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Ganesan S, Misaki M, Zalesky A, Tsuchiyagaito A. Functional brain network dynamics of brooding in depression: insights from real-time fMRI neurofeedback. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.05.05.24306889. [PMID: 38766116 PMCID: PMC11100839 DOI: 10.1101/2024.05.05.24306889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
Background Brooding is a critical symptom and prognostic factor of major depressive disorder (MDD), which involves passively dwelling on self-referential dysphoria and related abstractions. The neurobiology of brooding remains under characterized. We aimed to elucidate neural dynamics underlying brooding, and explore their responses to neurofeedback intervention in MDD. Methods We investigated functional MRI (fMRI) dynamic functional network connectivity (dFNC) in 36 MDD subjects and 26 healthy controls (HCs) during rest and brooding. Rest was measured before and after fMRI neurofeedback (MDD-active/sham: n=18/18, HC-active/sham: n=13/13). Baseline brooding severity was recorded using Ruminative Response Scale - Brooding subscale (RRS-B). Results Four recurrent dFNC states were identified. Measures of time spent were not significantly different between MDD and HC for any of these states during brooding or rest. RRS-B scores in MDD showed significant negative correlation with measures of time spent in dFNC state 3 during brooding (r=-0.5, p= 1.7E-3, FDR-significant). This state comprises strong connections spanning several brain systems involved in sensory, attentional and cognitive processing. Time spent in this anti-brooding dFNC state significantly increased following neurofeedback only in the MDD active group (z=-2.09, p=0.037). Limitations The sample size was small and imbalanced between groups. Brooding condition was not examined post-neurofeedback. Conclusion We identified a densely connected anti-brooding dFNC brain state in MDD. MDD subjects spent significantly longer time in this state after active neurofeedback intervention, highlighting neurofeedback's potential for modulating dysfunctional brain dynamics to treat MDD.
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Affiliation(s)
- Saampras Ganesan
- Department of Psychiatry, Melbourne Medical School, Carlton, Victoria 3053, Australia
- Department of Biomedical Engineering, The University of Melbourne, Carlton, Victoria 3053, Australia
- Contemplative Studies Centre, Melbourne School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Masaya Misaki
- Laureate Institute for Brain Research, Tulsa, OK, USA
- Oxley College of Health and Natural Sciences, The University of Tulsa, Tulsa, OK, USA
| | - Andrew Zalesky
- Department of Psychiatry, Melbourne Medical School, Carlton, Victoria 3053, Australia
- Department of Biomedical Engineering, The University of Melbourne, Carlton, Victoria 3053, Australia
| | - Aki Tsuchiyagaito
- Laureate Institute for Brain Research, Tulsa, OK, USA
- Oxley College of Health and Natural Sciences, The University of Tulsa, Tulsa, OK, USA
- Research Center for Child Mental Development, Chiba University, Chiba, Japan
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Langenecker SA, Westlund Schreiner M, Bessette KL, Roberts H, Thomas L, Dillahunt A, Pocius SL, Feldman DA, Jago D, Farstead B, Pazdera M, Kaufman E, Galloway JA, Kerig PK, Bakian A, Welsh RC, Jacobs RH, Crowell SE, Watkins ER. Rumination-Focused Cognitive Behavioral Therapy Reduces Rumination and Targeted Cross-network Connectivity in Youth With a History of Depression: Replication in a Preregistered Randomized Clinical Trial. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2024; 4:1-10. [PMID: 38021251 PMCID: PMC10654545 DOI: 10.1016/j.bpsgos.2023.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 08/16/2023] [Accepted: 08/19/2023] [Indexed: 12/01/2023] Open
Abstract
Background Rumination-focused cognitive behavioral therapy (RF-CBT) is designed to reduce depressive rumination or the habitual tendency to dwell on experiences in a repetitive, negative, passive, and global manner. RF-CBT uses functional analysis, experiential exercises, and repeated practice to identify and change the ruminative habit. This preregistered randomized clinical trial (NCT03859297, R61) is a preregistered replication of initial work. We hypothesized a concurrent reduction of both self-reported rumination and cross-network connectivity between the left posterior cingulate cortex and right inferior frontal and inferior temporal gyri. Methods Seventy-six youths with a history of depression and elevated rumination were randomized to 10 to 14 sessions of RF-CBT (n = 39; 34 completers) or treatment as usual (n = 37; 28 completers). Intent-to-treat analyses assessed pre-post change in rumination response scale and in functional connectivity assessed using two 5 minute, 12 second runs of resting-state functional magnetic resonance imaging. Results We replicated previous findings: a significant reduction in rumination response scale and a reduction in left posterior cingulate cortex to right inferior frontal gyrus/inferior temporal gyrus connectivity in participants who received RF-CBT compared with those who received treatment as usual. Reductions were large (z change = 0.84; 0.73, respectively [ps < .05]). Conclusions This adolescent clinical trial further demonstrates that depressive rumination is a brain-based mechanism that is modifiable via RF-CBT. Here, we replicated that RF-CBT reduces cross-network connectivity, a possible mechanism by which rumination becomes less frequent, intense, and automatic. This National Institute of Mental Health-funded fast-fail study continues to the R33 phase during which treatment-specific effects of RF-CBT will be compared with relaxation therapy.
