Elsevier

Journal of Affective Disorders

Volume 210, 1 March 2017, Pages 265-268
Journal of Affective Disorders

Brief report
Behavioral activation treatment for major depression: A randomized trial of the efficacy of augmentation with cognitive control training

https://doi.org/10.1016/j.jad.2017.01.003Get rights and content

Highlights

  • 34 adults with MDD received four sessions of brief behavioral activation therapy.

  • Randomized to concurrently receive 4 sessions of cognitive control training or sham.

  • Large within group effect of behavioral activation on depressive symptoms over time.

  • Cognitive control training did not enhance behavioral activation outcomes.

Abstract

Background

Major depressive disorder (MDD) is associated with hypoactivation of the dorsolateral prefrontal cortex, a brain region involved in emotion regulation and basic cognitive control processes. Recent studies have indicated that computerized interventions designed to activate this region may reduce depressive and ruminative symptoms. In this double-blind randomized controlled trial, we tested whether one such program, called Cognitive Control Training (CCT), enhanced treatment outcomes when used in adjunct to brief behavior therapy for MDD.

Methods

Thirty-four adults with MDD were randomly assigned to complete four sessions of either computerized CCT or a control task, concurrently with four sessions of Brief Behavioral Activation Therapy for Depression (BATD). Post-treatment and one-month follow-up assessments were conducted, with self-reported depressive symptoms as the primary outcome and clinician-rated depressive symptoms and self-reported rumination as secondary outcomes.

Results

In both intent-to-treat and completer analyses, depressive symptoms and rumination decreased significantly over the course of treatment in both treatment conditions. There were no significant differences in treatment outcome depending on the augmentation condition.

Limitations

The sample size was small, hindering secondary analyses and identification of potential predictors or moderators of treatment effect.

Conclusions

Results demonstrate substantial clinical benefit following four sessions of BATD; however, adjunctive CCT did not enhance outcomes. This study and other recent research suggest that the effects of CCT may not be as robust as previously indicated, highlighting the need for continued investigation of the conditions under which CCT may be effective.

Section snippets

Participant enrollment and randomization

Participants were recruited through advertisements and referrals from an outpatient clinic and were required to be between ages 18 and 65 and have a primary psychiatric diagnosis of MDD. Exclusion Criteria included a history of psychotic, bipolar, or neurological disorder or alcohol/substance dependence in the past 6 months; current use of modafinil, or antipsychotic or stimulant medications; or use of an antidepressant or anxiolytic medication if not taken at a stable dose for at least 8 weeks

Treatment outcome

Means and standard deviations for primary and secondary outcome measures are presented in Table 2 for the both the ITT and completer sample. BDI, MADRS, and RRS scores all decreased significantly over time, reflecting large effect sizes (all ηp2 >.3). However, for each of these measures, the interaction between time and treatment condition was not significant, and all treatment by time effect sizes fell in the small range for ITT and completer analyses (see Table 2; all ηp2<.07). Results of the

Discussion

This study tested whether CCT, a neurocognitive intervention previously shown to reduce depression symptoms, enhanced the effects of a 4-session behavioral activation therapy when compared to a control condition. No enhancement was observed on primary and secondary outcomes; both treatment groups demonstrated similar significant improvements in depression symptom severity and rumination, reflecting a large within-group effect size. This poses a contrast to studies in which CCT was shown to be

Conclusion

Our results suggest that weekly CCT does not add clinical benefit to a four-session BATD treatment, and was not associated with unique change in rumination. These findings indicate that the effects of CCT may not be as robust as previous studies have suggested, consistent with a recent re-analysis of the most comprehensive CCT study in clinically depressed patients (Siegle et al., 2014) suggesting that CCT may benefit a select group of patients who are able to allocate sufficient attentional

References (20)

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