# Developing rumination-focused treatment to reduce risk for depression recurrence (RDR) in adolescence

> **NIH NIH R33** · UTAH STATE HIGHER EDUCATION SYSTEM--UNIVERSITY OF UTAH · 2022 · $1,014,594

## Abstract

Emerging evidence suggests that the recurrent form of Major Depressive Disorder (MDD) tends to worsen,
with more severe and longer episodes as people move into adulthood. Yet, we are still a very long way from
treatments that can reduce short- and long-term Risk for Depressive Relapse (RDR). Understanding specific
mechanisms of RDR is urgently needed to promote relapse prevention (and may have long-term benefits for
treatment). The present proposal uses a treatment that has evidence for modifying the ruminative habit, a
tendency to approach difficulties and associated negative emotions with a repetitive, passive and abstract
mental pattern (habit). In contrast, we teach adolescents to utilize adaptive, concrete and specific mental
patterns (e.g., problem-solving, emotion processing). Rumination focused CBT (RFCBT) was developed to
specifically target and reduce or modify the ruminative habit. Initial work among adults and our pilot data
among adolescents suggests that rumination can be effectively reduced with RFCBT. In addition, work by our
group and a few other small studies suggests that the ruminative habit can be measured at the neural level in
connectivity of brain nodes in the Default Mode Network (DMN, increased within network connectivity) as well
as in patterns of connectivity between the DMN and Cognitive Control Network (CCN). As such, we proposed
to use RFBCT to modify the ruminative habit in 160 adolescents (age 14-18) with remitted MDD (via KSAD-PL)
and elevated rumination (above T of 50), with the goal of achieving significant clinical change in rumination,
and to observe changes in connectivity between key DMN and CCN nodes associated with decline in the
ruminative habit. The latter knowledge may provide information on how to use alternative therapies (e.g.,
neuromodulation) to effectively modify the ruminative habit and the associated neural network pathways, which
would lead to greater precision in the targeting of treatment. The RFCBT arm (N=30) is compared to an
assessment only (AO) arm (N=30) for the R61, and to an active therapy, Relaxation Therapy (RelaxT) for the
R33 (N = 50 in each group), that shares some of the active strategies for change.. For R61, we expect that
(Aim 1) RF-CBT will result in (a) significant decreases in rumination and (b) decreased connectivity from LPPC
to RIFG, both "Go" criteria for continuation to the R33 phase. For (Aim 2), we expect that degree of homework
engagement will relate to degree of change in (a) ruminative habit, (b) in LPCC-RIFG rs-fMRI connectivity, and
degree of increased activation during exploratory rumination induction task. Stability of RRS changes will also
be evaluated at 12 months. This R61/R33 has the same Go criteria of RRS change (effect size of .5) and
LPCC - RIFG connectivity changes (.5 effect size). In addition, the R33 adds prediction of MDD recurrence
(Aims 3a (dimensional) and Aim 3b(categorical)) to proceed to the RO1 multisite phase. Our preliminary data
suggest...

## Key facts

- **NIH application ID:** 10019712
- **Project number:** 4R33MH116080-03
- **Recipient organization:** UTAH STATE HIGHER EDUCATION SYSTEM--UNIVERSITY OF UTAH
- **Principal Investigator:** Scott A Langenecker
- **Activity code:** R33 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $1,014,594
- **Award type:** 4N
- **Project period:** 2018-08-01 → 2023-04-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10019712

## Citation

> US National Institutes of Health, RePORTER application 10019712, Developing rumination-focused treatment to reduce risk for depression recurrence (RDR) in adolescence (4R33MH116080-03). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10019712. Licensed CC0.

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