An open pilot study of an internet-delivered intervention targeting self-perceived residual cognitive symptoms after major depressive disorder

Figures & data

Table 1. Overview of intervention.

Module	Main content	Tasks
1	Psychoeducation on self-perceived and objectively measured residual cognitive symptoms and treatment.	Articulate experiences with residual cognitive symptoms. Setting personal goals for treatment.
2	Introducing approaches to increase helpful thoughts. Psychoeducation about attention processes. Introducing attention training.	Registration of negative thoughts and identification of helpful thoughts about experiences related to symptoms. Daily attention training following the principles of the Attention Training Technique developed by Wells (1990).
3	Introducing compensatory strategies to cope with attention problems.	Talk to oneself during complex tasks. Take frequent breaks. Continue attention training.
4	Psychoeducation about rumination and coping strategies.	Planning and register coping strategies ( e.g. “office-time,” gratitude exercise) Continue attention training.
5	Psychoeducation about memory. Introducing different memory aids.	Find “homes” for important objects. Use notebook and calendar. Prepare, repeat, and rephrase key messages to remember.
6	Introduction to memory strategies and training.	Chunk and organizing material. Develop travel paths by applying the method of loci. Practice finding appropriate strategies for different situations.
7	Psychoeducation about executive functions. Introduction to strategies to cope with executive problems.	Make systems to sort material and organize the home environment. Engage in detailed activity planning. Quiz self to test knowledge about executive functions.
8	Introduction to a stepwise problem-solving tool.	Register a current problem and solve the problem using the stepwise problem-solving tool.
9	Psychoeducation about consequences for social interactions.	Practice increased eye contact and active listening during social interactions. Rephrasing messages to remember.
10	Summary of modules. Planning for future use of strategies and cognitive training.	Register the most helpful strategies and training tasks from the program. List helpful strategies and training tasks for further coping of residual cognitive symptoms.

Table 2. Participant characteristics.

Variable	Mean (SD) n (%)
Age	35.31 (13.0)
Female	35 (79%)
Higher education (13 years +)	70%
Employed	91%
Married or cohabiting	47%
Total years of depression
5 years or more	38%
<5 years->2 years	19%
<2 years->1 year	19%
<1 year->6 months	12%
<6 months	12%
Episodes of MDD
>2 episodes of MDD	74%

Note. N = 43; n: number; SD: standard deviation; MDD: major depressive disorder.

Figure 1. Participant flow diagram.

Table 3. Primary and secondary outcomes.

Variables	Estimated means [95% CI]	SD	ES^w	Linear mixed models
BRIEF-A GEC
Pretreatment	134.28 [128.94–139.62]	17.38
Post-treatment	117.12 [109.90–124.34]	21.77	0.98
6-month follow-up	115.88 [107.52–124.23]	23.38	1.06	F = 16.72, p < .001
BRIEF-A BRI-Index
Pretreatment	49.51 [46.88–52.14]	8.59
Post-treatment	44.32 [41.29–47.35]	9.12	0.60
6-month follow-up	45.61 [42.06–49.15]	9.91	0.45	F = 7.92, p = .002
BRIEF-A MI-Index
Pretreatment	84.77 [81.16–88.38]	11.74
Post-treatment	72.81 [68.14–77.47]	14.13	1.02
6-month follow-up	70.15 [64.82–75.49]	14.94	1.25	F = 24.08, p < .001
PDQ-5
Pretreatment	10.84 [9.56–12.12]	4.20
Post-treatment	6.15 [4.95–7.34]	3.59	1.12
6-month follow-up	5.93 [4.76–7.10]	3.28	1.17	F = 16.87, p < .001
RRS Total
Pretreatment	42.65 [39.06–46.24]	11.68
Post-treatment	35.28 [31.89–38.67]	10.21	0.63
6-month follow-up	32.63 [29.07–36.20]	9.96	0.86	F = 15.61, p < .001
RRS Depression subscale
Pretreatment	24.95 [22.90–27.01]	6.69
Post-treatment	20.88 [18.71–23.04]	6.51	0.61
6-month follow-up	18.87 [16.57–21.16]	5.40	0.91	F = 13.32, p < .001
RRS Brooding subscale
Pretreatment	9.56 [8.53–10.59]	3.35
Post-treatment	7.76 [6.86–8.66]	2.74	0.54
6-month follow-up	7.41 [6.54–8.29]	2.43	0.64	F = 11.75, p < .001
RRS Reflection subscale
Pretreatment	8.14 [7.29–8.99]	2.76
Post-treatment	6.65 [5.96–7.34]	2.07	0.54
6-month follow-up	6.41 [5.76–7.07]	1.92	0.62	F = 8.36, p < .001
MADRS-S
Pretreatment	8.74 [7.76–9.73]	3.21
Post-treatment	9.16 [7.38–10.94]	5.35	–0.13
6-month follow-up	9.05 [6.90–11.97]	6.00	–0.10	F = .11, p = .898

Note. BRIEF-A: The Behavior Rating Inventory of Executive Function-Adult; GEC: Global Executive Composite; BI: Behavioral Regulation Index; MI: Metacognition Index; PDQ-5: The Perceived Deficits Questionnaire-Depression 5-item; RRS: Rumination Response Scale; MADRS-S: Montgomery Åsberg Depression Rating Scale Self-report; CI: confidence interval; SD: standard deviation; ES^w: Cohen’s d within-group effect size. Adjusted p = .0056 after correction analysis.

Table 4. Reliable changes from pretreatment to post-treatment and at 6-month follow-up, as measured by the BRIEF-A GEC.

	Reliable change	Unchanged	Deteriorated
Pretreatment to post-treatment
Completers (n = 37)	60%	35%	5%
Intention-to-treat (N = 43)	51%	44%	5%
Pretreatment to 6-month follow-up
Completers (n = 31)	55%	42%	3%
Intention-to-treat (N = 43)	42%	56%	2%

Note. BRIEF-A GEC: The Behavior Rating Inventory of Executive Function-Adult Global Executive.

Wells, A. (1990). Panic disorder in association with relaxation induced anxiety: An attentional training approach to treatment. Behavior Therapy, 21(3), 273–280. https://doi.org/10.1016/S0005-7894(05)80330-2

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