Objectives
The primary goal of this study is to conduct a randomized controlled trial (RCT) to examine the combination of antidepressants (SSRI) and attention bias modification (ABM) training. This will be compared with two different control conditions: one where participants respond to a set of questionnaires and another where participants only answer a few questionnaires at the beginning and end of the follow-up period. The hypothesis is that those who undergo active ABM training will show a significant reduction in depressive symptoms compared to the control conditions.
Methods
Patients will be recruited from general practitioners in Norwegian municipalities (community health services). The procedure involves the general practitioner notifying a project coordinator when initiating SSRI treatment for a depressive disorder. The coordinator will provide information about the study, obtain informed consent, and conduct clinical diagnostic interviews. If the patient scores for a depressive disorder, they will be randomized into one of the groups. The patients will then be regularly monitored by the general practitioner while also participating in the study.
Due to the use of information and communication technology, this study is cost-effective. Clinical evaluations and the intervention will take place digitally.
Background
Depression is the most common mental disorder, affecting 15% of the population during their lifetime. It significantly impacts daily functioning and quality of life and is a leading cause of disability worldwide. The risk of suicide is increased in individuals struggling with depression. While psychotherapy and medications have proven effective for many patients, the combination of psychological treatment and antidepressants is deemed most effective. However, many individuals do not achieve full recovery, and relapse is common.
Attention bias
The rationale for this project stems from the tendency of depressed individuals to focus attention on negative stimuli, sustaining negative thoughts and feelings. This bias is not solely a result of a depressed mood but persists in individuals who have previously experienced depressive episodes, even in symptom-free phases. This attention bias can be influenced by a simple computer program (Attention Bias Modification; ABM). Unconscious redirection of attention from negative to positive stimuli has shown symptom improvement over time in many cases.
Combining cognitive training and antidepressants
Current knowledge about the effects of antidepressant treatment on the brain is substantial, but less is known about how brain processes translate into perceived and observed improvements in mood and daily functioning. An hypothesis suggests that antidepressants may not directly impact mood but indirectly shift attention from negative to more positive focus, contributing to symptom improvement over time. Changes in attention focus have been observed to precede changes in mood and function. Combining the psychological ABM intervention with antidepressants may potentially enhance the shift in attention focus, thus contributing to greater mood improvement in individuals with depression compared to medication alone.
Funding
This project has received funding from the Norwegian Research council.
Collaboration
- Orkland kommune
- Oslo kommune
- Universitetet i Oxford
- Norges teknisk-naturvitenskapelige universitet (NTNU)
- Ledidi
- P1vital