1
|
Woolf C, Kaplan L, Norrie LM, Burke D, Cunich M, Mowszowski L, Naismith SL. A feasibility, randomised controlled trial of Club Connect: a group-based healthy brain ageing cognitive training program for older adults with major depression within an older people's mental health service. BMC Psychiatry 2024; 24:208. [PMID: 38500095 PMCID: PMC10946102 DOI: 10.1186/s12888-023-05391-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 11/21/2023] [Indexed: 03/20/2024] Open
Abstract
BACKGROUND Using the RE-AIM (reach, effectiveness, adoption, implementation, maintenance) framework, we outline steps taken to implement an evidence-based cognitive training program, Club Connect, in older adults with major depressive disorder in an Older People's Mental Health Service in Sydney, Australia. The primary aim was to explore feasibility (or 'reach'), tolerability (or 'implementation'), and acceptability (or 'adoption'). The secondary aim was to explore the most sensitive clinical outcomes and measurement tools (i.e. 'effectiveness') to inform a formal randomised controlled trial, and to explore the healthcare resources used (i.e. costs) to assist decision-making by health care managers and policy-makers in relation to future resource allocation. METHODS Using a single blinded feasibility design, 40 participants (mean age: 76.13 years, SD: 7.45, range: 65-95 years) were randomised to either (a) Club Connect, a 10-week group-based multifaceted program, comprising psychoeducation and computer-based cognitive training, or (b) a waitlist control group. RESULTS Implementing group-based cognitive training within a clinical setting was feasible, well tolerated and accepted by participants. Further, cognitive training, in comparison to the waiting list control, was associated with moderate to very large effect size improvements in depression, stress and inhibition (ηp2 = 0.115-0.209). We also found moderate effect size improvements on measures of daily functioning, wellbeing and cognitive flexibility. Small effect size improvements for other cognitive and psychosocial outcomes were also observed. The average cost per person participating in in the intervention was AU$607.50. CONCLUSIONS Our findings support the feasibility of implementing group-based cognitive training into a specialised clinical (public health) setting. This trial was registered on the Australian and New Zealand Clinical Trial Registry (ACTRN12619000195156, 12/02/2019).
Collapse
Affiliation(s)
- Claudia Woolf
- Older People's Mental Health Service, St Vincent's Hospital, 390 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia.
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia.
- Faculty of Science, School of Psychology, The University of Sydney, Camperdown, NSW, Australia.
| | - L Kaplan
- Older People's Mental Health Service, St Vincent's Hospital, 390 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia
| | - L M Norrie
- Older People's Mental Health Service, St Vincent's Hospital, 390 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia
- School of Psychiatry, University of New South Wales, Randwick, NSW, Australia
| | - D Burke
- Older People's Mental Health Service, St Vincent's Hospital, 390 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia
- Discipline of Psychiatry, University of Notre Dame, Sydney, NSW, Australia
- Department of Psychiatry, Trinity College, Dublin, Ireland
| | - M Cunich
- Charles Perkins Centre, The Faculty of Medicine and Health (Central Clinical School), The University of Sydney, Camperdown, NSW, Australia
- Sydney Health Economics Collaborative, Sydney Local Health District, Camperdown, NSW, Australia
| | - L Mowszowski
- Healthy Brain Ageing Program, Brain and Mind Centre, The University of Sydney, Camperdown, NSW, Australia
- Faculty of Science, School of Psychology, The University of Sydney, Camperdown, NSW, Australia
- Charles Perkins Centre, The Faculty of Medicine and Health (Central Clinical School), The University of Sydney, Camperdown, NSW, Australia
| | - S L Naismith
- Older People's Mental Health Service, St Vincent's Hospital, 390 Victoria St, Darlinghurst, Sydney, NSW, 2010, Australia
| |
Collapse
|
2
|
Verhülsdonk S, Folkerts AK, Hasenberg C, Bohn C, Christl J, Kalbe E, Krieger T. Cognitive training for older prisoners: a qualitative analysis of prisoners' and staff members' perceptions. Front Aging Neurosci 2024; 15:1332136. [PMID: 38259639 PMCID: PMC10800784 DOI: 10.3389/fnagi.2023.1332136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024] Open
Abstract
