- ICH GCP
- US Clinical Trials Registry
- Clinical Trial NCT04106375
Neural Effects of Wellness Classes in Women With Vulnerability to Depression ("The Women's Wellness Study") (WWS)
Brain Mechanisms of Mindfulness Based Cognitive Therapy in Women at High Risk for Depressive Relapse ("The Women's Wellness Study")
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
Overall, this study aims to characterize the neural and psychological effects of an eight-week mindfulness based cognitive therapy (MBCT) intervention (online group class) in preventing depressive relapse in women with past history of major depression when exposed to different forms of self-relevant and context-specific emotional challenge. The investigators also aim to establish psychological and neural mechanisms contributing to depressive symptoms prior to intervention. A key objective of the study is to assess baseline markers of depressive symptoms and possible change resulting from the MBCT intervention from interdisciplinary perspectives, including the psychological perspective (i.e. measured with computer-based tasks, self-report ratings, questionnaires, etc.) and the neural perspective (neural activity measured with functional MRI).
In addition, a critical factor the investigators will be observing is the shift from more 'narrative' to 'experiential' forms of self-related awareness as a function of MBCT. Narrative self-focus refers to a concept of self that is extended in time, including past memories and intentions for the future, together with abstract self-representations in relation to socio-emotional values. In contrast, the "experiential self-focus" refers to a more immediate self-experience and is associated with greater awareness of external stimuli and internal somatic-visceral bodily states. MBSR has been shown to increase brain activity in regions relevant for conferring "experiential" self-focus (insula-opercula, dorsal anterior cingulate/supplementary motor area), while decreasing responses in rostral-medial, lateral frontal and hippocampal regions that support the "narrative" mode of self-focus. Such changes in brain activity are associated with increased well-being. Brain regions to be examined include: 1) insula-opercula and dorsal anterior cingulate brain regions responsible for mediating 'narrative' self-focus thinking styles; 2) rostral-medial and lateral frontal, and hippocampal brain regions responsible for mediating 'experiential' self-focus thinking styles; and 3) default mode and insular-paralimbic networks thought to be involved in the generation and maintenance of depressive episodes.
Behavioral Tasks
- Breath Count Task - an objective behavioral measure of mindfulness; Dot-Probe Task - a measure of negative emotion attentional bias
- Autobiographical Memory Interview - a means to quantify the nature of participants' autobiographical memory recall in an ecologically-valid manner
- Free-Association Semantic Task - a measure of associative processing
- Emotional Movies - a measure of emotional reactivity
- N-Back Task - a measure of working memory.
Neuroimaging Tasks
- Rest Task - a means to examine brain activity and thought content during an unconstrained task
- 'Narrative' vs 'Experiential' Task during Autobiographical Memory Recall vs. n-back - a means to examine brain activity during 'narrative' vs 'experiential' forms of self-focus during autobiographical memory recall, vs. a demanding working memory task.
- Self-Syllable Judgment Task - a means to examine brain activity during self-judgment vs non-self-judgment tasks.
Thought Sampling Participants will undergo an experience sampling paradigm in which daily thought surveys will be administered multiple times per day over the course of 7-10 days. These thought sampling surveys are designed to estimate several factors characterizing the occurrence of spontaneous thoughts in real-world settings as well as the nature and content of individuals' thoughts in real-world settings.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria:
Inclusion Criteria:
Women with past history of recurrent major depressive disorder
- Women who are not currently pregnant
- Meeting criteria for prior depression (at least two episodes) and showing residual symptoms of depression (PHQ-9 score of 5-12)
- Not meeting criteria for a current active depressive episode (SCID criteria)
- Having access to internet and a smartphone with data plan
- Receiving no antidepressant/anxiolytic medication or under a stable regime of antidepressants/anxiolytics
Healthy control women
- Women that are not currently pregnant
- Do not meet criteria for prior or current depression
- Have access to internet and a smartphone with data plan
Exclusion Criteria:
Exclusion criteria for all participants include:
- Current diagnoses of: psychosis, bipolar disorder/maniac episodes, OCD, persistent antisocial behavior, severe developmental delay, or persistent self-injury needing clinical management or therapy, organic brain injury, substance misuse.
