Rumination induction task in fMRI: Effects of rumination focused cognitive behavioral therapy and stability in youth

Mindy Westlund Schreiner; Anna M Jacobsen; Brian Farstead; Raina H Miller; Rachel H Jacobs; Leah R Thomas; Katie L Bessette; Myah Pazdera; Sheila E Crowell; Erin A Kaufman; Daniel A Feldman; Henrietta Roberts; Robert C Welsh; Edward R Watkins; Scott A Langenecker

doi:10.1016/j.jad.2024.12.056

Rumination induction task in fMRI: Effects of rumination focused cognitive behavioral therapy and stability in youth

J Affect Disord. 2024 Dec 17:S0165-0327(24)02044-5. doi: 10.1016/j.jad.2024.12.056. Online ahead of print.

Authors

Affiliations

¹ Department of Psychiatry and 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. Electronic address: [email protected].
² 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.
³ Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, UT, USA.
⁴ Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, UT, USA; Department of Psychology, University of Utah, Salt Lake City, UT, USA.
⁵ Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
⁶ 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.
⁷ Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA.
⁸ Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, UT, USA; Department of Psychology, University of Utah, Salt Lake City, UT, USA; Department of Psychology, University of Oregon, Eugene, OR, USA.
⁹ Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, UT, USA; Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, USA.
¹⁰ Department of Experimental & Applied Clinical Psychology, University of Exeter, Exeter, UK.
¹¹ Department of Psychiatry, Huntsman Mental Health Institute, University of Utah, Salt Lake City, UT, USA; Department of Psychiatry & Biobehavioral Sciences, University of California Los Angeles, Los Angeles, CA, USA.

PMID: 39701467
DOI: 10.1016/j.jad.2024.12.056

Abstract

Background: 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).

Method: 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.

Results: 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).

Conclusion: 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.

Keywords: Adolescence; Neuroimaging; Reliability; Rumination; Stability; Therapy.