Associated organisationsLudwig-Maximilians-Universität München · University of California · University of Exeter · University of Exeter Medical SchoolEurope PMC affiliations are not treated as award recipients or mapped locations.
Funding£5.0M
PeriodNov 2023 — Nov 2029
In plain English
AI plain-English summary
A therapist’s core technique for quieting anxious thoughts is about to be put under an experimental microscope. This project tests exactly which parts of cognitive-behavioural therapy (CBT) actually break the cycle of repetitive negative thinking—worry and rumination that fuel anxiety and depression—and how they work. Although CBT that targets repetitive negative thought is effective, the mechanisms behind its success remain unknown. Without knowing *why* it works, therapists cannot refine treatments to be faster, cheaper, or more reliable. This study fills that gap by running a large-scale online trial that systematically varies five candidate mechanisms: shifting from vague to concrete thinking, breaking the habit of rumination, replacing self-criticism with self-compassion, improving present-moment focus, and increasing patient understanding of their own difficulties. If the research succeeds, it will identify the active ingredients of therapy and discard the inactive ones. The result could be a streamlined, internet-delivered treatment that is more potent, economical, and accessible—transforming early intervention for millions of people with anxiety and depression. People with lived experience will help shape which mechanisms are prioritised and how interventions are adapted.
View original technical description
Repetitive negative thought (RNT, worry, rumination) influences the onset and maintenance of anxiety and depression. Reducing RNT is an established active therapeutic ingredient. Although cognitive-behavioural therapy (CBT) targeting RNT is effective, the mechanisms underpinning treatment effects are unknown. Our key goals are to delineate the active therapeutic components and associated mechanisms-of-action of CBT targeting RNT, via experimental manipulation of treatment components within internet-delivered RNT-focused CBT and assessment of mediators in a large-scale factorial trial for individuals with elevated RNT. Combining components in a factorial experiment is more efficient for sample size and resource than conducting separate experiments and better tests the main effects and interactions of each factor than dismantling designs. Hypothesized mechanisms include (i) shifting from overgeneral abstract to specific thinking; (ii) breaking out of RNT-as-a-habit; (iii) replacing self-criticism with self-compassion; (iv) improved present-moment focus; (v) increased patient understanding of difficulties. People with Lived Experience will shape research questions and design: they will guide prioritising which mechanisms-to-study and they will co-design adaptations to existing interventions to better manipulate these mechanisms. This novel project will test these hypotheses experimentally, leading to more potent, economical, and accessible treatments for RNT available via an online platform to transform early intervention.
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