A randomised controlled trial of psychotherapy and cognitive remediation to target cognition in mood disorders

Abstract

Objective To examine the impact of a treatment package combining Interpersonal and Social Rhythm Therapy (IPSRT) and cognitive remediation (CR), vs IPSRT alone, on cognition, functioning, and mood disturbance outcomes in mood disorders. Methods A pragmatic randomised controlled trial in adults with bipolar disorder (BD) or major depressive disorder (MDD), recently discharged from mental health services in Christchurch, New Zealand, with subjective cognitive difficulties. Individuals were randomised to a 12‐month course of IPSRT with CR (IPSRT‐CR), or without CR (IPSRT). In IPSRT‐CR, CR was incorporated into therapy sessions from approximately session 5 and continued for 12 sessions. The primary outcome was change in Global Cognition (baseline to 12 months). Results Sixty‐eight individuals (BD n = 26, MDD n = 42; full/partial remission n = 39) were randomised to receive IPSRT‐CR or IPSRT (both n = 34). Across treatment arms, individuals received an average of 23 IPSRT sessions. Change in Global Cognition did not differ between arms from baseline to treatment‐end (12 months). Psychosocial functioning and longitudinal depression symptoms improved significantly more in the IPSRT compared with IPSRT‐CR arm over 12 months, and all measures of functioning and mood symptoms showed moderate effect size differences favouring IPSRT (0.41–0.60). At 18 months, small to moderate, non‐significant benefits (0.26–0.47) of IPSRT vs IPSRT‐CR were found on functioning and mood outcomes. Conclusions Combining two psychological therapies to target symptomatic and cognitive/functional recovery may reduce the effect of IPSRT, which has implications for treatment planning in clinical practice and for CR trials in mood disorders.

Can biomarkers aid the stratification of individuals with mood disorders for cognitive remediation interventions?

“…poor cognition at baseline was associated with better CR response) out of a total of 16 candidate predictors (cognitive, functional, demographic, clinical) 5 . In contrast, data from the RCTs by Ott et al and Douglas et al showed no associations between baseline objective (executive function 1 and global cognition 3 ) and subjective cognition and CR‐associated improvement in cognition. Douglas et al, in as‐yet unpublished analyses, have reported predictive effects of demographic and clinical variables on CR‐related cognitive effects.…”

“…First, similar samples in terms of diagnoses and inclusion criteria across studies are needed to be able to pool data for larger-scale prediction analyses. Regarding the impact of the diagnosis on CR response, whilst Strawbridge et al 2 did not observe a difference in CR response between BD type I and II, Douglas et al 3 reported that their BD sample showed larger pro-cognitive effects than MDD. Thus, pooling data in MDD and BD samples separately may identify predictors specific to each group.…”

“…We conducted three independent RCTs of CR interventions in Denmark (group‐based CR for BD), 1 United Kingdom (individual CR for BD), 2 and New Zealand (individual CR merged into psychotherapy sessions for mood disorders) 3 (see Table 1 for study characteristics) involving baseline assessments spanning biological (e.g. blood analysis), neuroimaging, clinical, cognitive and psychological measures.…”

Efficacy of cognitive remediation in bipolar disorder: systematic review and meta-analysis of randomized controlled trials

“…In the former, the removal of Ott et al (2021b) or Tsapekos et al (2023) rendered the observed effects nonsignificant, and similarly did the removal of either of two studies (Gomes et al, 2019;Lewandowski et al, 2017) in the latter variable. Interestingly, the removal of Douglas et al (2022), which is the only study including patients with different mood states and exploring a combination of psychological treatments, did not change the overall effects. Similarly, the exclusion of Torrent et al (2013) /Bonnin et al (2016b), which used a different CR approach, did not change the overall outcome.…”

“…Only three RCTs considered cognitive impairment subjectively (Demant et al, 2015;Douglas et al, 2022) or objectively measured (Ott et al, 2021a(Ott et al, , 2021b as an inclusion criterion, whereas the RCT by Torrent et al (2013) considered the presence of moderate-to-severe functional impairment defined as a score ⩾ 18 on the Functioning Assessment Short Test (FAST) (Rosa et al, 2007) together with a score ⩾ 4 in the cognitive domain of the same scale for inclusion in the study.…”