Abstract
Cognitive difficulties constitute a core contributor to functional impairment in major depressive disorder (MDD). Cognitive remediation (CR) is a psychotherapeutic treatment for complex mental illness which employs computerized cognitive training exercises. While treatment effect is largely dependent upon engagement in training, degree of engagement is quite varied. We developed and tested a psychoeducational intervention video to investigate effects on subjective and objective engagement in computerized cognitive training exercises in MDD. Sixty-one participants with MDD were randomized into a psychoeducational or control video condition. Repeated-measure analysis of variance was used to investigate changes in subjective perception of cognitive malleability, willingness to engage in CR, and insight into cognitive problems over time. Participants were given access to computerized training exercises at home for 2 weeks following intervention to investigate behavioral engagement. The intervention did not significantly increase participants’ perceived cognitive malleability or willingness to engage in CR, nor the degree to which they independently trained on computerized cognitive training tasks, though a small effect on insight into cognitive problems was found. The sample was limited in demographic and cognitive diversity. Further research is necessary to clarify contributors of the observed effect on insight into cognitive problems. This research provides an important step in addressing a critical gap in the literature pertaining to bolstering engagement of participants with MDD in CR. This work highlights the need to continue to investigate ways of inciting engagement in computerized cognitive training for those with MDD.
Similar content being viewed by others
Explore related subjects
Discover the latest articles, news and stories from top researchers in related subjects.Data Availability
The data that support the findings of this study may be available from the corresponding author upon request.
References
Armstrong, S. N., Anderson, M., Le, E. T., & Nguyen, L. H. (2009). Application of the health belief model to bariatric surgery. Gastroenterology Nursing, 32(3), 171–178. https://doi.org/10.1097/SGA.0b013e3181a7cf5a
Baune, B. T., Miller, R., McAfoose, J., Johnson, M., Quirk, F., & Mitchell, D. (2010). The role of cognitive impairment in general functioning in major depression. Psychiatry Research, 176(2–3), 183–189. https://doi.org/10.1016/j.psychres.2008.12.001
Beard, C., Stein, A. T., Hearon, B. A., Lee, J., Hsu, K. J., & Björgvinsson, T. (2016). Predictors of depression treatment response in an intensive CBT partial hospital. Journal of Clinical Psychology, 72(4), 297–310. https://doi.org/10.1002/jclp.22269
Benton, A. L., & Hamsher, K. (1976). Multilingual aphasia examination (2nd ed.). AJA Associates.
Blue, C. L., & Valley, J. M. (2002). Predictors of influenza vaccine: Acceptance among healthy adult workers. Workplace Health & Safety Journal - AAOHN, 50(5), 227–233. https://doi.org/10.1177/216507990205000509
Bowie, C. R. (2016). Cognitive remediation for major depressive disorder. In R. S. McIntyre & D. S. Cha (Eds.), Cognitive impairment in major depressive disorder. Cambridge University Press.
Bowie, C. R., Gupta, M., Holshausen, K., Jokic, R., Best, M., & Milev, R. (2013). Cognitive remediation for treatment-resistant depression: Effects on cognition and functioning and the role of online homework. The Journal of Nervous and Mental Disease, 201(8), 680–685. https://doi.org/10.1097/NMD.0b013e31829c5030
Brandt, J., & Benedict, R. H. B. (2001). Hopkins verbal learning test - revised. Professional manual. Psychological Assessment Resources.
Castonguay, J., Filer, C. R., & Pitts, M. J. (2016). Seeking help for depression: Applying the health belief model to illness narratives. Southern Communication Journal, 81(5), 289–303. https://doi.org/10.1080/1041794X.2016.1165729
Christensen, H., Griffiths, K. M., & Jorm, A. F. (2004). Delivering interventions for depression by using the internet: Randomised controlled trial. British Medical Journal, 328(7434), 265. https://doi.org/10.1136/bmj.37945.566632.EE
Cohen, J. (1988). Statistical power analysis for the behavior sciences (2nd ed.). Lawrence Erlbaum Associates.
