-based
interventions (Coelho, Canter, & Ernst, 2007). Our study suggests
that it may be worth to examine more systematically in future
research whether individual differences in habitual mindfulness
might affect the efficacy of mindfulness programs in such a way.
An interesting finding of our study was the positive association
between habitual distraction and mindfulness. While mindfulness
is about being aware of and being in touch with one’s thoughts,
feelings, and sensations, distraction implies an attention shift from
one’s internal state to external cues. As such, both attention foci are
inherently different in terms of their content. However, there seem
to be some overlapping elements which may account for the
identified positive association. Studies have shown that both vari-
ables are linked to positive affectivity, openness to experience, and
extraversion (Bagby & Parker, 2001; Brown & Ryan, 2003), and it is
possible that these associated traits partly explain the shared
variance of mindfulness and distraction. However, future research
is clearly needed in order to delineate similarities and differences of
the two constructs in more detail.
There are several limitations to our study. First, our experi-
mental manipulation of response induction by asking participants
to focus their attention on statements presented on cards for some
minutes does not allow a direct test whether the three induction
conditions actually initiated different modes of processing, as
hypothesized. Instead, we have only indirect evidence for this
assumption by considering their effects on mood-related outcomes.
This limitation is shared with many previous experimental studies
on the topic.
Second, we identified only a statistical trend for habitual
mindfulness to enhance mood improvement after induction of
a mindful self-focus. This was possibly due to restricted power in
analyses with response induction subgroups, considering that in
the total sample the main effect of habitual mindfulness and its
interaction with response induction were highly significant. Clearly,
larger replication studies are warranted to examine the influence of
habitual variables on related experimentally manipulated attention
foci with sufficient statistical power.
Third, we investigated a mixed follow-up sample of clinically
remitted and non-remitted depressed patients, which may be seen
as an interpretative disadvantage. To control for this heterogeneity,
we included baseline MADRS depression scores as a covariate in
respective analyses. While baseline depression levels only
marginally affected the course of mood following mood induction,
mood changes after response induction were clearly unaffected by
baseline depression scores.
Fourth, present research on habitual mindfulness suffers from
the problem that existing mindfulness scales show considerable
variation in content and structure, exhibit only moderate inter-
correlations and poor construct validation (see also Brown et al.,
2007a). This highlights the need for improved mindfulness scales
with good discriminant and convergent validity that would
strengthen future research on the topic of mindfulness as an
enduring cognitive style.
Finally, it must be stressed again that our experimental mindful
self-focus manipulation hardly taps the complex multidimensional
construct of mindfulness. In contrast to MBCT or other mindfulness
interventions, a short experimental induction of selected elements
of a transient mindful focus as the one used in this study is not
S. Huffziger, C. Kuehner / Behaviour Research and Therapy 47 (2009) 224–230 229aimed at truly teaching mindfulness and at producing lasting shifts
in participants’ relationships to their thoughts, feelings, and bodily
sensations. Nevertheless, they provide the opportunity to assess
causal effects on mood, cognitive processes, or biological parame-
ters and – in principle – to delineate possible mechanisms of
momentary mindful self-focusing (cf. Arch & Craske, 2006). Future
experimental and observational studies exploring mindfulness as
a specific mode of adaptive attention focusing may particularly look
at predictive effects of enhanced mindful awareness for the course
of depression and psychopathology. In addition, future research on
patient variables that predict increased positive outcomes
following mindfulness interventions seems of particular interest.
This research was supported by the German Research Founda-
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