Introduction Correctional institutions are challenged by increasing numbers of older prisoners. Existing literature highlights the vulnerability of this group that is reflected by various somatic and mental health issues including cognitive dysfunctions. Although cognitive training studies in various target groups of older people have been conducted, there is lack of data regarding cognitive training in older prisoners. A structured cognitive group training program ("NEUROvitalis Prison") with 12 weekly sessions was offered to male prisoners in Germany. Methods Post intervention an exploratory qualitative study was conducted. Prisoners (N = 18) and staff (N = 4) perspectives were explored by conducting face-to-face semi-structured interviews. Audiotaped data were fully transcribed and deductive-inductive content analyses applied. Results Both the prisoners and the staff perceived the cognitive training as very positive and stimulating. Moreover, the importance of the training was pronounced in terms of an increase in self-esteem and understanding of cognition and aging in the prisoners. Discussion Our data indicate that cognitive training may be a feasible and valuable intervention for older prisoners that will be appreciated by both inmates and staff. The qualitative data provide substantial insight into the experiences with the applied cognitive training program. Moreover, valuable modifications for future conduct can be derived.
Collapse
Affiliation(s)
- Sandra Verhülsdonk
- Department of Psychiatry and Psychotherapy, LVR-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
- Medical Psychology, Neuropsychology and Gender Studies, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ann-Kristin Folkerts
- Medical Psychology, Neuropsychology and Gender Studies, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Caroline Hasenberg
- Medical Psychology, Neuropsychology and Gender Studies, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Claire Bohn
- Department of Psychiatry and Psychotherapy, LVR-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Julia Christl
- Department of Psychiatry and Psychotherapy, LVR-Klinikum Düsseldorf, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Elke Kalbe
- Medical Psychology, Neuropsychology and Gender Studies, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Theresia Krieger
- Medical Psychology, Neuropsychology and Gender Studies, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| |
Collapse
|
3
|
Myklebost SB, Nordgreen T, Klakegg OS, Hammar Å. Long-term outcomes of an internet-delivered cognitive enhancement intervention targeting residual cognitive deficits after major depressive disorder: a 2-year follow-up of an open trial. Front Psychol 2023; 14:1194689. [PMID: 37655198 PMCID: PMC10466045 DOI: 10.3389/fpsyg.2023.1194689] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/25/2023] [Indexed: 09/02/2023] Open
Abstract
Background Cognitive deficits are common and disabling residual symptoms following major depressive disorder (MDD) and are related to increased risk of relapse. Residual cognitive deficits should thus be considered an important target for treatment. However, few have reported long-term outcomes of interventions targeting residual cognitive deficits. Objective This study aimed to (1) investigate change between pre-treatment and 2-year follow-up assessments in cognitive deficits, rumination, and symptoms of MDD after an internet-delivered intervention targeting residual cognitive deficits; (2) to investigate stability in outcomes between 6-month and 2-year follow-up assessments; (3) to report the number of participants' experiencing a new episode of MDD in the follow-up period; and (4) to investigate differences in outcomes between those who experienced a new episode of MDD and those who did not. Methods A total of 43 partly remitted adults were included to test a guided internet-delivered intervention, which consisted of 10 modules involving psychoeducation, cognitive strategies, and attention training. Participants were assessed at pre-treatment, post-treatment, after 6-months, and after 2-years, with measures assessing self-reported residual cognitive deficits, rumination, symptoms of MDD and relapse. Overall, 32 participants completed the 2-year follow-up assessment. Results Between the pre-treatment and 2-year follow-up assessments, there was a reduction in cognitive deficits and rumination, while there was an increase in symptoms of MDD. Cognitive deficits were stable between the 6-month and the 2-year follow-up, while there was an increase in rumination and symptoms of MDD. Thirteen of 32 participants reported a new episode of MDD during the follow-up period. The relapse group reported longer duration of MDD at pre-treatment and showed a difference in all outcomes after 2 years compared to the no-relapse group. The no-relapse group showed improvement in MDD symptoms at post-treatment, while the relapse group did not. Conclusion Delivering cognitive enhancement interventions over the internet is potentially related to stable improvements in residual cognitive deficits. The effects on rumination and symptoms of MDD are less certain. Lack of improvement in MDD symptoms after the intervention period should be investigated as an indicator of relapse. Results should be interpreted with caution due to the lack of control group and sample size.
