Changes in hierarchical brain dynamics of rumination following mindfulness-based cognitive therapy for depression
Paulina Clara Dagnino, Anne Maj van der Velden, Henricus G. Ruhé, Willem Kuyken, Morten L. Kringelbach, Jakub Vohryzek, Gustavo Deco
medRxiv June 23, 2026 Peer reviewed DOI: 10.64898/2026.06.21.26356048 via OpenAlex
Summary
Mindfulness-based cognitive therapy (MBCT) combined with treatment as usual (TAU) improved brain hierarchy during rumination in individuals with major depressive disorder (MDD). In a study of 80 participants, MBCT+TAU showed increased global directedness during rumination, which was not observed at rest. This change in brain organization correlated with better clinical and behavioral outcomes, suggesting that MBCT may help reduce ruminative thought patterns by promoting more differentiated cognitive processes.
Study at a glance
| Design | randomised controlled trial |
|---|---|
| Sample size | 80 |
| Population | individuals with major depressive disorder |
| Key finding | Global directedness in the brain increased during rumination after mindfulness training, indicating a shift away from ruminative thought patterns. |
Abstract
Abstract Major depressive disorder (MDD) is a leading cause of disability worldwide with risk of onset and recurrence linked to depressive ruminative thought patterns. Mindfulness-based cognitive therapy (MBCT) is an evidence-based treatment for depression that targets the ability to recognise, decenter, and disengage from ruminative thought patterns. Elucidating how MBCT impacts hierarchical brain organisation may be key to understanding the processes by which MBCT can modulate ruminative tendencies. In a randomised controlled functional magnetic resonance imaging (fMRI) trial on individuals with MDD (N=80) before and after MBCT in addition to treatment as usual (TAU), we investigated changes in hierarchical brain organisation during resting-state and rumination. We built whole-brain models to obtain generative connectivity (GEC) matrices per patient and quantified brain hierarchy by measuring the global directedness and regional trophic levels in each GEC, in which greater directedness reflects more directional information flow and less recurrence. Global directedness in MBCT+TAU compared to TAU increased during rumination, with no changes during resting-state. Furthermore, increased regional breadth of hierarchy during rumination was related to improvements in clinical and behavioural outcomes following MBCT+TAU. Increased brain hierarchy during rumination following mindfulness training may be consistent with a shift away from self-reinforcing negative mental loops towards more differentiated and less coupled cognitive and bodily cycles, supporting MBCT’s ability to interrupt ruminative processes. Hierarchical brain dynamics may hold promise as a treatment-sensitive marker and a potential mechanism of therapeutic change in MBCT for depression. Trial registration ClinicalTrials.gov NCT03353493 .