The effect of rumination-focused cognitive behavior therapy on negative self-evaluation and suicidal ideation, versus mindfulness-based cognitive therapy in depressed adolescent girls aged 14 to 19 committing suicide: two-month follow up

Subject Areas : Clinical

Hadi Izanloo ¹ (Clinical Psychology, Department of Psychology, Islamic Azad University, Birjand Branch, Birjand, Iran.)
Fatemeh Shahabizadeh ² (Associate Professor. Department of Psychology, Birjand Branch, Islamic Azad University, Birjand, Iran)
Seyed Kaveh Hojjat ³ (Assistant Professor of psychiatry, psychiatry and behavioral siences research center, Department of Psychology, Birjand branch, Islamic Azad University, Birjand. Iran)
Seyed Abdolmajid Bahrainian ⁴ (Professor, Department of Psychology, Birjand Branch, Islamic Azad University, Birjand. Iran.)

Received: 2021-02-20 Accepted : 2021-05-17 Published : 2023-05-22

Keywords: rumination-focused cognitive behavioral therapy, adolescent girls aged 14 to 19, mindfulness-based cognitive therapy, negative self-evaluation, Depression, suicidal ideation,

Abstract :

Suicide attempt is on the rise among adolescent girls due to negative cognitions, so the aim of this study was to investigate the effect of Rumination-Focused Cognitive Behavioral Therapy (RFCBT) versus Mindfulness Based Cognitive Therapy (MBCT) on negative self-evaluation, and suicidal ideation among depressed girls adolescents aged 14 to 19 attempting suicide. This study was a quasi-experimental design with pre-test and post-test with a control group. Thirty-three depressed adolescent girls attempting suicide who were referred to the emergency department of Samen Al-Aeme and Imam Hassan Hospitals in Bojnourd from October 23, 2019 to March 5, 2020, after having the inclusion criteria, were selected with targeted sampling method, then randomly divided into three groups of rumination-focused cognitive behavioral therapy, mindfulness-based cognitive therapy (10 individual sessions) and control. The research tools included Depression Inventory-2 (Beck & Steer, 1993) and Suicide Probability Scale (Cull & Gill, 1989). Findings obtained from Analysis of covariance showed that both interventions had a significant effect on reducing negative self-evaluation and suicidal ideation at the time of post-test (p <0.001) and follow-up (p <0.05), and this effect was stable during the two-month follow-up period. Therefore, both interventions can reduce negative self-evaluation and suicidal ideation in different ways (decreased rumination and increased mindfulness) but without superiority, so it is recommended to use these two interventions in times of depression and in times of suicidal crisis.

References:

Beck, A.T., Steer, R.A, & Brown, G.K. (1996). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation.

Beck, A. T., Weissman, A., Lester, D., & Trexler, L. (1974). The measurement of pessimism: The hopelessness scale. Journal of Consulting and Clinical Psychology, 42, 861-865.

Bessette, K.L., Jacobs, R.H., Heleniak, C., Peters, A.T., Welsh, R.C., Watkins, E.R., & Langenecker, S.A. (2020). Malleability of rumination: An exploratory model of CBT-based plasticity and long-term reduced risk for depressive relapse among youth from a pilot randomized clinical trial. Public Library of Science, 15(6), e0233539.

Birmaher, B., Brent, D. A., Chiappetta, L., Bridge, J., Monga, S., & Baugher, M. (1999). Psychometric properties of the screen for child anxiety related emotional disorders (SCARED): a replication study. Journal of the American academy of child & adolescent psychiatry, 38(10), 1230-1236.

Butter, S., Shevlin, M., & Murphy, J. (2019). Negative self-evaluation and the genesis of internal threat: beyond a continuum of suicidal thought and behaviour. Psychological medicine, 49(15), 2591–2599.

Chesin, M.S., Benjamin-Phillips, C.A., Keilp, J., Fertuck, E.A., Brodsky, B.S., & Stanley, B. (2016). Improvements in executive attention, rumination, cognitive reactivity, and mindfulness among high-Suicide risk patients participating in adjunct mMindfulness-Based Cognitive Therapy: Preliminary Findings. Journal of alternative and complementary medicine (New York, N.Y.), 22(8), 642–649.

