Edward Watkins
University of Exeter, Psychology, Faculty Member
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This chapter explores attention. It defines the key concepts within attention research (selective attention, self-focused attention), and reviews evidence across psychological disorders with a particular focus on determining the extent to... more
This chapter explores attention. It defines the key concepts within attention research (selective attention, self-focused attention), and reviews evidence across psychological disorders with a particular focus on determining the extent to which attentional processes are truly transdiagnostic, and/or whether they are distinct to particular disorders (including anxiety disorders, phobias, somatoform disorders, sexual disorders, eating disorders, sleep disorders, mood disorders, psychotic disorders, and substance-related disorders).
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ObjectiveDepressed patients rate social support as important for prognosis, but evidence for a prognostic effect is lacking. We aimed to test the association between social support and prognosis independent of treatment type, and the... more
ObjectiveDepressed patients rate social support as important for prognosis, but evidence for a prognostic effect is lacking. We aimed to test the association between social support and prognosis independent of treatment type, and the severity of depression, and other clinical features indicating a more severe illness.MethodsIndividual patient data were collated from all six eligible RCTs (n = 2858) of adults seeking treatment for depression in primary care. Participants were randomized to any treatment and completed the same baseline assessment of social support and clinical severity factors. Two‐stage random effects meta‐analyses were conducted.ResultsSocial support was associated with prognosis independent of randomized treatment but effects were smaller when adjusting for depressive symptoms and durations of depression and anxiety, history of antidepressant treatment, and comorbid panic disorder: percentage decrease in depressive symptoms at 3–4 months per z‐score increase in soc...
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Guided, internet-based, rumination-focused cognitive behavioural therapy (i-RFCBT) versus a no-intervention control to prevent depression in high-ruminating young adults, along with an adjunct assessment of the feasibility of unguided i-RFCBT, in the REducing Stress and Preventing Depression tria...more
Depression is a global health challenge. Prevention is highlighted as a priority to reduce its prevalence. Although effective preventive interventions exist, the efficacy and coverage can be improved. One proposed means to increase... more
Depression is a global health challenge. Prevention is highlighted as a priority to reduce its prevalence. Although effective preventive interventions exist, the efficacy and coverage can be improved. One proposed means to increase efficacy is by using interventions to target specific risk factors, such as rumination. Rumination-focused CBT (RFCBT) was developed to specifically target depressive rumination and reduces acute depressive symptoms and relapse for patients with residual depression in a randomised controlled trial. Preliminary findings from a Dutch randomised prevention trial in 251 high-risk 15- to 22-year-old subjects selected with elevated worry and rumination found that both supported internet-RFBCT and group-delivered RFCBT equally reduced depressive symptoms and the onset of depressive cases over a period of 1 year, relative to the no-intervention control. A phase III randomised controlled trial following the Medical Research Council (MRC) Complex Interventions Fram...
Research Interests: Depression, Adolescent, Medicine, Worry, Humans, and 14 moreFeasibility Studies, Cognitive Therapy, Psychological Intervention, Young Adult, Rumination, Clinical Sciences, Adult, Randomized Controlled Trial, Trials, Clinical Protocols, Internet, Psychological Stress, Outcome assessment (Health care), and Cardiovascular medicine and haematology
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Research Interests: Psychiatry, Research Design, Depression, Mindfulness, Medicine, and 15 moreHumans, Antidepressant, Major Depressive Disorder, Clinical Governance, Cognitive Therapy, Mindfulness Based Cognitive Therapy, Randomised Controlled Trial, Clinical Sciences, Randomized Controlled Trial, Trials, SECONDARY PREVENTION, trial protocol, Cardiovascular medicine and haematology, Antidepressive agents, and Substance Withdrawal Syndrome
BackgroundThe development of widely accessible, effective psychological interventions for depression is a priority. This randomized trial provides the first controlled data on an innovative cognitive bias modification (CBM) training... more
BackgroundThe development of widely accessible, effective psychological interventions for depression is a priority. This randomized trial provides the first controlled data on an innovative cognitive bias modification (CBM) training guided self-help intervention for depression.MethodOne hundred and twenty-one consecutively recruited participants meeting criteria for current major depression were randomly allocated to treatment as usual (TAU) or to TAU plus concreteness training (CNT) guided self-help or to TAU plus relaxation training (RT) guided self-help. CNT involved repeated practice at mental exercises designed to switch patients from an unhelpful abstract thinking habit to a helpful concrete thinking habit, thereby targeting depressogenic cognitive processes (rumination, overgeneralization).ResultsThe addition of CNT to TAU significantly improved depressive symptoms at post-treatment [mean difference on the Hamilton Rating Scale for Depression (HAMD) 4.28, 95% confidence inter...
