Improving Depression Outcome by Enhancing Memory for Cognitive Therapy
Improving Depression Outcome by Enhancing Memory for Cognitive Therapy
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.
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