Depressive rumination: Investigating mechanisms to improve cognitive behavioural treatments
Open accessAbstract
Rumination has been identified as a core process in the development and maintenance of depression. Treatments targeting ruminative processes may, therefore, be particularly helpful for treating chronic and recurrent depression. The development of such treatments requires translational research that marries clinical trials, process-outcome research, and basic experimental research that investigates the mechanisms underpinning pathological rumination. For example, a program of experimental research has demonstrated that there are distinct processing modes during rumination that have distinct functional effects for the consequences of rumination on a range of clinically relevant cognitive and emotional processes: an adaptive style characterized by more concrete, specific processing and a maladaptive style characterized by abstract, overgeneral processing. Based on this experimental work, two new treatments for depression have been developed and evaluated: (a) rumination-focused cognitive therapy, an individual-based face-to-face therapy, which has encouraging results in the treatment of residual depression in an extended case series and a pilot randomized controlled trial; and (b) concreteness training, a facilitated self-help intervention intended to increase specificity of processing in patients with depression, which has beneficial findings in a proof-of-principle study in a dysphoric population. These findings indicate the potential value of process-outcome research (a) explicitly targeting identified vulnerability processes and (b) developing interventions informed by research into basic mechanisms.
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Mindfulness improves concrete thinking abilities.
“Moreover, mindfulness improves concrete thinking abilities, focusing on internal and external experiences occurring in the present moment and helping to reduce rumination in depressive and anxiety disorders.3,24”
From Mindfulness in mood and anxiety disorders: A review of the literature (2017) · cites this paper as [24]
The Increasing specificity section reports that concreteness training led to more specific descriptions and reduced rumination in dysphoric participants. It does not identify that training as mindfulness or show that mindfulness improves concrete thinking; the passages also do not establish the claim for anxiety disorders. Searches for mindfulness and present-moment attention found no supporting passage. (LLM, conf=0.82)
Experimental — accuracy not yet measuredMindfulness helps reduce rumination in depressive and anxiety disorders.
“Moreover, mindfulness improves concrete thinking abilities, focusing on internal and external experiences occurring in the present moment and helping to reduce rumination in depressive and anxiety disorders.3,24”
From Mindfulness in mood and anxiety disorders: A review of the literature (2017) · cites this paper as [24]
The Discussion (page unavailable) says that training people to think more concretely may reduce depressive rumination. The Rumination-focused CBT section (page unavailable) discusses other strategies for reducing rumination, but neither section addresses whether mindfulness reduces rumination in depression or anxiety disorders (searched: mindfulness, anxiety disorders, present-moment awareness). (LLM, conf=0.76)
Experimental — accuracy not yet measuredAdolescents and adults with childhood abuse histories are more likely to ruminate.
“Research indicating that adolescents and adults abused as children are more likely to engage in rumination lends credence to this idea (Conway et al. 2004; Sarin and Nolen-Hoeksema 2010; Watkins 2009).”
From Childhood maltreatment exposure and disruptions in emotion regulation: A transdiagnostic pathway to adolescent internalizing and externalizing psychopathology (2016) · cites this paper as Watkins 2009
Maltreated adolescents engaged in higher levels of rumination.
“Our finding that maltreated adolescents engaged in higher levels of rumination is consistent with prior evidence suggesting that child abuse influences reliance on passive cognitive response styles rather than a more active problem-solving response style focused on remedying the cause of distress”
From Childhood maltreatment exposure and disruptions in emotion regulation: A transdiagnostic pathway to adolescent internalizing and externalizing psychopathology (2016) · cites this paper as Watkins 2009
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Cites
Baron, R. M., & Kenny, D. A. (1986) · Journal of Personality and Social Psychology · doi:10.1037//0022-3514.51.6.1173 · Cited by 91,542 · see citing works
Responses to depression and their effects on the duration of depressive episodes
Nolen-Hoeksema, S. (1991) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.100.4.569 · Cited by 4,529 · see citing works
The role of rumination in depressive disorders and mixed anxiety/depressive symptoms.
