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Edward Watkins

University of Exeter, Psychology, Faculty Member

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South African Medical Research Council

Vrije Universiteit Amsterdam

Rachel Vanderkruik

Andreas Walther

M. Katherine Shear

Università degli Studi di Udine / University of Udine

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Papers by Edward Watkins

Socioeconomic Indicators of Treatment Prognosis for Adults With Depression

JAMA Psychiatry, 2022

IMPORTANCE Socioeconomic factors are associated with the prevalence of depression, but their asso... more IMPORTANCE Socioeconomic factors are associated with the prevalence of depression, but their associations with prognosis are unknown. Understanding this association would aid in the clinical management of depression. OBJECTIVE To determine whether employment status, financial strain, housing status, and educational attainment inform prognosis for adults treated for depression in primary care, independent of treatment and after accounting for clinical prognostic factors.

Attention

Oxford Clinical Psychology, 2015

This chapter explores attention. It defines the key concepts within attention research (selective... more This chapter explores attention. It defines the key concepts within attention research (selective attention, self-focused attention), and reviews evidence across psychological disorders with a particular focus on determining the extent to which attentional processes are truly transdiagnostic, and/or whether they are distinct to particular disorders (including anxiety disorders, phobias, somatoform disorders, sexual disorders, eating disorders, sleep disorders, mood disorders, psychotic disorders, and substance-related disorders).

Is social support pre‐treatment associated with prognosis for adults with depression in primary care?

Acta Psychiatrica Scandinavica, 2021

ObjectiveDepressed patients rate social support as important for prognosis, but evidence for a pr... more ObjectiveDepressed patients rate social support as important for prognosis, but evidence for a prognostic effect is lacking. We aimed to test the association between social support and prognosis independent of treatment type, and the severity of depression, and other clinical features indicating a more severe illness.MethodsIndividual patient data were collated from all six eligible RCTs (n = 2858) of adults seeking treatment for depression in primary care. Participants were randomized to any treatment and completed the same baseline assessment of social support and clinical severity factors. Two‐stage random effects meta‐analyses were conducted.ResultsSocial support was associated with prognosis independent of randomized treatment but effects were smaller when adjusting for depressive symptoms and durations of depression and anxiety, history of antidepressant treatment, and comorbid panic disorder: percentage decrease in depressive symptoms at 3–4 months per z‐score increase in soc...

Reducing Stress and Preventing Depression (RESPOND): Randomized Controlled Trial of Web-Based Rumination-Focused Cognitive Behavioral Therapy for High-Ruminating University Students

Journal of Medical Internet Research, 2019

Background: Prevention of depression is a priority to reduce its global disease burden. Targeting... more Background: Prevention of depression is a priority to reduce its global disease burden. Targeting specific risk factors, such as rumination, may improve prevention. Rumination-focused Cognitive Behavioral Therapy (RFCBT) was developed to specifically target depressive rumination. Objective: The primary objective of this study was to test whether guided Web-based RFCBT (i-RFCBT) would prevent the incidence of major depression relative to usual care in UK university students. The secondary objective was to test the feasibility and estimated effect sizes of unguided i-RFCBT. Methods: To address the primary objective, a phase III randomized controlled trial was designed and powered to compare high risk university students (N=235), selected with elevated worry/rumination, recruited via an open access website in response to circulars within universities and internet advertisements, randomized to receive either guided i-RFCBT (interactive Web-based RFCBT, supported by asynchronous written Web-based support from qualified therapists) or usual care control. To address the secondary objective, participants were also randomized to an adjunct arm of unguided (self-administered) i-RFCBT. The primary outcome was the onset of a major depressive episode over 15 months, assessed with structured diagnostic interviews at 3 (postintervention), 6, and 15 months post randomization, conducted by telephone, blind to the condition. Secondary outcomes of symptoms of depression and anxiety and levels of worry and rumination were self-assessed through questionnaires at baseline and the same follow-up intervals. Results: Participants were randomized to guided i-RFCBT (n=82), unguided i-RFCBT (n=76), or usual care (n=77). Guided i-RFCBT reduced the risk of depression by 34% relative to usual care (hazard ratio [HR] 0.66, 95% CI 0.35 to 1.25; P=.20). Participants with higher levels of baseline stress benefited most from the intervention (HR 0.43, 95% CI 0.21 to 0.87; P=.02). Significant improvements in rumination, worry, and depressive symptoms were found in the short-to-medium term. Of the 6 modules, guided participants completed a mean of 3.46 modules (SD 2.25), with 46% (38/82) being compliant (completing ≥4 modules). Similar effect sizes and compliance rates were found for unguided i-RFCBT. Conclusions: Guided i-RFCBT can reduce the onset of depression in high-risk young people reporting high levels of worry/rumination and stress. The feasibility study argues for formally testing unguided i-RFCBT for prevention: if the observed effect sizes are robustly replicated in a phase III trial, it has potential as a scalable prevention intervention.

