Rumination and distraction as predictors of response and relapse following cognitive therapy or pharmacotherapy for major depression

The current study explored the clinical utility of Nolen-Hoeksema's (1991) Response Styles Theory of depression in predicting treatment response and relapse in a sample of 73 individuals with major depression treated with either pharmacotherapy (n=26) or cognitive therapy ( n=47). The research further examined whether the tendency to ruminate or use distraction to cope with depressive symptoms was modified depending on the type of treatment received. Results indicated that participants experienced similar reductions in rumination over the course of treatment as their mood improved, regardless of whether they achieved remission via medication or psychotherapy. A greater increase in the use of distracting activities in response to depressed mood was observed, however, in the cognitive therapy group compared to those receiving antidepressants. This finding might be attributed to the emphasis on behavioural interventions that are specific to cognitive therapy. The tendency to ruminate about depressive symptoms as a means of coping with low mood did not reduce the efficacy of treatment overall, and even very high levels of rumination were not found to be detrimental to recovery. Follow up data on remitted patients indicated that individuals who endorsed a high level of rumination at the start of treatment were at significantly greater risk of relapse over a twelve month period, even after controlling for other known predictors of relapse such as depression severity and number of previous depressive episodes. Theoretical and clinical implications of these findings are discussed.