State rumination predicts inhibitory control failures and dysregulation of default, salience, and cognitive control networks in youth at risk of depressive relapse: Findings from the RuMeChange trial

Background

Trait rumination is a habitual response to negative experiences that can emerge during adolescence, increasing risk of depression. Trait rumination is correlated with poor inhibitory control (IC) and altered default mode network (DMN) and cognitive control network (CCN) engagement. Provoking state rumination in high ruminating youth permits investigation of rumination and IC at the neural level, highlighting potential treatment targets.

Methods

Fifty-three high-ruminating youth were cued with an unresolved goal that provoked state rumination, then completed a modified Sustained Attention to Response Task (SART) that measures IC (commissions on no-go trials) in a functional MRI study. Thought probes measured state rumination about that unresolved goal and task-focused thoughts during the SART.

Results

Greater state rumination during the SART was correlated with more IC failures. CCN engagement increased during rumination (relative to task-focus), including left dorsolateral prefrontal cortex and dorsalmedial prefrontal cortex. Relative to successful response suppression, DMN engagement increased during IC failures amongst individuals with higher state and trait rumination. Exploratory analyzes suggested more bothersome unresolved goals predicted higher left DLPFC activation during rumination.

Limitations

The correlational research design did not permit a direct contrast of causal accounts of the relationship between rumination and IC.

Conclusions

State rumination was associated with impaired IC and disrupted modulation of DMN and CCN. Increased CCN engagement during rumination suggested effortful suppression of negative thoughts, and this was greater for more bothersome unresolved goals. Relative task disengagement was observed during rumination-related errors. DMN-CCN dysregulation in high-ruminating youth may be an important treatment target.

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

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.

Human emotion processing accuracy, negative biases, and fMRI activation are associated with childhood trauma

Introduction

Emerging literature suggests that childhood trauma may influence facial emotion perception (FEP), with the potential to negatively bias both emotion perception and reactions to emotion-related inputs. Negative emotion perception biases are associated with a range of psychiatric and behavioral problems, potentially due or as a result of difficult social interactions. Unfortunately, there is a poor understanding of whether observed negative biases are related to childhood trauma history, depression history, or processes common to (and potentially causative of) both experiences.

Methods

The present cross-sectional study examines the relation between FEP and neural activation during FEP with retrospectively reported childhood trauma in young adult participants with remitted major depressive disorder (rMDD, n = 41) and without psychiatric histories (healthy controls [HC], n = 34). Accuracy of emotion categorization and negative bias errors during FEP and brain activation were each measured during exposure to fearful, angry, happy, sad, and neutral faces. We examined participant behavioral and neural responses in relation to total reported severity of childhood abuse and neglect (assessed with the Childhood Trauma Questionnaire, CTQ).

Results

Results corrected for multiple comparisons indicate that higher trauma scores were associated with greater likelihood of miscategorizing happy faces as angry. Activation in the right middle frontal gyrus (MFG) positively correlated with trauma scores when participants viewed faces that they correctly categorized as angry, fearful, sad, and happy.

Discussion

Identifying the neural mechanisms by which childhood trauma and MDD may change facial emotion perception could inform targeted prevention efforts for MDD or related interpersonal difficulties.

Rumination Induction Task in fMRI: Test-Retest Reliability in Youth and Potential Mechanisms of Change with Intervention

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.

Negative association between non-suicidal self-injury in adolescents and default mode network activation during the distraction blocks of a rumination task

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.

The Rapid Evolution of Crisis Mental Health Services in Utah: Opportunities and Challenges as a Result of the Global Pandemic

Our country is facing a resurgence of behavioral health crises from over the past 30 years, further illuminated and exacerbated by the global COVID-19 pandemic. Increasing suicide crises among youths over recent decades, untreated anxiety and depression, and serious mental illness are signs of the need for improvements in accessible, affordable, timely, and comprehensive behavioral health services. Against the backdrop of high suicide rates and low behavioral health services in Utah, statewide collaborators aligned with a common goal: deliver crisis services to anyone, anytime, and anywhere. After its initiation in 2011, the integrated behavioral health crisis response system continued to expand and excel, ultimately improving access and referral to services, flattening suicide rates, and reducing stigma. The global pandemic further motivated the expansion of Utah's crisis response system. This review focuses on the unique experiences of the Huntsman Mental Health Institute as a catalyst and partner in these changes. Our goals are to: inform about unique Utah partnerships and actions in the crisis mental health space, describe initial steps and outcomes, highlight continuing challenges, discuss pandemic-specific barriers and opportunities, and explore the long-term vision to improve quality and access to mental health resources.

