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

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.