Mood reactivity rather than cognitive reactivity is predictive of depressive relapse: A randomized study with 5.5-year follow-up.

Abstract

Objective:The current study examined whether cognitive reactivity, cognitive extremity reactivity, and mood reactivity following mood provocation predicted relapse in depression over 5.5 years. Additionally, this study was the 1st to examine whether changes in cognitive reactivity and mood reactivity following preventive cognitive therapy (PCT) mediated the preventive effect of PCT on relapse. Method: One hundred eightyseven remitted recurrently depressed outpatients were randomized over treatment as usual (TAU) versus TAU ϩ PCT with 5.5-year follow-up. Relapse in depression was assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders (Spitzer, Williams, Gibbon, & First, 1990). Results: Mood reactivity predicted time to relapse over 5.5 years. We found no evidence that cognitive reactivity was a risk factor for relapse in depression. Moreover, unprimed dysfunctional beliefs predicted relapse directly. There was no indication of mediation by changes in cognitive reactivity (including extremity of the beliefs and unprimed beliefs) or mood reactivity on the preventive effect of PCT. Further, explorative analyses revealed that increases in cognitive and mood reactivity over time also predicted time to relapse. Conclusions: Our findings highlight a need to focus on mood reactivity instead of beliefs as a risk factor for relapse in depression. Similar to a previous study, we found no indications that cognitive therapy after remission reduced dysfunctional beliefs, cognitive reactivity, or extremity. Future studies should examine cognitive reactivity and mood reactivity in daily life as predictors of relapse.

A lifetime approach to major depressive disorder: The contributions of psychological interventions in preventing relapse and recurrence

“…Three studies have found support for the notion that cognitive reactivity predicts subsequent relapse following remission from MDD (Kuyken et al, 2010;Segal, Gemar, & Williams, 1999;Segal et al, 2006). However, two studies found no evidence for cognitive reactivity as risk factor for relapse in participants remitted from MDD (Jarrett et al, 2012;van Rijsbergen et al, 2013), although Jarrett and associates showed that unprimed dysfunctional attitudes did predict relapse and recurrence. Thus, evidence is mixed for the role of cognitive reactivity being a risk factor for relapse in MDD but substantial evidence links dysfunctional attitudes to depressive relapse and recurrence (Beshai et al, 2011;van Rijsbergen et al, 2013).…”

“…However, two studies found no evidence for cognitive reactivity as risk factor for relapse in participants remitted from MDD (Jarrett et al, 2012;van Rijsbergen et al, 2013), although Jarrett and associates showed that unprimed dysfunctional attitudes did predict relapse and recurrence. Thus, evidence is mixed for the role of cognitive reactivity being a risk factor for relapse in MDD but substantial evidence links dysfunctional attitudes to depressive relapse and recurrence (Beshai et al, 2011;van Rijsbergen et al, 2013). It is possible that preventive CBT might protect against relapse and recurrence because it makes negative schema less accessible after exposure to repeated depressive episodes (Hollon, Stewart, & Strunk, 2006).…”

A resilience framework for promoting stable remission from depression

“…Investigators found that increased emotional reactivity to a sad mood induction (listening to sad music while thinking about a sad time in their life) predicted earlier time to recurrence in people being treated for their depression (van Rijsbergen et al, 2013). Investigators have also found that increased cognitive reactivity to sad mood inductions predicts increased risk of relapse even when controlling for number of previous depressive episodes (Segal et al, 2006).…”

Cognitive reactivity, self-depressed associations, and the recurrence of depression

“…High CR may also increase the risk of recurrence of depression and two studies using mood induction procedures have shown CR to be a significant predictor of recurrence over periods of 15 and 18 months after remission (Segal et al, 2006;Kuyken et al, 2010). However, two other studies, failed to find a similar relationship between CR and recurrence/return of symptoms (Lethbridge and Allen, 2008;van Rijsbergen et al, 2013). Unfortunately, the number of previous episodes was not taken into consideration in any of these studies.…”