Metacognitive stop-and-think training shows promise in improving emotion regulation in depressed patients

Cognitive training interventions appear to improve aspects of emotion regulation in patients with major depression, according to a new study published in behavioral research and therapy.

While the emotional toll of major depressive disorder is well known, the disorder is also associated with various cognitive deficits, including problems with memory, processing speed, attention, and executive function. Previous research has shown that improving cognitive function can improve the severity of depressive symptoms. The authors of the current study 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,” said study author Jan Egil Stubberud, associate professor of clinical neuropsychology at the University of Oslo.

“Emotion regulation and cognitive deficits are common and major complaints in depression. However, these processes are not satisfactorily addressed by existing treatments. Knowing that depression is a major contributor to the global burden of disability and disease, I wanted to explore the potential of improving existing interventions through the use of novel techniques that target underlying susceptibility factors such as cognitive functioning.”

The study enrolled 60 participants aged 18 to 60 who had been diagnosed with mild or moderate major depressive disorder and who reported executive dysfunction in everyday life.

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

The other half of the participants were assigned full computer-based cognitive training that included intensive procedural learning tasks aimed at improving basic cognitive functions such as attention, memory, and processing speed.

Participants completed validated rumination and emotion regulation assessments before treatment, immediately after treatment, and 6 months after completing treatment.

Researchers observed a significant decrease in brooding rumination over time. Both those who completed goal management training and those who completed computer-based cognitive training reported fewer rumination-related symptoms after the intervention.

Non-acceptance of emotional responses, an aspect of emotion 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 experiencing.

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

Researchers noted that improvements in emotional clarity were still seen 6 months after the intervention was completed. “Applying the metacognitive ‘stop-and-think’ strategy, alongside practicing mindfulness techniques and monitoring performance in real-life situations, are core aspects of GMT. We propose that these elements were critical in bringing about the self-reported long-term changes in emotion regulation observed post-GMT,” Stubberud and his colleagues wrote in their study.

The first results serve as an important springboard for future research. “Future studies should include a control group that receives no intervention/or receives a placebo intervention,” explained Stubberud. “Crucially, the present results need to be cross-validated in a larger and more representative depression sample, especially given the small sample size.”

“Depression research has identified cognitive processes that play critical roles in the onset and maintenance of depression, and our results demonstrate the potential of cognitive remediation in reducing maladaptive emotion regulation in depression,” Stubberud added.

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

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