Mini Cambridge-Exeter Repetitive Thought Scale--French Version

PsycTESTS Dataset, 2014

Guided, internet-based, rumination-focused cognitive behavioural therapy (i-RFCBT) versus a no-intervention control to prevent depression in high-ruminating young adults, along with an adjunct assessment of the feasibility of unguided i-RFCBT, in the REducing Stress and Preventing Depression tria...

Trials, Jan 4, 2016

Depression is a global health challenge. Prevention is highlighted as a priority to reduce its pr... more Depression is a global health challenge. Prevention is highlighted as a priority to reduce its prevalence. Although effective preventive interventions exist, the efficacy and coverage can be improved. One proposed means to increase efficacy is by using interventions to target specific risk factors, such as rumination. Rumination-focused CBT (RFCBT) was developed to specifically target depressive rumination and reduces acute depressive symptoms and relapse for patients with residual depression in a randomised controlled trial. Preliminary findings from a Dutch randomised prevention trial in 251 high-risk 15- to 22-year-old subjects selected with elevated worry and rumination found that both supported internet-RFBCT and group-delivered RFCBT equally reduced depressive symptoms and the onset of depressive cases over a period of 1 year, relative to the no-intervention control. A phase III randomised controlled trial following the Medical Research Council (MRC) Complex Interventions Fram...

Cognitive Behavioural Processes across Psychological Disorders (DRAFT)

Reciprocity is probably one of the most debated theories in evolutionary research. After more tha... more Reciprocity is probably one of the most debated theories in evolutionary research. After more than 40 years of research, some scientists conclude that reciprocity is an almost uniquely human trait mainly because it is cognitively demanding. Others, however, conclude that reciprocity is widespread and of great importance to many species. Yet, it is unclear how these species reciprocate, given its apparent cognitive complexity. Therefore, our aim was to unravel the psychological processes underlying reciprocity. By bringing together findings from studies investigating different aspects of reciprocity, we show that reciprocity is a rich concept with different behavioural strategies and cognitive mechanisms that require very different psychological processes. We reviewed evidence from three textbook examples, i.e. the Norway rat, common vampire bat and brown capuchin monkey, and show that the species use different strategies and mechanisms to reciprocate. We continue by examining the psychological processes of reciprocity. We show that the cognitive load varies between different forms of reciprocity. Several factors can lower the memory demands of reciprocity such as distinctiveness of encounters, memory of details and network size. Furthermore, there are different information operation systems in place, which also vary in their cognitive load due to assessing the number of encounters and the quality and quantity of help. We conclude that many species possess the psychological processes to show some form of reciprocity. Hence, reciprocity might be a widespread phenomenon that varies in terms of strategies and mechanisms.

Update to the study protocol for a randomized controlled trial comparing mindfulness-based cognitive therapy with maintenance anti-depressant treatment depressive relapse/recurrence: The PREVENT trial

