Mindfulness-based Real-time fMRI Neurofeedback for Depressed Adolescents: A Randomized Controlled Dosing Trial

Depression is highly prevalent and lacks effective treatment for ~50% of adolescents. Rumination increases the severity and duration of depressive symptoms and is characterized by increased activation within the default mode network (DMN), which includes core midline hubs of medial prefrontal cortex and posterior cingulate cortex. We developed a mindfulness-based real-time fMRI neurofeedback (mbNF) protocol to facilitate mindfulness acquisition through downregulating DMN activation. A proof-of-concept study demonstrated that one 15-minute session of mbNF was feasible in this population, reduced within-DMN functional connectivity, and increased state mindfulness. The current randomized controlled dosing trial has two main aims. First, we aim to test target engagement and hypothesize decreases in within-DMN functional connectivity following mbNF among depressed adolescents. Second, we aim to test dosage and hypothesize that a 30- versus 15-minute dose will lead to greater target engagement. We will further explore whether there are reductions in depressive symptoms and rumination following mbNF.