Malleability of rumination: An exploratory model of CBT-based plasticity and long-term reduced risk for depressive relapse among youth from a pilot randomized clinical trial.
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ABSTRACT:
SUBMITTER: Bessette KL
PROVIDER: S-EPMC7299403 | biostudies-literature | 2020
REPOSITORIES: biostudies-literature
Publications
Malleability of rumination: An exploratory model of CBT-based plasticity and long-term reduced risk for depressive relapse among youth from a pilot randomized clinical trial.
Bessette Katie L KL Jacobs Rachel H RH Heleniak Charlotte C Peters Amy T AT Welsh Robert C RC Watkins Edward R ER Langenecker Scott A SA
PloS one 20200617 6
<h4>Clinical trials registration</h4>NCT01905267, https://clinicaltrials.gov/ct2/show/NCT01905267. ...[more]
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Project description: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 registrationClinicalTrials.gov NCT01905267.
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Project description:The risk of relapse in major depressive disorder (MDD) is associated with high worldwide disease burden. Cognitive behavioral therapy (CBT) and its modifications might be effective in relapse prevention. The aim of this review was to evaluate the efficacy of these treatments for reducing relapse of MDD.The retrieval was performed in the databases of MEDLINE via Pubmed, EMBASE and PsycINFO via OVID, The Cochrane Library and four Chinese databases. Clinical trials registry platforms and references of relevant articles were retrieved as well. Hazard ratio (HR) and corresponding 95% confidence interval (CI) were used to pool evidences.A total of 16 eligible trials involving 1945 participants were included. In the first 12 months, CBT was more efficacious than control in reducing the risk of developing a new episode of depression for MDD patients in remission (HR:0.50, 95%CI:0.35-0.72, I2 = 11%). Mindfulness-based cognitive therapy (MBCT) was more efficacious than control only among patients with 3 or more previous depressive episodes (HR:0.46, 95%CI:0.31-0.70, I2 = 38%). Besides, compared with maintenance antidepressant medication (m-ADM), MBCT was a more effective intervention (HR:0.76, 95%CI:0.58-0.98, I2 = 0%). These positive effects might be only maintained at two and nearly 6 years follow up for CBT.The use of CBT for MDD patients in remission might reduce risk of relapse. Besides, the effect of MBCT was moderated by number of prior episodes and MBCT might only be effective for MDD patients with 3 or more previous episodes. Further exploration for the influence of previous psychological intervention is required.
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Project description:Learning induces plasticity in neuronal networks. As neuronal populations contribute to multiple representations, we reasoned plasticity in one representation might influence others. We used human fMRI repetition suppression to show that plasticity induced by learning another individual's values impacts upon a value representation for oneself in medial prefrontal cortex (mPFC), a plasticity also evident behaviorally in a preference shift. We show this plasticity is driven by a striatal "prediction error," signaling the discrepancy between the other's choice and a subject's own preferences. Thus, our data highlight that mPFC encodes agent-independent representations of subjective value, such that prediction errors simultaneously update multiple agents' value representations. As the resulting change in representational similarity predicts interindividual differences in the malleability of subjective preferences, our findings shed mechanistic light on complex human processes such as the powerful influence of social interaction on beliefs and preferences.
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Project description:Existing literature on rumination has predominately focused on depressive rumination; thus, there is little research directly comparing different forms of rumination as correlates of psychopathological outcomes. The present study investigated anger and depressive rumination as correlates of internalizing and externalizing psychopathology. Cross-sectional confirmatory factor analyses on data from 764 young adults from the Colorado Longitudinal Twin Study indicated that anger and depressive rumination were separable at the latent variable level, and were both associated with lifetime symptoms of internalizing and externalizing psychopathology. However, depressive rumination was more strongly associated with psychopathology than was anger rumination. Further analysis indicated that depressive rumination was independently associated with internalizing psychopathology, whereas associations between anger rumination and psychopathology were predominately due to shared variance with depressive rumination. Anger rumination was independently associated with externalizing psychopathology in women and was inversely associated with internalizing psychopathology in men. This result supports the clinical relevance of ruminative thought processes and the potential differential utility of anger and depressive content for understanding internalizing and externalizing psychopathology.
