title: Rumination-focused cognitive-behavioural therapy for residual depression: phase II randomised controlled trial.
abstract: 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).
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  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.
authors.affiliation: Mood Disorders Centre, School of Psychology, University of Exeter, UK. e.r.watkins@exeter.ac.uk
authors.forename: Edward R
authors.initials: ER
authors.lastname: Watkins
authors.forename: Eugene
authors.initials: E
authors.lastname: Mullan
authors.forename: Janet
authors.initials: J
authors.lastname: Wingrove
authors.forename: Katharine
authors.initials: K
authors.lastname: Rimes
authors.forename: Herbert
authors.initials: H
authors.lastname: Steiner
authors.forename: Neil
authors.initials: N
authors.lastname: Bathurst
authors.forename: Rachel
authors.initials: R
authors.lastname: Eastman
authors.forename: Jan
authors.initials: J
authors.lastname: Scott
mesh_terms: D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology / Q000523:psychology; D002908:Chronic Disease; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D061218:Depressive Disorder, Treatment-Resistant / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012008:Recurrence; D012720:Severity of Illness Index; D013850:Thinking; D016896:Treatment Outcome