Depressive Rumination Research Articles

Exploring potential working mechanisms of accelerated HF-rTMS in refractory major depression with a focus on locus coeruleus connectivity.

This study investigates the effects of accelerated high-frequency repetitive transcranial magnetic stimulation (aHF-rTMS), applied to the left dorsolateral prefrontal cortex (DLPFC), on locus coeruleus (LC) functional connectivity in the treatment of refractory medication-resistant major depression (MRD). We studied 12 antidepressant-free refractory MRD patients, focusing on how aHF-rTMS affects the LC, a central component of the brain's noradrenergic system and key to mood regulation and stress response. A stronger decrease in LC functional connectivity following aHF-rTMS treatment resulted in better clinical improvement. We observed such LC functional connectivity decreases with several brain regions, including the superior frontal gyrus, precentral gyrus, middle occipital gyrus, and cerebellum. Moreover, our exploratory analyses hint at a possible role for E-field modeling in forecasting clinical outcomes. Additional analyses suggest potential genetic and dopaminergic factors influencing changes in LC functional connectivity in relation to clinical response. The findings of this study underscore the pivotal role of the LC in orchestrating higher cognitive functions through its extensive connections with the prefrontal cortices, facilitating decision-making, influencing attention, and addressing depressive rumination. Additionally, the observed enhancement in LC-(posterior) cerebellar connectivity not only highlights the cerebellum's role in moderating clinical outcomes through noradrenergic system modulation but also suggests its potential as a predictive marker for aHF-rTMS efficacy. These results reveal new insights into the neural mechanisms of refractory depression and suggest therapeutic targets for enhancing noradrenergic activity, thereby addressing both cognitive and psychomotor symptoms associated with the disorder.

Neural correlates of thought–action fusion and their associations with rumination in patients with major depressive disorder

Thought-action fusion (TAF) is the metacognitive belief that the power of thoughts can have real-life consequences, often inducing unpleasant inner experiences and recruiting coping strategies such as rumination. Therefore, this study aimed to investigate the neural correlates of TAF and their associations with rumination in depression. A total of 37 patients with major depressive disorder (MDD) and 37 healthy controls (HCs) underwent functional magnetic resonance imaging with a TAF induction task and psychological assessments. In the TAF induction task, participants were asked to read the name of a close person (CP) or neutral person (NP) in association with negative (Neg) TAF and neutral (Neu) control statements. In this study, our TAF induction task activated brain regions, including the salient and default-mode networks, in the MDD and HC groups. However, along with higher likelihood TAF and rumination, behavioral data showed less negative feelings and longer reaction times under the NegCP condition in the MDD group compared with the HC group. Furthermore, in the MDD group, significantly higher activation in the bilateral caudate nuclei, left inferior frontal gyrus/anterior insula, putamen, and inferior parietal lobule under the NegCP condition was positively correlated with TAF and reflection. These findings suggest that during the TAF task, patients with MDD may activate different brain areas associated with the maintenance of high stimulus saliency and habit formation, which are important neural correlates linking TAF and rumination in depression.

Structural alterations in a rumination-related network in patients with major depressive disorder

Rumination is a common symptom in major depressive disorder (MDD). Previous work has connected individual differences in rumination to structural properties in various brain regions. Some of these, such as the dorsolateral prefrontal cortex (dlPFC), have also been highlighted as being altered in MDD, suggesting a connection between structural changes and ruminative symptoms. Although informative, such localised relations have limitations in the context of a network view of the brain. To further investigate rumination-related structural changes in depression, and to situate these within potential functional networks, we acquired T1-weighted structural MRI data from patients with MDD (n=32) and controls (n=69). Rumination was measured with the Rumination Response Scale. Surface-based, whole-brain analysis of cortical grey-matter identified group differences in the dlPFC that were, however, not related to rumination. Instead, rumination was correlated with grey-matter properties in the right precuneus. Using normative functional connectivity analysis on an independent sample (n = 100), we show these two regions to be interconnected. Further developing a network-based perspective, it was shown that the rumination-related precuneus region is connected with networks associated with processes such as executive function, autobiographical memory, and visual perception. Notably, these processes have been connected to rumination. These results suggest that rumination in depression may be linked to focal structural changes. The effects of these focal changes on rumination may then be connected to their influence on distributed functional networks.