Research Interests: Psychology, Clinical Psychology, Primary Health Care, Self Care, Medicine, and 15 morePsychological Medicine, Humans, Major Depressive Disorder, Female, Cognitive Therapy, Male, Rumination, Middle Aged, Concreteness, Public health systems and services research, Randomized Controlled Trial, Neurosciences, Relaxation Therapy, Hamd, and Intention to treat analysis
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This article defines and explains the transdiagnostic approach to cognitive-behavioral therapy (CBT) and elaborates on its conceptual foundations and implications for research and practice. We argue that the approach has good... more
This article defines and explains the transdiagnostic approach to cognitive-behavioral therapy (CBT) and elaborates on its conceptual foundations and implications for research and practice. We argue that the approach has good philosophical, historical, pragmatic, and empirical foundations. We distinguish between transdiagnostic approaches based on multiple processes that are universally applied (e.g., Harvey, Watkins, Mansell, & Shafran, 2004), multiple processes limited in the range of disorders covered (e.g., Fairburn, Cooper, & Shafran, 2003), symptom-based accounts (e.g., Persons, 1986), and universal single process accounts (e.g., experiential avoidance, self-absorption). We summarize existing evidence and identify key issues relating to the methodology of future research on the transdiagnostic approach. The article concludes by highlighting the great potential benefits of the approach and highlights significant practical, political, and scientific obstacles to putting it into ...
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Research Interests: Psychology, Clinical Psychology, Depression, Adolescent, Medicine, and 15 moreHumans, Business and Management, Female, Cognitive Therapy, Male, Dysphoria, Psychological Intervention, Concreteness, Adult, Depressive Symptoms, Pilot Projects, Compact Disc, Behaviour Therapy, Combined Modality Therapy, and Psychiatric Status Rating Scales
The study examined the relationship between brooding, the maladaptive sub-component of depressive rumination, an important cognitive mechanism implicated in the aetiology of depression, and a range of depressogenic psychosocial factors,... more
The study examined the relationship between brooding, the maladaptive sub-component of depressive rumination, an important cognitive mechanism implicated in the aetiology of depression, and a range of depressogenic psychosocial factors, including insecure attachment styles and maladaptive interpersonal behaviours. It was hypothesised that brooding (but not the more adaptive reflection component) is associated with an attachment pattern characterised by fear of rejection, and an interpersonal style characterised by submissiveness. Currently depressed (n = 29), previously depressed (n = 42) and never-depressed (n = 32) adults completed self-report measures assessing depressive symptoms, rumination (brooding and reflection), attachment orientation and maladaptive interpersonal behaviours. The study hypotheses were partially supported: After controlling for gender and depressive symptoms, brooding was significantly associated with one indicator of underlying rejection concerns (rejection sensitivity, p = .05), but was not associated with another indicator of underlying rejection concerns (anxious attachment style) or with avoidant attachment style. After controlling for depressive symptoms, brooding was uniquely associated with the submissive interpersonal style (p < .01). Brooding was not correlated with needy or cold interpersonal styles after controlling for depressive symptoms.
