1 - (OP1) How Japanese Men Experience Rumination-focused Cognitive-behavioral Therapy: A Qualitative Study

Rumination is a notable behavior among Japanese men who repeatedly take temporary leave from work because of depression. Although rumination-focused cognitive-behavioral therapy (RFCBT) may be effective, no studies have examined its effectiveness among Japanese men with depression, to the best of the author’s knowledge. In this study, the author administered RFCBT to 10 Japanese men with depression who had returned to work, and explored their experiences and perceived effectiveness using a qualitative study method. The study took place from January 2024 to August 2025. The intervention used Watkins’ (2016) RFCBT, delivered in person through group sessions. Researchers collected data on baseline attributes, statements made during program sessions, and responses to semi-structured interviews. The interviews included questions such as, "Does the way you deal with rumination following the program differ from how you dealt with rumination before the program?" "What do you find the most challenging in dealing with rumination?" and "Has your everyday life changed since undergoing the program?" Researchers conducted the semi-structured interviews three months after the intervention, and each interview lasted about 45 minutes. Researchers analyzed the interview responses using content analysis. The study received approval from the ethics board of the International University of Health and Welfare (approval number 23-Ig-195-2). The median age of participants was 46.7 years (standard deviation = 7.97). Participants’ occupations were as follows: two local-government workers, three finance or insurance workers, three in the aviation industry, three in survey and design, one in manufacturing, and one in transportation. Participants reported experiences and subjective efficacy in several areas, including realization about the effects of rumination, realization about what triggers rumination, what is effective or ineffective in stopping rumination, post-program changes in everyday life, challenges of the program, and the advantages and disadvantages of group therapy. Before the program, participants restricted their activities because they feared or disliked rumination. For example, one participant stated, "I’d avoid baths because I ruminate when bathing." Another said, "I’d ruminate when I had nothing to do, so I’d constantly occupy myself with something to the point of exhaustion." A third participant reported, "I started working from home because I don’t like to ruminate during the commute to work." However, these rumination-related behavior restrictions decreased after participants gained insights about rumination during the program and learned therapeutic methods independently. After the program, participants reported positive changes in sleep and other health factors, which made it easier for them to live their daily lives as they preferred. Further research is needed to examine how the program can be tailored to each participant’s specific characteristics, such as difficulty managing fatigue or stopping thoughts, and how to support continued participation once participants return to work.