Reducing Rumination in Depression: Mechanisms and Effects

减少抑郁症中的沉思：机制和效果

• 批准号: 8891982
• 负责人: IAN H GOTLIB
• 金额: $ 24.08万
• 依托单位: STANFORD UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-02-18 至 2017-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8891982
• 关键词: Affect; Affective; Anterior; Attention; Autonomic nervous system; Biological; Biological Process; Brain; Brain region; Chronic; Cognitive; Data; Depressed mood; Diagnosis; Disease; Distress; Dorsal; Emotional; Emotions; Exhibits; Future; Home environment; Individual; Investigation; Laboratories; Life; Link; Literature; Lobule; Maintenance; Major Depressive Disorder; Medial; Mediating; Mental Depression; Mental disorders; Methodology; Methods; Modification; Neurosecretory Systems; Parietal; Parietal Lobe; Participant; Population; Prefrontal Cortex; Process; Recovery; Recurrence; Research; Research Personnel; Rest; Short-Term Memory; Stimulus; Stress; Symptoms; Testing; Thinking; Time; Training; World Health Organization; base; cingulate cortex; cognitive process; cost; depressive symptoms; design; emotion regulation; experience; follow-up; improved; information processing; neuroimaging; neuromechanism; psychobiologic; psychologic; public health relevance; relating to nervous system; response; stressor; theories

 DESCRIPTION (provided by applicant): Major Depressive Disorder (MDD) is among the most prevalent and devastating of all psychiatric disorders, and is the single most burdensome disease worldwide. Consequently, it is imperative that we identify and examine the effects of altering mechanisms involved in the maintenance of MDD. In this context, investigators have documented that difficulty removing negative information from working memory is a core cognitive feature of MDD. Importantly, this cognitive difficulty is implicated in the persistence o both depressive symptoms and rumination, a style of thinking that hinders recovery from stress and exacerbates negative affect. To date, research linking difficulty removing negative information from working memory with rumination, the persistence of negative affect, and stress recovery in MDD has been limited by the use of correlational methodologies. Importantly, the Cognitive Bias Modification (CBM) literature underscores the viability of manipulating cognitive processes both to test causal relations and to identify mechanisms involved in the onset and maintenance of disorders. Therefore, a major aim of the proposed study is to build on established CBM methods to improve depressed individuals' ability to remove negative information (RNI) from working memory. We propose to examine the cognitive, affective, and biological effects of RNI training (Aim 1). In addition, we also propose to examine the neural mechanisms that underlie the beneficial effects of RNI training (Aim 2). To achieve these aims, 50 participants diagnosed with MDD will be assigned to receive either Real or Sham RNI training. All participants will complete pre-training laboratory-based and neuroimaging sessions, six at-home Real or Sham RNI training sessions, post-training laboratory-based and neuroimaging sessions, and a three-month follow-up assessment. We expect that, compared to Sham RNI training, Real RNI training will a) improve depressed participants' ability to remove negative information from working memory from pre- to post-training; b) decrease levels of rumination and depressive symptoms; and c) improve subsequent emotional and biological stress recovery. We further expect that RNI training will achieve its beneficial effects by decreasing brain activation from pre- to post-training in regions that subserve cognitive effort (dorsal anterior cingulate, posterior parietal lobe, and insular cortex), and by decreasing functional connectivity in regions posited to underlie rumination (subgenual anterior cingulate cortex and medial prefrontal cortex). The results of this study will increase our understanding of the relations among biases in working memory, rumination, and depressive symptoms, and will help to identify and elucidate specific mechanisms that contribute to the onset and maintenance of MDD.

 描述（由申请人提供）：重度抑郁症（MDD）是所有精神疾病中最普遍和最具破坏性的疾病之一，也是全世界最令人负担的疾病，因此我们必须确定并检查改变相关机制的影响。在这种情况下，研究人员发现，从工作记忆中消除负面信息的困难是抑郁症的一个核心认知特征，重要的是，这种认知困难与抑郁症状和沉思的持续存在有关。迄今为止，将难以从工作记忆中消除负面信息与沉思、负面情绪的持续性和重度抑郁症的压力恢复联系起来的研究受到相关方法的使用的限制。认知偏差修正 (CBM) 文献强调了操纵认知过程的可行性，既可以测试因果关系，也可以识别疾病发生和维持的机制。因此，本研究的主要目的是建立在已建立的 CBM 方法的基础上。提高抑郁症患者从工作记忆中消除负面信息 (RNI) 的能力。我们建议检查 RNI 训练的认知、情感和生物效应（目标 1）。此外，我们还建议检查其背后的神经机制。 RNI 培训的有益效果（目标 2），50 名被诊断患有 MDD 的参与者将被分配接受真实或假 RNI 培训，所有参与者将完成基于实验室的预培训和神经影像学课程，其中 6 次在家。真实的或假 RNI 培训课程、培训后基于实验室和神经影像学的课程以及为期三个月的后续评估，我们预计，与假 RNI 培训相比，真实 RNI 培训将 a) 提高抑郁参与者消除负面情绪的能力。训练前和训练后工作记忆中的信息；b) 减少沉思和抑郁症状的水平；c) 改善随后的情绪和生物压力恢复，我们进一步预计 RNI 训练将通过减少训练前的大脑激活来实现其有益效果。 -到训练后促进认知努力的区域（背侧前扣带皮层、后顶叶和岛叶皮层），以及减少位于反刍思维基础的区域（膝下前扣带皮层和内侧前额叶皮层）的功能连接。将增加我们对工作记忆、沉思和抑郁症状之间关系的理解，并将有助于识别和阐明有助于发生和维持抑郁症状的具体机制。医学博士