Rumination and implicit avoidance following bereavement: an approach avoidance task investigation

Maarten C Eisma, Mike Rinck, Margaret Stroebe, Henk Schut, Paul Boelen, Wolfgang Stroebe, Jan van den Bout

Research output: Contribution to journalArticlepeer-review

38 Citations (Scopus)


BACKGROUND AND OBJECTIVES: Rumination, a risk factor in adjustment to bereavement, has often been considered a confrontation process. However, building on research on worry in generalized anxiety disorder (GAD) and rumination in post-traumatic stress disorder (PTSD), researchers recently developed the Rumination as Avoidance Hypothesis (RAH), which states that rumination after bereavement serves to avoid the reality of the loss. In the present study, RAH was tested by investigating if rumination is associated with implicit loss avoidance.

METHODS: An Approach Avoidance Task (AAT) was used to assess automatic behavior tendencies. Using a joystick, 71 persons who recently lost a first-degree relative (90.1% women), pulled stimuli toward themselves or pushed them away from themselves. Stimuli represented the loss (picture deceased + loss word), were loss-related but ambiguous (picture deceased + neutral word; picture stranger + loss word), or were non-loss-related (picture stranger + neutral word; puzzle picture + X's).

RESULTS: Participants who ruminated more were relatively faster in pushing loss stimuli away from themselves and slower in pulling loss stimuli towards themselves, implying more rumination was associated with stronger implicit loss avoidance. Effects were maintained after controlling for depressive or post-traumatic stress symptom levels, but not when controlling for prolonged grief symptom levels.

LIMITATIONS: Conjugally bereaved women were overrepresented in the sample, which limits generalizability of results. The study was correlational, precluding causal inferences.

CONCLUSIONS: In line with RAH, rumination was positively associated with loss avoidance. This may indicate that the application of exposure-based techniques can reduce rumination and loss-related psychopathology.

Original languageEnglish
Pages (from-to)84-91
Number of pages8
JournalJournal of Behavior Therapy and Experimental Psychiatry
Early online date24 Nov 2014
Publication statusPublished - 1 Jun 2015

Bibliographical note

Copyright © 2014 Elsevier Ltd. All rights reserved.
This research was supported with a ZonMw TOP grant of the Dutch Association for Scientific Research (NWO), grant number: 91208009. The sponsor of this research had no role in the study design, the collection, analysis and interpretation of data and in the decision to submit this article for publication.


  • rumination
  • worry
  • prolonged grief
  • avoidance
  • approach avoidance task


Dive into the research topics of 'Rumination and implicit avoidance following bereavement: an approach avoidance task investigation'. Together they form a unique fingerprint.

Cite this