The effects of cognitive-behavior therapy for depression on repetitive negative thinking: A meta-analysis

Abstract

It is not clear if treatments for depression targeting repetitive negative thinking (RNT: rumination, worry and content-independent perseverative thinking) have a specific effect on RNT resulting in better outcomes than treatments that do not specifically target rumination. We conducted a systematic search of PsycINFO, PubMed, Embase and the Cochrane library for randomized trials in adolescents, adults and older adults comparing CBT treatments for (previous) depression with control groups or with other treatments and reporting outcomes on RNT. Inclusion criteria were met by 36 studies with a total of 3307 participants. At post-test we found a medium-sized effect of any treatment compared to control groups on RNT (g = 0.48; 95% CI: 0.37-0.59). Rumination-focused CBT: g = 0.76, <0.01; Cognitive Control Training: g = 0.62, p < .01; CBT: g = 0.57, p < .01; Concreteness training: g = 0.53, p < .05; and Mindfulness-based Cognitive Therapy: g = 0.42, p < .05 had medium sized and significantly larger effect sizes than other types of treatment (i.e., anti-depressant medication, light therapy, engagement counseling, life review, expressive writing, yoga) (g = 0.14) compared to control groups. Effects on RNT at post-test were strongly associated with the effects on depression severity and this association was only significant in RNT-focused CBT. Our results suggest that in particular RNT-focused CBT may have a more pronounced effect on RNT than other types of interventions. Further mediation and mechanistic studies to test the predictive value of reductions in RNT following RNT-focused CBT for subsequent depression outcomes are called for.

Group rumination-focused cognitive-behavioural therapy (CBT) v. group CBT for depression: phase II trial

“…As such, we need to be cautious about making any strong interpretation of these findings. Second, it may be that group CBT is also effective at reducing rumination, perhaps because challenging negative thoughts, increased problem solving and activity scheduling all act to break the vicious circle of rumination, as suggested in a recent meta-analysis (Spinhoven et al ., 2018), although this meta-analysis also found that treatments targeting rumination tended to produce stronger reductions in rumination.…”

Emotion regulation in posttraumatic stress disorder (PTSD): Rumination accounts for the association between emotion regulation difficulties and PTSD severity

“…In fact, a recent meta‐analysis of randomized trials for depression found that interventions targeting repetitive negative thoughts (e.g., RF‐CBT, Cognitive Control Training) demonstrated medium‐sized treatment effects on rumination at posttreatment when compared to alternative control interventions (e.g., anti‐depressant medication). For RF‐CBT specifically, posttreatment effects on repetitive negative thoughts were strongly associated with posttreatment effects on depressive symptoms (Spinhoven et al, ). Taken together with past research, our findings suggest that rumination may be even more important to target in PTSD treatment than ER difficulties—a more common focus of recent treatments—given that rumination accounted for the association between ER difficulties and PTSD.…”

Brief, Non-Pharmacological, Interventions for Pediatric Anxiety: Meta-Analysis and Evidence Base Status

“…Statistical Package for the Social Sciences (IBM's SPSS) with the MetaF macros provided by Wilson (2003). This macro uses a mixed effect model to test for moderation, whereby studies within subgroups are pooled using random effects approaches, while tests of significance between subgroups are conducted using fixed effect approaches (Borenstein et al, 2009;Spinhoven et al, 2018). In addition, two approaches were taken to increase confidence in moderator findings.…”