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Updated: May 30, 2026
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MRI-guided dmPFC-rTMS as a Treatment for Treatment-resistant Major Depressive Disorder
Published on: August 11, 2015
Rumination-focused cognitive-behavioural therapy for residual depression: phase II randomised controlled trial
Edward R Watkins1, Eugene Mullan, Janet Wingrove
1Mood Disorders Centre, School of Psychology, University of Exeter, UK. e.r.watkins@exeter.ac.uk
Summary
Adding targeted cognitive-behavioural therapy (CBT) for rumination to treatment as usual significantly improved outcomes for persistent depression. This approach offers a new avenue for treating chronic, medication-refractory depression.
Area of Science:
- Psychiatry
- Clinical Psychology
- Behavioral Science
Background:
- Approximately 20% of major depressive episodes become chronic and medication-refractory.
- These chronic cases show reduced responsiveness to standard treatments like cognitive-behavioural therapy (CBT).
Purpose of the Study:
- To evaluate if CBT targeting depressive rumination enhances treatment as usual (TAU) for residual depression.
- To assess the efficacy of a specialized CBT intervention focused on rumination.
Main Methods:
- A randomized controlled trial involving 42 participants with medication-refractory residual depression.
- Participants received either TAU or TAU plus up to 12 sessions of rumination-focused CBT.
- Trial registered under ISRCTN22782150.
Main Results:
- Rumination-focused CBT added to TAU significantly improved residual depressive symptoms.
- Enhanced remission rates were observed in the group receiving the specialized CBT.
- Observed treatment effects were mediated by a reduction in rumination.
Conclusions:
- This study provides the first randomized controlled trial evidence for the benefits of rumination-focused CBT in persistent depression.
- Findings suggest the internal validity of this approach for residual depression.
- The trial's limitation is the absence of an attentional control group, preventing definitive conclusions about specific versus non-specific therapy effects.
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