Research Interests: Psychology, Clinical Psychology, Interpersonal Communication, Depression, Attachment Theory, and 15 moreMedicine, Humans, Behaviour, Business and Management, Female, Male, Psychosocial, Interpersonal Relations, Middle Aged, Adult, Risk Factors, Depressive Symptoms, Object Attachment, Behaviour Therapy, and interpersonal relation
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Research Interests: Clinical Psychology, Depression, Adolescent, Medicine, Distress, and 15 moreAffect, Humans, Business and Management, Female, Male, Depressive Disorder, Aged, Adult, Experience Sampling, Depressive Symptoms, Experience Sampling Method, Life Change Events, LIFE EVENT, Behaviour Therapy, and attitude to health
IntroductionCognitive behavioural therapies (CBTs) are one of the most effective treatments for major depression. However, ~50% of individuals do not adequately respond to intervention and of those who do remit from a depressive episode,... more
IntroductionCognitive behavioural therapies (CBTs) are one of the most effective treatments for major depression. However, ~50% of individuals do not adequately respond to intervention and of those who do remit from a depressive episode, over 50% will experience later relapse. Identification of patient-level factors which moderate treatment response may ultimately help to identify cognitive barriers that could be targeted to improve treatment efficacy. This individual patient data meta-analysis explores one such potential moderator—the ability to retrieve specific, detailed memories of the autobiographical past—as cognitive-based therapeutic techniques draw heavily on the ability to use specific autobiographical information to challenge the dysfunctional beliefs which drive depression.Methods and analysisWe have formed a collaborative network which will contribute known datasets. This will be supplemented by datasets identified through literature searches in Medline, PsycInfo, Web o...
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Background: Pre-treatment severity is a key indicator of prognosis for those with depression. Knowledge is limited on how best to encompass severity of disorders. A number of non-severity related factors such as social support and life... more
Background: Pre-treatment severity is a key indicator of prognosis for those with depression. Knowledge is limited on how best to encompass severity of disorders. A number of non-severity related factors such as social support and life events are also indicators of prognosis. It is not clear whether this holds true after adjusting for pre-treatment severity as a) a depressive symptom scale score, and b) a broader construct encompassing symptom severity and related indicators: “disorder severity”. In order to investigate this, data from the individual participants of clinical trials which have measured a breadth of “disorder severity” related factors are needed. Aims: 1) To assess the association between outcomes for adults seeking treatment for depression and the severity of depression pre-treatment, considered both as i) depressive symptom severity only and ii) “disorder severity” which includes depressive symptom severity and comorbid anxiety, chronicity, history of depression, hi...
IntroductionEmergency workers dedicate their lives to promoting public health and safety, yet suffer higher rates of post-traumatic stress disorder (PTSD) and major depression (MD) compared with the general population. They also suffer an... more
IntroductionEmergency workers dedicate their lives to promoting public health and safety, yet suffer higher rates of post-traumatic stress disorder (PTSD) and major depression (MD) compared with the general population. They also suffer an associated increased risk for physical health problems, which may be linked to specific immunological and endocrine markers or changes in relevant markers. Poor physical and mental health is costly to organisations, the National Health Service and society. Existing interventions aimed at reducing risk of mental ill health in this population are not very successful. More effective preventative interventions are urgently needed. We first conducted a large-scale prospective study of newly recruited student paramedics, identifying two cognitive factors (rumination and resilience appraisals) that predicted episodes of PTSD and MD over a 2-year period. We then developed internet-delivered cognitive training for resilience (iCT-R), a supported online inte...
Sleep difficulties might be a contributory causal factor in the occurrence of mental health problems. If this is true, improving sleep should benefit psychological health. We aimed to determine whether treating insomnia leads to a... more
Sleep difficulties might be a contributory causal factor in the occurrence of mental health problems. If this is true, improving sleep should benefit psychological health. We aimed to determine whether treating insomnia leads to a reduction in paranoia and hallucinations. We did this single-blind, randomised controlled trial (OASIS) at 26 UK universities. University students with insomnia were randomly assigned (1:1) with simple randomisation to receive digital cognitive behavioural therapy (CBT) for insomnia or usual care, and the research team were masked to the treatment. Online assessments took place at weeks 0, 3, 10 (end of therapy), and 22. The primary outcome measures were for insomnia, paranoia, and hallucinatory experiences. We did intention-to-treat analyses. The trial is registered with the ISRCTN registry, number ISRCTN61272251. Between March 5, 2015, and Feb 17, 2016, we randomly assigned 3755 participants to receive digital CBT for insomnia (n=1891) or usual practice ...
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The aim of the present study was to use fMRI to examine the neural correlates of engaging in rumination among a sample of remitted depressed adolescents, a population at high risk for future depressive relapse. A rumination induction task... more
The aim of the present study was to use fMRI to examine the neural correlates of engaging in rumination among a sample of remitted depressed adolescents, a population at high risk for future depressive relapse. A rumination induction task was used to assess differences in the patterns of neural activation during rumination versus a distraction condition among 26 adolescents in remission from major depressive disorder (rMDD) and in 15 healthy control adolescents. Self-report depression and rumination, as well as clinician-rated depression, were also assessed among all participants. All of the participants recruited regions in the default mode network (DMN), including the posterior cingulate cortex, medial prefrontal cortex, inferior parietal lobe, and medial temporal gyrus, during rumination. Increased activation in these regions during rumination was correlated with increased self-report rumination and symptoms of depression across all participants. Adolescents with rMDD also exhibi...
