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

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

Research output: Contribution to journalArticleAcademicpeer-review



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.


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).


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.


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


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.

Copyright © 2014 Elsevier Ltd. All rights reserved.
Original languageEnglish
Pages (from-to)84-91
JournalJournal of Behavior Therapy and Experimental Psychiatry
Publication statusPublished - Jun 2015


  • Approach avoidance task
  • Avoidance
  • Prolonged grief
  • Rumination
  • Worry


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