Affective temperament, attachment style and life events related to abandonment in an Italian sample with somatic symptoms

ObjectiveThis study investigates the psychological factors influencing somatic symptoms following the end of a romantic relationship. We hypothesize that affective temperaments may predict attachment styles and depressive rumination components in individuals who have experienced abandonment. Furthermore, we postulate that gender differences exist in the variables under investigation. MethodsThe administered tests included: Temperament Evaluation of Memphis, Pisa, Paris and San Diego Questionnaire (TEMPS-A), Attachment Style Questionnaire (ASQ) and Ruminative Response Scale (RRS). The differences between the groups were assessed using Student's t-test for independent samples. In addition, regression analysis, in which the RRS (Brooding, Reflection and Depression) and ASQ (Confidence, Discomfort with Closeness, Need for Approval, Preoccupation with Relationships, and Relationships as Secondary) variables were considered dependent variables and all the TEMPS-A factors were included in the equation. ResultsSubjects at the end of a love affair presented the following psychosomatic symptoms: difficulty breathing, chest pain, feeling faint, sweating, dizziness, fatigue, palpitations, air hunger, difficulty sleeping, and swollen legs and ankles. The Anxious and Hyperthymic temperaments were negative predictors of the ruminative depressive dimension, and of “Confidence” and “Discomfort with Closeness” in the ASQ. The Cyclothymic and Anxious temperaments were predictors of “Discomfort with Closeness”, “Need for Approval”, “Preoccupation with Relationships”, and “Relationships as Secondary”. ConclusionAffective temperaments play a crucial role in determining how an individual deals abandonment in a romantic relationship, significantly influencing attachment styles and the tendency towards depressive rumination.

Reexamining gender differences and the transdiagnostic boundaries of various conceptualizations of perseverative cognition.

Research examining gender differences in perseverative cognition (repetitive, negative, and difficult-to-control thoughts) has focused on depressive rumination and internalizing syndromes. This study examines the transdiagnostic role of depressive rumination, anger rumination, and repetitive negative thinking across gender on internalizing and externalizing symptoms. Utilizing an ethnoracially diverse sample (33% Black, 35% Latinx, 32% White non-Hispanic) of n = 1,187 young adults (49.5% women), we found equivalent instrument functioning across gender for depressive rumination (specifically brooding), anger rumination, and internalizing problems. Differential item functioning was found for repetitive negative thinking and externalizing problems; partial metric and scalar invariance were established for repetitive negative thinking, and partial metric invariance was established for externalizing problems. After accounting for bias in measurement, women engaged in more perseverative cognition, though effects were small for brooding and anger rumination and large for repetitive negative thinking. Different types of perseverations were positively associated with internalizing and externalizing symptoms across gender. Perseverative cognition may be a transdiagnostic mechanism beyond internalizing problems. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Brain mechanisms of rumination and negative self-referential processing in adolescent depression

BackgroundDepression is linked to cognitive biases towards more negative and less positive self-relevant information. Rumination, perseverative negative thinking about the past and the self, may contribute to these biases. Methods159 adolescents (12–18 years), with a range of depression symptoms, completed the SRET during fMRI. Multiple regressions tested associations between conventional self-report and ecological momentary assessment (EMA) measured rumination, and neural and behavioral responses during a self-referent encoding task (SRET). ResultsHigher rumination (conventional self-report and EMA) was associated with more negative and fewer positive words endorsed and recalled. Higher self-reported (but not EMA) rumination was associated with higher accuracy in recognizing negative words and greater insula and dorsal anterior cingulate activity to negative versus positive words. LimitationsThe sample included mostly non-Hispanic White participants with household incomes above the national average, highlighting the need for replication in more diverse samples. Word endorsement discrepancies required fMRI analyses to model neural response to viewing negative versus positive words. ConclusionsAdolescents with higher rumination endorsed and recalled more negative and fewer positive words and recognized more negative words during the SRET. Higher insula reactivity, a key region for modulating externally-oriented attention and internally-oriented self-referential processes, may contribute to links between rumination and negative memory biases. These findings provide insight into neurocognitive mechanisms underlying depression.

