Neural Effects of Wellness Classes in Women With Vulnerability to Depression ("The Women's Wellness Study")
Condition: Recurrent Major Depression
MeSH terms: Depression; Depressive Disorder; Depressive Disorder, Major
Study type: Interventional

Summary: 
      The primary objective of the study is to examine the efficacy of mindfulness based cognitive
      therapy (MBCT) on the prevention of relapse in women with a history of depression.
      Additionally, the investigators will explore how brain activity might be affected in several
      brain regions as a result of MBCT. This study consists of two groups, a patient group
      consisting of women with a history of depression and a control group consisting of healthy
      women. All participants within the patient group will receive an 8-week MBCT intervention
      program and will continue their normal medication treatment. Participants will undergo, both
      pre and post intervention, various behavioral and neuroimaging tasks to assess intervention
      effects of well-established psychological measurements related to cognitive and emotional
      function.
    

Detailed description: 
      Overall, this study aims to characterize the neural and psychological effects of an
      eight-week mindfulness based cognitive therapy (MBCT) intervention (online group class) in
      preventing depressive relapse in women with past history of major depression when exposed to
      different forms of self-relevant and context-specific emotional challenge. The investigators
      also aim to establish psychological and neural mechanisms contributing to depressive symptoms
      prior to intervention. A key objective of the study is to assess baseline markers of
      depressive symptoms and possible change resulting from the MBCT intervention from
      interdisciplinary perspectives, including the psychological perspective (i.e. measured with
      computer-based tasks, self-report ratings, questionnaires, etc.) and the neural perspective
      (neural activity measured with functional MRI).

      In addition, a critical factor the investigators will be observing is the shift from more
      'narrative' to 'experiential' forms of self-related awareness as a function of MBCT.
      Narrative self-focus refers to a concept of self that is extended in time, including past
      memories and intentions for the future, together with abstract self-representations in
      relation to socio-emotional values. In contrast, the "experiential self-focus" refers to a
      more immediate self-experience and is associated with greater awareness of external stimuli
      and internal somatic-visceral bodily states. MBSR has been shown to increase brain activity
      in regions relevant for conferring "experiential" self-focus (insula-opercula, dorsal
      anterior cingulate/supplementary motor area), while decreasing responses in rostral-medial,
      lateral frontal and hippocampal regions that support the "narrative" mode of self-focus. Such
      changes in brain activity are associated with increased well-being. Brain regions to be
      examined include: 1) insula-opercula and dorsal anterior cingulate brain regions responsible
      for mediating 'narrative' self-focus thinking styles; 2) rostral-medial and lateral frontal,
      and hippocampal brain regions responsible for mediating 'experiential' self-focus thinking
      styles; and 3) default mode and insular-paralimbic networks thought to be involved in the
      generation and maintenance of depressive episodes.

      Behavioral Tasks

        1. Breath Count Task - an objective behavioral measure of mindfulness; Dot-Probe Task - a
           measure of negative emotion attentional bias

        2. Autobiographical Memory Interview - a means to quantify the nature of participants'
           autobiographical memory recall in an ecologically-valid manner

        3. Free-Association Semantic Task - a measure of associative processing

        4. Emotional Movies - a measure of emotional reactivity

        5. N-Back Task - a measure of working memory.

      Neuroimaging Tasks

        1. Rest Task - a means to examine brain activity and thought content during an
           unconstrained task

        2. 'Narrative' vs 'Experiential' Task during Autobiographical Memory Recall vs. n-back - a
           means to examine brain activity during 'narrative' vs 'experiential' forms of self-focus
           during autobiographical memory recall, vs. a demanding working memory task.

        3. Self-Syllable Judgment Task - a means to examine brain activity during self-judgment vs
           non-self-judgment tasks.

      Thought Sampling Participants will undergo an experience sampling paradigm in which daily
      thought surveys will be administered multiple times per day over the course of 7-10 days.
      These thought sampling surveys are designed to estimate several factors characterizing the
      occurrence of spontaneous thoughts in real-world settings as well as the nature and content
      of individuals' thoughts in real-world settings.
    

Intervention name(s): Online mindfulness based cognitive therapy intervention
Intervention type(s): Behavioral
Intervention description(s): MBCT is based on Mindfulness-Based Stress Reduction (MBSR), combining principles of cognitive therapy (CT) with those of mindfulness meditation to prevent depression relapse. Both MBSR and MBCT use contemplative practices, including sitting meditation, body scan and walking meditation, as core methods to teach awareness of negative thoughts and emotions with the aim of disengaging from pervasive patterns of ruminative self-centered mentation. Participants will be given an initial orientation session and then complete an online 8-week MBCT program. Each week participants will take part in one 2-hour online group session and will complete homework assignments anticipated to take 15-30 minutes per day to complete. Additionally, weekly phone coaching will be offered based on the modified tele-coach manual developed by Mohr and colleagues (Duffecy et al. 2010).
Other intervention name(s): online MBCT; Mindful mood balance (MMB)
Allocation: Non-Randomized
Intervention model: Parallel Assignment
Intervention model description: One group of 25 currently remitted recurrent major depression patients undergoing mindfulness based cognitive therapy for 8 weeks and one group of 25 matched healthy controls to control for time-repetition effects on brain activity and task performance
Masking: None (Open Label)
Primary purpose: Basic Science
Keywords: major depression; Mindfulness based cognitive therapy; MBCT; fMRI; recurrent depression; brain