Psychological treatment of depressive rumination

• Rumination is repetitive thinking about symptoms, causes, meanings of depression.
• Rumination is implicated in the onset and maintenance of depression.
• Recent trials suggest that targeting rumination may enhance treatment.
• There needs to be a direct and definitive comparison with existing psychotherapies.
• Because rumination is a mental habit, cognitive bias modification may usefully target it.

Depressive rumination is the tendency to repeatedly dwell on the causes and meanings of negative symptoms, feelings, and problems. It has been robustly implicated as an important mechanism in the onset and maintenance of depression, and has recently been proposed as a potential therapy target to improve treatment efficacy. I describe emerging trial research on psychological therapies that target rumination, which provides encouraging preliminary evidence that rumination-focused interventions may enhance treatment outcome, although key limitations are noted, including the lack of a definitive comparison to existing therapies. Recent advances in cognitive bias modification that implicate cognitive biases in the maintenance of rumination are highlighted as indicating that this approach has potential to treat rumination.