Collapse
Affiliation(s)
- Sunniva Brurok Myklebost
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Oda Stakkestad Klakegg
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Åsa Hammar
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Office for Psychiatry and Habilitation, Psychiatry Research Skåne, Skåne, Sweden
| |
Collapse
|
4
|
Staniszewski K, Ronold EH, Hammar Å, Rosén A. Neurocognitive Functioning in Patients with Painful Temporomandibular Disorders. J Pain Res 2023; 16:2015-2025. [PMID: 37337610 PMCID: PMC10277003 DOI: 10.2147/jpr.s414922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 06/08/2023] [Indexed: 06/21/2023] Open
Abstract
Aim To investigate psychosocial factors in painful TMD (pTMD) which could have consequences for mastering chronic pain. Methods Our study included 22 patients (20 women, 2 men) with pTMD, refractory to conservative treatment, and 19 healthy controls. The control group was matched for gender, age, and educational level, and IQ tested on the Wechsler Abbreviated Scale of Intelligence. Neurocognitive function was tested with the Color-Word Interference Test (CWIT). Pain intensity was reported according to the General Pain Intensity Questionnaire (GPI), using the Numeric Rating Scale (NRS). Self-perceived cognitive difficulties were reported by the Perceived Deficits Questionnaire-Depression 5-item (PDQ-5). Two measures of rumination were included: the Rumination-Reflection Questionnaire (RRQ) and the Ruminative Response Scale (RRS). The Montgomery Åsberg Depression Rating Scale Self-report (MADRS-S) was used to measure depressive symptoms, and the Oral Health Impact Profile-TMD (OHIP-TMD) to measure QoL related to oral health. Results There were no statistical differences in age (median pTMD: 55 years, median control: 53 years), educational level, and IQ between pTMD and controls. Median pain intensity in pTMD was NRS 8 at maximum and the median pain duration was 18 years. There were no significant differences in CWIT between pTMD and controls. Self-perceived cognitive function (PDQ) was significantly poorer in pTMD. Rumination scores from both measures, and the depression score from MADRS, were significantly higher in pTMD. The OHIP-TMD score revealed a significantly poorer QoL in pTMD. Conclusion The group of pTMD patients have self-perceived cognitive difficulties that may make it more difficult to master chronic pain and common everyday tasks. They reported significantly more self-perceived cognitive difficulties, higher rumination, more depressive symptoms, and lower QoL compared to healthy controls, suggesting that these psychosocial factors could be targeted in treatment and interventions. However, the tested neurocognitive performance was equivalent to the control group.
Collapse
Affiliation(s)
| | - Eivind Haga Ronold
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| | - Åsa Hammar
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden
| | - Annika Rosén
- Department of Clinical Dentistry, University of Bergen, Bergen, Norway
- Department of Oral and Maxillofacial Surgery, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
5
|
Ronold EH, Myklebost SB, Hammar Å. Improvement in self-reported cognitive functioning but not in rumination following online working memory training in a two-year follow-up study of remitted major depressive disorder. Front Psychiatry 2023; 14:1163073. [PMCID: PMC10277740 DOI: 10.3389/fpsyt.2023.1163073] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 05/16/2023] [Indexed: 06/21/2023] Open
Abstract
Self-reported subjective cognitive difficulties (subjective deficits) and rumination are central residual cognitive symptoms following major depressive disorder (MDD). These are risk factors for more a severe course of illness, and despite the considerable relapse risk of MDD, few interventions target the remitted phase, a high-risk period for developing new episodes. Online distribution of interventions could help close this gap. Computerized working memory training (CWMT) shows promising results, but findings are inconclusive regarding which symptoms improve following this intervention, and its long-term effects. This study reports results from a longitudinal open-label two-year follow-up pilot-study of self-reported cognitive residual symptoms following 25 sessions (40 min), five times a week of a digitally delivered CWMT intervention. Ten of 29 patients remitted from MDD completed two-year follow-up assessment. Significant large improvements in self-reported cognitive functioning on the behavior rating inventory of executive function-adult version appeared after two-years (d = 0.98), but no significant improvements were found in rumination (d < 0.308) measured by the ruminative responses scale. The former showed moderate non-significant associations to improvement in CWMT both post-intervention (r = 0.575) and at two-year follow-up (r = 0.308). Strengths in the study included a comprehensive intervention and long follow-up time. Limitations were small sample and no control group. No significant differences between completers and drop-outs were found, however, attrition effects cannot be ruled out and demand characteristics could influence findings. Results suggested lasting improvements in self-reported cognitive functioning following online CWMT. Controlled studies with larger samples should replicate these promising preliminary findings.
