Action-Based Cognitive Remediation to Improve Vocational Outcomes in Depression
Condition: Depression
MeSH terms: Depression; Depressive Disorder
Study type: Interventional

Summary: 
      Major depressive disorder places a tremendous burden on workplace disability each year. Its
      diagnosis is based on the presence of characteristic symptoms that include disturbances in
      mood regulation, maladaptive beliefs, and behaviour. Impairment in neurocognitive functions
      (e.g., information processing speed, attention, memory, problem solving skills) is absent
      from current diagnostic criteria and off the radar in most clinical treatment settings, yet
      increasingly recognized as a primary cause of poor work functioning and outcomes. This
      disconnect between the root causes of poor vocational outcomes and targets of treatment has
      resulted in a failure to return to work following illness, job underproductivity, and
      work-related stress, which contribute to indirect costs to society each year. The
      investigators seek to expand scientific support for treating neurocognitive impairments in
      order to increase occupational productivity and reduce job-related stress associated with
      depression. The investigators developed a novel group cognitive remediation (CR) treatment,
      Action-Based Cognitive Remediation (ABCR). It builds on procedural learning skills with
      explicit work-related role-plays to facilitate immediate and salient abstraction of drill and
      practice remediation techniques. The activities were developed in collaboration with a
      community rehabilitation partner in this study through systematic interviews with job
      placement specialists and supervisors from employment sites used by the agency. The props
      match those used in work settings and include miniature versions of a cash register, filing
      system, conveyer belt, cleaning closet, garden nursery, and secretarial station. The
      activities capitalize on procedural learning skills through roleplays and props that simulate
      a work environment. ABCR maintains important aspects of drill and practice, strategic
      monitoring to enhance flexible problem solving approaches, and bridging. The role-plays
      follow computerized drill and practice exercise and therapists facilitate group discussions
      of how cognitive skills and flexibility in thinking from drill and practice can be effective
      while directly engaged in an everyday work environment. Thus, bridging used in ABCR is a
      tangible, procedural, and realistic. This approach to bridging differentiates the treatment
      from standard CR, where the discussion-based approach is limited by the auditory learning,
      memory, and abstraction deficits observed in depression.
    

Detailed description: 
      Participants will meet with the PI or clinical graduate student to discuss components of
      cognitive remediation, expectations, and client goals. Follow-up meetings will occur to
      ensure client satisfaction and determine progress on goal achievement.

      Randomization to ABCR or standard CR will be done in groups of 8 to ensure an adequate number
      of participants in each group. Twenty-four participants will be randomized to each group over
      the course of the study. Several aspects of the treatments are matched for ideal comparison.
      Both groups will meet two times per week, two hours per session, for 8 weeks. The same
      computerized drill and practice, strategic monitoring, and verbal bridging approaches will be
      used in both groups. The primary differences are the ratio of each aspect of treatment and
      the manner in which they are bridged work environment. In the standard CR group 60% of the
      sessions involve computerized drill and practice. In the ABCR group, only 20% of the group
      sessions are devoted to computer drills, whereas 40% involve the simulated work skills that
      are directly linked to those computer tasks (see Figure 1 for an example). The remaining 40%
      of both of the groups involve a didactic component that introduces concepts for that session
      (e.g., memory strategies, how to avoid distractors), review of homework, and group discussion
      of bridging. Strategic monitoring occurs during all aspects of treatment, though in ABCR the
      link between computerized drills and work is made explicit by moving back and forth from
      computer drills to the role-play tasks. Graduate students in a clinical psychology program
      who are trained and supervised by Dr. Bowie will conduct the treatment groups. These students
      will be blind to study hypotheses, though it will not be possible to blind them to the group.
      Video recordings of sessions are regularly reviewed with Dr. Bowie to ensure treatment
      fidelity.

      In both groups, participants are given the opportunity to engage in supplemental homework
      exercises outside of the scheduled treatment groups. Scientific Brain Training Pro will be
      used for computer drills in session and for homework, a program the investigators have used
      in previous studies. The company provides its software for this research at no cost, but has
      no input into the design or output of this study. Due to the online availability of the
      exercises, participants are encouraged to login to the program one or two times per day for
      20 minutes each session. Variability in homework completion is expected (and therefore
      considering it as a treatment process variable and potential mediator of longer-term
      durability and generalization), yet compliance with the sample is anticipated because they
      will be engaged standard vocational services programs four days per week, giving them access
      to an on-site computer room before or after attending their regular appointments.

      Few previous studies have examined work stress as a function of supplemental treatments in
      vocational rehabilitation and to the investigators' knowledge this project will be the first
      to measure both self-reported and psychophysiological indicators of stress.
    

Intervention name(s): Action based cognitive remediation; Cognitive remediation
Intervention type(s): Behavioral; Behavioral
Intervention description(s): This is a novel form of cognitive remediation in which participants engage in simulated real world tasks in groups and receive therapist feedback in addition to receiving standard cognitive remediation.; Cognitive remediation engages participants in computerized exercises meant to improve cognitive functions and provides therapist feedback for how these improvements manifest in everyday life.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Double (Participant, Outcomes Assessor)
Primary purpose: Treatment
Keywords: cognitive remediation; vocational outcomes