Gamified cognitive control training for remitted depressed individuals : user requirements analysis

Background: The high incidence and relapse rates of major depressive disorder demand novel treatment options. Standard treatments (psychotherapy, medication) usually do not target cognitive control impairments, although these seem to play a crucial role in achieving stable remission. The urgent need for treatment combined with poor availability of adequate psychological interventions has instigated a shift toward internet interventions. Numerous computerized programs have been developed that can be presented online and offline. However, their uptake and adherence are oftentimes low. Objective: The aim of this study was to perform a user requirements analysis for an internet-based training targeting cognitive control. This training focuses on ameliorating cognitive control impairments, as these are still present during remission and can be a risk factor for relapse. To facilitate uptake of and adherence to this intervention, a qualitative user requirements analysis was conducted to map mandatory and desirable requirements. Methods: We conducted a user requirements analysis through a focus group with 5 remitted depressed individuals and individual interviews with 6 mental health care professionals. All qualitative data were transcribed and examined using a thematic analytic approach. Results: Results showed mandatory requirements for the remitted sample in terms of training configuration, technological and personal factors, and desirable requirements regarding knowledge and enjoyment. Furthermore, knowledge and therapeutic benefits were key requirements for therapists. Conclusions: The identified requirements provide useful information to be integrated in interventions targeting cognitive control in depression

User requirements of a remitted depressed sample for a gamified PASAT as a cognitive control training

Background. Cognitive control impairments are present during depression but often remain during remission. What is more, these residual impairments can be predictive of future depressive episodes. Enhancing cognitive control, by means of cognitive control training (CCT), has been shown to have a positive influence on the future depressive symptomatology in some populations. One of the tasks used for this CCT is the Paced Auditory Serial Addition Task (PASAT). However, in its current form, the training may benefit from considering feedback and motivational enhancement. Research has shown that adding gamification elements can increase motivation, for starting and continuing a task. Our aim is to involve target population within the process of co-creation to adjust cognitive training using the PASAT. This step is an essential part of adjusting this cognitive training from a basic experimental paradigm to a clinical intervention that can be widely disseminated for preventative purposes. Method. A focus group has been conducted with a remitted depressed sample, part of whom previously participated in a cognitive control training study. Moreover, a group of therapists with experience in treating depression from various backgrounds (ambulatory as well as in-patient care) were interviewed in a second focus group. Before starting the group discussions, a PASAT demo has been shown, alongside information regarding the aim and format of the CCT. Open questions and topics were presented to the group, to gather as much input as possible. These findings were discussed with a game developer who was present during these focus groups. Results. The results of the focusgroups are currently being analyzed and will be presented at the conference

Online cognitive control training for remitted depressed individuals : a replication and extension study

Background Remitted depressed (RMD) individuals form a risk group for developing future depressive episodes. Improving cognitive control may reduce the risk to develop novel depressive symptoms, as beneficial effects of such training were demonstrated in RMD individuals. Method The current study attempted to replicate and extend these results. In this randomized controlled trial (ClinicalTrials.gov NCT03278756), 68 RMD individuals were allocated to a cognitive control training or an active control condition, each comprised of 10 homework sessions dispersed over two weeks. Primary outcome measures were depressive symptomatology and rumination. Assessment took place before and after training and at 3 and 6 month follow-up. Results This study showed training-related cognitive transfer and mixed effects on indicators of subjective cognitive functioning, depressive- and anxiety symptoms, as well as broader residual complaints. In addition, we failed to observe previously reported beneficial effects of CCT on indicators of emotion regulation and resilience. Conclusions Given the partial replication of previously reported effects of cognitive control training in RMD, further research is needed