Improving Depression Outcome by Enhancing Memory for Cognitive Therapy

摘要 在开发有效的精神障碍干预措施方面取得的进展必须包括确定新的 安全、强大、廉价和可部署的干预目标。我们的重点是一个这样的目标-- 以患者记忆为治疗内容。之所以选择这个目标是因为：(1)患者的记忆 治疗效果差；(2)记忆力差与治疗依从性差、疗效差相关；(3)记忆力差 使用记忆支持策略可以最大限度地减少记忆损伤的影响，并且(4)改进了 用于治疗的记忆改善了结果。在这项提议中，我们建立在NIMH资助的R34的基础上，结果是 这提供了新目标已被使用和验证的初步证明。具体来说， 我们开发并试行了一种辅助干预--记忆支持干预--以改善 用于治疗的病人记忆。这项干预是从基础的、非患者的认知研究中提炼出来的 科学和教育是由八个强有力的记忆促进战略组成的，这些战略是积极主动的， 在战略上，并密集地融入照常治疗。这项提案的目的是进行一项 验证性疗效试验，以测试记忆支持干预是否改善病程和 功能结果。作为下一步研究这一方法的平台，我们将重点放在主要 抑郁障碍(MDD)和认知治疗(CT)。其基本原理是：(1)MDD流行；(2)存在 需要改进MDD的治疗；(3)MDD的CT表现良好，有很有希望的证据表明 疗效，但仍有改善空间；(4)治疗记忆力差；(5)记忆力较差 MDD是可修改的，(6)来自R34的有希望的数据表明，向CT添加内存支持可以提高 结果，明确表明年龄在16岁以下的个人将获得更长期的好处。 教育。在四年的时间里，患有MDD的成年人(n=178，包括20%的潜在自然减员)将 随机分配到CT+内存支持或CT照常，他们将在基线、后 治疗后分别进行6个月和12个月的随访。我们将比较CT+记忆支持和CT-AS-AS的效果。 通常用于确定新的干预措施是否改善病程和减少功能障碍 (目标1)。我们将确定患者的治疗记忆(靶点)是否在 治疗条件和结果(目标2)。我们将评估之前报告的治疗反应是否较差 亚组适度目标投入(目标3)。这项研究有可能在以下方面提高结果 广泛的干预措施。具有以社区为基础的治疗和医患关系方面的专业知识的顾问 沟通将帮助团队开始开发更广泛的应用程序。这项研究将对 将RDoC知识作为与认知系统RDoC领域相关的交叉诊断结构--贫乏 为了治疗而记忆--是干预的目标。还有陈述性记忆和工作记忆，它们是 将测量认知系统RDoC领域中的构造。

Abstract Progress toward developing effective interventions for mental disorders must include the identification of novel intervention targets that are safe, powerful, inexpensive and deployable. Our focus is on one such target— patient memory for the contents of treatment. This target was selected because: (1) patient memory for treatment is poor, (2) poor memory for treatment is associated poorer adherence and poorer outcome, (3) the impact of memory impairment can be minimized by the use of memory support strategies and (4) improved memory for treatment improves outcome. In this proposal we build on an NIMH-funded R34, the results of which provide a preliminary demonstration that the novel target has been engaged and validated. Specifically, we developed and pilot tested an adjunctive intervention—the Memory Support Intervention—to improve patient memory for treatment. The intervention was distilled from the basic, non-patient research in cognitive science and education and is comprised of eight powerful memory promoting strategies that are proactively, strategically, and intensively integrated into treatment-as-usual. The aim of this proposal is to conduct a confirmatory efficacy trial to test whether the Memory Support Intervention improves illness course and functional outcomes. As a `platform' for the next step in investigating this approach, we focus on major depressive disorder (MDD) and cognitive therapy (CT). The rationale is that: (1) MDD is prevalent; (2) there is a need to improve treatment for MDD; (3) CT for MDD is well articulated, there is promising evidence for efficacy, yet there is room for improvement; (4) memory for treatment is poor in MDD; (5) poorer memory in MDD is modifiable and (6) promising data from the R34 suggests that adding memory support to CT improves outcome, with a specific indication of longer-term benefit among individuals with less than 16 years of education. Over a four-year period, adults with MDD (n = 178, including 20% for potential attrition) will be randomly allocated to CT+Memory Support or CT-as-usual and they will be assessed at baseline, post- treatment, and at 6 and 12 months follow-up. We will compare the effects of CT+Memory Support vs. CT-as- usual to determine if the new intervention improves the course of illness and reduces functional impairment (Aim 1). We will determine if patient memory for treatment (the target) mediates the relationship between treatment condition and outcome (Aim 2). We will evaluate if previously reported poor treatment response subgroups moderate target engagement (Aim 3). This research has the potential to enhance outcomes across a broad range of interventions. Consultants with expertise in community-based treatment and doctor-patient communication will assist the team to begin to develop the broader applications. This research will contribute knowledge to RDoC as a cross-diagnostic construct related to the Cognitive Systems RDoC domain—poor memory for treatment—is the intervention target. Also, declarative memory and working memory, which are constructs within the Cognitive Systems RDoC domain, will be measured.