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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

Change in connectivity of the left posterior cingulate cortex across eight weeks of Rumination-Focused Cognitive Behavior Therapy.Panel a displays significant connectivity of the left posterior cingulate seed with the whole brain among all participants at baseline. Panel b illustrates reduced connectivity with the right inferior frontal gyrus. Panel c illustrates reduced connectivity with the bilateral inferior temporal gyri. Panel d illustrates reduced connectivity with the middle frontal gyrus. Panel e illustrates reduced connectivity with the caudate body. Panel f illustrates reduced connectivity with the middle cingulate. z denotes z coordinates for axial slices and statistical maps are illustrated to the right of relevant images.
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pone.0163952.g003: Change in connectivity of the left posterior cingulate cortex across eight weeks of Rumination-Focused Cognitive Behavior Therapy.Panel a displays significant connectivity of the left posterior cingulate seed with the whole brain among all participants at baseline. Panel b illustrates reduced connectivity with the right inferior frontal gyrus. Panel c illustrates reduced connectivity with the bilateral inferior temporal gyri. Panel d illustrates reduced connectivity with the middle frontal gyrus. Panel e illustrates reduced connectivity with the caudate body. Panel f illustrates reduced connectivity with the middle cingulate. z denotes z coordinates for axial slices and statistical maps are illustrated to the right of relevant images.

Mentions: The main effect of time in the RFCBT group revealed significant changes in several regions. Table 3 and Fig 3 detail significant change in connectivity across eight weeks within the RFCBT group. Across the intervention period, connectivity between the left PCC and frontal regions including the bilateral inferior frontal gyrus (IFG, Brodmann Areas, BA 46 and 47) decreased. Connectivity of the left PCC with medial (BA = 21) and inferior temporal (BA = 20) regions also decreased. Connectivity decreased to regions including the orbital frontal cortex, cuneus (BA = 18), and cingulate (BA = 23). Relative reductions in connectivity were also observed between the left PCC and the right caudate and mid-cingulate. Fig 4 displays extracted data between the left PCC and the right IFG and ITG. Corresponding values for the AO group are included to allow a general examination of the specificity of effects and to offer some control for the effect of time and acclimation to scanner environment.


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
Change in connectivity of the left posterior cingulate cortex across eight weeks of Rumination-Focused Cognitive Behavior Therapy.Panel a displays significant connectivity of the left posterior cingulate seed with the whole brain among all participants at baseline. Panel b illustrates reduced connectivity with the right inferior frontal gyrus. Panel c illustrates reduced connectivity with the bilateral inferior temporal gyri. Panel d illustrates reduced connectivity with the middle frontal gyrus. Panel e illustrates reduced connectivity with the caudate body. Panel f illustrates reduced connectivity with the middle cingulate. z denotes z coordinates for axial slices and statistical maps are illustrated to the right of relevant images.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5120778&req=5

pone.0163952.g003: Change in connectivity of the left posterior cingulate cortex across eight weeks of Rumination-Focused Cognitive Behavior Therapy.Panel a displays significant connectivity of the left posterior cingulate seed with the whole brain among all participants at baseline. Panel b illustrates reduced connectivity with the right inferior frontal gyrus. Panel c illustrates reduced connectivity with the bilateral inferior temporal gyri. Panel d illustrates reduced connectivity with the middle frontal gyrus. Panel e illustrates reduced connectivity with the caudate body. Panel f illustrates reduced connectivity with the middle cingulate. z denotes z coordinates for axial slices and statistical maps are illustrated to the right of relevant images.
Mentions: The main effect of time in the RFCBT group revealed significant changes in several regions. Table 3 and Fig 3 detail significant change in connectivity across eight weeks within the RFCBT group. Across the intervention period, connectivity between the left PCC and frontal regions including the bilateral inferior frontal gyrus (IFG, Brodmann Areas, BA 46 and 47) decreased. Connectivity of the left PCC with medial (BA = 21) and inferior temporal (BA = 20) regions also decreased. Connectivity decreased to regions including the orbital frontal cortex, cuneus (BA = 18), and cingulate (BA = 23). Relative reductions in connectivity were also observed between the left PCC and the right caudate and mid-cingulate. Fig 4 displays extracted data between the left PCC and the right IFG and ITG. Corresponding values for the AO group are included to allow a general examination of the specificity of effects and to offer some control for the effect of time and acclimation to scanner environment.

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