A randomised controlled trial of positive memory training for the treatment of depression within schizophrenia

Abstract

BackgroundDepression is highly prevalent within individuals diagnosed with schizophrenia, and is associated with an increased risk of suicide. There are no current evidence based treatments for low mood within this group. The specific targeting of co-morbid conditions within complex mental health problems lends itself to the development of short-term structured interventions which are relatively easy to disseminate within health services. A brief cognitive intervention based on a competitive memory theory of depression, is being evaluated in terms of its effectiveness in reducing depression within this group.Methods/DesignThis is a single blind, intention-to-treat, multi-site, randomized controlled trial comparing Positive Memory Training plus Treatment as Usual with Treatment as Usual alone. Participants will be recruited from two NHS Trusts in Southern England. In order to be eligible, participants must have a DSM-V diagnosis of schizophrenia or schizo-affective disorder and exhibit at least a mild level of depression. Following baseline assessment eligible participants will be randomly allocated to either the Positive Memory Training plus Treatment as Usual group or the Treatment as Usual group. Outcome will be assessed at the end of treatment (3-months) and at 6-month and 9-month post randomization by assessors blind to group allocation. The primary outcome will be levels of depression and secondary outcomes will be severity of psychotic symptoms and cost-effectiveness. Semi-structured interviews will be conducted with all participants who are allocated to the treatment group so as to explore the acceptability of the intervention.DiscussionCognitive behaviour therapy is recommended for individuals diagnosed with schizophrenia. However, the number of sessions and length of training required to deliver this intervention has caused a limit in availability. The current trial will evaluate a short-term structured protocol which targets a co-morbid condition often considered of primary importance by service users. If successful the intervention will be an important addition to current initiatives aimed at increasing access to psychological therapies for people diagnosed with severe mental health problems.Trial registrationCurrent Controlled Trials. ISRCTN99485756. Registered 13 March 2014.

Cognitive therapy of psychosis: Research and implementation

“…There continue to be new developments addressing specific issues that present with psychosis and the 'third wave' of cognitive therapies are beginning to provide further alternatives. Further research is underway into clozapine resistant patients (Pyle et al, 2016) and imagery approaches to depression (Steel et al, 2015). The interaction, choices and potential synergies between medications, family and social interventions and CBTp, is however still far from being fully explored and understood.…”

Exploratory examination of clinician perspectives on positive memories and post‐traumatic stress disorder interventions

“…This is relevant because trauma‐exposed individuals with PTSD symptoms experience emotion dysregulation with a prominence of negative affect (Litz, Orsillo, Kaloupek, & Weathers, ) and negative schemas (Foa & Kozak, ; Janoff‐Bulman, ). To this point, the effects of positive memory recall on positive affect and/or self‐representations are supported by experimental (Rusting & DeHart, ), neurobiological (Speer, Bhanji, & Delgado, ) and intervention research (Neshat‐Doost et al, ; Panagioti, Gooding, & Tarrier, ; Schneider et al, ; Steel et al, ). This enhanced positive affect may improve physical and mental health (Steptoe, Dockray, & Wardle, ) by activating positive interpretations of events and pleasant thoughts (Rusting & DeHart, ; Rusting & Larsen, ), improving self‐esteem (Steel et al, ), increasing positive content in thoughts (Fredrickson, ) and reducing negative rumination (Raes et al, ).…”

“…Other therapeutic approaches suggest that focusing on positive memories builds distress tolerance (i.e., Dialectical Behavioural Therapy; Linehan, ), elicits values (i.e., Acceptance and Commitment Therapy [ACT]; Hayes, Luoma, Bond, Masuda, & Lillis, ), fosters positive self‐/other‐ representations and strengthens the affective therapeutic relationship (i.e., psychoanalysis; Freud, ), increases the self‐actualising tendency (i.e., client‐centred therapy; Rogers, ), and promotes social bonding and supportive relationships (i.e., Seeking Safety; Najavits, Weiss, & Liese, ). Positive memory interventions have been used for individuals with PTSD, such as Broad‐Minded Affective Coping (BMAC; capitalises on positive affect to reciprocally improve cognitions; Tarrier, ), Positive Memory Enhancement Training (targeting retrieval of specific positive memories; Arditte Hall, De Raedt, Timpano, & Joormann, ), and Positive Memory Training (targeting retrieval of specific positive memories; Steel et al, ); however, these protocols were not developed to uniquely and focally address PTSD symptoms and have not been implemented within existing PTSD interventions.…”

Does Assessing Outcomes in Terms of Capability for Schizophrenic Patients with Depression Provide more Information Than use of the NICE Recommended QALY? - An Empirical Comparison of the OxCAP-MH, ICECAP-A and EQ-5D-5L Instruments

“…The analysis in this paper was based on data from the PoMeT trial (20), which investigated the impact of Positive Memory Training on depression symptoms of schizophrenia patients (n = 100) in the UK between 2014-2016. The trial received ethical approval from the Berkshire Research Ethics Committee (REC ref 13/SC/0634).…”

“…Patients were assessed at four time points through the 9-month study period: baseline, 3 months, 6 months and 9 months. More details about the PoMeT trial can be found in Steel et al (20).…”