Panel Discussion 8 - Cognitive Behavior Therapy for Analytical Rumination in Depression

Depressive episodes usually resolve on their own. Traditionally glossed over as "spontaneous remission," these recovery processes are being increasingly studied as coordinated systemic recruitments of motivational, attentional, mnemonic, and cognitive resources. In evolutionary biology the innovative Analytical Rumination Hypothesis (ARH) of Panelist 3 holds that ruminative processes in depression evolved because they tended to facilitate effective root cause analyses of the precipitating problems (i.e., recalling and reconstruing causal chains of events that led to a harmful event, usually a mistake, loss, or failure). These analyses - facilitated by precisely the Type 2 thinking processes of slow, deliberative, repetitive, past-focused, self-focused cognitive elaborations - in turn helped lead to effective operant avoidance learning and thus helped prevent future depressive episodes. In essence, the ARH posits that rumination in depression is a species-typical cognitive adaptation that draws together those elements of avoidance learning that are crucial for remission and relapse prevention. Processes that interfere with, suppress, prevent, or subvert full avoidance learning tend to prolong depressive episodes and make them more likely to recur or become chronic. Experiments directly testing the ARH now show that, even in non-clinical individuals, inducing depressive mood does initiate the steps of a root cause analysis that includes self-blame, problem identification, and causal reconstruction of the precipitating problem. Clinical implications of the ARH point to specific methodologies (such as increasing sadness tolerance and utilization, combining reasonable self-blame with self-acceptance, normalizing the initial cognitive effects of a depressive state, and iteratively constructing a moral to the story of a depressive episode) that could further optimize CBT's already superior ability to prevent relapse. Discussants will elaborate on the clinical significance of this new understanding of depressive rumination and its growing experimental evidence base.