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Rumination and worry are common risk factors of depression and anxiety. Internet‐based transdiagnostic interventions targeting individuals with these specific risks may be an effective way to prevent depression and anxiety. This three‐arm randomized controlled trial compared the efficacy of Internet‐based rumination‐focused cognitive behavioral therapy (RFCBT), mindfulness‐based intervention (MBI), and psychoeducation (EDU) control among 256 at‐risk individuals. Participants' levels of rumination, worry, depressive, and anxiety symptoms were assessed at post‐intervention (6 weeks), 3‐month, and 9‐month follow‐ups. Linear mixed model analysis results showed similar levels of improvement in all outcomes across the three conditions. Changes in rumination differed comparing RFCBT and MBI, where a significant reduction in rumination was noted at a 3‐month follow‐up among participants in RFCBT, and no significant long‐term effect among participants in MBI was noted at a 9‐month follow‐up. All three conditions showed similar reductions in risks and symptoms, implying that the two active interventions were not superior to EDU control. The high attrition at follow‐ups suggested a need to exercise caution when interpreting the findings. Future studies should tease apart placebo effect and identify ways to improve adherence. [ABSTRACT FROM AUTHOR]

Introduction: Repetitive negative thinking (RNT) has been described as a maintaining transdiagnostic factor for psychopathology within the areas of depression, anxiety and insomnia. We investigated the effects of ruminationfocused cognitive-behaviour therapy (RF-CBT) in a group format at a primary health care centre on symptoms of depression, anxiety, insomnia, RNT, and quality of life. The participants presented clinical symptom levels of worry and at least two disorders among anxiety disorders, major depressive disorder, and insomnia disorder. Methods: A randomised controlled superiority parallel arm trial was used. 73 participants were included and randomised in pairs to either group-administered RF-CBT or a waiting list condition. The primary outcomes were self-rated worry and transdiagnostic symptoms (depression, anxiety, and insomnia). Intention-totreat analyses of group differences were conducted using linear mixed models. Adverse side effects and incidents were presented descriptively. Results: Group RF-CBT significantly reduced self-reported insomnia at posttreatment and self-reported insomnia and depression at the 2 month-followup, relative to the wait-list control group. There was no significant difference in change in RNT, anxiety, or quality of life. Discussion: The current study suggests that group-administered RF-CBT may be effective for insomnia and potentially effective for depression symptomatology. However, the study was underpowered to detect small and moderate effects and the results should therefore be interpreted with caution. [ABSTRACT FROM AUTHOR]

