Differential Effects of Reflection and Brooding on the Relationship Between Anxiety Sensitivity and Self-harm: A Serial Mediation Study

Abstract

Anxiety sensitivity is known to increase the risk of self-harm; however, the underlying mechanisms remain unclear. Studies have considered rumination as a potential factor that increases the risk of suicide, and anxiety sensitivity has been proposed as a probable factor that affects self-harm through rumination. We investigated the mediating effect of rumination on anxiety sensitivity and self-harm and extended the study by examining the involvement of two subtypes of rumination, reflection and brooding. Responses on anxiety sensitivity, rumination, and history of self-harm were collected from psychiatric patients (N = 148) at a university hospital. Mediation analyses were conducted to examine the simple mediating effect of global rumination and serial mediating effect of reflection and brooding between anxiety sensitivity and self-harm. Rumination mediated the relationship between anxiety sensitivity and self-harm, while reflection and brooding sequentially mediated the path from anxiety sensitivity to self-harm. Additionally, brooding alone mediated this path, whereas reflection alone did not. Our findings indicate that rumination increases the risk of self-harm in psychiatric patients with high anxiety sensitivity. Furthermore, they indicate that reflection may turn into brooding and heighten the risk of self-harm, suggesting that interventions for individuals with high anxiety sensitivity to prevent self-harm should target both reflection and brooding.