A Psychoeducational CBT-based Group Intervention (“Drop It”) for Repetitive Negative Thinking: Theoretical Concepts and Treatment Processes

ABSTRACT

Repetitive negative thinking (RNT)—such as worry and rumination—is an important transdiagnostic factor in the onset, course, and recurrence of depressive and anxiety disorders. This article describes a psychoeducational cognitive behavioral therapy (CBT)-based group intervention entitled “Drop It” that focuses exclusively on treating RNT in patients with major depressive disorder and/or generalized anxiety disorder. The theoretical concepts and treatment goals of the intervention are outlined. The organization and therapeutic processes of the different sessions are described and illustrated with statements of participants. Special attention is given to how the intervention capitalizes on the group structure and process to maximize the effectiveness of psychoeducation and CBT-based techniques. We also provide practical guidelines for clinicians treating patients with RNT.

ACKNOWLEDGMENTS

We would like to thank Eva Buytaert, Evi De Lissnyder, and Marianne Hendrickx for their contribution to the concept of training, and the manuals for participants and trainers. We also wish to express our gratitude to all the participants of the intervention for their commitment, without whom this study would have been impossible.

DISCLOSURE STATEMENT

No potential conflict of interest was reported by the authors.

ETHICS

The intervention was carried out in accordance with the approval of the Ethics Committee of the University Hospital of Ghent, Belgium. All participants provided informed consent.

Notes

¹ RFCBT is focusing on the process of rumination, rather than on the content of RNT. Interventions are based on classical conditioning and behavioral activation, learning to think in “how” rather than why-modes, self-compassion and well-being strategies, and experimental imagery exercises.

² In metacognitive therapy, the focus of intervention is on the metacognitions (cognitions about RNT). For example: “Worrying helps you in finding solutions.” These metacognitions are targeted by classical cognitive strategies.

³ In cognitive memory training (COMET), the patient is trained in retrieving positive memories, mostly related to self-efficacy. The intervention assumes that memory retrieval is mood-dependent and that mood-related memories impact mood. By counterconditioning, the patient learns that they can have an impact on their mood through their positive memories.

⁴ The name “Drop it” was inspired by patients often receiving advice from their families and friends to “get over it” and to “drop it.”

⁵ The latter are not drawn from any one specific client or group.

⁶ “Courtroom Technique” is a classic cognitive intervention, whereby dysfunctional cognitions are challenged by a “Prosecuting Attorney” resulting in a more appropriate cognition (“Judge/Jury”).

⁷ “Arrow Down” technique is based on Socratic questioning. Therapist and client are thus investigating the layered interpretations of the client and the core beliefs. Classic examples of Arrow Down questions are: “And if that is true (or would happen), what does this means to you?” “What does this tell us about you as a person?”

Additional information

Funding

This intervention was conceived and executed by the staff and with resources from the Department of Psychiatry, of the University Hospital of Ghent. This project did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Notes on contributors

Roland Rogiers

Roland Rogiers, is a clinical psychologist and cognitive behavior therapist at Center for Anxiety and Mood Disorders, Department of Psychiatry, Ghent University Hospital, Ghent, Belgium and clinical psychologist at Department of Psychiatry and Medical Psychology, Ghent University, Ghent, Belgium. Chris Baeken is Associate Professor, psychiatrist at the Department of Psychiatry and Medical Psychology, Ghent University, Ghent, Belgium and Primary Investigator at Ghent Experimental Psychiatry (GHEP) lab, Ghent University, Ghent, Belgium; Associate Professor, psychiatrist and Primary Investigator at the Department of Psychiatry, University Hospital (UZBrussel), Brussels, Belgium; and Distinguished Professor at Eindhoven University of Technology, Department of Electrical Engineering, The Netherlands. Edward R. Watkins is Professor of Experimental and Applied Clinical Psychology, Chartered Clinical Psychologist, Member of NICE Guidelines for Adult Depression 2015-2020, Director of Sir Henry Wellcome Building for Mood Disorders Research, at College of Life and Environmental Sciences, University of Exeter, Exeter, UK. Dirk Van den Abbeele is psychiatrist, Solution Focused Therapist and supervisor of the Center for Anxiety and Mood Disorders, Department of Psychiatry, Ghent University Hospital, Ghent, Belgium. Jonathan Remue is clinical psychologist and Cognitive Behaviour Therapist at the Center for Anxiety and Mood Disorders, Department of Psychiatry, Ghent University Hospital, Ghent, Belgium. Rudi De Raedt is Professor of Clinical Psychology, Principal Investigator at the Psychopathology and Affective Neuroscience lab and Head of the Department of Experimental Clinical and Health Psychology, Ghent University, Ghent. Gilbert M.D. Lemmens is psychiatrist, Family Therapist, and Head of the Department of Psychiatry, Ghent University Hospital, Ghent, Belgium and is Associate Professor of Department of Psychiatry and Medical Psychology, Ghent University, Ghent, Belgium.