Rates of depression increase rapidly during adolescence, especially for girls, and, thus, research is needed to spur the development of novel interventions to prevent adolescent depression. This project seeks to determine if a novel visuocortical probe of affect-biased attention (i.e., steady-state visual evoked potentials derived from EEG) can 1) be used to prospectively predict depression using a multi-wave repeated measures design and 2) modify affect-biased attention and buffer subsequent mood reactivity using real time neurofeedback. This work could ultimately lead to improved identification of adolescents who are at high risk for depression and directly inform the development of mechanistic treatment targets to be used in personalized intervention prescriptions for high-risk youth.

Inclusion Criteria:

• Participants will include 90 female adolescents ages 13 years 0 months through 15 years 11 months at study entry.

Exclusion Criteria:

1. Lifetime history of any Diagnostic and Statistical Manual of Mental Disorders (DSM) 5 depressive disorder
2. Lifetime history of taking antidepressants [e.g., selective serotonin reuptake inhibitor (SSRIs)]
3. Lifetime history of a DSM 5 psychotic, bipolar, or autistic spectrum disorder.
4. Presence of EEG contraindications (e.g., personal lifetime history of seizures or family history of hereditary epilepsy).
5. Being pre-pubertal
6. Lifetime history of a neurological or serious medical condition.
7. Lifetime history of head injury or congenital neurological anomalies (based on parent report).
8. Intelligence quotient (IQ) less than 80, as assessed using the Wechsler Abbreviated Scale of Intelligence (WASI).
9. Uncorrected visual disturbance
10. Being acutely suicidal or at risk for harm to self or others.

We will comply with all National Institute of Mental Health (NIMH) guidelines regarding data repository/sharing.

All 15 participants assigned to the neurofeedback arm were included in the baseline analysis.

Single-session monitoring on the intervention day: from the start of baseline procedures (pre-neurofeedback) through 60 minutes after completion of the neurofeedback session; total monitoring duration ≈ 2 hours on the same day.

Adverse events were monitored continuously during the above window via non-systematic assessment: spontaneous participant report and study-staff observation. Participants were queried at end-of-session and again at +60 minutes prior to discharge. No adverse events were observed or reported.

The study was a small, single-arm pilot trial with 15 participants, which may limit generalizability. Results should be interpreted as preliminary pending replication in larger, controlled samples.