Cohen, J. (1992). Statistics: A power primer. Psychological Bulletin, 112(1), 155–159. https://doi.org/10.1037//0033-2909.112.1.155
Daniel, B. D., Montali, A., Gerra, M. L., Innamorati, M., Giradi, P., Pompili, M., & Amore, M. (2013). Cognitive impairment and its associations with the path of illness in affective disorders: A comparison between patients with bipolar and unipolar depression in remission. Journal of Psychiatric Practice, 19(4), 275–287. https://doi.org/10.1097/01.pra.0000432597.79019.e2
De Castella, K., & Byrne, D. (2015). My intelligence may be more malleable than yours: The revised implicit theories of intelligence (self-theory) scale is a better predictor of achievement, motivation, and student disengagement. European Journal of Psychology of Education, 30(3), 245–267. https://doi.org/10.1007/s10212-015-0244-y
Delis, D. C., Kaplan, E., & Kramer, J. H. (2001). Delis-Kaplan executive function system (D-KEFS): Examiner’s manual. The Psychological Corporation.
Dweck, C. S. (2000). Self-theories: Their role in motivation, personality, and development. Taylor & Francis.
Fernández-Aguilar, L., Navarro-Bravo, B., Ricarte, J., Ros, L., & Latorre, J. M. (2019). How effective are films in inducing positive and negative emotional states? A Meta-Analysis. Plos One, 14(11), E0225040. https://doi.org/10.1371/journal.pone.0225040
Geisner, I. M., Neighbors, C., & Larimer, M. E. (2006). A randomized clinical trial of a brief, mailed intervention for symptoms of depression. Journal of Consulting and Clinical Psychology, 74(2), 393–399. https://doi.org/10.1037/0022-006X.74.2.393
Godard, J., Grondin, S., Baruch, P., & Lafleur, M. F. (2011). Psychosocial and neurocognitive profiles in depressed patients with major depressive disorder and bipolar disorder. Psychiatry Research, 190(2–3), 244–252. https://doi.org/10.1016/j.psychres.2011.06.014
Gold, J. M., Carpenter, C., Randolph, C., Goldberg, T. E., & Weinberger, D. R. (1997). Auditory working memory and Wisconsin Card Sorting Test performance in schizophrenia. Archives of General Psychiatry, 54(2), 159–165. https://doi.org/10.1001/archpsyc.1997.01830140071013
Gupta, M., Holshausen, K., Best, M. W., Jokic, R., Milev, R., & Bernard, T.,…Bowie, C. R. (2013). Relationships among neurocognition, symptoms, and functioning in treatment-resistant depression. Archives of Clinical Neuropsychology, 28(3), 272–281. https://doi.org/10.1093/arclin/act002
Hollingshead, A. B. (2011). Four factor index of social status. Yale Journal of Sociology, 8, 21–52.
Jacob, K. S., Bhugra, D., & Mann, A. H. (2002). A randomised controlled trial of an educational intervention for depression among Asian women in primary care in the United Kingdom. International Journal of Social Psychiatry, 48(2), 139–148. https://doi.org/10.1177/002076402128783190
Keshavan, M. S., Vinogradov, S., Rumsey, J., Sherrill, J., & Wagner, A. (2014). Cognitive training in mental disorders: Update and future directions. American Journal of Psychiatry, 171(5), 510–522. https://doi.org/10.1176/appi.ajp.2013.13081075
Kjaergaard, M., Elisabeth, C., Wang, A., Waterloo, K., & Jorde, R. (2014). A study of the psychometric properties of the Beck Depression Inventory-II, the Montgomery and Åsberg Depression Rating Scale, and the Hospital Anxiety and Depression Scale in a sample from a healthy population. Scandinavian Journal of Psychology, 55(1), 83–89. https://doi.org/10.1111/sjop.12090
Leon, A. C., Solomon, D. A., Mueller, T. I., Turvey, C. L., Endicott, J., & Keller, M. B. (1999). The Range of Impaired Functioning Tool (LIFE-RIFT): A brief measure of functional impairment. Psychological Medicine, 29(4), 869–878. https://doi.org/10.1017/s0033291799008570
McDermott, L. M., & Ebmeier, K. P. (2009). A meta-analysis of depression severity and cognitive function. Journal of Affective Disorders, 119(1–3), 1–8. https://doi.org/10.1016/j.jad.2009.04.022
McIntyre, R. S., Cha, D. S., Soczynska, J. K., Woldeyohannes, H. O., Gallaugher, L. A., Kudlow, P.,…Baskaran, A. (2013). Cognitive deficits and functional outcomes in major depressive disorder: Determinants, substrates, and treatment interventions. Depression and Anxiety, 30(6), 515-527. https://doi.org/10.1002/da.22063
Medalia, A., & Thysen, J. (2008). Insight into neurocognitive dysfunction in schizophrenia. Schizophrenia Bulletin, 34(6), 1221–1230. https://doi.org/10.1093/schbul/sbm144
Medalia, A., Thysen, J., & Freilich, B. (2008). Do people with schizophrenia who have objective cognitive impairment identify cognitive deficits on a self report measure? Schizophrenia Research, 105(1–3), 156–164. https://doi.org/10.1016/j.schres.2008.07.007
Medalia, A., Saperstein, A., Choi, K.-H., & Choi, J. (2012). The efficacy of a brief psycho-educational intervention to improve awareness of cognitive dysfunction in schizophrenia. Psychiatry Research, 199(3), 164–168. https://doi.org/10.1016/j.psychres.2012.04.042
Meusel, L.-A. C. (2011). Cognitive remediation in patients with mood disorders: Behavioural and neural correlates (Doctoral dissertation, McMaster University, Hamilton, Canada). https://macsphere.mcmaster.ca/handle/11375/11626. Accessed 11 July 2019.
