Assessing in-session rumination and its effects on CBT for depression

J. C. Kennedy, B. W. Dunlop, L. W. Craighead, C. B. Nemeroff, H. S. Mayberg, W. E. Craighead

Research output: Contribution to journalArticlepeer-review


The study evaluated if rumination of patients during therapy (i.e., in-session rumination) relates to whether or not they do less well in CBT treatment. We developed a reliably assessed in-session rumination observational measure and evaluated its relationship to depression over the course of CBT. Rated sessions came from 63 treatment-naïve patients with major depressive disorder who participated in CBT in the PReDICT study (Dunlop et al., 2017). In-session rumination was operationalized as repetitive, negative, and passive talking about depressive topics. Trained undergraduates rated the intensity and duration of in-session rumination occurring during 57 initial therapy sessions (i.e., session one) and 45 sessions in the middle of treatment (i.e., session eight). The observational ratings were sufficiently reliable (all ICCs > 0.69). Mixed model results indicated that greater intensity of in-session rumination during the initial treatment session predicted higher levels of subsequent clinician-rated depressive symptoms (p < .023). Regression results indicated that greater intensity and duration of in-session rumination at session 8 significantly predicted higher clinician-rated symptoms at end of treatment (p's < 0.02). In-session rumination intensity and duration were not, however, related to subsequent self-reported depressive symptoms. The results support efforts to identify which patients might benefit from rumination-specific interventions.

Original languageEnglish
Article number104209
JournalBehaviour Research and Therapy
StatePublished - Dec 2022


  • Behavioral ratings in-session rumination
  • In-session rumination
  • Rumination duration
  • Rumination during CBT
  • Rumination intensity


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