In-session rumination during CBT for depression: Implications for treatment outcomes and the working alliance Open Access
Kennedy, James (Summer 2020)
Abstract
Although many patients experience significant improvement when participating in Cognitive Behavior Therapy (CBT) for depression, some patients fare less well. The current study evaluated if the extent to which patients ruminated during therapy sessions (i.e., in-session rumination) explained why some patients do less well in treatment. The specific aims were to develop an observational measure of in-session rumination and to evaluate its relationship with depressive symptoms and ratings of the therapeutic relationship. Rated therapy sessions came from sixty-three treatment naïve patients (52.4% female; Mage = 40.1; 74.6% Caucasian) with Major Depression who participated in CBT as part of the PReDICT randomized controlled trial. In-session rumination was operationalized as the extent to which patients talked about their problems in a repetitive, negative, and passive way during therapy. A team of two trained undergraduates produced ratings of both the intensity and duration of in-session rumination that occurred during fifty-seven initial therapy sessions (i.e., session one), and another equally-trained team produced ratings for forty-five sessions in the middle of treatment (i.e., session eight). Intraclass correlation coefficients evaluated the reliability of the observational ratings, and linear-mixed models and linear regressions were used for the analyses of depressive symptoms and ratings of the working alliance. Results indicated that the observational ratings were sufficiently reliable (all ICCs > .69), and the ratings generally correlated with depressive symptom as expected. Specifically, there was some evidence of a cross-sectional relationship between in-session rumination and self-reported symptoms at the beginning of treatment, and there was consistent evidence that higher levels of in-session rumination predicted higher levels of subsequent clinician-rated depressive symptoms. In-session rumination was not, however, related to subsequent self-reported depressive symptoms or ratings of the working alliance. This study adds to our understanding of why some patients do less well when participating in CBT for depression, and the results support efforts to integrate rumination-specific interventions into treatment for depression.
Table of Contents
Introduction………………………………………………………………………………………. 1
Method………………………………………………………………………………………….... 10
Results………………………………………………………………………………………….... 19
Discussion……………………………………………………………………….………………. 23
References……………………………………………………………………………………….. 31
Tables…………………………………………………………………………………………….. 42
Appendices………………………………………………………………………………………. 44
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