- Past diagnoses of psychosis, bipolar disorder/mania episodes or OCD.
- Use of marijuana equal or more than 4 days per week.
Additional exclusion criteria related to Magnetic Resonance Imaging safety requirements:
We will exclude participants who have metal or electrical equipment including:
- Non-removable metal piercing
- Tattoos on head or neck, an older tattoo with metal-containing inks, and/or permanent makeup (eyeliner).
- An implanted (internal) defibrillator or pacemaker
- Cochlear (ear) implant
- Some type of clips used on brain aneurysms
- An intrauterine device (IUD) that is not compatible with the MRI scanner
- An implanted infusion pump device like an insulin pump
- Implanted nerve stimulators
- Magnetic dental appliances or fillings
- Metal plates, screws, staples, joint replacement, and prosthetics.
Additional exclusion criteria for all participants include the following:
- Clear claustrophobic symptoms.
- Abnormal capability of performing the experimental tasks as they are designed and implemented (e.g., unable to read, unable to cooperate during fMRI examination, showing visual processing impairments that cannot be corrected using lenses or any significant impairments in the processing of auditory stimulation).
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Basic Science
- Allocation: Non-Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
---|---|
Experimental: Intervention Group
Women with a history of depression and no other mental health disorders undergoing Mindfulness Based Cognitive Therapy.
|
MBCT is based on Mindfulness-Based Stress Reduction (MBSR), combining principles of cognitive therapy (CT) with those of mindfulness meditation to prevent depression relapse.
Both MBSR and MBCT use contemplative practices, including sitting meditation, body scan and walking meditation, as core methods to teach awareness of negative thoughts and emotions with the aim of disengaging from pervasive patterns of ruminative self-centered mentation.
Participants will be given an initial orientation session and then complete an online 8-week MBCT program.
Each week participants will take part in one 2-hour online group session and will complete homework assignments anticipated to take 15-30 minutes per day to complete.
Additionally, weekly phone coaching will be offered based on the modified tele-coach manual developed by Mohr and colleagues (Duffecy et al. 2010).
Other Names:
|
No Intervention: Control
Healthy women with no prior history of depression or other mental health disorders as a control group for time-repetition effects on brain activity and task performance
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Occurrence of mood episodes and post treatment relapse rate
Time Frame: Throughout study (pre-intervention to 6 months post-intervention)
|
Assessed via clinical interview
|
Throughout study (pre-intervention to 6 months post-intervention)
|
Depression symptoms
Time Frame: Throughout study (pre-intervention to 6 months post-intervention)
|
Assessed via Patient Health Questionnaire-9 (PHQ-9; Kroenke, Spitzer, & Williams, 2001)
|
Throughout study (pre-intervention to 6 months post-intervention)
|
Rumination
Time Frame: Throughout study (pre-intervention to 6 months post-intervention)
|
Rumination score measured using the Ruminative Response Scale (RRS; Nolen-Hoeksema 1987;1999).
|
Throughout study (pre-intervention to 6 months post-intervention)
|
Cognitive Decentering
Time Frame: Throughout study (pre-intervention to 6 months post-intervention)
|
Score in the Experiences Questionnaire (Fresco, Moore, Dulmen, Segal, Ma, Teasdale, & Williams, 2007)
|
Throughout study (pre-intervention to 6 months post-intervention)
|
Self-Compassion
Time Frame: Throughout study (pre-intervention to 6 months post-intervention)
|
Self-compassion scores measured using the Self-Compassion Scale (SCS: Neff, 2003).