Miu, A. S., & Yeager, D. S. (2015). Preventing symptoms of depression by teaching adolescents that people can change: Effects of a brief incremental theory of personality intervention at 9-month follow-up. Clinical Psychological Science, 3(5), 726–743. https://doi.org/10.1177/2167702614548317
Montgomery, S. A., & Åsberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382–389. https://doi.org/10.1192/bjp.134.4.382
Nash, S., Weston, D., & Wheeler, M. (2011). Desert seas [Film]. National Geographic.
Reitan, R. M. (1992). Trail Making Test: Manual for administration and scoring. Reitan Neuropsychology Laboratory.
Rock, P. L., Roiser, J. P., Riedel, W. J., & Blackwell, A. D. (2014). Cognitive impairment in depression: A systematic review and meta-analysis. Psychological Medicine, 44(10), 2029–2040. https://doi.org/10.1017/s0033291713002535
Rosenstock, I. M. (1974). Historical origins of the health belief model. Health Education Monographs, 2(4), 328–335. https://doi.org/10.1177/109019817400200403
Ryan, R. M., & Deci, E. L. (2000). Self-determination theory and the facilitation of intrinsic motivation, social development, and well-being. American Psychologist, 55(1), 68–78. https://doi.org/10.1037/0003-066X.55.1.68
Ryan, R. M., Plant, R. W., & O’Malley, S. (1995). Initial motivations for alcohol treatment: Relations with patient characteristics, treatment involvement, and dropout. Addictive Behaviours, 20(3), 279–297. https://doi.org/10.1016/0306-4603(94)00072-7
Schindler, A., Hiller, W., & Witthöft, M. (2012). What predicts outcome, response, and drop-out in CBT of depressive adults? A naturalistic study. Behavioural and Cognitive Psychotherapy, 41(3), 365–370. https://doi.org/10.1017/S1352465812001063
Schleider, J. L., & Weisz, J. R. (2016). Reducing risk for anxiety and depression in adolescents: Effects of a single-session intervention teaching that personality can change. Behaviour Research and Therapy, 87, 170–181. https://doi.org/10.1016/j.brat.2016.09.011
Sheehan, D. V., Lecrubier, Y., Harnett-Sheehan, K., Janvas, J., Weiller, E., Keskiner, A., …Dunbar, G. C. (1997). The validity of the Mini International Neuropsychiatric Interview (MINI) according to the SCID-P and its reliability. European Psychiatry, 12(5), 232-241. https://doi.org/10.1016/S0924-9338(97)83297-X
Sheehan, D. V., Lecrubier, Y., Harnett-Sheehan, K., Amorim, P., Janavs, J., Weiller, E.,…Dunbar, G. C. (1998). The M.I.N.I. International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview. Journal of Clinical Psychiatry, 59(Suppl 20): 22–33.
