A blended brain training treatment for overthinking in students

The intervention is called CoCA - Cognitive Control Training Aotearoa. The digital aspects of the CoCA intervention have been recently developed by our study team at the Department of Psychological Medicine (UOC), in collaboration with University of Otago software design staff and independent sound engineers. ‘Blended’ refers to CoCA including therapist-guided and online/digital components. Participants will access an online interface which will deliver the online cognitive task. The specific training task is modelled on the adaptive Paced Auditory Serial Addition Task (aPASAT), a widely used task for cognitive control training interventions, found to be effective in reducing ruminative thinking and depression severity. In the aPASAT, participants are presented with digits in a sequential fashion and asked to provide the sum of the 2 last heard digits (by selecting the correct sum on the screen). The aPASAT tailors the exercise based on individual performance by modifying the intertrial interval following every 4 consecutive correct (-100 milliseconds) or incorrect (+100 milliseconds) responses. Within the context of this task, individuals are continuously required to update information in working memory while preventing interference from previous responses. An auditory distraction component, using a New Zealand-focused soundscape, has been incorporated into the end trial in the aPASAT to more specifically train executive functions of selective attention, mental flexibility, and inhibition. The soundscape plays four sounds, common in New Zealand, through headphones (New Zealand birds, circadas, a running stream, ticking clock and footsteps). Participants will engage with the online cognitive task (described above) at least once per day for two weeks, at a maximum of twice per day (e.g., total of between 14 – 28 practice sessions). The task will take 8-12 minutes to complete. Participants will meet with a therapist (in-person or via Zoom) three times over the course of the 2-week intervention: 1) an intake session including consent, study information, and psychoeducation about rumination/over-thinking before the start of the intervention, 2) a ‘check-in’ session in the middle involving psychoeducation, supportive listening, and problem-solving, if needed, to increase engagement with online practices, and 3) close-out reflection session. Each session with the therapist will be 30-60 minutes. The therapist will be a Research Assistant who has extensive experience working with mental health patients within clinical trials. She will be trained in supportive therapy techniques by KD (Clinical Psychologist) and supervised regularly (weekly 1:1 supervision sessions) over the course of the study. Training will occur over the course of 2 weeks, prior to study commencement, with 3 sessions of up to 2 hours. Training and supervision will continue over the course of the study, with weekly, 1 hour sessions. Adherence to the intervention will be monitored via tracking responses to questions asked immediately after each cognitive training session, on the same app delivering the aPASAT. Participants will also be asked about the number of practices they have completed during the in-person therapist sessions.