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Affiliation(s)
- Scott A. Langenecker
- Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, Ohio
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
- Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, Illinois
| | | | - Katie L. Bessette
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
- Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, Illinois
- Center for Cognitive Neuroscience, University of California Los Angeles, Los Angeles, California
| | - Henrietta Roberts
- Department of Experimental and Applied Clinical Psychology, University of Exeter, Sir Henry Wellcome Building for Mood Disorders Research, Exeter, United Kingdom
| | - Leah Thomas
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Alina Dillahunt
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Stephanie L. Pocius
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Daniel A. Feldman
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Dave Jago
- Department of Experimental and Applied Clinical Psychology, University of Exeter, Sir Henry Wellcome Building for Mood Disorders Research, Exeter, United Kingdom
| | - Brian Farstead
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Myah Pazdera
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Erin Kaufman
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Jennica A. Galloway
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Patricia K. Kerig
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Amanda Bakian
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Robert C. Welsh
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
- Center for Cognitive Neuroscience, University of California Los Angeles, Los Angeles, California
| | - Rachel H. Jacobs
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sheila E. Crowell
- Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah
| | - Edward R. Watkins
- Department of Experimental and Applied Clinical Psychology, University of Exeter, Sir Henry Wellcome Building for Mood Disorders Research, Exeter, United Kingdom
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Schreiner MW, Miller RH, Jacobsen AM, Crowell SE, Kaufman EA, Farstead B, Feldman DA, Thomas L, Bessette KL, Welsh RC, Watkins ER, Langenecker SA. Rumination Induction Task in fMRI: Test-Retest Reliability in Youth and Potential Mechanisms of Change with Intervention. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.10.09.23296759. [PMID: 37873244 PMCID: PMC10592982 DOI: 10.1101/2023.10.09.23296759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2023]
Abstract
Background Rumination is a transdiagnostic problem that is common in major depressive disorder (MDD). Rumination Focused Cognitive Behavioral Therapy (RF-CBT) explicitly targets the ruminative habit. This study examined changes in brain activation during a rumination induction task in adolescents with remitted MDD following RF-CBT. We also evaluated the reliability of the rumination task among adolescents who received treatment as usual (TAU). Method Fifty-five adolescents ages 14-17 completed a self-relevant rumination induction fMRI task and were then randomized to either RF-CBT (n = 30) or TAU (n = 25). Participants completed the task a second time either following 10-14 sessions of RF-CBT or the equivalent time delay for the TAU group. We assessed activation change in the RF-CBT group using paired-samples t-tests and reliability by calculating intraclass correlation coefficients (ICCs) of five rumination-related ROIs during each of three blocks for the TAU and RF-CBT groups separately (Rumination Instruction, Rumination Prompt, and Distraction). Results Following treatment, participants in the RF-CBT group demonstrated an increase in activation of the left precuneus during Rumination Instruction and the left angular and superior temporal gyri during Rumination Prompt ( p < .01). The TAU group demonstrated fair to excellent reliability ( M = .52, range = .27-.86) across most ROIs and task blocks. In contrast, the RF-CBT group demonstrated poor reliability across most ROIs and task blocks ( M = .21, range = -.19-.69). Conclusion RF-CBT appears to lead to rumination-related brain change. We demonstrated that the rumination induction task has fair to excellent reliability among individuals who do not receive an intervention that explicitly targets the ruminative habit, whereas reliability of this task is largely poor in the context of RF-CBT. This has meaningful implications in longitudinal and intervention studies, particularly when conceptualizing it as an important target for intervention. It also suggests one of many possible mechanisms for why fMRI test-retest reliability can be low that appears unrelated to the methodology itself.
