Cognitive Change, Depression
Conditions
Keywords
Cognitive Biases, Cognitive Bias Modification, Depression, Online intervention, Cognitive Bias Interpretation
Brief summary
Cognitive biases have been found to be possible causal and vulnerability factors for depression. There is empirical evidence on the presence of negative emotional biases in interpretation in people with depressive symptoms. A whole new area of research, called Cognitive Bias Modification (CBM), is focused on targeting negative cognitive emotional biases to investigate its impact on clinical symptoms. A recent meta-analysis has shown that this type of programs are effective in reducing cognitive biases but there is still controversy on their clinical value to reduce symptoms. The purpose of the study is to create a brief online intervention aimed to reduce negative emotional cognitive biases present in depression and to analyze its impact on clinical symptoms and well-being.
Detailed description
More specifically, the intervention is framed within the area of CBM but it is rooted on techniques and change procedures used in cognitive-behavioral therapies. While original CBM studies train participants to change cognitive biases in an automatic manner, by forcing individuals to find positive outcomes to ambiguous scenarios, this new intervention focuses on teaching participants the meaning of emotional cognitive biases and how to modify them by using an effortful type of processing (i.e., looking for adaptive alternative interpretations to ambiguous stories). The study has been design to overcome some of the limitations that have been pointed out in this emerging research area. Firstly, although there are recent efforts to understand how interpretation, attention and memory cognitive biases may be related, it is still not clear how they interact with each other. For this purpose, some authors have pointed out the need to use longitudinal data to see how one process may affect each other over time. Secondly, different systematic reviews and meta-analyses have investigated the moderating role of variables that may be affecting the heterogeneity of results found in CBM interventions. Mental imagery has been found to be a useful tool to help participants in their changing process, while there is no preferred number of sessions for these interventions. This study will help shed some light into this factors by using mental imagery during four sessions online.
Interventions
BEHAVIORALInterpretation bias modification program
Brief online program aimed at the modification of negative interpretation biases.
BEHAVIORALWaiting list
Waiting list procedure for the control group.
Sponsors
Universidad Complutense de Madrid
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* Present (PHQ-9) or past (DID) episode of depression. * Access to Internet * Fluent in Spanish language
Exclusion criteria
* Being under any psychological treatment * Having a psychotic condition * Having any cognitive impairment or condition that do not allow to follow the program * Serious auditory or visual impairments
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Total score of pleasantness ratings given to the ambiguous scenarios presented in the Ambiguous Scenarios Test for Depression-II, (AST-D-II) to measure interpretation bias. | Change from the first assesment (the day before starting the intervention) to the second assessment (the day after completing the intervention) and the follow-up assessments (2 weeks and 3 months after completing the intervention). | Participants are asked to rate how pleasant they perceive 15 ambiguous scenarios in a scale from -5 (very unpleasant) to 5 (very pleasant). |
| Total score on general, eudaimonic, hedonic, and social well-being as measured by the Pemberton Happiness Index (PHI) | Change from the first assesment (the day before starting the intervention) to the second assessment (the day after completing the intervention) and the follow-up assessments (2 weeks and 3 months after completing the intervention). | Scale of 11 items measuring emotional well-being at different levels. |
| Total score of each of the three subscales of the Depression, Anxiety and Stress Scale-21 (DASS) questionnaire. | Change from the first assesment (the day before starting the intervention) to the second assessment (the day after completing the intervention) and the follow-up assessments (2 weeks and 3 months after completing the intervention). | Three subscales, with 7 items each, measuring symptoms of depression, anxiety and stress. Scores multiplied by 2 and summed up for each scale. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Proportion of time fixating the mouse cursor on negative over positive words to uncover them during the SST. | Change from the first assesment (the day before starting the intervention) to the second assessment (the day after completing the intervention). | During the SST, words are covered so that participants can only see them when placing the mouse cursor over them. The time spent on negative words is a measure of negative attention bias. |
