No abstract

Patient memory for treatment contents is defined as memory for the ideas, concepts, skills, and/or insights (termed treatment points) that the therapist thinks are important for the patient to remember and implement as a part of therapy. This article reviews key findings on patient memory for treatment contents, describes the development and evaluation of the Memory Support Intervention (MSI), and outlines future directions for research. Patient memory for treatment contents is poor, and worse memory is associated with worse treatment outcome. The MSI is composed of eight memory support strategies that therapists incorporate frequently alongside treatment points delivered during treatment-as-usual. Training therapists to deliver the MSI may yield better treatment outcomes by enhancing patient memory for treatment contents. Future research is needed to understand how to best measure patient memory for treatment contents, and the mediators, moderators, and dissemination potential of the MSI.

BackgroundThe Memory Support Intervention was developed in response to evidence showing that: (1) patient memory for treatment is poor, (2) poor memory for treatment is associated with poorer adherence and poorer outcome, (3) the impact of memory impairment can be minimized by the use of memory support strategies and (4) improved memory for treatment improves outcome. The aim of this study protocol is to conduct a confirmatory efficacy trial to test whether the Memory Support Intervention improves illness course and functional outcomes. As a “platform” for the next step in investigating this approach, we focus on major depressive disorder (MDD) and cognitive therapy (CT).Method/designAdults with MDD (n = 178, including 20% for potential attrition) will be randomly allocated to CT + Memory Support or CT-as-usual and will be assessed at baseline, post treatment and at 6 and 12 months’ follow-up (6FU and 12FU). We will compare the effects of CT + Memory Support vs. CT-as-usual to determine if the new intervention improves the course of illness and reduces functional impairment (aim 1). We will determine if patient memory for treatment mediates the relationship between treatment condition and outcome (aim 2). We will evaluate if previously reported poor treatment response subgroups moderate target engagement (aim 3).DiscussionThe Memory Support Intervention has been developed to be “transdiagnostic” (relevant to a broad range of mental disorders) and “pantreatment” (relevant to a broad range of types of treatment). This study protocol describes a “next step” in the treatment development process by testing the Memory Support Intervention for major depressive disorder (MDD) and cognitive therapy (CT). If the results are promising, future directions will test the applicability to other kinds of interventions and disorders and in other settings.Trial registrationClinicalTrials.gov, ID: NCT01790919. Registered on 6 October 2016.Electronic supplementary materialThe online version of this article (doi:10.1186/s13063-017-2276-x) contains supplementary material, which is available to authorized users.

Background: Previous meta-analyses have established that computerized cognitive behavioral therapy (cCBT) is an effective, acceptable, and efficient method of delivering treatment for anxiety and depression. However, the potential generalizability of these conclusions to nonresearch settings has not yet been investigated. Materials and Methods: We conducted a multidimensional meta-analysis of randomized controlled trials of cCBT for anxiety and/or depressive disorders quantifying generalizability by examining the relationship between participant exclusion and treatment outcome. Thirty-six trials of cCBT were identified through systematic searches in six databases. The number of exclusion criteria and exclusion rate served as indices of participant exclusion. Outcome variables included betweenand within-group effect sizes in addition to rates of clinically significant improvement. Results: Analyses were performed for all studies, depression studies (n = 11), and anxiety studies (n = 23). Pooling across all studies, we found a between-group effect size of 0.85 (95% confidence interval, 0.77-0.94). The mean number of exclusionary criteria was 12 (range, 2-24), and the mean exclusion rate was 0.49 (range, 0.08-0.92). Risk for suicide was the most common criterion for exclusion. Correlation analyses revealed a large relationship between number of exclusion criteria and proportion clinically changed in the treatment group for anxiety studies (r = 0.70). Results provide evidence for the limited effectiveness of cCBT for anxiety disorders in nonresearch samples. Conclusions: As computerized therapy is developed to address barriers to dissemination, future trials should examine the effectiveness of cCBT for anxiety for patients with more complex clinical presentations.