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Westlund Schreiner M, Roberts H, Dillahunt AK, Farstead B, Feldman D, Thomas L, Jacobs RH, Bessette KL, Welsh RC, Watkins ER, Langenecker SA, Crowell SE. Negative association between non-suicidal self-injury in adolescents and default mode network activation during the distraction blocks of a rumination task. Suicide Life Threat Behav 2023; 53:510-521. [PMID: 36942887 PMCID: PMC10441767 DOI: 10.1111/sltb.12960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 02/17/2023] [Accepted: 03/06/2023] [Indexed: 03/23/2023]
Abstract
INTRODUCTION Rumination, or repetitive and habitual negative thinking, is associated with psychopathology and related behaviors in adolescents, including non-suicidal self-injury (NSSI). Despite the link between self-reported rumination and NSSI, there is limited understanding of how rumination is represented at the neurobiological level among youth with NSSI. METHOD We collected neuroimaging and rumination data from 39 adolescents with current or past NSSI and remitted major depression. Participants completed a rumination induction fMRI task, consisting of both rumination and distraction blocks. We examined brain activation associated with total lifetime NSSI in the context of the rumination versus distraction contrast. RESULTS Lifetime NSSI was associated with a greater discrepancy in activation during rumination relative to distraction conditions in clusters including the precuneus, posterior cingulate, superior, and middle frontal gyrus, and cerebellum. CONCLUSION Difficulties associated with rumination in adolescents with NSSI may be related to requiring greater cognitive effort to distract from ruminative content in addition to increased attention in the context of ruminative content. Increasing knowledge of neurobiological circuits and nodes associated with rumination and their relationship with NSSI may enable us to better tailor interventions that can facilitate lasting well-being and neurobiological change.
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Affiliation(s)
- Mindy Westlund Schreiner
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, Utah, USA
| | | | - Alina K Dillahunt
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, Utah, USA
- Department of Psychology, Eastern Michigan University, Ypsilanti, Michigan, USA
| | - Brian Farstead
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, Utah, USA
| | - Daniel Feldman
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, Utah, USA
| | - Leah Thomas
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, Utah, USA
| | - Rachel H Jacobs
- Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Evanston, Illinois, USA
| | - Katie L Bessette
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, Utah, USA
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois, USA
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, California, USA
| | - Robert C Welsh
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, California, USA
| | | | - Scott A Langenecker
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, Utah, USA
| | - Sheila E Crowell
- Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, Utah, USA
- Department of Psychology, University of Utah, Salt Lake City, Utah, USA
- Department of Obstetrics and Gynecology, University of Utah, Salt Lake City, Utah, USA
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Robberegt SJ, Brouwer ME, Kooiman BEAM, Stikkelbroek YAJ, Nauta MH, Bockting CLH. Meta-Analysis: Relapse Prevention Strategies for Depression and Anxiety in Remitted Adolescents and Young Adults. J Am Acad Child Adolesc Psychiatry 2023; 62:306-317. [PMID: 35513189 DOI: 10.1016/j.jaac.2022.04.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 04/06/2022] [Accepted: 04/21/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Depression and anxiety cause a high burden of disease and have high relapse rates (39%-72%). This meta-analysis systematically examined effectiveness of relapse prevention strategies on risk of and time to relapse in youth who remitted. METHOD PubMed, PsycInfo, Embase, Cochrane, and ERIC databases were searched up to June 15, 2021. Eligible studies compared relapse prevention strategies to control conditions among youth (mean age 13-25 years) who were previously depressed or anxious or with ≥30% improvement in symptoms. Two reviewers independently assessed titles, abstracts, and full texts; extracted study data; and assessed risk of bias and overall strength of evidence. Random-effects models were used to pool results, and mixed-effects models were used for subgroup analyses. Main