Can the Memory Support Intervention Improve Depression Outcome Following Cognitive Therapy?
28 janvier 2021 mis à jour par: Allison Harvey, University of California, Berkeley
The aim of this study protocol is to conduct a confirmatory efficacy trial to test whether the Memory Support Intervention improves illness course and functional outcomes in major depressive disorder (MDD) and cognitive therapy (CT).
Aperçu de l'étude
Statut
Complété
Les conditions
Description détaillée
Background. Major depressive disorder (MDD) is one of the most prevalent psychiatric disorders and a leading cause of disability worldwide. Existing therapies fail to produce complete recovery. Progress toward improving outcome must include innovations that are safe, powerful, inexpensive and simple (for fast and effective dissemination). The proposed research seeks to test one such innovation. The investigators seek to improve outcome by improving memory for the content of cognitive therapy (CT) sessions. CT is one of the most promising approaches to the treatment of MDD, yet there is room for improvement.
It is proposed that adding memory enhancing strategies to CT may improve MDD outcome because: (a) MDD is often characterized by memory impairment, (b) there is evidence that the memory impairment is modifiable, (c) CT typically entails the activation of emotion, (d) emotion can impair or bias memory and (e) there is evidence that memory for the content of therapy sessions is poor.
Hence, the overall goal is to evaluate if integrating strategies designed to enhance memory for the content of CT sessions improves treatment outcome for MDD. Cognitive support involves a series of specific procedures that support the encoding and retrieval stages of an episodic memory. It is hypothesized that CT+Memory Support, relative to CT-as-usual, will be associated with improved illness course and functional outcome at the end of treatment as well as 6 and 12 months post-treatment.
Type d'étude
Interventionnel
Inscription (Réel)
178
Phase
- N'est pas applicable
Contacts et emplacements
Cette section fournit les coordonnées de ceux qui mènent l'étude et des informations sur le lieu où cette étude est menée.
Lieux d'étude
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California
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Berkeley, California, États-Unis, 94720-1650
- University of California, Berkeley
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Critères de participation
Les chercheurs recherchent des personnes qui correspondent à une certaine description, appelée critères d'éligibilité. Certains exemples de ces critères sont l'état de santé général d'une personne ou des traitements antérieurs.
Critère d'éligibilité
Âges éligibles pour étudier
18 ans et plus (Adulte, Adulte plus âgé)
Accepte les volontaires sains
Oui
Sexes éligibles pour l'étude
Tout
La description
Inclusion Criteria:
- Age 18+ years
- Willing and able to give full consent
- English language fluency
- Diagnosis of major depressive disorder (MDD), first episode, recurrent or chronic, according to DSM-5
- Minimum score 26 or above on the Inventory of Depressive Symptomatology, Self-Report (IDS-SR). This cutoff denotes at least 'moderate' depression
- If taking medications for mood, medications must be stable for the past four weeks
Exclusion Criteria:
- History of Bipolar Disorder
- History of Psychosis or psychotic features
- Lifetime history of failure to respond to 4 or more sessions of CBT/CT for depression
- Current non-psychotic disorder if it constitutes the principal diagnosis and if it requires treatment other than that offered in the project. 'Principal' is defined as the disorder currently most distressing and disabling, using a widely accepted severity rating scale capturing distress and interference (0-8, 4+ indicates clinical severity)
- Moderate or severe substance use in the past 6 months where 'moderate' is defined as 4-5 symptoms and 'severe' is defined as 6+ listed in DSM-5 for each of the substance-related disorders
- Evidence of any medical disorder or condition that could cause depression, preclude participation in CT, or is associated with memory problems, that is not currently stabilized and/or managed under the care of a physician or the presence of an active and progressive physical illness or neurological degenerative disease,
- Current suicide risk sufficient to preclude treatment on an outpatient basis (assessed by the Columbia-Suicide Severity Rating Scale) or current homicide risk (assessed by our staff, a case manager or psychiatrist)
- Pregnancy or breastfeeding
- Not able/willing to participate in and/or complete the pre-treatment assessments
Plan d'étude
Cette section fournit des détails sur le plan d'étude, y compris la façon dont l'étude est conçue et ce que l'étude mesure.
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: Traitement
- Répartition: Randomisé
- Modèle interventionnel: Affectation parallèle
- Masquage: Double
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
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Expérimental: Cognitive Therapy plus Memory Support
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The Memory Support Intervention will be delivered interwoven with CT.
The Memory Support Intervention is designed to improve patient memory for treatment and involves a series of specific procedures that support the encoding and retrieval stages of episodic memory.
It is comprised of eight memory promoting strategies: attention recruitment, categorization, evaluation, application, repetition, practice remembering, cued-based reminder and praise recall.
These strategies are proactively, strategically and intensively integrated into treatment-as-usual to support encoding.
