The effects of cognitive-behavior therapy for depression on repetitive negative thinking: A meta-analysis
Open accessAbstract
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.
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Spinhoven et al. (2018) conducted a meta-analysis of 36 studies investigating the effects of various forms of CBT on repetitive negative thinking compared with control groups and other treatments.
“Similar to the review by Cristea et al. (2015), Spinhoven et al. (2018) conducted a meta-analysis of 36 studies that investigated the effects of various forms of CBT on repetitive negative thinking (i.e., rumination) compared with control groups and other treatments.”
From The Role of Common Factors in Psychotherapy Outcomes (2019) · cites this paper as Spinhoven et al. 2018
Spinhoven et al. found a medium-size effect of any treatment compared with control, but significantly larger effect sizes for CBT treatments such as rumination-focused CBT and original CBT compared with antidepressant medication and counseling.
“They found a medium-size effect of any treatment compared with the control group, but they also found significantly larger effect sizes for CBT treatments such as rumination-focused CBT and original CBT compared with treatments such as antidepressant medication and counseling.”
From The Role of Common Factors in Psychotherapy Outcomes (2019) · cites this paper as Spinhoven et al. 2018
Spinhoven et al. concluded that CBT and, in particular, rumination-focused CBT might have specific and pronounced effects on repetitive thinking, establishing a link between a therapeutic procedure and a therapeutic process.
“The authors concluded that CBT and, in particular, rumination-focused CBT might have specific and pronounced effects on repetitive thinking, which might be interpreted as establishing a link between a therapeutic procedure (i.e., specific CBT interventions) and a therapeutic process (i.e., rumination).”
From The Role of Common Factors in Psychotherapy Outcomes (2019) · cites this paper as Spinhoven et al. 2018
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Self-citation
- Authors
- Spinhoven, P., Klein, N., Kennis, M., Cramer, A. O. J., Siegle, G., Cuijpers, P., Ormel, J., Hollon, S. D., & Bockting, C. L.
- Affiliations
- Leiden University (NL)
- University of Groningen (NL)
- Utrecht University (NL)
- Tilburg University (NL)
- University of Pittsburgh (US)
- Vrije Universiteit Amsterdam (NL)
- University Medical Center Groningen (NL)
- Vanderbilt University (US)
- Amsterdam UMC Location University of Amsterdam (NL)
- Corresponding author
- Spinhoven, Philip
- ORCID
- Venue
- Behaviour Research and Therapy
- Publisher
- Elsevier BV
- Published
- 2018-07
- Volume
- 106
- Pages
- 71-85
- ISSN
- 0005-7967 (ISSN-L)
- OpenAlex
- W2802393978
- Cited by
- 185
- References
- 37
- Citations by year
- 2026: 16 · 2025: 25 · 2024: 33 · 2023: 27 · 2022: 23 · 2021: 26 · 2020: 18 · 2019: 12 · 2018: 5
- FWCI
- 2.43
- Type
- journal article
- Language
- en
- Open access
- green
- research.rug.nl
- Licence
- Locations
- Behaviour Research and Therapy (publishedVersion)
- PubMed (publishedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (publishedVersion, other-oa)
- VU Research Portal (publishedVersion, other-oa)
- Leiden Repository (Leiden University) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- Pure Amsterdam UMC (submittedVersion)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, cc-by-nc-nd)
- Utrecht University Repository (Utrecht University) (submittedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- cognitive behavioral therapy, repetitive negative thinking, rumination, worry, perseverative thinking, depression treatment, cognitive control training, mindfulness-based cognitive therapy, depression severity, antidepressants, phototherapy, expressive writing
- MeSH terms
- Pessimism, Rumination, Cognitive, Depressive Disorder, Humans, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Treatment Outcome
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