Abstract
BackgroundDepression is a debilitating mental health problem that tends to run a chronic, recurrent course. Even when effectively treated, relapse and recurrence rates remain high. Accordingly, interventions need to focus not only on symptom reduction, but also on reducing the risk of relapse by targeting depression-related disturbances that persist into remission. We are addressing this need by investigating the efficacy, acceptability and feasibility of a MEmory Specificity Training (MEST) programme, which directly targets an enduring cognitive marker of depression - reduced autobiographical memory specificity. Promising pilot data suggest that training memory specificity ameliorates this disturbance and reduces depressive symptoms. A larger, controlled trial is now needed to examine the efficacy of MEST. This trial compares MEST to an education and support (ES) group, with an embedded mechanism study.Methods/DesignIn a single blind, parallel cluster randomised controlled trial, 60 depressed individuals meeting diagnostic criteria for a current major depressive episode will be recruited from the community and clinical services. Using a block randomisation procedure, groups of 5 to 8 participants will receive five weekly sessions of MEST (n = 30) or education and support (n = 30). Participants will be assessed immediately post-treatment, and at 3- and 6-months post-treatment (MEST group only for 6-month follow-up). Depressive symptoms at 3-month follow-up will be the primary outcome. Secondary outcomes will be change in depressive status and memory specificity at post-treatment and 3-months. The 6-month follow-up of the MEST group will allow us to examine whether treatment gains are maintained. An explanatory question will examine variables mediating improvement in depression symptoms post-treatment and at 3-month follow-up.DiscussionThis trial will allow us to investigate the efficacy of MEST, whether treatment gains are maintained, and the mechanisms of change. Evidence will be gathered regarding whether this treatment is feasible and acceptable as a low-intensity intervention. If efficacy can be demonstrated, the results will support MEST as a treatment for depression and provide the foundation for a definitive trial.Trial registrationNCT01882452 (ClinicalTrials.gov), registered on 18 June 2013.
Highlights
Depression is a debilitating mental health problem that tends to run a chronic, recurrent course
This trial will allow us to investigate the efficacy of MEmory Specificity Training (MEST), whether treatment gains are maintained, and the mechanisms of change
From a public health perspective, this treatment is very much in line with UK government initiatives aiming to deliver more accessible, cost-effective psychosocial interventions, such as the Improving Access to Psychological Therapies (IAPT) programme [29]. Another advantage associated with MEST is that it targets a cognitive marker of depression that does not necessarily improve as an individual comes out of a depressive episode
Summary
According to the World Health Organisation [1], depression is major global burden of disease and, by 2020, will be the second leading cause of world disability. One of the pilot studies was conducted with Afghan refugees in Iran, the other in an inpatient sample in Belgium This is of particular interest given that risk factors for depression include economic and social disadvantage [40] and those in impoverished communities have greater difficulty accessing health care [41]. It is possible that MEST may have utility in reducing symptoms to a level where patients are able to engage in more demanding therapies such as CBT. Results of this trial will indicate whether there is potential for MEST to be used as a stand-alone treatment for depression.
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