Rumination-focused cognitive-behavioural therapy for residual depression: phase II randomised controlled trial

Br J Psychiatry. 2011 Oct;199(4):317-22. doi: 10.1192/bjp.bp.110.090282. Epub 2011 Jul 21.


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).

Aims: 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.

Method: 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.

Publication types

  • Clinical Trial, Phase II
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Anxiety Disorders / epidemiology
  • Anxiety Disorders / psychology
  • Chronic Disease
  • Cognitive Behavioral Therapy / methods*
  • Comorbidity
  • Depressive Disorder, Major / epidemiology
  • Depressive Disorder, Major / psychology
  • Depressive Disorder, Major / therapy*
  • Depressive Disorder, Treatment-Resistant / epidemiology
  • Depressive Disorder, Treatment-Resistant / psychology
  • Depressive Disorder, Treatment-Resistant / therapy
  • Female
  • Humans
  • Male
  • Middle Aged
  • Psychiatric Status Rating Scales
  • Recurrence
  • Severity of Illness Index
  • Thinking*
  • Treatment Outcome

Associated data

  • ISRCTN/ISRCTN22782150