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Background Female university students face an elevated risk of developing common mental health problems, including depression and anxiety. Rumination, a specific form of repetitive negative thought (RNT), is a well-documented risk factor for these conditions. Rumination-focused cognitive-behavioral therapy (RFCBT) represents a promising intervention for the prevention and treatment of depression and anxiety, fostering mental well-being during young adulthood. Although RFCBT has demonstrated effectiveness in numerous randomized controlled trials (RCTs), cultural adaptation has emerged as a critical consideration. This study aims to evaluate the effectiveness of a culturally adapted, guided RFCBT self-help intervention in reducing RNT as well as symptoms of depression and anxiety among Japanese female university students, employing an RCT design. Methods This study is a single-site, assessor-blinded, parallel-group, two-arm randomized controlled trial (guided self-help vs. waitlist), employing block randomization in a 1:1 ratio. A total of 102 female university students with elevated levels of RNT will be recruited. Participants will be randomly assigned to either the intervention group receiving guided RFCBT self-help, or the waitlist control group. The primary outcome is rumination, assessed using the Ruminative Responses Scale. Measurements will be conducted at 4- and 8-week post-randomization. Discussion Empirical evidence regarding the effectiveness of culturally adapted RFCBT in mitigating RNT and symptoms of depression and anxiety among East Asian populations remains scarce. If proven effective, this study will provide empirical evidence supporting the effectiveness of RFCBT in reducing RNT, depression, and anxiety within an East Asian population. Trial registration Japan Registry of Clinical Trials (jRCT): jRCT1050240305, registered 27 March, 2025. (Initially registered with UMIN-CTR: UMIN000053430, on 24 January, 2024. Prospectively registered. Later transferred to jRCT.) Protocol version Ver. 1.3, February 9th 2026.

Mindfulness-based cognitive therapy (MBCT) was developed to reduce the risk of relapse for people suffering with chronic depression. The change processes identified to date focus on the individual level, e.g. “de-centering” or identifying less with thoughts. However, substantial research indicates that interpersonal processes play a major role in chronic depression and suggest that mindfulness practice is associated with more fulfilling interpersonal relationships. This study analyzed participants' experiences of MBCT and their relationships with others in-depth, through the use of qualitative methodology, specifically theoretical sampling of participants' interview data using grounded theory. The core construct that emerged from participants' accounts was “relating mindfully”. Findings show the interconnectedness of individual and interpersonal changes through MBCT, and are summarized in diagrammatic form. Participants described “relating mindfully” to their own experiences with consequential profound changes in their relationships with others. Specifically, participants were more aware of their tendency to react automatically to internal and external triggers (distressing interpersonal situations). This awareness allowed them space to mindfully respond to others rather than react in habitual (and often painful) ways. Relationships were enriched through profound and varied changes: Some participants were more able to “be with” others in distress rather than jumping to “fix” or avoid them. At other times, they were more able to enjoy and appreciate being with others due to their increased tendency to live in the present moment. Participants described improvements in communication, such as increased empathy and ability to see others' perspectives, arguments being more constructive as opposed to just frustrated, habitual rowing. These findings suggest the need for an expanded conceptualization of mindfulness, which acknowledges and encompasses these important relational change processes in addition to the individual psychological changes.

To cope with the rising demand for psychological treatment, evidence-based low-intensity cognitive behavioural therapy (LiCBT) delivered by trained para-professionals was introduced internationally. This pilot study aimed at examining the effectiveness of LiCBT in Hong Kong. This study was of an uncontrolled pre- and post-treatment design, testing LiCBT at a local community mental health centre in Hong Kong. Two hundred and eighty-five Chinese adult help-seekers to the centre attended two or more sessions of LiCBT delivered by trained para-professionals. These participants also rated their depression and anxiety on the Patient Health Questionnaire-9 (PHQ-9) and Generalised Anxiety Disorder Scale-7 (GAD-7), respectively, at pre- and post-treatment. Comparison of the pre- and post-treatment PHQ-9 and GAD-7 scores of 285 participants indicated significant improvements in depression and anxiety with large effect sizes (depression: = 0.87; anxiety: = 0.95). For those participants reaching the clinical level of either depression and/or anxiety at pre-treatment ( = 229, 80.4%), they reported even larger effect sizes (depression: = 1.00; anxiety: = 1.15). The recovery rate was 55.9% with a reliable improvement rate of 63.9%. An average of 5.6 sessions was offered to the participants with each session spanning a mean of 42 minutes. The baseline clinical conditions and participants' educational level were predictive of post-treatment recovery. The results supported the effectiveness and cost-efficiency of LiCBT for depression and anxiety at a Hong Kong community mental health centre. The effect sizes and the recovery and reliable improvement rates achieved were comparable to those reported from countries such as the UK and Australia.

