The effectiveness of cognitive behavioral therapy on treatment-resistant depression

Rezvan Sadrmohammadi, Simin Gholamrezaei, Ezatolah Ghadampoor

DOI: 10.22122/cdj.v0i0.499


BACKGROUND: Treatment-resistant depression (TRD) is a severe and chronic form of major depression. It poses significant clinical, personal, and economic burden and does not respond to antidepressants. Psychotherapy can be a suggested option. The aim of this study was to survey the effectiveness of cognitive behavioral therapy (CBT) on patients with TRD.

METHODS: The present study was a quasi-experimental study with pretest, posttest, and follow-up. The statistical population included patients with TRD in Rafsanjan City, Iran, in 2018. 30 subjects were randomly selected and placed into experimental and control groups. Data were collected by Beck Depression Inventory (BDI), Rumination Questionnaire, and Brunel Mood Scale (BRUMS). To analyze data, multivariate analysis of covariance (MANCOVA) was used with SPSS software.

RESULTS: CBT led to reducing depression and rumination and improving mood and this outcome was better than control group (P < 0.05).

CONCLUSION: TRD is a chronic and disabling disorder that little research has been done about its treatment. CBT can be a good treatment offer for TRD.


Depressive Disorder: Treatment-Resistant; Cognitive Behavioral Therapy

Full Text:



American Psychiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®). Washington, DC: American Psychiatric Pub; 2013.

IsHak WW, Bonifay W, Collison K, Reid M, Youssef H, Parisi T, et al. The recovery index: A novel approach to measuring recovery and predicting remission in major depressive disorder. J Affect Disord 2017; 208: 369-74.

World Health Organization. Depression and other common mental disorders. Geneva, Switzerland: WHO; 2017.

Trivedi MH, Rush AJ, Wisniewski SR, Nierenberg AA, Warden D, Ritz L, et al. Evaluation of outcomes with citalopram for depression using measurement-based care in STAR*D: implications for clinical practice. Am J Psychiatry 2006; 163(1): 28-40.

Fiorillo A, Carpiniello B, De Giorgi S, La Pia S, Maina G, Sampogna G, et al. Assessment and management of cognitive and psychosocial dysfunctions in patients with major depressive disorder: A clinical review. Front Psychiatry 2018; 9: 493.

Fava M. Diagnosis and definition of treatment-resistant depression. Biol Psychiatry 2003; 53(8): 649-59.

Belmaker RH, Agam G. Major depressive disorder. N Engl J Med 2008; 358(1): 55-68.

Wijeratne C, Sachdev P. Treatment-resistant depression: Critique of current approaches. Aust N Z J Psychiatry 2008; 42(9): 751-62.

DeVane CL. Pharmacologic characteristics of ideal antidepressants in the 21st century. J Clin Psychiatry 2000; 61(Suppl 11): 4-8.

Cuijpers P, Cristea IA, Karyotaki E, Reijnders M, Huibers MJ. How effective are cognitive behavior therapies for major depression and anxiety disorders? A meta-analytic update of the evidence. World Psychiatry 2016; 15(3): 245-58.

Franklin G, Carson AJ, Welch KA. Cognitive behavioural therapy for depression: systematic review of imaging studies. Acta Neuropsychiatr 2016; 28(2): 61-74.

Joormann J. Differential effects of rumination and dysphoria on the inhibition of irrelevant emotional material: Evidence from a negative priming task. Cognit Ther Res 2006; 30(2): 149-60.

Nolen-Hoeksema S. The role of rumination in depressive disorders and mixed anxiety/depressive symptoms. J Abnorm Psychol 2000; 109(3): 504-11.

Beck AT, Steer RA, Brown GK. Manual for the beck depression inventory-II. San Antonio, TX: Psychological Corporation; 1996.

Farrokhi A, Aghasi Brojeni S, Motesharee E, Farahani A. The relationship and comparison between perfectionism and mood states of team and individual sports athletes. Research in Sports Management and Motor Behaviour Journal 2019; 2(3): 111-23. [In Persian].

Friedrich MJ. Depression is the leading cause of disability around the world. JAMA 2017; 317(15): 1517.

Li JM, Zhang Y, Su WJ, Liu LL, Gong H, Peng W, et al. Cognitive behavioral therapy for treatment-resistant depression: A systematic review and meta-analysis. Psychiatry Res 2018; 268: 243-50.

Proudfoot J, Ryden C, Everitt B, Shapiro DA, Goldberg D, Mann A, et al. Clinical efficacy of computerised cognitive-behavioural therapy for anxiety and depression in primary care: randomised controlled trial. Br J Psychiatry 2004; 185: 46-54.

Lopez MA, Basco MA. Effectiveness of cognitive behavioral therapy in public mental health: comparison to treatment as usual for treatment-resistant depression. Adm Policy Ment Health 2015; 42(1): 87-98.

Conradi HJ, Ormel J, de Jonge P. Presence of individual (residual) symptoms during depressive episodes and periods of remission: a 3-year prospective study. Psychol Med 2011; 41(6): 1165-74.


  • There are currently no refbacks.

Creative Commons Attribution-NonCommercial 4.0

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.