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

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 p Trial Registration: ClinicalTrials.gov NCT01905267本先导随机对照试验旨在探究聚焦反刍的认知行为疗法（Rumination-Focused Cognitive Behavior Therapy, RFCBT）能否降低有重性抑郁障碍（Major Depressive Disorder, MDD）病史且存在复发风险的青少年的反刍思维与残留抑郁症状。本研究同时探究症状的这些变化是否与默认模式网络（default mode network, DMN）的关键节点——后扣带回皮层（posterior cingulate cortex, PCC）的功能连接变化相关。本试验共纳入33名12至18岁的青少年，将其随机分配至8周的RFCBT组或仅评估（assessment only, AO）对照组。最终有22名青少年顺利完成了干预前后的功能磁共振成像（functional Magnetic Resonance Imaging, fMRI）扫描。研究对象均从门诊及社区招募，符合至少1次重性抑郁障碍发作史的诊断标准，且目前处于完全或部分缓解状态。独立评估员分别在8周干预前后对青少年及其家长进行访谈。本研究以左侧后扣带回皮层（坐标：-5, -50, 36）为种子点，探究默认模式网络的静息态功能连接。接受RFCBT干预的青少年反刍思维水平显著降低（F=-2.76，df=112，p<0.05）。试验注册：ClinicalTrials.gov 编号NCT01905267