Background: Depression is a common and distressing mental health problem that is responsible for ... more Background: Depression is a common and distressing mental health problem that is responsible for significant individual disability and cost to society. Medication and psychological therapies are effective for treating depression and maintenance anti-depressants (m-ADM) can prevent relapse. However, individuals with depression often express a wish for psychological help that can help them recover from depression in the long-term. A recently developed treatment, mindfulness-based cognitive therapy (MBCT), shows potential as a brief group program for people with recurring depression. This trial asks the policy research question; is MBCT with support to taper/discontinue antidepressant medication (MBCT-TS) superior to m-ADM in terms of: a primary outcome of preventing depressive relapse/recurrence over 24 months; and secondary outcomes of (a) depression free days, (b) residual depressive symptoms, (c) antidepressant medication (ADM) usage, (d) psychiatric and medical co-morbidity, (e) quality of life, and (f) cost effectiveness? An explanatory research question also asks whether an increase in mindfulness skills is the key mechanism of change. The design is a single-blind, parallel randomized controlled trial examining MBCT-TS versus m-ADM with an embedded process study. To answer the main policy research question the proposed trial compares MBCT-TS with m-ADM for patients with recurrent depression. Four hundred and twenty patients with recurrent major depressive disorder in full or partial remission will be recruited through primary care. Results: Depressive relapse/recurrence over two years is the primary outcome variable. Analyses will be conducted following CONSORT standards and overseen by the trial's Data Monitoring and Safety Committee. Initial analyses will be conducted on an intention-to-treat basis, with subsequent analyses being per protocol. The explanatory question will be addressed in two mutually informative ways: quantitative measurement of potential mediating variables pre-and post-treatment and a qualitative study of service users' views and experiences. Conclusions: If the results of our exploratory trial are extended to this definitive trial, MBCT-TS will be established as an alternative approach to maintenance antidepressants for people with a history of recurrent depression. The process studies will provide evidence about the effective components which can be used to improve MBCT and inform theory as well as other therapeutic approaches.

Guided self-help concreteness training as an intervention for major depression in primary care: a Phase II randomized controlled trial

Psychological Medicine, 2011

BackgroundThe development of widely accessible, effective psychological interventions for depress... more BackgroundThe development of widely accessible, effective psychological interventions for depression is a priority. This randomized trial provides the first controlled data on an innovative cognitive bias modification (CBM) training guided self-help intervention for depression.MethodOne hundred and twenty-one consecutively recruited participants meeting criteria for current major depression were randomly allocated to treatment as usual (TAU) or to TAU plus concreteness training (CNT) guided self-help or to TAU plus relaxation training (RT) guided self-help. CNT involved repeated practice at mental exercises designed to switch patients from an unhelpful abstract thinking habit to a helpful concrete thinking habit, thereby targeting depressogenic cognitive processes (rumination, overgeneralization).ResultsThe addition of CNT to TAU significantly improved depressive symptoms at post-treatment [mean difference on the Hamilton Rating Scale for Depression (HAMD) 4.28, 95% confidence inter...

Why “why” seems better than “how”. Processes underlining repetitive thinking in an Italian non-clinical sample

Personality and Individual Differences, 2014

Given the evidence for the dysfunctional effects of rumination, the fundamental question remains:... more Given the evidence for the dysfunctional effects of rumination, the fundamental question remains: why depressed patients continue to ruminate over long periods of time? Watkins has shown that unconstructive repetitive thought is focused on ''why'', aiming at detecting the personal reasons of negative events. This strategy leads people to find evaluative answers of personal inadequacy or negativity of the world. The research aims at (a) test the hypotheses that why RT is significantly correlated to negative mood, even when controlling for depressive symptoms; (b) test whether non-clinical participants really tend to prefer the ''how'' RT, when coping with an unexpected negative event of everyday life; this results would suggest that the ''how'' style is more functional than the ''why'' style; (c) exploring beliefs that may guide the choice between the ''how'' or the ''why'' modes; (d) investigate the influence of a previous choice on the subsequent thinking style. 212 participants have been recruited. We include questionnaires about rumination and depression and 8 vignette describing negative unexpected situations, followed by three tasks. The results confirm the detrimental role of why focused repetitive thinking on mood state and show a significant influence of a ''why tendency''.

Conceptual Foundations of the Transdiagnostic Approach to CBT

Journal of Cognitive Psychotherapy, 2009

This article defines and explains the transdiagnostic approach to cognitive-behavioral therapy (C... more This article defines and explains the transdiagnostic approach to cognitive-behavioral therapy (CBT) and elaborates on its conceptual foundations and implications for research and practice. We argue that the approach has good philosophical, historical, pragmatic, and empirical foundations. We distinguish between transdiagnostic approaches based on multiple processes that are universally applied (e.g., Harvey, Watkins, Mansell, & Shafran, 2004), multiple processes limited in the range of disorders covered (e.g., Fairburn, Cooper, & Shafran, 2003), symptom-based accounts (e.g., Persons, 1986), and universal single process accounts (e.g., experiential avoidance, self-absorption). We summarize existing evidence and identify key issues relating to the methodology of future research on the transdiagnostic approach. The article concludes by highlighting the great potential benefits of the approach and highlights significant practical, political, and scientific obstacles to putting it into ...

