Pretreatment levels of rumination predict cognitive-behavioral therapy outcomes in a transdiagnostic sample of adults with anxiety-related disorders

Increasing research has implicated rumination in the development and maintenance of many types of psychopathology, including anxiety-related disorders. A few studies have explored the impact of rumination during cognitive-behavioral therapy (CBT) for anxiety-related disorders (which relies heavily on exposure-based interventions), with mixed results. The present study assessed levels of (trait) rumination before starting treatment for predicting outcomes in 147 adults seeking CBT for anxiety-related disorders in an open treatment clinic. Results revealed that pretreatment levels of rumination significantly predicted (lower) quality of life at the end of treatment, after accounting for baseline variance in quality of life. This finding remained robust when also accounting for demographics, depression, general anxiety, and diagnosis. This result was not observed for self-reflection (a construct related to, but distinguishable from, rumination). Nevertheless, a follow-up (receiveroperator characteristic) analysis showed that pretreatment rumination did not reliably distinguish participants who showed clinically meaningful gains in quality of life during treatment from those who did not. Theoretical and clinical implications of these findings are discussed. We propose that rumination may impede emotional processing during CBT for anxiety, and warrants further attention and treatment. However, more advanced methods (e.g., multivariate modeling) are needed to improve the prognostic utility of rumination.