Shimizu, Y., Kitagawa, N., Mitsui, N., Fujii, Y., Toyomaki, A., Hashimoto, N.,…Kusumi, I. (2013). Neurocognitive impairments and quality of life in unemployed patients with remitted major depressive disorder. Psychiatry Research, 210(3), 913–918. https://doi.org/10.1016/j.psychres.2013.08.030
Siegle, G. J., Ghinassi, F., & Thase, M. E. (2007). Neurobehavioral therapies in the 21st century: Summary of an emerging field and an extended example of cognitive control training for depression. Cognitive Therapy and Research, 31, 235–262. https://doi.org/10.1007/s10608-006-9118-6
Tsai, J., Huang, M., Rosenheck, R. A., & Wilkinson, S. (2020). A randomized controlled trial of video psychoeducation for electroconvulsive therapy in the United States. Psychiatric Service, 71(6), 562–569. https://doi.org/10.1176/appi.ps.201900448
Tsai, J., Huang, M., Wilkinson, S. T., & Edelen, C. (2020). Effects of video psychoeducation on perceptions and knowledge about electroconvulsive therapy. Psychiatry Research, 286, 112844. https://doi.org/10.1016/j.psychres.2020.112844
Tukey, J. W. (1962). The future of data analysis. The Annals of Mathematical Statistics, 33(1), 1–67.
Tursi, M. F. S., Baes, C. W., Camacho, F. R. B., Tofoli, S. M. C., & Juruena, M. F. (2013). Effectiveness of psychoeducation for depression: A systematic review. Australian & New Zealand Journal of Psychiatry, 47(11), 1019–1031. https://doi.org/10.1177/0004867413491154
Urbaniak, G. C., & Plous, S. (2018). Research Randomizer (Version 4.0) [Computer software]. Retrieved on November 25, 2018 from http://www.randomizer.org/
Veiel, H. O. F. (1997). A preliminary profile of neuropsychological deficits associated with major depression. Journal of Clinical and Experimental Neuropsychology, 19(4), 587–603. https://doi.org/10.1080/01688639708403745
Watson, D., Clark, L. A., & Tellegen, A. (1988). Development and validation of brief measures of positive and negative affect: The PANAS scales. Journal of Personality and Social Psychology, 54(6), 1063–1070.
Wechsler, D. (1997). Wechsler Adult Intelligence Scale (3rd ed.). The Psychological Corporation.
Wechsler, D. (1997). Wechsler Memory Scale (3rd ed.). The Psychological.
Wilkinson, G. S. (1993). The Wide Range Achievement Test. Wide Range Inc.
Acknowledgements
We thank Kassandra Cardinale for her collaborative role in filming and producing the original Psychoeducational video used in this study; as well as Matthew Campbell and Jim Perrott (of Last Universal Common Ancestor, LUCA) for their original music featured within it.
Funding
Funds of CRB supported data collection (participant compensation) and filming/production of the psychoeducational video.
Author information
Authors and Affiliations
Contributions
MM and CRB designed the study. MM, LES, RLT, NVB, and SHI acquired the data under supervision of CRB. MM analyzed the data and wrote the first draft of the article under supervision of CRB. MM, LES, RLT, NVB, SHI, and CRB revised the article. All authors contributed to and have approved the final manuscript.
Corresponding author
Ethics declarations
Ethics Approval
All procedures performed were in accordance with the ethical standards of the committee of the Queen’s University Health Sciences & Affiliated Teaching Hospitals Research Ethics Board (HSREB reference: HSREB-6024507) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Consent to Participate and Consent to Publish
Written informed consent was obtained from all individual participants to participate in the study, as well as informed consent regarding publishing of group-level data.
Conflict of Interest
CRB was supported by the Canadian Foundation for Innovation, Ontario Ministry of Research and Innovation, the Queen’s University Senate Advisory Research Council, and the Pfizer Canada/Sun Life Mutual/Healthy Minds Canada Workplace Depression Award. CRB has served as a consultant for Boehringer Ingelheim, Lundbeck,and Pfizer; he has received research funds from Lundbeck, Pfizer, and Takeda; and he has received in-kind user accounts for research purposes from Scientific Brain Training PRO. The other authors report no financial relationships with commercial interests. MM was supported by the Ontario Graduate Scholarship and Joseph-Armand Bombardier Master’s Canada Graduate Scholarship (Social Sciences and Humanities Research Council (SSHRC)).
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Milanovic, M., Simourd, L.E., Toubache, R.L. et al. The Efficacy of a Brief Psychoeducational Intervention to Improve Engagement in Computerized Cognitive Training Exercises in Major Depressive Disorder. J Cogn Enhanc 8, 21–35 (2024). https://doi.org/10.1007/s41465-023-00280-z
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s41465-023-00280-z