Targeting negative repetitive thought as a transdiagnostic mechanism:
translating cognitive science into innovative treatment

Rumination contributes to the maintenance and onset of depression and anxiety, acts as a final common pathway for multiple vulnerabilities, and is identified as a transdiagnostic mechanism (Nolen-Hoeksema & Watkins, 2011). Thus, understanding and targeting it is a potential way to improve the effectiveness and efficacy of psychotherapy. This talk reviews the application of cognitive science principles to understanding rumination and its translation to innovations in CBT (Watkins, 2015), providing proof-of-principle of how psychological science can enhance interventions (Holmes et al., 2014). Cognitive science research using lab-based experimental manipulations has explored what underlies pathological rumination, suggesting (a) rumination can be usefully conceived as a mental habit (Watkins & Nolen-Hoeksema; 2014; Hertel, 2004) with particular patterns of selective information processing implicated in its development (e.g., Koster et al., 2011; Hertel et al., 2011); (b) the consequences of repetitive thinking about negative content depend upon the thinking style adopted, with an abstract, decontextualized thinking style, characteristic of rumination, causally implicated in increased negative emotional reactivity and impaired problem solving, relative to concrete and contextualised processing (Watkins, 2008). This led to Rumination-focused CBT (RFCBT), which explicitly uses functional analysis to target rumination-as-habit, and uses exercises and experiments to shift thinking style, instead of challenging thought content. In clinical trials, RFCBT is efficacious for difficult-to-treat residual depression (Watkins et al., 2010), outperforms standard CBT in treating major depression (Hvennegard et al., submitted) and prevents anxiety and depression in high risk young adults via an e-technology variant (Topper et al., submitted).

Professor Edward Watkins
University of Exeter
3.00pm to 4.00pm in 35 AC 04

Ed Watkins is Professor of Experimental and Applied Clinical Psychology at the School of Psychology, University of Exeter. He trained as a chartered clinical psychologist at the Institute of Psychiatry, London, and then held a joint research position between the Institute of Psychiatry and the Medical Research Council – Cognition and Brain Sciences Unit. He has specialist clinical training and expertise in cognitive therapy for depression. He currently works as a researcher, teacher, and clinical practitioner, and directs SMART Lab (Study of Maladaptive to Adaptive Repetitive Thought), specialising in psychological research and treatment for depression and anxiety. His research programme focuses on worry and rumination, utilising both experimental methods to understand its mechanisms and then clinical process-outcome research to translate these experimental findings into improved psychological interventions to treat and prevent depression and anxiety. He has been funded by the Wellcome Trust, UK Medical Research Council (MRC) Experimental Medicine Award, European Commission FP7, and a NARSAD Young Investigators Award. Current research includes examining diet and behavioural change to prevent depression and obesity; the use of therapy targeting rumination to improve outcomes for depression and anxiety,  the use of e-therapies to prevent depression and anxiety, tested in UK, Netherlands, Sweden, and Hong Kong, and the use of innovative trial designs to disentangle the active ingredients of internet-delivered CBT. He was awarded the British Psychological Society’s May Davidson Award 2004 for outstanding early-career contribution to the development of clinical psychology, was a member of the Wellcome Trust Expert Review Group for Cognitive Neuroscience and Mental Health 2011-2014, and is a current member of the UK NICE guidelines review board for adult depression.