Rumination-focused cognitive behaviour therapy for non-responsive chronic depression: an uncontrolled group study

Abstract

Background:One-third of patients with depression do not respond satisfactorily to treatment, and approximately 20% of all patients treated for depression develop a chronic depression. One approach to more effective treatment of chronic and treatment-resistant depression is to target rumination – an underlying mechanism implicated in the development and maintenance of depression.Aim:The purpose of this uncontrolled group study was to investigate the feasibility of individual rumination-focused cognitive behavioural therapy (RfCBT) for patients with chronic and treatment-resistant depression.Method:A total of 10 patients with chronic and treatment-resistant depression were offered 12–16 individual sessions of RfCBT. The primary outcome was depressive symptoms as measured by Hamilton Depression Scale at pre-, post- and 3-month follow-up. Secondary symptoms measured included self-reported rumination and worry.Results:There was a significant reduction in depressive symptoms (p < 0.05), rumination (p < 0.01) and worry (p < 0.5) from pre- to post-treatment. Half of the participants (n = 5) showed significant reliable change on levels of depressive symptoms post-treatment. The reduction in depressive symptoms, rumination and worry were maintained at follow-up.Conclusions:RfCBT was associated with significant reductions in depressive symptoms in a small sample with chronic and treatment-resistant depression. Despite limitations of being a small uncontrolled study with limited follow-up, these results are promising in a difficult to treat population. RfCBT warrants further systematic evaluation.

Treatment of worry and comorbid symptoms within depression, anxiety, and insomnia with a group-based rumination-focused cognitive-behaviour therapy in a primary health care setting: a randomised controlled trial

“…Third. the intervention dose was smaller than in a comparable study ( Møller et al, 2017 ). The current treatment was administered over a shorter period, with eight instead of 12 sessions at 2 h instead of 3 h per session, and an individual session was not offered before the group sessions.…”

“…The treatment protocol used in the study was based on the published manuals “Rumination-Focused Cognitive-Behavioral Therapy for Depression” ( Watkins, 2018 ) and “Ruminationsfokuseret Kognitiv Adfærdsterapi for Depression” ( Møller et al, 2017 ). All material was translated to Swedish and modified to fit eight 2-h group sessions with nine participants (including 15-min breaks).…”

“…Why is this hard?,” alternative strategy = concrete thinking “What steps can I take to prepare?”). For further elaborations and clarifications regarding specific techniques, see Watkins (2018) and Møller et al (2017) . The treatment protocol used in this study may be shared upon on formal request.…”

Rumination across depression, anxiety, and eating disorders in adults: A meta-analytic review.

“…Although there is some research which highlights the efficacy of rumination-focused CBT, most studies target psychological illnesses in isolation (Hvenegaard et al, 2020; Moeller et al, 2020; Teismann et al, 2014; Watkins, 2016) and often it is only repetitive negative thinking (RNT)-focused treatments that are investigated (Monteregge et al, 2020; Spinhoven et al, 2018). For example, a meta-analysis by Spinhoven et al (2018) investigated whether RNT-focused treatments for depression have a positive effect on RNT that may in turn result in improved depressive symptoms compared with non-RNT-focused treatments.…”

The Impact of Somatic Symptoms on kinesiophobia after Esophagectomy among Cancer Patients: The Mediating Roles of Intrusive Rumination and Avoidant Coping

“…Health care professionals should pay attention to postoperative psychological health in esophageal cancer patients, actively address patients' discomfort, promptly identify patients' intrusive rumination, and take effective intervention measures. Research has shown that cognitive-behavioral therapy [43], mindfulness-based cognitive therapy [44], acceptance and commitment therapy [45], and other methods can effectively reduce patients' levels of intrusive rumination. Moreover, guiding patients to adopt a positive and optimistic approach to dealing with their illness can lower their levels of kinesiophobia.…”