Dynamics of spontaneous thoughts: Exploration, attentional profile and the segmentation of the stream of thoughts

For a long time, clinical knowledge and first-person reports have pointed to individual differences in the dynamics of spontaneous thoughts, in particular in the extreme case of psychiatric conditions (e.g. racing thoughts in Attention Deficit / Hyperactivity Disorder, ADHD; rumination in depression). We used a novel procedure to investigate this individual variability by combining verbal fluency tasks and introspective reports of thought content. Our goal was twofold. First, we tested the hypothesis that a greater segmentation of the stream of thoughts would be associated with trait inattention, in line with subjective reports of ADHD patients. Second, we tested whether the segmentation of the stream of thoughts increased with an increased tendency for exploratory behavior, following recent theoretical claims on the mechanisms underpinning the generation of spontaneous thoughts. Our results support both hypotheses, shedding light on the factors contributing to the individual variability in the dynamics of the stream of thought.

Investigating the transdiagnostic potential of rumination in relation to Cluster B personality disorder symptoms.

This study examined several forms of repetitive negative thinking in relation to measures of Cluster B disorders to identify unique and co-occurring cognitive mechanisms contributing to these symptom presentations. MTurk participants (N = 725; 53% men; 76% White) completed categorical and dimensional trait-based measures of Cluster B disorders alongside six measures of rumination and worry. Oversampling strategies were used during participant recruitment to obtain a sample with clinically relevant personality features. Path analyses examined each form of repetitive negative thinking in relation to Cluster B measures while controlling for shared variance between each construct. Anger rumination demonstrated notable relations across all four Cluster B personality disorders. Similarly, sadness rumination was positively associated with all four Cluster B personality disorders. Self-critical rumination and depressive rumination were uniquely associated with borderline symptoms. Worry demonstrated negative associations with measures of narcissistic, histrionic, and antisocial/psychopathy symptoms. Findings expand previous research by highlighting probable transdiagnostic and distinguishing cognitive process contributing to the presentation of Cluster B personality pathology. However, partialling the influence of overlapping constructs presents notable challenges in identifying and interpreting unique relations between various forms of repetitive negative thinking and Cluster B symptoms. Future research investigating these relations within outpatient and inpatient samples may provide avenues for the development of effective cognitive-based interventions for treating these symptoms. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Coupled changes between ruminating thoughts and resting-state brain networks during the transition into adulthood.

Perseverative negative thoughts, known as rumination, might arise from emotional challenges and preclude mental health when transitioning into adulthood. Due to its multifaceted nature, rumination can take several ruminative response styles, that diverge in manifestations, severity, and mental health outcomes. Still, prospective ruminative phenotypes remain elusive insofar. Longitudinal study designs are ideal for stratifying ruminative response styles, especially with resting-state functional MRI whose setup naturally elicits people's ruminative traits. Here, we considered self-rated questionnaires on rumination and psychopathology, along with resting-state functional MRI data in 595 individuals assessed at age 18 and 22 from the IMAGEN cohort. We conducted independent component analysis to characterize eight single static resting-state functional networks in each subject and session and furthermore conducted a dynamic analysis, tackling the time variations of functional networks during the entire scanning time. We then investigated their longitudinal mediation role between changes in three ruminative response styles (reflective pondering, brooding, and depressive rumination) and changes in internalizing and co-morbid externalizing symptoms. Four static and two dynamic networks longitudinally differentiated these ruminative styles and showed complemental sensitivity to internalizing and co-morbid externalizing symptoms. Among these networks, the right frontoparietal network covaried with all ruminative styles but did not play any mediation role towards psychopathology. The default mode, the salience, and the limbic networks prospectively stratified these ruminative styles, suggesting that maladaptive ruminative styles are associated with altered corticolimbic function. For static measures, only the salience network played a longitudinal causal role between brooding rumination and internalizing symptoms. Dynamic measures highlighted the default-mode mediation role between the other ruminative styles and co-morbid externalizing symptoms. In conclusion, we identified the ruminative styles' psychometric and neural outcome specificities, supporting their translation into applied research on young adult mental healthcare.

Behavioral Activation and Brain Network Changes in Depression.

