Efficacy of Internet‐based rumination‐focused cognitive behavioral therapy and mindfulness‐based intervention with guided support in reducing risks of depression and anxiety: A randomized controlled trial

Abstract

AbstractRumination and worry are common risk factors of depression and anxiety. Internet‐based transdiagnostic interventions targeting individuals with these specific risks may be an effective way to prevent depression and anxiety. This three‐arm randomized controlled trial compared the efficacy of Internet‐based rumination‐focused cognitive behavioral therapy (RFCBT), mindfulness‐based intervention (MBI), and psychoeducation (EDU) control among 256 at‐risk individuals. Participants' levels of rumination, worry, depressive, and anxiety symptoms were assessed at post‐intervention (6 weeks), 3‐month, and 9‐month follow‐ups. Linear mixed model analysis results showed similar levels of improvement in all outcomes across the three conditions. Changes in rumination differed comparing RFCBT and MBI, where a significant reduction in rumination was noted at a 3‐month follow‐up among participants in RFCBT, and no significant long‐term effect among participants in MBI was noted at a 9‐month follow‐up. All three conditions showed similar reductions in risks and symptoms, implying that the two active interventions were not superior to EDU control. The high attrition at follow‐ups suggested a need to exercise caution when interpreting the findings. Future studies should tease apart placebo effect and identify ways to improve adherence.