The mediator role of ruminative thinking style in the relationship between dysfunctional attitudes and depression Ömer Şenormancı a, ⁎ , Adviye Esin Yılmaz b , Özge Saraçlı a , Nuray Atasoy a , Güliz Şenormancı c , Levent Atik a a Bülent Ecevit University School of Medicine, Psychiatry, Zonguldak, Turkey b Dokuz Eylul University, Faculty of Letters Department of Psychology, İzmir, Turkey c Zonguldak Atatürk State Hospital, Zonguldak, Turkey Abstract Background: The main aim of the present study was to examine whether ruminative thinking styles (brooding and reflection) mediate the effects of dysfunctional attitudes on depressive symptoms. Methods: 120 psychotropic drug-naive first episode depression patients recruited from Bulent Ecevit University School of Medicine psychiatry department and Zonguldak State Hospital psychiatry department outpatient clinics were involved in the study. Participants completed the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I), Beck Depression Inventory (BDI), Dysfunctional Attitude Scale (DAS) and Ruminative Responses Scale (RRS-short version). Regression analyses together with the Sobel tests were performed for testing the mediator hypothesis. Results: According to the path model, the level of brooding fully mediated the relationship between dysfunctional attitudes and depressive symptomatology but reflection did not play a mediator role in the relationship between dysfunctional attitudes and depressive symptoms. Conclusions: Assessment of brooding with both mental status examination and specific measurements and focusing on brooding as an intervention strategy would be beneficial components for an effective treatment of depression. © 2014 Elsevier Inc. All rights reserved. 1. Introduction According to traditional cognitive theory of depression, individual’s cognitions and beliefs, which are based on attitudes or assumptions (schemas), have an important role in the development of depression [1]. In particular, dysfunc- tional attitudes influenced by early life experiences are latent in the periods of euthymia. However, these schemas can be activated by specific stressful circumstances that correspond to the initial experiences responsible for embedding these negative attitudes, which ultimately serve to precipitate depression [2]. In other words, interactions between negative life events and dysfunctional attitudes trigger individual’s negative thoughts about the self, world and future [3], which is known as cognitive reactivity phenomenon [1]. A number of researchers have reported that dysfunctional attitudes increase the risk for depression [4–7]. Not only dysfunctional attitudes but also ruminative response styles have been accepted as important vulnerabil- ity factors to depression [8,9]. Response styles theory considers the processing of thought, rather than the content of the thought. According to this theory, rumination is the repetitive and passive thinking of the possible causes and consequences of depression symptoms [10]. In prospective studies, it has been found that ruminative response style plays an important role in the development and maintenance of depression [11–14]. Treynor et al. (2003) have reported two components of ruminative response style in terms of depression. Brooding is a passive comparison of unmet expectations with the current situation and related to thinking anxiously and gloomily about things. On the other hand, reflective pondering is a purposeful turning inward to engage in mental efforts to solve depressive symptoms cognitively [13]. Indicating the Available online at www.sciencedirect.com ScienceDirect Comprehensive Psychiatry 55 (2014) 1556 – 1560 www.elsevier.com/locate/comppsych Author Disclosure Statement: No competing financial interests exist. ⁎ Corresponding author at: Bülent Ecevit University School of Medicine Esenler-Kozlu, Zonguldak, TR 67600. Tel.: +90 505 794 20 52; fax: +90 212 572 95 95. E-mail address: senorman_7@hotmail.com (Ö. Şenormancı). http://dx.doi.org/10.1016/j.comppsych.2014.05.017 0010-440X/© 2014 Elsevier Inc. All rights reserved.