Hostname: page-component-8448b6f56d-c4f8m Total loading time: 0 Render date: 2024-04-24T16:43:05.894Z Has data issue: false hasContentIssue false
  • English
  • Français

No change in neuropsychological dysfunction or emotional processing during treatment of major depression with cognitive–behaviour therapy or schema therapy

Published online by Cambridge University Press:  08 October 2015

R. J. Porter ,
C. Bourke ,
J. D. Carter ,
K. M. Douglas ,
V. V. W. McIntosh ,
J. Jordan ,
P. R. Joyce  and
C. M. A. Frampton
R. J. Porter*
Affiliation:
Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
C. Bourke
Affiliation:
Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
J. D. Carter
Affiliation:
Department of Psychology, University of Canterbury, Christchurch, New Zealand
K. M. Douglas
Affiliation:
Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
V. V. W. McIntosh
Affiliation:
Department of Psychological Medicine, University of Otago, Christchurch, New Zealand Clinical Research Unit, Canterbury District Health Board, Christchurch, New Zealand
J. Jordan
Affiliation:
Department of Psychological Medicine, University of Otago, Christchurch, New Zealand Clinical Research Unit, Canterbury District Health Board, Christchurch, New Zealand
P. R. Joyce
Affiliation:
Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
C. M. A. Frampton
Affiliation:
Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
*
*Address for correspondence: R. Porter, Department of Psychological Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch 8140, New Zealand. (Email: richard.porter@otago.ac.nz)
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Impaired neuropsychological functioning is a feature of major depression. Previous studies have suggested that at least some aspects of neuropsychological functioning improve with successful treatment of major depression. The extent to which medications may affect the degree of normalization of these functions is unclear. The aim of the current study was to examine the course of neuropsychological functioning during treatment of major depression with cognitive–behaviour therapy (CBT) or schema therapy (ST).

Method

A total of 69 out-patients with a primary diagnosis of major depression and 58 healthy controls completed mood ratings, neuropsychological measures, and measures of emotional processing at baseline and after 16 weeks. Participants were randomized after baseline assessment to a year-long course of CBT or ST. Patients reassessed at 16 weeks were medication-free throughout the study.

Results

Significant neuropsychological impairment was evident at baseline in depressed participants compared with healthy controls. After 16 weeks of psychotherapy, mean depression rating scores fell more than 50%. However, no neuropsychological measures showed convincing evidence of significant improvement and emotional processing did not change.

Conclusions

Persisting impairment in neuropsychological functioning after the first 16 weeks of CBT or ST suggests a need to modify psychological treatments to include components targeting cognitive functioning.

