‘Transforming thoughts to feel better? The mediating effect of cognitive restructuring on depression symptoms in adolescents.’

Abstract

As maladaptive cognitions are an important aspect of depression, they are major targets in both prevention and treatment of depression in adolescents. Although cognitive restructuring (CR) is one of the most applied techniques in effective cognitive behavioural treatment (CBT) programs for depression, it is still unclear if the explicit modification of maladaptive cognitions is the mechanism that ensures positive results. Therefore, this explorative study examined if CR mediates treatment outcomes of an indicated CGT-based depression prevention program; the STARr-training. Adolescents aged 11 to 17 (M=13.82, SD=1.44, n=68, 51,5% girls) were randomly assigned to either the CR condition (n=18) or one of three non-CR conditions (n=50). The complete program consists of four modules, each containing three group-sessions. The present study focusses on outcomes of solely the first module. Depression symptoms were assessed using the CDI-2 and cognitive errors using the CNCEQ-R, at pre- and intermediate measurements. Results showed no decrease in either depression symptoms or cognitive errors in the total group, CR group and non-CR group after completing the first three group-sessions of the program. Whereas overall, depression symptoms and cognitive errors were positively related, depression symptoms before and after the intervention did not significantly relate with change in cognitive errors. Therefore, a regression analysis was not performed. It was concluded that after three group-sessions, the intervention did not affect the level of depression symptoms and cognitive errors in participants, regardless of their treatment condition. Moreover, the hypothesis that CR evokes change in cognitive errors and thereby mediates treatment outcomes, is rejected. Possible explanations and implications for future research and clinical practice are discussed.