Sustained Attention as Mediator in Mindfulness-Based Cognitive Therapy for Depression

基于正念的认知疗法（MBCT）有效地预防了重度抑郁症的复发/复发。将注意力部署和保持在特定焦点上的能力被认为是“正念”、“元认知”意识的先决条件，因此对治疗成功至关重要。因此，持续的注意力集中是MBCT中最广泛教授的技能。在之前DFG资助的一项研究中，我们测试了这种能力是否在MBCT后增加。晚关联负变（LCNV），一种事件相关脑电位（ERP），已知实时反映注意力资源的分配，被用作集中能力的测量。与治疗前基线和未治疗对照组相比，MBCT后LCNV显著增加。由于我们的“正念LCNV任务”包括悲伤情绪诱导和反刍挑战，我们将这一结果解释为反映了患者将注意力转移到当前体验的能力提高，并在轻度烦躁状态下远离潜在的抑郁思维或反刍（抑郁复发/复发的已知风险因素）。然而，LCNV效应的临床和鉴别相关性，以及因此测量的浓度能力的临床和鉴别相关性仍然不清楚，这是本拨款提案的原因。我们打算进一步验证LCNV作为持续注意力的衡量标准，通过比较MBCT治疗组的LCNV与认知疗法（CT）治疗组的LCNV（无正念），并通过调查LCNV与新开发的持续注意力自我报告指标之间的关系。然而，拟议项目的最终目标是在治疗后一年的随访期间调查LCNV与抑郁症症状的存在和严重程度和/或复发/复发之间的关系。我们打算招募160名复发性抑郁症患者，并将他们随机分配到MBCT或CT。将在治疗前即刻、治疗后即刻和治疗后一年测量患者的LCNV。将在治疗前一年回顾性评估抑郁症状和/或复发/复发的存在和严重程度，并在随访年回顾性和连续评估（通过互联网辅助的自我报告）。据我们所知，这将是第一个检验这一假设的研究，即注意力集中能力的提高可以预测抑郁症症状的频率和严重程度的降低和/或复发/复发。

Mindfulness-based cognitive therapy (MBCT) effectively prevents relapse/recurrence in major depression. The ability to deploy and maintain attention on a particular focus is considered a prerequisite for 'mindful', 'metacognitive' awareness, and hence crucial for therapy success. Accordingly, sustained concentration, is the skill most extensively taught in MBCT. In a previous DFG-funded study, we tested whether this ability increases after MBCT as assumed. The late contingent negative variation (LCNV), an event-related brain potential (ERP), known to reflect the allocation of attentional resources in real-time, was used as a measure of concentration ability. The LCNV was significantly increased after MBCT compared to both pre-therapy baseline and no-treatment control group. Since our 'mindfulness LCNV task' included sad mood induction and rumination challenge, we interpreted this result as reflecting the patients' improved ability to shift their attention toward current moment experience and away from potentially depressogenic thinking or rumination during mild dysphoric states (a known risk factor for depressive relapse/recurrence). However, the clinical and discriminating relevance of the LCNV effect and, consequently, of the measured concentration ability still remains unclear, which is the reason for the present grant proposal. We intend to validate further the LCNV as a measure of sustained mindful attention by comparing the LCNV in a group treated with MBCT with the LCNV in a group treated with cognitive therapy (CT) without mindfulness, and also by investigating the relationship between LCNV and a newly developed self-report measure of sustained mindful attention. The ultimate goal of the proposed project, however, is to investigate the relationship between LCNV and the presence and severity of symptoms and/or relapse/recurrence of depression during a one-year follow-up period after treatment. We intend to recruit 160 recurrently depressed patients in remission and to assign them randomly to MBCT or CT. Patients' LCNV will be measured immediately before, immediately after, and one year after treatment. Presence and severity of depressive symptoms and/or relapse/recurrence will be assessed retrospectively for the year preceding the treatment and both retrospectively and continuously (via internet-assisted self-report) for the follow-up year. To the best of our knowledge, this will be the first study to test the hypothesis that increased mindful concentration ability predicts reduction in frequency and severity of symptoms and/or relapse/recurrence of major depression.