Behavioral activation (BA) is a well-established method of evidence-based treatment for depression. There are clear links between the neural mechanisms underlying reward processing and BA treatment for depressive symptoms, including anhedonia; however, integrated interpretations of these two domains are lacking. Here we examine brain imaging studies involving BA treatments to investigate how changes in brain networks, including the reward networks, mediate the therapeutic effects of BA, and whether brain circuits are predictors of BA treatment responses. Increased activation of the prefrontal and subcortical regions associated with reward processing has been reported after BA treatment. Activation of these regions improves anhedonia. Conversely, some studies have found decreased activation of prefrontal regions after BA treatment in response to cognitive control stimuli in sad contexts, which indicates that the therapeutic mechanism of BA may involve disengagement from negative or sad contexts. Furthermore, the decrease in resting-state functional connectivity of the default-mode network after BA treatment appears to facilitate the ability to counteract depressive rumination, thereby promoting enjoyable and valuable activities. Conflicting results suggest that an intact neural response to rewards or defective reward functioning is predictive of the efficacy of BA treatments. Increasing the benefits of BA treatments requires identification of the unique individual characteristics determining which of these conflicting findings are relevant for the personalized treatment of each individual with depression.

"Too much of a burden": Lived experiences of depressive rumination in early adulthood.

Rumination is an established transdiagnostic factor in mental illness, but there remains a significant gap in understanding the subjective experiences of those affected by it. This study explored the lived experiences of depressive rumination in early adulthood, a population notably susceptible to its effects. We interviewed 20 participants aged between 18 and 35 years using a semistructured approach and generated five distinct but interconnected themes using reflective thematic analysis. The first theme delved into recurrent narratives of past traumas and unresolved pain, with participants unable to move on from their past. The second theme illustrated how participants, due to real or perceived pressure, often equated their self-worth with their ability to meet expectations, leading to a distorted self-view and diminished self-esteem. The third theme captured the relentless pursuit of mental peace, with tranquility remaining ever elusive despite the frequent use of distraction. The fourth theme highlighted the profound isolation stemming from internalized mental health stigma, with participants grappling with fears of being perceived as burdensome and facing rejection from their close ones. Finally, the fifth theme underscored the far-reaching and interconnected repercussions of rumination on mental, emotional, and physical health and individuals' ability to achieve their life goals. These findings emphasize the intertwined nature of psychological, physiological, and social risk factors for the development and maintenance of rumination, advocating for a holistic treatment approach to rumination and paving the way for more timely, tailored care. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Effect of a Defusion Exercise Including a Hierarchical Procedure on Depressive Rumination

AbstractThis study examined the effect of a defusion exercise with a hierarchical procedure in the context of depression, depressive rumination, and behavioral inflexibility. A total of 38 undergraduates were randomly assigned to either a defusion or control group. All participants answered questionnaires and engaged in a behavioral flexibility task before and after intervention. For the intervention, the defusion group engaged in a hierarchical defusion procedure. They sorted their depressive private events into either thoughts, feelings, or sensations, and all of them were integrated to “depression.” Subsequently, they engaged in word‐repetition exercises for “depression.” The control group read an emotionally neutral article on Japanese culture for 5 min. Results showed that the defusion exercise decreased cognitive fusion regarding depression. However, it did not decrease depressive rumination or promote behavioral flexibility. These results suggest that adjustments in the implementation of defusion exercises and other interventions may be necessary to reduce depressive rumination and promote behavioral flexibility.

Effects of childhood experiences of parental attitude, depressive rumination, and sleep disturbances on adulthood depressive symptoms.

Various factors are thought to be involved in the development of depression, but the mechanisms are not yet clear. Although several reports have demonstrated that parental attitude experienced in childhood, depressive rumination, and sleep disturbances each influence depressive symptoms, and the association between two of these four variables, to our knowledge, no reports to date have investigated the association among the four variables. A questionnaire survey was administered to 576 adults who agreed to participate in this study between April 2017 and April 2018. Questionnaires assessed parental attitudes experienced in childhood, depressive rumination, sleep disturbances, and depressive symptoms in adulthood. The associations among the four variables were tested by structural equation modeling. Regarding the direct effects, the parental attitude of "care" had a negative influence on depressive rumination and depressive symptoms, whereas "overprotection" had a positive influence on depressive rumination. Depressive rumination had a positive influence on sleep disturbance and depressive symptoms, whereas sleep disturbances had a positive influence on depressive symptoms. Regarding indirect effects, depressive rumination mediated the association between parental attitudes and sleep disturbances or depressive symptoms. Furthermore, sleep disturbances mediated the association between depressive rumination and depressive symptoms. Care and overprotection showed opposite effects. The goodness of fit of this model was high. The results of this study demonstrated that there were associations among the four variables. Clinical assessment and intervention of depressive rumination and sleep disturbances that are closely associated with previous parental attitudes may lead to an improvement of depressive symptoms.

