Neural Correlates of Sustained Attention During Disengagement From Repetitive Thought

Background: Repetitive thought (e.g., worry; rumination) is a major transdiagnostic symptom and mechanism of internalizing psychopathology. Ability to regulate RT is particularly clinically important. Prior work implicates the default mode network (DMN) in self-generated and memory-driven cognitions including RT. However, few studies have investigated the neural correlates corresponding to successful RT regulation. Method: Participants were 57 (32 female, 4 nonbinary, M age = 30) community-residing adults aged 20-45 oversampled for severe RT. 79% met criteria for one or more DSM-5 disorders. Participants completed an fMRI RT disengagement task during which they first viewed their own self-identified RT stimuli and perseverated as normal, then shifted attention to a validated sustained attention task, and finally responded to thought probes assessing momentary RT disengagement success. Study design, hypotheses, and analytic plan were preregistered on OSF (https://osf.io/qy4df). Results: More difficulty disengaging from RT corresponded to worse attention task performance (slower responding with no increase in accuracy); reduced activity in the salience, ventral and dorsal attention networks; and reduced connectivity between the DMN (posterior cingulate cortex) and dorsal attention network; but not reduced activity in or connectivity of DMN.Conclusions and relevance: Successful regulation of repetitive thought may rely on the effective recruitment of attentional resources, but downregulation of DMN may not be necessary. Clinically, these findings suggest potential benefit from interventions that focus more on upregulating attentional functioning than on downregulating networks believed to subserve repetitive thought.