Reducing Depression by Targeting Ruminations

Cognitive-behavioral therapy (CBT) is an effective, frequently used treatment for depression, but fewer than half of patients achieve remission with CBT alone. Rumination is defined as repetitive negative thinking about causes and consequences of symptoms, and greater levels predict greater depression severity and poor response to treatment. Unlike standard CBT, which targets negative thoughts and behavioral avoidance, rumination-focused CBT (RFCBT; developed by one of these authors) targets ruminations directly as problematic, learned habitual behaviors developed through negative reinforcement.

In RFCBT, functional analysis is used to help patients identify antecedent cues and triggers for ruminations, control exposure to these cues, and pr…