Collapse
Affiliation(s)
- Eivind Haga Ronold
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | | | - Åsa Hammar
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Department of Clinical Sciences Lund, Psychiatry, Faculty of Medicine Lund University, Lund, Sweden
- Office for Psychiatry and Habilitation, Psychiatry Research Skåne, Skåne, Sweden
| |
Collapse
|
6
|
Chen L, Wang Q, Xu T. Working memory function in patients with major depression disorder: A narrative review. Clin Psychol Psychother 2022; 30:281-293. [PMID: 36510396 DOI: 10.1002/cpp.2811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 12/02/2022] [Accepted: 12/04/2022] [Indexed: 12/15/2022]
Abstract
Working memory (WM) deficits are recognized as serious cognitive impairment in patients with major depressive disorder (MDD). This review aims to clarify the effects of impaired WM function in patients with MDD and explore non-invasive and effective treatments that can be adopted in clinical practice. This review (1) synthesizes extant literature examining brain function and brain areas in terms of WM in individuals with depression, (2) utilizes the outcomes of the studies presented in this review to discuss the effects of impaired WM function on cognitive processing in individuals with depression, (3) integrates the treatments explored in current studies and (4) provides some suggestions for future research. We found that (1) central executive (CE) components affect the processing of WM, and this might be one of the factors influencing cognitive biases, as it is implicated in repetitive negative thinking and rumination; (2) the left dorsal anterior cingulate cortex (dACC), the left dorsolateral prefrontal cortex (DLPFC) and the regions of the default mode network (DMN) play a vital role in CE functioning; and (3) psychotherapy, cognitive training, exercise and physical therapy can be used as complementary treatments for MDD.
Collapse
Affiliation(s)
- Lijie Chen
- School of Medical Humanities, China Medical University, Shenyang, China.,Department of Psychiatry and Psychology, General Hospital of Northern Theater Command, Shenyang, China
| | - Qi Wang
- Department of Psychiatry and Psychology, General Hospital of Northern Theater Command, Shenyang, China
| | - Tianchao Xu
- Department of Psychiatry and Psychology, General Hospital of Northern Theater Command, Shenyang, China
| |
Collapse
|
7
|
Myklebost SB, Amundsen OM, Geraghty AWA, Inal Y, Hammar Å, Nordgreen T. Developing an internet-delivered intervention targeting residual cognitive symptoms after major depressive disorder: a person-based approach. J Ment Health 2022; 31:842-850. [PMID: 34983282 DOI: 10.1080/09638237.2021.2022618] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Cognitive difficulties are rarely addressed after the treatment of major depressive disorder (MDD). New scalable treatments are needed. To ensure relevance and engagement of novel interventions, there is a need to understand the perspectives of the users. AIM Explore former depressed adults needs and perspectives during the planning and development of a novel internet-delivered intervention targeting residual cognitive symptoms after MDD. METHOD The planning phase included exploratory qualitative interviews with former depressed adults (n = 16). In the development phase, a prototype including psychoeducation, attention training and compensatory strategies was tested in think-aloud interviews with former depressed adults (n = 7) and psychologists (n = 4). Data were analysed thematically. RESULTS Analysis of exploratory interviews identified four themes. Experiences of residual cognitive symptoms consisted of two sub-themes (Everyday life is more demanding; Concerns about cognitive difficulties). Coping with residual cognitive symptoms had two sub-themes (Compensatory strategies; Acceptance). Needs from an intervention consisted of two-subthemes (Need for information; Therapist support). Barriers for engagement consisted of three sub-themes (Being overwhelmed; Not being motivated; Frequent registration). Analysis of think-aloud interviews was organized into three themes: Positive perceptions of content; Concerns regarding content; Perceptions of Layout, Visuals and Navigation. CONCLUSION The intervention may address concerns and consequences of cognitive difficulties by including psychoeducation, compensatory strategies and elements to increase acceptance and motivation, provided in manageable proportions.