Cull, J.G., & Gill, W.S. (2002). Suicide Probability Scale (SPS) Manual. Los Angeles, CA: Western Psychological Service.

Eltz, M., Evans, A.S., Celio, M., Dyl, J., Hunt, J., Armstrong, L., & Spirito, A. (2007). Suicide probability scale and its utility with adolescent psychiatric patients. Child psychiatry and human development, 38(1), 17–29.

Eskin, M. (1993). Reliability of the Turkish version of the perceived social support from friends and family scales, scale for interpersonal behavior, and suicide probability scale. Journal of Clinical Psychology, 49(4), 515-22.

Farb, N., Anderson, A., Ravindran, A., Hawley, L., Irving, J., Mancuso, E., Gulamani, T., Williams, G., Ferguson, A., & Segal, Z.V. (2018). Prevention of relapse/recurrence in major depressive disorder with either mindfulness-based cognitive therapy or cognitive therapy. Journal of Consulting and Clinical Psychology, 86(2), 200-204.

Fata, L., Birashk, B., Atefvahid, M., & Dabson, K. (2005). Assignment structures/Schema, emotional states and cognitive processing of emotional information: comparing frameworks. Iranian Journal of Psychiatry and Clinical Psychology, 11(3), 312-326. (Persian)

Fazakas-DeHoog, L.L., Rnic, K., & Dozois, D. (2017). A Cognitive distortions and deficits model of suicide ideation. Europe's journal of psychology, 13(2), 178–193.

Feldhaus, C.G., Jacobs, R.H., Watkins, E.R., Peters, A.T., Bessette, K.L., & Langenecker, S.A. (2020). Rumination-focused Cognitive Behavioral Therapy decreases anxiety and increases bahavioral activation among remitted adolescents. Journal of child and family studies, 29(27), 1982-1991.

First, M.B., Williams, J.B.W., Benjamin, L.S., & Spitzer, R.L. (2016). Structured cClinical Interview for DSM-5 Disorders, clinical version (Scid-5-CV). Arlington, VA, American Psychiatric Association. Translated by: Tina Shadloo., Samaneh Karimian., & Behrang Shadloo, Tehran: Ebnesina.

Fortuna, L.R., Porche, M.V., & Padilla, A. (2018). A treatment development study of a cognitive and mindfulness-based therapy for adolescents with co-occurring post-traumatic stress and substance use disorder. Psychology and psychotherapy, 91(1), 42–62.

Garnefski, N., & Kraaij, V. (2018). Specificity of relations between adolescents’ cognitive emotion regulation strategies and symptoms of depression and anxiety. Cognition and Emotion, 32(7), 1401-1408.  

Goldberg, S.B., Tucker, R.P., Greene, P.A., Davidson, R.J., Kearney, D.J., & Simpson, T.L. (2019). Mindfulness-based cognitive therapy for the treatment of current depressive symptoms: A meta-analysis. Cognitive Behaviour Therapy, 48(6), 445–462.

Goodyer, I.M., Reynolds, S., Barrett, B., Byford, S., Dubicka, B., Hill, J., & Roberts, C. (2017). Cognitive‐behavioural therapy and short‐term psychoanalytic psychotherapy versus brief psychosocial intervention in adolescents with unipolar major depression (IMPACT): A multicentre, pragmatic, observer‐blind, randomized controlled trial. Health Technology Assessment (Winchester, England), 21(12), 1.

Hajialiani, V., Bahrami Ehsan, H., & Noferesti, A. (2020). The effect of Mindfulness-Based Cognitive Therapy on reducing Suicidal ideations and increasing self-compassion in students. Frooyesh, 9 (5), 147-154. (Persian)

Hanasabzadeh, M., Yazdandoost, R., Asgharnejad Farid, A.A., & Gharaei, B. (2011). Mindfulness-based cognitive therapy (MBCT) on suicidal depressed patients: A qualitative study. Journal of Behavior Sciences, 5(1): 33-38. (Persian)

Hvenegaard, M., Moeller, S., Poulsen, S., Gondan, M., Grafton, B., Austin, S., Kistrup, M., Rosenberg, NG., Howard, H., & Watkins, ER. (2020). Group rumination-focused cognitive-behavioural therapy (CBT) v. group CBT for depression: Phase II trial. Psychological Medicine, 50 (1), 11-19.