Using Network Parcels and Resting-State Networks to Estimate Correlates of Mood Disorder and Related Research Domain Criteria Constructs of Reward Responsiveness and Inhibitory Control

BACKGROUND

Resting-state graph-based network edges can be powerful tools for identification of mood disorders. We address whether these edges can be integrated with Research Domain Criteria (RDoC) constructs for accurate identification of mood disorder-related markers, while minimizing active symptoms of disease.

METHODS

We compared 132 individuals with currently remitted or euthymic mood disorder with 65 healthy comparison participants, ages 18-30 years. Subsets of smaller brain parcels, combined into three prominent networks and one network of parcels overlapping across these networks, were used to compare edge differences between groups. Consistent with the RDoC framework, we evaluated individual differences with performance measure regressors of inhibitory control and reward responsivity. Within an omnibus regression model, we predicted edges related to diagnostic group membership, performance within both RDoC domains, and relevant interactions.

RESULTS

There were several edges of mood disorder group, predominantly of greater connectivity across networks, different than those related to individual differences in inhibitory control and reward responsivity. Edges related to diagnosis and inhibitory control did not align well with prior literature, whereas edges in relation to reward responsivity constructs showed greater alignment with prior literature. Those edges in interaction between RDoC constructs and diagnosis showed a divergence for inhibitory control (negative interactions in default mode) relative to reward (positive interactions with salience and emotion network).

CONCLUSIONS

In conclusion, there is evidence that prior simple network models of mood disorders are currently of insufficient biological or diagnostic clarity or that parcel-based edges may be insufficiently sensitive for these purposes.

Advancing a temporal framework for understanding the biology of nonsuicidal self- injury: An expert review

Nonsuicidal self-injury (NSSI) is a serious clinical problem, particularly for adolescents and young adults. NSSI is a complex behavior that emerges through the intersecting effects of social, psychological, and biological mechanisms. Although the social and psychological contributions to risk for developing NSSI are relatively well understood and have guided the development of effective psychosocial treatments for self-injury, the biological mechanisms underlying NSSI have just begun to come to light. To evaluate and categorize the biological research conducted on the topic of NSSI, we propose a model that distinguishes between trait and state markers. According to this model, risk factors and mechanisms involved in NSSI can be distinguished into both trait and state factors. We review the existing evidence on distal biological traits (predictors) of NSSI, proximal biological traits (correlates) of NSSI, and biological states directly preceding or following NSSI. We conclude by providing recommendations for future research on the neurobiology of NSSI.

Brain entropy and neurotrophic molecular markers accompanying clinical improvement after ketamine: Preliminary evidence in adolescents with treatment-resistant depression

BACKGROUND

Current theory suggests that treatment-resistant depression (TRD) involves impaired neuroplasticity resulting in cognitive and neural rigidity, and that clinical improvement may require increasing brain flexibility and adaptability.

AIMS

In this hypothesis-generating study, we sought to identify preliminary evidence of brain flexibility correlates of clinical change within the context of an open-label ketamine trial in adolescents with TRD, focusing on two promising candidate markers of neural flexibility: (a) entropy of resting-state functional magnetic resonance imaging (fMRI) signals; and (b) insulin-stimulated phosphorylation of mammalian target of rapamycin (mTOR) and glycogen synthase-3-beta (GSK3β) in peripheral blood mononuclear cells.

METHODS

We collected resting-state functional magnetic resonance imaging data and blood samples from 13 adolescents with TRD before and after a series of six ketamine infusions over 2 weeks. Usable pre/post ketamine data were available from 11 adolescents for imaging and from 10 adolescents for molecular signaling. We examined correlations between treatment response and changes in the central and peripheral flexibility markers.

RESULTS

Depression reduction correlated with increased nucleus accumbens entropy. Follow-up analyses suggested that physiological changes were associated with treatment response. In contrast to treatment non-responders (n=6), responders (n=5) showed greater increase in nucleus accumbens entropy after ketamine, together with greater post-treatment insulin/mTOR/GSK3β signaling.

CONCLUSIONS

These data provide preliminary evidence that changes in neural flexibility may underlie symptom relief in adolescents with TRD following ketamine. Future research with adequately powered samples is needed to confirm resting-state entropy and insulin-stimulated mTOR and GSK3β as brain flexibility markers and candidate targets for future clinical trials.