outcome was relapse rate at last follow-up (PROSPERO ID: CRD42020149326). RESULTS Of 10 randomized controlled trials (RCTs) that examined depression, 9 were eligible for analysis: 4 included psychological interventions (n = 370), 3 included antidepressants (n = 80), and 2 included combinations (n = 132). No RCTs for anxiety were identified. Over 6 to 75 months, relapse was half as likely following psychological treatment compared with care as usual conditions (k = 6; odds ratio 0.56, 95% CI 0.31 to 1.00). Sensitivity analyses including only studies with ≥50 participants (k = 3), showed similar results. Over 6 to 12 months, relapse was less likely in youth receiving antidepressants compared with youth receiving pill placebo (k = 3; OR 0.29, 95% CI 0.10 to 0.82). Quality of studies was suboptimal. CONCLUSION Relapse prevention strategies for youth depression reduce risk of relapse, although adequately powered, high-quality RCTs are needed. This finding, together with the lack of RCTs on anxiety, underscores the need to examine relapse prevention in youth facing these common mental health conditions.
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Affiliation(s)
- Suzanne J Robberegt
- Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Depression Expertise Centre-Youth, GGZ Oost Brabant, the Netherlands
| | - Marlies E Brouwer
- Amsterdam University Medical Centers, University of Amsterdam, the Netherlands
| | - Bas E A M Kooiman
- Depression Expertise Centre-Youth, GGZ Oost Brabant, the Netherlands; University of Groningen, the Netherlands
| | - Yvonne A J Stikkelbroek
- Depression Expertise Centre-Youth, GGZ Oost Brabant, the Netherlands; Utrecht University, the Netherlands
| | - Maaike H Nauta
- University of Groningen, the Netherlands; Accare Child Study Centre, the Netherlands
| | - Claudi L H Bockting
- Amsterdam University Medical Centers, University of Amsterdam, the Netherlands; Centre for Urban Mental Health, University of Amsterdam, the Netherlands.
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Robberegt SJ, Kooiman BEAM, Albers CJ, Nauta MH, Bockting C, Stikkelbroek Y. Personalised app-based relapse prevention of depressive and anxiety disorders in remitted adolescents and young adults: a protocol of the StayFine RCT. BMJ Open 2022; 12:e058560. [PMID: 36521888 PMCID: PMC9756181 DOI: 10.1136/bmjopen-2021-058560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 10/05/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Youth in remission of depression or anxiety have high risks of relapse. Relapse prevention interventions may prevent chronicity. Aim of the study is therefore to (1) examine efficacy of the personalised StayFine app for remitted youth and (2) identify high-risk groups for relapse and resilience. METHOD AND ANALYSIS In this Dutch single-blind parallel-group randomised controlled trial, efficacy of app-based monitoring combined with guided app-based personalised StayFine intervention modules is assessed compared with monitoring only. In both conditions, care as usual is allowed. StayFine modules plus monitoring is hypothesised to be superior to monitoring only in preventing relapse over 36 months. Participants (N=254) are 13-21 years and in remission of depression or anxiety for >2 months. Randomisation (1:1) is stratified by previous treatment (no treatment vs treatment) and previous episodes (1, 2 or >3 episodes). Assessments include diagnostic interviews, online questionnaires and monitoring (ecological momentary assessment with optional wearable) after 0, 4, 12, 24 and 36 months. The StayFine modules are guided by certified experts by experience and based on preventive cognitive therapy and ingredients of cognitive behavioural therapy. Personalisation is based on shared decision-making informed by baseline assessments and individual symptom networks. Time to relapse (primary outcome) is assessed by the Kiddie Schedule for Affective Disorders and Schizophrenia-lifetime version diagnostic interview. Intention-to-treat survival analyses will be used to examine the data. Secondary outcomes are symptoms of depression and anxiety, number and duration of relapses, global functioning, and quality of life. Mediators and moderators will be explored. Exploratory endpoints are monitoring and wearable outcomes. ETHICS, FUNDING AND DISSEMINATION The study was approved by METC Utrecht and is funded by the Netherlands Organisation for Health Research and Development (636310007). Results will be submitted to peer-reviewed scientific journals and presented at (inter)national conferences. TRIAL REGISTRATION NUMBER NCT05551468; NL8237.
