Targeting Ruminative Thinking in Adolescents at Risk for Depressive Relapse: Rumination-Focused Cognitive Behavior Therapy in a Pilot Randomized Controlled Trial with Resting State fMRI

Abstract

This pilot randomized control trial was designed to examine whether Rumination-Focused Cognitive Behavior Therapy (RFCBT) reduces rumination and residual depressive symptoms among adolescents with a history of Major Depressive Disorder (MDD) who are at risk for relapse. We also examined whether these changes in symptoms were associated with changes in functional connectivity of the posterior cingulate cortex (PCC), a key node in the default mode network (DMN). Thirty-three adolescents (ages 12–18) were randomized to eight weeks of RFCBT or an assessment only (AO) control. Twenty two adolescents successfully completed fMRI scans pre- and post-intervention. Adolescents were recruited from the clinic and community and met criteria for at least one previous episode of MDD and were currently in full or partial remission. An Independent Evaluator interviewed parent and child before and after the eight-week intervention. The left PCC (-5, -50, 36) seed was used to probe resting state functional connectivity of the DMN. Adolescents who received RFCBT demonstrated reduced rumination (F = -2.76, df = 112, p < .01, 95% CI [-4.72,-0.80]) and self-report depression across eight weeks (F = -2.58, df = 113, p < .01, 95% CI [-4.21, -0.94]). Youth who received RFCBT also demonstrated significant decreases in connectivity between the left PCC and the right inferior frontal gyrus (IFG) and bilateral inferior temporal gyri (ITG). Degree of change in connectivity was correlated with changes in self-report depression and rumination. These data suggest that rumination can be reduced over eight weeks and that this reduction is associated with parallel decreases in residual depressive symptoms and decreased functional connectivity of the left PCC with cognitive control nodes. These changes may enhance the ability of vulnerable youth to stay well during the transition to adulthood.Trial Registration: ClinicalTrials.gov NCT01905267

Perseverate or decenter? Differential effects of metacognition on the relationship between parasympathetic inflexibility and symptoms of depression in a multi-wave study

“…Alternatively, even if training in mindfulness or decentering does not directly alter these risk factors, the results of this study suggest that improving decentering could de-automatize emotional reactions to PC, and might reduce the risk conferred by PC and parasympathetic inflexibility. In addition, several existing treatments explicitly target PC, including rumination-focused CBT (Watkins et al, 2011; Jacobs et al, 2016), ERT (Mennin & Fresco, 2013b; Mennin et al, 2015), metacognitive therapy (Wells, 2012), and cognitive control training (Siegle et al, 2014). It is possible that these treatments also could be tailored for prevention to apply to individuals who are at risk, but do not have a history of depression.…”

Developmental changes in resting-state functional networks among individuals with and without internalizing psychopathologies

“…Subsets of these samples have been reported in prior work, including from MH091811 awarded to Langenecker (Bessette et al, 2018;Bhaumik et al, 2017;DelDonno et al, 2017;Jacobs et al, 2014Jacobs et al, , 2016Jenkins et al, 2017;Rao et al, 2016;Stange et al, 2017), MH086517 awarded to Monk and Phan (Hamm et al, 2014;Wu et al, 2016), UIC CCTS UL1TR000050, Mind and Life Foundation, and Klingenstein Third Generation Foundation Fellowship awarded to Jacobs Peters et al, 2016). Data is also present from MH101487 (awarded to Langenecker).…”

Relations between cortical thickness, serotonin 1A receptor binding, and structural connectivity: A multimodal imaging study

“…In addition, greater temporal lobe cortical thickness has been found in MDD patients with anxiety than MDD patients without (Inkster et al, ). Interestingly, despite the association of increased temporal cortex‐PCC connectivity with rumination mentioned previously (Jacobs et al, ), a separate study found decreased connectivity between these regions in MDD (Yang et al, ). Regardless, there is evidence that inferior temporal cortex shows connectivity with the PCC in resting state (Uddin, Kelly, Biswal, Castellanos, & Milham, ); therefore, we believe our finding in this region further supports an interaction between 5‐HT 1A and the DMN.…”

“…Plausibility of this hypothesis is increased by the fact that patients with MDD tend to have higher 5‐HT 1A binding and cortical thickness in the PCC. Interestingly, a recent study has found that functional resting state connectivity between the PCC and inferior temporal cortex is also associated with rumination and depressive symptoms (Jacobs et al, ).…”