REMIND-group: predicting learning from group cognitive behavioral therapy for depression

Major depressive disorder (MDD) is one of the most prevalent mental health disorders, and a main contributor to the global burden of disease (World Health organization, 2024). However, treatment effects are suboptimal: over a thousand randomized trials showed many effective treatments for MDD, but no significant differences exist between them, and effect sizes have not improved in 50 years (Cuijpers, 2024). One reason patients might not benefit optimally from current treatment is because patients are limited in their capacity to learn new concepts and skills. Patients affected by a wide array of psychological disorders suffer from cognitive and neurobiological impairments such as problems with attention, memory and executive functions (Chavez-Baldini et al., 2020). For instance, patients with MDD tend to ruminate and focus on negative information, have difficulties remembering and executing previously set intentions and have limited capacity to store information contradicting existing beliefs. This is problematic because these abilities are needed for successful learning during therapy. In fact, patients often do not remember the content of previous sessions and show poor practice of skills learned in therapy (Gumport et al., 2015, 2018). Learning from therapy may differ between and within patients across therapy sessions. For example, studies point out that the success of memory support strategies may depend on learners’ motivation to learn, their background knowledge on the to-be-learned topic and their working memory capacity (Fiorella, 2023; Witherby & Carpenter, 2021). A systematic review on the role of learning in CBT for MDD points out that patients with MDD seem to differ in their learning capacity and thus may vary in their need for learning support (Bruijniks et al., 2019). Besides these differences, factors that likely vary between sessions such as sleep, mood states and experienced stress have been related to learning outcomes and might predict how well patients learn from treatment sessions (Kube et al., 2021; Newbury et al., 2021; Vogel & Schwabe, 2016). Potential predictors of learning in therapy have rarely been tested and have never been combined into one model. Understanding between and within patient differences in learning from CBT can help us to understand when strategies to improve memory for treatment contents can benefit treatment outcomes. This study focuses on predictors of learning from group-CBT for depression. Relevant literature: Bruijniks, S. J. E., DeRubeis, R. J., Hollon, S. D., & Huibers, M. J. H. (2019). The Potential Role of Learning Capacity in Cognitive Behavior Therapy for Depression: A Systematic Review of the Evidence and Future Directions for Improving Therapeutic Learning. Clinical Psychological Science, 7(4), 668–692. https://doi.org/10.1177/2167702619830391 Chavez-Baldini, U., Nieman, D., Keestra, A., Verweij, K., Vulink, N., Wigman, J., & Denys, D. (2020). The relationship between cognitive functioning and psychopathology in patients with psychiatric disorders: a transdiagnostic network analysis. European Psychiatry, 63(1, SI), S448–S449. https://doi.org/10.17605/OSF.IO/YHVTB Cuijpers, P. (2024). How to improve outcomes of psychological treatment of depression: Lessons from “next-level” meta-analytic research. The American Psychologist, 79(9), 1407–1417. https://doi.org/10.1037/amp0001387 Fiorella, L. (2023). Making Sense of Generative Learning. In Educational Psychology Review (Vol. 35, Issue 2). Springer. https://doi.org/10.1007/s10648-023-09769-7 Gumport, N. B., Dong, L., Lee, Y. L., & Harvey, A. G. (2018). Patient learning of treatment contents in cognitive therapy. Journal of Behavior Therapy and Experimental Psychiatry, 58, 51–59. Gumport, N. B., Williams, J. J., & Harvey, A. G. (2015). Learning Cognitive Behavior Therapy. Journal of Behavior Therapy and Experimental Psychiatry, 48, 164–169. https://doi.org/10.1016/j.physbeh.2017.03.040 Kube, T., Kirchner, L., Gärtner, T., & Glombiewski, J. A. (2021). How negative mood hinders belief updating in depression: Results from two experimental studies. Psychological Medicine. https://doi.org/10.1017/S0033291721002798 Newbury, C. R., Crowley, R., Rastle, K., & Tamminen, J. (2021). Sleep Deprivation and Memory: Meta-Analytic Reviews of Studies on Sleep Deprivation Before and After Learning. Psychological Bulletin. https://doi.org/10.1037/bul0000348.supp Vogel, S., & Schwabe, L. (2016). Learning and memory under stress: implications for the classroom. Npj Science of Learning, 1(1), 1–10. https://doi.org/10.1038/npjscilearn.2016.11 Witherby, A. E., & Carpenter, S. K. (2021). The Rich-Get-Richer Effect: Prior Knowledge Predicts New Learning of Domain-Relevant Information. Journal of Experimental Psychology: Learning Memory and Cognition, 48(4), 483–498. https://doi.org/10.1037/xlm0000996 World Health organization. (2024). World mental health report: transforming mental health for all . https://www.who.int/publications/i/item/9789240049338