Skip to main content Accessibility help
×
Home

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

  • Morten Hvenegaard (a1), Stine B. Moeller (a2), Stig Poulsen (a1), Matthias Gondan (a1), Ben Grafton (a3), Stephen F. Austin (a2), Morten Kistrup (a4), Nicole G. K. Rosenberg (a5), Henriette Howard (a6) and Edward R. Watkins (a7)...

Abstract

Background

Although cognitive-behavioural therapy (CBT) is an effective treatment for depression, less than half of patients achieve satisfactory symptom reduction during treatment. Targeting known psychopathological processes such as rumination may increase treatment efficacy. The aim of this study was to test whether adding group rumination-focused CBT (RFCBT) that explicitly targets rumination to routine medical management is superior to adding group CBT to routine medical management in treating major depression.

Methods

A total of 131 outpatients with major depression were randomly allocated to 12 sessions group RFCBT v. group CBT, each in addition to routine medical management. The primary outcome was observer-rated symptoms of depression at the end of treatment measured on the Hamilton Rating Scale for Depression. Secondary outcomes were rumination at post-treatment and depressive symptoms at 6 months follow-up (Trial registered: NCT02278224).

Results

RFCBT significantly improved observer-rated depressive symptoms (Cohen's d 0.38; 95% CI 0.03–0.73) relative to group CBT at post-treatment on the primary outcome. No post-treatment differences were found in rumination or in depressive symptoms at 6 months follow-up, although these secondary analyses may have been underpowered.

Conclusions

This is the first randomized controlled trial providing evidence of benefits of RFCBT in major depression compared with CBT. Group RFCBT may be a beneficial alternative to group CBT for major depression.

Copyright

Corresponding author

Author for correspondence: Morten Hvenegaard, E-mail: morten.hvenegaard@psy.ku.dk

