Rumination-focused cognitive-behavioural therapy for residual depression: Phase II randomised controlled trial
Open accessAbstract
Background: About 20% of major depressive episodes become chronic and medication-refractory and also appear to be less responsive to standard cognitive–behavioural therapy (CBT). Aims: To test whether CBT developed from behavioural activation principles that explicitly and exclusively targets depressive rumination enhances treatment as usual (TAU) in reducing residual depression. Method: Forty-two consecutively recruited participants meeting criteria for medication-refractory residual depression were randomly allocated to TAU v. TAU plus up to 12 sessions of individual rumination-focused CBT. The trial has been registered (ISRCTN22782150). Results: Adding rumination-focused CBT to TAU significantly improved residual symptoms and remission rates. Treatment effects were mediated by change in rumination. Conclusions: This is the first randomised controlled trial providing evidence of benefits of rumination-focused CBT in persistent depression. Although suggesting the internal validity of rumination-focused CBT for residual depression, the trial lacked an attentional control group so cannot test whether the effects were as a result of the specific content of rumination-focused CBT v. non-specific therapy effects.
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More residual depression and rumination after acute MDD treatment with CBT or MBCT predict higher relapse risk.
“higher levels of residual depression symptoms and rumination are associated with a greater likelihood of relapse following acute treatment for MDD with CBT (Watkins et al., 2011) and mindfulness based cognitive therapy (MBCT; Michalak, Hölz, & Teismann, 2011).”
From What, me worry and ruminate about dsm-5 and rdoc? The importance of targeting negative self-referential processing (2013) · cites this paper as Watkins et al., 2011
The Abstract links incomplete recovery after acute depression treatment to relapse risk, and the relapse-prevention section says residual symptoms tend to predict relapse. The Abstract also describes rumination as a predictor of later depression, but the paper does not establish that higher rumination predicts relapse specifically after acute CBT. MBCT is attributed to a different citation in the sentence. (LLM, conf=0.84)
Experimental — accuracy not yet measuredPurposefully targeting worry and rumination improves how long treatment gains last.
“deliberate efforts to target forms of negative self-referencing (worry and rumination) improve treatment durability (e.g., van Aalderen et al., 2011; Watkins et al., 2011; Wells et al., 2012).”
From What, me worry and ruminate about dsm-5 and rdoc? The importance of targeting negative self-referential processing (2013) · cites this paper as Watkins et al., 2011
The Secondary outcomes section reports less relapse between baseline and post-intervention with rumination-focused CBT than with treatment as usual, supporting the claim for targeting rumination during the study. It does not establish that treatment gains lasted longer after treatment, and this trial did not test targeting worry. (LLM, conf=0.85)
Experimental — accuracy not yet measuredCBT-based interventions significantly reduce rumination.
“In addition, according to randomized controlled studies (Smith et al., 2015; Topper et al., 2017; Watkins et al., 2011), CBT-based interventions showed a significant reduction in rumination.”
From Reducing Test Anxiety During the COVID-19 Pandemic: A Comparison of the Effectiveness of Cognitive Behavioral Therapy and Acceptance and Commitment Therapy (2024) · cites this paper as Watkins et al., 2011
Higher levels of residual depression symptoms and rumination are associated with a greater likelihood of relapse following acute treatment for MDD with CBT and MBCT.
“Similarly, higher levels of residual depression symptoms and rumination are associated with a greater likelihood of relapse following acute treatment for MDD with CBT (Watkins et al., 2011) and MBCT (Michalak et al., 2008; Farb et al., 2011; Bieling et al., 2012).”
From Emotion Regulation Therapy: A Mechanism-Targeted Treatment for Disorders of Distress (2017) · cites this paper as Watkins et al., 2011
Deliberate efforts to target forms of NSRP (e.g., worry and rumination) improve treatment durability.
“Finally, deliberate efforts to target forms of NSRP (e.g., worry and rumination) improve treatment durability (van Aalderen et al., 2011; Watkins et al., 2011; Wells et al., 2012), providing evidence for the utility of developing and honing treatments that are specifically aimed at reducing levels of NSRP among individuals with distress disorders.”
From Emotion Regulation Therapy: A Mechanism-Targeted Treatment for Disorders of Distress (2017) · cites this paper as Watkins et al., 2011
Excessive emotionality and negative self-referentiality complicate treatment response in distress disorders.
“These core features of distress disorders excessive emotionality [24] and negative self-referentiality [25, 26] complicate treatment response.”
From All together now: utilizing common functional change principles to unify cognitive behavioral and mindfulness-based therapies (2019) · cites this paper as [26]
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- Authors
- Watkins, E. R., Mullan, E., Wingrove, J., Rimes, K., Steiner, H., Bathurst, N., Eastman, R., & Scott, J.
- Affiliations
- King's College London (GB)
- University of Exeter (GB)
- Devon Partnership NHS Trust (GB)
- Corresponding author
- Watkins, Edward R.
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2011-10
- Volume
- 199
- Issue
- 4
- Pages
- 317-322
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2133505852
- Cited by
- 410
- References
- 43
- Citations by year
- 2026: 29 · 2025: 28 · 2024: 30 · 2023: 41 · 2022: 34 · 2021: 35 · 2020: 33 · 2019: 23 · 2018: 28 · 2017: 26 · 2016: 29 · 2015: 34 · 2014: 17 · 2013: 13 · 2012: 8
- FWCI
- 16.06
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- National Alliance for Research on Schizophrenia and Depression
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
- Keywords
- residual depression, dysthymia, behavioral activation, rumination, treatment-resistant depression, remission
- MeSH terms
- Adolescent, Adult, Anxiety Disorders, Chronic Disease, Major Depressive Disorder, Female, Humans, Male, Middle Aged, Psychiatric Status Rating Scales, Recurrence, Severity of Illness Index, Thinking, Comorbidity, Cognitive Behavioral Therapy, Treatment Outcome, Depressive Disorder, Treatment-Resistant
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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