Cognitive Remediation Therapy for Mood Disorders: Rationale, Early                     Evidence, and Future Directions

Bowie, Christopher R.; Gupta, Maya; Holshausen, Katherine

doi:10.1177/070674371305800603

Cited by 60 publications

(36 citation statements)

References 39 publications

(46 reference statements)

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“…Psychotherapy programs that address cognitive rehabilitation and remediation have been investigated in schizophrenia 43 and bipolar depression, 44 and may also be effective for neurocognitive symptoms in MDD. 45 Modifying the negative memory bias in patients with MDD may also reduce cognitive vulnerability and prevent depressive relapse. 46 These studies suggest that CBT and memory-specific therapies hold promise to alleviate subjective cognitive symptoms and dysfunction in patients with acute or remitted MDD.…”

Section: Effects Of Psychotherapy On Cognitive Dysfunctionmentioning

confidence: 99%

Cognitive Dysfunction in Major Depressive Disorder: Effects on Psychosocial Functioning and Implications for Treatment

et al. 2014

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Major depressive disorder is a common condition with a high rate of recurrence, chronicity, and staggering economic burden, including disability in the workforce.1 In 2010, MDD was the second leading medical cause of burden globally, with highest estimates of disability in people of working age.2 In Canada, the annual prevalence of MDD is 3% to 4% overall, and 79% of people with MDD report some interference with work functioning, either decreased work productivity and (or) absenteeism.1 In addition to work impairment, the psychosocial impact of MDD often affects a person's level of functioning in family and social relationships. While there is clearly an association between improvement in depressive symptoms and functioning, symptom improvement can also be dissociated from functional improvement and work loss.3,4 Hence there has been increasing recognition that symptomatic remission is an insufficient goal of treatment for MDD and that return to premorbid psychosocial functioning should be targeted. 5Cognitive dysfunction refers to deficits in attention, verbal and nonverbal learning, short-term and working memory, visual and auditory processing, problem solving, processing speed, and motor functioning. Cognitive dysfunction may be a primary mediator of functional impairment in MDD. 6 Cognitive complaints are core symptoms of acute MDEs, and diminished ability to think or concentrate and (or) indecisiveness are criterion items for the diagnosis of MDD. Several other core symptoms of MDD may act as mediators of cognitive dysfunction, including psychomotor retardation, amotivation, fatigue, insomnia, and mood disturbances. Deficits on neuropsychological testing are well demonstrated in people with MDD, compared with healthy subjects, with many studies and meta-analyses showing moderate effect sizes in neurocognitive domains of processing speed, attention, executive function, learning, and memory 7,8 as well as in cognitive affective bias. Cognitive affective bias reflects distorted information processing and (or) focus moving away from positive stimuli and toward negative stimuli, 7 and abnormal responses to negative feedback and decision making. It is also apparent that, while cognitive dysfunction in MDD may improve with treatment and resolution of depressive symptoms, cognitive deficits can still be detected even in periods of symptom remission. In a 3-year, follow-up study of patients with MDD, the proportion of time with cognitive complaints was reported as 94% during acute depressive episodes; this remained at 44% despite full or partial symptom remission during treatment. 10 Cognitive performance on tests of immediate memory, attention, 11 and processing speed 12 was reported to be inferior in patients with MDD who met criteria for remission, compared with healthy subjects. Meta-analyses show that cognitive deficits in executive function are still present in remitted patients, 13,14 which may explain persistent psychosocial impairment in remission.While it is beyond the scope of our paper to review the unde...

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Section: Effects Of Psychotherapy On Cognitive Dysfunctionmentioning

confidence: 99%

Cognitive Dysfunction in Major Depressive Disorder: Effects on Psychosocial Functioning and Implications for Treatment

et al. 2014

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“…In addition, cognitive rehabilitation training has been demonstrated to improve aspects of cognition in a range of disorders, including some commonly comorbid with substance use disorders, such as major depressive disorder, bipolar disorder, and schizophrenia (Bowie, Gupta, & Holshausen, 2013a; Elliott & Parente, 2014; Revell, Neill, Harte, Khan, & Drake, 2015; Wykes, Huddy, Cellard, McGurk, & Czobor, 2011). In a meta-analysis of cognitive enhancement treatments for schizophrenia that included 2,104 participants, durable effects on global cognition and functioning were reported (Wykes et al, 2011).…”

Section: Treatment Approaches Targeting Cognitive Functionsmentioning

confidence: 99%

Cognitive Function as a Transdiagnostic Treatment Target in Stimulant Use Disorders

