The purpose of this study is to understand the effects of mindfulness and fantasizing in reducing perseverative cognition underlying vulnerability for depression.
A cross-over design will be used comparing measures before and during both a mindfulness- and a positive fantasizing intervention period in individuals who remitted from two major depressive episodes (i.e. remitted Major Depressive Disorder (rMDD) patients) and a never-depressed control group. After checking for eligibility of the participants, participants will fill-out several questionnaires about their personal characteristics, experiences and expectations. These questionnaires will be used to study individual characteristics that could serve as treatment markers predicting the effectivity of interventions. Furthermore, diary measures of thought patterns (experience sampling method \[ESM\]), behavioural measures (using the Sustained Attention to Response Task \[SART\]), actigraphy, (neuro)physiological measures (impedance cardiography \[ICG\], electrocardiography \[ECG\] and electroencephalogram \[EEG\]) and measures of depressive mood (self-report questionnaires) will be performed during the week before (pre-) the interventions and the week during (peri-) performance of the interventions. In-between pre-and peri-intervention measures, there is a one month wash-out period. The order of the interventions will be counterbalanced across participants. Pre- and peri-intervention measures will be compared to study intervention effects in remitted MDD patients, remitted MDD patients vs. healthy controls and in relation with individual characteristics
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
OTHER
Masking
NONE
Enrollment
100
Participants receive a two-hour professional training to get familiar with the basic techniques of mindfulness. The training is given by a mindfulness professional and consists of psycho-education, instructions for mindfulness and guided practice. It focuses mainly on attending to stimuli such as breathing, external sounds or bodily sensations and becoming aware of where one's attention is. After the professional training, participants receive instructions about the audio application with which participants continue performing short exercises using the learned technique every day guided by an application on their smartphone customized for this research. Specifically, participants perform one short exercise (10 min) per day for in total six days. The exercises that are being performed are: attention to breathing part 1, attention to breathing part 2, attention to sounds, attention to bodily sensations, attention to thoughts, attention to emotions and feelings.
In a two-hour training session by a professional trainer, participants get familiar with the positive fantasizing technique. Participants receive psycho-education about the role of dysfunctional beliefs. The positive fantasizing technique starts with identifying dysfunctional "beliefs and schema" and subsequently fantasize about a positive "fantasy belief". Participants are guided by the professional using imagery and experiencing thoughts and feelings that would be elicited when using their fantasy belief as if in an ideal world. After using imagery techniques, participants are asked, with help of the professional, to reflect on their experience during the fantasizing exercise and to think of how they could implement this fantasy belief more in their daily life, by adapting their fantasy belief into a more practical belief. After the training, participants are asked to perform one exercise per day using the fantasizing technique using a mobile application for six days in total.
University Medical Center Groningen
Groningen, Netherlands
RECRUITINGPerseverative Cognition measured with daily Experience Sampling Methods
Daily fluctuations in self-reported perseverative cognition using Experience Sampling Methods. The main outcome measure to assess perseverative cognition using Experience Sampling Measurement is the item asking whether participants are currently ruminating. An increase in rumination scores would indicate an increase in perseverative cognition.
Time frame: 7 days, 10 times per day
Physiological correlates of perseverative cognition using heart rate measured with electrocardiogram.
Physiological correlates of perseverative cognition measured as heart rate, measured with electrocardiogram.
Time frame: 24 hours
Physiological correlates of perseverative cognition using heart rate variability measured with electrocardiogram.
Physiological correlates of perseverative cognition measure das heart rate variability measured with electrocardiogram
Time frame: 24 hours
Neurophysiological correlates of perseverative cognition using electroencephalogram during performance of the Sustained Attention to Response Task.
