Effects of paradoxical reframing and restraining strategies and psychological reactance in the treatment of depression

The differential effects of paradoxical reframing versus restraining directives in high- or low-reactance clients who experienced moderate to severe depression was investigated. Previous studies have shown that reframing directives are effective in decreasing depression over time but, in general, found that they were no better than nonparadoxical directives. A 3 (treatment condition) x 2 (reactance level) x 3 (time) design was used for two measures of depression (BDI and the SDS) and on an attribution measure (the Attribution Scale). Subjects were 74 high- and low-reactant clients of a mental health center who were randomly assigned to one of three treatment conditions: a paradoxical reframing condition, a paradoxical restraining condition, or a pseudotherapy control condition. Treatment involved five sessions with a counselor. A follow-up session occurred approximately four to six weeks after treatment stopped. Results showed that there were no differential effects due to treatment condition or reactance level. Subjects in all treatment conditions significantly reduced their depression on the BDI but only for the reframing condition on the SDS. Both the reframing and restraining conditions resulted in rapid decreases in depression pretest to posttest, with the reframing condition showing the greatest decrease. The pseudotherapy control condition resulted in a modest decrease but only after posttest. Results overall are consistent with previous studies which have failed to find a strong effect for paradox; results on the SDS indicate that reframing strategies may be more efficacious than other interventions in reducing depression. Previous findings that client reactance level may be an important mediating variable for change were not supported. Subjects across all treatment conditions felt more in control and better able to cope with depression at follow-up as compared to pretest. Implications of the results for the compliance-defiance model of paradox and the need to assess client variables which affect outcome are discussed