Memory support is delivered alongside each 'treatment point', defined as a main idea, principle, or experience that the treatment provider wants the patient to remember or implement as part of the treatment.
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Comparateur actif: Cognitive Therapy-as-usual
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There is evidence that CT for major depressive disorder (MDD) can be as effective as antidepressant medication for the initial treatment of moderate to severe MDD.
Moreover, following the withdrawal of treatment, patients treated with CT are significantly less likely to relapse than patients treated with antidepressant medication and CT is at least as effective as antidepressant medication in preventing subsequent relapse.
CT aims to alter the symptomatic expression of depression and reduce risk for subsequent episodes by correcting the negative beliefs and maladaptive information processing presumed to underlie the disorder and alter the systematic tendency to misperceive reality in a pessimistic fashion.
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Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
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Remission
Délai: Post-Treatment which is two weeks after final therapy session (i.e. 18-20 weeks after initial intake interview)
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% Remission is defined as signs and symptoms must be absent or close to it for >=3 weeks and operationalized as IDS-SR less than 14.
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Post-Treatment which is two weeks after final therapy session (i.e. 18-20 weeks after initial intake interview)
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Relapse at 6 Months
Délai: Calculated at 6-months after the end of treatment [the end of treatment is defined as two weeks after the final therapy session (i.e. 18-20 weeks after the initial intake interview
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% Relapse is defined as 'return to an MDE following remission' and operationalized as greater than or equal to 14 on the IDS-SR at follow-up for those who had remitted.
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Calculated at 6-months after the end of treatment [the end of treatment is defined as two weeks after the final therapy session (i.e. 18-20 weeks after the initial intake interview
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Relapse at 12 Months
Délai: Calculated at 12 months after the end of treatment [the end of treatment is defined as two weeks after the final therapy session (i.e. 18-20 weeks after the initial intake interview
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% Relapse is defined as 'return to an MDE following remission' and operationalized as greater than or equal to 14 on the IDS-SR at follow-up for those who had remitted.
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Calculated at 12 months after the end of treatment [the end of treatment is defined as two weeks after the final therapy session (i.e. 18-20 weeks after the initial intake interview
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Functional Impairment
Délai: Change from pre-treatment to post-treatment defined as two weeks after the final therapy session (i.e. 18-20 weeks after the initial intake interview) to 6-month follow-up to 12-month follow-up
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WHODAS 2.0 total score
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Change from pre-treatment to post-treatment defined as two weeks after the final therapy session (i.e. 18-20 weeks after the initial intake interview) to 6-month follow-up to 12-month follow-up
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Patient Memory for Treatment
Délai: Week 4, Week 8, Week 12, Week 16 of treatment as well as Post Treatment, defined as two post-treatment defined as two weeks after the final therapy session (i.e. 18-20 weeks after the initial intake interview) to 6-month follow-up to 12-month follow-up
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Cumulative Recall on the Patient Treatment Recall Task
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Week 4, Week 8, Week 12, Week 16 of treatment as well as Post Treatment, defined as two post-treatment defined as two weeks after the final therapy session (i.e. 18-20 weeks after the initial intake interview) to 6-month follow-up to 12-month follow-up
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Generalization Task
Délai: Week 4, Week 8, Week 12, and Week 16 of treatment as well as Post Treatment, defined as two weeks after the final therapy session (i.e. 18-20 weeks after the initial intake interview) to 6-month follow-up to 12-month follow-up
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Week 4, Week 8, Week 12, and Week 16 of treatment as well as Post Treatment, defined as two weeks after the final therapy session (i.e. 18-20 weeks after the initial intake interview) to 6-month follow-up to 12-month follow-up
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Declarative Memory
Délai: Change from pre-treatment to post-treatment defined as two weeks after the final therapy session (i.e. 18-20 weeks after the initial intake interview) to 6-month follow-up to 12-month follow-up
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Hit Rate minus False Alarm Rate minus Lure Rate on the Episodic Face-Name Learning Task
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Change from pre-treatment to post-treatment defined as two weeks after the final therapy session (i.e. 18-20 weeks after the initial intake interview) to 6-month follow-up to 12-month follow-up
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Working Memory
Délai: Change from pre-treatment to post-treatment defined as two weeks after the final therapy session (i.e. 18-20 weeks after the initial intake interview) to 6-month follow-up to 12-month follow-up
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No. of correct hits minus the no. of false positives on 3-Back of the N-Back
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Change from pre-treatment to post-treatment defined as two weeks after the final therapy session (i.e. 18-20 weeks after the initial intake interview) to 6-month follow-up to 12-month follow-up
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Memory Support
Délai: 20-26 sessions of treatment (over 16 weeks) spanning 18-20 weeks after initial intake interview
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Total Amount on the Memory Support Rating Scale on randomly selected therapy tapes.
