title: 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.
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.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01905267.
authors.affiliation: Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States of America.
authors.forename: Rachel H
authors.identifier: http://orcid.org/0000-0003-4951-2704
authors.initials: RH
authors.lastname: Jacobs
authors.affiliation: Mood Disorders Centre, University of Exeter, Exeter, United Kingdom.
authors.forename: Edward R
authors.initials: ER
authors.lastname: Watkins
authors.affiliation: Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States of America.
authors.forename: Amy T
authors.initials: AT
authors.lastname: Peters
authors.affiliation: Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States of America.
authors.forename: Claudia G
authors.initials: CG
authors.lastname: Feldhaus
authors.affiliation: Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States of America.
authors.forename: Alyssa
authors.initials: A
authors.lastname: Barba
authors.affiliation: Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States of America.
authors.forename: Julie
authors.initials: J
authors.lastname: Carbray
authors.affiliation: Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, United States of America.
authors.forename: Scott A
authors.initials: SA
authors.lastname: Langenecker
mesh_terms: D000293:Adolescent; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000503:physiopathology; D003865:Major Depressive Disorder / Q000503:physiopathology / Q000628:therapy*; D019959:Feeding and Eating Disorders of Childhood / Q000473:pathology; D005260:Female; D006179:Gyrus Cinguli / Q000000981:diagnostic imaging; D006801:Humans; D007407:Interviews as Topic; D008279:Magnetic Resonance Imaging; D008297:Male; D010865:Pilot Projects; D012008:Recurrence; D016896:Treatment Outcome