Ruminative self-focus and negative affect: An experience sampling study

Journal of Abnormal Psychology, 2008

Cognitive Behavioral Processes Across Psychological Disorders: A Review of the Utility and Validity of the Transdiagnostic Approach

International Journal of Cognitive Therapy, 2008

The transdiagnostic approach states that there are key cognitive and behavioral processes respons... more The transdiagnostic approach states that there are key cognitive and behavioral processes responsible for maintaining symptoms and these are shared across psychological disorders (Harvey, Watkins, Mansell, & Shafran, 2004). The first goal of this article is to justify the potential utility of a transdiagnostic perspective for theory, research and treatment using empirical evidence and clinical vignettes. We then take as an example one set of cognitive processes-attentional processes-to illustrate the approach. Evidence for three attentional processes is provided: vigilance to external concern-related stimuli; vigilance to internal concern-related stimuli (self-focused attention) and attentional avoidance. It is concluded that each of these attentional processes are transdiagnostic. We then discuss three possible resolutions to the question: How can a transdiagnostic perspective be valid when the different psychological disorders present so differently? The three proposals are: (1) variations in idiosyncratic current concerns; (2) variations in the degree of shared processes and (3) distinct processes for specific disorders or groups of disorders. The role of a transdiagnostic approach in supporting the development and testing of theories of psychopathology is highlighted and the need for future studies that incorporate multiple patient groups is discussed.

Processing mode causally influences emotional reactivity: Distinct effects of abstract versus concrete construal on emotional response

Emotion, 2008

Negative affect and ruminative self-focus during everyday goal pursuit

Cognition & Emotion, 2010

When the ends outweigh the means: Mood and level of identification in depression

Cognition & Emotion, 2011

Concreteness training reduces dysphoria: A pilot proof-of-principle study

Behaviour Research and Therapy, 2009

We hypothesized that a tendency towards abstract, general and decontextualized processing is a co... more We hypothesized that a tendency towards abstract, general and decontextualized processing is a cognitive distortion that causally contributes to symptoms of depression. This hypothesis predicts that training dysphoric individuals to become more concrete and specific in their thinking would reduce depressive symptoms. To test this prediction, participants with stable dysphoria (scoring ! 14 on BDI-II at 2 consecutive weekly assessments) were randomly allocated in an additive design either to an active intervention control consisting of relaxation training or relaxation training plus concreteness training. Concreteness training involved repeated mental exercises designed to encourage more concrete and specific thinking about emotional events. Both interventions involved a training session and then repeated daily use of compact disc recordings for 7 days. Relaxation training plus concreteness training resulted in significantly greater decreases in depressive symptoms and marginally significantly greater decreases in state rumination than relaxation training alone. These findings suggest the potential value of concreteness training as a guided self-help intervention for mild-to-moderate depressive symptoms.

Psychosocial correlates of depressive rumination

Behaviour Research and Therapy, 2010

The study examined the relationship between brooding, the maladaptive sub-component of depressive... more The study examined the relationship between brooding, the maladaptive sub-component of depressive rumination, an important cognitive mechanism implicated in the aetiology of depression, and a range of depressogenic psychosocial factors, including insecure attachment styles and maladaptive interpersonal behaviours. It was hypothesised that brooding (but not the more adaptive reflection component) is associated with an attachment pattern characterised by fear of rejection, and an interpersonal style characterised by submissiveness. Currently depressed (n = 29), previously depressed (n = 42) and never-depressed (n = 32) adults completed self-report measures assessing depressive symptoms, rumination (brooding and reflection), attachment orientation and maladaptive interpersonal behaviours. The study hypotheses were partially supported: After controlling for gender and depressive symptoms, brooding was significantly associated with one indicator of underlying rejection concerns (rejection sensitivity, p = .05), but was not associated with another indicator of underlying rejection concerns (anxious attachment style) or with avoidant attachment style. After controlling for depressive symptoms, brooding was uniquely associated with the submissive interpersonal style (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .01). Brooding was not correlated with needy or cold interpersonal styles after controlling for depressive symptoms.

Processing Mode Influences the Relationship Between Trait Rumination and Emotional Vulnerability

Behavior Therapy, 2006

Adaptive and Maladaptive Self-Focus: A Pilot Extension Study With Individuals High and Low in Fear of Negative Evaluation

Behavior Therapy, 2009

Socioeconomic Indicators of Treatment Prognosis for Adults With Depression

JAMA Psychiatry, 2022

IMPORTANCE Socioeconomic factors are associated with the prevalence of depression, but their asso... more IMPORTANCE Socioeconomic factors are associated with the prevalence of depression, but their associations with prognosis are unknown. Understanding this association would aid in the clinical management of depression. OBJECTIVE To determine whether employment status, financial strain, housing status, and educational attainment inform prognosis for adults treated for depression in primary care, independent of treatment and after accounting for clinical prognostic factors.

Attention

Oxford Clinical Psychology, 2015

This chapter explores attention. It defines the key concepts within attention research (selective... more This chapter explores attention. It defines the key concepts within attention research (selective attention, self-focused attention), and reviews evidence across psychological disorders with a particular focus on determining the extent to which attentional processes are truly transdiagnostic, and/or whether they are distinct to particular disorders (including anxiety disorders, phobias, somatoform disorders, sexual disorders, eating disorders, sleep disorders, mood disorders, psychotic disorders, and substance-related disorders).

Is social support pre‐treatment associated with prognosis for adults with depression in primary care?

Acta Psychiatrica Scandinavica, 2021

ObjectiveDepressed patients rate social support as important for prognosis, but evidence for a pr... more ObjectiveDepressed patients rate social support as important for prognosis, but evidence for a prognostic effect is lacking. We aimed to test the association between social support and prognosis independent of treatment type, and the severity of depression, and other clinical features indicating a more severe illness.MethodsIndividual patient data were collated from all six eligible RCTs (n = 2858) of adults seeking treatment for depression in primary care. Participants were randomized to any treatment and completed the same baseline assessment of social support and clinical severity factors. Two‐stage random effects meta‐analyses were conducted.ResultsSocial support was associated with prognosis independent of randomized treatment but effects were smaller when adjusting for depressive symptoms and durations of depression and anxiety, history of antidepressant treatment, and comorbid panic disorder: percentage decrease in depressive symptoms at 3–4 months per z‐score increase in soc...

Reducing Stress and Preventing Depression (RESPOND): Randomized Controlled Trial of Web-Based Rumination-Focused Cognitive Behavioral Therapy for High-Ruminating University Students

Journal of Medical Internet Research, 2019

Background: Prevention of depression is a priority to reduce its global disease burden. Targeting... more Background: Prevention of depression is a priority to reduce its global disease burden. Targeting specific risk factors, such as rumination, may improve prevention. Rumination-focused Cognitive Behavioral Therapy (RFCBT) was developed to specifically target depressive rumination. Objective: The primary objective of this study was to test whether guided Web-based RFCBT (i-RFCBT) would prevent the incidence of major depression relative to usual care in UK university students. The secondary objective was to test the feasibility and estimated effect sizes of unguided i-RFCBT. Methods: To address the primary objective, a phase III randomized controlled trial was designed and powered to compare high risk university students (N=235), selected with elevated worry/rumination, recruited via an open access website in response to circulars within universities and internet advertisements, randomized to receive either guided i-RFCBT (interactive Web-based RFCBT, supported by asynchronous written Web-based support from qualified therapists) or usual care control. To address the secondary objective, participants were also randomized to an adjunct arm of unguided (self-administered) i-RFCBT. The primary outcome was the onset of a major depressive episode over 15 months, assessed with structured diagnostic interviews at 3 (postintervention), 6, and 15 months post randomization, conducted by telephone, blind to the condition. Secondary outcomes of symptoms of depression and anxiety and levels of worry and rumination were self-assessed through questionnaires at baseline and the same follow-up intervals. Results: Participants were randomized to guided i-RFCBT (n=82), unguided i-RFCBT (n=76), or usual care (n=77). Guided i-RFCBT reduced the risk of depression by 34% relative to usual care (hazard ratio [HR] 0.66, 95% CI 0.35 to 1.25; P=.20). Participants with higher levels of baseline stress benefited most from the intervention (HR 0.43, 95% CI 0.21 to 0.87; P=.02). Significant improvements in rumination, worry, and depressive symptoms were found in the short-to-medium term. Of the 6 modules, guided participants completed a mean of 3.46 modules (SD 2.25), with 46% (38/82) being compliant (completing ≥4 modules). Similar effect sizes and compliance rates were found for unguided i-RFCBT. Conclusions: Guided i-RFCBT can reduce the onset of depression in high-risk young people reporting high levels of worry/rumination and stress. The feasibility study argues for formally testing unguided i-RFCBT for prevention: if the observed effect sizes are robustly replicated in a phase III trial, it has potential as a scalable prevention intervention.

Mini Cambridge-Exeter Repetitive Thought Scale--French Version

PsycTESTS Dataset, 2014

Guided, internet-based, rumination-focused cognitive behavioural therapy (i-RFCBT) versus a no-intervention control to prevent depression in high-ruminating young adults, along with an adjunct assessment of the feasibility of unguided i-RFCBT, in the REducing Stress and Preventing Depression tria...

Trials, Jan 4, 2016

Depression is a global health challenge. Prevention is highlighted as a priority to reduce its pr... more Depression is a global health challenge. Prevention is highlighted as a priority to reduce its prevalence. Although effective preventive interventions exist, the efficacy and coverage can be improved. One proposed means to increase efficacy is by using interventions to target specific risk factors, such as rumination. Rumination-focused CBT (RFCBT) was developed to specifically target depressive rumination and reduces acute depressive symptoms and relapse for patients with residual depression in a randomised controlled trial. Preliminary findings from a Dutch randomised prevention trial in 251 high-risk 15- to 22-year-old subjects selected with elevated worry and rumination found that both supported internet-RFBCT and group-delivered RFCBT equally reduced depressive symptoms and the onset of depressive cases over a period of 1 year, relative to the no-intervention control. A phase III randomised controlled trial following the Medical Research Council (MRC) Complex Interventions Fram...

Cognitive Behavioural Processes across Psychological Disorders (DRAFT)

Reciprocity is probably one of the most debated theories in evolutionary research. After more tha... more Reciprocity is probably one of the most debated theories in evolutionary research. After more than 40 years of research, some scientists conclude that reciprocity is an almost uniquely human trait mainly because it is cognitively demanding. Others, however, conclude that reciprocity is widespread and of great importance to many species. Yet, it is unclear how these species reciprocate, given its apparent cognitive complexity. Therefore, our aim was to unravel the psychological processes underlying reciprocity. By bringing together findings from studies investigating different aspects of reciprocity, we show that reciprocity is a rich concept with different behavioural strategies and cognitive mechanisms that require very different psychological processes. We reviewed evidence from three textbook examples, i.e. the Norway rat, common vampire bat and brown capuchin monkey, and show that the species use different strategies and mechanisms to reciprocate. We continue by examining the psychological processes of reciprocity. We show that the cognitive load varies between different forms of reciprocity. Several factors can lower the memory demands of reciprocity such as distinctiveness of encounters, memory of details and network size. Furthermore, there are different information operation systems in place, which also vary in their cognitive load due to assessing the number of encounters and the quality and quantity of help. We conclude that many species possess the psychological processes to show some form of reciprocity. Hence, reciprocity might be a widespread phenomenon that varies in terms of strategies and mechanisms.

Update to the study protocol for a randomized controlled trial comparing mindfulness-based cognitive therapy with maintenance anti-depressant treatment depressive relapse/recurrence: The PREVENT trial

Background: Depression is a common and distressing mental health problem that is responsible for ... more Background: Depression is a common and distressing mental health problem that is responsible for significant individual disability and cost to society. Medication and psychological therapies are effective for treating depression and maintenance anti-depressants (m-ADM) can prevent relapse. However, individuals with depression often express a wish for psychological help that can help them recover from depression in the long-term. A recently developed treatment, mindfulness-based cognitive therapy (MBCT), shows potential as a brief group program for people with recurring depression. This trial asks the policy research question; is MBCT with support to taper/discontinue antidepressant medication (MBCT-TS) superior to m-ADM in terms of: a primary outcome of preventing depressive relapse/recurrence over 24 months; and secondary outcomes of (a) depression free days, (b) residual depressive symptoms, (c) antidepressant medication (ADM) usage, (d) psychiatric and medical co-morbidity, (e) quality of life, and (f) cost effectiveness? An explanatory research question also asks whether an increase in mindfulness skills is the key mechanism of change. The design is a single-blind, parallel randomized controlled trial examining MBCT-TS versus m-ADM with an embedded process study. To answer the main policy research question the proposed trial compares MBCT-TS with m-ADM for patients with recurrent depression. Four hundred and twenty patients with recurrent major depressive disorder in full or partial remission will be recruited through primary care. Results: Depressive relapse/recurrence over two years is the primary outcome variable. Analyses will be conducted following CONSORT standards and overseen by the trial's Data Monitoring and Safety Committee. Initial analyses will be conducted on an intention-to-treat basis, with subsequent analyses being per protocol. The explanatory question will be addressed in two mutually informative ways: quantitative measurement of potential mediating variables pre-and post-treatment and a qualitative study of service users' views and experiences. Conclusions: If the results of our exploratory trial are extended to this definitive trial, MBCT-TS will be established as an alternative approach to maintenance antidepressants for people with a history of recurrent depression. The process studies will provide evidence about the effective components which can be used to improve MBCT and inform theory as well as other therapeutic approaches.

Guided self-help concreteness training as an intervention for major depression in primary care: a Phase II randomized controlled trial

Psychological Medicine, 2011

BackgroundThe development of widely accessible, effective psychological interventions for depress... more BackgroundThe development of widely accessible, effective psychological interventions for depression is a priority. This randomized trial provides the first controlled data on an innovative cognitive bias modification (CBM) training guided self-help intervention for depression.MethodOne hundred and twenty-one consecutively recruited participants meeting criteria for current major depression were randomly allocated to treatment as usual (TAU) or to TAU plus concreteness training (CNT) guided self-help or to TAU plus relaxation training (RT) guided self-help. CNT involved repeated practice at mental exercises designed to switch patients from an unhelpful abstract thinking habit to a helpful concrete thinking habit, thereby targeting depressogenic cognitive processes (rumination, overgeneralization).ResultsThe addition of CNT to TAU significantly improved depressive symptoms at post-treatment [mean difference on the Hamilton Rating Scale for Depression (HAMD) 4.28, 95% confidence inter...

Why “why” seems better than “how”. Processes underlining repetitive thinking in an Italian non-clinical sample

Personality and Individual Differences, 2014

Given the evidence for the dysfunctional effects of rumination, the fundamental question remains:... more Given the evidence for the dysfunctional effects of rumination, the fundamental question remains: why depressed patients continue to ruminate over long periods of time? Watkins has shown that unconstructive repetitive thought is focused on ''why'', aiming at detecting the personal reasons of negative events. This strategy leads people to find evaluative answers of personal inadequacy or negativity of the world. The research aims at (a) test the hypotheses that why RT is significantly correlated to negative mood, even when controlling for depressive symptoms; (b) test whether non-clinical participants really tend to prefer the ''how'' RT, when coping with an unexpected negative event of everyday life; this results would suggest that the ''how'' style is more functional than the ''why'' style; (c) exploring beliefs that may guide the choice between the ''how'' or the ''why'' modes; (d) investigate the influence of a previous choice on the subsequent thinking style. 212 participants have been recruited. We include questionnaires about rumination and depression and 8 vignette describing negative unexpected situations, followed by three tasks. The results confirm the detrimental role of why focused repetitive thinking on mood state and show a significant influence of a ''why tendency''.

Conceptual Foundations of the Transdiagnostic Approach to CBT

Journal of Cognitive Psychotherapy, 2009

This article defines and explains the transdiagnostic approach to cognitive-behavioral therapy (C... more This article defines and explains the transdiagnostic approach to cognitive-behavioral therapy (CBT) and elaborates on its conceptual foundations and implications for research and practice. We argue that the approach has good philosophical, historical, pragmatic, and empirical foundations. We distinguish between transdiagnostic approaches based on multiple processes that are universally applied (e.g., Harvey, Watkins, Mansell, & Shafran, 2004), multiple processes limited in the range of disorders covered (e.g., Fairburn, Cooper, & Shafran, 2003), symptom-based accounts (e.g., Persons, 1986), and universal single process accounts (e.g., experiential avoidance, self-absorption). We summarize existing evidence and identify key issues relating to the methodology of future research on the transdiagnostic approach. The article concludes by highlighting the great potential benefits of the approach and highlights significant practical, political, and scientific obstacles to putting it into ...

Ruminative self-focus and negative affect: An experience sampling study

Journal of Abnormal Psychology, 2008

Cognitive Behavioral Processes Across Psychological Disorders: A Review of the Utility and Validity of the Transdiagnostic Approach

International Journal of Cognitive Therapy, 2008

The transdiagnostic approach states that there are key cognitive and behavioral processes respons... more The transdiagnostic approach states that there are key cognitive and behavioral processes responsible for maintaining symptoms and these are shared across psychological disorders (Harvey, Watkins, Mansell, & Shafran, 2004). The first goal of this article is to justify the potential utility of a transdiagnostic perspective for theory, research and treatment using empirical evidence and clinical vignettes. We then take as an example one set of cognitive processes-attentional processes-to illustrate the approach. Evidence for three attentional processes is provided: vigilance to external concern-related stimuli; vigilance to internal concern-related stimuli (self-focused attention) and attentional avoidance. It is concluded that each of these attentional processes are transdiagnostic. We then discuss three possible resolutions to the question: How can a transdiagnostic perspective be valid when the different psychological disorders present so differently? The three proposals are: (1) variations in idiosyncratic current concerns; (2) variations in the degree of shared processes and (3) distinct processes for specific disorders or groups of disorders. The role of a transdiagnostic approach in supporting the development and testing of theories of psychopathology is highlighted and the need for future studies that incorporate multiple patient groups is discussed.

Processing mode causally influences emotional reactivity: Distinct effects of abstract versus concrete construal on emotional response

Emotion, 2008

Negative affect and ruminative self-focus during everyday goal pursuit

Cognition & Emotion, 2010

When the ends outweigh the means: Mood and level of identification in depression

Cognition & Emotion, 2011

Concreteness training reduces dysphoria: A pilot proof-of-principle study

Behaviour Research and Therapy, 2009

We hypothesized that a tendency towards abstract, general and decontextualized processing is a co... more We hypothesized that a tendency towards abstract, general and decontextualized processing is a cognitive distortion that causally contributes to symptoms of depression. This hypothesis predicts that training dysphoric individuals to become more concrete and specific in their thinking would reduce depressive symptoms. To test this prediction, participants with stable dysphoria (scoring ! 14 on BDI-II at 2 consecutive weekly assessments) were randomly allocated in an additive design either to an active intervention control consisting of relaxation training or relaxation training plus concreteness training. Concreteness training involved repeated mental exercises designed to encourage more concrete and specific thinking about emotional events. Both interventions involved a training session and then repeated daily use of compact disc recordings for 7 days. Relaxation training plus concreteness training resulted in significantly greater decreases in depressive symptoms and marginally significantly greater decreases in state rumination than relaxation training alone. These findings suggest the potential value of concreteness training as a guided self-help intervention for mild-to-moderate depressive symptoms.

Psychosocial correlates of depressive rumination

Behaviour Research and Therapy, 2010

The study examined the relationship between brooding, the maladaptive sub-component of depressive... more The study examined the relationship between brooding, the maladaptive sub-component of depressive rumination, an important cognitive mechanism implicated in the aetiology of depression, and a range of depressogenic psychosocial factors, including insecure attachment styles and maladaptive interpersonal behaviours. It was hypothesised that brooding (but not the more adaptive reflection component) is associated with an attachment pattern characterised by fear of rejection, and an interpersonal style characterised by submissiveness. Currently depressed (n = 29), previously depressed (n = 42) and never-depressed (n = 32) adults completed self-report measures assessing depressive symptoms, rumination (brooding and reflection), attachment orientation and maladaptive interpersonal behaviours. The study hypotheses were partially supported: After controlling for gender and depressive symptoms, brooding was significantly associated with one indicator of underlying rejection concerns (rejection sensitivity, p = .05), but was not associated with another indicator of underlying rejection concerns (anxious attachment style) or with avoidant attachment style. After controlling for depressive symptoms, brooding was uniquely associated with the submissive interpersonal style (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .01). Brooding was not correlated with needy or cold interpersonal styles after controlling for depressive symptoms.

Processing Mode Influences the Relationship Between Trait Rumination and Emotional Vulnerability

Behavior Therapy, 2006

Adaptive and Maladaptive Self-Focus: A Pilot Extension Study With Individuals High and Low in Fear of Negative Evaluation

Behavior Therapy, 2009