Web-Based Rumination-Focused Cognitive Behavioural Therapy (i-RFCBT) for High-Ruminating University Students: an examination of feasibility and efficacy
Cook, L
Date: 14 September 2020
Publisher
University of Exeter
Degree Title
PhD in Psychology
Abstract
Depression is both highly prevalent and highly impactful in the student population. The aim of the PhD was to assess internet-based rumination-focused cognitive-behavioural therapy (i-RFCBT) as an intervention to reduce the impact of depression in university students. The intervention was first implemented as a treatment within a ...
Depression is both highly prevalent and highly impactful in the student population. The aim of the PhD was to assess internet-based rumination-focused cognitive-behavioural therapy (i-RFCBT) as an intervention to reduce the impact of depression in university students. The intervention was first implemented as a treatment within a university Wellbeing service. An audit of treatment usage and clinical outcomes (N = 82) found the intervention significantly reduced acute depressive and anxious symptoms. Within a case series subsample (N = 26) there were improvements in clinical outcomes as well as significant reductions in rumination, consistent with the hypothesised mechanism of change. Acute treatment has a limited impact on the disease burden of depression within a population. A greater focus on prevention is identified as a priority. A qualitative study was conducted to investigate the acceptability of i-RFCBT as a preventive intervention. Having established that the intervention was acceptable, the RESPOND randomised-controlled trial (N = 235) tested whether guided i-RFCBT was an efficacious at preventing the incidence of depression in UK undergraduates with elevated rumination and worry. The trial found that guided i-RFCBT reduced the incidence of a major depressive episode (MDE) over the course of the 12-month follow-up period by 34% relative to usual care, although this difference was not significant. Baseline stress was a significant moderator of the intervention effect, such that participants with higher stress levels experienced a significant benefit of i-RFCBT in reducing the incidence of MDE relative to usual care. Short- to- medium- term improvements in worry, rumination and depressive symptoms were also found. As guided interventions are limited in terms of scalability, an additional, quasi phase-II pilot feasibility arm was incorporated within the RESPOND trial to test the acceptability and estimate the effect sizes of unguided i-RFCBT. The pattern of effects for unguided i-RFCBT was similar to that of guided i-RFCBT. The clinical implications of the thesis findings are discussed.
Doctoral Theses
Doctoral College
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