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Relation Between Executive Function Test Performance and Treatment Outcomes During Brief Psychotherapies for
Matthew S Schurr1, Yiqun T Chen1, Patrick J Raue1
1Department of Psychology (MSS, BNR), University of Nevada, Las Vegas, NV; Department of Psychiatry (MSS), McLean Hospital, Belmont, MA; Data Science Institute and Department of Biomedical Data Science (YTC), Stanford University, Stanford, CA; Department of Psychiatry and Behavioral Sciences (PJR, PAA), University of Washington, Seattle, WA; and the Weill Cornell Institute of Geriatric Psychiatry (GSA), Weill Cornell Medicine, White Plains, NY.
Objectives:
Executive dysfunction is common in later-life depression (LLD). This study examined whether: 1) executive function predicts change in depressive symptoms during brief psychotherapy and 2) performance on cognitive tests changes during psychotherapy.
Design:
Post hoc analysis of a noninferiority randomized clinical trial comparing 9 weekly sessions of problem-solving therapy (PST) and Engage, a streamlined psychotherapy for depression.
Setting:
Two-site trial at academic medical centers in Seattle, WA and New York, NY.
Participants:
Participants were 150 older adults (68% women) with major depressive disorder, Mini-Mental State Examination (MMSE) ≥24, and cognitive test data available for primary analysis. Participants ranged in age from 60 to 89 years (M = 70.4, SD = 7.4).
Measurements:
Cognitive measures included the Iowa Gambling Task (IGT), Wisconsin Card Sorting Test (WCST), Stroop test, Digit Span, and Hopkins Verbal Learning Test (HVLT-R). Treatment outcomes consisted of longitudinal assessment using the Hamilton Depression Rating Scale (HAM-D) and World Health Organization Disability Assessment Schedule 2.0 (WHODAS).
Results:
Linear mixed effects models showed that baseline executive functioning did not predict improvement in HAM-D scores. Better Stroop performance was associated with improved WHODAS scores. Paired t-tests revealed pre- and post-treatment improvement in executive functioning test performance as measured by the IGT (Total Money subscale; p = 0.002) and Stroop test (p = 0.002) across 9 weeks of both treatments.
Conclusions:
Baseline cognitive functions, including executive function, did not influence reduction in depressive symptoms during brief psychotherapies. Brief psychotherapies may improve aspects of executive function such as decision-making related to reward.
Clinicaltrialsgov Identifier:
NCT0208G201.
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