Web-Based Rumination-Focused Cognitive Behavioural Therapy (i-RFCBT) for High-Ruminating University Students: an examination of feasibility and efficacy

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 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.