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Depression is a global health challenge. Although there are effective psychological and pharmaceutical interventions, our best treatments achieve remission rates less than 1/3 and limited sustained recovery. Underpinning this efficacy gap... more
Depression is a global health challenge. Although there are effective psychological and pharmaceutical interventions, our best treatments achieve remission rates less than 1/3 and limited sustained recovery. Underpinning this efficacy gap is limited understanding of how complex psychological interventions for depression work. Recent reviews have argued that the active ingredients of therapy need to be identified so that therapy can be made briefer, more potent, and to improve scalability. This in turn requires the use of rigorous study designs that test the presence or absence of individual therapeutic elements, rather than standard comparative randomised controlled trials. One such approach is the Multiphase Optimization Strategy, which uses efficient experimentation such as factorial designs to identify active factors in complex interventions. This approach has been successfully applied to behavioural health but not yet to mental health interventions. A Phase III randomised, singl...
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This pilot randomized control trial was designed to examine whether Rumination-Focused Cognitive Behavior Therapy (RFCBT) reduces rumination and residual depressive symptoms among adolescents with a history of Major Depressive Disorder... more
This pilot randomized control trial was designed to examine whether Rumination-Focused Cognitive Behavior Therapy (RFCBT) reduces rumination and residual depressive symptoms among adolescents with a history of Major Depressive Disorder (MDD) who are at risk for relapse. We also examined whether these changes in symptoms were associated with changes in functional connectivity of the posterior cingulate cortex (PCC), a key node in the default mode network (DMN). Thirty-three adolescents (ages 12-18) were randomized to eight weeks of RFCBT or an assessment only (AO) control. Twenty two adolescents successfully completed fMRI scans pre- and post-intervention. Adolescents were recruited from the clinic and community and met criteria for at least one previous episode of MDD and were currently in full or partial remission. An Independent Evaluator interviewed parent and child before and after the eight-week intervention. The left PCC (-5, -50, 36) seed was used to probe resting state funct...
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Individuals with a history of recurrent depression have a high risk of repeated depressive relapse/recurrence. Maintenance antidepressant medication (m-ADM) for at least 2 years is the current recommended treatment, but many individuals... more
Individuals with a history of recurrent depression have a high risk of repeated depressive relapse/recurrence. Maintenance antidepressant medication (m-ADM) for at least 2 years is the current recommended treatment, but many individuals are interested in alternatives to m-ADM. Mindfulness-based cognitive therapy (MBCT) has been shown to reduce the risk of relapse/recurrence compared with usual care but has not yet been compared with m-ADM in a definitive trial. To establish whether MBCT with support to taper and/or discontinue antidepressant medication (MBCT-TS) is superior to and more cost-effective than an approach of m-ADM in a primary care setting for patients with a history of recurrent depression followed up over a 2-year period in terms of preventing depressive relapse/recurrence. Secondary aims examined MBCT's acceptability and mechanism of action. Single-blind, parallel, individual randomised controlled trial. UK general practices. Adult patients with a diagnosis of rec...
Research Interests: Primary Health Care, Mindfulness, Quality of life, Treatment Outcome, Humans, and 17 moreMajor Depressive Disorder, Female, Cognitive Therapy, Male, Young Adult, Health Technology Assessment, Recurrence, Lancet, Aged, Great Britain, Middle Aged, Adult, Time Factors, Cost Benefit Analysis, SECONDARY PREVENTION, Socioeconomic Factors, and Combined Modality Therapy
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Processing mode theory proposes that rumination is characterized by abstract processing that involves increased thinking about the implications of emotional events, which derives the prediction that heightened ruminative disposition will... more
Processing mode theory proposes that rumination is characterized by abstract processing that involves increased thinking about the implications of emotional events, which derives the prediction that heightened ruminative disposition will be associated with elevated emotional extrapolation from current events when formulating future expectancies. To test this, we used a novel Emotional Extrapolation Assessment Task that measured individual differences in the degree to which the emotional tone of initial events influences relative expectancy for subsequent events that are emotionally consistent or inconsistent with this initial event. In Experiment 1, ruminative disposition was associated with increased self-reported expectancy for negative subsequent events relative to positive subsequent events. As predicted, in Experiment 2, heightened ruminative disposition was associated with increased emotional extrapolation, assessed using a comprehension latency performance-based measure.
