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Cognitive reappraisal in adolescents with major depression: from neurobiological mechanisms to intervention

Subject Area Personality Psychology, Clinical and Medical Psychology, Methodology
Clinical Psychiatry, Psychotherapy, Child and Adolescent Psychiatry
Term from 2018 to 2022
Project identifier Deutsche Forschungsgemeinschaft (DFG) - Project number 399482529
 
Final Report Year 2023

Final Report Abstract

Major depression (MD) is common during adolescence and associated with significant morbidity and mortality. One important factor for the development and maintenance of adolescent MD are disturbances in emotion regulation (ER), including deficits in cognitive reappraisal (CR). CR is a mostly adaptive ER strategy that aims at reinterpreting emotional events to modify affective responses. In adolescent MD, the neurophysiological correlates that are associated with deficits in CR had not yet been investigated. Moreover, it was unknown whether a targeted training of CR might prove effective in reducing depression-related symptoms, and whether processes of CR are influenced by the training. To address these basic and clinical research questions, the project combined the investigation of neurophysiological mechanisms of CR in adolescents with MD (compared to healthy adolescents) with the investigation of the effects of a short-term CR training based on a randomized controlled trial. In Main Study 1, adolescents with MD and controls performed a well-established CR task to assess the ability to down-regulate negative affect to negative pictures. During the task, the event-related potential “Late Positive Potential” (LPP), behavioral indices of CR and gaze fixations were assessed simultaneously. The main result of the study was that participants in both groups showed an increased LPP during CR. This contrasts findings in adults, which have found a diminished LPP during CR, and might suggest that ER processes in adolescence are challenging and require a high amount of cognitive resources. On the behavioral level, youth with MD indicated less regulation success compared to controls based on self-report. In the context of absent neurophysiological aberrations, this might reflect impaired self-evaluation in adolescents with MD. In Main Study 2, adolescents with MD were randomized to a task-based CR training or a control training over four sessions. Rumination, stress- and affect-related measures were assessed as primary outcomes. In addition to these outcomes, the LPP, behavioral indices of CR and gaze fixations were assessed simultaneously during all training sessions. While there was no significant differential effect of the CR training on primary outcomes, we found small to moderate effects on rumination in the CR group, but not the control group. The study provides first evidence that a CR training might be promising to decrease rumination in adolescent MD, albeit further studies are warranted to demonstrate differential training effects. Another important finding from the study was that the CR group showed an unexpected increase of the LPP during the first, but not during later training sessions. This suggests that cognitive effort during CR was successfully reduced over the sessions. The project findings contribute to an improved understanding of ER in youth MD. Moreover, the project marks the first research into a task-based CR training for adolescent MD, which - in the long term - could be used as an add-on to established interventions in MD to improve their effectivity.

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