Neural correlates of stress-reactive rumination in depression – The role of childhood trauma and social anxiety

Recent work showed an association of prefrontal dysfunctions in patients with Major Depressive Disorder (MDD) and social stress induced rumination. However, up to date it is unclear which etiological features of MDD might cause prefrontal dysfunctions. In the study at hand, we aimed to replicate recent findings, that showed prefrontal activation alterations during the Trier Social Stress Test (TSST) and subsequently increased stress-reactive rumination in MDD compared to healthy controls. Moreover, we aimed to explore the role of adverse childhood experiences and other clinical variables in this relationship. N = 55 patients currently suffering from MDD and n = 42 healthy controls (HC) underwent the TSST, while cortical activity in areas of the Cognitive Control Network (CCN) was measured via functional near-infrared spectroscopy (fNIRS). The TSST successfully induced a stress reaction (physiologically, as well as indicated by subjective stress ratings) and state rumination in all subjects with moderate to large effect sizes. In comparison to HC, MDD patients showed elevated levels of state rumination with large effect sizes, as well as a typical pattern of reduced cortical oxygenation during stress in the CCN with moderate effect sizes. Self-reported emotional abuse and social anxiety were moderately positively associated with increased stress-reactive rumination. Within the MDD sample, emotional abuse was negatively and social anxiety positively associated with cortical oxygenation within the CCN with moderate to large effect sizes. In conclusion, our results replicate previous findings on MDD-associated prefrontal hypoactivity during stress and extends the research toward specific subtypes of depression.

Relationship between ruminative style and adolescent depression

BackgroundThe role of rumination in depression remains controversial. We aimed to establish the ruminative tendency style theory (RTST), discuss the occurrence of depression in adolescents with rumination as the core, and explore the different associations between adolescent ruminative tendency, ruminative style, and depression. MethodsThis study employed an online questionnaire survey of 1110 Chinese adolescents aged 12–17 years, assessing ruminative tendency, ruminative style, stressful life events, depressive state, depressive trait, the Big Five personality traits, and social support. Conditional process analysis was used to test the chain mediation effect with Ruminative Style as a moderator. After screening for the predictor variables, a logistic regression risk prediction model was established and validated internally. ResultsThe chain mediation effect of ruminative tendency and depressive trait between stressful life events and depressive state was significant, with the indirect effect accounting for 63.4%. Ruminative Style negatively moderated the relationship between Ruminative Tendency and Depressive Trait (β=-0.053，P＜0.001). The risk prediction model for depressive state showed good calibration and clinical utility. Area under the curve values for the validation and training sets were 0.926 and 0.927, respectively. ConclusionDifferent associations may exist between adolescent ruminative tendency, ruminative style, and depression, and the proposal of ruminative style is of great significance for intervention in adolescent depression.

Computerized cognitive control training to reduce rumination in major depression: A randomized controlled trial

ObjectiveRumination is a major risk factor for the onset and recurrence of depressive episodes and has been associated with deficits in updating working memory content. This randomized controlled trial examines whether training updating-specific cognitive control processes reduces daily ruminative thoughts in clinically depressed individuals. MethodsSixty-five individuals with a current major depressive episode were randomized to 10 sessions of either cognitive control training (N = 31) or placebo training (N = 34). The frequency and negativity of individuals’ daily ruminative thoughts were assessed for seven days before training, after training, and at a 3-month follow-up using experience sampling methodology. Secondary outcomes were depressive symptoms, depressed mood, and level of disability. ResultsCognitive control training led to stronger improvements in the trained task than placebo training. However, cognitive control training did not lead to greater reductions in the frequency or negativity of daily ruminative thoughts than placebo training. There were no training-specific effects on participants' depressive symptoms or level of disability. ConclusionsThe robustness of the present null-findings, combined with the methodological strengths of the study, suggest that training currently depressed individuals to update emotional content in working memory does not affect the frequency or negativity of their daily ruminative thoughts.

An experimental paradigm for triggering a depressive syndrome.