Sofuoglu

DeVito

Waters

et al. 2016

Journal of Dual Diagnosis

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Stimulant use disorder is an important public health problem, with an estimated 2.1 million current users in the United States alone. No pharmacological treatments are approved by the U.S. Food and Drug Administration (FDA) for stimulant use disorder and behavioral treatments have variable efficacy and limited availability. Most individuals with stimulant use disorder have other comorbidities, most with overlapping symptoms and cognitive impairments. The goal of this article is to present a rationale for cognition as a treatment target in stimulant use disorder, and to outline potential treatment approaches. Rates of lifetime comorbid psychiatric disorders among people with stimulant use disorders are estimated at 65% - 73%, with the most common being mood disorders (13% - 64%) and anxiety disorders (21% - 50%), as well as non-substance induced psychotic disorders (under 10%). There are several models of addictive behavior, but the dual process model particularly highlights the relevance of cognitive impairments and biases to the development and maintenance of addiction. This model explains addictive behavior as a balance between automatic processes and executive control, which in turn are related to individual (genetics, comorbid disorders, psychosocial factors) and other (craving, triggers, drug use) factors. Certain cognitive impairments, such as attentional bias and approach bias, are most relevant to automatic processes, while sustained attention, response inhibition, and working memory are primarily related to executive control. These cognitive impairments and biases are also common in disorders frequently comorbid with stimulant use disorder, and predict poor treatment retention and clinical outcomes. As such, they may serve as feasible trans-diagnostic treatment targets. There are promising pharmacological, cognitive, and behavioral approaches that aim to enhance cognitive function. Pharmacotherapies target cognitive impairments associated with executive control and include cholinesterase inhibitors (e.g., galantamine, rivastigmine) and monoamine transporter inhibitors (e.g., modafinil, methylphenidate). Cognitive behavioral therapy and cognitive rehabilitation also enhance executive control, while cognitive bias modification targets impairments associated with automatic processes. Cognitive enhancements to improve treatment outcomes is a novel and promising strategy, but its clinical value for the treatment of stimulant use disorder, with or without other psychiatric comorbidities, remains to be determined in future studies.

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“…In psychiatry, CRT has been most commonly associated with the investigation of cognitive dysfunction in patients with schizophrenia, and dating back to the early 1990’s, there is an extensive body of work describing positive outcomes of CRT for this patient group [18,19]. The approach has also been successful in treating other mental health conditions such as mood disorders [20] attention deficit hyperactivity disorder (ADHD) [21], alcohol dependence [22], geriatric depression [23] and obsessive compulsive disorder (OCD) [24]. …”

Section: Introductionmentioning

confidence: 99%

A systematic review of cognitive remediation therapy for anorexia nervosa - development, current state and implications for future research and clinical practice

Dahlgren

Rø

2014

J Eat Disord

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ObjectiveTo systematically review studies of cognitive remediation therapy (CRT) for anorexia nervosa (AN), and to discuss findings with references to clinical practice and future research.MethodThe literature was reviewed using the PubMed, Web of Science and PsycINFO search terms “cognitive remediation therapy” AND “anorexia nervosa”. Papers published online between 2005 and 2013 were selected on the basis of three inclusion criteria: 1) studies of any design focusing on CRT for AN, 2) papers that were written in English or had an available published English translation, and 3) papers published in peer reviewed journals.ResultsA total of 45 papers were identified of which 21 were recognized as being relevant for the review. Relevant papers were divided into three different categories 1) single case reports, 2) case series and 3) randomised controlled trials (RCTs). Single case studies and case series yielded strong evidence of feasibility and acceptability of CRT for AN despite great variety in sample compositions. Four RCTs demonstrate that CRT has the potential of enhancing the effectiveness of current treatments, reduce attrition, increase cognitive set-shifting abilities and quality of life, as well as reduce eating disorder psychopathology.DiscussionThe number of CRT studies published is growing rapidly, in particular RCTs. Further research is needed to define the primary aim of delivering CRT to patients with eating disorders, and to establish how to best measure the effect of the intervention. Moreover, researchers and clinicians should focus on identifying and assessing specific versus non-specific CRT contributions, and explore long-term effects of the intervention. It is imperative that adolescent RCTs are conducted to evaluate how CRT may be effective as a treatment for this young patient group.

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Cognitive Remediation Therapy for Mood Disorders: Rationale, Early Evidence, and Future Directions

Cited by 60 publications

References 39 publications

Cognitive Dysfunction in Major Depressive Disorder: Effects on Psychosocial Functioning and Implications for Treatment

Cognitive Dysfunction in Major Depressive Disorder: Effects on Psychosocial Functioning and Implications for Treatment

Cognitive Function as a Transdiagnostic Treatment Target in Stimulant Use Disorders

A systematic review of cognitive remediation therapy for anorexia nervosa - development, current state and implications for future research and clinical practice

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