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

Published online by Cambridge University Press:  11 January 2019

Morten Hvenegaard ,
Stine B. Moeller ,
Stig Poulsen ,
Matthias Gondan ,
Ben Grafton ,
Stephen F. Austin ,
Morten Kistrup ,
Nicole G. K. Rosenberg ,
Henriette Howard  and
Edward R. Watkins
Morten Hvenegaard*
Affiliation:
Department of Psychology, University of Copenhagen, Copenhagen, Denmark
Stine B. Moeller
Affiliation:
Psychiatric Research Unit, Mental Health Centre North Zealand, University of Copenhagen, Hillerød, Denmark
Stig Poulsen
Affiliation:
Department of Psychology, University of Copenhagen, Copenhagen, Denmark
Matthias Gondan
Affiliation:
Department of Psychology, University of Copenhagen, Copenhagen, Denmark
Ben Grafton
Affiliation:
Cognition and Emotion Lab, School of Psychology, University of Western Australia, Crawley, Australia
Stephen F. Austin
Affiliation:
Psychiatric Research Unit, Mental Health Centre North Zealand, University of Copenhagen, Hillerød, Denmark
Morten Kistrup
Affiliation:
Psychiatric Outpatient Service, Mental Health Centre North Zealand, Hillerød, Denmark
Nicole G. K. Rosenberg
Affiliation:
Psychotherapeutic Clinic Nannasgade, Mental Health Centre Copenhagen, Capital Region Mental Health Services, Copenhagen, Denmark
Henriette Howard
Affiliation:
Mental Health Centre for Child and Adolescent Psychiatry, Glostrup, Denmark
Edward R. Watkins
Affiliation:
Mood Disorders Centre, School of Psychology, University of Exeter, Exeter, UK
*
Author for correspondence: Morten Hvenegaard, E-mail: [email protected]
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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.

Keywords

Cognitive-behavioural therapydepressionRCTrumination-focused CBTrumination
Type
Original Articles
Information
Psychological Medicine , Volume 50 , Issue 1 , January 2020 , pp. 11 - 19
Copyright
Copyright © Cambridge University Press 2019 

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References

American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th Edn. (DSM-IV). Washington, DC: APA.Google Scholar
Bech, P (1975) Quantitative rating of depressive states. Acta Psychiatrica Scandinavica 51, 161–170.Google Scholar
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.Google Scholar
Beck, JS (2011) Cognitive Behavior Therapy: Basics and Beyond. New York, NY: Guilford press.Google Scholar
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, 556–572.Google Scholar
Ciesla, JA and Roberts, JE (2002) Self-directed thought and response to treatment for depression: a preliminary investigation. Journal of Cognitive Psychotherapy 16, 435–453.Google Scholar
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, 118–126.Google Scholar
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, 245–258.Google Scholar
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, 409–416.Google Scholar
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, 295–300.Google Scholar
Dobson, KS, Shaw, BF and Vallis, TM (1985) Reliability of a measure of the quality of cognitive therapy. British Journal of Clinical Psychology 24, 295–300.Google Scholar
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, 177–183.Google Scholar
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, 2467–2484.Google Scholar
Hamilton, M (1960) A rating scale for depression. Journal of Neurology Neurosurgery & Psychiatry 23, 52–62.Google Scholar
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.Google Scholar
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.Google Scholar
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, 12–19.Google Scholar
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, 591–604.Google Scholar
Martell, CR, Addis, ME and Jacobson, NS (2001) Depression in Context: Strategies for Guided Action. New York: W. W. Norton & Company, Inc.Google Scholar
Meyer, TJ, Miller, ML, Metzger, RL and Borkovec, TD (1990) Development and validation of the Penn State Worry Questionnaire. Behaviour Research and Therapy 28, 487–495.Google Scholar
Møller, SB, Hvenegaard, M and Kistrup, M (2017) Ruminationsfokuseret Kognitiv Adfærdsterapi for Depression – Manual Til Gruppeterapi. København: Hans Reitzels Forlag.Google Scholar
Nolen-Hoeksema, S (2000) The role of rumination in depressive disorders and mixed anxiety/depressive symptoms. Journal of Abnormal Psychology 109, 504–511.Google Scholar
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, 115–121.Google Scholar
Nolen-Hoeksema, S, Wisco, BE and Lyubomirsky, S (2008) Rethinking Ruminatio’. Perspectives on Psychological Science 3, 400–424.Google Scholar
Oei, TPS and Dingle, G (2008) The effectiveness of group cognitive behaviour therapy for unipolar depressive disorders. Journal of Affective Disorders 107, 5–21.Google Scholar
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, 829–835.Google Scholar
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, 871–880.Google Scholar
Roberts, C and Roberts, SA (2005) Design and analysis of clinical trials with clustering effects due to treatment. Clinical Trials 2, 152–162.Google Scholar
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, 247–258.Google Scholar
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.Google Scholar
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, 71–85.Google Scholar
Spitzer, RL, Kroenke, K, Williams, JW and Löwe, B (2006) A brief measure for assessing generalized anxiety disorder. Archives of Internal Medicine 166, 1092–1097.Google Scholar
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, 80–90.Google Scholar
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, 57–71.Google Scholar
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, 1–9.Google Scholar
van Buuren, S and Groothuis-Oudshoorn, K (2011) Mice: multivariate imputation by chained equations in R. Journal of Statistical Software 45, 1–67.Google Scholar
Watkins, ER (2008) Constructive and unconstructive repetitive thought. Psychological Bulletin 134, 163–206.Google Scholar
Watkins, ER (2015) Psychological treatment of depressive rumination. Current Opinion in Psychology 4, 32–36.Google Scholar
Watkins, ER (2016) Rumination-Focused Cognitive-Behavioral Therapy for Depression. New York, NY: Guildford Press.Google Scholar
Watkins, ER and Nolen-Hoeksema, S (2014) A habit-goal framework of depressive rumination. Journal of Abnormal Psychology 123, 24–34.Google Scholar
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, 364–378.Google Scholar
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, 317–322.Google Scholar
Young, J and Beck, AT (1980) Cognitive Therapy Scale: Rating Manual. Unpublished manuscript, Philadelphia: University of Pennsylvania.Google Scholar
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