Reducing Rumination in Depression: Developing and Testing a Novel Intervention

描述(由申请人提供)：严重抑郁障碍(MDD)是最常见的精神疾病之一，与巨大的个人和社会成本有关。从工作记忆中去除负面信息的困难是MDD的一个核心认知特征。越来越多的研究表明，这种认知困难与抑郁症状的持续存在有关，在面对负面事件时，与反复思考此类事件的负面方面的倾向有关。反过来，沉思与从压力中受损的恢复有关，无论是从情感上还是从生理上都是如此，这进一步促进了症状的持续。到目前为止，将难以从工作记忆中去除负面信息与沉思、症状持续和压力恢复联系起来的研究一直受到相关方法的限制。因此，这项研究的一个主要目的是使用已建立的认知偏差修正方法来实验性地操纵个体从工作记忆中删除负面信息(RNI)的能力。我们建议测试RNI训练对认知、沉思和抑郁水平以及从压力中恢复情绪和生理的影响。为了实现这些目标，被诊断为MDD的参与者将完成一次以实验室为基础的前培训课程(第一阶段)、六次家庭培训课程和第二次以实验室为基础的培训后课程(第二阶段)。在第一阶段，参与者将完成一次有组织的临床访谈，自我报告基线沉思和抑郁症状的测量，以及两项基于计算机的认知任务-其中一项明确评估他们从工作记忆中删除负面信息的能力。然后，参与者将被随机分配到真正的RNI培训或假RNI培训条件。他们将学习如何执行培训任务，并将获得一台笔记本电脑，在接下来的六天里，他们将在家里每天完成培训。在第七天，参与者将返回实验室进行后培训课程2，在此期间，他们将完成他们在课程1中完成的自我报告测量和基于计算机的认知任务。此外，参与者将接触到心理社会应激源，在此期间，我们将测量应激诱导的状态反思，并评估从应激源中恢复的心理和生物恢复。与Sham RNI训练相比，我们预计Real RNI训练将a)提高参与者从工作记忆中移除负面信息的能力；b)降低抑郁和反省症状的水平；c)降低压力诱导的冥想水平，我们假设这将反过来促进随后的情绪和生物压力的恢复。这项研究的结果不仅将增加我们对认知、反省和应激恢复之间关系的理解，还将为探索一种新的、创新的治疗方法提供洞察力，该方法有可能减少反省并改善MDD对应激的心理和生物反应。因此，我们预计目前的研究将有助于抑郁症的认知模型和临床干预努力。

DESCRIPTION (provided by applicant): Major Depressive Disorder (MDD) is one of the most common psychiatric illnesses, and is associated with substantial personal and societal costs. Difficulty removing negative information from working memory is a core cognitive feature of MDD. A growing body of research indicates that this cognitive difficulty is associated with the persistence of depressive symptoms and, in the face of negative events, with the tendency to repetitively ruminate about the negative aspects of such events. Rumination, in turn, is associated with impaired recovery from stress, both emotionally and biologically, which further contributes to symptom persistence. To date, research linking difficulty removing negative information from working memory with rumination, symptom persistence, and stress recovery has been limited by the use of correlational methodologies. Therefore, a major aim of the proposed study is to use established Cognitive Bias Modification methods to experimentally manipulate individuals' ability to remove negative information (RNI) from working memory. We propose to test the effects of RNI training on cognition, levels of rumination and depression, and emotional and biological recovery from stress. To achieve these aims, participants diagnosed with MDD will complete a laboratory- based pre-training session (Session 1), six at-home training sessions, and a second laboratory-based post- training session (Session 2). In Session 1, participants will complete a structured clinical interview, self-report measures of baseline rumination and depressive symptoms, and two computer-based cognitive tasks - one of which explicitly assesses their ability to remove negative information from working memory. Participants then will be randomly assigned to either Real RNI training or to a Sham RNI training condition. They will be taught how to perform the training tasks and will be provided with a laptop on which they will complete the training at home daily for the next six days. On the seventh day, participants will return to the laboratory for the post- training Session 2, during which they will complete the self-report measures and computer-based cognitive tasks that they completed in Session 1. In addition, participants will be exposed to a psychosocial stressor, during which we will measure stress-induced state rumination and assess psychological and biological recovery from the stressor. Compared to Sham RNI training, we expect that Real RNI training will a) increase participants' ability to remove negative information from working memory; b) decrease levels of depressive and ruminative symptoms from baseline; and c) decrease levels of stress-induced rumination, which we posit will, in turn, improve subsequent emotional and biological stress recovery. The results of this study will not only increase our understanding of the relations among cognition, rumination, and stress recovery, but will also provide insight into a novel and innovative treatment approach that has the potential to decrease rumination and improve psychological and biological responses to stress in MDD. Thus, we anticipate that the current study will contribute to both cognitive models of depression and clinical intervention efforts.