Westlund Schreiner Mindy, Jacobsen Anna M, Farstead Brian W, Miller Raina H, Jacobs Rachel H, Thomas Leah R, Bessette Katie L, Pazdera Myah, Crowell Sheila E, Kaufman Erin A, Feldman Daniel A, Roberts Henrietta, Welsh Robert C, Watkins Edward R, Langenecker Scott A
Behavioral Health, Nationwide Children's Hospital, Columbus, OH, USA; Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA; Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, UT, USA.
Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, UT, USA; Department of Adult Psychiatry and Psychotherapy, University of Zurich, Zurich, CH, Switzerland; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA.
J Affect Disord. 2025 Mar 1;372:608-615. doi: 10.1016/j.jad.2024.12.056. Epub 2024 Dec 17.
Rumination is implicated in the onset and maintenance of major depressive disorder (MDD). Rumination-Focused Cognitive Behavioral Therapy (RF-CBT) effectively targets rumination and may change resting-state brain connectivity and change in activation during a rumination induction task (RIT) post-intervention predicts depressive symptoms two years later. We examined brain activation changes during an RIT in adolescents with remitted MDD following RF-CBT and evaluated RIT reliability (or stability) during treatment as usual (TAU).
Fifty-five adolescents ages 14-17 completed an RIT at baseline, were randomized to 10-14 sessions of RF-CBT (n = 30) or treatment as usual (n = 25) and completed an RIT at post-treatment or equivalent time delay. The RIT includes recalling negative memories (Rumination Instruction), dwelling on their meaning/consequences (Rumination Prompt), and imagining unrelated scenes and objects (Distraction). We assessed activation change in the RF-CBT group using paired-samples t-tests. We assessed reliability (or stability) via intraclass correlation coefficients (ICCs) of five rumination-related ROIs for TAU and RF-CBT separately across task blocks.
Following treatment, participants receiving RF-CBT demonstrated increased activation of left precuneus during Rumination Instruction and of left angular and superior temporal gyri during Rumination Prompt blocks (p < .01). From baseline to post-treatment, across most ROIs and task blocks, the RF-CBT group demonstrated poor stability (M = 0.21, range = -0.19-0.69), while the TAU group demonstrated fair-to-excellent stability (M = 0.52, range = 0.27-0.86).
RF-CBT changes activation of rumination-related circuitry during state-induced rumination, offering exciting avenues for future interventions. The RIT has fair-to-excellent stability among individuals not explicitly treated for rumination, and as expected, RIT stability is disrupted by RF-CBT.
反刍思维与重度抑郁症（MDD）的发病和维持有关。以反刍思维为重点的认知行为疗法（RF-CBT）有效地针对反刍思维，可能会改变静息态脑连接，干预后反刍思维诱导任务（RIT）中的激活变化可预测两年后的抑郁症状。我们研究了RF-CBT治疗后缓解期MDD青少年在RIT期间的脑激活变化，并评估了常规治疗（TAU）期间RIT的可靠性（或稳定性）。
55名14-17岁的青少年在基线时完成了一次RIT，被随机分为接受10-14次RF-CBT治疗（n = 30）或常规治疗（n = 25），并在治疗后或同等时间延迟时完成一次RIT。RIT包括回忆负面记忆（反刍思维指导）、细想其意义/后果（反刍思维提示）以及想象不相关的场景和物体（分心）。我们使用配对样本t检验评估RF-CBT组的激活变化。我们通过组内相关系数（ICC）分别评估TAU和RF-CBT在不同任务块中五个与反刍思维相关的感兴趣区域（ROI）的可靠性（或稳定性）。
治疗后，接受RF-CBT治疗的参与者在反刍思维指导期间左侧楔前叶激活增加，在反刍思维提示块期间左侧角回和颞上回激活增加（p <.01）。从基线到治疗后，在大多数ROI和任务块中，RF-CBT组显示出较差的稳定性（M = 0.21，范围 = -0.19 - 0.69），而TAU组显示出中等至极好的稳定性（M = 0.52，范围 = 0.27 - 0.86）。
RF-CBT在状态诱导的反刍思维期间改变了与反刍思维相关的神经回路的激活，为未来的干预提供了令人兴奋的途径。RIT在未明确针对反刍思维进行治疗的个体中具有中等至极好的稳定性，正如预期的那样，RF-CBT破坏了RIT的稳定性。
