Introduction
cognitive behavior, reductions in rumination symptoms, visual or auditory, depressed, depressive symptoms, MDD, depression, Depression, disability
CORTEX
Depression is a leading cause of disability worldwide [A potentially impactful target for treatment may be rumination, or the perseveration of negative self-referential thoughts, memories, and one’s own negative mood [Recent neuroimaging research has observed increased activation during rumination compared to control conditions within the default mode network (DMN), which has core hubs in cortical midline regions (medial prefrontal cortex [mPFC], posterior cingulate cortex [PCC]) as well as the medial temporal lobe (MTL) and angular gyrus [Mindfulness-based treatments, which train attentional focus on the present moment, are one approach to treating depression through targeting reductions in rumination symptoms [Although mindfulness approaches show comparable treatment outcomes relative to other first-line approaches (e.g., cognitive behavior therapy, antidepressant medication) [An unexplored potential avenue for enhancing mindfulness interventions for adolescent MDD is real-time neurofeedback, a procedure in which individuals receive moment-by-moment visual or auditory feedback based on their brain signals (e.g. electroencephalography, fMRI, magnetoencephalography) [A further critical gap is that few real-time neurofeedback studies have tested network-based targets, in particular the DMN and FPN, for downregulating rumination symptoms or treating MDD [Building on this pilot research, the current project aims will test real-time fMRI neurofeedback combined with mindfulness practice and, crucially, whether such an intervention is effective for adolescents with MDD. Specifically, the current study will clarify whether DMN modulation is a mechanism of action for improving rumination and depressive symptoms in depressed adolescents and test different dosing lengths. Many real-time neurofeedback treatment studies use multiple feedback sessions [In summary, the current randomized clinical trial (RCT) (ClinicalTrials.gov Identifier #NCT05617495; R61MH132072) will enroll depressed adolescents ages 13–18-years-old. Participants will be randomized to either a 15-min or 30-min dose of mindfulness-based neurofeedback (mbNF) and clinical assessments will be completed over a one-month follow-up. The following hypotheses will be tested. First, a single session of mbNF will lead to reductions in within-DMN functional connectivity 