Recognizing Rumination and Examining the Relationship with Pain Experience and Physical Activity: A Traditional Review
Yıl 2023,
Cilt: 7 Sayı: 3, 381 - 390, 20.12.2023
Damla Karabay
,
Faruk Tanık
,
Merve Keskin
,
Orhan Öztürk
,
Merve Kurt
,
Derya Özer Kaya
Öz
In recent years, it has been frequently emphasized that musculoskeletal pain should be addressed with a biopsychosocial approach centered on exercise interventions. Negative pain beliefs such as pain catastrophizing can lead to kinesiophobia and thus to physical inactivity. Physical inactivity can lead to chronic pain and increased fear, leading to a vicious circle. Along with magnification and helplessness, rumination is among the three sub-dimensions of pain catastrophizing. Rumination, defined as "ruminating" and "repeatedly reviewing" in the dictionary, and it is well-known that rumination negatively affects physical health, and rumination levels are high in individuals with chronic conditions such as chronic pain, cardiovascular disease, and obesity. Research showed that rumination is positively associated with pain and negatively associated with physical activity. An increase in the rumination level may cause increases in pain intensity, emotional distress, and negative attitude towards pain and may also result in reduced physical activity levels. Structured exercise programs may have beneficial consequences for musculoskeletal pain as well as the negative effects of rumination. However, depression often accompanies increased rumination and may pose a risk for exercise adherence by reducing the physical activity pleasure. This review aimed to overwiev the relationship of rumination with pain and physical activity. In conclusion, physical activity programs aimed to reduce rumination may include aerobic activities, mindfulness exercises, stretching, and strengthening exercises. It can be beneficial to perform the exercises three times a week for 30-60 minutes.
Kaynakça
- 1. Siddall PJ, Cousins MJ. Persistent pain as a disease entity: implications for clinical management. Anesthesia and analgesia. 2004;99(2):510-520.
- 2. Booth J, Moseley GL, Schiltenwolf M, et al. Exercise for chronic musculoskeletal pain: A biopsychosocial approach. Musculoskeletal care. 2017;15(4):413-421.
- 3. Moseley GL, Butler DS. Fifteen years of explaining pain: The past, present, and future. J Pain. 2015;16(9):807-813.
- 4. Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull. 2007;133(4):581-624.
- 5. Watson JA, Ryan CG, Cooper L, et al. Pain neuroscience education for adults with chronic musculoskeletal pain: A mixed-methods systematic review and meta-analysis. J Pain. 2019;20(10): 1140.e1-1140.e22.
- 6. Louw A, Zimney K, Puentedura EJ, Diener I. The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. Physiother Teory Pract. 2016;32(5):332-355.
- 7. Silva Guerrero AV, Maujean A, Campbell L, Sterling M. A systematic review and meta-analysis of the effectiveness of psychological interventions delivered by physiotherapists on pain, disability and psychological outcomes in musculoskeletal pain conditions. Clin J Pain. 2018;34(9):838-857.
- 8. Kagawa F, Yokoyama S, Takamura M, et al. Decreased physical activity with subjective pleasure is associated with avoidance behaviors. Sci Rep. 2022;12(1):1-8.
- 9. Mata J, Thompson RJ, Gotlib IH. BDNF genotype moderates the relation between physical activity and depressive symptoms. Health Psychol. 2010;29(2): 130-133.
- 10. Synnott A, O'Keeffe M, Bunzli S, et al. Physiotherapists may stigmatise or feel unprepared to treat people with low back pain and psychosocial factors that influence recovery: a systematic review. J Physiother. 2015;61(2):68-76.
- 11. Chen Y, Ju P, Xia Q, et al. Potential role of pain catastrophic thinking in comorbidity patients of depression and chronic pain. Front Psychiatry. 2022;13:839173.
- 12. Craner JR, Gilliam WP, Sperry JA. Rumination, magnification, and helplessness: how do different aspects of pain catastrophizing relate to pain severity and functioning? Clin J Pain. 2016;32(12):1028-1035.
- 13. Szabo YZ, Burns CM, Lantrip C. Understanding associations between rumination and inflammation: A scoping review. Neurosci Biobehav Rev. 2022;135:104523.
- 14. Watkins ER, Roberts H. Reflecting on rumination: Consequences, causes, mechanisms and treatment of rumination. Behav Res Ther. 2020;127:103573.