CLINICAL TRIAL NAME

Ketamine in adolescents with treatment-resistant depressionURL: https://clinicaltrials.gov/ct2/show/NCT02078817Registration number: NCT02078817.

Classifying Treated vs. Untreated MDD Adolescents from Anatomical Connectivity using Nonlinear SVM

Identification of the treatment-related responders for adolescent Major Depressive Disorder (MDD) is urgently needed to develop effective treatments. In this paper, machine learning based classifiers are used to reveal anatomical features as responders for distinguishing MDD patients who have received treatment from those who never received any treatment. The features are drawn from two sets of measurements: 1) anatomical connectivity defined by diffusion tensor imaging measurements between a pair of brain regions, and 2) topological measurements from anatomical networks. Feature selection was performed based on p-value and minimum redundancy maximum relevance (mRMR) method to achieve improved classification accuracy. The classification performance is evaluated with a leave-one-out cross-validation method using 37 treated and 15 untreated subjects. The proposed methodology achieves 73% accuracy, 100% specificity, and 100% precision for 52 subjects. The most distinguishing features are the strength of the right hippocampus of the mean diffusivity (MD) network at 18% density and of the track-count (TR) network, the participation coefficient of the left middle temporal gyrus of the radial diffusivity (RD) network at 20% density, the axial diffusivity (AD) connectivity between right middle temporal gyrus and right supramarginal gyrus, the betweenness centrality of the right hippocampus of the TR network at 11% density, the apparent diffusion coefficient (ADC) connectivity between the left pars opercularis and the left rostral anterior cingulate cortex, the clustering coefficient of the middle anterior corpus callosum of the TR network at 11% density, and the AD connectivity between the left pars opercularis and the left rostral anterior cingulate cortex.

Anatomical Biomarkers for Adolescent Major Depressive Disorder from Diffusion Weighted Imaging using SVM Classifier

Adolescent Major Depressive Disorder (MDD) is a common and serious mental illness that could lead to tragic outcomes including chronic adult disability and suicide. In this paper, we explore anatomical features and apply machine learning approaches to identify responsive biomarkers distinguishing MDD patients from healthy subjects. The features of interest include metrics in two categories: a) anatomical connectivity defined by diffusion tensor imaging measurements between a pair of brain regions, and b) topological measurements from anatomical networks. A combination of p-value based filtering and minimum redundancy maximum relevance method is performed to select features for optimal classification accuracy. A leave-one-out cross-validation method is used for the classification performance evaluation. The proposed methodology achieves an improved accuracy of 78%, 90.39% sensitivity, and 79.66% precision for 79 subjects. The most distinguishing features are the betweenness centrality of the right lingual gyrus of the ADC network at 12% sparsity, the participation coefficient of the right lateral occipital sulcus of the ADC network at 22% sparsity, the participation coefficient of the right pars opercularis of the AD network at 16% sparsity, and the participation coefficient of the right lateral orbitofrontal cortex in the ADC network at 10% sparsity. Those network measures reflect the change of connectivity between the regions and their associated anatomical subnetworks.

Biomarkers for Adolescent MDD from Anatomical Connectivity and Network Topology Using Diffusion MRI

Due to the high resistance (35%) to the current treatment methods in adolescent Major Depressive Disorder (MDD) and its tragic outcomes, the discovery of treatmentrelated responders is critical to developing effective treatments. In this paper, the permutation test is performed to identify statistically significant changes in anatomical characteristics during pairwise comparisons among the control group (n=27), treated MDD group (n=37), and untreated MDD group (n=15). The anatomical characteristics include: 1) anatomical connectivity defined using DTI metrics between a pair of brain regions, and 2) topological measurements of anatomical networks. With the Bonferroni correction for multiple-comparison, significant alterations in community structure and local topology were identified as the p-value < 5%, which include: 1) a reduced nodal centrality (degree and strength) on right hippocampus for treated compared to untreated group, 2) an elevated clustering coefficient and local efficiency on right lateral orbitofrontal cortex for untreated compared to the combination of control and treated groups, 3) an increased participation coefficient for untreated patients on left insula cortex in the meandiffusivity network compared to the combination of control and treated groups, and 4) a degraded module degree z-score on right caudate nucleus for all the patients compared to the control group. Two connections, hippocampus-insula in the right hemisphere and parahippocampal-insula in the left hemisphere, were found significantly altered in TR, AD, and FA due to MDD.