Memory Flexibility training (MemFlex) to reduce depressive symptomatology in individuals with major depressive disorder: study protocol for a randomised controlled trial

Caitlin Hitchcock, Emily Hammond, Catrin Rees, Inderpal Panesar, Peter Watson, Aliza Werner-Seidler, Tim Dalgleish, Caitlin Hitchcock, Emily Hammond, Catrin Rees, Inderpal Panesar, Peter Watson, Aliza Werner-Seidler, Tim Dalgleish

Abstract

Background: Major depressive disorder (MDD) is associated with chronic biases in the allocation of attention and recollection of personal memories. Impaired flexibility in attention and autobiographical memory retrieval is seen to both maintain current symptoms and predict future depression. Development of innovative interventions to reduce maladaptive cognitive patterns and improve cognitive flexibility in the domain of memory may therefore advance current treatment approaches for depression. Memory specificity training and cognitive bias modification techniques have both shown some promise in improving cognitive flexibility. Here we outline plans for a trial of an innovative memory flexibility training programme, MemFlex, which advances current training techniques with the aim of improving flexibility of autobiographical memory retrieval. This trial seeks to estimate the efficacy of MemFlex, provide data on feasibility, and begin to explore mechanisms of change.

Methods/design: We plan a single-blind, randomised, controlled, patient-level trial in which 50 individuals with MDD will complete either psychoeducation (n = 25) or MemFlex (n = 25). After completing pre-treatment measures and an orientation session, participants complete eight workbook-based sessions at home. Participants will then be assessed at post-treatment and at 3 month follow-up. The co-primary outcomes are depressive symptoms and diagnostic status at 3 month follow-up. The secondary outcomes are memory flexibility at post-treatment and number of depression free days at 3 month follow-up. Other process outcomes and mediators of any treatment effects will also be explored.

Discussion: This trial will establish the efficacy of MemFlex in improving memory flexibility, and reducing depressive symptoms. Any effects on process measures related to relapse may also indicate whether MemFlex may be helpful in reducing vulnerability to future depressive episodes. The low-intensity and workbook-based format of the programme may improve access to psychological therapies, and, if encouraging, the results of this study will provide a platform for later-phase trials.

Trial registration: NCT02371291 (ClinicalTrials.gov), registered 9 February 2015.

