Mood Regulation Focused CBT Based on Memory Reconsolidation, Reduced Suicidal Ideation and Depression in Youth in a Randomised Controlled Study

Abstract

Suicide attempts and suicidal ideation in adolescence are considered to be related to suicide and psychiatric adversity later in life. Secondary prevention by improving the treatment of suicidal youth is a distinct possibility. In this study, treatment with a systematised mood-regulation focused cognitive behavioural therapy (MR-CBT) (n = 15) was compared with treatment as usual (TAU) (n = 12) in a group of depressed adolescents in a clinical setting. MR-CBT focuses on mood regulation by means of counter conditioning with memory reconsolidation being the proposed mechanism of change. Subjects practice keeping emotionally positive memories to diminish the emotional impact of negative memories. Symptoms of depression were tested with a short version of the Mood and Feelings Questionnaire (SMFQ), and wellbeing with the World Health Organization 5 Wellbeing Index (WHO-5). Suicidal events were rated according to the clinical interview Columbia Suicide Severity Rating Scale (C-SSRS). Suicidal events at the end of treatment were significantly reduced in the MR-CBT group, but not in the TAU group. Depression and wellbeing improved significantly in both treatment groups. While far from conclusive, the results are encouraging enough to suggest that further studies should be undertaken to examine whether psychotherapy focusing on mood regulation for young individuals at risk might enhance secondary prevention of suicide.

Evidence Base Update of Psychosocial Treatments for Self-Injurious Thoughts and Behaviors in Youth

“…Given our emphasis on RCTs, we have removed discussion of the pilots and non-randomized trials from the prior review. In addition, we excluded trials with small sample sizes (< 20 adolescents per group; Hsu, 2016), which removed a number of smaller CBT trials (Alavi, Sharifi, Ghanizadeh, & Dehbozorgi, 2013;Donaldson, Spirito, & Esposito-Smythers, 2005;Högberg & Hällström, 2018;Spirito et al, 2015) from the current review. However, we discuss these trials briefly when applicable as potentially promising interventions to be explored in future research.…”

“…One additional trial did not meet inclusion criteria for our review based on the small sample size, but is worth mentioning given that it also examined a CBT-Individual treatment. In a small (N=32; 12-15 per group) RCT with depressed youth in outpatient care, mood regulation focused CBT (MR-CBT) was compared to TAU (standard practice in psychiatry; Högberg, &Hällström, 2018). MR-CBT is a treatment based on memory reconsolidation that aims to increase positive and decrease negative emotions related to autobiographical memories.…”

Positive memory intervention techniques: a scoping review

“…MR-CBT, proposed by Högberg and Hällström (2018), aims to achieve emotional regulation through counter-conditioning techniques. Participants are trained to retain memories that generate positive emotions to reduce emotional impacts of negative memories.…”

“…Empirically, MR-CBT was tested by Högberg and Hällström (2018) on 27 adolescents with depressive symptoms: 15 participants underwent MR-CBT, and the remaining 12 received TAU. Results showed a significant improvement in the levels of depression and well-being in both groups, with no differences between groups.…”

Towards a Greater Understanding of Suicidal Behaviour and Its Prevention

“…Several articles reported the results from studies conducted in clinical settings. A study performed in Sweden about secondary prevention (i.e., targeted to high risk groups) tested the effectiveness of systematised mood-regulation focused cognitive behavioural therapy (MR-CBT) in comparison with the treatment as usual (TAU) [ 33 ]. At the end of treatment, the suicidal events were significantly reduced in the MR-CBT group, but not in the TAU group.…”