Department of Research, Lovisenberg Diaconal Hospital, Norway.
Department of Psychology, University of Oslo, Norway.
J Affect Disord. 2020 Oct 1;275:268-277. doi: 10.1016/j.jad.2020.07.015. Epub 2020 Jul 10.
Major depressive disorder (MDD) is associated with deficits in executive functioning (EF) that may have a detrimental effect on everyday functioning. Despite this, there are no established cognitive remediation interventions available targeting EF in MDD. Hence, the primary aim of the present pre-registered randomized controlled trial was to evaluate the effectiveness of Goal Management Training (GMT), a metacognitive and strategy-based cognitive remediation intervention to improve EF in MDD.
Sixty-three participants with current or previous mild or moderate MDD and self-reported executive deficits were included and randomized to nine sessions of either GMT (two hours, once weekly; n = 35) or computerized cognitive training (one hour, twice weekly; n = 28). Assessments were conducted at baseline (T1), immediately following training (T2), and at six-month follow-up (T3). The primary outcome measure was The Behavior Rating Inventory of Executive Function - Adult version, pertained to daily life EF. Secondary outcome measures included additional EF assessments (performance-based measures and questionnaires), and depressive symptom severity.
Forty-three participants completed treatment. Both groups improved following training, and linear mixed model analyses revealed no statistically significant differences between the groups for any outcome measure. Additional exploratory within-group analyses revealed a statistically significant reduction of everyday executive dysfunction and reduced depressive symptoms at the six-month follow-up in GMT only.
The study was single-blind, and the sample size was modest.
Our findings indicate comparable improvements in everyday and performance-based measures of EF, in addition to reductions in depressive symptoms following both GMT and CCT.
重度抑郁症（MDD）与执行功能（EF）缺陷有关，这可能对日常功能产生不利影响。尽管如此，目前尚无针对 MDD 患者 EF 的既定认知矫正干预措施。因此，本预先注册的随机对照试验的主要目的是评估目标管理训练（GMT）的有效性，GMT 是一种元认知和基于策略的认知矫正干预措施，旨在改善 MDD 患者的 EF。
纳入 63 名当前或既往患有轻度或中度 MDD 且报告存在执行功能缺陷的参与者，并随机分为 GMT 组（9 次，每次 2 小时，每周一次；n=35）或计算机化认知训练组（9 次，每次 1 小时，每周两次；n=28）。评估在基线（T1）、培训后立即（T2）和 6 个月随访（T3）进行。主要结局测量指标为《行为评定量表：成人版》，与日常生活 EF 相关。次要结局测量指标包括额外的 EF 评估（基于表现的测量和问卷）和抑郁症状严重程度。
43 名参与者完成了治疗。两组在训练后均有所改善，线性混合模型分析显示，两组在任何结局测量指标上均无统计学显著差异。额外的探索性组内分析显示，GMT 组仅在 6 个月随访时日常生活执行功能障碍显著降低，抑郁症状减轻。
该研究为单盲，样本量适中。
我们的发现表明，GMT 和 CCT 后，日常和基于表现的 EF 测量以及抑郁症状均有相似的改善。
