Cognitive remediation therapy for patients with depression

抑郁症是导致长期残疾的主要原因之一，给个人、患者和社会带来了高昂的代价。除了疾病严重程度本身，认知障碍对严重抑郁症的一般功能也起着关键作用，因为即使在其他精神病理症状缓解后，认知障碍也可能持续存在。因此，认知补救疗法(CRT)作为抑郁症患者的一种重要治疗干预手段越来越受到人们的关注。到目前为止，只有很少的实证研究调查认知补救对伴有持续性认知缺陷的MDD患者的有效性。因此，这项研究的主要目的是检验认知训练对那些急性抑郁症状缓解但仍存在认知缺陷的MDD患者的有效性。与被动控制条件相比，认知训练有望显著改善神经心理功能。此外，对于一般的精神病患者来说，CRT现有的积极结果源于一系列不同的训练设计，这使得最佳设计成为一个相当有争议的问题。几位作者强调了个性化CRT的必要性，以增加对认知、动机和迁移到现实世界情景的影响。这种方法与面向广泛功能的通用培训计划形成了鲜明对比。然而，到目前为止，还没有对个性化培训计划和通用培训计划进行直接比较。因此，在本研究中，既使用了个别化的训练方法，也使用了泛化的训练方法，并在探索性水平上进行了比较。6个月随访的长期干预效果以及对心理社会功能的影响也将在探索性水平上进行调查。此外，将采用静息状态和基于任务的功能磁共振成像方案相结合的方法来研究患者与治疗相关的神经功能适应性变化。将调查特定区域大脑激活的变化和功能网络连接的变化。

Depression is one of the major causes of long-term disability at a high cost for the individual patient and society. Beside illness severity itself, cognitive impairment plays a critical role for general functioning in major depression as it may persist even after remission of other psychopathological symptoms. Therefore, Cognitive Remediation Therapy (CRT) is increasingly discussed as an important therapeutic intervention for depressed patients. Up to now, only few empirical studies investigated the usefulness of cognitive remediation in MDD patients with persistent cognitive deficits. For this reason, the main goal of this study is to examine the effectiveness of cognitive training in those MDD patients who suffer from cognitive deficits despite remission of acute depressive symptoms. It is expected that cognitive training significantly improves neuropsychological functioning in comparison to the passive control condition. Furthermore, for psychiatric patients in general the existing positive findings of CRT stem from a wide array of different training designs, which render the optimal design a matter of considerable debate. Several authors have emphasized the need to individualize CRT in order to increase effects on cognition, motivation and transfer to real-world situations. This approach contrasts with generic training programs, which target a broad set of functions. However, no direct comparison between individualized and generic training programs has been conducted so far. Therefore, in the present study, both an individualized as well as a generalized training approach will be used and compared on an exploratory level. Long term effects of the intervention at 6-month follow-up as well as effects on psychosocial functioning will also be investigated on an exploratory level.Moreover, a combined resting-state and task-based functional magnetic resonance imaging protocol will be employed to investigate treatment-related adaptive changes of neural function in patients. Both regional specific brain activation changes and changes of functional network connectivity will be investigated.