References

Hide All
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th Edn. (DSM-IV). Washington, DC: APA.
Bech, P (1975) Quantitative rating of depressive states. Acta Psychiatrica Scandinavica 51, 161170.
Bech, P and Larsen, ER (2012) Interview-guide til Hamiltons Depressionsskala. Available at https://www.psykiatrien.rm.dk/siteassets/forskning/afdeling-q---forskning/interview_guide_hamd17_rev_pb_21_12_12_1358151150.pdf.
Beck, JS (2011) Cognitive Behavior Therapy: Basics and Beyond. New York, NY: Guilford press.
Burlingame, GM, Gleave, R, Erekson, D, Nelson, PL, Olsen, J, Thayer, S and Beecher, M (2016) Differential effectiveness of group, individual, and conjoint treatments: an archival analysis of OQ-45 change trajectories. Psychotherapy Research 26, 556572.
Ciesla, JA and Roberts, JE (2002) Self-directed thought and response to treatment for depression: a preliminary investigation. Journal of Cognitive Psychotherapy 16, 435453.
Cuijpers, P, Karyotaki, E, Weitz, E, Andersson, G, Hollon, SD and van Straten, A (2014) The effects of psychotherapies for major depression in adults on remission, recovery and improvement: a meta-analysis. Journal of Affective Disorders 159, 118126.
Cuijpers, P, Cristea, IA, Karyotaki, E, Reijnders, M and Huibers, MJH (2016) How effective are cognitive behavior therapies for major depression and anxiety disorders? A meta-analytic update of the evidence. World Psychiatry 15, 245258.
DeRubeis, RJ, Hollon, SD, Amsterdam, JD, Shelton, RC, Young, PR, Salomon, RM, O'Reardon, JP, Lovett, ML, Gladis, MMBL, Gallop, R, Brown, LL and Gallop, R (2005) Cognitive therapy vs medications in the treatment of moderate to severe depression. Archives of General Psychiatry 62, 409416.
Dimidjian, S, Hollon, SD, Dobson, KS, Schmaling, KB, Kohlenberg, RJ, Addis, ME, Gallop, R, McGlinchey, JB, Markley, DK, Gollan, JK, Atkins, DC, Dunner, DL, Dobson, KS, Shaw, BF and Vallis, TM (2006) Reliability of a measure of the quality of cognitive therapy. British Journal of Clinical Psychology 24, 295300.
Dobson, KS, Shaw, BF and Vallis, TM (1985) Reliability of a measure of the quality of cognitive therapy. British Journal of Clinical Psychology 24, 295300.
Drost, J, Van der Does, W, van Hemert, AM, Penninx, BW and Spinhoven, P (2014) Repetitive negative thinking as a transdiagnostic factor in depression and anxiety: a conceptual replication. Behaviour Research and Therapy 63, 177183.
Grierson, AB, Hickie, IB, Naismith, SL and Scott, J (2016) The role of rumination in illness trajectories in youth: linking trans-diagnostic processes with clinical staging models. Psychological Medicine 46, 24672484.
Hamilton, M (1960) A rating scale for depression. Journal of Neurology Neurosurgery & Psychiatry 23, 5262.
Hvenegaard, M, Watkins, ER, Poulsen, S, Rosenberg, NK, Gondan, M, Grafton, B, Austin, SF, Howard, H and Moeller, SB (2015) Rumination-focused cognitive behaviour therapy vs. cognitive behaviour therapy for depression: study protocol for a randomised controlled superiority trial. Trials 16, 344.
Jacobs, RH, Watkins, ER, Peters, AT, Feldhaus, CG, Barba, A, Carbray, J and Langenecker, SA (2016) Targeting ruminative thinking in adolescents at risk for depressive relapse: rumination-focused cognitive behavior therapy in a pilot randomized controlled trial with resting state fMRI. PLoS ONE 11, e0163952.
Jacobson, NS and Truax, P (1991) Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology 59, 1219.
Jones, NP, Siegle, GJ and Thase, ME (2008) Effects of rumination and initial severity on remission to cognitive therapy for depression. Cognitive Therapy and Research 32, 591604.
Martell, CR, Addis, ME and Jacobson, NS (2001) Depression in Context: Strategies for Guided Action. New York: W. W. Norton & Company, Inc.
Meyer, TJ, Miller, ML, Metzger, RL and Borkovec, TD (1990) Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy 28, 487495.
Møller, SB, Hvenegaard, M and Kistrup, M (2017) Ruminationsfokuseret Kognitiv Adfærdsterapi for Depression – Manual Til Gruppeterapi. København: Hans Reitzels Forlag.
Nolen-Hoeksema, S (2000) The role of rumination in depressive disorders and mixed anxiety/depressive symptoms. Journal of Abnormal Psychology 109, 504511.
Nolen-Hoeksema, S and Morrow, J (1991) A prospective study of depression and posttraumatic stress symptoms after a natural disaster: the 1989 Loma Prieta Earthquake. Journal of Personality and Social Psychology 61, 115121.
