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

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, 16:344

First Online: 11 August 2015Received: 25 March 2015Accepted: 17 July 2015DOI: 10.1186-s13063-015-0875-y

Cite this article as: Hvenegaard, M., Watkins, E.R., Poulsen, S. et al. Trials 2015 16: 344. doi:10.1186-s13063-015-0875-y


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 Identifier: NCT02278224, registered 28 Oct. 2014.

KeywordsRumination-focused cognitive behavioural therapy Depression Rumination Worry Relapse prevention Attentional bias AbbreviationsBADSBehavioural Activation for Depression Scale

CBTCognitive Behavioural Therapy

CTRSCognitive Therapy Rating Scale

DSM-IVDiagnostic and Statistical Manual of Mental Disorders, 4th Edition

GAD-7Generalised Anxiety Scale

g-CBTGroup-based standard cognitive behavioural therapy

g-RFCBTGroup-based rumination-focused cognitive behaviour therapy

HAM-D66-item Hamilton Depression Rating Scale

HRSDHamilton Rating Scale for Depression

PSWQThe Penn State Worry Questionnaire

RFCBTRumination-focused Cognitive Behavioural Therapy

RRSRumination Response Scale


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Author: Morten Hvenegaard - Ed R. Watkins - Stig Poulsen - Nicole K. Rosenberg - Matthias Gondan - Ben Grafton - Stephen F. Aust



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