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Affiliation(s)
- Suzanne J Robberegt
- Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Depression Expertise Centre-Youth, GGZ Oost Brabant, Boekel, The Netherlands
| | - Bas E A M Kooiman
- Depression Expertise Centre-Youth, GGZ Oost Brabant, Boekel, The Netherlands
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Casper J Albers
- Department of Psychometrics and Statistics, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
| | - Maaike H Nauta
- Department of Clinical Psychology and Experimental Psychopathology, Faculty of Behavioural and Social Sciences, University of Groningen, Groningen, The Netherlands
- Child Study Centre, Accare, Groningen, The Netherlands
| | - Claudi Bockting
- Department of Psychiatry, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Centre for Urban Mental Health, University of Amsterdam, Amsterdam, The Netherlands
| | - Yvonne Stikkelbroek
- Depression Expertise Centre-Youth, GGZ Oost Brabant, Boekel, The Netherlands
- Department of Clinical Child and Family Studies, Faculty of Social and Behavioural Sciences, Utrecht University, Utrecht, The Netherlands
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Philippi CL, Leutzinger K, Pessin S, Cassani A, Mikel O, Walsh EC, Hoks RM, Birn RM, Abercrombie HC. Neural signal variability relates to maladaptive rumination in depression. J Psychiatr Res 2022; 156:570-578. [PMID: 36368247 PMCID: PMC9817305 DOI: 10.1016/j.jpsychires.2022.10.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 10/28/2022] [Accepted: 10/31/2022] [Indexed: 11/05/2022]
Abstract
Rumination is a common feature of depression and predicts the onset and maintenance of depressive episodes. Maladaptive and adaptive subtypes of rumination contribute to distinct outcomes, with brooding worsening negative mood and reflection related to fewer depression symptoms in healthy populations. Neuroimaging studies have implicated several cortical midline and lateral prefrontal brain regions in rumination. Recent research indicates that blood oxygen level-dependent (BOLD) signal variability may be a novel predictor of cognitive flexibility. However, no prior studies have investigated whether brooding and reflection are associated with distinct patterns of BOLD signal variability in depression. We collected resting-state fMRI data for 79 women with different depression histories: no history, past history, and current depression. We examined differences in BOLD signal variability (BOLDSD) related to rumination subtypes for the following regions of interest previously implicated in rumination: amygdala, medial prefrontal, anterior cingulate, posterior cingulate, and dorsolateral prefrontal cortices (dlPFC). Rumination subtype was associated with BOLDSD in the dlPFC, with greater levels of brooding associated with lower BOLDSD in the dlPFC, even after controlling for depression severity. Depression history was related to BOLDSD in the dlPFC, with reduced BOLDSD in those with current depression versus no history of depression. These findings provide a novel demonstration of the neural circuitry associated with maladaptive rumination in depression and implicate decreased prefrontal neural signal variability in the pathophysiology of depression.
