Improving outcome for mental disorders by enhancing memory for treatment

Abstract

Summary Patients exhibit poor memory for treatment. A novel Memory Support Intervention, derived from basic science in cognitive psychology and education, is tested with the goal of improving patient memory for treatment and treatment outcome. Adults with major depressive disorder (MDD) were randomized to 14 sessions of cognitive therapy (CT)+Memory Support (n = 25) or CT-as-usual (CTMS; n = 23). Outcomes were assessed at baseline, post-treatment and 6 months later. Memory support was greater in CT+Memory Support compared to the CT-as-usual. Compared to CT-as-usual, small to medium effect sizes were observed for recall of treatment points at post-treatment. There was no difference between the treatment arms on depression severity (primary outcome). However, the odds of meeting criteria for ‘response’ and ‘remission’ were higher in CT+Memory Support compared with CT-as-usual. CT+Memory Support also showed an advantage on functional impairment. While some decline was observed, the advantage of CT+Memory Support was evident through 6-month follow-up. Patients with less than 16 years of education experience greater benefits from memory support than those with 16 or more years of education. Memory support can be manipulated, may improve patient memory for treatment and may be associated with an improved outcome.

Patient recall of specific cognitive therapy contents predicts adherence and outcome in adults with major depressive disorder

“…Written informed consent was obtained and all participants gave this consent willingly. Details of the study are reported elsewhere (Harvey et al, 2016). Table 1 presents the demographic variables of the sample.…”

“…Indeed, a recent pilot randomized controlled trial (RCT) provided initial evidence supporting the use of Memory Support Intervention (MSI) as an adjunctive treatment to enhance patients’ memory for treatment and to improve treatment outcome in the context of cognitive therapy (CT) for depression (Harvey et al, 2016). The current version of the MSI is comprised of eight memory support (MS) strategies, including attention recruitment, categorization, evaluation, application, repetition, practice remembering, cue-based reminders, and praise recall (for more detail see Supplemental Material A).…”

“…The current version of the MSI is comprised of eight memory support (MS) strategies, including attention recruitment, categorization, evaluation, application, repetition, practice remembering, cue-based reminders, and praise recall (for more detail see Supplemental Material A). These MS strategies are integrated into treatment-as-usual by treatment providers with the goal of enhancing patients’ memory for treatment contents (Harvey et al, 2014, 2016). Note that the MSI is not intended to directly enhance patients’ memory functioning per se.…”

“…In this pilot study, MSI was integrated into standard CT for depression (CT + Memory Support) and was compared to standard CT (CT-as-usual). Results suggested that the MSI exerted promising effects on patient recall of treatment contents and treatment outcomes (Harvey et al, 2016). …”

“…To date, the total number of distinct treatment points recalled, regardless of the specific contents, have been examined in relation to the use of memory support, treatment adherence, and treatment outcome. Briefly, greater patient recall of cumulative treatment contents at mid-treatment was associated with better treatment adherence (Dong, Lee, & Harvey, 2017a) and greater recall of the most recent session was associated with clinical outcomes including treatment responses, remission, and recurrence (Harvey et al, 2016). However, the specific contents of patient recall have not been examined.…”