Cognitive-Behaviour Therapy for Depressive Rumination

Depressive rumination, defined as “behaviour and thoughts that focus one’s attention on one’s depressive symptoms and on the implications of these symptoms” (Nolen-Hoeksema, 1991, p.569) has been identified as a core process in the onset and maintenance of depression. Rumination is elevated in both currently and formerly depressed patients and tends to be elevated in women relative to men, i.e., in groups known to be at increased risk for depression (Riso et al., 2003; Roberts, Gilboa, & Gotlib, 1998). Prospective longitudinal studies have found that selfreported depressive rumination predicts the onset and maintenance of major depression and depressive symptoms (Nolen-Hoeksema, 2000; Spasojevic & Alloy, 2001). Furthermore, there is evidence that increased rumination is associated with less therapeutic responsiveness to both antidepressant and cognitive-behavioural interventions (Ciesla & Roberts, 2002; Schmaling, Dimidjian, Katon, & Sullivan, 2002). This article will highlight key issues in understanding depressive rumination and review state-of-the-art treatment approaches.