- 15. Lebel RD. Moving beyond fight and flight: A contingent model of how the emotional regulation of anger and fear sparks proactivity. Acad Manag Rev. 2017;42(2):190-206.
- 16. Merriam-Webster online dictionary website. https://www.merriam-webster.com/dictionary/rumination Erişim tarihi 26 Ekim, 2022.
- 17. Karatepe HT. Ruminatif Düşünme Biçimi Ölçeği’nin Türkçe Uyarlaması, Geçerlik ve Güvenirlik Çalışması. Tıpta Uzmanlık Tezi. Sağlık Bakanlığı; 2010.
- 18. Watkins ER. Constructive and unconstructive repetitive thought. Psychol Bull. 2008;134(2):163-206.
- 19. Nolen-Hoeksema S, Wisco BE, Lyubomirsky S. Rethinking Rumination. Perspect Psychol Sci. 2008;3(5):400-424.
- 20. Surrence K, Miranda R, Marroquín BM, Chan S. Brooding and reflective rumination among suicide attempters: Cognitive vulnerability to suicidal ideation. Behav Res Ther. 2009;47(9):803-808.
- 21. Treynor W, Gonzalez R, Nolen-Hoeksema S. Rumination reconsidered: A psychometric analysis. Cognit Ther Res. 2003;27(3):247-259.
- 22. Busch LY, Pössel P, Valentine JC. Meta-analyses of cardiovascular reactivity to rumination: A possible mechanism linking depression and hostility to cardiovascular disease. Psychol Bull. 2017;143(12): 1378-1394.
- 23. Clancy F, Prestwich A, Caperon L, O'Connor DB. Perseverative cognition and health behaviors: A systematic review and meta-analysis. Front Hum Neurosci. 2016;10:534.
- 24. Thomsen DK, Mehlsen MY, Olesen F, et al. Is there an association between rumination and self-reported physical health? A one-year follow-up in a young and an elderly sample. J Behav Med. 2004;27(3):215-231.
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- 26. Ling FC, Masters RS, McManus AM. Rehearsal and pedometer reactivity in children. J Clin Psychol. 2011;67(3):261-266.
- 27. Puterman E, O'Donovan A, Adler NE, et al. Physical activity moderates effects of stressor-induced rumination on cortisol reactivity. Psychosom Med. 2011;73(7):604-611.
- 28. Wells A, Matthews G. Modelling cognition in emotional disorder: the S-REF model. Behav Res Ther. 1996;34(11-12):881-888.
- 29. Weber F, Exner C. Metacognitive beliefs and rumination: A longitudinal study. Cognit Ther Res. 2013;37(6):1257-1261.
- 30. Schütze R, Rees C, Smith A, Slater H, O'Sullivan P. Metacognition, perseverative thinking, and pain catastrophizing: A moderated-mediation analysis. Eur J Pain. 2020;24(1):223-233.
- 31. Peters ML. Emotional and cognitive influences on pain experience. Mod Trends Pharmacopsychiatry. 2015;30:138-152.
- 32. Melzack R, Wall PD. The Challenge of Pain. United Kingdom:Penguin; 1988.
- 33. Leeuw M, Goossens ME, Linton SJ, et al. The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. J Behav Med. 2007;30(1):77-94.
- 34. Ugurlu M, Karakas Ugurlu G, Erten S, Caykoylu A. Validity of Turkish form of Pain Catastrophizing Scale and modeling of the relationship between pain-related disability with pain intensity, cognitive, and emotional factors. Psychiatry Clin Psychopharmacol. 2017;27(2):189-196.
- 35. Stubbs B, Patchay S, Soundy A, Schofield P. The avoidance of activities due to fear of falling contributes to sedentary behavior among community-dwelling older adults with chronic musculoskeletal pain: a multisite observational study. Pain Med. 2014;15(11):1861-1871.
- 36. Duport A, Pelletier R, Martel M, Léonard G. The influence of kinesiophobia and pain catastrophizing on pain-induced corticomotor modulation in healthy participants: A cross sectional study. Neurophysiol Clin. 2022;52(5):375-383.
- 37. Luque-Suarez A, Martinez-Calderon J, Falla D. Role of kinesiophobia on pain, disability and quality of life in people suffering from chronic musculoskeletal pain: a systematic review. Br J Sports Med. 2019;53(9):554-559.
- 38. Caneiro JP, Bunzli S, O'Sullivan P. Beliefs about the body and pain: the critical role in musculoskeletal pain management. Braz J Phys Ther. 2021;25(1):17-29.
