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Rumination-Focused Cognitive Behavioral Therapy (RFCBT)

Repetitive thinking is a critical transdiagnostic mechanism that is implicated in the onset and maintenance of depression and anxiety. We can conceptualize repetitive thinking about the future as ‘worry,’ and repetitive thinking about the past as ‘rumination.’ Repetitive thinking can be a maintenance factor in conditions including anxiety and depression. Rumination-focused cognitive behavioral therapy (RFCBT) as described by Watkins (2016) involves the components of:
  • a longitudinal case formulation which views rumination as a learned behavior;
  • the use of diaries to notice rumination and avoidance;
  • functional analysis to examine the context and function of rumination and avoidance;
  • behavioral experiments to examine the effect of different modes of thinking (why vs. how);
  • behavioral activation;
  • focus on the patient’s values;
  • relapse prevention.
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Therapy tool

Living With Worry And Anxiety Amidst Global Uncertainty

This free guide was published in March 2020 in response to the coronavirus pandemic and is designed for anyone experiencing anxiety or worry. In times ...

Free Guide

Problem Solving (CYP)

Effective problem solving is an essential life skill and this Problem Solving worksheet is designed to guide children and adolescents through steps wh ...


Rumination Diary (Archived)

Self-monitoring of thoughts, feelings, and symptoms is an essential skill in cognitive behavioral therapy (CBT). The Rumination Diary helps clients to ...


Rumination Self-Monitoring Record (Edition 1)

Rumination-Focused CBT (RF-CBT) takes a functional-analytic approach to rumination and aims to help depressed clients to identify the contexts in whic ...


What Is Rumination?

Rumination and repetitive thought is a transdiagnostic maintenance process underpinning a range of difficulties. This information sheet explores the c ...

Information Handout

What Keeps Depression Going?

The “What Keeps It Going?” series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concis ...

Information Handout

Worry Decision Tree

Worry is a cognitive process that involves thinking about problems that might happen in a way that can leave you feeling anxious or apprehensive. Not ...


Worry Diary (Archived)

In the initial stages of treatment for GAD it is helpful to orient clients to observing their worries as a process rather than focus on their content. ...


Worry Postponement

Worry postponement is often prescribed as an exploratory or standalone intervention relatively early in the treatment of GAD, but ‘worry postponeme ...


Worry Thought Record

Anxiety stems from negative predictions about the future (and also from assumptions that one will not be able to cope with the magnitude of the threat ...





  • The how and why of rumination and worry – presentation by Professor Ed Watkins
  • Targeting rumination by changing processing style: Experiential and Imagery exercises – presentation by Professor Ed Watkins

Recommended Reading

  • Watkins, E. R. (2009). Depressive Rumination and Co-Morbidity: Evidence for Brooding as a Transdiagnostic Process. Journal of Rational-Emotive Cognitive Behaviour Therapy, 27, 160-175
  • Watkins, E. (2015). Psychological treatment of depressive rumination. Current Opinion in Psychology4, 32-36.
  • Watkins, E. R. (2016). Rumination-focused cognitive-behavioral therapy for depression. Guilford Publications.


  • Watkins, E. R. (2016). Rumination-focused cognitive-behavioral therapy for depression. New York: Guilford.