This randomized clinical trial evaluates which specific components of internet-delivered cognitive behavioral therapy are active ingredients that reduce symptoms among patients with depression. Key Points: Question: Which specific components within internet-delivered cognitive behavioral therapy (CBT) for depression are active ingredients that reduce symptoms? Findings: In this randomized optimization trial that included 767 adults with depression, 6 treatment components (activity scheduling, thought challenging, relaxation, concreteness training, functional analysis, and self-compassion training) did not show a significant main effect on depression. However, the presence of the absorption component outperformed its absence in reducing depression at 6-month follow-up. Meaning: The findings suggest that the majority of treatment benefit from internet-delivered CBT is likely to accrue from factors common to all CBT components and/or from generic factors common to all therapies, with the possible exception of absorption. Importance: There is limited understanding of how complex evidence-based psychological interventions such as cognitive behavioral therapy (CBT) for depression work. Identifying active ingredients may help to make therapy more potent, brief, and scalable. Objective: To test the individual main effects and interactions of 7 treatment components within internet-delivered CBT for depression to investigate its active ingredients. Design, Setting, and Participants: This randomized optimization trial using a 32-condition, balanced, fractional factorial optimization experiment (IMPROVE-2) recruited adults with depression (Patient Health Questionnaire−9 [PHQ-9] score ≥10) from internet advertising and the UK National Health Service Improving Access to Psychological Therapies service. Participants were randomized from July 7, 2015, to March 29, 2017, with follow-up for 6 months after treatment until December 29, 2017. Data were analyzed from July 2018 to April 2023. Interventions: Participants were randomized with equal probability to 7 experimental factors within the internet CBT platform, each reflecting the presence vs absence of specific treatment components (activity scheduling, functional analysis, thought challenging, relaxation, concreteness training, absorption, and self-compassion training). Main Outcomes and Measures: The primary outcome was depression symptoms (PHQ-9 score). Secondary outcomes include anxiety symptoms and work, home, and social functioning. Results: Among 767 participants (mean age [SD] age, 38.5 [11.62] years; range, 18-76 years; 635 women [82.8%]), 506 (66%) completed the 6-month posttreatment follow-up. On average, participants receiving internet-delivered CBT had reduced depression (pre-to-posttreatment difference in PHQ-9 score, −7.79 [90% CI, −8.21 to −7.37]; 6-month follow-up difference in PHQ-9 score, −8.63 [90% CI, −9.04 to −8.22]). A baseline score–adjusted analysis of covariance model using effect-coded intervention variables (−1 or +1) found no main effect on depression symptoms for the presence vs absence of activity scheduling, functional analysis, thought challenging, relaxation, concreteness training, or self-compassion training (posttreatment: largest difference in PHQ-9 score [functional analysis], −0.09 [90% CI, −0.56 to 0.39]; 6-month follow-up: largest difference in PHQ-9 score [relaxation], −0.18 [90% CI, −0.61 to 0.25]). Only absorption training had a significant main effect on depressive symptoms at 6-month follow-up (posttreatment difference in PHQ-9 score, 0.21 [90% CI, −0.27 to 0.68]; 6-month follow-up difference in PHQ-9 score, −0.54, [90% CI, −0.97 to −0.11]). Conclusions and Relevance: In this randomized optimization trial, all components of internet-delivered CBT except absorption training did not significantly reduce depression symptoms relative to their absence despite an overall average reduction in symptoms. The findings suggest that treatment benefit from internet-delivered CBT probably accrues from spontaneous remission, factors common to all CBT components (eg, structure, making active plans), and nonspecific therapy factors (eg, positive expectancy), with the possible exception of absorption focused on enhancing direct contact with positive reinforcers. Trial Registration: isrctn.org Identifier: ISRCTN24117387 [ABSTRACT FROM AUTHOR]

Substantial evidence suggests that rumination is an important vulnerability factor for adolescent depression. Despite this, few studies have examined environmental risk factors that might lead to rumination and, subsequently, depression in adolescence. This study examined the hypothesis that an adverse family environment is a risk factor for rumination, such that the tendency to ruminate mediates the longitudinal association between a negative family environment and adolescent depressive symptoms. It also investigated adolescent gender as a moderator of the relationship between family environment and adolescent rumination. Participants were 163 mother-adolescent dyads. Adolescents provided self-reports of depressive symptoms and rumination across three waves of data collection (approximately at ages 12, 15, and 17 years). Family environment was measured via observational assessment of the frequency of positive and aggressive parenting behaviors during laboratory-based interactions completed by mother-adolescent dyads, collected during the first wave. A bootstrap analysis revealed a significant indirect effect of low levels of positive maternal behavior on adolescent depressive symptoms via adolescent rumination, suggesting that rumination might mediate the relationship between low levels of positive maternal behavior and depressive symptoms for girls. This study highlights the importance of positive parenting behaviors as a possible protective factor against the development of adolescent rumination and, subsequently, depressive symptoms. One effective preventive approach to improving adolescent mental health may be providing parents with psychoeducation concerning the importance of pleasant and affirming interactions with their children. (Contains 1 figure and 6 tables.)

