The Effects of Cranial Electrotherapy Stimulation, Cognitive-Behavioral Therapy, and Pharmacotherapy on Rumination and Depression in Women

Depression is the most common psychiatric disorder. Depression imposes extant costs to the affected individual and society. Rumination and negative and disturbing thoughts and cognitions experienced in unpleasant life events can lead to future depression and hopelessness. Patients with depression are usually managed with antidepressants and psychotherapy. Cognitive–Behavioral Therapy (CBT) is another treatment of choice for depression based on information processing theory. A highly different and innovative method for treating depression, stress, anxiety, sleep problems, chronic pain, and substance abuse and improve intelligence and cognition is the Cranial Electrotherapy Stimulation (CES) of the skull with direct current by stimulating the central and peripheral nervous systems. The present study aimed to explore the effects of CES, CBT, and pharmacotherapy on rumination and depressive symptoms in women.

This was a quasi–experimental study with pretest–posttest–follow–up and a control group design. The statistical population of this study included all women with Major Depressive Disorder (MDD) referring to mental health clinics in Alborz Province, Iran in 2019. Of them, 40 qualified volunteers were randomly divided into 3 experimental groups (CES, CBT, & pharmacotherapy) and one control group. The inclusion criteria included an age range of 25–45 years, a diagnosis of MDD based on structured interviews by psychiatrists and obtaining high scores in the Beck Depression Inventory (BDI; Beck et al., 1961), educational level of above diploma, no bipolar disorder, and borderline personality disorder, no history of drug use, not concurrently receiving psychological services, having chronic physical illnesses, like neurological diseases (e.g., epilepsy), using a pacemaker or having heart disease, using a platinum shunt, and having thyroid, diabetes, and cancer. The exclusion criteria of the study were refusal to continue research and failure to complete the questionnaires. At the pretest and posttest, the study subjects completed the BDI and the Ruminative Response Scale (Nolen–Hoeksema & Morrow, 1991). After conducting 12 sessions of CES, 9 sessions of CBT based on Beck and Beck's (2011) training package, and pharmacotherapy in the experimental groups, the posttest data, and after 2 months, the follow–up data were collected. To analyze the obtained data, repeated–measures Analysis of Variance (ANOVA) was used in SPSS at a significance level of 0.05.

The current research results suggested that all presented interventions (CBT, CES, pharmacotherapy) reduced rumination (p=0.008) and depression (p<0.001) in the test groups, compared to the controls. Rumination (p<0.001) and depression (p<0.001) significantly decreased over time. The time*group interaction reduced rumination (p<0.001) and depression (p=0.001) in the intervention groups, compared to the control group. Furthermore, Bonferroni posthoc test data indicated no significant difference between the provided interventions in reducing rumination and depression (p>0.05). Additionally, Bonferroni posthoc test results revealed a significant difference between the mean pretest and posttest as well as pretest and follow–up scores concerning rumination (p<0.001) and depression (p<0.001). The achieved data also indicated the positive effects of CBT, CES, and pharmacotherapy on rumination and depression variables at the follow–up phase (p=0.001 & p=0.066, respectively).

The present study findings highlighted that CBT, CES, and pharmacotherapy were effective in treating rumination and depression in women; however, according to the mean scores of the three test groups, CES seemed to be more effective than the other approaches.