Collapse
Affiliation(s)
- Sunniva Brurok Myklebost
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | | | - Adam W A Geraghty
- Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Yavuz Inal
- Department of Design, Faculty of Architecture and Design, Norwegian University of Science and Technology, Trondheim, Norway
| | - Åsa Hammar
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| |
Collapse
|
8
|
Ronold EH, Joormann J, Hammar Å. Computerized Working Memory Training in Remission From Major Depressive Disorder: Effects on Emotional Working Memory, Processing Speed, Executive Functions, and Associations With Symptoms. Front Behav Neurosci 2022; 16:887596. [PMID: 35832292 PMCID: PMC9272008 DOI: 10.3389/fnbeh.2022.887596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/30/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Remission from major depressive disorder (MDD) is associated with residual symptoms related to reduced functioning, quality of life, and relapse risk. Previous studies have raised questions about mechanisms involved-in and affected by cognitive training. This study investigated the associations and changes among depressive symptoms, rumination, processing speed (PS), executive functioning (EF), and emotional working memory (e-WM) pre- post computerized working memory training (CWMT). Method Twenty-nine remitted participants were included in a pre- post pilot study of within-subject effects of online CWMT. A total of 20 participants completed the intervention and pre- post tests of EF and PS, e-WM, in addition to symptom and rumination measures. Associations between changes in symptoms and cognition were investigated pre- post. Associations between improvements in CWMT, depression history, and changes in cognition were explored. Hypotheses and statistics were preregistered before data were analyzed. Results Manipulation of negatively valanced stimuli in e-WM showed an inverse association with rumination pre-intervention, but the association disappeared post-intervention. Cognitive functioning improved in most conditions with largest effects in EF. Symptoms did not change in the remitted sample. CWMT improvements were related to improvements in some aspects of EF and PS, but also to worse self-reported attention. Depression history was related to less improvement in EF. Limitations Sample size was small and there was dropout from the study. There was no control group, thus precluding practice and placebo effects and causal relationships. Conclusions Computerized WM training improves cognitive functions and could influence associations between e-WM and rumination. This could counteract functional impairment following MDD.
Collapse
Affiliation(s)
- Eivind Haga Ronold
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Jutta Joormann
- Department of Psychology, Yale University, New Haven, CT, United States
| | - Åsa Hammar
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway
| |
Collapse
|
9
|
Myklebost SB, Gjestad R, Inal Y, Hammar Å, Nordgreen T. Predictors of Treatment Response to an Internet-Delivered Intervention Targeting Residual Cognitive Symptoms After Major Depressive Disorder. Front Psychiatry 2022; 13:795698. [PMID: 35418884 PMCID: PMC8995427 DOI: 10.3389/fpsyt.2022.795698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Residual cognitive symptoms after depression are common and associated with reduced daily life functioning and an increased risk of depression relapse. There is a lack of knowledge on treatments targeting residual cognitive symptoms after major depressive disorder (MDD), including the factors associated with treatment response. The aim of the current study is to explore factors of treatment response to a guided internet-delivered intervention for former depressed adults experiencing residual cognitive symptoms. METHOD Forty-three former depressed adults with residual cognitive symptoms were included. Linear mixed model analyses were used to investigate the impact of pre-treatment demographic-, illness, and symptom variables, and therapy process variables, such as credibility, expectancy, and user behavior, on reduction in residual cognitive symptoms from pre-treatment to 6-month follow-up. RESULTS Having had MDD for a year or less predicted more reductions in residual cognitive symptoms from pre- to 6-month follow-up. Higher levels of perceived treatment credibility and expectancy evaluated in the early course of treatment did also predict a positive treatment response. No demographic-, symptom-variables, previous number of episodes with MDD, and user behavior were associated with change in residual cognitive symptoms. CONCLUSION This study suggests that individuals with shorter duration of previous depressions might have larger reductions in residual cognitive symptoms at 6-month follow-up compared to those with a longer duration of depression. Treatment credibility and expectancy also predicted treatment response and effort should also be made to ensure interventions credibility. Results should be interpreted with caution due to the study having a low sample size. Further investigation of predictors should be conducted in a full scale randomized controlled trial.
