Construal level, rumination, and psychological distress in palliative care


Mood Disorders Centre, Washington Singer Laboratories, University of Exeter, Perry Road, Exeter EX4 4QG, UK. E-mail:



Patients with a life-limiting illness, such as cancer, and their carers experience elevated psychological distress. However, the psychological mechanisms underpinning distress in palliative care have been little studied. Recent theories predict that individuals who experience increased uncertainty in the context of ongoing difficulties, such as palliative patients and their carers, will (a) think more abstractly; (b) ruminate more; and (c) be more distressed.


Palliative patients (n = 36, 90% with cancer), their carers (n = 29), and age-matched controls (n = 30) completed standardized questionnaires to assess anxiety, depression, and rumination, and open-ended interviews to identify their concerns and idiosyncratic levels of rumination. Concerns were analyzed linguistically for level of abstraction.


As predicted, (i) palliative patients and carers reported significantly more uncertainty, rumination, and abstract thinking than controls; (ii) uncertainty, abstractness, and rumination were associated with psychological distress.


Abstraction and rumination are psychological mechanism potentially involved in increased psychological distress in palliative care.

Copyright © 2011 John Wiley & Sons, Ltd.