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SELF-HYPNOSIS FOR DEPRESSION IN PRIMARY CARE
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(Becker, 2006), and chronic physical illness (Katon, 2003). In individuals
vulnerable to depression, thinking tends to be analytical, abstract, and
evaluative, that is, “focusing on one’s symptoms of distress . . . and on
the meanings of those symptoms . . . without taking action to correct
the problems . . .” (Nolen-Hoeksema, 1998, p. 216). If such thinking is
induced experimentally (i.e., “take some time to think about how you
feel inside”) against a background of dysphoria, it magnifies the effect
of the dysphoria in previously depressed individuals (Nolen- Hoek-
sema, 1991) compared to a distraction induction. This pattern of think-
ing, “depressive rumination,” is measured with the Response Style
Questionnaire (RSQ; Nolen-Hoeksema & Morrow, 1991) and predicts
depression in longitudinal (Just & Alloy, 1997) and cross-sectional
studies (Nolen-Hoeksema, 2000; Roberts, Gilboa, & Gotlib, 1998).
In contrast to depressive rumination, a decentered-thinking style,
induced by experimental manipulation (e.g., “focus your attention on
your experience of the way you feel inside”), effectively inducing an
external locus of observation, has been shown to be constructive in
currently depressed and dysphoric individuals, decreasing negative
generalized self-evaluation (Rimes & Watkins, 2005), reducing over-
general autobiographical memory in previously depressed individuals
(Watkins & Teasdale, 2004), improving problem solving in currently
depressed individuals to levels of those who had never been depressed
(Watkins & Baracaia, 2002), and reducing emotional vulnerability to
subsequent failure (Moberly & Watkins, 2006). Decentered thinking is
positively associated with reappraisal and negatively associated with
depressive rumination, experiential avoidance, and emotional sup-
pression and is defined as “the ability to view one’s self as not synony-
mous with one’s thoughts . . . the ability to not react habitually to one’s
negative experiences” (Fresco et al., 2007, p. 236).
The recognition of constructive-thinking styles led to a reexamina-
tion of depressive rumination and the discovery that the RSQ itself has
a minor positive predictive subscale that is called reflective pondering
(Joorman, Dkane, & Gotlib, 2006; Lo, Ho, & Hollon, 2008), suggesting
that there are some constructive elements also to rumination. Watkins
in his Elaborated Control Theory (2008) redefines rumination (because
of its negative connotations) as
construal
(the way in which people per-
ceive, comprehend and interpret the world), depressive rumination as
abstract construal
(generalized, superordinate, decontextualized, ver-
bally based, and self-evaluative thinking), and decentered thinking as
concrete construal
(contextual, process focused, specific, and subordi-
nate thinking). He suggests that, rather than rumination per se being
maladaptive, depressed individuals are disabled by the inability to
adaptively shift between ruminative and decentered thinking; “indi-
viduals tend by default to use more abstract construals [ruminative
style], focused on the meanings, consequences, and implications of
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