Depression and rumination: an updated review

Depression is a prevalent and disabling mental disorder characterized by multifactorial etiologies. Among the psychological processes implicated in its onset, maintenance, and recurrence, rumination — defined as the tendency to repeatedly and passively dwell on negative emotions and thoughts — has emerged as a significant transdiagnostic risk factor. Rumination not only precipitates and amplifies depressive symptoms but also sustains them by disrupting adaptive emotion regulation, a mechanism central to depressive psychopathology. This review examines the relationship between depression and rumination, focusing on shared theoretical models and evaluating treatment strategies specifically targeting ruminative processes. Evidence suggests that interventions directly addressing rumination — such as Rumination-Focused Cognitive Behavioural Therapy (RFCBT), Metacognitive Therapy (MCT), and Mindfulness-Based Cognitive Therapy (MBCT) demonstrate superior efficacy in reducing depressive symptoms and preventing relapse compared to standard treatments. These findings highlight the clinical importance of assessment approaches that extend beyond symptom severity to capture the cognitive mechanisms underlying rumination, including metacognitive beliefs, perceived thought controllability, and patterns of repetitive negative thinking. Integrating such assessments into clinical practice enables more precise case conceptualization and better-informed selection of targeted interventions, ultimately improving treatment outcomes for individuals with depression.