Reducing Rumination in Depression: Developing and Testing a Novel Intervention

描述（由申请人提供）：重度抑郁症（MDD）是最常见的精神疾病之一，与大量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，并且在面对负面事件时，倾向于反复反思这些事件的负面方面。反过来，沉思与从情绪和生物上的压力中恢复受损有关，这进一步导致症状持续存在。到目前为止，研究联系困难，从工作记忆中删除负面信息与反刍，症状持续性和压力恢复一直受到限制的相关性方法的使用。因此，本研究的一个主要目的是利用已有的认知偏差修正方法来实验性地操纵个体从工作记忆中去除负面信息（RNI）的能力。我们建议测试RNI训练对认知、反刍和抑郁水平以及从压力中恢复情绪和生物的影响。为了实现这些目标，诊断为MDD的参与者将完成一次基于实验室的预培训课程（课程1）、六次在家培训课程和第二次基于实验室的后培训课程（课程2）。在第一阶段，参与者将完成一个结构化的临床访谈，自我报告基线反刍和抑郁症状的测量，以及两个基于计算机的认知任务-其中一个明确评估他们从工作记忆中删除负面信息的能力。然后将参与者随机分配到真实的RNI训练或假RNI训练条件。他们将学习如何执行培训任务，并将获得一台笔记本电脑，他们将在未来六天内每天在家完成培训。在第七天，参与者将返回实验室进行培训后课程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，参与者将暴露于心理社会压力源，在此期间，我们将测量压力引起的状态反刍，并评估心理和生物恢复的压力源。与假RNI训练相比，我们预计真实的RNI训练将a）增加参与者从工作记忆中去除负面信息的能力; B）从基线降低抑郁和沉思症状的水平;以及c）降低压力诱导的沉思水平，我们认为这反过来会改善随后的情绪和生物压力恢复。这项研究的结果不仅将增加我们对认知，反刍和压力恢复之间关系的理解，而且还将提供一种新颖和创新的治疗方法，有可能减少反刍，改善MDD对压力的心理和生物反应。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工作。

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.