Cognitive Training in Major Depressive Disorder: Perceptions of Cognitive Malleability, Importance of Autonomy, and Efficacy of a Brief Psychoeducational Intervention
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Cognitive difficulties constitute a diagnostic criterion of major depressive disorder (MDD) and are associated with functional impairments and barriers to recovery in this condition. Cognitive Remediation (CR) is a psychotherapeutic treatment that aims to improve cognitive and functional skills; however, engagement in CR is varied, contributing to a range of outcomes. Though this treatment has demonstrated efficacy in MDD, a major gap in the literature pertains to factors that may underlie approach of cognitively challenging activities, and methods of fostering willingness of this population to engage in CR. In this dissertation, Chapter 2 presents correlational relations of objective cognition, perceived malleability of cognition, and approach of cognitive activities; and factors associated with reported willingness to engage in CR for participants with MDD. Though perceived cognitive malleability did not moderate the relationship between objective cognition and approach of cognitive challenges, it was significantly positively associated with willingness to engage in CR, alongside subjective approach of daily cognitive challenges. Chapter 3 investigated whether participants endorse greater engagement, perceived competence, and motivation to participate in cognitive exercises as a function of whether they self-select their difficulty levels while training or if their training is algorithmically titrated by the program. Contrary to hypotheses, no significant difference was found in reported engagement or intrinsic motivation to participate in training; however, perceived competence ratings increased in the autonomous condition. Chapter 4 reports upon a psychoeducational video that was developed to educate participants about CR. Effects of this video on subjective and objective engagement in CR was studied. The intervention did not significantly increase MDD participants’ willingness to engage in CR, nor the degree to which they trained on computerized cognitive exercises during a 2-week period of at-home access, though a small effect on subjective cognition was found. This research provides initial steps in addressing a critical gap in the literature pertaining to bolstering engagement of participants with MDD in CR, with important implications for factors that may underlie engagement in CR at the outset of treatment. This work highlights the need for continued investigation into ways of inciting engagement in cognitive training for those with MDD.
URI for this recordhttp://hdl.handle.net/1974/28071
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