|
Throughout study (pre-intervention to 6 months post-intervention)
|
Mindfulness
Time Frame: Throughout study (pre-intervention to 6 months post-intervention)
|
Score on the Five-factor Mindfulness Scale (FFMQ; Baer, Smith, Hopkins, Krietemeyer & Toney, 2006)
|
Throughout study (pre-intervention to 6 months post-intervention)
|
Autobiographical Memory
Time Frame: Throughout study (pre-intervention to 6 months post-intervention)
|
Assessed via the Autobiographical Memory Test (Williams & Broadbent, 1986)
|
Throughout study (pre-intervention to 6 months post-intervention)
|
Self concept
Time Frame: Throughout study (pre-intervention to 6 months post-intervention)
|
Assessed via the Twenty Statements Test (Kuhn and McPartland, 1954)
|
Throughout study (pre-intervention to 6 months post-intervention)
|
Brain activity during autobiographical memory recall
Time Frame: Up to 15 weeks
|
Measured using task-based fMRI bold sequence
|
Up to 15 weeks
|
Brain activity in the absence of a task
Time Frame: Up to 15 weeks
|
Measured using fMRI resting-state bold sequence
|
Up to 15 weeks
|
Brain activity during processing of self-referential traits
Time Frame: Up to 15 weeks
|
Measured using task-based fMRI bold sequence
|
Up to 15 weeks
|
Everyday thinking patterns
Time Frame: Up to 15 weeks
|
Measured with experience sampling in daily life, questions developed for our study
|
Up to 15 weeks
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
---|---|---|
Mindfulness
Time Frame: Up to 15 weeks
|
Assessed using the previously validated breath counting task (Levinson et al., 2014)
|
Up to 15 weeks
|
Lexical Associations
Time Frame: Up to 15 weeks
|
Assessed using the Thought fluency task (Andrews-Hanna et al., in prep.)
|
Up to 15 weeks
|
Worry
Time Frame: Throughout study (pre-intervention to 6 months post-intervention)
|
Worry score using the Penn State Worry Questionnaire (PSWQ; Meyer, Miller, Metzger, & Borkovec, 1990).
|
Throughout study (pre-intervention to 6 months post-intervention)
|
Fatigue
Time Frame: Throughout study (pre-intervention to 6 months post-intervention)
|
Assessed using the Multidimensional Fatigue Inventory (Smets et al. 1995).
|
Throughout study (pre-intervention to 6 months post-intervention)
|
Physical pain
Time Frame: Throughout study (pre-intervention to 6 months post-intervention)
|
Assessed using the Brief Pain Inventory-short form (Cleeland and Ryan, 1994).
|
Throughout study (pre-intervention to 6 months post-intervention)
|
Expectations about treatment outcome
Time Frame: Pre-intervention
|
Score in the Credibility/Expectancy Questionnaire (CEQ, Devilly, G. J., & Borkovec, T. D. 2000)
|
Pre-intervention
|
Client satisfaction about treatment outcome
Time Frame: Up to 15 weeks
|
Assessed using the Client Satisfaction Questionnaire (CSQ, Attkisson & Greenfield, 2009).
|
Up to 15 weeks
|
Positive and negative emotion
Time Frame: Up to 15 weeks
|
Assessed by measuring responses while watching emotional movies (based on Gruber et al, 2008)
|
Up to 15 weeks
|
Positive and negative affect
Time Frame: Throughout study (pre-intervention to 6 months post-intervention)
|
Assessed using the Positive and Negative Affect Scale (PANAS; Watson & Clark, 1994)
|
Throughout study (pre-intervention to 6 months post-intervention)
|
Emotion-induced attentional bias
Time Frame: Up to 15 weeks
|
Assessed using the dot-brobe task (Kruijt et al., 2016)
|
Up to 15 weeks
|
Mind wandering
Time Frame: Throughout study (pre-intervention to 6 months post-intervention)
|
Score on the Imaginal Process Inventory (IPI, Singer et al., 1963)
|
Throughout study (pre-intervention to 6 months post-intervention)
|
Well-being
Time Frame: Throughout study (pre-intervention to 6 months post-intervention)
|
Assessed via the Ryff Scales of Psychological Well-Being (RYFF; Ryff, 1989; Ryff & Keyes, 1995)
|
Throughout study (pre-intervention to 6 months post-intervention)
|
Collaborators and Investigators
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Actual)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 13-0257
Plan for Individual participant data (IPD)
Plan to Share Individual Participant Data (IPD)?
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.
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