Efficacy of cognitive behavioral therapy in treating repetitive negative thinking, rumination, and worry – a transdiagnostic meta-analysis

Abstract Repetitive negative thinking (RNT) is a transdiagnostic process associated with the onset, maintenance, and risk of relapse of various mental disorders. However, previous research syntheses addressing the effect of cognitive behavioral therapy (CBT) on RNT are limited to specific diagnoses, treatments, or RNT constructs (transdiagnostic RNT, worry, rumination). In the present meta-analysis, we integrate findings from randomized controlled trials (RCTs) of CBT on RNT across diagnoses, intervention types, and RNT constructs. We investigate the following questions: What is the overall transdiagnostic efficacy of CBT interventions on all post-treatment RNT outcomes? Which RNT construct is addressed most effectively? Are RNT-specific treatments superior in reducing RNT than less specific approaches? Inclusion criteria were met by 55 studies with a total of 4,970 participants. The overall post-treatment effect of CBT interventions on RNT compared to respective control groups was moderate in favor of CBT ( g = −0.67). Treatment efficacy did not differ significantly by RNT construct. RNT-specific interventions ( g = −0.99) were significantly more efficacious in reducing RNT than less specific approaches ( g = −0.56). Treatment efficacy was not significantly enhanced by individual or in-person settings. Our results advocate a dissemination of RNT-specific treatments in research and practice and a general improvement of CBT treatments by focusing on relevant transdiagnostic processes such as RNT.