Introduction: Rumination, or repetitive and habitual negative thinking, is associated with psychopathology and related behaviors in adolescents, including non‐suicidal self‐injury (NSSI). Despite the link between self‐reported rumination and NSSI, there is limited understanding of how rumination is represented at the neurobiological level among youth with NSSI. Method: We collected neuroimaging and rumination data from 39 adolescents with current or past NSSI and remitted major depression. Participants completed a rumination induction fMRI task, consisting of both rumination and distraction blocks. We examined brain activation associated with total lifetime NSSI in the context of the rumination versus distraction contrast. Results: Lifetime NSSI was associated with a greater discrepancy in activation during rumination relative to distraction conditions in clusters including the precuneus, posterior cingulate, superior, and middle frontal gyrus, and cerebellum. Conclusion: Difficulties associated with rumination in adolescents with NSSI may be related to requiring greater cognitive effort to distract from ruminative content in addition to increased attention in the context of ruminative content. Increasing knowledge of neurobiological circuits and nodes associated with rumination and their relationship with NSSI may enable us to better tailor interventions that can facilitate lasting well‐being and neurobiological change. [ABSTRACT FROM AUTHOR]

In this reply to the comment of McVay and Kane (2010), I consider their argument concerning how Watkins's (2008) elaborated control theory informs their perspective on the role of executive control in mind wandering. I argue that although in a number of places the elaborated control theory is consistent with the perspective of McVay and Kane that mind wandering represents a failure of executive control, their account makes a number of claims that are not articulated in the elaborated control theory--most notably, the hypothesis that level of construal moderates entry of thoughts into awareness. Moreover, the relevant literature suggests that the relationship between level of construal and executive control may be more complex, and may be determined by multiple factors beyond those proposed in this executive-control failure account of mind wandering. Finally, the implications of this model of mind wandering for understanding repetitive thought in general are considered, and it is proposed that examining level of executive control as a further moderating variable within elaborated control theory may be of value.

The author reviews research showing that repetitive thought (RT) can have constructive or unconstructive consequences. The main unconstructive consequences of RT are (a) depression, (b) anxiety, and (c) difficulties in physical health. The main constructive consequences of RT are (a) recovery from upsetting and traumatic events, (b) adaptive preparation and anticipatory planning, (c) recovery from depression, and (d) uptake of health-promoting behaviors. Several potential principles accounting for these distinct consequences of RT are identified within this review: (a) the valence of thought content, (b) the intrapersonal and situational context in which RT occurs, and (c) the level of construal (abstract vs. concrete processing) adopted during RT. Of the existing models of RT, it is proposed that an elaborated version of the control theory account provides the best theoretical framework to account for its distinct consequences.

Adolescents frequently engage in high-risk behaviours (HRB) following childhood sexual abuse (CSA). Aberrant reward processes are implicated in HRB, and their underlying fronto-striatal networks are vulnerable to neurodevelopmental changes during adversity representing a promising candidate for understanding links between CSA and HRB. We examined whether fronto-striatal responses during reward anticipation and feedback (i) are altered in depressed adolescents with CSA compared to depressed, non-abused peers and (ii) moderate the relationship between CSA and HRB irrespective of depression. Forty-eight female adolescents {14 with CSA and depression [CSA +  major depressive disorder (MDD)]; 17 with MDD but no CSA (MDD); 17 healthy, non-abused controls} completed a monetary reward task during functional magnetic resonance imaging. No differences in fronto-striatal response to reward emerged between CSA + MDD and MDD. Critically, high left nucleus accumbens activation during reward anticipation was associated with greater HRB in CSA + MDD compared to MDD and controls. Low left putamen activation during reward feedback was associated with the absence of HRB in CSA + MDD compared to MDD. Striatal reward responses appear to play a key role in HRB for adolescents with CSA irrespective of depression, providing initial support for a CSA ecophenotype. Such information is pivotal to identify at-risk youth and prevent HRB in adolescents after CSA. [ABSTRACT FROM AUTHOR]

Repetitive negative thinking (RNT)—such as worry and rumination—is an important transdiagnostic factor in the onset, course, and recurrence of depressive and anxiety disorders. This article describes a psychoeducational cognitive behavioral therapy (CBT)-based group intervention entitled "Drop It" that focuses exclusively on treating RNT in patients with major depressive disorder and/or generalized anxiety disorder. The theoretical concepts and treatment goals of the intervention are outlined. The organization and therapeutic processes of the different sessions are described and illustrated with statements of participants. Special attention is given to how the intervention capitalizes on the group structure and process to maximize the effectiveness of psychoeducation and CBT-based techniques. We also provide practical guidelines for clinicians treating patients with RNT. [ABSTRACT FROM AUTHOR]