Memory Reshaping for Depression: A Remote Digital Randomised Controlled Feasibility Trial

抑郁症是残疾的主要原因，主要是因为大多数抑郁症患者要么没有从标准治疗中受益，要么觉得标准治疗不适合他们。重要的原因是许多人对依赖药物、药物副作用或积极参与复杂的谈话疗法的困难感到复杂，这些疗法需要家庭作业并积极改变一个人的行为和惯例，如认知行为疗法（CBT）。后者很难做到，特别是当感觉更明显的抑郁水平。这里提出的项目的目的是开发一种新的心理治疗方法，用于大量由于标准治疗的局限性而不参与或脱离目前可用的心理健康服务的人。使用简单的自我指导策略，可以很容易地在日常的基础上实施，有希望满足那些对药物副作用敏感和不想依赖他人的人的需求，以及那些症状阻止他们参与积极的行为改变的人，即使是标准心理治疗的在线版本也是如此。我们的项目提案建立在扭曲的个人记忆在其中起作用的证据之上。在解释抑郁症的两个关键症状方面发挥了重要作用：期待积极体验的能力下降和自我感觉丧失。这种新的治疗方法结合了以前的两种治疗方法，使抑郁症患者能够通过以下方式来解决记忆扭曲：1）训练记忆灵活性以获得积极的体验，2）处理与自责相关的记忆。这两种方法在我们之前的试点试验中都显示出了有希望的结果，但是使用在线会话和可以在人们的移动的手机上访问的应用程序以及它们在8周内组合成一个疗程的方法尚未被研究。目前的建议开发这种新的心理治疗，并随后测试其可行性，在临床试验中比较新的治疗与标准的计算机化的CBT，目前可在英国国家卫生服务中心。我们最近完成的试点试验中的人与重性抑郁症使用简单的自我引导的记忆重新解释和记忆灵活性策略的监督下，一个未经训练的心理学家。在这里，我们将研究是否可以以一种组合和完全远程的方式提供这些治疗，并通过一个扩展的基于网络的心理健康平台来加强其日常实施，我们的合作者已经开发了这个平台，以阻止巴西与流行病相关的抑郁症治疗需求的增加。在开发了我们的综合心理治疗的在线版本之后，我们计划招募86名目前患有严重抑郁症但没有躁郁症的人。他们将被随机分配到两种类型的在线治疗中的任何一种：1）8周标准的基于互联网的CBT课程，或2）5周的记忆灵活性训练，随后是3周的自责记忆重新解释，两者都集成到我们的基于网络的应用程序中。这个项目将使我们能够确定我们提出的治疗和心理健康应用程序是否有潜力在未来有用。这将使我们能够申请大型试验的资金，为我们的新疗法提供明确的证据。这是实现我们长期目标的不可或缺的一步，即为那些我们无法通过标准治疗提供帮助的人提供新型、负担得起且广泛可用的替代治疗。

Depression is a leading cause of disability, mainly because most people with depression are either not benefitting from standard treatments or feel that standard treatments are not suitable for them. Important reasons are many people's mixed feelings about relying on medication, medication side effects, or difficulties in actively engaging in complex talking therapies which require homework and actively changing one's behaviour and routines, such as cognitive behavioural therapy (CBT). The latter is very difficult to do particularly when feeling more marked levels of depression. The aim of the project proposed here is to develop a novel psychological treatment for the large number of people who either do not engage with or disengage from currently available mental health services due to the limitations of standard treatments. Using simple self-guided strategies which can be easily implemented on a day-to-day basis is promising to meet the needs of people who are sensitive to medication side effects and who do not want to depend on others, as well as those whose symptoms prevent them from engaging in active behaviour change as required even by online versions of standard psychotherapies.Our project proposal builds on evidence that distorted personal memories play an important role in explaining two key symptoms of depression: a diminished ability to look forward to positive experiences and feelings of self-worthlessness. The proposed novel treatment combines two previous treatments, which empower people with depression to tackle their memory distortions by 1) training memory flexibility for positive experiences, and 2) tackling self-blame-related memories. Both approaches have shown promising results in our previous pilot trials, but their delivery using online sessions and an app which can be accessed on people's mobile phones, as well as their combination into one course of treatment over 8 weeks has not been investigated. The current proposal develops this novel psychological treatment and subsequently tests its feasibility in a clinical trial comparing the novel treatment with a standard computerised CBT as currently available in the UK National Health Service.Our recently completed pilot trials in people with major depression used simple self-guided memory re-interpretation and memory flexibility strategies under supervision of a non-trained psychologist. Here, we will investigate whether it is feasible to deliver these treatments in a combined and fully remote way and to enhance their day-to-day implementation with an extended web-based mental health platform, which our collaborators have developed to stem the pandemic-related increase in demand for depression treatments in Brazil.After developing an online version of our combined psychological treatment, we propose to recruit 86 people with current major depression and no bipolar disorder. They will be randomly allocated to either of two types of online treatment: 1) 8 weekly standard internet-based CBT sessions, or 2) 5 weeks of memory flexibility training, followed by 3 weeks of self-blame memory re-interpretation, both integrated into our web-based app.This project will allow us to determine whether our proposed treatment and mental health app has the potential to be useful in the future. This would enable us to apply for funding for a large trial to provide clear evidence for our novel treatment. This is an indispensable step towards our long-term goal of delivering novel affordable and widely available alternative treatments for those who we cannot help with standard treatments.