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Project description:Background:Although there is good evidence to support the effectiveness of cognitive behavioral therapy (CBT) for the outpatient treatment of adolescent major depressive disorder (MDD), evidence-based manuals for the inpatient setting are lacking. This pilot study sought to (i) adapt an existing CBT manual (treatment of adolescent depression; TADS) to an inpatient setting (TADS-in), (ii) test its effectiveness at symptom reduction and remission of MDD in a pre-post design, and (iii) assess the strengths and limitations of the manual via a focus-group with clinicians. Methods:Twenty nine adolescents aged 12-17?years with a primary ICD-10 diagnosis of MDD being treated as inpatients at a psychiatric clinic were included. Embedded in the regular inpatient treatment course (8?weeks), patients received 12 sessions of the TADS-in manual. Quantitative assessment of symptom reduction and remission of MDD was conducted using a non-controlled pre-post design. The quantitative results were supplemented by a focus group with participating psychotherapists. Results:Of the 29 patients included in the study at the beginning, 19 (65.5%) remained in the study at week 8. Symptoms of depression were statistically significantly lower at the end of treatment than at baseline according to self- (d = 1.38; mean change = 19.88; 95% CI = 12.48-27.28) and other reports (d = 0.64, mean change = 0.35; 95% CI = 0.08-0.62). Clinicians ratings of improvement (CGI-I) suggested that at the end of treatment, 15.8% were very much improved, 68.4% much improved, and 15.8% were minimally improved. According to diagnostic interviews with patients conducted at the end of treatment, 73.3% were in remission. The qualitative analysis showed that on the whole, the TADS-in manual is suitable for the inpatient setting. However, clinicians believed the effectiveness of TADS-in was limited by patient comorbidity and the fact that the inpatients were unable to practice incorporating techniques learnt into everyday life. Conclusions:This study is the first to adapt the TADS manual to the inpatient setting. The sample of depressed adolescents showed reduced symptomology following treatment, although these findings require replicating in a randomized controlled trial before effects can be attributed to the TADS-in manual specifically. This pilot study informs further development of the manual as well as representing an important first step in the evaluation of the inpatient treatment of adolescent depression.The study was retrospectively registered (DRKS00017308) and received no external funding.
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Project description:Suicide attempts and suicidal ideation in adolescence are considered to be related to suicide and psychiatric adversity later in life. Secondary prevention by improving the treatment of suicidal youth is a distinct possibility. In this study, treatment with a systematised mood-regulation focused cognitive behavioural therapy (MR-CBT) (n = 15) was compared with treatment as usual (TAU) (n = 12) in a group of depressed adolescents in a clinical setting. MR-CBT focuses on mood regulation by means of counter conditioning with memory reconsolidation being the proposed mechanism of change. Subjects practice keeping emotionally positive memories to diminish the emotional impact of negative memories. Symptoms of depression were tested with a short version of the Mood and Feelings Questionnaire (SMFQ), and wellbeing with the World Health Organization 5 Wellbeing Index (WHO-5). Suicidal events were rated according to the clinical interview Columbia Suicide Severity Rating Scale (C-SSRS). Suicidal events at the end of treatment were significantly reduced in the MR-CBT group, but not in the TAU group. Depression and wellbeing improved significantly in both treatment groups. While far from conclusive, the results are encouraging enough to suggest that further studies should be undertaken to examine whether psychotherapy focusing on mood regulation for young individuals at risk might enhance secondary prevention of suicide.
