title: Depressive rumination: investigating mechanisms to improve cognitive behavioural treatments.
abstract: 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.
authors.affiliation: Mood Disorders Centre, University of Exeter, Exeter, United Kingdom. e.r.watkins@exeter.ac.uk
authors.forename: Edward R
authors.initials: ER
authors.lastname: Watkins
mesh_terms: D002986:Clinical Trials as Topic; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003863:Depression / Q000523:psychology / Q000628:therapy*; D004644:Emotions; D006801:Humans; D012657:Self-Help Groups; D013850:Thinking
references.citation: J Abnorm Psychol. 1983 Aug;92(3):330-7
references.pmid: 6619408
references.citation: Psychol Bull. 2008 Mar;134(2):163-206
references.pmid: 18298268
references.citation: J Abnorm Psychol. 1991 Nov;100(4):569-82
references.pmid: 1757671
references.citation: J Abnorm Psychol. 2000 Aug;109(3):504-11
references.pmid: 11016119
references.citation: Psychol Bull. 2007 Jan;133(1):122-48
references.pmid: 17201573
references.citation: Behav Res Ther. 2009 Jan;47(1):48-53
references.pmid: 19036353
references.citation: Cogn Emot. 2006 Apr 1;20(3-4):402-29
references.pmid: 26529213
references.citation: Behav Res Ther. 2007 Sep;45(9):2144-54
references.pmid: 17367751
references.citation: Arch Gen Psychiatry. 1999 Sep;56(9):829-35
references.pmid: 12884889
references.citation: J Pers. 1998 Aug;66(4):607-19
references.pmid: 9728418
references.citation: J Consult Clin Psychol. 1996 Apr;64(2):295-304
references.pmid: 8871414
references.citation: Arch Gen Psychiatry. 2002 Oct;59(10):877-83
references.pmid: 12365874
references.citation: Psychol Med. 2003 May;33(4):693-702
references.pmid: 12785471
references.citation: J Abnorm Psychol. 2009 Feb;118(1):55-64
references.pmid: 19222314
references.citation: J Consult Clin Psychol. 1999 Aug;67(4):578-82
references.pmid: 10450629
references.citation: Emotion. 2008 Jun;8(3):364-78
references.pmid: 18540752
references.citation: J Pers Soc Psychol. 1986 Dec;51(6):1173-82
references.pmid: 3806354