Nolen-Hoeksema, S. (2000) · Journal of Abnormal Psychology · doi:10.1037//0021-843x.109.3.504 · Cited by 2,998 · see citing works
Cognitive Therapy and the Emotional Disorders
Ince, L. P. (1977) · American Journal of Psychotherapy · doi:10.1176/appi.psychotherapy.1977.31.4.633 · Cited by 2,889 · see citing works
Mediators and Moderators of Treatment Effects in Randomized Clinical Trials
Kraemer, H. C., Wilson, G. T., Fairburn, C. G., & Agras, W. S. (2002) · Archives of General Psychiatry · doi:10.1001/archpsyc.59.10.877 · Cited by 2,562 · cited 1× · see citing works
“Without temporal precedence, the relationship between change in the putative mediator and symptom change could reflect reverse causation such that change in depressive symptoms results in change in rumination (Kraemer et al., 2002).”
BackgroundConstructive and unconstructive repetitive thought
Watkins, E. R. (2008) · Psychological Bulletin · doi:10.1037/0033-2909.134.2.163 · Cited by 2,421 · see citing works
Self-citationAutobiographical memory specificity and emotional disorder.
Williams, J. M. G., Barnhofer, T., Crane, C., Herman, D., Raes, F., Watkins, E., & Dalgleish, T. (2007) · Psychological Bulletin · doi:10.1037/0033-2909.133.1.122 · Cited by 1,688 · cited 3× · see citing works
“…in which a general rule or conclusion is drawn on the basis of isolated incidents and applied across the board to related and unrelated situations (Beck, 1976; Carver & Ganellen, 1983) or increased retrieval of categoric and overgeneral autobiographical memories (Williams et al., 2007).”
BackgroundSelf-citationA component analysis of cognitive-behavioral treatment for depression.
Jacobson, N. S., Dobson, K. S., Truax, P. A., Addis, M. E., Koerner, K., Gollan, J. K., Gortner, E., & Prince, S. E. (1996) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.64.2.295 · Cited by 1,413 · see citing works
Cognitive therapy and emotional disorders
Wolpe, J. (1977) · Journal of Behavior Therapy and Experimental Psychiatry · doi:10.1016/0005-7916(77)90053-2 · Cited by 1,282 · see citing works
(2001) · Medical Entomology and Zoology · Cited by 915 · see citing works
Determinants of change in cognitive therapy for depression
DeRubeis, R. J., & Feeley, M. (1990) · Cognitive Therapy and Research · doi:10.1007/bf01172968 · Cited by 401 · see citing works
Feeley, M., DeRubeis, R. J., & Gelfand, L. A. (1999) · Journal of Consulting and Clinical Psychology · doi:10.1037//0022-006x.67.4.578 · Cited by 349 · see citing works
Rumination-focused cognitive behaviour therapy for residual depression: A case series
Watkins, E. R., Scott, J. L., Wingrove, J., Rimes, K. A., Bathurst, N., Steiner, H., Kennell-Webb, S. A., Moulds, M. L., & Malliaris, Y. (2007) · Behaviour Research and Therapy · doi:10.1016/j.brat.2006.09.018 · Cited by 324 · see citing works
Self-citationWatkins, E. R., Moberly, N. J., & Moulds, M. L. (2008) · Emotion · doi:10.1037/1528-3542.8.3.364 · Cited by 286 · see citing works
Self-citationWatkins, E., Baeyens, C., & Read, R. (2009) · Journal of Abnormal Psychology · doi:10.1037/a0013642 · Cited by 243 · see citing works
Self-citationFeeley, M., DeRubeis, R. J., & Gelfand, L. A. (1999) · Journal of Consulting and Clinical Psychology · doi:10.1037/0022-006x.67.4.578 · Cited by 243 · see citing works