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20-26 sessions of treatment (over 16 weeks) spanning 18-20 weeks after initial intake interview
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Mesures de résultats secondaires
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
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Response to Treatment
Délai: Post-Treatment which is two weeks after final therapy session (i.e. 18-20 weeks after initial intake interview)
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% Response is defined as a clinically significant degree of symptom reduction and operationalized as 50% reduction in pre-treatment symptom severity on the IDS-SR.
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Post-Treatment which is two weeks after final therapy session (i.e. 18-20 weeks after initial intake interview)
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Magnitude of symptom change is operationalized as change on IDS-SR
Délai: Change from Pretreatment to Post-Treatment
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Change from Pretreatment to Post-Treatment
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Recovery
Délai: Calculated at 6-months and 12-months after the end of treatment [the end of treatment is defined as two weeks after the final therapy session (i.e. 18-20 weeks after the initial intake interview
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% Recovery is defined as 'remission sustained for >=4 months' and is operationalized via the LIFE.
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Calculated at 6-months and 12-months after the end of treatment [the end of treatment is defined as two weeks after the final therapy session (i.e. 18-20 weeks after the initial intake interview
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Recurrence
Délai: Calculated at 6-months and 12-months after the end of treatment [the end of treatment is defined as two weeks after the final therapy session (i.e. 18-20 weeks after the initial intake interview
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% Recurrence is defined as 'return to an MDE following recovery' and is established using the SCID.
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Calculated at 6-months and 12-months after the end of treatment [the end of treatment is defined as two weeks after the final therapy session (i.e. 18-20 weeks after the initial intake interview
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Time to relapse or recurrence
Délai: Calculated at 6-months and 12-months after the end of treatment [the end of treatment is defined as two weeks after the final therapy session (i.e. 18-20 weeks after the initial intake interview
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Time to relapse or recurrence following response or remission will be established using the SCID.
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Calculated at 6-months and 12-months after the end of treatment [the end of treatment is defined as two weeks after the final therapy session (i.e. 18-20 weeks after the initial intake interview
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Functional Impairment
Délai: Change from pre-treatment to post-treatment defined as two weeks after the final therapy session (i.e. 18-20 weeks after the initial intake interview) to 6-month follow-up to 12-month follow-up
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4-question Healthy Days core module
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Change from pre-treatment to post-treatment defined as two weeks after the final therapy session (i.e. 18-20 weeks after the initial intake interview) to 6-month follow-up to 12-month follow-up
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Patient Memory for Treatment
Délai: Change from pre-treatment to post-treatment defined as two weeks after the final therapy session (i.e. 18-20 weeks after the initial intake interview) to 6-month follow-up to 12-month follow-up
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Past Session Recall on the Patient Treatment Recall Task
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Change from pre-treatment to post-treatment defined as two weeks after the final therapy session (i.e. 18-20 weeks after the initial intake interview) to 6-month follow-up to 12-month follow-up
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Working Memory
Délai: Change from pre-treatment to post-treatment defined as two weeks after the final therapy session (i.e. 18-20 weeks after the initial intake interview) to 6-month follow-up to 12-month follow-up
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No. of correct hits minus the no. of false positives on 0-Back, 1-Back, 2-Back of the N-Back
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Change from pre-treatment to post-treatment defined as two weeks after the final therapy session (i.e. 18-20 weeks after the initial intake interview) to 6-month follow-up to 12-month follow-up
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Memory Support
Délai: 20-26 sessions of treatment (over 16 weeks) spanning 18-20 weeks after initial intake interview
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Number of Types on the Memory Support Rating Scale
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20-26 sessions of treatment (over 16 weeks) spanning 18-20 weeks after initial intake interview
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Competencies of Cognitive Therapy Scale (CCTS) (Exploratory)
Délai: Post Treatment, defined as two weeks after the final therapy session (i.e. 18-20 weeks after the initial intake interview), 6 month Follow-Up, 12 month Follow-Up
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Measure of patient competence at using cognitive therapy skills.