Figures

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CONSORT diagram

References

    1. Judd LL. The clinical course of unipolar major depressive disorders. Arch Gen Psychiatry. 1997;54(11):989–91. doi: 10.1001/archpsyc.1997.01830230015002.
    1. Association AP. Diagnostic and statistical manual of mental disorders. 5. Washington, DC: Author; 2013.
    1. Gotlib IH, Joormann J. Cognition and depression: current status and future directions. Annu Rev Clin Psychol. 2010;6:285. doi: 10.1146/annurev.clinpsy.121208.131305.
    1. Williams JMG, Barnhofer T, Crane C, Herman D, Raes F, Watkins E, et al. Autobiographical memory specificity and emotional disorder. Psychol Bull. 2007;133(1):122. doi: 10.1037/0033-2909.133.1.122.
    1. Dalgleish T, Werner-Seidler A. Disruptions in autobiographical memory processing in depression and the emergence of memory therapeutics. Trends Cogn Sci. 2014;18(11):596–604. doi: 10.1016/j.tics.2014.06.010.
    1. Mathews A, MacLeod C. Cognitive vulnerability to emotional disorders. Annu Rev Clin Psychol. 2005;1(1):167–95. doi: 10.1146/annurev.clinpsy.1.102803.143916.
    1. Kashdan TB, Rottenberg J. Psychological flexibility as a fundamental aspect of health. Clin Psychol Rev. 2010;30(7):865–78. doi: 10.1016/j.cpr.2010.03.001.
    1. Joormann J. Cognitive inhibition and emotion regulation in depression. Curr Dir Psychol Sci. 2010;19(3):161–6. doi: 10.1177/0963721410370293.
    1. Beck AT. Depression: clinical, experimental, and theoretical aspects. New York, United States of America: Hoeber Medical Division, Harper & Row; 1967.
    1. Alloy LB, Abramson LY, Hogan ME, Whitehouse WG, Rose DT, Robinson MS, et al. The temple-wisconsin cognitive vulnerability to depression project: lifetime history of Axis I psychopathology in individuals at high and low cognitive risk for depression. J Abnorm Psychol. 2000;109(3):403–18. doi: 10.1037/0021-843X.109.3.403.
    1. Dritschel B, Beltsos S, McClintock SM. An “alternating instructions” version of the Autobiographical Memory Test for assessing autobiographical memory specificity in non-clinical populations. Memory. 2013;22(8):881–9. doi: 10.1080/09658211.2013.839710.
    1. Matt GE, Vázquez C, Campbell WK. Mood-congruent recall of affectively toned stimuli: a meta-analytic review. Clin Psychol Rev. 1992;12(2):227–55. doi: 10.1016/0272-7358(92)90116-P.
    1. Joormann J, Gotlib IH. Selective attention to emotional faces following recovery from depression. J Abnorm Psychol. 2007;116(1):80–5. doi: 10.1037/0021-843X.116.1.80.
    1. Hallion LS, Ruscio AM. A meta-analysis of the effect of cognitive bias modification on anxiety and depression. Psychol Bull. 2011;137(6):940. doi: 10.1037/a0024355.
    1. See J, MacLeod C, Bridle R. The reduction of anxiety vulnerability through the modification of attentional bias: a real-world study using a home-based cognitive bias modification procedure. J Abnorm Psychol. 2009;118(1):65. doi: 10.1037/a0014377.
    1. Sumner JA, Griffith JW, Mineka S. Overgeneral autobiographical memory as a predictor of the course of depression: a meta-analysis. Behav Res Ther. 2010;48(7):614–25. doi: 10.1016/j.brat.2010.03.013.
    1. Sutherland K, Bryant RA. Social problem solving and autobiographical memory in posttraumatic stress disorder. Behav Res Ther. 2008;46(1):154–61. doi: 10.1016/j.brat.2007.10.005.
    1. Kleim B, Graham B, Fihosy S, Stott R, Ehlers A. Reduced specificity in episodic future thinking in posttraumatic stress disorder. Clin Psychol Sci. 2014;2(2):165–73. doi: 10.1177/2167702613495199.
    1. Raes F, Williams JMG, Hermans D. Reducing cognitive vulnerability to depression: a preliminary investigation of MEmory Specificity Training (MEST) in inpatients with depressive symptomatology. J Behav Ther Exp Psychiatry. 2009;40(1):24–38. doi: 10.1016/j.jbtep.2008.03.001.
    1. Neshat-Doost HT, Dalgleish T, Yule W, Kalantari M, Ahmadi SJ, Dyregrov A, et al. Enhancing autobiographical memory specificity through cognitive training: an intervention for depression translated from basic science. Clin Psychol Sci. 2013;1(1):84–92. doi: 10.1177/2167702612454613.
    1. Moradi AR, Moshirpanahi S, Parhon H, Mirzaei J, Dalgleish T, Jobson L. A pilot randomized controlled trial investigating the efficacy of MEmory Specificity Training in improving symptoms of posttraumatic stress disorder. Behav Res Ther. 2014;56:68–74. doi: 10.1016/j.brat.2014.03.002.
    1. Dalgleish T, Bevan A, McKinnon A, Breakwell L, Mueller V, Chadwick I, et al. A comparison of MEmory Specificity Training (MEST) to education and support (ES) in the treatment of recurrent depression: study protocol for a cluster randomised controlled trial. Trials. 2014;15(1):293. doi: 10.1186/1745-6215-15-293.
    1. Werner-Seidler A, Moulds ML. Autobiographical memory characteristics in depression vulnerability: formerly depressed individuals recall less vivid positive memories. Cognition Emotion. 2011;25(6):1087–103. doi: 10.1080/02699931.2010.531007.
    1. Werner-Seidler A, Moulds ML. Characteristics of self-defining memory in depression vulnerability. Memory. 2012;20(8):935–48. doi: 10.1080/09658211.2012.712702.
    1. Joormann J, Siemer M. Memory accessibility, mood regulation, and dysphoria: difficulties in repairing sad mood with happy memories? J Abnorm Psychol. 2004;113(2):179. doi: 10.1037/0021-843X.113.2.179.
    1. Joormann J, Siemer M, Gotlib IH. Mood regulation in depression: differential effects of distraction and recall of happy memories on sad mood. J Abnorm Psychol. 2007;116(3):484. doi: 10.1037/0021-843X.116.3.484.
    1. Rusting CL, DeHart T. Retrieving positive memories to regulate negative mood: consequences for mood-congruent memory. J Pers Soc Psychol. 2000;78(4):737–52. doi: 10.1037/0022-3514.78.4.737.
    1. Watkins ER, Baeyens CB, Read R. Concreteness training reduces dysphoria: proof-of-principle for repeated cognitive bias modification in depression. J Abnorm Psychol. 2009;118(1):55. doi: 10.1037/a0013642.
    1. Watkins E, Taylor R, Byng R, Baeyens C, Read R, Pearson K, et al. Guided self-help concreteness training as an intervention for major depression in primary care: a Phase II randomized controlled trial. Psychol Med. 2012;42(7):1359. doi: 10.1017/S0033291711002480.
    1. Dalgleish T, Navrady L, Bird E, Hill E, Dunn BD, Golden A-M. Method-of-Loci as a mnemonic device to facilitate access to self-affirming personal memories for individuals with depression. Clin Psychol Sci. 2013;1(2):156–62. doi: 10.1177/2167702612468111.
    1. First M, Spitzer R, Gibbons M, Williams J. Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-IV) Washington, DC: American Psychiatric Press; 1996.
    1. Williams JM, Broadbent K. Autobiographical memory in suicide attempters. J Abnorm Psychol. 1986;95(2):144. doi: 10.1037/0021-843X.95.2.144.
    1. Sumner JA. The mechanisms underlying overgeneral autobiographical memory: an evaluative review of evidence for the CaR-FA-X model. Clin Psychol Rev. 2012;32(1):34–48. doi: 10.1016/j.cpr.2011.10.003.
    1. Lyubomirsky S, Nolen-Hoeksema S. Effects of self-focused rumination on negative thinking and interpersonal problem solving. J Pers Soc Psychol. 1995;69(1):176–90. doi: 10.1037/0022-3514.69.1.176.
    1. Treynor W, Gonzalez R, Nolen-Hoeksema S. Rumination reconsidered: a psychometric analysis. Cogn Ther Res. 2003;27(3):247–59. doi: 10.1023/A:1023910315561.
    1. Sexton KA, Dugas MJ. The cognitive avoidance questionnaire: validation of the English translation. J Anxiety Disord. 2008;22(3):355–70. doi: 10.1016/j.janxdis.2007.04.005.
    1. Tombaugh TN, Kozak J, Rees L. Normative data stratified by age and education for two measures of verbal fluency: FAS and animal naming. Arch Clin Neuropsychol. 1999;14:167–77.
    1. Hayes AF. Introduction to mediation, moderation, and conditional process analysis: a regression-based approach. New York, United States of America: Guilford Press; 2013.

Source: PubMed

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