RUMINATION FOLLOWING BEREAVEMENT: ASSESSMENT, WORKING MECHANISMS AND INTERVENTION Maarten C. Eisma Cover drawing: Huike Thinking, attributed to: Shi Ke © Tokyo National Museum Huike says to Bodhidharma: “My mind is anxious, please pacify it.” ISBN: 978-94-6299-002-9 Printing: Ridderprint BV, the Netherlands Layout: Nikki Vermeulen, Ridderprint BV, the Netherlands Copyright: Maarten C. Eisma, 2015 RUMINATION FOLLOWING BEREAVEMENT: ASSESSMENT, WORKING MECHANISMS AND INTERVENTION Ruminatie na een overlijden: Meting, werkzame mechanismen en interventie (met een samenvatting in het Nederlands) Proefschrift ter verkrijging van de graad van doctor aan de Universiteit Utrecht op gezag van de rector magnificus, prof. dr. G.J. van der Zwaan, ingevolge het besluit van het college voor promoties in het openbaar te verdedigen op vrijdag 16 januari 2015 des middags te 2.30 uur door Maarten Cornelis Eisma geboren op 14 mei 1982 te Nijmegen Promotoren: Prof. dr. M.S. Stroebe Prof. dr. W. Stroebe Prof. dr. J. van den Bout Prof. dr. P. A. Boelen Copromotor: Dr. H. A. W. Schut The research described in this thesis was financially supported by a ZonMw TOP Grant of the Dutch Organization for Scientific Research (NWO). “Don’t worry, be happy.” - Bobby McFerrin TABLE OF CONTENTS Chapter 1 General introduction 9 PART 1 ASSESSMENT Chapter 2 Development and psychometric evaluation of the Utrecht Grief 25 Rumination Scale Chapter 3 Adaptive and maladaptive rumination after loss: A three-wave 47 longitudinal study PART 2 WORKING MECHANISMS Chapter 4 Avoidance processes mediate the relationship between rumination 69 and symptoms of complicated grief and depression following loss Chapter 5 Is rumination after bereavement linked with loss avoidance? 91 Evidence from eye-tracking Chapter 6 Rumination and implicit avoidance following bereavement: 115 An approach avoidance task investigation PART 3 INTERVENTION Chapter 7 Internet-delivered exposure and behavioral activation for complicated 135 grief and rumination. A randomized controlled trial Chapter 8 Summary and general discussion 163 Samenvatting (Dutch summary) 181 Dankwoord (Acknowledgements) 195 Curriculum Vitae 201 Publications 205 Appendices 211 C General introduction h a p t e r 1