Examining the Role of Rumination in User Perceptions and Treatment Planning within Unguided Internet-Delivered Cognitive Behavioral Therapy for Depression

Abstract Unguided internet-delivered cognitive behavioral therapy (iCBT) for depression integrates various components, that users can usually utilize in any order and frequency. Among these components, behavioral activation (BA) is considered essential for addressing ruminative thinking, a common emotion regulation strategy in depressed individuals. However, studies found that rumination can interfere with effective coping strategies and affect therapy preferences, sometimes leading to suboptimal decisions. Thus, the current research investigated the connection between rumination and how users perceive and plan to engage with components within unguided-iCBT – a self-directed program that relies on personal judgment. Ninety-two participants viewed a simulation of iCBT app, focusing on two core components: BA and Cognitive Restructuring (CR). Participants evaluated the credibility, perceived stressfulness, and effortfulness of CR and BA, and allocated their planned usage time between them. Additionally, they completed questionnaires to assess their depression and rumination levels. Higher rumination scores were associated with perceiving BA as more stressful, even after accounting for depression levels. Additionally, significant negative and positive correlations were found between rumination scores and the time allocated to BA and CR, respectively. Lastly, participants who reported psychiatric diagnoses (e.g., clinical depression) rated CR as more credible and allocated to it more time at the expense of BA, compared to those without such diagnoses. These findings highlight the potential necessity of personalized iCBT that considers rumination levels to identify and manage users who might be inclined to avoid key CBT components. Future studies should assess whether the present results extend to real‑world engagement with iCBT.