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Cited by 470Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesTreatment of Major DepressionPsychological Treatments and Disorders

Cognitive reactivity to sad mood provocation and the prediction of depressive relapse

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Segal, Zindel V., Kennedy, Sidney, Gemar, Michael, Hood, Karyn, Pedersen, Rebecca, Buis, Tom·2006·Archives of General Psychiatry
DOI 10.1001/archpsyc.63.7.749
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Abstract

Context: Episode remission in unipolar major depression, while distinguished by minimal symptom burden, can also be a period of marked sensitivity to emotional stress as well as an increased risk of relapse. Objective: To examine whether mood-linked changes in dysfunctional thinking predict relapse in recovered patients who were depressed. Design: In phase 1 of this study, patients with major depressive disorder were randomly assigned to receive either antidepressant medication or cognitive behavior therapy. In phase 2, patients who achieved clinical remission underwent sad mood provocation and were then observed with regular clinical assessments for 18 months. Setting: Outpatient psychiatric clinics at the Centre for Addiction and Mental Health, Toronto, Ontario. Participants: A total of 301 outpatients with major depressive disorder, aged 18 to 65 years, participated in phase 1 of this study and 99 outpatients with major depressive disorder in remission, aged 18 to 65 years, participated in phase 2. Main Outcome Measure: Occurrence of a relapse meeting DSM-IV criteria for a major depressive episode as assessed by the longitudinal interval follow-up evaluation and a Hamilton Depression Rating Scale score of 16 or greater. Results: Patients who recovered through antidepressant medication showed greater cognitive reactivity following the mood provocation than those who received cognitive behavior therapy. Regardless of type of prior treatment, the magnitude of mood-linked cognitive reactivity was a significant predictor of relapse over the subsequent 18 months. Patients whose mood-linked endorsement of dysfunctional attitudes increased by a minimum of 8 points had a significantly shorter time to relapse than those whose scores were not as elevated. Conclusions: The vulnerability of remitted depressed patients for illness relapse may be related to the (re)activation of depressive thinking styles triggered by temporary dysphoric states. This is the first study to link such differences to prognosis following successful treatment for depression. Further understanding of factors predisposing to relapse/recurrence in recovered patients may help to shorten the potentially lifelong course of depression.

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  • The capacity to disengage temporally extended narrative and engage more momentary neural modes of self-focus has important implications for mood and anxiety disorders, with the narrative focus having been shown to increase illness vulnerability.

    “As such, the capacity to disengage temporally extended narrative and engage more momentary neural modes of self-focus has important implications for mood and anxiety disorders, with the narrative focus having been shown to increase illness vulnerability (Segal et al., 2006).”

    From Attending to the present: mindfulness meditation reveals distinct neural modes of self-reference (2007) · cites this paper as Segal et al., 2006

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  • Abnormal processing of emotional stimuli may mediate vulnerability to relapse after remission.

    “Other work has iden fied abnormal processing of emo onal s muli that may be media ng a vulnerability to relapse a er remission, such as frontotemporal connec vity during emo onal face processing [50], emo onal reac vity [51-53] and hyperconnec vity between anterior temporal and subgenual cor ces while experiencing self-blaming emo ons [54].”

    From Amygdala Reactivity, Antidepressant Discontinuation, and Relapse (2024) · cites this paper as [51]

  • Patients who recovered with CBT showed less cognitive reactivity to affective challenge than those who recovered with antidepressants.

    “Moreover, patients who recovered with cognitive behavior therapy (CBT) showed significantly less cognitive reactivity to affective challenge than those who recovered with ADM.”

    From Mindfulness-Based Cognitive Therapy Improves Emotional Reactivity to Social Stress: Results from a Randomized Controlled Trial (2012) · cites this paper as Segal (2006)

  • Greater cognitive reactivity after CBT or antidepressants predicted higher relapse rates over 18 months.

    “Segal (2006) showed that greater cognitive reactivity after CBT or antidepressant medications (ADM) predicted higher rates of relapse over the course of 18 months.”

    From Mindfulness-Based Cognitive Therapy Improves Emotional Reactivity to Social Stress: Results from a Randomized Controlled Trial (2012) · cites this paper as Segal (2006)

  • The usual negative mood provocation method probably lacks the ecological validity of being rejected by a social partner.

    “Segal (2006) warned that the negative mood provocation method that is typically used to generate negative affect (i.e. sad music or negative slides) probably does not have the ecological validity of “being rejected by a social partner” (p. 755).”

    From Mindfulness-Based Cognitive Therapy Improves Emotional Reactivity to Social Stress: Results from a Randomized Controlled Trial (2012) · cites this paper as Segal (2006)

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Research works printed but not linked: 4

  1. [11]11. Ingram RE, Bernet CZ, McLaughlin SC. Attention allocation processes in de- pressed individuals. Cognit Ther Res. 1994;18:317-332.
  2. [14]14. First MB, Spitzer RL, Gibbon M, Williams JBW. Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-CV). Washington, DC: Ameri- can Psychiatric Press Inc; 1996.
  3. [20]20. Frank E, Prien RF, Jarrett RB, Keller MB, Kupfer DJ, Lavori PW, Rush AJ, Weissman MM. Conceptualization and rationale for consensus definitions of terms in ma- jor depressive disorder. Arch Gen Psychiatry. 1991;48:851-855.
  4. [23]23. Weissman A. The Dysfunctional Attitude Scale: A Validation Study [dissertation]. Philadelphia, Pa: University of Pennsylvania; 1979.

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Authors
Segal, Z. V., Kennedy, S., Gemar, M., Hood, K., Pedersen, R., & Buis, T.
Affiliations
  • University of Toronto (CA)
  • Centre for Addiction and Mental Health (CA)
Corresponding author
Segal, Zindel V.
ORCID
Venue
Archives of General Psychiatry
Publisher
American Medical Association (AMA)
Published
2006-07-01
Volume
63
Issue
7
Pages
749
ISSN
0003-990X (ISSN-L)
DOI
10.1001/archpsyc.63.7.749
OpenAlex
W2103695158
Cited by
470
References
47
Citations by year
2026: 10 · 2025: 8 · 2024: 13 · 2023: 16 · 2022: 24 · 2021: 13 · 2020: 10 · 2019: 24 · 2018: 16 · 2017: 21 · 2016: 42 · 2015: 32 · 2014: 36 · 2013: 40 · 2012: 32
FWCI
32.35
Type
journal article
Language
en
Open access
Locations
  • Archives of General Psychiatry (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Health Sciences › Medicine › Pharmacology › Treatment of Major Depression
  • Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Disorders
Keywords
cognitive reactivity, depression relapse, major depressive disorder, remission, dysfunctional attitudes, cognitive behavioral therapy, antidepressants, recurrence prediction
MeSH terms
Acoustic Stimulation, Adult, Ambulatory Care, Antidepressive Agents, Auditory Perception, Cognition Disorders, Major Depressive Disorder, Emotions, Female, Follow-Up Studies, Humans, Male, Prognosis, Psychiatric Status Rating Scales, Mental Recall, Recurrence, Self Concept, Stress, Psychological, Cognitive Behavioral Therapy, Treatment Outcome, Diagnostic and Statistical Manual of Mental Disorders

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