Carver, C. S., & Ganellen, R. J. (1983) · Journal of Abnormal Psychology · doi:10.1037/0021-843x.92.3.330 · Cited by 173 · see citing works
Reduced autobiographical memory specificity and affect regulation
Raes, F., Hermans, D., Williams, J. M. G., & Eelen, P. (2006) · Cognition & Emotion · doi:10.1080/02699930500341003 · Cited by 131 · see citing works
Generalization, Adverse Events, and Development of Depressive Symptoms
Carver, C. S. (1998) · Journal of Personality · doi:10.1111/1467-6494.00026 · Cited by 94 · see citing works
Concreteness training reduces dysphoria: A pilot proof-of-principle study
Watkins, E. R., & Moberly, N. J. (2008) · Behaviour Research and Therapy · doi:10.1016/j.brat.2008.10.014 · Cited by 83 · see citing works
Self-citationManber, R., Arnow, B. A., Blasey, C. M., Vivian, D., McCullough, J. P., Blalock, J. A., Klein, D. N., Markowitz, J. C., Riso, L. P., Rothbaum, B. O., et al. (2003) · Psychological Medicine · doi:10.1017/s0033291703007608 · Cited by 50 · see citing works
Carver, C. S., & Ganellen, R. J. (1983) · Journal of Abnormal Psychology · doi:10.1037//0021-843x.92.3.330 · Cited by 48 · see citing works
Prevention of Relapse in Residual Depression by Cognitive Therapy: A Controlled Trial
Paykel, E. S., Scott, J., Teasdale, J. D., Johnson, A. L., Garland, A., Moore, R., Jenaway, A., Cornwall, P. L., Hayhurst, H., Abbott, R., et al. (1999) · Archives of General Psychiatry · doi:10.1001/archpsyc.56.9.829 · Cited by 20 · see citing works
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- Watkins E. R. Scott J. Wingrove J. Rimes K. A. Bathurst N. Steiner H. Rumination-focused cognitive behaviour therapy for residual depression: A case series Behaviour Research and Therapy 2007 45 2144 2154 17367751
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Sorted by citations
Nolen-Hoeksema, S., & Watkins, E. R. (2011) · Perspectives on Psychological Science · doi:10.1177/1745691611419672 · Cited by 863 · see citing works
Self-citationWatkins, E. R., Mullan, E., Wingrove, J., Rimes, K., Steiner, H., Bathurst, N., Eastman, R., & Scott, J. (2011) · British Journal of Psychiatry · doi:10.1192/bjp.bp.110.090282 · Cited by 410 · see citing works
Self-citationDesrosiers, A., Vine, V., Klemanski, D. H., & Nolen-Hoeksema, S. (2013) · Depression and Anxiety · doi:10.1002/da.22124 · Cited by 392 · see citing works
“[32, 59] In addition, recent studies show that improving concrete thinking abilities and increasing experiential absorption in present experiences are critical for reducing rumination.[59] Mindfulness involves both of these processes in that it encourages individuals to observe and describe experiences in the present…”
BackgroundHeleniak, C., Jenness, J. L., Vander Stoep, A., McCauley, E., & McLaughlin, K. A. (2016) · Cognitive Therapy and Research · doi:10.1007/s10608-015-9735-z · Cited by 371 · see citing works
Mapping Mindfulness Facets Onto Dimensions of Anxiety and Depression
Desrosiers, A., Klemanski, D. H., & Nolen-Hoeksema, S. (2013) · Behavior Therapy · doi:10.1016/j.beth.2013.02.001 · Cited by 176 · see citing works
“…and general distress-depression, as staying focused on present moment experience is antithetical to cardinal features of generalized psychological distress, such as rumination about past events (i.e., depression) or worry about future events (i.e., anxiety; Holzel et al., 2011; Watkins, 2009).”