Collapse
Affiliation(s)
- Sunniva Brurok Myklebost
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Rolf Gjestad
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Yavuz Inal
- Department of Design, Faculty of Architecture and Design, Norwegian University of Science and Technology, Gjøvik, Norway
| | - Åsa Hammar
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
| |
Collapse
|
10
|
Improved emotion regulation in depression following cognitive remediation: A randomized controlled trial. Behav Res Ther 2021; 147:103991. [PMID: 34740101 DOI: 10.1016/j.brat.2021.103991] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 08/23/2021] [Accepted: 10/25/2021] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Executive functions (EFs) play a key role in emotion regulation and, related to this, depression. Cognitive remediation (CR) targeting EFs, such as Goal Management Training (GMT) and computerized cognitive training (CCT), may reduce maladaptive emotion regulation. However, the clinical potential of GMT in the context of depression and emotion regulation remains to be tested. Hence, the primary aim of the present study was to compare effects of GMT with CCT on symptoms of emotion dysregulation. METHOD The paper reports the effects of a preregistered randomized controlled trial. Sixty-three participants (18-60yrs) with active or remitted depression and EF complaints were randomized to nine sessions of GMT (n = 35) or CCT (n = 28). All were assessed at baseline, post-intervention, and at 6-month follow-up. The Ruminative Response Scale and the Difficulties in Emotion Regulation Scale were employed to assess emotion regulation. RESULTS Both groups improved following the intervention on emotion regulation domains after controlling for intention-to-treat, including brooding rumination and on items reflecting non-accepting reactions to distress. Relative to CCT, the GMT-group demonstrated increased clarity of emotional responses in the per protocol analysis. CONCLUSIONS Our findings demonstrate the potential of GMT and CCT in reducing maladaptive emotion regulation in depression.
Collapse
|
11
|
Lin J, Su Y, Shi C, Liu Q, Wang G, Wei J, Zhu G, Chen Q, Tian H, Zhang K, Wang X, Zhang N, Wang Y, Yu X, Si T. Neurocognitive profiles of patients with first-episode and recurrent depression: a cross-sectional comparative study from China. J Affect Disord 2021; 286:110-116. [PMID: 33714171 DOI: 10.1016/j.jad.2021.02.068] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/20/2021] [Accepted: 02/26/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Accumulating evidence has shown that cognitive deficits are prevalent among patients with major depressive disorder (MDD). However, the pattern and extent of cognitive deficits in patients with first-episode and recurrent depression remain unclear. METHODS Objective measures of cognitive function were assessed in 433 first-episode of depression (FED) patients, 206 recurrent major depression (RMD) patients during the acute phase and 287 healthy controls (HCs). Five domains of cognition (speed of processing, attention, verbal learning, visual learning and execution function) were assessed by seven neuropsychological tests. Neuropsychological data were transformed into T scores according to the Chinese norm. RESULTS Both FED and RMD patients displayed deficits of mild-to-medium severity across all cognitive domains and their subtests, relative to HCs (Cohen's d = 0.12-0.62). Among MDD patients, RMD patients exhibited poorer verbal learning (Cohen's d = 0.17) and visual learning (Cohen's d = 0.21) than FED patients. CONCLUSIONS MDD patients in the acute phase exhibited broad cognitive impairments, and there were significant differences in verbal and visual learning between FED and RMD patients. Our findings indicate that more attention should be paid to the domains of verbal and visual learning in future screening assessments and targeted interventions.
