Transdiagnostic Cognitive Control Training for Patients Waiting for Outpatient Psychotherapy: Randomized Clinical...

Various mental disorders are associated with impaired cognitive control, which is crucial for effective emotion regulation. Cognitive control training has demonstrated promise in enhancing emotion regulation and alleviating distress in disorders characterized by repetitive negative thinking, such as depression and anxiety.

Given the importance of cognitive control and emotion regulation across mental disorders, this study investigates the efficacy of a mobile cognitive control training in a transdiagnostic outpatient sample awaiting psychotherapy.

In this randomized clinical superiority trial with 2 parallel arms, 80 patients with various mental disorders from an outpatient waiting list received either 10 sessions of mobile cognitive control training using the Paced Auditory Serial Addition Test (PASAT) or an active control training using a speed of response task. The primary outcome was mental distress, measured by the Hopkins Symptom Checklist-11 (HSCL-11). Secondary outcomes included measures of cognitive control, rumination, repetitive negative thinking, difficulties in emotion regulation, cognitive emotion regulation, and disorder-specific symptoms. Outcomes were measured at baseline, post training, and at 3-month and 6-month follow-up.

Contrary to our primary hypothesis, cognitive control training was not superior in improving global mental distress directly after training (B=-.03, 95% CI -0.21, 0.16; t179.60=-0.26; P=.80; d=-0.04, 95% CI -0.35, 0.28); however, it led to greater improvements in cognitive control (B=-0.56, 95% CI -0.59,-0.54; z=-18.02; P<.001; d=-1.23, 95% CI -1.30,-1.20). This effect was similar at the 3-month and 6-month follow-up. Furthermore, at 3-month follow-up, cognitive control training resulted in fewer difficulties in emotion regulation (B=4.73, 95% CI 0.52, 9.12; t177.99=2.09; P=.04; d=0.34, 95% CI 0.04, 0.65), and anxiety symptoms (B=2.94, 95% CI 0.38, 5.82; t66.51=2.09; P=.04; d=0.70, 95% CI 0.09, 1.38), although the latter refers to a small subsample of patients with anxiety disorders. At 6-month follow-up, cognitive control training led to more adaptive cognitive emotion regulation (B=-5.18, 95% CI -9.74,-0.41; t180.90=-2.16; P=.03; d=-0.40, 95% CI -0.75,-0.03), and less social anxiety (B=2.00, 95% CI 0.14, 3.81; t43.43=2.08; P=.04; d=0.66, 95% CI 0.05, 1.24). The groups did not differ in any other outcome at any point in time.

This study is the first to assess the efficacy of a mobile cognitive control training using the PASAT in a transdiagnostic outpatient sample. There was no evidence for the training's efficacy on global mental distress and only weak evidence for the superiority in measures of emotion regulation and anxiety at follow-ups. Potential mediating pathways and moderating factors, such as the number of training sessions, should be investigated in larger studies.