Author ' s personal copy Shorter communication When self-help is no help : Traditional cognitive skills training does not prevent depressive symptoms in people who ruminate q

A randomized trial was conducted to test the efficacy of three self-directed prevention intervention workbooks for depression. Cognitively at-risk college freshmen were randomly assigned to one of three conditions: traditional cognitive, non-traditional cognitive, and academic skills. Consistent with hypotheses, participants who were high in rumination and experienced stress exhibited significantly greater levels of depressive symptoms after completing the traditional cognitive skills workbook than after completing the other two workbooks. This pattern of results held post-intervention and 4 months later. These findings indicate that rumination may hinder ones ability to identify and dispute negative thoughts (at least without the help of a trained professional). The results underscore the importance of identifying individual difference variables that moderate intervention efficacy. They also raise concerns about the potential benefits of self-help books, an industry that generates billions of dollars each year. 2009 Elsevier Ltd. All rights reserved. Cognitive interventions are among the most effective interventions for depression. These interventions are based on the idea that some people develop depression because they have a tendency to generate negative interpretations of stressful life events (e.g., Beck, Rush, Shaw, & Emery, 1979). Thus, a central goal of cognitively-based interventions is to teach people to identify negative cognitions, evaluate them, and then generate more adaptive cognitions. Research indicates that cognitive therapy (and related cognitive behavioral therapies) is as effective as medication, has no side effects, and may even have a relapse prevention effect (Hollon, Thase, & Markowitz, 2002). Like most mental health resources, cognitive interventions have focused largely on treatment. Treatment interventions occur after the onset of the disorder and focus on bringing the clinical episode to an end. Although treatment interventions bring much needed relief to those who are suffering, they rarely eradicate a disorder (Albee, 1985). In order to eradicate a disorder, it is necessary to prevent the disorder from occurring in the first place. To this end, depression researchers have begun to create and test prevention interventions. Results from these initial prevention studies have been promising. They indicate that high-risk individuals are less likely to develop depression after receiving a cognitively-based intervention than after receiving a control intervention (e.g., Horowitz & Garber, 2006). However, the research to date has two major limitations. First, most interventions have been time intensive (e.g., >12 sessions) and have required trained professionals. These characteristics make dissemination to the general public difficult. Ideally, prevention interventions should be cost effective, highly accessible, and self-directed. Second, previous studies have not identified which individuals are likely to benefit from a cognitive prevention intervention. This is an important limitation because approximately half of participants do not respond to cognitive interventions (Hollon et al., 2002; Horowitz & Garber, 2006). In light of these limitations, the goal of the current study was to: (a) create and test a cognitive prevention intervention that could be easily disseminated to the general public, and (b) identify moderators of intervention efficacy. To this end, the current study tested a cognitive prevention intervention that uses workbooks. Workbooks were chosen because they are cost-efficient, portable, highly accessible, and can be used without the help of a therapist. We also identified two potential moderators of intervention efficacy to examine – stress and rumination. It is necessary to measure life stress when evaluating the efficacy of cognitive interventions because the cognitive theories of depression specify a vulnerabilitystress model. According to this model, the effectiveness of a prevention intervention (assuming the vulnerability was reduced) should only emerge in the presence of stressful life events. Similarly, rumination also has the potential to moderate intervention efficacy. Rumination is the maladaptive tendency to q This research was supported, in part, by a University of Notre Dame Undergraduate Research Opportunity Program (UROP) grant to Jennifer Hames, Lauren Gulley, Jim McGuire, and Dezzie Zamora. E-mail address: ghaeffel@nd.edu