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

抑郁症是导致残疾的主要原因，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存在困难，这些复杂的谈话疗法需要家庭作业，并积极改变一个人的行为和常规，如认知行为疗法(CBT)。后者很难做到，尤其是当感觉到更明显的抑郁程度时。这里提出的项目的目的是为由于标准治疗的限制而不参与或脱离现有心理健康服务的大量人开发一种新的心理治疗。使用简单的自我指导策略，可以很容易地在日常基础上实施，有望满足对药物副作用敏感、不想依赖他人的人的需求，以及那些症状使他们无法按照标准心理疗法的在线版本进行主动行为改变的人的需求。我们的项目提案建立在证据的基础上，即扭曲的个人记忆在解释抑郁症的两个关键症状方面发挥着重要作用：期待积极经历的能力减弱和自我价值感减弱。这项提议的新疗法结合了之前的两种疗法，这两种疗法使抑郁症患者能够通过1)训练积极经历的记忆灵活性和2)处理与自责相关的记忆来解决记忆扭曲问题。这两种方法在我们之前的试点试验中都显示了有希望的结果，但它们使用在线会话和可以在人们的手机上访问的应用程序的交付，以及它们在8周内组合成一个疗程的情况还没有得到调查。目前的建议开发了这种新的心理疗法，并随后在临床试验中测试其可行性，将新疗法与英国国家医疗服务体系目前提供的标准计算机化CBT进行比较。我们最近完成了对严重抑郁症患者的试点试验，在未受过培训的心理学家的监督下，使用了简单的自我引导记忆重新解释和记忆灵活性策略。在这里，我们将调查是否可行以联合和完全远程的方式提供这些治疗，并通过扩展的基于网络的精神健康平台来加强日常实施，我们的合作者开发了该平台，以遏制巴西大流行相关的抑郁症治疗需求的增加。在开发了我们的联合心理治疗的在线版本后，我们提议招募86名目前患有严重抑郁症且没有双相情感障碍的人。他们将被随机分配到两种在线治疗中的任何一种：1)每周8次基于互联网的标准CBT课程，或2)5周的记忆灵活性培训，然后是3周的自责记忆重新解读，两者都整合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。这将使我们能够为一项大型试验申请资金，为我们的新疗法提供明确的证据。这是朝着我们的长期目标迈出的不可或缺的一步，我们的目标是为那些我们无法在标准治疗方面提供帮助的人提供新的、负担得起的和广泛可用的替代疗法。

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.