A growing body of literature

A growing body of literature suggests that Major Depressive Disorder (MDD) is associated with impaired cognitive control processes necessary for effective emotion regulation (Diener et al., 2012). These impairments are often coupled with ineffective or maladaptive regulation strategies that may exacerbate reactivity to, and the impact of, negative or distressing emotions (Campbell-Sills and Barlow, 2007). Rumination, or brooding, is one such maladaptive regulation strategy that involves recurring thoughts about self-relevant negative emotional states or situations (Nolen-Hoeksema, Nov 1991). Rumination has been associated with MDD, including the development, severity, and chronicity of depressive episodes (Nolen-Hoeksema, 2000; Nolen-Hoeksema et al., 2008). It has been hypothesized that rumination in MDD stems from deficits in cognitive control functions such as inhibition (De Lissnyder et al., 2011) and disengagement (Koster et al., 2011), leading to excessive processing and preoccupation with self-relevant negative emotion (Joormann and Gotlib, 2010). The period of late childhood and early adolescence is one in which the incidence of MDD increases (Angold and Costello, 2006), and corresponds with significant development of cognitive emotional regulation strategies, which begin to supplant more rudimentary behavioral strategies (e.g. covering ears) from middle childhood (McRae et al., 2012; Davis and Levine, 2013; Garnefski et al., 2007). This period also marks increased use of cognitive emotion regulation strategies, which increase over a protracted period, with even late adolescents using fewer strategies than adults (Garnefski and Kraaij, 2006), though patterns of cognitive strategy use are similar between late childhood and early adolescence (Garnefski et al., 2007). However, use of rumination as a regulation strategy also peaks in early adolescence, with higher rates than in late childhood (Hampel and Petermann, 2005), which then decrease from early- to mid-adolescence (Hankin, 2008). Rumination and depression are more closely associated in adolescents compared to younger children (Rood et al., 2009). It has been suggested that rumination may contribute to psychopathology by interfering with the use of effective self-regulation techniques (Nolen-Hoeksema et al., 2015), though the mechanism by which this occurs is unclear. Thus, it is important to understand the association between maladaptive regulation strategies such as rumination and ineffective use of adaptive regulation strategies in this critical developmental period. In purchase Ruxolitinib to rumination, cognitive reappraisal is considered to be an adaptive emotion regulation strategy shown to effectively minimize the excessive experience of negative emotions (Ochsner et al., 2004). Cognitive reappraisal is the reinterpretation of the meaning of affective stimuli or events in a way that may change the magnitude and valence of affective responses. Research has shown that reappraisal modulates the emotional experience of a negative event or stimulus (Ochsner et al., 2004), and that habitual use of reappraisal is associated with improved well being, interpersonal functioning, and overall greater positive emotion (Gross and John, 2003). Neurally, studies have shown that use of cognitive reappraisal is associated with increased activity of prefrontal and parietal cognitive control regions and semantic and perceptual regions of the lateral temporal cortex, as well as with modulation of amygdala activity (Buhle et al., 2013). Importantly, this pattern has been shown in healthy school aged children (Belden et al., 2014) as well as in adults (Goldin et al., 2008; Wager et al., 2008). The neuroimaging literature on reappraisal indicates less effective modulation of emotion processing regions, such as the amygdala, by prefrontal control regions in adult MDD. One study found greater activation of right amygdala, insula, temporal pole, and dorsal cingulate in MDD adults compared to controls during reappraisal (Beauregard et al., 2006). A study of medication-free MDD adults showed increased activation of right lateral middle frontal gyrus during a “reappraise” condition compared to an “attend” condition while controls showed the opposite pattern (Johnstone et al., 2007). A separate study of MDD adults found a different pattern in which controls showed greater dorsolateral prefrontal cortex (DLPFC) activation and greater down-regulation of amygdala activity than MDD adults during reappraisal (Erk et al., 2010). Additionally, during negative emotion reappraisal, MDD adults fail to reduce activity in a number of regions in the default mode network (DMN), including ventromedial prefrontal cortex and anterior cingulate cortex, that show reduced activity in controls (Sheline et al., 2009). As the DMN is associated with self-referential thought (Fox et al., 2005), this may indicate difficulty in regulating self-referential activity in the context of negative emotions. In children with MDD history (many of whom overlapped with the current sample), deficits in emotion regulation abilities were associated with decreased activity of left inferior frontal gyrus (IFG) and inferior temporal sulcus (ITS) during reappraisal, while increased MDD severity was associated with increased amygdala activation during passive viewing of sad images (Belden et al., 2015). Together, these findings suggest that MDD is characterized by increased activation of emotional reactivity regions during reappraisal of negative emotions, and that this reactivity may be associated with abnormal function of prefrontal control regions (whether hyper- or hypoactive), leading to deficient emotional regulation.