BackgroundWatkins, E. R., Taylor, R. S., Byng, R., Baeyens, C., Read, R., Pearson, K., & Watson, L. (2012) · Psychological Medicine · doi:10.1017/s0033291711002480 · Cited by 160 · see citing works
“, including warning signs and actions that may have influenced its outcome; (iii) focusing on how to move forward by specifying the particular steps and behaviours to do next (Watkins, 2009 ; Watkins et al. 2009).”
BackgroundSelf-citationDesrosiers, A., Vine, V., Curtiss, J., & Klemanski, D. H. (2014) · Journal of Affective Disorders · doi:10.1016/j.jad.2014.04.024 · Cited by 163 · see citing works
Psychological therapies for treatment-resistant depression in adults
Ijaz, S., Davies, P., Williams, C. J., Kessler, D., Lewis, G., & Wiles, N. (2018) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd010558.pub2 · Cited by 155 · see citing works
Dysregulation in level of goal and action identification across psychological disorders
Watkins, E. (2011) · Clinical Psychology Review · doi:10.1016/j.cpr.2010.05.004 · Cited by 141 · see citing works
Self-citationJohannsen, M., Nissen, E. R., Lundorff, M., & O'Toole, M. S. (2022) · Clinical Psychology Review · doi:10.1016/j.cpr.2022.102156 · Cited by 116 · see citing works
McEvoy, P. M., & Brans, S. (2013) · Cognitive Therapy and Research · doi:10.1007/s10608-012-9448-5 · Cited by 87 · see citing works
Mindfulness in mood and anxiety disorders: A review of the literature
Rodrigues, M. F., Nardi, A. E., & Levitan, M. (2017) · Trends in Psychiatry and Psychotherapy · doi:10.1590/2237-6089-2016-0051 · Cited by 69 · see citing works
“The remaining 402 references underwent title (354) and abstract analyses (24), resulting in exclusion of 378 references.”
BackgroundRelations between trait anxiety and depression: A mediated moderation model
Wang, T., Li, M., Xu, S., Liu, B., Wu, T., Lu, F., Xie, J., Peng, L., & Wang, J. (2019) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.09.074 · Cited by 58 · see citing works
Burrows, C. A., Timpano, K. R., & Uddin, L. Q. (2017) · Clinical Psychological Science · doi:10.1177/2167702616683506 · Cited by 43 · see citing works
Laidlaw, K., & Kishita, N. (2015) · GeroPsych · doi:10.1024/1662-9647/a000128 · Cited by 37 · see citing works
Hawley, L. L., Rogojanski, J., Vorstenbosch, V., Quilty, L. C., Laposa, J. M., & Rector, N. A. (2017) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2017.03.003 · Cited by 28 · see citing works
- Authors
- Watkins, E. R.
- Affiliations
- University of Exeter (GB)
- Corresponding author
- Watkins, Edward R.
- ORCID
- Watkins, Edward R.
- Venue
- Cognitive Behaviour Therapy
- Publisher
- Informa UK Limited
- Published
- 2009-01
- Volume
- 38
- Issue
- sup1
- Pages
- 8-14
- ISSN
- 1650-6073 (ISSN-L)
- 1651-2316
- PMC
- PMC3357968
- OpenAlex
- W2092505096
- Cited by
- 108
- References
- 23
- Citations by year
- 2026: 5 · 2025: 15 · 2024: 4 · 2023: 8 · 2022: 8 · 2021: 10 · 2020: 5 · 2019: 5 · 2018: 5 · 2017: 13 · 2016: 2 · 2015: 5 · 2014: 4 · 2013: 7 · 2012: 5
- FWCI
- 4.65
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Cognitive Behaviour Therapy (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Open Research Exeter (University of Exeter) (publishedVersion)
- Figshare (submittedVersion)
- Funders
- Wellcome Trust (GR065809, GR080099)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
- Keywords
- depressive rumination, residual depression, self-help intervention, process-outcome research
- MeSH terms
- Clinical Trials as Topic, Depression, Emotions, Humans, Self-Help Groups, Thinking, Cognitive Behavioral Therapy
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