Publication: Brain activity and changes in depressive symptoms following cognitive restructuring in depressive disorders: a case series
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Date
2025
Authors
Zulkipli, Aisyah
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Abstract
Depression is a major mental health concern with psychological and neurobiological underpinnings. Cognitive restructuring (CR), a core component of cognitive behavioural therapy (CBT), is effective in reducing negative automatic thoughts and depressive symptoms, yet few studies have examined its neural effects using electroencephalography (EEG), particularly in Malaysia. This case series explored clinical and neurophysiological outcomes of a structured CR intervention in individuals with depressive disorders.
Three female participants aged 20-23 years old with clinically diagnosed Major Depressive Disorder (one also with underlying Persistent Depressive Disorder) completed six individual CR sessions. Resting-state EEG (eyes closed, eyes open) was recorded pre- and post-intervention, focusing on absolute alpha (8–13 Hz) and theta (4–7 Hz) power at the F3 electrode, associated with emotional regulation. Clinical measures included the Malay versions of the Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Automatic Thoughts Questionnaire (ATQ).
All participants showed clinically meaningful improvements. Participant 1: BDI 34 to 20, BAI 27 to 23, ATQ (items 4–5) 14 to 8. Participant 2: BDI 32 to 19, BAI 10 to 4, ATQ 18 to 1. Participant 3: BDI 20 to 3, BAI 21 to 0, ATQ 5 to 0. EEG results showed participant-specific changes: Participant 1 had modest increases in both bands;
Participant 2 showed reduced alpha (EC) but increased alpha (EO) and marked theta gains; Participant 3 had large alpha and theta increases, especially theta (EC: 0.04 to 42.09 μV²).
Findings suggest CR may reduce depressive symptoms and negative thoughts while inducing measurable resting-state EEG changes, particularly in alpha and theta bands. EEG shows promise for monitoring individualised neural responses to psychotherapy, supporting integration into clinical practice and culturally relevant care in Malaysia.
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Keywords
cognitive restructuring , cognitive behaviour therapy