- 39. Cigdem Karacay B, Sahbaz T, Medin Ceylan C. The vicious cycle of physical inactivity, fatigue and kinesiophobia in patients with fibromyalgia syndrome. Reumatismo. 2023;74(4):160-167.
- 40. Kucyi A, Moayedi M, Weissman-Fogel I, et al. Enhanced medial prefrontal-default mode network functional connectivity in chronic pain and its association with pain rumination. J Neurosci. 2014;34(11):3969-3975.
- 41. Sansone RA, Sansone LA. Rumination: relationships with physical health. Innov Clin Neurosci. 2012;9(2): 29-34.
- 42. Sullivan MJL, Bishop SR, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assess. 1995;7(4):524-532.
- 43. Nijs J, Van de Putte K, Louckx F, Truijen S, De Meirleir K. Exercise performance and chronic pain in chronic fatigue syndrome: the role of pain catastrophizing. Pain Med. 2008;9(8):1164-1172.
- 44. Gilliam W, Burns JW, Quartana P, et al. Interactive effects of catastrophizing and suppression on responses to acute pain: a test of an appraisal x emotion regulation model. J Behav Med. 2010;33(3): 191-199.
- 45. Edwards MJ, Tang NKY, Wright AM, Salkovskis PM, Timberlake CM. Thinking about thinking about pain: a qualitative investigation of rumination in chronic pain. Pain Manag. 2011;1(4):311-323.
- 46. Schütze R, Rees C, Slater H, Smith A, O'Sullivan P. ‘I call it stinkin’thinkin’’: A qualitative analysis of metacognition in people with chronic low back pain and elevated catastrophizing. Br J Health Psychol. 2017;22(3):463-480.
- 47. Sousa T, Neves P. Two tales of rumination and burnout: Examining the effects of boredom and overload. Appl Psychol. 2021;70(3):1018-1044.
- 48. Nolen-Hoeksema S, Morrow J. A prospective study of depression and posttraumatic stress symptoms after a natural disaster: the 1989 Loma Prieta Earthquake. J Pers Soc Psychol. 1991;61(1):115.
- 49. Brinker JK, Dozois DJ. Ruminative thought style and depressed mood. J Clin Psychol. 2009;65(1):1-19.
- 50. Erdur Baker Ö, Bugay Tuna A. The Turkish version of the Ruminative Response Scale An examination of its reliability and validity. Int J Educ Psychol Assess. 2012;10(2):1-16.
- 51. Erdur O. Psychological Reactions of Turkish Earthquake Survivors. Doktora Tezi. University of Texas; 2002.
- 52. Karatepe HT, Yavuz FK, Turkcan A. Validity and reliability of the Turkish version of the ruminative thought style questionnaire. Bull Clin Psychopharmacol. 2013;23(3):231-241.
- 53. İlçin N, Gürpınar B, Bayraktar D, et al. Cross-cultural adaptation and validation of the Turkish version of the pain catastrophizing scale among patients with ankylosing spondylitis. J Phys Ther Sci. 2016;28(1): 298-303.
- 54. Alderman BL, Olson RL, Brush CJ, Shors TJ. MAP training: combining meditation and aerobic exercise reduces depression and rumination while enhancing synchronized brain activity. Transl Psychiatry. 2016;6(2):e726.
- 55. Brand S, Colledge F, Ludyga S, et al. Acute Bouts of Exercising Improved Mood, Rumination and Social Interaction in Inpatients With Mental Disorders. Front Psychol. 2018;13(9):249.
