CBT reduces ‘brooding’ among depressed adolescents

Results of a preliminary study suggest that adding cognitive-behavioural therapy (CBT) to standard treatment with serotonin-specific reuptake inhibitor antidepressant (SSRI) and psychosocial therapy can reduce mood-related ruminative response style (MRRS) among depressed adolescents, which may lessen the risk of future relapse. MMRS or ‘brooding’ refers to the degree to which dysphoric patients focus on one’s symptoms, emotions and one’s self. It has been shown this style of thinking is related to vulnerability for the future development of clinical depression. Wilkinson and Goodyer sought to determine if CBT could reduce MRRS among depressed adolescents. They hypothesised that adding CBT to SSRIs plus psychosocial treatment would result in a greater reduction in rumination compared with SSRI plus psychosocial therapy. Twenty-six depressed adolescents (ages 11 to 17 years, inclusive) were randomised to receive either SSRI therapy plus psychosocial treatment (defined as ‘usual’ therapy), or ‘usual’ therapy plus CBT. Thirty-eight healthy controls were recruited to demonstrate whether rumination levels were similar to those of healthy controls following CBT, or remained high. The Responses to Depression Questionnaire and Mood and Feelings Questionnaire was used to measure MRRS and depressive symptoms at baseline and following 30 weeks of treatment. Of the 26 people randomised, 23 consented to take part in the final follow up — 13 from the CBT group and 10 from the usual treatment group. The findings of this preliminary study suggested that CBT together with usual therapy result in significantly greater reductions in total rumination among depressed adolescents compared with usual therapy alone (p=0.002). The Response to Depression Questionnaire was administered to seven participants in each treatment group who met pre-determined criteria for recovery. In both groups, rumination remained higher in those patients who had not received CBT (effect size = 1.9; p=0.023), whereas those who received CBT demonstrated levels of rumination similar to the healthy controls (effect size = 0.18; p=0.5). “This study provides preliminary evidence that CBT (but not usual therapy) leads to a reduction in rumination to levels seen in healthy controls at recovery,” the authors asserted. They also noted that since rumination predicts onset of depression, “it is possible that CBT provided during partial remission can reduce the risk of relapse of adolescent depression, as has been demonstrated for depressed adults.” They concluded that adding CBT to usual SSRI and psychosocial therapy may reduce MRRS, which may reduce the cognitive risk of future depressive episodes. Reference...