Jury, T.K., & Jose, P.E. (2019). Does rumination function as a longitudinal mediator between mindfulness and depression? Mindfulness 10(6), 1091-1104.

Law, K.C., & Tucker, R.P. (2018). Repetitive negative thinking and suicide: a burgeoning literature with need for further exploration. Current opinion in psychology, 1(22), 68–72.

Lim, G.Y., Tam, W.W., Lu, Y., Ho, C.S., Zhang, M.W., & Ho, R.C. (2018). Prevalence of depression in the community from 30 countries between 1994 and 2014. Scientific reports, 8(1), 2861.

Lindsay, E.K., Chin, B., Greco, C.M., Young, S., Brown, K.W., Wright, A., Smyth, J.M., Burkett, D., & Creswell, J.D. (2018). How mindfulness training promotes positive emotions: Dismantling acceptance skills training in two randomized controlled trials. Journal of personality and social psychology, 115(6), 944–973.

Luoma, J.B., & Villatte, J.L. (2012). Mindfulness in the treatment of suicidal individuals. Cognitive and Behavioral Practice, 19(2), 265-276.

Lobbestael J, Leurgans M, & Arntz A. (20011). Inter‐rater reliability of the structured clinical interview for DSM‐IV Axis I disorders (SCID I) and Axis II disorders (SCID II). Clinical Psychology & Psychotherapy. 18(1): 75-79.

Mullarkey, M.C., Marchetti, I., & Beevers, C.G. (2019). Using network analysis to identify central symptoms of adolescent depression. Journal of Clinical Child & Adolescent Psychology, 48(4), 656-668.

Orchard, F., Pass, L., & Reynolds, S. (2019). 'I am worthless and kind'; the specificity of positive and negative self-evaluation in adolescent depression. The British journal of clinical psychology, 58(3), 260–273.

Orchard, F., & Reynolds, S. (2018). The combined influence of cognitions in adolescent depression: Biases of interpretation, self‐evaluation, and memory. British Journal of Clinical Psychology, 57(4), 420–435.

Parmentier, F.B.R., Garcia-Toro, M., Garcia-Campayo, J., Yanez, A.M., Andres, P., & Gili, M. (2019). Mindfulness and symptoms of depression and anxiety in the general population: The mediating roles of worry, rumination, reappraisal and suppression. Frontiers in Psychology, 10, 506.

Pepping, C.A., O’Donovan, A & Davis, P.J. (2013). The positive effects of mindfulness on self-esteem. The Journal of Positive Psychology, 8(5), 376-386. 

Raj, S., Sachdeva, S.A., Jha, R., Sharad, S., Singh, T., Arya, Y.K., & Verm, S.K. (2019). Effectiveness of mindfulness based cognitive behavior therapy on life satisfaction, and life orientation of adolescents with depression and suicidal ideation. Asian Journal of Psychiatry, 39, 58-62.

Ribeiro, J. D., Huang, X., Fox, K. R., & Franklin, J. C. (2018). Depression and hopelessness as risk factors for suicide ideation, attempts and death: meta-analysis of longitudinal studies. The British journal of psychiatry: journal of mental science, 212(5), 279–286.

Rimes, K.A., & Watkins, E.D. (2005). The effects of self-focused rumination on global negative self-judgements in depression. Behaviour Research and Therapy, 43(12), 1673-1681.

Sarmad, Z., Bazargan, A., & Hejazi, E. (2014). Research methods in behavioral science. Tehran: Agah Publication.  (Persian)

Schanche, E., Vøllestad, J., Visted, E., Svendsen, J.L., Osnes, B., Binder, P.E., Franer, P., Sørensen, & L. (2020). The effects of mindfulness-based cognitive therapy on risk and protective factors of depressive relapse – a randomized wait-list controlled trial. BMC psychology, 8(57)1-16.

Segal, Z.V., Dimidjian, S., Beck, A., Boggs, J.M., Vanderkruik, R., Metcalf, CA., Gallop, R., Felder, J.N., & Levy, J. (2020). Outcomes of online Mindfulness-Based Cognitive Therapy for patients with residual depressive symptoms: A randomized clinical trial. JAMA Psychiatry, 77(6), 563–573.

