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Behavioral Intervention for Overthinking in Teens Linked to Changes in Brain Activity

The original post from The Ohio State University can be found here.

A new study from Huntsman Mental Health Institute at the University of Utah, The Ohio State University Wexner Medical Center and College of Medicine, and University of Exeter (UK) substantiates previous groundbreaking research that rumination (overthinking) can be reduced through an intervention called Rumination-focused Cognitive Behavioral Therapy (RF-CBT). In addition, the use of fMRI technology allowed researchers to observe correlated shifts in the brain connectivity associated with overthinking.

The study’s findings are published online in the journal Biological Psychiatry Global Open Science. 

“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. We were particularly excited that the treatment seemed developmentally appropriate and was acceptable and accessible via telehealth during the early pandemic,” said corresponding author Scott Langenecker, PhD, vice chair of research in the Department of Psychiatry and Behavioral Health at Ohio State, who carried out most of the project while at HMHI. 

Teen boy looks depressed and is gazing out the window. He is wearing a dark blue sweatshirt and has brown hair and blue eyes.


RF-CBT is a promising approach pioneered by Ed Watkins, PhD, professor of experimental and applied Clinical Psychology at the University of Exeter. It has been shown to be effective 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 Rachel Jacobs, PhD, adjunct assistant professor of psychiatry and behavioral sciences at Northwestern University who conducted a similar pilot study in 2016. 

"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," Jacobs said.

In the just-published trial, 76 teenagers with a history of depression were randomly assigned to 10-14 sessions of RF-CBT, while their peers in the study were allowed and encouraged to receive any standard treatment. Teens reported ruminating significantly less if they received RF-CBT. Even more intriguing, fMRI illustrated shifts in brain connectivity, marking a change at the neural level.

Specifically, there was a reduction in the connection between the left posterior cingulate cortex and two other regions; the right inferior frontal gyrus and right inferior temporal gyrus. These zones, involved in self-referential thinking and emotional stimuli processing, respectively, suggest RF-CBT can enhance the brain's ability to shift out of the rumination habit. Notably, this work is a pre-registered replication; it demonstrates the same brain and clinical effects in the Utah study population in 2023 that were first reported in Jacob’s pilot study in 2016. 

“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. 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,” Watkins said.

Next, the researchers will focus on demonstrating the efficacy of RF-CBT in a larger sample with an active treatment control, including continued work at Ohio State, Nationwide Children’s Hospital, University of Exeter, HMHI and the Utah Center for Evidence Based Treatment. Future directions include bolstering access to teens in clinical settings and learning how this treatment helps youth with similar conditions.

“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. 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,” Langenecker said.

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