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Project description:BackgroundAdolescent-onset depression often results in a chronic and recurrent course, and is associated with worse outcomes relative to adult-onset depression. Targeting habitual depressive rumination, a specific known risk factor for relapse, may improve clinical outcomes for adolescents who have experienced a depressive episode. Randomized controlled trials (RCTs) thus far have demonstrated that rumination-focused cognitive behavioral therapy (RFCBT) reduces depressive symptoms and relapse rates in patients with residual depression and adolescents and young adults with elevated rumination. This was also observed in a pilot RCT of adolescents at risk for depressive relapse. Rumination can be measured at the self-report, behavioral, and neural levels- using patterns of connectivity between the Default Mode Network (DMN) and Cognitive Control Network (CCN). Disrupted connectivity is a putative important mechanism for understanding reduced rumination via RFCBT. A feasibility trial in adolescents found that reductions in connectivity between DMN and CCN regions following RFCBT were correlated with change in rumination and depressive symptoms.MethodThis is a phase III two-arm, two-stage, RCT of depression prevention. The trial tests whether RFCBT reduces identified risk factors for depressive relapse (rumination, patterns of neural connectivity, and depressive symptoms) in adolescents with partially or fully remitted depression and elevated rumination. In the first stage, RFCBT is compared to treatment as usual within the community. In the second stage, the comparator condition is relaxation therapy. Primary outcomes will be (a) reductions in depressive rumination, assessed using the Rumination Response Scale, and (b) reductions in resting state functional magnetic resonance imaging connectivity of DMN (posterior cingulate cortex) to CCN (inferior frontal gyrus), at 16 weeks post-randomization. Secondary outcomes include change in symptoms of depression following treatment, recurrence of depression over 12 months post-intervention period, and whether engagement with therapy homework (as a dose measure) is related to changes in the primary outcomes.DiscussionRFCBT will be evaluated as a putative preventive therapy to reduce the risk of depressive relapse in adolescents, and influence the identified self-report, behavioral, and neural mechanisms of change. Understanding mechanisms that underlie change in rumination is necessary to improve and further disseminate preventive interventions.Trial registrationClinicalTrials.gov Identifier: NCT03859297 , registered 01 March 2019.
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Project description:BackgroundBody motion-activated video games are a promising strategy for promoting engagement in and adherence to addiction treatment among youth.ObjectiveThis pilot randomized trial (N=80) investigated the feasibility of a body motion-activated video game prototype, Recovery Warrior 2.0, targeting relapse prevention in the context of a community inpatient care program for youth.MethodsParticipants aged 15-25 years were recruited from an inpatient drug treatment program and randomized to receive treatment as usual (control) or game play with treatment as usual (intervention). Assessments were conducted at baseline, prior to discharge, and at 4 and 8 weeks postdischarge.ResultsThe provision of the game play intervention was found to be feasible in the inpatient setting. On an average, participants in the intervention group played for 36.6 minutes and on 3.6 different days. Participants in the intervention group mostly agreed that they would use the refusal skills taught by the game. Participants in the intervention group reported attending more outpatient counseling sessions than those in the control group (10.8 versus 4.8), but the difference was not significant (P=.32). The game had no effect on drug use at 4 or 8 weeks postdischarge, with the exception of a benefit reported at the 4-week follow-up among participants receiving treatment for marijuana addiction (P=.04).ConclusionsPreliminary evidence indicates that a motion-activated video game for addiction recovery appears to be feasible and acceptable for youth within the context of inpatient treatment, but not outpatient treatment. With further development, such games hold promise as a tool for the treatment of youth substance use disorder.Trial registrationClinicalTrials.gov NCT03957798; https://clinicaltrials.gov/show/NCT03957798 (Archived by WebCite at http://www.webcitation.org/78XU6ENB4).
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Project description:Executive function (EF) deficits have been proposed as transdiagnostic risk factors for psychopathology, and recent research suggests EF impairments are associated with what is shared across forms of psychopathology (p factor). However, most research has not employed methods that differentiate between EF components, and little is known about the mediating mechanisms linking EF and psychopathology dimensions. The current study tested associations between the latent unity/diversity model of EF and latent dimensions of psychopathology and investigated mediating mechanisms in a community sample of 292 youth age 13-22. The results confirmed the finding that poor EF is associated with internalizing psychopathology in older youth via higher dependent stress and rumination, and showed that this pathway was transdiagnostic, predicting the p factor rather than internalizing specifically. Links with psychopathology were specific to the common EF factor, rather than updating- or shifting-specific EF.
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Project description:The goal of the current study was to examine the role of brooding rumination in children at risk for depression. We found that children of mothers with a history of major depression exhibited higher levels of brooding rumination than did children of mothers with no depression history. Examining potential mechanisms of this risk, we found no evidence for shared genetic influences (BDNF or 5-HTTLPR) or modeling of mothers' rumination. However, we did find that children with a history of prior depressive disorders exhibited higher current levels of brooding rumination than children with no depression history. Importantly, children's brooding predicted prospective onsets of new depressive episodes over a 20-month follow-up even when we statistically controlled for depressive symptom levels at the initial assessment, suggesting that the predictive effect of brooding rumination in children was not due simply to co-occurring depressive symptoms.
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