Improving Depression Outcome by Enhancing Memory for Cognitive Therapy

描述（由申请人提供）：重度抑郁症（MDD）是最常见的精神疾病之一，也是全球残疾的主要原因。现有的治疗方法不能产生完全恢复。改善结果的进展必须包括安全、强大、廉价和简单的创新（以便快速有效地传播）。这项拟议中的研究旨在测试这样一种创新。我们寻求通过改善认知治疗（CT）会话内容的记忆来改善结果。CT是治疗MDD最有前途的方法之一，但仍有改进的余地。我们认为，在CT中加入记忆增强策略可能会改善MDD的结局，因为：（a）MDD通常以记忆障碍为特征，（B）有证据表明记忆障碍是可改变的，（c）CT通常需要激活情绪，（d）情绪会损害或偏向记忆，（e）有证据表明治疗会话内容的记忆较差。瞄准评价增加一种源自记忆文献并旨在增强对CT会话内容的记忆的新策略是否会改善MDD的治疗结局。认知支持涉及一系列支持情景记忆编码和提取阶段的特定程序。假设CT+认知支持相对于常规CT，将与治疗结束时和治疗完成后6个月的抑郁结局改善相关。研究计划。第1阶段涉及通过测试MDD成人（n = 8）的治疗来开发和完善认知支持干预的迭代过程。在II期研究中，将对MDD成人患者（n = 48）进行一项小型初探性可行性RCT，这些患者将随机接受：（a）CT+认知支持（n = 24）或（B）CT常规治疗（n = 24）。将在基线、治疗结束和治疗后6个月进行结局测量。长期目标。如果结果是积极的，将有重大的公共卫生影响，因为简单，廉价的记忆增强策略可以很容易地作为一个标准的功能，在所有的心理社会治疗范围广泛的精神疾病。作为实现这一目标的第一步，本研究将提供准备更大规模干预研究所需的试点数据，重点是通过改善MDD治疗会话内容的记忆来改善结局。

DESCRIPTION (provided by applicant): Major depressive disorder (MDD) is one of the most prevalent psychiatric disorders and a leading cause of disability worldwide. Existing therapies fail to produce complete recovery. Progress toward improving outcome must include innovations that are safe, powerful, inexpensive and simple (for fast and effective dissemination). The proposed research seeks to test one such innovation. We seek to improve outcome by improving memory for the content of cognitive therapy (CT) sessions. CT is one of the most promising approaches to the treatment of MDD, yet there is room for improvement. We believe that adding memory enhancing strategies to CT may improve MDD outcome because: (a) MDD is often characterized by memory impairment, (b) there is evidence that the memory impairment is modifiable, (c) CT typically entails the activation of emotion, (d) emotion can impair or bias memory and (e) there is evidence that memory for the content of therapy sessions is poor. Aim. To evaluate if the addition of a novel strategy, derived from the memory literature and designed to enhance memory for the content of CT sessions, will improve treatment outcome for MDD. Cognitive support involves a series of specific procedures that support the encoding and retrieval stages of an episodic memory. It is hypothesized that CT+Cognitive Support, relative to CT-as-usual, will be associated with improved depression outcome at the end of treatment and 6 months after the completion of treatment. Research Plan. Phase 1 involves an iterative process of developing and refining the cognitive support intervention by testing the treatment with adults with MDD (n = 8). In Phase 2, a small pilot feasibility RCT will be conducted on adults with MDD (n = 48) who will be randomized to either: (a) CT+Cognitive Support (n = 24) or (b) CT-as-usual (n = 24). Outcome measures will be taken at baseline, end of treatment, and 6 months after treatment. Long-term objective. The outcomes, if positive, will have major public health implications because simple, inexpensive memory enhancing strategies can be readily included as a standard feature in all psychosocial treatments for a broad range of mental illness. As a first step toward achieving this goal, this research will provide the pilot data needed to prepare a larger scale intervention study focused on improving outcomes by improving memory for the content of therapy sessions in MDD.