Research investigating whether depression is an adaptation or a disorder has been hindered by the lack of an experimental paradigm that can test causal relationships. Moreover, studies attempting to induce the syndrome often fail to capture the suite of feelings, thoughts, and behaviors that characterize depression. An experimental paradigm for triggering depressive symptoms can improve our etiological understanding of the syndrome. The present study attempts to induce core symptoms of depression, particularly those related to rumination, in a healthy, nonclinical sample through a controlled social experiment. These symptoms are sad or depressed mood, anhedonia, feelings of worthlessness or guilt, and difficulty concentrating. One hundred and thirty-four undergraduate students were randomly assigned to either an exclusion (E) or control (C) group. Participants in the exclusion group were exposed to a modified Cyberball paradigm, designed to make them feel socially excluded, followed by a dual-interference task to assess whether their exclusion interfered with their working memory. Excluded participants: (a) self-reported a significant increase in sadness and decrease in happiness, but not anxiety or calmness; (b) scored significantly higher in four of five variables related to depressive rumination; and (c) performed significantly worse on a dual-interference task, suggesting an impaired ability to concentrate. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Examining the relationship between subtypes of rumination and non-suicidal self-injury: A meta-analytic review.

Non-suicidal self-injury (NSSI) is a highly prevalent maladaptive behavior, often used to cope with intense negative affect. Rumination is an emotion regulation strategy that leads to fixation on and exacerbation of (typically) negative affective states. However, studies examining the relationship between rumination and NSSI have yielded mixed results, showing high degrees of heterogeneity. The present study conducted meta-analyses (k = 50) of the association between overall rumination and NSSI, and independent meta-analyses for each of four subtypes of rumination (general, depressive, brooding, reflection rumination). Potential moderators that may influence the magnitude of these relationships were also examined. A small-to-moderate positive association between rumination and NSSI was found independent of rumination subtype. Moderating effects included NSSI outcome measure and study design for overall rumination and general rumination, respectively. Race was found to moderate the relationships between both brooding and depressive rumination and NSSI, though in inverse directions. An analysis of effect heterogeneity across studies suggested that undetected moderators may be present. Results of this study support the relationships between rumination subtypes and NSSI and identify factors that may impact these relationships. Continued research is needed to understand this association, particularly in more varied subtypes of rumination and cognitive-affective moderators.

Investigating the mediating roles of executive functioning and rumination in the relations between dispositional mindfulness and depression among high school students

This study investigates the intricate relations between dispositional mindfulness, executive functioning, rumination, and depression among Chinese high school students. It aims to understand how dispositional mindfulness can potentially predict depression in this demographic, providing insights for preventive interventions targeting adolescent depression. Despite growing recognition of mindfulness in mental health, its relations between executive functioning, rumination, and depression in high school students is not fully understood. The study involved 608 high school students (59.5% female; M age = 16.37 SD = 0.53) from the southwestern region of China. Data were collected using established scales: the Mindful Attention Awareness Scale (MAAS), the Teenage Executive Functioning Inventory (TEXI), the Ruminative Response Scale (RRS), and the Centre for Epidemiological Studies Depression Scale (CES-D). The analysis revealed significant correlations: a significant positive association between mindfulness and executive functioning capabilities, alongside notable negative associations between mindfulness and both rumination and depression, and a negative correlation between executive functioning and both rumination and depression.A positive correlation was observed between rumination and depression. Analytical the mediation model indicated that mindfulness predicts depression in directly, with this predictive effect being partially mediated by executive functioning and rumination in a serial multiple mediation model. These results corroborate the initial hypotheses and highlight the intricate interactions between mindfulness, executive functioning, rumination, and depression in high school student. This study underscores the importance of mindfulness, executive functioning, and rumination in understanding adolescent depression. The findings offer valuable insights for future research and highlight key areas for potential preventive strategies in adolescent mental health.

Symphonic resonance: optimizing hypnotic suggestions with music to harmonize depression and rumination

ABSTRACT Depression is a complex, multi-dimensional disorder that is recognized as a leading cause of human suffering and disability. A wide variety of treatments, both physical and psychological, have been developed to lessen the burden on depressed individuals and those they may affect. Hypnosis has been shown to be an effective vehicle for delivering psychological treatments for alleviating depression in a number of studies, but it is always a challenge to increase the effectiveness of suggestions given in hypnosis. The addition of music to enhance hypnotic approaches has been studied and received substantial support for its potential effectiveness. This article explores the merits of incorporating music into the delivery of hypnosis sessions and offers specific recommendations for the use of rhythmic methods as a means of deepening hypnosis and increasing the impact of one’s suggestions for reducing depressive ruminations. Five case examples are provided to illustrate the successful use of this integrative approach to treatment.