Repetitive Negative Thinking as a Predictor of Cognitive Behavioral Therapy Outcomes in a Naturalistic Outpatient Treatment

Abstract Background Previous research has reported associations between various forms of repetitive negative thinking (RNT; e.g., rumination, worry, and the content-independent process of RNT) and the onset and maintenance of psychological disorders. Additionally, reductions in RNT are linked to improved treatment outcomes, primarily based on findings from randomized controlled trials. This study examined RNT in the context of outpatient cognitive behavioral therapy (CBT) in routine clinical care. Methods We investigated the predictive value of RNT in a sample of 506 patients from an outpatient clinic and postgraduate training center for CBT, all of whom received CBT for various mental health conditions. Of these, 256 (50.6%) presented with depressive disorder, and we repeated our analyses using only this subsample. We assessed content-independent RNT, brooding, and worrying at pre- and post-assessment. General psychopathology and depression were assessed at pre- and post-assessment as well as at 6- and 12-month follow-up. Results There were significant reductions in general psychopathology and depression between pre-assessment and all subsequent assessments. All forms of RNT showed significant reductions from pre- to post-assessment. These reductions predicted general psychopathology and depression at post-assessment. At follow-up, findings were mixed, with only some forms of RNT being significantly associated with treatment outcome. Conclusions Naturalistic CBT reduced general psychopathology and depression, as well as content-independent RNT, rumination, and worrying. Change in all forms of RNT predicted reductions in general psychopathology and depression at post-assessment. This study highlights the relevance of addressing different forms of RNT in therapeutic interventions.