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

Cognitive training interventions appear to improve aspects of emotion regulation among patients with major depression, according to new research published in Behavior Research and Therapy.

While the emotional toll of major depressive disorder is well known, the condition is also associated with various cognitive deficits, including problems with memory, processing speed, attention, and executive functioning. Previous research has indicated that improving cognitive function can improve depressive symptom severity. The authors of the current research were interested in learning more about potential cognitive training programs that could be of help.

“As a neuropsychologist I am interested in cognitive functions, and their relation to emotional health,” said study author Jan Egil Stubberud, an associate professor in clinical neuropsychology at the University of Oslo.

“Emotional regulation and cognitive deficits are common and major complaints in depression. Yet, these processes are not satisfactorily addressed by existing treatments. Knowing that depression is a leading cause of the global burden of disability and disease, I wanted to explore the potential of improving existing interventions, by using novel techniques that target underlying vulnerability factors, such as cognitive functions.”

The study included 60 participants aged 18-60 years who had received a diagnosis of mild or moderate major depressive disorder and reported executive dysfunction in everyday life.

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

The other half of the participants were assigned to complete computerized cognitive training, which included intensive procedural learning tasks designed to improve basic cognitive functions, such as attention, memory, and processing speed.

The participants completed validated assessments of brooding rumination and emotional regulation prior to treatment, immediately following treatment, and 6 months following treatment completion.

The researchers observed a significant decrease of brooding rumination over time. Both those who completed Goal Management Training and those who completed the computerized cognitive training reported less brooding symptoms following the intervention.

Nonacceptance of emotional responses, an aspect of emotional regulation, also improved over time for both groups. But only the Goal Management Training intervention was associated with improved clarity of emotional responses, meaning the extent to which individuals can identify the emotions they are experiencing.

“Due to interplay between cognitive functions and emotion regulation, our findings suggest that there is great potential in supplementing other therapeutic interventions with cognitive remediation techniques,” Stubberud told PsyPost. “On balance, addressing cognitive (dys)functions may facilitate patients with depression to achieve greater benefit from cognitively demanding treatments, such as cognitive behavioral therapy.”

The researchers noted that the improvements in emotional clarity were still seen 6 months after the intervention had concluded. “The application of the metacognitive ‘stop-and-think’ strategy, in addition to practicing mindfulness techniques, and the monitoring of performance in real-life situations, are core aspects of GMT. We suggest that these elements were vital to effecting the self-reported long-term changes in emotion regulation observed after GMT,” Stubberud and his colleagues wrote in their study.

The initial findings act as an important stepping stone for future research. “Future studies should include a control group not receiving an intervention/or receiving a placebo intervention,” Stubberud explained. “Critically, the present findings need to be cross-validated in a larger and more representative depression sample, especially considering the small sample size.”

“Research on depression has identified cognitive processes that play a critical role in the onset and maintenance of depression, and our findings demonstrate the potential of cognitive remediation in reducing maladaptive emotion regulation in depression,” Stubberud added.

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

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