Development and Evaluation of a Group Psycho-Cognitive Remediation Intervention for Adults with Major Depressive Disorder

Background: Despite notable advances in the psychological treatment of major depressive disorder (MDD), many treatment challenges remain, such as the high probability of relapse after recovery, lack of treatment efficacy for many patients, and functional impairment after treatment. In overcoming these challenges, ignoring mediator factors such as cold cognition impairment which may be caused or associated with causation mechanisms leading to these challenges appears to play a major role. Therefore, this study seeks to (I) develop a manual based on the hot and cold cognition model of depression, (II) investigate the content validity of the manual, and (III) test its effectiveness on psychological and neuropsychological symptoms. Methods: In 2022, this research was conducted in three stages: First, a psycho-cognitive remediation treatment manual was developed based on the most reliable existing treatments: Cognitive Behavior Therapy (CBT) and Cognitive Remediation Therapy (CRT). 8 experts evaluated the content validity of the manual at a second stage. Lastly, the quasi-experimental method and an active control group in a pre-test post-test follow-up design assessed the effectiveness of the developed treatment. Finally, the effectiveness of the developed treatment was evaluated by the quasi-experimental method with an active control group, pretest-posttest follow-up design. 28 adults aged 24-45 years who had been diagnosed with MDD were purposefully selected and assigned to one of the two experimental or control groups. The experimental group participated in 12 two-hour weekly sessions and the control group played video games at home. The Beck Depression Inventory-Second Edition (BDI-II) and the THINC-it tools as neuropsychological tests were used for gathering data. Only 25 patients remained in the study at week 12. To statistically analyze the data, One-way analysis of covariance was used (SPSS 26). Results: Data analysis showed that depression and anhedonia were substantially lower at the post-test compared to the pre-test, according to the BDI-II and SHAPS scores. All objective and subjective cognitive functions were significantly improved. The three-month follow-up scores remained noticeably stable compared to the post-test scores, indicating the treatment effects durability. Conclusion: As far as the authors know, this is the first study to evaluate two validated combined therapies in adults with MDD. It was evaluated based on feasibility, acceptability, and effectiveness. In clinical practice, the authors of the study advise healthcare professionals to use these combinations. Although this treatment manual had a good effect, some of its limitations must be addressed in future research.