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Ruminasyonun Tanınması ve Ağrı Deneyimi ve Fiziksel Aktivite ile İlişkisinin İncelenmesi: Geleneksel Derleme
Yıl 2023,
Cilt: 7 Sayı: 3, 381 - 390, 20.12.2023
Damla Karabay
,
Faruk Tanık
,
Merve Keskin
,
Orhan Öztürk
,
Merve Kurt
,
Derya Özer Kaya
Öz
Kas iskelet sistemi ağrılarının, egzersiz müdahalelerini merkeze alan biyopsikososyal bir yaklaşımla ele alınması gerektiği son yıllarda sıklıkla vurgulanmaktadır. Ağrı felaketleştirme gibi olumsuz ağrı inançları kinezyofobi ve fiziksel inaktiviteye yol açabilir. Fiziksel inaktivite ise ağrının kronikleşmesi ve korkunun artmasına yol açarak bir kısır döngüye neden olabilir. Ruminasyon, abartılı algılama ve çaresizlik ile birlikte ağrı felaketleştirmenin üç alt boyutu arasında yer alır. Sözlükte “geviş getirmek” ve “zihinde tekrar tekrar gözden geçirmek” olarak tanımlanan ruminasyonun fiziksel sağlığı olumsuz etkilediği ve kronik ağrı, kardiyovasküler hastalık ve obezite gibi kronik durumlara sahip bireylerde yüksek bulunduğu bilinmektedir. Araştırmalar ruminasyonun ağrı ile pozitif ve fiziksel aktivite ile negatif yönde ilişkili olduğunu ortaya koymaktadır. Ruminasyon düzeyindeki artış daha fazla ağrı şiddeti, duygusal sıkıntı ve ağrıya karşı olumsuz tutum oluşturabilmekte ve aynı zamanda fiziksel aktivite seviyesinde azalma ile sonuçlanabilmektedir. Yapılandırılmış egzersiz programları, kas iskelet sistemi ağrısının yanı sıra ruminasyonun olumsuz etkileri için de faydalı sonuçlar oluşturabilir. Ancak depresyon artmış ruminasyona sıklıkla eşlik eder ve fiziksel aktiviteden alınan keyfi azaltarak egzersize bağlılık açısından risk oluşturabilir. Bu derleme ile ruminasyonun ağrı ve fiziksel aktivite ile ilişkisi hakkındaki bilgilerin gözden geçirilmesi amaçlanmıştır. Sonuç olarak, ruminasyonun azaltılmasını amaçlayan fiziksel aktivite programları aerobik aktiviteler, farkındalık egzersizleri, germe ve kuvvetlendirme egzersizlerini içerebilir. Egzersizlerin haftada 3 kez ve 30-60 dakika olarak yapılması fayda sağlayabilir.
Kaynakça
- 1. Siddall PJ, Cousins MJ. Persistent pain as a disease entity: implications for clinical management. Anesthesia and analgesia. 2004;99(2):510-520.
- 2. Booth J, Moseley GL, Schiltenwolf M, et al. Exercise for chronic musculoskeletal pain: A biopsychosocial approach. Musculoskeletal care. 2017;15(4):413-421.
- 3. Moseley GL, Butler DS. Fifteen years of explaining pain: The past, present, and future. J Pain. 2015;16(9):807-813.
- 4. Gatchel RJ, Peng YB, Peters ML, Fuchs PN, Turk DC. The biopsychosocial approach to chronic pain: scientific advances and future directions. Psychol Bull. 2007;133(4):581-624.
- 5. Watson JA, Ryan CG, Cooper L, et al. Pain neuroscience education for adults with chronic musculoskeletal pain: A mixed-methods systematic review and meta-analysis. J Pain. 2019;20(10): 1140.e1-1140.e22.
- 6. Louw A, Zimney K, Puentedura EJ, Diener I. The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. Physiother Teory Pract. 2016;32(5):332-355.
- 7. Silva Guerrero AV, Maujean A, Campbell L, Sterling M. A systematic review and meta-analysis of the effectiveness of psychological interventions delivered by physiotherapists on pain, disability and psychological outcomes in musculoskeletal pain conditions. Clin J Pain. 2018;34(9):838-857.
- 8. Kagawa F, Yokoyama S, Takamura M, et al. Decreased physical activity with subjective pleasure is associated with avoidance behaviors. Sci Rep. 2022;12(1):1-8.
- 9. Mata J, Thompson RJ, Gotlib IH. BDNF genotype moderates the relation between physical activity and depressive symptoms. Health Psychol. 2010;29(2): 130-133.
- 10. Synnott A, O'Keeffe M, Bunzli S, et al. Physiotherapists may stigmatise or feel unprepared to treat people with low back pain and psychosocial factors that influence recovery: a systematic review. J Physiother. 2015;61(2):68-76.
- 11. Chen Y, Ju P, Xia Q, et al. Potential role of pain catastrophic thinking in comorbidity patients of depression and chronic pain. Front Psychiatry. 2022;13:839173.
- 12. Craner JR, Gilliam WP, Sperry JA. Rumination, magnification, and helplessness: how do different aspects of pain catastrophizing relate to pain severity and functioning? Clin J Pain. 2016;32(12):1028-1035.
