Malleability of rumination: An exploratory model of CBT-based plasticity and long-term reduced risk for depressive relapse among youth from a pilot randomized clinical trial
Malleability of rumination: An exploratory model of CBT-based plasticity and long-term reduced risk for depressive relapse among youth from a pilot randomized clinical trial
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DOI：
10.1371/journal.pone.0233539
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发表时间：
2020-06-17
期刊：
影响因子：
3.7
通讯作者：
Langenecker, Scott A.
中科院分区：
文献类型：
--
作者：
Bessette, Katie L.;Jacobs, Rachel H.;Langenecker, Scott A.
早发性抑郁症与增加的寿命慢性化、自杀倾向以及与复发性发作相关的功能负担有关。减少这些负面的长期结果需要了解哪些干预措施可以减少脆弱性或改善其相关的神经模式。反刍集中认知行为疗法（RFCBT）是一种循证治疗，直接针对众所周知的抑郁复发风险（即，反刍的习惯），已经显示出初步的成功，减少复发率的青少年和成年人缓解的主要抑郁症（rMDD）。在目前的试点研究中，在为期8周的RFCBT（n= 17）或仅评估（AO;n= 16）的随机对照试验后，对临床结局和神经影像学预测因素进行了为期两年的探索，以预防青少年抑郁症复发。检查反刍诱导任务期间的基线神经激活、治疗期间的神经变化和治疗组作为复发的预测因子。选择的区域是基于rMDD与健康青少年相比的过度激活模式，主要发生在默认模式，躯体运动，视觉和显着网络区域。25名青少年在基线和RFCBT或AO治疗8周后成功完成了高质量的fMRI扫描。RFCBT治疗的青少年在两年期间保持较低的抑郁评分，复发率较低且频率较低，并且因自杀而住院的频率低于AO。尽管两组在一年后报告了较低的反刍倾向，但在两年的随访中，RFCBT保持了减少，而AO报告了反刍倾向的恢复。在基线时在默认模式和反刍诱导期间边缘系统区域表现出较高激活的青少年在随访期间报告抑郁症状减少。这些数据提供了初步证据，表明针对反刍可以避免易受伤害的青少年抑郁复发，并且这种针对性治疗可能有助于疾病相关脑功能的补偿过程，从而降低进一步抑郁发作的风险。
Early-onset depression is associated with increased lifespan chronicity, suicidality, and the functional burdens associated with recurrent episodes. Reduction of these negative long-term outcomes requires an understanding of what interventions reduce vulnerabilities or ameliorate their associated neural patterns. Rumination-Focused Cognitive Behavior Therapy (RFCBT), an evidence-based treatment which directly targets a well-known risk for depressive relapse (i.e., ruminative habit), has shown preliminary success for reducing relapse rates among adolescents and adults in remission from Major Depressive Disorder (rMDD). In the current pilot study, clinical outcomes and neuroimaging predictors are explored over two years following a randomized controlled trial of eight weeks of RFCBT (n= 17) or Assessment Only (AO;n= 16) to prevent depressive relapse among adolescents. Baseline neural activation during a rumination induction task, neural change during treatment, and treatment group are examined as predictors of relapse. Regions selected were based upon hyperactivation patterns in rMDD compared to healthy adolescents, and occurred largely in default mode, somatomotor, visual and salience network regions. Twenty-five adolescents successfully completed quality fMRI scans at Baseline and after eight weeks of RFCBT or AO. RFCBT-treated youth maintained lower depression scores over the two-year period, relapsed at slower and less frequent rates, and were hospitalized less often for suicidality than AO. Although both groups reported lower ruminative tendencies after one year, at two-year follow-up, RFCBT maintained reductions whereas AO reported a return of ruminative tendencies. Adolescents who demonstrated higher activation at Baseline in default mode and limbic regions during rumination induction reported reduced depressive symptoms over the follow-up period. These data offer preliminary evidence that targeting rumination can stave off depressive relapse among vulnerable adolescents, and that such targeted treatment may aid a compensation process for disease-related brain functioning reducing risk to further depressive episodes.