About 20% of major depressive episodes become chronic and medication-refractory and also appear to be less responsive to standard cognitive-behavioural therapy (CBT). To test whether CBT developed from behavioural activation principles that explicitly and exclusively targets depressive rumination enhances treatment as usual (TAU) in reducing residual depression. Forty-two consecutively recruited participants meeting criteria for medication-refractory residual depression were randomly allocated to TAU v. TAU plus up to 12 sessions of individual rumination-focused CBT. The trial has been registered (ISRCTN22782150). Adding rumination-focused CBT to TAU significantly improved residual symptoms and remission rates. Treatment effects were mediated by change in rumination. This is the first randomised controlled trial providing evidence of benefits of rumination-focused CBT in persistent depression. Although suggesting the internal validity of rumination-focused CBT for residual depression, the trial lacked an attentional control group so cannot test whether the effects were as a result of the specific content of rumination-focused CBT v. non-specific therapy effects.

The principles of the Armed Forces Covenant state that Armed Forces Veterans should be at no disadvantage resulting from their service compared with a general adult population. However, despite being at increased risk of experiencing common mental health difficulties, evidence indicates that 82% of Armed Forces Veterans receive no treatment, compared with 63% of the general adult population. To gain a better appreciation of factors that inform the type of adaptations to cognitive behavioural therapy (CBT) interventions for depression and mainstream service promotion materials to enhance acceptability for Armed Forces Veterans. This is a qualitative study employing a focus group of 12 participants to examine the main impacts of depression on Armed Forces Veterans alongside attitudes towards terminology and visual imagery. Thematic analysis was used to identify themes and sub-themes with rigour established through two researchers independently developing thematic maps to inform a final agreed thematic map. A behavioural activation intervention supporting re-engagement with activities to overcome depression had good levels of acceptability when adapted to reflect an Armed Forces culture. Preferences regarding terminology commonly used within CBT adapted for Armed Forces Veterans were identified. Concerns were expressed with respect to using imagery that emphasized physical rather than mental health difficulties. There is the need to consider the Armed Forces community as a specific institutional culture when developing CBT approaches with potential to enhance engagement, completion and recovery rates. Results have potential to inform the practice of CBT with Armed Forces Veterans and future research.

Overviews the clinical protocol for the PROMOTE self-help programme to inform the delivery of a written low intensity intervention based on behavioural activation for the treatment of depression and low mood in people with dementia. Source: National Library of New Zealand Te Puna Matauranga o Aotearoa, licensed by the Department of Internal Affairs for re-use under the Creative Commons Attribution 3.0 New Zealand Licence.

The general practitioner was once America's doctor. The GP delivered babies, removed gallbladders, and sat by the bedsides of the dying. But as the twentieth century progressed, the pattern of medical care in the United States changed dramatically. By the 1960s, the GP was almost extinct. The later part of the twentieth century, however, saw a rebirth of the idea of the GP in the form of primary care practitioners. In this engrossing collection of oral histories and provocative essays about the past and future of generalism in health care, Fitzhugh Mullan-a pediatrician, writer, and historian-argues that primary care is a fascinating, important, and still endangered calling. In conveying the personal voices of primary care practitioners, Mullan sheds light on the political and economic contradictions that confront American medicine. Mullan interviewed dozens of primary care practitioners-family physicians, internists, pediatricians, nurse practitioners, and physician assistants-asking them about their lives and their work. He explains how, during the last forty years, the primary care movement has emerged built on the principles of \"big doctoring\"--coordinated, comprehensive care over time. This book is essential reading for understanding core issues of the current health care dilemma. As our country struggles with managed care, market reforms, and cost containment strategies in medicine,Big Doctoring in Americaprovides an engrossing and illuminating look at those in the trenches of the profession.