Depression (Major Depressive Disorder; MDD) has been dubbed "the common cold among the mental illnesses" and it is also a highly recurrent disorder. Secondary prevention has been identified as a key goal in the long-term management of depression. High recurrence rate suggests that there are specific vulnerability factors that increase people's risk for developing repeated episodes of the disorder. Preventive strategies should identify and ameliorate these factors to reduce the individual's risk of subsequent episodes. Biased attention for emotional stimuli is central to the cognitive model where increased sensitivity to negative cues is believed to fuel the negative thoughts and feelings in depression and play a key role in maintaining the illness. Selective biases in attention can be modified by a simple computerized technique; The Attention Bias Modification Task (ABM). This project aims to investigate whether ABM can reduce surrogate and clinical markers of relapse in a large group highly vulnerable to depressive episodes. The effects of ABM, immediately after the two weeks intervention, on three key risk factors for depression will be studied: Residual symptoms, cortisol awakening response and emotion regulation strategies. The participants will be followed up after 1 month, 6 months and 12 months. The hypothesis that ABM will reduce subsequent episodes of low mood over the following 12 months in this group in a manner predicted by early changes in these risk factors will be investigated. It will also be tested if such effects in the lab may be dependent on candidate genes which affect serotonin reuptake and which have been implicated in malleability and emotional learning. Effects on underlying neural correlates of emotion regulation will be studied in an fMRI experiment in a sub-sample and which will also be stratified by serotonin transporter genotype (see also NCT02931487). The predictive value of meta cognitions related to rumination and the possible mediating effects of automatic thoughts and perceived stress will also be investigated in a sub group (see also NCT02648165). The characterization of the cognitive, genetic and neural mechanisms underlying the ABM effect will have key implications for future treatment development and combination with other treatment modalities like pharmacotherapy.
Name: Attention Bias Modification
Description: Computer based Attention Bias ModificationType: BehavioralABM +
Name: Sham Attention Bias Modification
Description: Computer based Sham Attention Bias ModificationType: BehavioralABM -
Description: Beck Depression Inventory
Measure: Change in residual symptoms of depression. Self report. Time: At baseline and immediately after ABM intervention (during first week after ABM).Description: Hamilton Depression Rating Scale
Measure: Change in residual symptoms of depression. Clinician rating Time: At baseline and immediately after ABM intervention (during first week after ABM).Description: Measured by the MINI structured interview
Measure: Recurrence of major depressive episodes Time: Will be measured 12 month after baselineDescription: Emotion Regulation Questionnaire (ERQ).
Measure: Changes in Emotion Regulation Time: At baseline.Description: The Rumination Response Scale
Measure: Changes in Rumination Time: At baseline and 12 months after interventionDescription: Cortisol samples from saliva measured by diural variation (6 samples).
Measure: Changes in cortisol response. Time: At baseline, immediately after ABM intervention and one month after intervention.Description: Beck Anxiety Inventory
Measure: Changes in symptoms of anxiety Time: At baseline, immediately after ABM intervention (during first week after ABM intervention), 1 month after intervention, 6 months after intervention and 12 months after interventionDescription: Automatic Thought Questionnaire (ATQ)
Measure: Automatic thoughts Time: At baseline, immediately after ABM intervention (average one day), 1 month after intervention, 6 months after intervention and 12 months after interventionDescription: Perceived Stress Scale (PSS).
Measure: Changes in perceived stress Time: At baseline, immediately after ABM intervention (average one day), , 1 month after intervention, 6 months after intervention and 12 months after interventionDescription: Positive and Negative Beliefs about Rumination scale (PBRS and NBRS)
Measure: Meta cognitions Time: At baseline and 12 months after interventionDescription: Beck Depression Inventory
Measure: Change in residual symptoms of depression. Self report Time: One month after intervention, 6 months after intervention and 12 months after interventionDescription: Hamilton Depression Rating Scale
Measure: Change in residual symptoms of depression. Clinical rating Time: One month after intervention, 6 month after intervention and 12 month after interventionAllocation: Randomized
Parallel Assignment
There is one SNP
Brain Derived Neurotrophic Factor (BDNF) val66met polymorphic variation linked to Brian Derived Neurotrophic Factor (BDNF) variation will moderate the effect of ABM on residual symptoms compared to neutral ABM placebo condition. --- val66met ---