Keywords

Facial emotion processingmajor depressive disordermemoryneuropsychological functionpsychological treatment
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 2 , January 2016 , pp. 393 - 404
Copyright
Copyright © Cambridge University Press 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Bastos, AG, Guimaraes, LS, Trentini, CM (2013). Neurocognitive changes in depressed patients in psychodynamic psychotherapy, therapy with fluoxetine and combination therapy. Journal of Affective Disorders 151, 1066–1075.CrossRefGoogle ScholarPubMed
Beck, A, Rush, AJ, Shaw, V, Emery, G (1979). Cognitive Therapy of Depression. Guilford Press: New York.Google Scholar
Beck, J (1995). Cognitive Therapy: Basics and Beyond. Guilford Press: New York.Google Scholar
Benton, AL, Hamsher, K (1976). Multilingual Aphasia Examination. University of Iowa: Iowa City, IA.Google Scholar
Bhagwagar, Z, Cowen, PJ, Goodwin, GM, Harmer, CJ (2004). Normalization of enhanced fear recognition by acute SSRI treatment in subjects with a previous history of depression. American Journal of Psychiatry 161, 166–168.CrossRefGoogle ScholarPubMed
Biringer, E, Mykletun, A, Sundet, K, Kroken, R, Stordal, KI, Lund, A (2007). A longitudinal analysis of neurocognitive function in unipolar depression. Journal of Clinical and Experimental Neuropsychology: Official Journal of the International Neuropsychological Society 29, 879–891.CrossRefGoogle ScholarPubMed
Bortolato, B, Carvalho, AF, McIntyre, RS (2014). Cognitive dysfunction in major depressive disorder: a state-of-the-art clinical review. CNS and Neurological Disorders Drug Targets 13, 1804–1818.CrossRefGoogle ScholarPubMed
Bourke, C, Douglas, K, Porter, R (2010). Processing of facial emotion expression in major depression: a review. Australian and New Zealand Journal of Psychiatry 44, 681–696.CrossRefGoogle ScholarPubMed
Bourke, C, Porter, RJ, Carter, JD, McIntosh, VV, Jordan, J, Bell, C, Carter, F, Colhoun, H, Joyce, PR (2012). Comparison of neuropsychological functioning and emotional processing in major depression and social anxiety disorder subjects, and matched healthy controls. Australian and New Zealand Journal of Psychiatry 46, 972–981.CrossRefGoogle ScholarPubMed
Bowie, CR, Gupta, M, Holshausen, K, Jokic, R, Best, M, Milev, R (2013). Cognitive remediation for treatment-resistant depression: effects on cognition and functioning and the role of online homework. Journal of Nervous and Mental Disease 201, 680–685.CrossRefGoogle ScholarPubMed
Carter, JD, McIntosh, VV, Jordan, J, Porter, RJ, Frampton, CM, Joyce, PR (2013). Psychotherapy for depression: a randomized clinical trial comparing schema therapy and cognitive behavior therapy. Journal of Affective Disorders 151, 500–505.CrossRefGoogle ScholarPubMed
Douglas, KM, Porter, RJ (2009). Longitudinal assessment of neuropsychological function in major depression. Australian and New Zealand Journal of Psychiatry 43, 1105–1117.CrossRefGoogle ScholarPubMed
Douglas, KM, Porter, RJ, Knight, RG, Maruff, P (2011). Neuropsychological changes and treatment response in severe depression. British Journal of Psychiatry 198, 115–122.CrossRefGoogle ScholarPubMed
First, MB, Spitzer, RL, Gibbon, M, Williams, JB (1998). Structured Clinical Interview for DSM-IV Disorders – Patient Edition (SCID-I/P, Version 2.0, 8/98 revision). New York State Psychiatric Institute: New York.Google Scholar
Gallagher, P, Robinson, LJ, Gray, JM, Porter, RJ, Young, AH (2007). Neurocognitive function following remission in major depressive disorder: potential objective marker of response? Australian and New Zealand Journal of Psychiatry 41, 54–61.CrossRefGoogle ScholarPubMed
Groves, SJ, Porter, RJ, Jordan, J, Knight, R, Carter, JD, McIntosh, VV, Fernando, K, Frampton, CM, Mulder, RT, Lacey, C, Joyce, PR (2015). Changes in neuropsychological function after treatment with metacognitive therapy or cognitive behavior therapy for depression. Depression and Anxiety 32, 437–444.CrossRefGoogle ScholarPubMed
Hamilton, M (1960). A rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry 23, 56–62.CrossRefGoogle ScholarPubMed
Harmer, CJ, Perrett, DI, Cowen, PJ, Goodwin, GM (2001). Administration of the β-adrenoceptor blocker propranolol impairs the processing of facial expressions of sadness. Psychopharmacology 154, 383–389.CrossRefGoogle ScholarPubMed
Hayward, G, Goodwin, GM, Cowen, PJ, Harmer, CJ (2005). Low-dose tryptophan depletion in recovered depressed patients induces changes in cognitive processing without depressive symptoms. Biological Psychiatry 57, 517–524.CrossRefGoogle ScholarPubMed
IBM Corporation (2013). SPSS Statistics for Windows. IBM Corporation: Armonk, NY.Google Scholar
McDermott, LM, Ebmeier, KP (2009). A meta-analysis of depression severity and cognitive function. Journal of Affective Disorders 119, 1–8.CrossRefGoogle ScholarPubMed
McIntyre, RS, Cha, DS, Soczynska, JK, Woldeyohannes, HO, Gallaugher, LA, Kudlow, P, Alsuwaidan, M, Baskaran, A (2013). Cognitive deficits and functional outcomes in major depressive disorder: determinants, substrates, and treatment interventions. Depression and Anxiety 30, 515–527.CrossRefGoogle ScholarPubMed
