Breakthrough therapy may stop repetitive thoughts in teens

A new study provides compelling evidence that Rumination-focused cognitive behavioral therapy (RF-CBT) is an effective intervention to reduce overthinking in adolescents. 

Using fMRI technology, the study demonstrated not only the therapy’s psychological benefits but also its biological effects on the brain.

The research was a collaboration between The Ohio State University Wexner Medical Center and College of Medicine, University of Utah, and the University of Exeter.

Adolescent brain development 

Study co-author Dr. Scott Langenecker is the vice chair of research in the Department of Psychiatry and Behavioral Health at Ohio State, who started this project while at the University of Utah.

“We know adolescent development is pivotal. Their brains are maturing, and habits are forming. Interventions like RF-CBT can be game-changers, steering them towards a mentally healthy adulthood,” said Dr. Langenecker. 

“We were particularly excited that the treatment seemed developmentally appropriate and was acceptable and accessible via telehealth during the early pandemic.”

Depressive relapses

Rumination-focused cognitive behavioral therapy, a concept advanced by Dr. Ed Watkins of the University of Exeter, originally showed promise for adults with recurrent depression.

“We wanted to see if we could adapt it for a younger population to prevent the ongoing burden of depressive relapse,” said study co-author Dr. Rachel Jacobs of Northwestern University.

“As a clinician, I continued to observe that standard CBT tools such as cognitive restructuring didn’t give young people the tools to break out of the painful mental loops that contribute to experiencing depression again. If we could find a way to do that, maybe we could help young people stay well as they transition to adulthood, which has become even more important since we’ve observed the mental health impact of COVID-19.”

Neurological shift 

In a trial involving 76 teenagers with a history of depression, participants were assigned to 10-14 sessions of RF-CBT, while a control group received standard treatments. 

The outcomes were telling: teens receiving RF-CBT reported less rumination. Most notably, fMRI scans revealed reduced connectivity between the left posterior cingulate cortex and regions linked to self-referential thinking and emotional processing, suggesting a neurological shift away from ruminative habits.

Exciting results

This study is a follow-up to a pilot in 2016 and confirms the earlier findings by showing the same brain and clinical effects in the Utah sample in 2023 as in the Chicago sample. 

“For the first time, this paper shows that the version of rumination-focused CBT we have developed at the University of Exeter leads to changes in connectivity in brain regions in adolescents with a history of depression relative to treatment as usual,” said Dr. Watkins.

“This is exciting, as it suggests the CBT either helps patients to gain more effortless control over rumination or makes it less habitual. We urgently need new ways to reduce rumination in this group in order to improve the mental health of our young people.”

Future research 

The next phase of the research involves a larger sample and an active treatment control to confirm RF-CBT’s efficacy further. 

The work continues across various institutions, with a strong focus on increasing access to RF-CBT for teens in clinical settings and understanding how it assists youth with related conditions.

Study implications 

“Our paper suggests a science-backed method to break the rumination cycle and reinforces the idea that it’s never too late or too early to foster healthier mental habits,” said Dr. Langenecker.

“Our research team thanks the youths and families who participated in this study for their commitment and dedication to reducing the burden of depression through science and treatment, particularly during the challenges of a global pandemic.”

This work was supported by the National Institutes of Mental Health and funds from the Huntsman Mental Health Institute. It is dedicated to researcher Kortni K. Meyers and others who have lost their lives to depression.

The study is published online in the journal Biological Psychiatry Global Open Science.

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