Targeting rumination with combined mindful breathing and tDCS in adolescents with suicidal thoughts

Abstract

Suicide is a leading cause of death among adolescents, and nearly 1 in 5 adolescents experience suicidal thoughts. Research is urgently needed to understand and prevent adolescent suicide. Rumination, or the persistent dwelling on negative, self-focused thoughts, is a key risk factor for suicidal behavior. This study will pilot a novel intervention designed to decrease rumination by altering its underlying neural circuitry in adolescents with suicidal thoughts. Neural correlates of rumination include (1) hyper-connectivity of the default mode network (DMN; a set of regions that mediate spontaneous cognitions during rest) with the salience network (regions underlying negative emotion), underlying excessive influence of negative emotion on resting-state thoughts, and (2) hypo-connectivity of DMN to dorsolateral prefrontal cortex (DLPFC), underlying impaired regulation of negative thoughts. Mindful breath training may be capable of decreasing rumination by reshaping the DMN to decrease its connections to the salience network. Further, transcranial direct current stimulation (tDCS) to DLPFC could augment mindful breathing by increasing DMN-DLPFC connectivity. This study will pilot the feasibility of randomizing 34 adolescents with rumination and suicidal thoughts into 2 experimental groups: (1) active tDCS plus mindful breath training (n=17); (2) sham tDCS plus mindful breath training (n=17). Our hypothesis is that combined mindful breath training and tDCS can decrease rumination by reshaping DMN connectivity in adolescents with suicidal thoughts. Anticipated drop-out is ∼10%; expected final size per group is 15. The study goals are to document feasibility of these interventions in the proposed population, to explore biological effects on the proposed construct of rumination and its underlying neural components, to characterize the target construct using multiple levels of analysis including self-report measures, behavioral measures, EEG, and fMRI to allow identification of the most useful metrics for the next study.