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Influence of Rumination and Distraction on the Therapeutic Process in Cognitive-Behavioral Therapy for Depression

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Abstract

The response styles theory by Nolen-Hoeksema (J Abnorm Psychol 100:569–582, 1991) suggests that rumination in response to depressed mood exacerbates and prolongs depression, while distraction ameliorates it. In addition, research has shown that rumination is associated with several undesirable interpersonal outcomes, including greater interpersonal problems and less satisfying social support. In a sample of depressed patients (n = 67) receiving cognitive-behavioral therapy, the current study investigated whether patients’ use of ruminative and distractive responses to depressed mood influences the therapeutic alliance and the patients’ receptivity to therapeutic interventions. Ruminative responses were neither predictive of the therapeutic alliance nor of patients’ receptivity. However, the more the patients reported distractive responses to depressed mood, the better therapists judged their receptivity in therapy and the better they evaluated the therapeutic alliance. In the course of therapy, distractive responses were also associated with patients’ ratings of the alliance. Implications for future research and psychotherapeutic practice are discussed.

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Notes

  1. The study was approved by the ethics committee of the German Society of Psychology (DGPs).

  2. Due to low internal consistency of the TEQ total score, it was further explored to what extent rumination and/or distraction were predictive of any subscale of the TEQ in early-, mid- and late-treatment—controlling for pretreatment symptom severity. Rumination was not predictive of any TEQ subscale at any time period. Distraction was not associated with any TEQ subscale in early treatment—yet, pretreatment distraction scores were associated with the TEQ subscale “trustworthiness” in mid- (β = .31; P < .05) and late treatment (β = .36; P < .01). Pretreatment distraction was further associated with the TEQ subscales “independence” (β = .30; P < .05), “consensus” (β = .46; P < .01) and “autonomy” (β = .31; P < .05) in late treatment. Again, none of the overall models reached statistical significance.

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Authors and Affiliations

  1. Department of Clinical Psychology and Psychotherapy, Faculty of Psychology, Ruhr-University of Bochum, Universitätsstraße 150, 44780, Bochum, Germany

    Tobias Teismann, Johannes Michalak, Ulrike Willutzki & Dietmar Schulte

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  1. Tobias Teismann
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  2. Johannes Michalak
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  3. Ulrike Willutzki
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  4. Dietmar Schulte
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Correspondence to Tobias Teismann.

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Teismann, T., Michalak, J., Willutzki, U. et al. Influence of Rumination and Distraction on the Therapeutic Process in Cognitive-Behavioral Therapy for Depression. Cogn Ther Res 36, 15–24 (2012). https://doi.org/10.1007/s10608-010-9347-6

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