Evaluating the efficacy of rumination-focused cognitive-behavioral therapy in alleviating depression, negative affect, and rumination among patients with recurrent major depressive disorder: a randomized, multicenter clinical trial.

Abstract

Background: Rumination plays a pivotal role in the onset, recurrence, and persistence of residual symptoms in major depressive disorder (MDD), making it a critical therapeutic target in the development of novel interventions. Rumination-Focused Cognitive-Behavioral Therapy (RFCBT), an adapted form of cognitive-behavioral therapy specifically designed to address ruminative thinking patterns, has garnered increasing attention in clinical research. In light of these developments, the present study was conducted to evaluate the efficacy of RFCBT in reducing rumination severity, depressive symptoms, and negative affect among individuals with recurrent MDD.

Methods: This randomized clinical trial enrolled 44 university students diagnosed with MDD. Participants were randomly assigned in equal proportions to either the group-based Rumination-Focused Cognitive-Behavioral Therapy (g-RFCBT) condition or a waitlist (WL) control group. The g-RFCBT received 10 weekly group therapy sessions supplemented by two individual sessions (the initial session and the 12th session), while participants in the WL group received no intervention until the conclusion of the study. Assessments were conducted at four time points; pre-treatment, post-treatment, 2-month follow-up, and 6-month follow-up. Outcome measures included the Beck Depression Inventory-II (BDI-II), the Repetitive Thinking Questionnaire-31 (RTQ-31), and the Negative Affect subscale of the Positive and Negative Affect Schedule (PANAS-NA).

Results: Repeated measures ANOVA revealed statistically significant improvements in the g-RFCBT group compared to the WL group. Within-group analyses indicated that RFCBT led to a 65% reduction in depressive symptoms and a 30% reduction in both rumination and negative affect from baseline to post-treatment. Furthermore, the g-RFCBT exhibited significantly greater reduction in depression, rumination, and negative affect compared to the WL group, with treatment effects sustained through the 6-month follow-up period.

Conclusions: Group-based Rumination-Focused Cognitive-Behavioral Therapy (g-RFCBT) demonstrated significant efficacy in reducing the severity of depressive symptoms, rumination, and negative affect among individuals with major depressive disorder (MDD). Moreover, these therapeutic benefits were maintained over a 6-month follow-up period, suggesting durable treatment effects.

Trial registration: This randomized clinical trial, consisting of an intervention and a waitlist control condition, that was registered in the Iranian Registry of Clinical Trials (IRCT Id: IRCT20181117041676N1) (Registration Date: June 3, 2019).