Improving Depression Outcome by Enhancing Memory for Cognitive Therapy

This study is ongoing, but not recruiting participants.
Sponsor:
Collaborators:
Vanderbilt University
Information provided by (Responsible Party):
Allison Harvey, University of California, Berkeley
ClinicalTrials.gov Identifier:
NCT01790919
First received: February 6, 2013
Last updated: March 6, 2014
Last verified: March 2014
  Purpose

Existing drug and talking therapies for major depressive disorder (MDD) fail to produce complete recovery. This study will determine if substantial improvements to one of the most promising therapies, cognitive therapy (CT), can be achieved by administering a carefully designed procedure to improve memory for the content of CT sessions. This is important because (a) memory deficits are common in MDD patients and (b) each CT therapy session typically covers a complex array of topics and various skills are taught.


Condition Intervention Phase
Major Depressive Disorder (MDD)
Behavioral: Cognitive therapy for depression
Phase 2

Study Type: Interventional
Study Design: Allocation: Randomized
Endpoint Classification: Efficacy Study
Intervention Model: Parallel Assignment
Masking: Double Blind (Subject, Outcomes Assessor)
Primary Purpose: Treatment
Official Title: Improving Depression Outcome by Enhancing Memory for Cognitive Therapy

Resource links provided by NLM:


Further study details as provided by University of California, Berkeley:

Primary Outcome Measures:
  • Inventory of Depressive Symptomatology (IDS) [ Time Frame: Change in IDS scores from pre-treatment to post-treatment (defined as within 2 weeks of completing the course of treatment, which is 14 sessions) ] [ Designated as safety issue: Yes ]
  • Longitudinal Interval Followup Evaluation (LIFE) [ Time Frame: 6 months ] [ Designated as safety issue: Yes ]
    Time to relapse


Other Outcome Measures:
  • Structured Clinical Interview for DSM-IV (SCID) [ Time Frame: Pre-treatment; Within 2 weeks of completing the course of treatment (14 sessions); 6 month followup ] [ Designated as safety issue: No ]
  • Longitudinal Interval Follow-up Evaluation (LIFE) [ Time Frame: Pre-treatment; within 2 weeks of completing the course of treatment (14 sessions); 6-month followup ] [ Designated as safety issue: No ]

Estimated Enrollment: 48
Study Start Date: February 2013
Estimated Study Completion Date: November 2014
Estimated Primary Completion Date: November 2014 (Final data collection date for primary outcome measure)
Arms Assigned Interventions
Experimental: Cognitive Therapy plus Cognitive Support
Cognitive therapy for depression with cognitive support added
Behavioral: Cognitive therapy for depression

Cognitive therapy (CT) for depression. There is evidence that CT for major depressive disorder (MDD) can be as effective as antidepressant medication for the initial treatment of moderate to severe MDD. Moreover, following the withdrawal of treatment, patients treated with CT are significantly less likely to relapse than patients treated with antidepressant medication and CT is at least as effective as antidepressant medication in preventing subsequent relapse. Over 14 sessions CT aims to alter the symptomatic expression of depression and reduce risk for subsequent episodes by correcting the negative beliefs and maladaptive information processing presumed to underlie the disorder and alter the systematic tendency to misperceive reality in a pessimistic fashion.

Cognitive support. An intervention to improve memory for the contents of therapy. Cognitive support involves a series of specific procedures that support the encoding and retrieval stages of an episodic memory.

Active Comparator: Cognitive therapy
Cognitive therapy for depression
Behavioral: Cognitive therapy for depression

Cognitive therapy (CT) for depression. There is evidence that CT for major depressive disorder (MDD) can be as effective as antidepressant medication for the initial treatment of moderate to severe MDD. Moreover, following the withdrawal of treatment, patients treated with CT are significantly less likely to relapse than patients treated with antidepressant medication and CT is at least as effective as antidepressant medication in preventing subsequent relapse. Over 14 sessions CT aims to alter the symptomatic expression of depression and reduce risk for subsequent episodes by correcting the negative beliefs and maladaptive information processing presumed to underlie the disorder and alter the systematic tendency to misperceive reality in a pessimistic fashion.

Cognitive support. An intervention to improve memory for the contents of therapy. Cognitive support involves a series of specific procedures that support the encoding and retrieval stages of an episodic memory.


Detailed Description:

Background. 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 two strategies designed to enhance memory for the content of CT sessions improve treatment outcome for MDD. Cognitive support involves a series of specific procedures that support the encoding and retrieval stages of an episodic memory. Sleep enhancement is based on robust evidence that insufficient sleep before learning impairs initial memory encoding, and that sleep after learning plays a critical role in the subsequent consolidation of memories. It is hypothesized that CT+Cognitive Support and CT+Sleep Enhancement, 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. A small pilot feasibility RCT will be conducted on adults with MDD (n = 72) who will be randomized to one of three groups: (a) CT+Cognitive Support (n = 24), (b) CT+Sleep Enhancement (n = 24) or (c) CT-as-usual (n = 24). Outcome measures will be taken at baseline, end of treatment, and 6 months after treatment. Long-term objective. To 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. 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. Project

  Eligibility

Ages Eligible for Study:   18 Years and older
Genders Eligible for Study:   Both
Accepts Healthy Volunteers:   No
Criteria

Inclusion Criteria:

  • diagnosis of major depressive disorder (MDD), first episode, recurrent or chronic, according to DSM-IV-TR criteria
  • score of 24 or above on the Inventory of Depressive Symptomatology (IDS)-Clinican and 26 or above on the IDS-Self-report
  • older than 18 years of age
  • if taking medications for mood, medications must be stable for the past 4 weeks
  • able and willing to give informed consent

Exclusion Criteria:

  • history of bipolar disorder
  • history of psychosis (including schizophrenia, schizophreniform disorder, schizoaffective disorder, delusional disorder, or psychotic organic brain syndrome)
  • current non-psychotic Axis I disorder if it constitutes the principal diagnosis and if it requires treatment other than that offered in the project (including anxiety disorders including active PTSD, somatoform disorders, dissociative disorders, or eating disorders, etc.)
  • history of substance dependence in the past six months
  • IQ below 80
  • evidence of any medical disorder or condition that could cause depression or preclude participation in CT
  • current suicide risk sufficient to preclude treatment on an outpatient basis
  Contacts and Locations
Please refer to this study by its ClinicalTrials.gov identifier: NCT01790919

Locations
United States, California
University of California, Berkeley
Berkeley, California, United States, 94720
Sponsors and Collaborators
University of California, Berkeley
Vanderbilt University
  More Information

No publications provided

Responsible Party: Allison Harvey, Professor of Clinical Psychology, University of California, Berkeley
ClinicalTrials.gov Identifier: NCT01790919     History of Changes
Other Study ID Numbers: R34 MH094535-01A1, R34MH094535-01A1
Study First Received: February 6, 2013
Last Updated: March 6, 2014
Health Authority: United States: Federal Government

Keywords provided by University of California, Berkeley:
Depression, Adults

Additional relevant MeSH terms:
Depression
Depressive Disorder
Depressive Disorder, Major
Behavioral Symptoms
Mood Disorders
Mental Disorders

ClinicalTrials.gov processed this record on April 17, 2014