| Ratio of the number of negative unscrambled sentences by the number of emotional unscrambled sentences in the Scrambled Sentence Test (SST) with cognitive load. | Change from the first assesment (the day before starting the intervention) to the second assessment (the day after completing the intervention). | The task presents 20 scrambled sentences with 6 words each. Participants are asked to construct a sentence using 5 of the 6 words. In addition, participants are shown a number, at the beginning of the task, to report it at the end (cognitive load). The resulting ratio of correctly negative unscrambled sentences between correctly emotional unscrambled sentences is an index of automatic interpretation bias. |
| Ratio of recalled negative unscrambled sentences and recalled emotional unscrambled sentences during the SST. | Change from the first assesment (the day before starting the intervention) to the second assessment (the day after completing the intervention). | Participants are asked to remember, during 5 minutes, the sentences they construct during the SST. The ratio of negative and emotional unscrambled sentences that participants recall is a measure of memory bias. |
| Number of items viewed before reaching a decision in the Computerized Beads Task. | Change from the first assesment (the day before starting the intervention) to the second assessment (the day after completing the intervention). | The task presents two jars with beads containing positive or negative adjectives. Each jar has a different ratio of positive and negative words. Participants are told that one of the jars is going to be selected and one bead is going to be taken out and returned to it in each trial. Participants have to decide which jar is being used based on the number of positive and negative adjectives that are taken in each trial. The number of beads viewed before reaching a decision is an index of jumping to conclusion bias. |
| Total score on the Dysfunctional Attitudes Scale (DAS) | Change from the first assesment (the day before starting the intervention) to the second assessment (the day after completing the intervention). | Scale of 40 sentences which participants have to rate from 1 (totally agree) to 7 (totally disagree). The sum of the scores given to each sentence is an index of dysfunctional cognitive schemas. |
| Total score on the Brooding subscale of the Ruminative Responses Scale (RRS) | Change from the first assesment (the day before starting the intervention) to the second assessment (the day after completing the intervention). | Subscale of 5 items which participants have to rate from 1 (totally disagree) to 5 (totally agree). The total score, ranging from 5 to 25, is an index of brooding. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Total number of events, total number of times, mean score on negative impact and mean duration time of the negative impact of the negative events selected in the Stressful events questionnaire (based on Life Events Scale, LES). | The questionnaire is used 2 weeks and 3 moths after finishing the program (follow-ups). | A 47-item questionnaire in which participants select negative events they have experienced during the last two weeks or three months, the number of times each event was experienced, the emotional impact of the event and the duration time of the emotional impact. The different indexes represent experience of stressful events. |
| Total score on each of the two subscales (treatment expectancy and rationale credibility) of the Credibility and expectancy questionnaire (CEQ) | This scale is administered the day before starting the intervention. | 6 items measuring patients' expectancy of treatment success and credibility of the treatment prior to the intervention. |
| Total score on the Client Satisfaction Questionnaire (CSQ-8) | The measure is administered one day after finishing the intervention. | 8 items measuring participants' satisfaction with the treatment rated with a 4-point scale where 1 reflects 'very low satisfaction' and 4 reflects 'very high satisfaction'. |
| Total score in each of the 5 subscales of the EVEA assessment of current mood. | Participants self-administer the scale right before each session at home and right after completing each session. | Participants have to rate, from 0 to 10, their current level of anger, happiness, anxiety, depression, and boredom. Scores of each subscale (4 items each) are summed up. |
| Four of more depressive symptoms (including anhedonia and depressed modd) in the Patient Health Questionnaire-9 (PHQ-9) | Screening measure used after potential participants contact the main researcher to collaborate and before selecting participants to include in the study. | 9 items measuring symptoms of depression from 1 (not at all) to 4 (nearly everyday). Diagnosis is made if participants select 3 o 4 in four or more items (including anhedonia and depressed mood). |
| Five of more depressive symptoms (including anhedonia and depressed modd) in the Diagnostic Inventory of Depression (DID). | Screening measure used after potential participants contact the main researcher to collaborate and before selecting participants to include in the study. | Scale of 42 items measuring symptoms of depression in the past from 0 to 4. |
Countries
Spain
Outcome results
None listed