Nolen-Hoeksema, S, Wisco, BE and Lyubomirsky, S (2008) Rethinking Ruminatio’. Perspectives on Psychological Science 3, 400424.
Oei, TPS and Dingle, G (2008) The effectiveness of group cognitive behaviour therapy for unipolar depressive disorders. Journal of Affective Disorders 107, 521.
Paykel, ES, Scott, J, Teasdale, JD, Johnson, AL, Garland, A, Hons, BA, Moore, R, Jenaway, A, Cornwall, PL, Hayhurst, H, Abbott, R and Pope, M (1999) Prevention of relapse in residual depression by cognitive therapy. Archives of General Psychiatry 56, 829835.
Richards, DA, Ekers, D, McMillan, D, Taylor, RS, Byford, S, Warren, FC, Barrett, B, Farrand, PA, Gilbody, S, Kuyken, W, O'Mahen, H, Watkins, ER, Wright, KA, Hollon, SD, Reed, N, Rhodes, S, Fletcher, E and Finning, K (2016) Cost and Outcome of Behavioural Activation versus Cognitive Behavioural Therapy for Depression (COBRA): a randomised, controlled, non-inferiority trial. The Lancet 388, 871880.
Roberts, C and Roberts, SA (2005) Design and analysis of clinical trials with clustering effects due to treatment. Clinical Trials 2, 152162.
Schneibel, R, Wilbertz, G, Scholz, C, Becker, M, Brakemeier, EL, Bschor, T, Zobel, I and Schmoll, D (2017) Adverse events of group psychotherapy in the in-patient setting – results of a naturalistic trial. Acta Psychiatrica Scandinavica 136, 247258.
Sheehan, D and Lecrubier, Y (1998) The Mini International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview. Journal of Clinical Psychiatry 59, 22.
Spinhoven, P, Klein, N, Kennis, M, Cramer, AO, Siegle, G, Cuijpers, P, Ormel, J, Hollon, S and Bockting, CL (2018) The effects of cognitive-behavior therapy for depression on repetitive negative thinking: a meta-analysis. Behaviour Research and Therapy 106, 7185.
Spitzer, RL, Kroenke, K, Williams, JW and Löwe, B (2006) A brief measure for assessing generalized anxiety disorder. Archives of Internal Medicine 166, 10921097.
Teismann, T, Von Brachel, R, Hanning, S, Grillenberger, M, Hebermehl, L, Hornstein, I and Willutzki, U (2014) A randomized controlled trial on the effectiveness of a rumination-focused group treatment for residual depression. Psychotherapy Research 24, 8090.
Topper, M, Emmelkamp, PM and Ehring, T (2010) Improving prevention of depression and anxiety disorders: repetitive negative thinking as a promising target. Applied and Preventive Psychology 14, 5771.
Trajković, G, Starčević, V, Latas, M, Leštarević, M, Ille, T, Bukumirić, Z and Marinković, J (2011) Reliability of the Hamilton Rating Scale for Depression: a meta-analysis over a period of 49 years. Psychiatry Research 189, 19.
van Buuren, S and Groothuis-Oudshoorn, K (2011) Mice: multivariate imputation by chained equations in R. Journal of Statistical Software 45, 167.
Watkins, ER (2008) Constructive and unconstructive repetitive thought. Psychological Bulletin 134, 163206.
Watkins, ER (2015) Psychological treatment of depressive rumination. Current Opinion in Psychology 4, 3236.
Watkins, ER (2016) Rumination-Focused Cognitive-Behavioral Therapy for Depression. New York, NY: Guildford Press.
Watkins, ER and Nolen-Hoeksema, S (2014) A habit-goal framework of depressive rumination. Journal of Abnormal Psychology 123, 2434.
Watkins, ER, Moberly, NJ and Moulds, ML (2008) Processing mode causally influences emotional reactivity: distinct effects of abstract versus concrete construal on emotional response. Emotion 8, 364378.
Watkins, ER, Mullan, E, Wingrove, J, Rimes, K, Steiner, H, Bathurst, N, Eastman, R and Scott, J (2011) Rumination-focused cognitive-behavioural therapy for residual depression: phase II randomised controlled trial. The British Journal of Psychiatry 199, 317322.
Young, J and Beck, AT (1980) Cognitive Therapy Scale: Rating Manual. Unpublished manuscript, Philadelphia: University of Pennsylvania.

Keywords

Type Description Title
UNKNOWN
Supplementary materials

Hvenegaard et al. supplementary material
Hvenegaard et al. supplementary material 1

 Unknown (53 KB)
53 KB

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

  • Morten Hvenegaard (a1), Stine B. Moeller (a2), Stig Poulsen (a1), Matthias Gondan (a1), Ben Grafton (a3), Stephen F. Austin (a2), Morten Kistrup (a4), Nicole G. K. Rosenberg (a5), Henriette Howard (a6) and Edward R. Watkins (a7)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed