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Rumination Focused Cognitive Behavioural Therapy

Ed Watkins

19 Apr 2024


On April 19th, 2024, Prof. Ed Watkins delivered a half-day workshop on rumination focused cognitive behavioural therapy.


Rumination is a core process in the maintenance and onset of depression and a transdiagnostic mechanism contributing to co-morbidity (Watkins, 2008).  It is a common hard-to-treat symptom and itself interferes with therapeutic benefit, contributing to poorer outcomes. As such, targeting rumination better can help with “stuck” patients, improve treatment outcome and address complex cases with co-morbidity.
This workshop will illustrate the innovative adaptations to the CBT approach that can help to overcome this problem and improve outcomes for chronic, recurrent and residual depression and co-morbid anxiety. The workshop will review the theoretical background, key principles, and core techniques of the therapy, including functional analysis of thinking style, behavioural activation, imagery, concreteness, experiential exercises and behavioural experiments.

Derived from experimental research (Watkins, 2008), Rumination-focused Cognitive-behavioural therapy (RFCBT, Watkins, 2016) focuses on (a) normalising the process of perseverative thinking in patients and shifting it from unhelpful to helpful ways of thinking, rather than only challenging content; (b) using behavioural activation and functional analysis approaches to target pathological rumination as a mental habit (Watkins & Nolen-Hoeksema, 2014).  RFCBT is proven to be of superior efficacy in randomised controlled trials for (i) difficult-to-treat residual depression patients relative to antidepressant alone (Watkins et al., 2011); (ii) in depressed outpatients in group treatment relative to group CBT (Hvennegard et al., 2019); (iii) in preventing depression and anxiety relative to usual practice in group and internet formats in high-risk young people (Topper et al., 2017; Cook et al., 2019).

Learning Objectives

Attendees will learn to….

1. Describe theory and research relevant to depressive rumination.
2. Understand the key principles and formulation approach of the rumination-focused CBT treatment.
3. Use functional analysis applied to treating rumination and worry as a means to change habitual thinking styles.
4. Consider the key experiential approaches to treating rumination including concreteness, absorption and self-compassion.

Training Modalities

Training modalities will include a mixture of didactic teaching, opportunities to ask questions experiential exercises, and watching of video.
Please consider in advance your own clients who ruminate – this will be a useful resource for the practice in the workshop.

Key References

Topper, M., Emmelkamp, P.M.G., Watkins, E.R., & Ehring, T. (2017). Prevention of anxiety disorders and depression by targeting excessive worry and rumination in adolescents and young adults: a randomized controlled trial. Behaviour Research and Therapy, 90, 123-126.

Watkins, E. (2008). Constructive and Unconstructive Repetitive Thought. Psychological Bulletin, 134, 163-206.

***Watkins, E.R. (2016). Rumination-focused Cognitive Behavioural Therapy for Depression. Guilford Press ****

Watkins, E.R., Mullan, E.G., Wingrove, J., Rimes, K., Steiner, H., Bathurst, N., Eastman, E., & Scott, J. (2011). Rumination-focused cognitive behaviour therapy for residual depression: phase II randomized controlled trial. British Journal of Psychiatry, 199, 317- 322. Doi:10.1192/bjp.bp.110.090282.

Watkins, E.R. & Nolen-Hoeksema, S. (2014). A habit-goal framework of depressive rumination. Journal of Abnormal Psychology, 123, 24-34. DOI: 10.1037/a0035540.

Watkins, E. R., & Roberts, H. (2020). Reflecting on rumination: Consequences, causes, mechanisms and treatment of rumination. Behaviour Research and Therapy, 127, 103573.

About the presenter

Dr Watkins is a pre-eminent international expert in the field of experimental psychopathology and psychological treatments for depression, with a particular emphasis on understanding and treating rumination and worry. He is the co-founder of the Mood Disorders Centre, University of Exeter, and has specialist clinical training and expertise in cognitive therapy for depression, working as a therapist and researcher for over 25 years including in specialist tertiary care for depression, in primary care, and on a number of large-scale treatment trials including of rumination-focused CBT, MBCT (PREVENT), and BA (COBRA;MooDFOOD). His research has been supported by major competitive grant funding as a Principal Investigator from the Wellcome Trust, UK Medical Research Council (MRC), a NARSAD Young Investigators Award, European Commission Horizon 2020 and US NIMH.  Professor Watkins was awarded the British Psychological Society's May Davidson Award 2004 for outstanding early-career contributions to the development of clinical psychology. He was an expert member of the UK NICE Guidelines for Adult Depression Committee from 2015 to 2022.

Who should attend

The workshop is designed for therapists with some prior knowledge of CBT.

Low Intensity clinical contact hours survey - BABCP Low Intensity Special Interest Group

Please click below if you are interested in contributing to the survey.


The BACP Low Intensity SIG are interested in the impact of clinical contact hours on Low Intensity/Wellbeing Practitioner wellbeing. This questionnaire contains six multi-choice questions and a free text box for you to share your experiences. The answers to these questions will help the BABCP SIG plan how to meet CPD topics and other developments within the SIG.  The SIG hope to produce a write up of the answers to this questionnaire to be shared with SIG members and to be used in training.

View Survey

This FREE conference is for Psychological Wellbeing Practitioners working in Talking Therapies for Anxiety and Depression services and is brought to you by Bespoke Mental Health in collaboration with the NHS England Talking Therapies National PWP Leads Network

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