TY - JOUR
T1 - Negative cognitive schema modification as mediator of symptom improvement after electroconvulsive therapy in major depressive disorder
AU - Scheepens, Dominique S.
AU - van Waarde, Jeroen A.
AU - ten Doesschate, Freek
AU - Westra, Mirjam
AU - Kroes, Marijn C. W.
AU - Schene, Aart H.
AU - Schoevers, Robert A.
AU - Denys, Damiaan
AU - Ruhé, Henricus G.
AU - van Wingen, Guido A.
N1 - Funding Information: The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008. This study was supported by the Brain Foundation of the Netherlands (Hersenstichting). All authors report no biomedical financial interests or potential conflicts of interest. Dr. H.G. Ruhe reports speaking fees from Janssen Netherlands and grant support from ZonMW, the Dutch Hersenstichting, EU Horizon 2020, all outside the current work. The sponsor had no role in the design and conduct of the study; in the collection, management, analysis, and interpretation of the data; in the preparation, review, or approval of the manuscript; nor in the decision to submit the manuscript for publication. DSS and GAvW had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. This study could not have been carried out without the cooperation of all participating patients, for which we would like to express our gratitude. Furthermore, we acknowledge Oscar Bruno Heslinga (ECT-Nurse) and Joost Derwig (MSc, neuropsychologist), Boudewijn de Pont (MD) in Rijnstate hospital, Etienne de Jonghe, Floor de Wit, Wendy Stam and Marijcke Toussaint in AUMC (ECT-Nurses), Paul Korsten (psychologist) and Michelle Bos (MSc) and, all ECT-staff in UMCG for their assistance in data collection. Funding Information: This study was supported by the Brain Foundation of the Netherlands (Hersenstichting). All authors report no biomedical financial interests or potential conflicts of interest. Dr. H.G. Ruhe reports speaking fees from Janssen Netherlands and grant support from ZonMW, the Dutch Hersenstichting, EU Horizon 2020, all outside the current work. Publisher Copyright: © 2022 The Authors
PY - 2022/8/1
Y1 - 2022/8/1
N2 - Background: Electroconvulsive therapy (ECT) is a potent option for treatment-resistant major depressive disorder (MDD). Cognitive models of depression posit that negative cognitions and underlying all-or-nothing negative schemas contribute to and perpetuate depressed mood. This study investigates whether ECT can modify negative schemas, potentially via memory reactivation, and whether such changes are related to MDD symptom improvement. Method: Seventy-two patients were randomized to either an emotional memory reactivation electroconvulsive therapy (EMR-ECT) or control memory reactivation electroconvulsive therapy (CMR-ECT) intervention prior to ECT-sessions in a randomized controlled trail. Emotional memories associated with patients' depression were reactivated before ECT-sessions. At baseline and after the ECT-course, negative schemas and depression severity were assessed using the Dysfunctional Attitude Scale (DAS) and Hamilton Depression Rating Scale HDRS. Mediation analyses were used to examine whether the effects of ECT on HDRS-scores were mediated by changes in DAS-scores or vice versa. Results: Post-ECT DAS-scores were significantly lower compared to baseline. Post-ECT, the mean HDRS-score of the whole sample (15.10 ± 8.65 [SD]; n = 59) was lower compared to baseline (24.83 ± 5.91 [SD]). Multiple regression analysis showed no significant influence of memory reactivation on schema improvement. Path analysis showed that depression improvement was mediated by improvement of negative cognitive schemas. Conclusion: ECT is associated with improvement of negative schemas, which appears to mediate the improvement of depressive symptoms. An emotional memory intervention aimed to modify negative schemas showed no additional effect.
AB - Background: Electroconvulsive therapy (ECT) is a potent option for treatment-resistant major depressive disorder (MDD). Cognitive models of depression posit that negative cognitions and underlying all-or-nothing negative schemas contribute to and perpetuate depressed mood. This study investigates whether ECT can modify negative schemas, potentially via memory reactivation, and whether such changes are related to MDD symptom improvement. Method: Seventy-two patients were randomized to either an emotional memory reactivation electroconvulsive therapy (EMR-ECT) or control memory reactivation electroconvulsive therapy (CMR-ECT) intervention prior to ECT-sessions in a randomized controlled trail. Emotional memories associated with patients' depression were reactivated before ECT-sessions. At baseline and after the ECT-course, negative schemas and depression severity were assessed using the Dysfunctional Attitude Scale (DAS) and Hamilton Depression Rating Scale HDRS. Mediation analyses were used to examine whether the effects of ECT on HDRS-scores were mediated by changes in DAS-scores or vice versa. Results: Post-ECT DAS-scores were significantly lower compared to baseline. Post-ECT, the mean HDRS-score of the whole sample (15.10 ± 8.65 [SD]; n = 59) was lower compared to baseline (24.83 ± 5.91 [SD]). Multiple regression analysis showed no significant influence of memory reactivation on schema improvement. Path analysis showed that depression improvement was mediated by improvement of negative cognitive schemas. Conclusion: ECT is associated with improvement of negative schemas, which appears to mediate the improvement of depressive symptoms. An emotional memory intervention aimed to modify negative schemas showed no additional effect.
KW - Electroconvulsive therapy
KW - Emotional memory reactivation
KW - Major depressive disorder
KW - Negative schemas
UR - http://www.scopus.com/inward/record.url?scp=85129960277&partnerID=8YFLogxK
U2 - https://doi.org/10.1016/j.jad.2022.04.088
DO - https://doi.org/10.1016/j.jad.2022.04.088
M3 - Article
C2 - 35490877
SN - 0165-0327
VL - 310
SP - 156
EP - 161
JO - Journal of affective disorders
JF - Journal of affective disorders
ER -