No worries: Online course to help people stop ruminating shows promise

An online course designed to curb negative thinking has had strong results in helping people reduce the time they spend ruminating and worrying, a new study from University of New South Wales Sydney has shown. The study was published in Behaviour Research and Therapy.

And researchers say the online course, which will soon be hosted on the online clinic This Way Up and is free with a prescription from a clinician, was found to significantly improve the mental health of the people who participated in the study. The trial was part of a collaboration between UNSW, the Black Dog Institute and The Clinical Research Unit for Anxiety and Depression at St Vincent's Health Network.

The "Managing Rumination and Worry Program" features three lessons to be completed over a six-week period. It aims to help participants reduce their levels of rumination, which is dwelling on past negative experiences, and worry, which is thinking over and over about bad things happening in future.

Professor Jill Newby, who is a clinical psychologist with UNSW's School of Psychology and the affiliated Black Dog Institute, says when the call went out to recruit people for the randomized controlled trial, the team was inundated with applications.

"Out of all the research we've done on online therapies, this is by far the most popular program we've done," Prof. Newby says.

"We got way more applicants for what we could manage in a very quick timeframe. So it's clear there is a community need for help with rumination and worry."

The researchers recruited 137 adults who were experiencing elevated levels of repetitive negative thinking. They were randomly allocated to one of three groups: a clinician-guided, three-lesson online course delivered over six weeks; the same course but without the assistance of a clinician; or a control group who received the online course after an 18-week waiting period.

The researchers found that 80% of the participants who did the online course with or without the assistance of a clinician reported significantly lower levels of repetitive negative thoughts, depression and distress immediately following the course, and at the three-month follow-up.

To quantify their progress, the participants were asked to self-report against a number of recognized questionnaires and scales measuring repetitive thinking, anxiety and depression before and after taking the online course.

Those in the group that had the assistance of the clinician showed the best results. Prof. Newby says clinicians spent an average total of 48 minutes across the six-week period helping participants, suggesting such a program can be delivered relatively easily and at scale.

The results in the two groups who did the online course also compared favorably with the control group which did not show the same rates of improvement.

"We've known for years now that online programs can help improve mental health. But this is one of the first that specifically focuses on rumination and worry. There were a couple of previous studies that were done in the UK to prevent mental illness in young people, but this is the first that focused on all-aged adults and that was used as an intervention program," Prof. Newby says.

Lessons and action plans

The content of the online course was presented in an illustrated comic-style story that follows two fictional characters who learn to better manage rumination and worry. Following each lesson, participants downloaded a lesson summary and action plan they would then practice in the upcoming week.

Lead researcher of the study, Dr. Amy Joubert who was a past Scientia Ph.D. student and now practices as a clinical psychologist, says an example of the sort of lesson the participants learn is to recognize when they're being consumed by worry.

"Just becoming aware of it and labeling it as a type of thinking can actually help people manage it," she says.

"The next thing we give them is a few rules of thumb about when to move from that type of thinking to something else.

"So if you find yourself ruminating or worrying about things and it has really eaten up a lot of your time, it is likely becoming very distressing. If it's not leading to an answer or helping you feel better, then it's unproductive, so we suggest moving on to something else—channel it into a new action."

The new action might be problem solving, like figuring out what one can do to solve the issue that is being fretted about. But if there's no obvious solution, participants are encouraged to find a distraction like a change of environment, talking to someone, or a new activity.

"The goal is to get out of your head and focus on the new activities," says Dr. Joubert.

The researchers say they would like the online course to be made available to the community and plan to evaluate how it performs based on feedback.

"The next step we'd like to take is potentially tailoring the program to specific populations. For example, helping people manage their climate anxiety or worries during pregnancy. We want to look at different types of worries, try to figure out who the program works best for, and how we can deliver it at scale to as many people as possible," Prof. Newby says.