Electrophysiological correlates of perseverative cognition measured using electroencephalogram (EEG) during performance of a Sustained Attention to Response Task. The Sustained Attention to Response Task is a Go/No-Go Task interrupted by thought probes asking participants about the content and characteristics of their current thoughts. While performing the task, EEG is measured. To measure the neurophysiological correlates of perseverative cognition, EEG voltage when participants reported perseverative cognition on the Sustained Attention to Response Task will be examined and and compared with the EEG voltage when participants did not report perseverative cognition.
Time frame: 40 minutes task performance while measuring electroencephalogram
Apathy Evaluation Scale
Self-report questionnaire measuring apathy levels (higher score reflects higher apathy levels) examined as an individual characteristic that could be a potential individual treatment marker in predicting the effectivity of the interventions.
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Time frame: At baseline before the start of the measurement weeks
Bermond-Vorst Alexithymia Questionnaire
Self-report questionnaire measuring alexithymia levels (higher score reflects higher alexithymia levels) examined as an individual characteristic that could be a potential individual treatment marker in predicting the effectivity of the interventions.
Time frame: At baseline before the start of the measurement weeks
Leiden Index of Depression Sensitivity
Self-report questionnaire measuring cognitive reactivity to sadness (higher score reflects higher cognitive reactivity) examined as an individual characteristic that could be a potential individual treatment marker in predicting the effectivity of the interventions.
Time frame: At baseline before the start of the measurement weeks
Childhood Trauma Questionnaire-Short Form
Self-report questionnaire measuring childhood trauma (higher score reflects higher childhood trauma levels) as an individual characteristic that are potential individual treatment markers in predicting the effectivity of the interventions.
Time frame: At baseline before the start of the measurement weeks
Dysfunctional Attitude Scale
Self-report questionnaire measuring dysfunctional attitudes (higher score reflects higher dysfunctional attitudes) examined as an individual characteristic that could be a potential individual treatment marker in predicting the effectivity of the interventions.
Time frame: At baseline before the start of the measurement weeks
Neuroticism-Extraversion-Openness Five-Factor Inventory
Self-report questionnaire measuring personality characteristics Neuroticism, Extraversion and Openness. The scores on these personality characteristics will be used as individual characteristics that are potential individual treatment markers in predicting the effectivity of the interventions.
Time frame: At baseline before the start of the measurement weeks
Inventory of Depressive Symptomatology
Self-report questionnaire measuring depressive symptoms (higher scores reflect higher depressive symptoms)
Time frame: Measured on day 7 at the end of each measurement week.
Perseverative Thinking Questionnaire
Self-report questionnaire measuring perseverative thinking (higher scores reflect higher levels of perseverative thinking)
Time frame: Measured on day 7 at the end of each measurement week.
Responses on Positive Affect Scale
Self-report questionnaire measuring ruminative and dampening thoughts in response to positive affect (higher scores reflect higher rumination levels).
Time frame: Measured on day 7 at the end of each measurement week.
Emotion Regulation Questionnaire
Self-report questionnaire measuring the emotion regulation strategies suppression and reappraisal (higher scores reflect using a particular strategy more).
Time frame: Measured on day 7 at the end of each measurement week.
Five Facet Mindfulness Questionnaire
Self-report questionnaire measuring five facets of mindfulness: non-reactivity to inner experience, observing, acting with awareness, describing and non-judging of experience.
Time frame: Measured on day 7 at the end of each measurement week.
Leuven Adaptation of the Rumination on Sadness Scale
Self-report questionnaire measuring ruminative thinking on sadness (higher scores reflect higher levels of ruminative thinking).
Time frame: Measured on day 7 at the end of each measurement week.
Positive and Negative Affect Schedule
Self-report questionnaire measuring positive and negative affect (higher scores reflect higher levels of positive or negative affect).
Time frame: Measured on day 7 at the end of each measurement week.
Sleep as measured with Actigraphy
Actigraphy is used as a measure of sleep-wake cycles, using the MotionWare 8. This is a device that can measure activity counts and sleep using accelerometer data interpreted by software algorithms. Actigraphy will be used to assess sleep efficacy during the measurement weeks.
Time frame: 7 days