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Affiliation(s)
- Carissa L Philippi
- Department of Psychological Sciences, University of Missouri-St. Louis, 1 University Blvd., St. Louis, Missouri, 63121, USA.
| | - Katie Leutzinger
- Department of Psychological Sciences, University of Missouri-St. Louis, 1 University Blvd., St. Louis, Missouri, 63121, USA
| | - Sally Pessin
- Department of Psychological Sciences, University of Missouri-St. Louis, 1 University Blvd., St. Louis, Missouri, 63121, USA
| | - Alexis Cassani
- Department of Psychological Sciences, University of Missouri-St. Louis, 1 University Blvd., St. Louis, Missouri, 63121, USA
| | - Olivia Mikel
- Department of Psychological Sciences, University of Missouri-St. Louis, 1 University Blvd., St. Louis, Missouri, 63121, USA
| | - Erin C Walsh
- Department of Psychiatry, University of North Carolina at Chapel Hill School of Medicine, CB# 7167, Chapel Hill, NC, 27599, USA
| | - Roxanne M Hoks
- Center for Healthy Minds, University of Wisconsin-Madison, 625 W. Washington Ave., Madison, WI, 53703, USA
| | - Rasmus M Birn
- Department of Psychiatry, University of Wisconsin-Madison, University of Wisconsin-Madison, 6001 Research Park Blvd., Madison, WI, 53719, USA
| | - Heather C Abercrombie
- Center for Healthy Minds, University of Wisconsin-Madison, 625 W. Washington Ave., Madison, WI, 53703, USA
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Boucher EM, Ward HE, Stafford JL, Parks AC. Effects of a Digital Mental Health Program on Perceived Stress in Adolescents Aged 13-17 Years: Protocol for a Randomized Controlled Trial. JMIR Res Protoc 2021; 10:e25545. [PMID: 33871377 PMCID: PMC8094018 DOI: 10.2196/25545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 02/16/2021] [Accepted: 02/25/2021] [Indexed: 11/25/2022] Open
Abstract
Background Stress is an important transdiagnostic risk factor in adolescence and predicts a host of physical and psychological problems in adolescence and adulthood. Adolescence is also a developmental stage in which people may be more sensitive or reactive to stress. Indeed, research has shown that adolescents report high levels of stress, particularly when enrolled in school. However, adolescents report engaging in few, if any, stress management techniques. Consequently, the development of effective programs to help address adolescent stress is particularly important. To date, most stress management programs for adolescents are delivered within schools, and the evidence for such programs is mixed. Furthermore, most of these programs rely on traditional stress management techniques rather than incorporating methods to address the underlying negative cognitive processes, such as rumination, that may contribute to or exacerbate the effects of perceived stress. Objective The aim of this study is to test the short-term effects of a digital mental health program designed for adolescents aged 13-17 years on perceived stress and rumination. Methods This is a randomized controlled trial in which adolescents between the ages of 13 and 17 years, with elevated levels of perceived stress and brooding, will be randomly assigned to complete 8 weeks of a digital mental health program (Happify for Teens) or to a corresponding wait-list control group. The study will take place over 3 months, including the 8-week intervention period and 1-month postintervention follow-up. The primary outcome, perceived stress, along with secondary and exploratory outcomes (ie, brooding, optimism, sleep disturbance, and loneliness) will be assessed via self-report at baseline, 4 weeks, 8 weeks, and 12 weeks to compare changes in these outcomes across conditions. Results Recruitment is expected to begin in the second quarter of 2021, with a target sample size of 800 participants (400 per condition). Participants will begin the study as they are recruited and will finish in waves, with the first wave of data expected 8 weeks after recruitment begins and the final wave of data expected by the end of the third quarter of 2021. Conclusions Although school-based stress management programs for adolescents are common, research suggests that they may be limited in their reach and more effective for school-based stress than other types of stress. This trial will be one of the first attempts to examine the potential benefits of a digital mental health program on adolescents to address stress along with negative cognitive processes such as rumination. If successful, this would help introduce a more scalable alternative to school-based programs that offers adolescents greater privacy while also providing insight into novel ways to target adolescent mental health more generally. Trial Registration ClinicalTrials.gov NCT04567888; https://clinicaltrials.gov/ct2/show/NCT04567888 International Registered Report Identifier (IRRID) PRR1-10.2196/25545
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