Self-focused thoughts may be both adaptive and maladaptive. We asked 67 patients who had received a colon-cancer diagnosis within the past 1–7 months to complete measures of rumination, reflection, intrusive and avoidance symptoms and depressive symptoms. At 8 months follow-up they completed the same measures. Higher rumination at time 1 was associated with more symptoms at both times 1 and 2. Reflection at time 1 did not show any associations with symptoms at time 1 and 2. However, time 1 reflection predicted higher time 2 avoidance symptoms, while controlling for time 1 avoidance symptoms. This suggests that while reflection may not be as maladaptive as rumination, it may still under some circumstances be associated with increased symptoms.