Gamification improves antidepressant effects of cognitive control training-A pilot trial

Simone Weller, Philipp A Schroeder, Christian Plewnia, Simone Weller, Philipp A Schroeder, Christian Plewnia

Abstract

Objective: Computerised cognitive trainings have been put forward to improve control over negatively biased information processing and associated depressive symptomatology. Yet, disease-related impairments of motivation and endurance, as well as insufficient accessibility hinder use of this promising therapeutic opportunity. Here, we developed an app (de:)press© ) that utilizes a cognitive control training (paced auditory serial addition task) enriched with gamification and information elements. We compared a six-week training with de:)press© to a non-gamified version (active control group).

Methods: Thirty-two depressed participants were included. Each received either de:)press© or the non-gamified version and was instructed to train three times per week for two weeks. Afterwards (four weeks) they were free to train at their own discretion. Depression severity was assessed during training and two follow-up sessions. Primary endpoint was defined as difference between groups [change of Montgomery-Åsberg Depression Rating Scale (MADRS)] four weeks after end of training.

Results: Depression severity decreased in both groups. At primary endpoint, MADRS scores were significantly lower in the de:)press© -group compared to the control group. No differences were observed at three months' follow-up. Intervention usability was consistently rated positively. Participants who had trained with de:)press© maintained the recommended training frequency without further prompting. Besides transient fatigue or frustration, no adverse effects were observed.

Conclusion: This pilot demonstrates that gamification and information elements can substantially increase cognitive control training efficacy in alleviating depressive symptoms. Moreover, it provides first evidence for the feasibility and efficacy of de:)press© as an add-on intervention to treat depression.

Clinical trial registration: The study is registered under ClinicalTrials.gov, identifier: NCT04400162.

Keywords: APP; cognitive control; cognitive control training; depression; digital intervention; gamification.

Conflict of interest statement

SW and CP are founders, associates, and chief executive officer (CP) of PsyKit GmbH. The company was founded after data collection of the study had finished and to allow certification of de:)press© as a medical device. PAS does not have any conflicts of interest to declare.

© 2022 Weller, Schroeder and Plewnia.

Figures

Figure 1
Figure 1
Visual representation of the PASAT. Participants heard single digit numbers (here shown in speech bubbles) from the tablet's speakers and were asked to add the last digit to the second-to-last digit (e.g., digits at timepoints A + B, B + C, C + D, and so forth). Numbers were presented with an initial interval of 3 s. Answers were then given on the keyboard. For correct answers the screen briefly flashed green, for wrong answers the screen flashed red and then immediately return to a dark background. This feedback was given concurrently to the following digit presentation (e.g., green feedback at E refers to the correct result given for the addition of C + D).
Figure 2
Figure 2
Screenshots from the IG app. (A) Login screen. (B) Training hub, from which participants were able to chose which area of the app they wanted to explore. (C) Introduction and instructions for the training. Furthermore, psychoeducative information was provided. (D) Keyboard layout during training. This layout shows the first level with an ascending button layout. (E) Progression graph that shows the number of correct responses within each training session (“highscore”). (F) Achievements that can be unlocked during training. In this screenshot no achievements have been unlocked yet. The CG app consisted of screens A (without avatars), (C,D).
Figure 3
Figure 3
Study timeline showing the content of each session.
Figure 4
Figure 4
Development of the MARDS scores over the course of the study. Depicted are means and standard deviations (SD). Participants of the IG showed significantly higher improvement in the reduction of depression scores up until 4 weeks after the end of the training (t4).
Figure 5
Figure 5
Development of the IDS-SR scores over the course of the study. Depicted are means and standard deviations (SD).
Figure 6
Figure 6
Development of the WHO5 scores over the course of the study. Depicted are means and standard deviations (SD).

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