A randomised controlled trial of psychotherapy and cognitive remediation to target cognition in mood disorders

Nov 20, 2021Acta psychiatrica Scandinavica

Testing talk therapy and brain training to improve thinking skills in mood disorders

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Abstract

Sixty-eight individuals with mood disorders participated in a trial comparing IPSRT-CR and IPSRT treatments.

Change in Global Cognition did not differ significantly between IPSRT-CR and IPSRT groups over 12 months.
Psychosocial functioning and depression symptoms improved significantly more in the IPSRT group compared to the IPSRT-CR group.
Moderate effect size differences (0.41-0.60) favored IPSRT for measures of functioning and mood symptoms.
At 18 months, IPSRT showed small to moderate, non-significant benefits (0.26-0.47) over IPSRT-CR for functioning and mood outcomes.
Combining IPSRT with cognitive remediation may reduce the effectiveness of IPSRT in improving mood and functioning.

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OBJECTIVE: To examine the impact of a treatment package combining Interpersonal and Social Rhythm Therapy (IPSRT) and cognitive remediation (CR), vs IPSRT alone, on cognition, functioning, and mood disturbance outcomes in mood disorders.

METHODS: A pragmatic randomised controlled trial in adults with bipolar disorder (BD) or major depressive disorder (MDD), recently discharged from mental health services in Christchurch, New Zealand, with subjective cognitive difficulties. Individuals were randomised to a 12-month course of IPSRT with CR (IPSRT-CR), or without CR (IPSRT). In IPSRT-CR, CR was incorporated into therapy sessions from approximately session 5 and continued for 12 sessions. The primary outcome was change in Global Cognition (baseline to 12 months).

RESULTS: Sixty-eight individuals (BD n = 26, MDD n = 42; full/partial remission n = 39) were randomised to receive IPSRT-CR or IPSRT (both n = 34). Across treatment arms, individuals received an average of 23 IPSRT sessions. Change in Global Cognition did not differ between arms from baseline to treatment-end (12 months). Psychosocial functioning and longitudinal depression symptoms improved significantly more in the IPSRT compared with IPSRT-CR arm over 12 months, and all measures of functioning and mood symptoms showed moderate effect size differences favouring IPSRT (0.41-0.60). At 18 months, small to moderate, non-significant benefits (0.26-0.47) of IPSRT vs IPSRT-CR were found on functioning and mood outcomes.

CONCLUSIONS: Combining two psychological therapies to target symptomatic and cognitive/functional recovery may reduce the effect of IPSRT, which has implications for treatment planning in clinical practice and for CR trials in mood disorders.

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A randomised controlled trial of psychotherapy and cognitive remediation to target cognition in mood disorders

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