Merens, W, Booij, L, Haffmans, PJ, van der Does, A (2008). The effects of experimentally lowered serotonin function on emotional information processing and memory in remitted depressed patients. Journal of Psychopharmacology 22, 653–662.CrossRefGoogle ScholarPubMed
Montgomery, SA, Åsberg, M (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry 134, 382–389.CrossRefGoogle ScholarPubMed
Naismith, SL, Diamond, K, Carter, PE, Norrie, LM, Redoblado-Hodge, MA, Lewis, SJ, Hickie, IB (2011). Enhancing memory in late-life depression: the effects of a combined psychoeducation and cognitive training program. American Journal of Geriatric Psychiatry 19, 240–248.CrossRefGoogle ScholarPubMed
Naismith, SL, Redoblado-Hodge, MA, Lewis, SJ, Scott, EM, Hickie, IB (2010). Cognitive training in affective disorders improves memory: a preliminary study using the NEAR approach. Journal of Affective Disorders 121, 258–262.CrossRefGoogle ScholarPubMed
Nelson, HE (1982). National Adult Reading Test (NART): For the Assessment of Premorbid Intelligence in Patients with Dementia: Test Manual. NFER-Nelson: Windsor.Google Scholar
Porter, RJ, Bourke, C, Gallagher, P (2007). Neuropsychological impairment in major depression: its nature, origin and clinical significance. Australian and New Zealand Journal of Psychiatry 41, 115–128.CrossRefGoogle ScholarPubMed
Porter, RJ, Bowie, CR, Jordan, J, Malhi, GS (2013). Cognitive remediation as a treatment for major depression: a rationale, review of evidence and recommendations for future research. Australian and New Zealand Journal of Psychiatry 47, 1165–1175.CrossRefGoogle ScholarPubMed
Porter, RJ, Douglas, K, Jordan, J, Bowie, CR, Roiser, J, Malhi, GS (2014). Psychological treatments for cognitive dysfunction in major depressive disorder: current evidence and perspectives. CNS and Neurological Disorders Drug Targets 13, 1677–1692.CrossRefGoogle Scholar
Rastle, K, Harrington, J, Coltheart, M (2002). 358,534 Nonwords: the ARC Nonword Database. Quarterly Journal of Experimental Psychology 55, 1339–1362.CrossRefGoogle ScholarPubMed
Reppermund, S, Zihl, J, Lucae, S, Horstmann, S, Kloiber, S, Holsboer, F, Ising, M (2007). Persistent cognitive impairment in depression: the role of psychopathology and altered hypothalamic–pituitary–adrenocortical (HPA) system regulation. Biological Psychiatry 62, 400–406.CrossRefGoogle ScholarPubMed
Rey, A (1964). L'Examen Clinique en Psychologie (Clinical Psychology Review). Press Universitaire de France: Paris.Google Scholar
Sachs, GS, Ice, KS, Chappell, PB, Schwartz, JH, Gurtovaya, O, Vanderburg, DG, Kasuba, B (2011). Efficacy and safety of adjunctive oral ziprasidone for acute treatment of depression in patients with bipolar I disorder: a randomized, double-blind, placebo-controlled trial. Journal of Clinical Psychiatry 72, 1413–1422.CrossRefGoogle ScholarPubMed
Sheehan, DV, Lecrubier, Y, Sheehan, KH, Amorim, P, Janavs, J, Weiller, E, Hergueta, T, Baker, R, Dunbar, GC (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry 59, 22–33.Google ScholarPubMed
Siegle, GJ, Ghinassi, F, Thase, ME (2007). Neurobehavioral therapies in the 21st century: summary of an emerging field and an extended example of cognitive control training for depression. Cognitive Therapy and Research 31, 235–262.CrossRefGoogle Scholar
Symonds, CS, Gallagher, P, Thompson, JM, Young, AH (2004). Effects of the menstrual cycle on mood, neurocognitive and neuroendocrine function in healthy premenopausal women. Psychological Medicine 34, 93–102.CrossRefGoogle ScholarPubMed
Vythilingam, M, Vermetten, E, Anderson, GM, Luckenbaugh, D, Anderson, ER, Snow, J, Staib, LH, Charney, DS, Bremner, JD (2004). Hippocampal volume, memory, and cortisol status in major depressive disorder: effects of treatment. Biological Psychiatry 56, 101–112.CrossRefGoogle ScholarPubMed
Wechsler, D (1997). Wechsler Adult Intelligence Scale-Third Edition (WAIS-III). The Psychological Corporation: New York.Google Scholar
Wells, A, Fisher, P, Myers, S, Wheatley, J, Patel, T, Brewin, CR (2009). Metacognitive therapy in recurrent and persistent depression: a multiple-baseline study of a new treatment. Cognitive Therapy and Research 33, 291–300.CrossRefGoogle Scholar
Young, AW, Rowland, D, Calder, AJ, Etcoff, NL, Seth, A, Perrett, DI (1997). Facial expression megamix: tests of dimensional and category accounts of emotion recognition. Cognition 63, 271–313.CrossRefGoogle ScholarPubMed
Young, J (1990). Cognitive Therapy for Personality Disorders: A Scheme-Focused Approach. Professional Resource Press: Sarasota, FL.Google Scholar
Young, J, Klosko, J (1993). Reinventing Your Life. PLUME: New York.Google Scholar
Young, J, Klosko, J, Weishaar, M (2003). Schema Therapy: A Practitioner's Guide. Guilford Press: New York.Google Scholar
Supplementary material: File

Porter supplementary material

Porter supplementary material 1

Download Porter supplementary material(File)
File 30.2 KB
Supplementary material: File

Porter supplementary material

Table S1

Download Porter supplementary material(File)
File 117.8 KB