- 13. Szabo YZ, Burns CM, Lantrip C. Understanding associations between rumination and inflammation: A scoping review. Neurosci Biobehav Rev. 2022;135:104523.
- 14. Watkins ER, Roberts H. Reflecting on rumination: Consequences, causes, mechanisms and treatment of rumination. Behav Res Ther. 2020;127:103573.
- 15. Lebel RD. Moving beyond fight and flight: A contingent model of how the emotional regulation of anger and fear sparks proactivity. Acad Manag Rev. 2017;42(2):190-206.
- 16. Merriam-Webster online dictionary website. https://www.merriam-webster.com/dictionary/rumination Erişim tarihi 26 Ekim, 2022.
- 17. Karatepe HT. Ruminatif Düşünme Biçimi Ölçeği’nin Türkçe Uyarlaması, Geçerlik ve Güvenirlik Çalışması. Tıpta Uzmanlık Tezi. Sağlık Bakanlığı; 2010.
- 18. Watkins ER. Constructive and unconstructive repetitive thought. Psychol Bull. 2008;134(2):163-206.
- 19. Nolen-Hoeksema S, Wisco BE, Lyubomirsky S. Rethinking Rumination. Perspect Psychol Sci. 2008;3(5):400-424.
- 20. Surrence K, Miranda R, Marroquín BM, Chan S. Brooding and reflective rumination among suicide attempters: Cognitive vulnerability to suicidal ideation. Behav Res Ther. 2009;47(9):803-808.
- 21. Treynor W, Gonzalez R, Nolen-Hoeksema S. Rumination reconsidered: A psychometric analysis. Cognit Ther Res. 2003;27(3):247-259.
- 22. Busch LY, Pössel P, Valentine JC. Meta-analyses of cardiovascular reactivity to rumination: A possible mechanism linking depression and hostility to cardiovascular disease. Psychol Bull. 2017;143(12): 1378-1394.
- 23. Clancy F, Prestwich A, Caperon L, O'Connor DB. Perseverative cognition and health behaviors: A systematic review and meta-analysis. Front Hum Neurosci. 2016;10:534.
- 24. Thomsen DK, Mehlsen MY, Olesen F, et al. Is there an association between rumination and self-reported physical health? A one-year follow-up in a young and an elderly sample. J Behav Med. 2004;27(3):215-231.
- 25. Zhou HX, Chen X, Shen YQ, et al. Rumination and the default mode network: Meta-analysis of brain imaging studies and implications for depression. Neuroimage. 2020;206:116287.
- 26. Ling FC, Masters RS, McManus AM. Rehearsal and pedometer reactivity in children. J Clin Psychol. 2011;67(3):261-266.
- 27. Puterman E, O'Donovan A, Adler NE, et al. Physical activity moderates effects of stressor-induced rumination on cortisol reactivity. Psychosom Med. 2011;73(7):604-611.
- 28. Wells A, Matthews G. Modelling cognition in emotional disorder: the S-REF model. Behav Res Ther. 1996;34(11-12):881-888.
- 29. Weber F, Exner C. Metacognitive beliefs and rumination: A longitudinal study. Cognit Ther Res. 2013;37(6):1257-1261.
- 30. Schütze R, Rees C, Smith A, Slater H, O'Sullivan P. Metacognition, perseverative thinking, and pain catastrophizing: A moderated-mediation analysis. Eur J Pain. 2020;24(1):223-233.
- 31. Peters ML. Emotional and cognitive influences on pain experience. Mod Trends Pharmacopsychiatry. 2015;30:138-152.
- 32. Melzack R, Wall PD. The Challenge of Pain. United Kingdom:Penguin; 1988.
- 33. Leeuw M, Goossens ME, Linton SJ, et al. The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. J Behav Med. 2007;30(1):77-94.
- 34. Ugurlu M, Karakas Ugurlu G, Erten S, Caykoylu A. Validity of Turkish form of Pain Catastrophizing Scale and modeling of the relationship between pain-related disability with pain intensity, cognitive, and emotional factors. Psychiatry Clin Psychopharmacol. 2017;27(2):189-196.
- 35. Stubbs B, Patchay S, Soundy A, Schofield P. The avoidance of activities due to fear of falling contributes to sedentary behavior among community-dwelling older adults with chronic musculoskeletal pain: a multisite observational study. Pain Med. 2014;15(11):1861-1871.
