Rumination-Focused Cognitive Behavioral Therapy Reduces Rumination and Targeted Cross-network Connectivity in Youth With a History of Depression: Replication in a Preregistered Randomized Clinical Trial

Scott A Langenecker; Mindy Westlund Schreiner; Katie L Bessette; Henrietta Roberts; Leah Thomas; Alina Dillahunt; Stephanie L Pocius; Daniel A Feldman; Dave Jago; Brian Farstead; Myah Pazdera; Erin Kaufman; Jennica A Galloway; Patricia K Kerig; Amanda Bakian; Robert C Welsh; Rachel H Jacobs; Sheila E Crowell; Edward R Watkins

doi:10.1016/j.bpsgos.2023.08.012

Rumination-Focused Cognitive Behavioral Therapy Reduces Rumination and Targeted Cross-network Connectivity in Youth With a History of Depression: Replication in a Preregistered Randomized Clinical Trial

Biol Psychiatry Glob Open Sci. 2023 Nov 3;4(1):1-10. doi: 10.1016/j.bpsgos.2023.08.012. eCollection 2024 Jan.

Authors

Scott A Langenecker^{1

2

3}, Mindy Westlund Schreiner², Katie L Bessette^{2

3

4}, Henrietta Roberts⁵, Leah Thomas², Alina Dillahunt², Stephanie L Pocius², Daniel A Feldman², Dave Jago⁵, Brian Farstead², Myah Pazdera², Erin Kaufman², Jennica A Galloway², Patricia K Kerig², Amanda Bakian², Robert C Welsh^{2

4}, Rachel H Jacobs⁶, Sheila E Crowell², Edward R Watkins⁵

Affiliations

¹ Department of Psychiatry and Behavioral Health, Ohio State University, Columbus, Ohio.
² Departments of Psychiatry and Psychology, University of Utah, Salt Lake City, Utah.
³ Departments of Psychiatry and Psychology, University of Illinois at Chicago, Chicago, Illinois.
⁴ Center for Cognitive Neuroscience, University of California Los Angeles, Los Angeles, California.
⁵ Department of Experimental and Applied Clinical Psychology, University of Exeter, Sir Henry Wellcome Building for Mood Disorders Research, Exeter, United Kingdom.
⁶ Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, Illinois.

Abstract

Background: Rumination-focused cognitive behavioral therapy (RF-CBT) is designed to reduce depressive rumination or the habitual tendency to dwell on experiences in a repetitive, negative, passive, and global manner. RF-CBT uses functional analysis, experiential exercises, and repeated practice to identify and change the ruminative habit. This preregistered randomized clinical trial (NCT03859297, R61) is a preregistered replication of initial work. We hypothesized a concurrent reduction of both self-reported rumination and cross-network connectivity between the left posterior cingulate cortex and right inferior frontal and inferior temporal gyri.

Methods: Seventy-six youths with a history of depression and elevated rumination were randomized to 10 to 14 sessions of RF-CBT (n = 39; 34 completers) or treatment as usual (n = 37; 28 completers). Intent-to-treat analyses assessed pre-post change in rumination response scale and in functional connectivity assessed using two 5 minute, 12 second runs of resting-state functional magnetic resonance imaging.

Results: We replicated previous findings: a significant reduction in rumination response scale and a reduction in left posterior cingulate cortex to right inferior frontal gyrus/inferior temporal gyrus connectivity in participants who received RF-CBT compared with those who received treatment as usual. Reductions were large (z change = 0.84; 0.73, respectively [ps < .05]).

Conclusions: This adolescent clinical trial further demonstrates that depressive rumination is a brain-based mechanism that is modifiable via RF-CBT. Here, we replicated that RF-CBT reduces cross-network connectivity, a possible mechanism by which rumination becomes less frequent, intense, and automatic. This National Institute of Mental Health-funded fast-fail study continues to the R33 phase during which treatment-specific effects of RF-CBT will be compared with relaxation therapy.

Keywords: Connectivity; Depression; Resting state; Rumination; Rumination-focused CBT.

Abstract

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