The Effectiveness of Enhancing Autobiographical Thinking on Cognitive Vulnerabilities Associated with Relapse Prevention in Remitted Depression: A Proof-of-Concept Pilot Trial

The aim of the current study is to conduct a proof-of-concept pilot trial to test an Autobiographical Thinking Training Program in people with Remitted Major Depressive Disorder (MDD), and to examine whether this program has an effect on autobiographical thinking (memory and future thinking) by the 3 month endpoint (primary outcome); as well as secondary outcomes of depressive symptoms, anticipatory pleasure, anxiety symptoms, psychosocial functioning, self-efficacy, self-esteem, behavioural activation, perceived control, optimism and meaning in life. The four-session autobiographical thinking training is conducted in a group-based, online format on the Zoom platform (90 minutes each). This program had been developed for this study and was adapted from memory training programs (e.g., cognitive-reminiscence therapy Hallford & Mellor, 2016; Watt & Cappeliez, 2000; Westerhof & Slatman, 2019) and future thinking training programs (e.g., Future Event Specificity Training; Hallford et al., 2020; Hallford, Rusanov, et al., 2022). Participant groups of 4 led by 1-2 facilitators. The facilitators are a Masters of Applied Science (Psychology) student with experience in running autobiographical thinking training and counselling skills in a clinical trial that had ethics approval, a Masters in Clinical Psychology student with experience in counselling skills, and Psychology Honours graduate with experience in mental health support work, and supervised by a registered clinical psychologist with experience in this training intervention and in assessment and treatment of clinical depression (Dr David Hallford). This program is delivered over the course of four weeks. Additionally, a session attendance was recorded and session adherence checklist was used to assess adherence to the intervention. Prior to the first session, a homework task is given in which participants will be asked to write down two people that they have a positive relationship with, and for each person listed provide a time in which they shared a positive memory with the person, followed by another instance where they felt supported/cared for by this person. The first session involves a guided imagery exercise recalling times where someone that participants have a positive relationship with shared a positive memory or felt supported/cared for by this person. Facilitators provide individual feedback and a homework task to be completed before the next session consisting of a section in which participants are to provide five memories of a specific experience of someone showing care/support or specific positive memory with that person, and to provide two challenges in the past that they successfully coped with. The second session (one week later) involves a guided imagery exercise exploring instances where participants successfully coped with challenges in the past. Facilitators provide individual feedback and a homework task to be completed before the next session consisting of a section in which participants are to provide five memories of challenges they overcame, followed by a task to provide four future goals. The third session (one week later) involves psycho-education about episodic future thinking and its functions. Participants then practice generating future events and goals. This is done with guided mental imagery to elicit meaningful future goals and imagine positive outcomes of achieving the goal (e.g., feelings, significance, meaning, consequences). Facilitators provide individual feedback and a homework task to be completed before the next session consisting of a section in which participants are to provide four future goals, steps to attain them and outcomes of achieving the goal, and also to provide a daily future thought of something that would or could happen the following day. The fourth session (one week later) involves guided mental imagery to elicit meaningful future goals, steps to attain goals, and positive outcomes of achieving the goal. Facilitators provide individual feedback and a homework task to be completed after the last session consisting of a section in which participants are to provide four future goals, steps to attain them and imagined outcomes of achieving the goal, and to record if any written goal was achieved in the months following the last session and describe the actual outcome of achieving the goal (e.g., thoughts, feelings, meaning, etc.). Participants are also be asked to provide a daily future thought of something that would or could happen the following day for a week following the last session. The four homework tasks were estimated to require 20 to 30 minutes each. Throughout the guided imagery tasks within all four sessions there is a focus on generating detail (e.g., sensorial and scene details, actions, people, thoughts, feelings, etc.), using mental imagery, imagining future thoughts or recalling past events from a first-person perspective. Facilitators monitor adherence using an attendance and adherence checklist for each session.