Can Rumination-Based Therapy Outperform Cognitive Behavioral Therapy?

A new clinical trial will test the effectiveness of rumination-focused cognitive behavioral therapy (RFCBT) to see if it can prove more effective than typical cognitive behavioral therapy (CBT) for treatment of depression, according to a paper published in Trials.

CBT can be very effective for depressed patients, but relapse rates are around 30% within the first post-treatment year. Rumination is a process of recurrent negative thinking that has been found to be a driver and predictor of depression, often predicting the onset, severity, and duration of future depression. The concept of therapy focused on rumination was developed by Edward Watkins and colleagues in a 2011 study British Journal of Psychology study.

According to the Trials study authors, “RFCBT focuses on functional analyses of the target behavior, rumination, and combines strategies from behavioral activation with novel strategies to foster concrete, process-focused, and specific thinking.” It is different from CBT because it focuses on modifying the process of thinking, whereas CBT focuses on modifying the content of the thoughts. RFCBT has only been the subject of a small number of clinical trials, although the results are promising.

The new study will be the first to make a direct comparison of RFCBT with standard CBT. It will be a two-arm, pragmatic, randomized, controlled superiority trial of 128 patients (64 in each arm) between ages 18 and 65 with depression. Patients with psychotic symptoms, bipolar disorder, functional illiteracy, or alcohol and drug abuse will be excluded. Patients with depression and co-morbid anxiety or personality disorder are included in the study. Patients receiving anti-depressants will not be excluded. The primary outcome will be severity of depressive symptoms (Hamilton Rating Scale for Depression) at completion of treatment. Secondary outcomes will be level of rumination, worry, anxiety, and quality of life, among others. A 6—month follow–up will help determine the important aspect of potential relapse.

Among the techniques the research will explore is to practice shifting from a general, evaluative, and abstract way of thinking to a more specific, descriptive, and concrete style of thinking. Later sessions will include training in the use of functional analysis to identify maladaptive behaviors; training in problem-solving; practice shifting from a negative, repetitive thinking style to a more constructive one; being absorbed in activities; using compassion for both oneself and others; and evaluating personal progress without getting stuck in unconstructive thinking.

Recruitment for the trial is ongoing.