Neurocognitive mechanisms of relapse prevention in depression, a fMRI-study

Major depressive disorder (MDD) is the most prevalent psychiatric disorder, characterized by at least one life disrupting depressive episode and high risk for relapse after recovery (40% within 2 years). Risk for relapse and chronic-MDD increases dramatically with the number of previous episodes. Therefore, preventing relapse in the remitted phase is a major, but largely overlooked opportunity in treating MDD. Preventive cognitive therapy (CT), a psychological therapy aiming at improving emotion regulation skills, in remitted-MDD has been successful in lowering relapse-risk, though not in all patients. Mechanisms underlying preventive-CT are unclear, hindering clinicians in predicting for whom preventive-CT is warranted. Reliable predictors of preventive-treatment success are currently lacking, yet urgently needed. Clearly, accurate prediction of preventive-success contributes to effective preventive-treatment allocation and lower relapse-rates. In this research, we hypothesize that the capacity of the brain’s prefrontal cortex to regulate emotional information is crucial for understanding and predicting preventive-CT-success. The main objective of this study is to understand the neurocognitive mechanisms of preventive-CT by studying neurophysiological (i.e. brain responsivity as measured with functional Magnetic Resonance Imaging and autonomic nervous system reactivity as measured from pupil dilation) and cognitive processes associated with attentional processing and regulation of emotional information. Secondarily, this study aims to identify neurophysiological and neurocognitive predictors of individual preventive-CT success. As routinely performing neuroimaging investigations for predicting treatment-success is clinically not feasible, a third aim of this study is to validate the pupil dilation-response (an autonomic index previously linked to emotion regulation-success and associated brain activation) as reflector of brain-activation during emotion regulation in remitted-MDD, for use in innovative non-imaging, brain-informed prediction and monitoring of preventive-CT success.

We hypothesize that the capacity of the brain’s prefrontal cortex to regulate emotional information is crucial for understanding and predicting preventive-CT-success.

Screening: with the SCID-I, the IDS-SR , the DART

First phase: Questionnaires, computer tasks, fMRI-scan

Second phase: Preventive cognitive therapy (8x 45 mins)

Third phase: 3 months after 1st phase, similar as 1st phase.

Fourth phase: questionnaires, 1,5 year after 1st phase,

Protocolised Preventive Cognitive Therapy