Rumination-focused cognitive behaviour therapy vs. cognitive behaviour therapy for depression: study protocol for a randomised controlled superiority trial

Abstract

BackgroundCognitive behavioural therapy is an effective treatment for depression. However, one third of the patients do not respond satisfactorily, and relapse rates of around 30 % within the first post-treatment year were reported in a recent meta-analysis. In total, 30–50 % of remitted patients present with residual symptoms by the end of treatment. A common residual symptom is rumination, a process of recurrent negative thinking and dwelling on negative affect. Rumination has been demonstrated as a major factor in vulnerability to depression, predicting the onset, severity, and duration of future depression. Rumination-focused cognitive behavioural therapy is a psychotherapeutic treatment targeting rumination. Because rumination plays a major role in the initiation and maintenance of depression, targeting rumination with rumination-focused cognitive behavioural therapy may be more effective in treating depression and reducing relapse than standard cognitive behavioural therapy.Method/designThis study is a two-arm pragmatic randomised controlled superiority trial comparing the effectiveness of group-based rumination-focused cognitive behaviour therapy with the effectiveness of group-based cognitive behavioural therapy for treatment of depression. One hundred twenty-eight patients with depression will be recruited from and given treatment in an outpatient service at a psychiatric hospital in Denmark. Our 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, quality of life, behavioural activation, experimental measures of cognitive flexibility, and emotional attentional bias. A 6-month follow-up is planned and will include the primary outcome measure and assessment of relapse.DiscussionThe clinical outcome of this trial may guide clinicians to decide on the merits of including rumination-focused cognitive behavioural therapy in the treatment of depression in outpatient services.Trial registrationClinicalTrials.gov Identifier: NCT02278224, registered 28 Oct. 2014.

High Academic Self-Efficacy and Dispositional Empathy in Future Teachers

“…Despite encountering controversies regarding the concept of fantasy and how it influences people's minds, which is related to neuroticism [62] and hallucinatory experiences [63], various studies affirm the benefits of fantasy thoughts on the development of imagination and creativity [64], openness to experience [62], behavioral self-regulation [65] and emotional regulation strategies [66]. In fact, there are problem-solving strategies based on mental simulation in which visual imagination is key in the process [67][68][69][70]. In addition, there are some studies that use visual images to enhance social relationships [71,72].…”

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

“…With an average size of the therapy group of m = 8 in both treatment arms and an intraclass correlation of about ρ = 0.05, a design effect of 1 + ( m − 1) ρ = 1.35 followed, so that we planned to recruit eight groups in each treatment arm (128 patients in total). Initial sample size ( N = 112) was adjusted upwards based on recommendations to control for design effects in group studies – this occurred after recruitment commenced, but before it completed, and was published in the study protocol (Hvenegaard et al ., 2015). The analysis plan was decided prior to the data collection and was described in the published study protocol (Hvenegaard et al ., 2015).…”

“…NCT02278224) on 28 October 2014. The study protocol was published in Trials on 17 August 2015 (Hvenegaard et al ., 2015).…”

“…Initial sample size ( N = 112) was adjusted upwards based on recommendations to control for design effects in group studies – this occurred after recruitment commenced, but before it completed, and was published in the study protocol (Hvenegaard et al ., 2015). The analysis plan was decided prior to the data collection and was described in the published study protocol (Hvenegaard et al ., 2015).…”

The Potential Role of Learning Capacity in Cognitive Behavior Therapy for Depression: A Systematic Review of the Evidence and Future Directions for Improving Therapeutic Learning

“…During cognitive change work, the therapist and patient work together to change the pattern of dysfunctional thinking by evaluating and targeting these negative beliefs. Note that cognitive change work can be distinguished from other third-wave CBT therapeutic procedures that do not primarily aim to change the content of dysfunctional beliefs (i.e., cognitive change) but focus on changing the function of dysfunctional thinking by targeting treatment processes such as rumination (i.e., during rumination-based CBT; Hvenegaard et al, 2015) or self-compassion (i.e., during mindfulness-based CBT; Kuyken et al, 2010). Numerous studies have shown that change in dysfunctional thinking is associated with a reduction of depressive symptoms during procedures focused on cognitive change work (Garratt et al, 2007; Lemmens et al, 2017) and that the extent to which dysfunctional beliefs can be activated in formerly depressed patients predicts subsequent relapse after CBT (Segal et al, 2006).…”