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The treatment of chronic and recurrent depression is a priority for the development of new interventions. The maintenance of residual symptoms following acute treatment for depression is a risk factor for both chronic depression and... more
The treatment of chronic and recurrent depression is a priority for the development of new interventions. The maintenance of residual symptoms following acute treatment for depression is a risk factor for both chronic depression and further relapse/recurrence. This open case series provides the first data on a cognitive-behavioural treatment for residual depression that explicitly targets depressive rumination. Rumination has been
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Postnatal maternal depressive symptoms are consistently associated with impairments in maternal attunement (i.e., maternal responsiveness and bonding). There is a growing body of literature examining the impact of maternal cognitive... more
Postnatal maternal depressive symptoms are consistently associated with impairments in maternal attunement (i.e., maternal responsiveness and bonding). There is a growing body of literature examining the impact of maternal cognitive factors (e.g., rumination) on maternal attunement and mood. However, little research has examined the role of infant temperament and maternal social support in this relationship. This study investigated the hypothesis that rumination would mediate (1) the relationship between depressive symptoms and attunement and (2) the relationship between social support and attunement. We further predicted that infant temperament would moderate these relationships, such that rumination would demonstrate mediating effects on attunement when infant difficult temperament was high, but not low. Two hundred and three mothers completed measures on rumination, depressive symptoms, attunement, perceived social support and infant temperament. Rumination mediated the effect of postnatal maternal depressive mood on maternal self-reported responsiveness to the infant when infants were low, but not high, in negative temperament. When infants had higher negative temperament, there were direct relationships between maternal depressive symptoms, social support and maternal self-reported responsiveness to the infant. This study is limited by its cross-sectional and correlational nature and the use of self-report measures to assess a mother's awareness of her infant needs and behaviours, rather than observational measures of maternal sensitivity. These findings suggest potentially different pathways to poor maternal responsiveness than those expected and provide new evidence about the contexts in which maternal cognitive factors, such as rumination, may impact on the mother-infant relationship.
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Individuals with a history of recurrent depression have a high risk of repeated depressive relapse or recurrence. Maintenance antidepressants for at least 2 years is the current recommended treatment, but many individuals are interested... more
Individuals with a history of recurrent depression have a high risk of repeated depressive relapse or recurrence. Maintenance antidepressants for at least 2 years is the current recommended treatment, but many individuals are interested in alternatives to medication. Mindfulness-based cognitive therapy (MBCT) has been shown to reduce risk of relapse or recurrence compared with usual care, but has not yet been compared with maintenance antidepressant treatment in a definitive trial. We aimed to see whether MBCT with support to taper or discontinue antidepressant treatment (MBCT-TS) was superior to maintenance antidepressants for prevention of depressive relapse or recurrence over 24 months. In this single-blind, parallel, group randomised controlled trial (PREVENT), we recruited adult patients with three or more previous major depressive episodes and on a therapeutic dose of maintenance antidepressants, from primary care general practices in urban and rural settings in the UK. Participants were randomly assigned to either MBCT-TS or maintenance antidepressants (in a 1:1 ratio) with a computer-generated random number sequence with stratification by centre and symptomatic status. Participants were aware of treatment allocation and research assessors were masked to treatment allocation. The primary outcome was time to relapse or recurrence of depression, with patients followed up at five separate intervals during the 24-month study period. The primary analysis was based on the principle of intention to treat. The trial is registered with Current Controlled Trials, ISRCTN26666654. Between March 23, 2010, and Oct 21, 2011, we assessed 2188 participants for eligibility and recruited 424 patients from 95 general practices. 212 patients were randomly assigned to MBCT-TS and 212 to maintenance antidepressants. The time to relapse or recurrence of depression did not differ between MBCT-TS and maintenance antidepressants over 24 months (hazard ratio 0·89, 95% CI 0·67-1·18; p=0·43), nor did the number of serious adverse events. Five adverse events were reported, including two deaths, in each of the MBCT-TS and maintenance antidepressants groups. No adverse events were attributable to the interventions or the trial. We found no evidence that MBCT-TS is superior to maintenance antidepressant treatment for the prevention of depressive relapse in individuals at risk for depressive relapse or recurrence. Both treatments were associated with enduring positive outcomes in terms of relapse or recurrence, residual depressive symptoms, and quality of life. National Institute for Health Research (NIHR) Health Technology Assessment (HTA) programme, and NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula.
