ABSTRACT
Cognitive-behaviour therapy (CBT) for depression (Beck, Rush, Shaw, & Emery, 1979) has been highly in¯uential in the psychological conceptualization and treatment of this common and disabling problem. CBT for depression is a structured, time-limited, and problem-focused approach that aims to modify negative thoughts and beliefs or schemas, and reverse behaviours associated with problem maintenance. CBT for depression is perhaps the most extensively evaluated psychological treatment for emotional disorders. CBT has been shown to be an effective treatment for mild to moderate depression (e.g., Clark, Beck, & Alford, 1999; DeRubeis & Crits-Christoph, 1998) and more effective than antidepressant medication when they are both withdrawn shortly after recovery (e.g., Blackburn, Eunson, & Bishop, 1986; Shea et al., 1992). However, a signi®cant proportion of individuals treated with CBT do not fully remit or they relapse and experience recurrences of depression. Estimates of relapse following CBT for depression vary between 25 per cent (DeRubeis & Crits-Christoph, 1998) and 50 per cent (Nezu, Nezu, Trunzo, & McClure, 1998). Therefore, treatment outcome data show that a signi®cant number of individuals with depression who receive CBT do not fully bene®t from this intervention, and given the nature, impact and prevalence of depression, there is an urgent need to maximize treatment effectiveness. For this to be achieved, clinical researchers have argued that interventions should aim to target core psychological processes implicated in the development, maintenance, and recurrence of depression (e.g., Papageorgiou & Wells, 2000, 2004; Wells, 2000; Wells & Matthews, 1994). A number of core psychological or cognitive processes have been implicated in the onset, perpetuation, and recurrence of depression. Persistent, recyclic, negative thinking, in the form of rumination, has attracted increasing theoretical, empirical, and clinical interest in the past few years (Papageorgiou & Wells, 2004). This chapter begins by reviewing the phenomenology of depressive rumination. It then describes a clinical metacognitive model of rumination and depression. In the ®nal section, a brief overview is provided of metacognitive therapy for
The concept of depressive rumination
Rumination is considered to be a relatively common response to negative moods (Rippere, 1977) as well as a salient cognitive feature of dysphoria and DSM-IV (American Psychiatric Association, 1994) major depressive disorder. Rumination may be symptomatic of dysphoria or depression, but it may also be perceived as serving a function. The content of rumination is experienced in both verbal and imaginal form and has been found to be similar in depressed and non-depressed individuals (Papageorgiou & Wells, 1999a, 1999b, 2004). Consistent with the content-speci®city hypothesis (Beck, 1967, 1976), rumination involves themes of past personal loss and failure. Ruminative thinking is characterized by `Why'-type questions. For example, `Why did it happen to me?', `Why do I feel so depressed?', and `Why don't I feel like doing anything?'
