Improving Depression Outcome by Enhancing Memory for Cognitive Therapy

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 a strategy designed to enhance memory for the content of CT sessions
improves 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. A small pilot feasibility RCT will be conducted on adults with MDD (n = 48)
who will be randomized to one of two groups: (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. 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

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)-Clinician
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