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CBT Improves Cognitive Flexibility, Mental Defeat Scores in MDD

Key clinical point: Patients’ cognitive flexibility and mental defeat scores improve along with major depressive disorder after participating in tailored cognitive-behavioral therapy.

Major finding: Adding imagery rescripting to CBT for patients with MDD leads to declines in Beck Depression Inventory-II (BDI-II) scores (pre-CBT, 29.89; mid-CBT, 26.56; post-CBT, 18.89), and on other important measures such as the Mental Defeat Scale (MDS) (pre-CBT, 55.61; mid-CBT, 54.5; post-CBT, 38.67). Meanwhile, participants’ scores on the Cognitive Flexibility Scale (CFS) increase after this intervention (pre-CBT, 31.89; mid-CBT, 32.78; post-CBT, 39.22).

Study details: The results are based on a preliminary pilot study of 18 adults with MDD and 33 healthy controls. Those in the intervention group completed 15 weekly CBT sessions. The CBT was culturally adapted for Japanese patients with MDD, and mental imagery and memory work were added to the protocol.

Disclosures: The study was funded by grants from the Japan Society for the Promotion of Science. The authors declared having no conflicts of interest.


Murata T et al. BMC Res Notes. 2019 Nov 6. doi: 10.1186/s13104-019-4758-2.


Murata et al. utilized a CBT approach typically used to treat PTSD in their study, but adapted it to patients with major depressive disorder (MDD). In PTSD, patients have intrusive thoughts and memories that are difficult to tolerate. In MDD, patients also can ruminate and have equally terrible thoughts of their depressed state or situation. Sometimes, MDD patients are felt to have “tunnel vision,” where they can only think of one negative thing repeatedly. Unfortunately, at times, this is focused on suicidal ideation. Although this paper did not look at suicidality, it did look at improving flexibility of the MDD patient’s thinking, and, specifically, lowered mental defeat. This is a compelling addition to the literature on psychotherapy approaches to manage specific MDD symptoms.—Thomas L. Schwartz, MD; Senior Associate Dean of Education, Interim Chair/Professor of Psychiatry, SUNY Upstate Medical University.