Optimizing outcomes, mechanisms, and recall of Cognitive Therapy for depression: Dose of constructive memory support strategies

Objective: Poor memory for treatment is associated with worse patient outcomes. Therapist use of constructive memory support strategies, which help patients actively engage with treatment content, may improve patient memory for treatment. We sought to identify the dose of constructive memory support needed to optimize treatment outcomes, mechanisms, and patient recall. Method: Adults with major depressive disorder (N = 178, mean age = 37.9, 63% female, 17% Hispanic or Latino/ a) were randomized to Cognitive Therapy plus a Memory Support Intervention or Cognitive Therapy as usual. Because therapists from both groups used constructive memory support, treatment conditions were combined to maximize data. Depression and overall impairment were assessed before treatment, immediately post-treatment (POST), and six (6FU) and 12 months (12FU) after treatment. Patients completed measures of treatment mechanisms - utilization/competency in Cognitive Therapy skills - and treatment recall at POST, 6FU, and 12FU. Patient adherence to treatment was averaged across sessions.Results: Using Kaplan-Meier Survival Analyses, the optimal dose of constructive memory support was eight uses per session (sensitivity analysis range: 5-12 uses). Pre-treatment depression symptoms and patient perceptions of treatment may impact the optimal dose. Conclusion: Eight uses of constructive memory support by therapists per session may optimize treatment out-comes, mechanisms, and recall over the long-term.