Cognitive Rehabilitation in Patients With Depression

Cognitive Rehabilitation in Patients With Active and Remitted Depression - a Randomized Controlled Trial

Depression is a highly prevalent and debilitating mental disorder, ranked one of the leading causes of disability worldwide. Several studies have identified neuropsychological deficits in populations of depressed patients affecting domains including attention, memory and executive functioning. These deficits often persist even in patients whose depressive symptoms have remitted. Cognitive impairment in depression represent a core feature of depression, and a valuable target for intervention. Identification of methods that would lead to amelioration would be of great clinical interest, and cognitive rehabilitation (CR) could be a potential way of achieving this. To date few studies on cognitive rehabilitation in depression has been conducted, but the preliminary results are promising. Still the demonstration of long-term effects and evidence relating to improved daily life executive functioning (i.e., generalization) is lacking. In the present study different group-based cognitive rehabilitation interventions will be compared. The aim of the study is to investigate if a group-based "brain training" intervention can improve executive function in patients with active and remitted depression. Efficacy will be assessed immediately after intervention, but also six months after the intervention.

9 GMT modules will be administered in 9X2 hour sessions (ten groups). Manualized intervention; metacognitive strategies for improving attention and problem solving.

9 modules will be administered in 9x1 hour session (ten groups). Computerized Cognitive Training using commercially available web-based platforms based on neuroplasticity, developed to target skills such as attention, memory, speed of processing and executive functioning. Homework assignment between sessions.

Executive function in daily life (range:70-210). Higher score indicate greater executive dysfunction.

Assess frequency of cognitive failures (range:0-100). Higher Score indicate more frequent cognitive failures.

Assess the level of current psychological distress (range:0-136). Higher score indicate higher level of distress.

Assess a general sense of perceived self-efficacy (range:10-40). Higher score indicate higher self-efficacy.

Assess self-efficacy in the Return to work context (range:0-55). Higher score indicate higher self-efficacy.

Inclusion Criteria: Completed treatment for mild or moderate MDD Evidence of executive dysfunction in everyday life determined by (a) a structured interview or (b) a self-report Behavior Rating Inventory of Executive Function (BRIEF) T-score < 55. Exclusion Criteria: Cognitive, sensory, physical, or language impairment affecting the capacity to complete the training program. Premorbid neurological disease or insult and/or comorbid neurological disorder. Reported ongoing alcohol or substance abuse. Psychotic disorders. Actively suicidal. Personality disorder sever enough to interfere with the protocol. Not fluent in Norwegian language.