Title : Behavioral effectiveness masks neural vulnerability: Thalamocortical predictors of distraction-based emotion regulation in remitted depression
Abstract:
Background: Emotion regulation deficits are central in depression recurrence risk. Yet, strategies like distraction appear behaviorally effective in remitted major depressive disorder (rMDD), raising the question of whether vulnerability in remission lies in how distraction effectiveness is achieved. Individuals with rMDD may appear behaviorally intact yet rely on distinct neural connections to achieve regulatory benefits of distraction. Identifying these residual vulnerabilities could inform targets for interventions aiming to sustain remission. We examined whether thalamic connectivity with salience, cognitive control, and default mode networks at rest predicted distraction effectiveness in daily life, and whether these neural correlates of distraction effectiveness differed in individuals with rMDD.
Method: 75 young adults with rMDD and healthy comparison participants completed a resting-state fMRI scan and 7-day EMA (6x/day) reporting momentary negative affect (NA) and distraction use. Multilevel models tested whether thalamus-to-ROI connectivity (Fisher z-scores) strength of distraction effectiveness (within-person association between momentary distraction use and negative affect), and whether moderation effects differed in rMDD.
Results: Greater momentary distraction use predicted lower subsequent NA (B= -1.67, p< .001) with no group differences in effectiveness (p=.86). Across participants, stronger thalamus–dorsolateral prefrontal cortex connectivity predicted greater distraction effectiveness. In individuals with rMDD (but not HC), stronger connectivity between thalamus and dorsomedial prefrontal cortex, inferior frontal gyrus, and superior AI (pfdr< .03) predicted greater distraction effectiveness.
Conclusion: Findings suggest that trait-like differences in remitted depression may reside less in distraction effectiveness, but more on greater dependence on thalamocortical connections required to achieve that effectiveness, which could potentially be more vulnerable to breakdown under high distress.