Collapse
Affiliation(s)
- Jingyu Lin
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Yunai Su
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Chuan Shi
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Qi Liu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China
| | - Gang Wang
- Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Jing Wei
- Peking Union Medical College (PUMC), Beijing, China
| | - Gang Zhu
- The first hospital of China medical University, Shenyang, China
| | | | | | - Kerang Zhang
- Department of Psychiatry, First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xueyi Wang
- The First Hospital of Hebei Medical University, Shijiazhuang, China
| | - Nan Zhang
- Tianjin Medical University General Hospital, Tianjin, China
| | - Ying Wang
- The 984th hospital of PLA, Beijing, China
| | - Xin Yu
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China.
| | - Tianmei Si
- Peking University Sixth Hospital, Peking University Institute of Mental Health, NHC Key Laboratory of Mental Health (Peking University), National Clinical Research Center for Mental Disorders (Peking University Sixth Hospital), Beijing, China.
| |
Collapse
|
12
|
Myklebost SB, Nordgreen T, Hammar Å. An open pilot study of an internet-delivered intervention targeting self-perceived residual cognitive symptoms after major depressive disorder. APPLIED NEUROPSYCHOLOGY-ADULT 2021; 29:1595-1604. [PMID: 33813984 DOI: 10.1080/23279095.2021.1901706] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Residual cognitive symptoms are associated with reduced daily life functioning, quality of life and represent a risk factor for relapse of major depressive disorder (MDD). There are few studies targeting self-perceived residual cognitive symptoms after MDD. The current open pilot study examines clinical outcomes and feasibility of a novel internet-delivered cognitive enhancement treatment for mood disorders specifically tailored to target self-perceived residual cognitive symptoms after MDD. A total of 43 adults with self-perceived residual cognitive symptoms after MDD were included. Participants were assessed pre- and post-treatment and at 6-month follow-up. The intervention consists of 10 modules that includes psychoeducation, cognitive strategies, and attention training, coupled with weekly therapist guidance. Results showed a significant reduction from pre- to post-treatment in self-perceived residual cognitive symptoms (d = 0.98) and rumination (d = 0.63). Results remained significant at the 6-month follow-up (d = 1.06; d = 0.86). Reliable change in self-perceived residual cognitive symptoms were obtained in 60% of the participants from pre- to post-treatment. Completion rates (86%) and treatment satisfaction (97%) were high. This open pilot study supports that targeting self-perceived residual cognitive symptoms after MDD through internet-delivered cognitive enhancement therapy for mood disorders may be feasible and provide stable reductions in self-perceived residual cognitive symptoms and rumination.
Collapse
Affiliation(s)
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Åsa Hammar
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| |
Collapse
|
13
|
Schmid M, Hammar Å. First-Episode Patients Report Cognitive Difficulties in Executive Functioning 1 Year After Initial Episode of Major Depressive Disorder. Front Psychiatry 2021; 12:667238. [PMID: 34135786 PMCID: PMC8200526 DOI: 10.3389/fpsyt.2021.667238] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 04/26/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Major Depressive Disorder (MDD) is associated with cognitive impairment in general, and Executive Functioning (EF) in particular, even in remitted phase of the disorder, suggesting residual cognitive symptoms. The aim of the present study was to investigate self-reported EF 1 year after the first episode of MDD and to explore this in relation to depressive mood symptoms, remission and relapse. Method: The study included data from 24 patients and 23 healthy control subjects 1 year after the patients' initial first episode of MDD. All participants completed the Behavior Rating Inventory of Executive Functioning-Adult version (BRIEF-A), a standardized self-report measure of perceived EF in everyday life, measuring nine different EF. Total index scores for metacognitive functions, behavior/emotional regulation functions and a global EF score is also calculated. Results: The patient group in total, independent of symptom status, reported significantly lower EF in all indexes compared to the healthy controls 1 year after the initial episode. However, higher depressive mood symptom load correlated with self-reported difficulties in metacognitive functions and poor global EF scores. Regulatory control of behavior and emotional responses did not show such strong association with mood symptoms, but low self-report scores on this measure was associated with relapse during the first year after the initial episode. Conclusion: First-episode patients report significant lower executive functioning in everyday life compared to individually matched healthy controls, 1 year after onset, independent of symptom load. Residual cognitive symptoms seem to be evident and associated with risk of relapse and should be targeted in treatment and prevention of recurrence in MDD.
