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

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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.