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Post Treatment, defined as two weeks after the final therapy session (i.e. 18-20 weeks after the initial intake interview), 6 month Follow-Up, 12 month Follow-Up
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Autres mesures de résultats
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
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Pre-Treatment Assessment Telephone Screen to determine Eligibility
Délai: Pre-Treatment
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Pre-Treatment
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Structure Clinical Interview for DSM-5 (SCID)
Délai: Pre-Treatment as well as Post Treatment, defined as two weeks after the final therapy session (i.e. 18-20 weeks after the initial intake interview), 6 month Follow-Up, 12 month Follow-Up
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Pre-Treatment as well as Post Treatment, defined as two weeks after the final therapy session (i.e. 18-20 weeks after the initial intake interview), 6 month Follow-Up, 12 month Follow-Up
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Quick Inventory for Depressive Symptomatology-Self-Report (QIDS)
Délai: At the beginning of every treatment session (i.e., for 18-20 weeks after the initial intake interview)
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At the beginning of every treatment session (i.e., for 18-20 weeks after the initial intake interview)
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IQ National Adult Reading Test (NART)
Délai: Pre-Treatment
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Pre-Treatment
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Treatment Provider Recall Task
Délai: Week 4, Week 8, Week 12, Week 16, and last session of treatment, defined as 16-18 weeks after the initial intake interview
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Week 4, Week 8, Week 12, Week 16, and last session of treatment, defined as 16-18 weeks after the initial intake interview
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Medication (medication type and dosage)
Délai: Duration of Study which is at the pre-treatment assessment, at the post-treatment which defined as two weeks after the final therapy session (i.e., 18-20 weeks after the initial intake interview), at the 6-month follow-up and at the 12-month follow-up.
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Duration of Study which is at the pre-treatment assessment, at the post-treatment which defined as two weeks after the final therapy session (i.e., 18-20 weeks after the initial intake interview), at the 6-month follow-up and at the 12-month follow-up.
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Other Treatment/Therapy Tracking Log (presence/absence)
Délai: Duration of Study which is at the pre-treatment assessment, at the post-treatment which defined as two weeks after the final therapy session (i.e., 18-20 weeks after the initial intake interview), at the 6-month follow-up and at the 12-month follow-up.
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Duration of Study which is at the pre-treatment assessment, at the post-treatment which defined as two weeks after the final therapy session (i.e., 18-20 weeks after the initial intake interview), at the 6-month follow-up and at the 12-month follow-up.
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Credibility/Expectancy Questionnaire (CEQ)
Délai: Treatment Week 2 and 2 weeks Post-Treatment, at the 6-month follow-up and at the 12-month follow-up
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Treatment Week 2 and 2 weeks Post-Treatment, at the 6-month follow-up and at the 12-month follow-up
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Patient usefulness and utilization of cognitive therapy skills scale (Exploratory)
Délai: 2 weeks post-treatment, 6-post-treatment, 6-month follow-up, and 12-month follow-up
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Measure completed by patients indicating how useful they found specific cognitive therapy skills, and how often they used each skill.
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2 weeks post-treatment, 6-post-treatment, 6-month follow-up, and 12-month follow-up
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Patient Conceptualization of Depression Task (Exploratory)
Délai: pre-treatment, post-treatment, 6-month follow-up
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pre-treatment, post-treatment, 6-month follow-up
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Treatment Adherence Rating Scale-Therapist Version
Délai: After each treatment session filled out by therapist (20-26 times)
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After each treatment session filled out by therapist (20-26 times)
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Memory Support Treatment Provider Checklist
Délai: After treatment sessions in weeks 4, 8, 12, and 16 filled out by therapist (4 times)
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After treatment sessions in weeks 4, 8, 12, and 16 filled out by therapist (4 times)
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Memory Support Rating Scale
Délai: Week 1, Week 4, Week 8, Week 12, Week 16 of treatment
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Week 1, Week 4, Week 8, Week 12, Week 16 of treatment
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Collaborateurs et enquêteurs
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Parrainer
Collaborateurs
Publications et liens utiles
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Dates d'enregistrement des études
Ces dates suivent la progression des dossiers d'étude et des soumissions de résultats sommaires à ClinicalTrials.gov. Les dossiers d'étude et les résultats rapportés sont examinés par la Bibliothèque nationale de médecine (NLM) pour s'assurer qu'ils répondent à des normes de contrôle de qualité spécifiques avant d'être publiés sur le site Web public.
Dates principales de l'étude
Début de l'étude
1 novembre 2016
Achèvement primaire (Réel)
5 août 2020
Achèvement de l'étude (Réel)
5 août 2020
Dates d'inscription aux études
Première soumission
6 octobre 2016
Première soumission répondant aux critères de contrôle qualité
17 octobre 2016
Première publication (Estimation)
19 octobre 2016
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Réel)
2 février 2021
Dernière mise à jour soumise répondant aux critères de contrôle qualité
28 janvier 2021
Dernière vérification
1 janvier 2021
Plus d'information
Termes liés à cette étude
Termes MeSH pertinents supplémentaires
Autres numéros d'identification d'étude
- R01MH108657 (Subvention/contrat des NIH des États-Unis)
Ces informations ont été extraites directement du site Web clinicaltrials.gov sans aucune modification. Si vous avez des demandes de modification, de suppression ou de mise à jour des détails de votre étude, veuillez contacter register@clinicaltrials.gov. Dès qu'un changement est mis en œuvre sur clinicaltrials.gov, il sera également mis à jour automatiquement sur notre site Web .