“Stop and think” metacognitive training shows promise for improving emotion regulation in depressed patients

According to new research published in Behavioral Research and Therapy.

While the emotional toll of major depressive disorder is well known, the condition is also associated with various cognitive deficits, including problems with memory, processing speed, attention, and executive functioning. Previous research has indicated that improving cognitive function can improve the severity of depressive symptoms. The authors of the current research were interested in learning more about potential cognitive training programs that might be helpful.

“As a neuropsychologist, I am interested in cognitive functions and their relationship to emotional health,” the study author said. Jan Egil Stubberudassociate professor in clinical neuropsychology at the University of Oslo.

“Emotion regulation and cognitive deficits are common and major complaints in depression. Yet these processes are not satisfactorily addressed by existing treatments. Knowing that depression is one of the leading causes of the global burden of disability and disease, I wanted to explore the potential for improving existing interventions, using new techniques that target underlying vulnerability factors, such as cognitive functions.

The study included 60 participants between the ages of 18 and 60 who had been diagnosed with mild or moderate major depressive disorder and reported executive dysfunction in daily life.

Half of the participants were randomly assigned to complete the goal management training, which included exercises to help plan, organize, and track a goal. The training also included a self-monitoring (“stop-and-think”) technique in which participants were encouraged to periodically stop their current behavior to reflect on the present moment and identify negative automatic thought processes.

The other half of the participants were assigned to comprehensive computer-based cognitive training, which included intensive procedural learning tasks designed to improve basic cognitive functions, such as attention, memory and processing speed.

Participants completed validated assessments of rumination and emotional regulation before treatment, immediately after treatment, and 6 months after treatment ended.

The researchers observed a significant decrease in brooding rumination over time. Both those who took the goal management training and those who took the computer-based cognitive training reported fewer moody symptoms after the intervention.

Non-acceptance of emotional responses, an aspect of emotional regulation, also improved over time for both groups. But only the Goal Management Training intervention was associated with improved clarity of emotional responses, that is, the extent to which individuals can identify the emotions they are feeling.

“Due to the interplay between cognitive functions and emotion regulation, our results suggest that there is great potential to complement other therapeutic interventions with cognitive remediation techniques,” Stubberud told PsyPost. “Overall, treating cognitive (dys)function may help patients with depression derive greater benefit from cognitively demanding treatments, such as cognitive behavioral therapy.”

The researchers noted that improvements in emotional clarity were still visible 6 months after the intervention ended. “Applying the ‘stop-and-think’ metacognitive strategy, in addition to practicing mindfulness techniques, and tracking performance in real-life situations, are essential aspects of GMT. We suggest that these elements were essential for effecting the self-reported long-term changes in emotion regulation seen after GMT,” Stubberud and colleagues wrote in their study.

The first results constitute an important springboard for future research. “Future studies should include a control group receiving no intervention/or receiving a placebo intervention,” Stubberud explained. “Critically, the current results need to be validated in a larger, more representative sample of depression, especially given the small sample size.”

“Depression research has identified cognitive processes that play a critical role in the onset and maintenance of depression, and our findings demonstrate the potential of cognitive remediation to reduce maladaptive emotion regulation in depression,” said added Stubberud.

The study, “Improved emotion regulation in depression following cognitive remediation: a randomized controlled trial“, was written by J. Stubberud, R. Huster, K. Hoorelbeke, Å. Hammar and BI Hagenb.

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