Abstract
BackgroundA mood-related ruminative response style increases the risk of onset and persistence of depression. This preliminary study investigated whether, in depressed adolescents, cognitive-behaviour therapy reduces mood-related ruminative response style. Whether specific factors within the rumination scale were differentially affected by CBT is also reported.Methods26 depressed adolescents were randomised to receiving serotonin-specific reuptake inhibitor antidepressants (SSRI) plus psychosocial treatment as usual or SSRI and psychosocial treatment as usual plus CBT. Ruminative response style and depressive symptoms were measured at baseline and after 30 weeks of treatment, with the Responses to Depression Questionnaire and Mood and Feelings Questionnaire.ResultsThere were significantly greater reductions in ruminations in the CBT group compared to the non-CBT group (p = .002). There was no significant difference in the reduction in self-reported depressive symptoms between the groups. Rumination was reduced to levels of never-depressed controls in adolescents who had recovered from depression and received CBT. There were greater falls in the CBT group in the more pathological 'brooding' factor of rumination.ConclusionThese findings suggest that adding CBT to SSRI medication in the presence of active clinical care causes a greater reduction in mood-related ruminative response style in depressed adolescents. This may reduce the risk of future relapse.Trial registrationCurrent Controlled Trials ISRCNT83809224.
Highlights
A mood-related ruminative response style increases the risk of onset and persistence of depression
In the latter study [9], rumination was highly correlated with depressive symptoms, and rumination predicted a persistent as opposed to a remitting major depressive episode, but not a remitting episode compared to no episode, when depressive symptoms were controlled for [10]
During the 28 weeks of the treatment study, participants in the treatment as usual (TAU) group had a mean of 11.7 treatment sessions and those in the cognitive-behavioural therapy (CBT) group had a mean of 13.6 treatment sessions (t(df = 21) = 1.02, p = .3). 2 participants allocated to TAU received CBT during the treatment study. 1 participant in the CBT group was admitted to a psychiatric unit. 2 participants in the CBT group and 1 in the TAU group received out-patient family therapy
Summary
A mood-related ruminative response style increases the risk of onset and persistence of depression. This preliminary study investigated whether, in depressed adolescents, cognitive-behaviour therapy reduces mood-related ruminative response style. Mood-related response style The degree to which a person, when dysphoric, focuses attention on his or her symptoms, and the 'potential causes, implications and consequences of these symptoms', is referred to as mood-related ruminative response style (MRRS) [1]. High scores, indicating greater MRRS, predict longer and more severe episodes of dysphoric mood [3,4,5] and onset of a major depressive episode [6] in adults. Studies have not directly compared the effects of rumination in different age groups, it appears that rumination has qualitatively similar adverse effects in adolescence and adulthood
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