- 36. Duport A, Pelletier R, Martel M, Léonard G. The influence of kinesiophobia and pain catastrophizing on pain-induced corticomotor modulation in healthy participants: A cross sectional study. Neurophysiol Clin. 2022;52(5):375-383.
- 37. Luque-Suarez A, Martinez-Calderon J, Falla D. Role of kinesiophobia on pain, disability and quality of life in people suffering from chronic musculoskeletal pain: a systematic review. Br J Sports Med. 2019;53(9):554-559.
- 38. Caneiro JP, Bunzli S, O'Sullivan P. Beliefs about the body and pain: the critical role in musculoskeletal pain management. Braz J Phys Ther. 2021;25(1):17-29.
- 39. Cigdem Karacay B, Sahbaz T, Medin Ceylan C. The vicious cycle of physical inactivity, fatigue and kinesiophobia in patients with fibromyalgia syndrome. Reumatismo. 2023;74(4):160-167.
- 40. Kucyi A, Moayedi M, Weissman-Fogel I, et al. Enhanced medial prefrontal-default mode network functional connectivity in chronic pain and its association with pain rumination. J Neurosci. 2014;34(11):3969-3975.
- 41. Sansone RA, Sansone LA. Rumination: relationships with physical health. Innov Clin Neurosci. 2012;9(2): 29-34.
- 42. Sullivan MJL, Bishop SR, Pivik J. The pain catastrophizing scale: development and validation. Psychol Assess. 1995;7(4):524-532.
- 43. Nijs J, Van de Putte K, Louckx F, Truijen S, De Meirleir K. Exercise performance and chronic pain in chronic fatigue syndrome: the role of pain catastrophizing. Pain Med. 2008;9(8):1164-1172.
- 44. Gilliam W, Burns JW, Quartana P, et al. Interactive effects of catastrophizing and suppression on responses to acute pain: a test of an appraisal x emotion regulation model. J Behav Med. 2010;33(3): 191-199.
- 45. Edwards MJ, Tang NKY, Wright AM, Salkovskis PM, Timberlake CM. Thinking about thinking about pain: a qualitative investigation of rumination in chronic pain. Pain Manag. 2011;1(4):311-323.
- 46. Schütze R, Rees C, Slater H, Smith A, O'Sullivan P. ‘I call it stinkin’thinkin’’: A qualitative analysis of metacognition in people with chronic low back pain and elevated catastrophizing. Br J Health Psychol. 2017;22(3):463-480.
- 47. Sousa T, Neves P. Two tales of rumination and burnout: Examining the effects of boredom and overload. Appl Psychol. 2021;70(3):1018-1044.
- 48. Nolen-Hoeksema S, Morrow J. A prospective study of depression and posttraumatic stress symptoms after a natural disaster: the 1989 Loma Prieta Earthquake. J Pers Soc Psychol. 1991;61(1):115.
- 49. Brinker JK, Dozois DJ. Ruminative thought style and depressed mood. J Clin Psychol. 2009;65(1):1-19.
- 50. Erdur Baker Ö, Bugay Tuna A. The Turkish version of the Ruminative Response Scale An examination of its reliability and validity. Int J Educ Psychol Assess. 2012;10(2):1-16.
- 51. Erdur O. Psychological Reactions of Turkish Earthquake Survivors. Doktora Tezi. University of Texas; 2002.
- 52. Karatepe HT, Yavuz FK, Turkcan A. Validity and reliability of the Turkish version of the ruminative thought style questionnaire. Bull Clin Psychopharmacol. 2013;23(3):231-241.
- 53. İlçin N, Gürpınar B, Bayraktar D, et al. Cross-cultural adaptation and validation of the Turkish version of the pain catastrophizing scale among patients with ankylosing spondylitis. J Phys Ther Sci. 2016;28(1): 298-303.
- 54. Alderman BL, Olson RL, Brush CJ, Shors TJ. MAP training: combining meditation and aerobic exercise reduces depression and rumination while enhancing synchronized brain activity. Transl Psychiatry. 2016;6(2):e726.
- 55. Brand S, Colledge F, Ludyga S, et al. Acute Bouts of Exercising Improved Mood, Rumination and Social Interaction in Inpatients With Mental Disorders. Front Psychol. 2018;13(9):249.
- 56. World Health Organization. WHO guidelines on physical activity and sedentary behaviour: web annex: evidence profiles. https://apps.who.int/iris/handle/10665/336657 Erişim tarihi 26 Ekim, 2022.
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