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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

View Article: PubMed Central - PubMed

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

No MeSH data available.


Related in: MedlinePlus

Changes in and depression and rumination over eight weeks among remitted adolescents.Predicted means and standard errors deriving from MRMs. RFCBT = Rumination-focused Cognitive Behavior Therapy, AO = Assessment Only, RRS = Ruminative Responses Scale, CDRS-R = Children’s Depression Rating Scale–Revised, RADS = Reynolds Adolescent Depression Scale. Panel a illustrates change in CDRS-R, panel b illustrates change in RADS, panel c illustrates change in RRS.
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pone.0163952.g002: Changes in and depression and rumination over eight weeks among remitted adolescents.Predicted means and standard errors deriving from MRMs. RFCBT = Rumination-focused Cognitive Behavior Therapy, AO = Assessment Only, RRS = Ruminative Responses Scale, CDRS-R = Children’s Depression Rating Scale–Revised, RADS = Reynolds Adolescent Depression Scale. Panel a illustrates change in CDRS-R, panel b illustrates change in RADS, panel c illustrates change in RRS.

Mentions: Table 2 details MRM results for the ITT sample including main and interaction effects for all outcome variables. Fig 2 depicts trajectories for predicted scores across groups. Adolescents who received RFCBT demonstrated significantly decreasing rumination (F = -2.76, df = 111.77, p < .01) and self-report depression across eight weeks (F = -2.58, df = 112.69, p < .01) relative to adolescents in the AO condition. As illustrated in Table 2, rumination and self-report depression remained constant among those in the AO group and decreased significantly (diverging by week 6) among the RFCBT group. There was a trend towards differences as measured by the IE using the CDRS-R (F = -1.44, df = 32.10, p = .08), wherein the AO group demonstrated a slight increase in symptoms compared to the RFCBT group who demonstrated a slight decrease. Supporting information including S1 Fig further examine clinical results.


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
Changes in and depression and rumination over eight weeks among remitted adolescents.Predicted means and standard errors deriving from MRMs. RFCBT = Rumination-focused Cognitive Behavior Therapy, AO = Assessment Only, RRS = Ruminative Responses Scale, CDRS-R = Children’s Depression Rating Scale–Revised, RADS = Reynolds Adolescent Depression Scale. Panel a illustrates change in CDRS-R, panel b illustrates change in RADS, panel c illustrates change in RRS.
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC5120778&req=5

pone.0163952.g002: Changes in and depression and rumination over eight weeks among remitted adolescents.Predicted means and standard errors deriving from MRMs. RFCBT = Rumination-focused Cognitive Behavior Therapy, AO = Assessment Only, RRS = Ruminative Responses Scale, CDRS-R = Children’s Depression Rating Scale–Revised, RADS = Reynolds Adolescent Depression Scale. Panel a illustrates change in CDRS-R, panel b illustrates change in RADS, panel c illustrates change in RRS.
Mentions: Table 2 details MRM results for the ITT sample including main and interaction effects for all outcome variables. Fig 2 depicts trajectories for predicted scores across groups. Adolescents who received RFCBT demonstrated significantly decreasing rumination (F = -2.76, df = 111.77, p < .01) and self-report depression across eight weeks (F = -2.58, df = 112.69, p < .01) relative to adolescents in the AO condition. As illustrated in Table 2, rumination and self-report depression remained constant among those in the AO group and decreased significantly (diverging by week 6) among the RFCBT group. There was a trend towards differences as measured by the IE using the CDRS-R (F = -1.44, df = 32.10, p = .08), wherein the AO group demonstrated a slight increase in symptoms compared to the RFCBT group who demonstrated a slight decrease. Supporting information including S1 Fig further examine clinical results.

View Article: PubMed Central - PubMed

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&ndash;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 &lt; .01, 95% CI [-4.72,-0.80]) and self-report depression across eight weeks (F = -2.58, df = 113, p &lt; .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

No MeSH data available.


Related in: MedlinePlus