Cognitive Control Emotion Training to Prevent Major Depression in Youth At-Risk

Cognitive Control Emotion Training to Prevent Major Depression in Youth At-Risk: A 5-Year Randomized Clinical Trial

The goal of this clinical trial is to learn if intervention of positive emotion working memory (PEWM), or negative emotion working memory (NEWM), or positive attention bias training (PABT) can prevent major depressive disorder (MDD) for the long-term effects of intervention in youth with depressive symptoms or with remitted MDD. The main questions it aims to answer are:

• Does intervention PEWM, NEWM or PABT lower the MDD onset in youth with depressive symptoms or with remitted MDD?
• How long does the intervention PEWM, NEWM or PABT can lower the MDD onset when taken an initial training added one booster training?
• Which cognitive factors can predict MDD onset?

Researchers will compare PEWM, NEWM, PABT to a placebo (a training that contains no active component) to see if the interventions work to prevent MDD.

Participants will:

• Take a PEWM, or a NEWM, or a PABT or a placebo nearly every day for 2 weeks with 10 sessions at initial.
• Take a PEWM, or a NEWM, or a PABT or a placebo the day after tomorrow for 2 weeks with 8 sessions at 6 months follow-up.
• Be interviewed by clinicians with standardized diagnostic schedules for affective disorders and schizophrenia for 5 years
• Answer survey questions about depression-related symptoms for 5 years.

1. PEWM: It is a computerized n-back task. Stimuli are positive words superimposed on happy facial pictures. Participants judge if the word is the same as the one presented n item(s) ago on the n-back level. If the words are the same, the participants make a key-press. The participants completed 10 sessions with (20 + n ) trials × 15 block each in two weeks at initial and 8 booster sessions at 6 months follow-up. Thus, the participants expose in a positive context, and learn to store and retrieve positive meaning in short-term memory during training.
2. NEWM: It is a dual n-back task with visual and auditory channals. The visual stimuli are sad facial pictures presented in one of a 4 × 4 grid. Auditory stimuli are audio record of sad words . Participants judge if the position of the facial picture presented in the grid is the same position as that of the nth previous picture on the n-back level. Meanwhile, they judge if the audio two-charater sad word heard through the earphones is the same meaning as the nth word before. If any of the same, they make separated key-press. The participants take 10 sessions with (20 +n ) trials × 16 block each for two weeks at initial and 8 booster sessions for two weeks at 6 months follow-up. Thus participants learn to focus on the judging task while inhibit the negative information interference.
3. Positive Attention Bias Modification (PABM): It is a variant of the dot-probe task. A pair of positive and neutral-concret words presents updown. After the word-pair disappears, a single or double-dot is present, and 90% of the probe dots fall on the position of positive words. The participants judge the number of the dot and press the left or right key of the mouse correspondingly. The participants take 10 sessions (216 trials each) for two weeks at initial and 8 booster sessions for two weeks at 6 months follow-up. They learn to direct attention towards positive words unconsiously.
4. Placebo (i.e., neutral attention bias training, NABT): The stimuli are the same as those in the PABT, except 90% of the probe dots falling on the position of concrete neutral words. The participants take 10 sessions (216 trials each) for two weeks at initial and 8 booster sessions for two weeks at 6 months follow-up. they learn to direct attention towards concrete neutral words.

Inclusion Criteria:

• Scores of the Beck Depression Inventory-II version (BDI-II) of a participant are equal to or more than 14.

Exclusion Criteria: A participant with

• A current episode of MDD, bipolar disorder, schizophrenia or organic mental disorder;
• Any concurrent psychotherapy;
• Any concurrent psychotropic medication.