Understanding mechanisms of depression prevention: study protocol of a randomized cross-over trial to investigate mechanisms of mindfulness and positive fantasizing as intervention techniques for reducing perseverative cognition in remitted depressed individuals.

Publication date: Feb 19, 2024

Major Depressive Disorder (MDD) is one of the most prevalent psychiatric disorders, and involves high relapse rates in which persistent negative thinking and rumination (i. e., perseverative cognition [PC]) play an important role. Positive fantasizing and mindfulness are common evidence-based psychological interventions that have been shown to effectively reduce PC and subsequent depressive relapse. How the interventions cause changes in PC over time, is unknown, but likely differ between the two. Whereas fantasizing may change the valence of thought content, mindfulness may operate through disengaging from automatic thought patterns. Comparing mechanisms of both interventions in a clinical sample and a non-clinical sample can give insight into the effectivity of interventions for different individuals. The current study aims to 1) test whether momentary psychological and psychophysiological indices of PC are differentially affected by positive fantasizing versus mindfulness-based interventions, 2) test whether the mechanisms of change by which fantasizing and mindfulness affect PC differ between remitted MDD versus never-depressed (ND) individuals, and 3) explore potential moderators of the main effects of the two interventions (i. e., what works for whom). In this cross-over trial of fantasizing versus mindfulness interventions, we will include 50 remitted MDD and 50 ND individuals. Before the start of the measurements, participants complete several individual characteristics. Daily-life diary measures of thoughts and feelings (using an experience sampling method), behavioural measures of spontaneous thoughts (using the Sustained Attention to Response Task), actigraphy, physiological measures (impedance cardiography, electrocardiography, and electroencephalogram), and measures of depressive mood (self-report questionnaires) are performed during the week before (pre-) the interventions and the week during (peri-) the interventions. After a wash-out of at least one month, pre- and peri-intervention measures for the second intervention are repeated. This is the first study integrating self-reports, behavioural-, and physiological measures capturing dynamics at multiple time scales to examine the differential mechanisms of change in PC by psychological interventions in individuals remitted from multiple MDD episodes and ND individuals. Unravelling how therapeutic techniques affect PC in remitted individuals might generate insights that allows development of personalised targeted relapse prevention interventions. ClinicalTrials. gov: NCT06145984, November 16, 2023.

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Concepts Keywords
Automatic Depression
Daily Mindfulness
Moderators Perseverative cognition
Nct06145984 Positive fantasizing
Psychophysiological Preventive cognitive therapy


Type Source Name
disease MESH Major Depressive Disorder
disease MESH psychiatric disorders
pathway REACTOME Reproduction
drug DRUGBANK Apomorphine
drug DRUGBANK Coenzyme M
drug DRUGBANK Pentaerythritol tetranitrate
disease MESH sleep onset latency
disease MESH childhood trauma
disease MESH cognitive dysfunction
disease MESH anhedonia
drug DRUGBANK Trestolone
drug DRUGBANK Methylphenidate
disease MESH depressive disorder
drug DRUGBANK Iron
disease MESH education level
disease MESH COVID 19
drug DRUGBANK Ademetionine
disease MESH apathy
disease MESH sleep quality
drug DRUGBANK Esomeprazole
drug DRUGBANK Tropicamide
disease MESH Comorbidity
drug DRUGBANK Copper
disease MESH social anxiety disorder
disease MESH sinus arrhythmia
drug DRUGBANK Serine

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