Neural Effects of Wellness Classes in Women With Vulnerability to Depression ("The Women's Wellness Study")
Neural Effects of Wellness Classes in Women With Vulnerability to Depression ("The Women's Wellness Study")
The primary objective of the study is to examine the efficacy of mindfulness based cognitive
 therapy (MBCT) on the prevention of relapse in women with a history of depression.
 Additionally, the investigators will explore how brain activity might be affected in several
 brain regions as a result of MBCT. This study consists of two groups, a patient group
 consisting of women with a history of depression and a control group consisting of healthy
 women. All participants within the patient group will receive an 8-week MBCT intervention
 program and will continue their normal medication treatment. Participants will undergo, both
 pre and post intervention, various behavioral and neuroimaging tasks to assess intervention
 effects of well-established psychological measurements related to cognitive and emotional
 function.
Overall, this study aims to characterize the neural and psychological effects of an
 eight-week mindfulness based cognitive therapy (MBCT) intervention (online group class) in
 preventing depressive relapse in women with past history of major depression when exposed to
 different forms of self-relevant and context-specific emotional challenge. The investigators
 also aim to establish psychological and neural mechanisms contributing to depressive symptoms
 prior to intervention. A key objective of the study is to assess baseline markers of
 depressive symptoms and possible change resulting from the MBCT intervention from
 interdisciplinary perspectives, including the psychological perspective (i.e. measured with
 computer-based tasks, self-report ratings, questionnaires, etc.) and the neural perspective
 (neural activity measured with functional MRI).

 In addition, a critical factor the investigators will be observing is the shift from more
 'narrative' to 'experiential' forms of self-related awareness as a function of MBCT.
 Narrative self-focus refers to a concept of self that is extended in time, including past
 memories and intentions for the future, together with abstract self-representations in
 relation to socio-emotional values. In contrast, the "experiential self-focus" refers to a
 more immediate self-experience and is associated with greater awareness of external stimuli
 and internal somatic-visceral bodily states. MBSR has been shown to increase brain activity
 in regions relevant for conferring "experiential" self-focus (insula-opercula, dorsal
 anterior cingulate/supplementary motor area), while decreasing responses in rostral-medial,
 lateral frontal and hippocampal regions that support the "narrative" mode of self-focus. Such
 changes in brain activity are associated with increased well-being. Brain regions to be
 examined include: 1) insula-opercula and dorsal anterior cingulate brain regions responsible
 for mediating 'narrative' self-focus thinking styles; 2) rostral-medial and lateral frontal,
 and hippocampal brain regions responsible for mediating 'experiential' self-focus thinking
 styles; and 3) default mode and insular-paralimbic networks thought to be involved in the
 generation and maintenance of depressive episodes.

 Behavioral Tasks

 1. Breath Count Task - an objective behavioral measure of mindfulness; Dot-Probe Task - a
 measure of negative emotion attentional bias

 2. Autobiographical Memory Interview - a means to quantify the nature of participants'
 autobiographical memory recall in an ecologically-valid manner

 3. Free-Association Semantic Task - a measure of associative processing

 4. Emotional Movies - a measure of emotional reactivity

 5. N-Back Task - a measure of working memory.

 Neuroimaging Tasks

 1. Rest Task - a means to examine brain activity and thought content during an
 unconstrained task

 2. 'Narrative' vs 'Experiential' Task during Autobiographical Memory Recall vs. n-back - a
 means to examine brain activity during 'narrative' vs 'experiential' forms of self-focus
 during autobiographical memory recall, vs. a demanding working memory task.

 3. Self-Syllable Judgment Task - a means to examine brain activity during self-judgment vs
 non-self-judgment tasks.

 Thought Sampling Participants will undergo an experience sampling paradigm in which daily
 thought surveys will be administered multiple times per day over the course of 7-10 days.
 These thought sampling surveys are designed to estimate several factors characterizing the
 occurrence of spontaneous thoughts in real-world settings as well as the nature and content
 of individuals' thoughts in real-world settings.
Inclusion Criteria:

 Inclusion Criteria:

 1. Women with past history of recurrent major depressive disorder

 1. Women who are not currently pregnant

 2. Meeting criteria for prior depression (at least two episodes) and showing
 residual symptoms of depression (PHQ-9 score of 5-12)

 3. Not meeting criteria for a current active depressive episode (SCID criteria)

 4. Having access to internet and a smartphone with data plan

 5. Receiving no antidepressant/anxiolytic medication or under a stable regime of
 antidepressants/anxiolytics

 2. Healthy control women

 1. Women that are not currently pregnant

 2. Do not meet criteria for prior or current depression

 3. Have access to internet and a smartphone with data plan

 Exclusion Criteria:

 Exclusion criteria for all participants include:

 -  Current diagnoses of: psychosis, bipolar disorder/maniac episodes, OCD, persistent
 antisocial behavior, severe developmental delay, or persistent self-injury needing
 clinical management or therapy, organic brain injury, substance misuse.

 -  Past diagnoses of psychosis, bipolar disorder/mania episodes or OCD.

 -  Use of marijuana equal or more than 4 days per week.

 Additional exclusion criteria related to Magnetic Resonance Imaging safety requirements:

 We will exclude participants who have metal or electrical equipment including:

 -  Non-removable metal piercing

 -  Tattoos on head or neck, an older tattoo with metal-containing inks, and/or permanent
 makeup (eyeliner).

 -  An implanted (internal) defibrillator or pacemaker

 -  Cochlear (ear) implant

 -  Some type of clips used on brain aneurysms

 -  An intrauterine device (IUD) that is not compatible with the MRI scanner

 -  An implanted infusion pump device like an insulin pump

 -  Implanted nerve stimulators

 -  Magnetic dental appliances or fillings

 -  Metal plates, screws, staples, joint replacement, and prosthetics.

 Additional exclusion criteria for all participants include the following:

 -  Clear claustrophobic symptoms.

 -  Abnormal capability of performing the experimental tasks as they are designed and
 implemented (e.g., unable to read, unable to cooperate during fMRI examination,
 showing visual processing impairments that cannot be corrected using lenses or any
 significant impairments in the processing of auditory stimulation).