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.
Highlights
Cognitive behavioural therapy is an effective treatment for depression
The 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
Elevated rumination is associated with diminished responsiveness to antidepressant medication and cognitive therapy [44, 45], and rumination has been demonstrated as a crucial factor in vulnerability to depression, predicting the onset, severity, and duration of future depression [16]
Summary
Cognitive behavioural therapy is an effective treatment for depression. 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. Recent studies have evaluated the potential benefit of continuation-phase CBT in reducing residual symptoms as well as in preventing subsequent depressive relapse or recurrence. Rumination is a passive process of recurrent negative thinking and dwelling on negative affect, causes, and symptoms [15] and has been shown to be a major factor in vulnerability to depression as well as predicting the onset, severity, and duration of future depressive episodes [16, 17]. The aim of the present study is to compare groupbased rumination-focused cognitive behaviour therapy (g-RFCBT) with group-based standard cognitive behavioural therapy (g-CBT) for depression on the effectiveness of treatment and the reduction of relapse rates at 6-month follow-up
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