Research Interests: Primary Health Care, Mindfulness, Quality of life, Treatment Outcome, Humans, and 17 moreMajor Depressive Disorder, Female, Cognitive Therapy, Male, Young Adult, Health Technology Assessment, Recurrence, Lancet, Aged, Great Britain, Middle Aged, Adult, Time Factors, Cost Benefit Analysis, SECONDARY PREVENTION, Socioeconomic Factors, and Combined Modality Therapy
Worry and depressive rumination have been found to be involved in the onset and maintenance of a range of psychological disorders. The development of brief screening measures for excessive worry and depressive rumination is therefore... more
Worry and depressive rumination have been found to be involved in the onset and maintenance of a range of psychological disorders. The development of brief screening measures for excessive worry and depressive rumination is therefore desirable to facilitate the assessment of worry and rumination in prevention and treatment settings where routine administration of full questionnaires is not practical due to time-related constraints. Using the Penn State Worry Questionnaire (PSWQ) and the Ruminative Response Scale (RRS) as gold standard starting points, brief versions of these measures were developed in a large sample of adolescents (N = 1,952) and results were cross-validated in two independent samples (N = 1,954; N = 457). The brief versions demonstrated acceptable to high internal consistency (brief PSWQ: α = .84-.91; brief RRS: α = .78-.81) and correlated highly with the full questionnaires (brief PSWQ: r = .91-.94; brief RRS: r = .88-.91). In addition, they showed high sensitivit...
Research Interests: Psychology, Cognitive Science, Anxiety Disorders, Psychometrics, Depression, and 17 moreAdolescent, Anxiety, Screening, Thinking, Humans, Female, Predictive Validity, Male, Obsessive Compulsive Disorder, Regression Analysis, Young Adult, Netherlands, Questionnaires, Adult, Sex Factors, Reproducibility of Results, and ANXIETY
A recent trial demonstrated that a brief guided self-help intervention reduces anxiety in palliative patients. This study investigated whether training palliative nurses to deliver a guided self-help intervention would improve their... more
A recent trial demonstrated that a brief guided self-help intervention reduces anxiety in palliative patients. This study investigated whether training palliative nurses to deliver a guided self-help intervention would improve their routine management of psychological distress. A randomized controlled cluster trial compared a team of nurses who attended training (n=5) with a team allocated to a no-training control condition (n=5) on self-reported behaviour and confidence in addressing psychological distress. Ratings of patient psychological distress at routine clinical assessments were also examined pre- and post-training to assess the impact of training on patient distress. As predicted, patients cared for by the trained team demonstrated a significantly greater reduction in distress post-training than patients cared for by the untrained team. However, there was no significant difference in self-reported behaviour and confidence. These findings suggest that brief workshop-based tra...
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The two most common forms of repetitive negative thought (RNT) are rumination and worry, which are both repeatedly implicated in the onset and maintenance of depression and anxiety disorders. It is therefore of theoretical and clinical... more
The two most common forms of repetitive negative thought (RNT) are rumination and worry, which are both repeatedly implicated in the onset and maintenance of depression and anxiety disorders. It is therefore of theoretical and clinical value to understand why people engage in worry and rumination, despite their negative consequences. A variety of vulnerability factors have been implicated, including distal factors relating to personality, abuse, and overcontrolling parenting; and proximal cognitive factors, including abstract processing and perceptions of the function of repetitive thought (RT). The current study provided a cross-sectional examination of these vulnerability factors alongside rumination and worry in a large sample of adults, with reference to a new integrative model of RNT. Structural equation modelling analyses indicated that a model in which neuroticism and emotional abuse were related to RNT via their association with perceptions about the function of RT provided a good fit to the data.