4 - (SYM 133) Innovative Approaches to Scaling and Enhancing CBT That Targets Rumination

Rumination has been identified as a core process in the maintenance and onset of depression (Nolen-Hoeksema, 1991; 2000) and as a possible transdiagnostic mechanism contributing to co-morbidity (Harvey et al., 2004; Nolen-Hoeksema & Watkins, 2011). Extensive research has suggested that the thinking style adopted during rumination can determine whether it has helpful or unhelpful consequences on social problem solving (Watkins & Moulds, 2005) and emotional processing (Watkins, 2004, 2008). This experimental work inspired adaptations to CBT to further enhance its efficacy, called Rumination-focused CBT, which focus on changing the process of thinking, rather than simply changing the content of thinking (Watkins, 2016). A series of clinical trials have found that this approach is efficacious for adult patients with difficult-to-treat depression (Watkins et al., 2011; Watkins, 2015) and with adolescents with a history of depression (Jacobs et al., 2016, Langenecker et al., 2024), outperformed standard group CBT for adults with outpatient depression (Hvennegard et al., 2019), and in group and internet versions of RFCBT halved the rates of depression and anxiety in a vulnerable high-risk group over 1 year (Topper et al., 2017; Cook et al., 2019). Research priorities are now to examine ways to make the intervention more scalable and to identify the active ingredients within the overall treatment package. For the former, the design and preliminary results of recent research trials investigating the conversion of the intervention into a self-guided app for high worriers and ruminators (Edge et al., 2021) in young people and in university students will be presented. For the latter, the design and methodology behind a Wellcome-Trust funded factorial trial to determine the active treatment components in CBT to target rumination and worry will be presented, building on a recent factorial trial of internet-CBT for depression (Watkins et al., 2023).