Does a group cognitive behavioral therapy with focus on worry and rumination lead to reduced comorbid mental health problems such as anxiety, depression and sleep problems for primary care patients?

Rumination focused Cognitive Behavioral Therapy (RFCBT) is based on general CBT principles: for example psychoeducation (viewing emotional regulation strategies such worry and rumination as mental habits automatically triggered in stressful situations and detained by negative reinforcement), functional analysis, behavioral activation, behavioral experiments, homework and relapse prevention. In this study, RFCBT consists of eight sessions in a group setting over 8 weeks (90 minutes per session: in total 8 x 90 min = 720 min therapy) where participants work with functional management strategies as opposed to repetitive negative thinking such as shifting from abstract to specific thinking, partly with visual imagery techniques. In stressful situations, participants are advised to try shifting the abstract thinking style associated with worrying to a more concrete style (e.g. "what do I need to do and how do I do it?" as opposed to "why am I such a looser?" or "are things ever going to get better?" . Mindfulness and self compassion strategies are also being used as as alternatives to worry and rumination. The use of dysfunctional emotional regulation strategies such as worry and rumination have been shown to be transdiagnostic maintaining factors in a variety of psychological problems. Therefore, the theoretical idea behind RFCBT is if we impact the automatic use of these emotional regulation strategies in stressful situations and events (stressors) and instead exercise an extended repertoire of more functional emotional regulation strategies, a wide range of mental problems will be improved. The strategies practiced in treatment can broadly be described as shifting from avoidance to engaged behaviors such as in behavioral experiments or in behavioral activation. Visualizing concrete activities and shifting from abstract to concrete thinking are specific techniques used in this study aiming to target worry and rumination. The therapy groups will consist of up to 10 participants (minimum of 6) and be administrated by two therapists per groups: one registered clinical psychologist and a student from the master of clinical psychology program. Attendance will be taken. Participant diaries will not be used. Homework is an integral part of this treatment and will take about 45 min to complete per week, spread over the week. The homework done each week are simply an extension of the theory and practice provided in session and consists of tasks such as worry diary, setting goals, functional analysis, if - then plans, shifting thinking style, presence in activities, visualizing concrete activities, self compassion, identifying and acting according to values, relating to and learning from experience and finally relapse prevention. A typical therapy sessions involves a review of last week's homework, a short lecture with new theoretical content (treatment rationale for different techniques), workshop exercises individually and in small groups (overseen by therapists), group discussions about the treatment content and the participants' experiences, and lastly new home work assignments.