Executive Functioning Changes Following Rumination Focused CBT in Adolescents with History of NSSI and Depression

• In Event: Using Developmental Science to Identify Mechanisms and Reduce Adolescent Suicidal Thoughts and Behaviors

Abstract

Rumination is common in active and remitted depression and is a risk factor for subsequent depressive episodes and suicidal thoughts and behaviors (SITBs). Non-suicidal self-injury (NSSI) has been identified as a potentially stronger predictor for suicide than prior suicidal crises (Mars et al., 2019). This highlights the significance of employing robust strategies to reduce NSSI and target possible vulnerability factors for this behavior. Rumination can be conceptualized as a failure to attend to the current experience, which is supported when considering that interventions that have been successful in addressing rumination (and consequently, SITBs including NSSI) emphasize mindfulness. Rumination Focused Cognitive Behavioral Therapy (RFCBT) reduces maladaptive rumination via identifying patterns, being attentive to details, and engaging in adaptive problem solving that focuses on the here and now (Watkins, 2016). These are preliminary data from the first few participants of a larger randomized clinical trial. Here we present data on the influence of RFCBT on executive functioning among a sample of adolescents with a history of NSSI and depression.

We identified 11 adolescents aged 14-17 with a history of NSSI from an ongoing study investigating the mechanisms of change associated with RFCBT in adolescents with remitted major depressive disorder. Participants completed a diagnostic interview and neuropsychological testing, which included the Parametric Go/No-Go (PGNG) task to assess inhibitory control. The also completed an MRI scan. Once completed, participants were randomized to either the RFCBT group or the Assessment Only (AO) group. The RFCBT group received 10-12 sessions of RFCBT while the AO group continued treatment as usual in the community. Approximately 12 weeks following randomization, participants completed another diagnostic interview with an independent evaluator, who was blind to group assignment, as well as neuropsychological testing and MRI scan. We calculated the change in PGNG performance for each participant, which included 2- and 3-target response times, commissions, and ommisions. We then evaluated whether there was a significant difference in change scores between the AO and RFCBT groups.

Of 11 adolescents with a history of NSSI, 7 had complete pre- and post-treatment neuropsychological testing data. Five were assigned to the AO group and 2 were assigned to the RFCBT group. We found a significant difference between groups in the change of number of commissions for 3-target trials, t(3.46) = 3.96, p = .022. Specifically, the RFCBT group had reduction in commission errors while the AO group demonstrated an increase in commission errors.

These are highly preliminary results investigating whether adolescents with a history of NSSI and depression show improvements in executive functioning following RFCBT. As we are now resuming data collection following a delay due to COVID-19, we will be re-examining this relationship as we collect more data. RFCBT is a novel intervention, particularly for NSSI, and may show promise in improving executive functioning in this population, which may protect against future NSSI and potentially suicidal behavior.

Authors

• Mindy Westlund Schreiner, University of Utah
  Presenting Author

• Summer Frandsen, University of Utah
  Non-Presenting Author

• Alina Dillahunt, University of Utah
  Non-Presenting Author

• Katie Bessette, University of California - Los Angeles
  Non-Presenting Author

• Sheila E Crowell, University of Utah
  Non-Presenting Author

• Edward Watkins, University of Exeter
  Non-Presenting Author

• Scott Langenecker, University of Utah
  Non-Presenting Author