British Journal of Clinical Psychology

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British Journal of Clinical Psychology - Early View Articles, Pages ${blockparams.parentJournalIssue.pageRange}

Self‐focused processing after severe traumatic brain injury: Relationship to neurocognitive functioning and mood symptoms


To investigate the impact of neurocognitive functioning on the self‐focused processing styles of rumination and reflection, and the relationship to mood symptoms after severe traumatic brain injury (TBI).


A cross‐sectional design with a between‐group component comparing self‐focused processing styles and mood symptoms of adults with TBI and age‐ and gender‐matched controls.


Fifty‐two participants with severe TBI (75% male, M age = 36.56, SD = 12.39) completed cognitive tests of attention, memory, executive functioning and the Awareness Questionnaire, Reflection and Rumination Questionnaire (RRQ), and Depression, Anxiety, and Stress Scales (DASS – 21). Fifty age‐ and gender‐matched controls completed the RRQ and DASS‐21.


TBI participants reported significantly greater mood symptoms than controls (< .05); however, levels of rumination and reflection did not significantly differ. TBI participants high on both reflection and rumination had significantly greater mood symptoms than those with high reflection and low rumination (< .001). Higher levels of rumination and reflection were associated with better working memory and immediate and delayed verbal memory (r = .36–.43, < .01). Higher levels of rumination were also associated with greater verbal fluency, self‐awareness, and mood symptoms (r = .36–.70, < .01).


Individuals with better memory functioning may be more likely to engage in self‐focused processing after severe TBI. Reflection without ruminative tendencies is more adaptive for mental health than reflection with rumination.

Practitioner points

  • Individuals with severe TBI report more mood symptoms than non‐injured controls but do not differ on self‐focused processing.
  • Poorer memory function is related to lower levels of rumination and reflection.
  • Reflection without ruminative tendencies is adaptive for mental health after severe TBI.
  • Individuals with greater self‐awareness and ruminative tendencies are at increased risk of mental health problems following severe TBI.


  • Rumination and reflection were assessed using a self‐report measure which assumes that people with severe TBI are able to reliably report on self‐focused processing styles.
  • The direction of associations between self‐focused processing, self‐awareness, and mood symptoms could not be determined due to the cross‐sectional design.

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