Dissertations, Theses, and Capstone Projects

Date of Degree

9-2024

Document Type

Dissertation

Degree Name

Ph.D.

Program

Psychology

Advisor

Joel R. Sneed

Committee Members

Valentina Nikulina

Justin Storbeck

Emily Jones

Deborah Walder

Subject Categories

Clinical Psychology

Abstract

Major Depressive Disorder is a serious mental health disorder that affects 8% of adults in the United States. Adults aged 18-29 are at an elevated risk with a prevalence of 12%. Depression is most often characterized by mood symptoms, however, individuals with depression often also present with cognitive weaknesses on objective neuropsychological measures across several domains. These deficits are not only associated with mood symptoms, but significantly interfere with treatment and have been found to persist even with successful treatment of affective symptoms. Research into interventions directly targeting cognition has increased in recent years. While traditional first-line treatments for depression, such as antidepressant medication and psychotherapy, generally fail to address cognitive deficits associated with depression, interventions such as computerized cognitive training (CCT) represent an encouraging novel treatment approach to target cognitive, affective, and functional outcomes in individuals with depression. However, several questions remain as to factors that may influence treatment response to CCT. A study conducted by our group identified that individual differences in baseline cognitive functioning can impact response, with individuals with lower processing speed showing greater cognitive gains from CCT than those functioning at a higher level at baseline. Another important factor to consider in future CCT research is individuals’ perceptions about the effectiveness of CCT. Expectancy-based placebo effects, or the impact of patient expectations on treatment outcome, have previously been found across pharmacological and behavioral interventions for depression. In the context of public controversy in the media surrounding CCT and possible misleading marketing made by brain training companies, this is a particularly important factor to consider. Existing research has found that people generally have positive attitudes towards CCT as a treatment alternative. However, these studies fail to include younger adults and do not account for prior treatment history and current depressive symptoms. Therefore, we conducted a study that addresses these gaps in the literature through a survey of individual perceptions of the effectiveness of CCT in improving cognition, mood, and everyday functioning. This study focused on young adults, as this population is at particularly heightened risk for depression and has generally been shown to respond more favorably to CCT than older populations. Results of this study suggest that knowledge about CCT significantly predicts perceived effectiveness of CCT in enhancing cognition and everyday functioning. There were no significant associations between mood and psychiatric treatment history on perceptions of CCT’s effectiveness. The results of these two studies highlight the need for future investigation into factors that may be relevant to consider in future CCT trials. Specifically, it is important to identify how baseline characteristics, such as cognitive functioning, may contribute to the likelihood of treatment gains in response to CCT. This may help to more precisely identify populations that will benefit from CCT. The second study indicates that factors such as knowledge about an intervention can substantially impact expectations about treatment outcome which in turn can influence treatment response.

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