Collapse
Affiliation(s)
- Marit Schmid
- Department of Welfare and Participation, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Åsa Hammar
- Division of Psychiatry, Haukeland University Hospital, University of Bergen, Bergen, Norway.,Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
| |
Collapse
|
14
|
Maj M, Stein DJ, Parker G, Zimmerman M, Fava GA, De Hert M, Demyttenaere K, McIntyre RS, Widiger T, Wittchen HU. The clinical characterization of the adult patient with depression aimed at personalization of management. World Psychiatry 2020; 19:269-293. [PMID: 32931110 PMCID: PMC7491646 DOI: 10.1002/wps.20771] [Citation(s) in RCA: 164] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Depression is widely acknowledged to be a heterogeneous entity, and the need to further characterize the individual patient who has received this diagnosis in order to personalize the management plan has been repeatedly emphasized. However, the research evidence that should guide this personalization is at present fragmentary, and the selection of treatment is usually based on the clinician's and/or the patient's preference and on safety issues, in a trial-and-error fashion, paying little attention to the particular features of the specific case. This may be one of the reasons why the majority of patients with a diagnosis of depression do not achieve remission with the first treatment they receive. The predominant pessimism about the actual feasibility of the personalization of treatment of depression in routine clinical practice has recently been tempered by some secondary analyses of databases from clinical trials, using approaches such as individual patient data meta-analysis and machine learning, which indicate that some variables may indeed contribute to the identification of patients who are likely to respond differently to various antidepressant drugs or to antidepressant medication vs. specific psychotherapies. The need to develop decision support tools guiding the personalization of treatment of depression has been recently reaffirmed, and the point made that these tools should be developed through large observational studies using a comprehensive battery of self-report and clinical measures. The present paper aims to describe systematically the salient domains that should be considered in this effort to personalize depression treatment. For each domain, the available research evidence is summarized, and the relevant assessment instruments are reviewed, with special attention to their suitability for use in routine clinical practice, also in view of their possible inclusion in the above-mentioned comprehensive battery of measures. The main unmet needs that research should address in this area are emphasized. Where the available evidence allows providing the clinician with specific advice that can already be used today to make the management of depression more personalized, this advice is highlighted. Indeed, some sections of the paper, such as those on neurocognition and on physical comorbidities, indicate that the modern management of depression is becoming increasingly complex, with several components other than simply the choice of an antidepressant and/or a psychotherapy, some of which can already be reliably personalized.
Collapse
Affiliation(s)
- Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Dan J Stein
- South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Gordon Parker
- School of Psychiatry, University of New South Wales, Sydney, NSW, Australia
| | - Mark Zimmerman
- Department of Psychiatry and Human Behavior, Brown University School of Medicine, Rhode Island Hospital, Providence, RI, USA
| | - Giovanni A Fava
- Department of Psychiatry, University at Buffalo, State University of New York, Buffalo, NY, USA
| | - Marc De Hert
- University Psychiatric Centre KU Leuven, Kortenberg, Belgium
- KU Leuven Department of Neurosciences, Leuven, Belgium
| | - Koen Demyttenaere
- University Psychiatric Centre, University of Leuven, Leuven, Belgium
| | - Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Thomas Widiger
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Hans-Ulrich Wittchen
- Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
- Department of Psychiatry and Psychotherapy, Ludwig Maximilans Universität Munich, Munich, Germany
| |
Collapse
|