Segal, Z.V., Williams, J.M.G., & Teasdale, J.D. (2002). Mindfulness-based cognitive therapy for depression: a new approach to preventing relapse. New York, NY: Guildford press.

Shallcross, A.J., Gross, J.J., Visvanathan, P.D., Kumar, N., Palfrey, A., Ford, B.Q., Dimidjian, S., Shirk, S., Holm-Denoma, J., Goode, K.M., & Cox, E. (2015). Relapse prevention in major depressive disorder: Mindfulness-based cognitive therapy versus an active control condition. Journal of consulting and clinical psychology, 83(5), 964–975.

Sharifi, V., Asadi, S.M., Mohammadi, M.R., Amini, H., Kaviani, H., Semnani, Y., Shabanikia, A., Shahrivar, Z., Davari Ashtiani, R., Hakim Shoushtari, M., & Sedigh, A. (2004). Reliability and Feasibility of the Persian Version of the Structured Diagnostic Interview for DSM-IV (SCID). Advances in Cognitive Sciences, 6 (1 and 2), 10-22. (Persian)

Sharifian, M., Lavasani, M., Ejei, J., Taremian, F., Amrani, K. (2011). The relationship among classroom community, attitude toward parents, anxiety disorders and depression with adolescent suicide probability. Procedia-Social and Behavioral Sciences,15, 520-525. (Persian)

Teismann, T., von Brachel, R., Hanning, S., Grillenberger, M., Hebermehl, L., Hornstein, I., & Willutzki, U. (2014). A randomized controlled trial on the effectiveness of a rumination-focused group treatment for residual depression. Psychotherapy research: journal of the Society for Psychotherapy Research, 24(1), 80–90.

Topper, M., Emmelkamp, P.M., Watkins, E.R., & Ehring, T. (2017). Prevention of anxiety disorders and depression by targeting excessive worry and rumination in adolescents and young adults: A randomized controlled trial. Behaviour research and therapy, 1(90), 123–136.

Uddin, R., Burton, N.W., Maple, M., Khan, S.R., & Khan, A. (2019). Suicidal ideation, suicide planning, and suicide attempts among adolescents in 59 low-income and middle-income countries: a population-based study. The Lancet. Child & adolescent health, 3(4), 223–233.

Van Aalderen, J.R., Donders, A.R., Giommi, F., Spinhoven, P., Barendregt, H.P., & Speckens, A.E. (2012). The efficacy of mindfulness-based cognitive therapy in recurrent depressed patients with and without a current depressive episode: a randomized controlled trial. Psychological medicine, 42(5), 989–1001.

Van Droogenbroeck, F., Spruyt, B., & Keppens, G. (2018). Gender differences in mental health problems among adolescents and the role of social support: results from the Belgian health interview surveys 2008 and 2013. BMC psychiatry, 18(1), 1-9.

Watkins, E.R. (2016). Rumination-Focused cognitive-behavior therapy for depression. New York: Guilford Press. Translated by: Elham Eshtad, Tehran: Ebnesina.

Watkins E.R. (2008). Constructive and unconstructive repetitive thought. Psychological bulletin, 134(2), 163–206.

Watkins, E.R., Mullan, E., Wingrove, J., Rimes, K., Steiner, H., Bathurst, N., Eastman, R., & Scott, J. (2011). Rumination-focused cognitive-behavioural therapy for residual depression: phase II randomised controlled trial. The British journal of psychiatry: the journal of mental science, 199(4), 317–322.

Watkins, E.R., Taylor, R., Byng, R., Baeyens, C., Read, R., Pearson, K., & Watson, L. (2012). Guided self-help concreteness training as an intervention for major depression in primary care: A Phase II randomized controlled trial. Psychological Medicine, 42(7), 1359-1371.

Wilkinson, P.O., Croudace, T.J. & Goodyer, I.M. (2013). Rumination, anxiety, depressive symptoms and subsequent depression in adolescents at risk for psychopathology: a longitudinal cohort study. BMC Psychiatry, 13(1), 1-9.