Improving Attentional and Cognitive Control in the Psychological Treatment of Intrusive Thoughts

Mass General Brigham

Status: Completed

Conditions: Obsessive-Compulsive Disorder; Major Depressive Disorder; Generalized Anxiety Disorder

Treatments: Behavioral: Emotion Regulation Therapy - Attention Regulation (AR-ERT); Behavioral: Supportive Psychotherapy (SPT)

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT04225624

2019P003768

1K23MH120351-01A1 (U.S. NIH Grant/Contract)

Details and patient eligibility

About

The investigators are conducting this study to learn more about the cognitive and attentional processes among individuals with three types of repetitive negative thinking (RNT): mental rituals (as seen in obsessive compulsive disorder, OCD), worries (as seen in generalized anxiety disorder, GAD), and ruminations (as seen in major depressive disorder, MDD). Specifically, the investigators are studying whether psychological treatment can help people with RNT who have trouble stopping unwanted thoughts and shifting their attention.

Full description

The current study will examine whether enhancing attention regulation skills in a transdiagnostic intervention for repetitive negative thinking (RNT) will significantly improve the target of attentional/cognitive control. Participants will be randomly assigned (like the flip of a coin) to receive eight 60 minute sessions (over 8 weeks) of either: Emotion Regulation Therapy-Attention Regulation (AR-ERT) or Supportive Psychotherapy (SPT). The investigators will use a multi-method approach to measure attentional/cognitive control: (a) behavioral (i.e., eye tracking fixations and reaction time), (b) electrophysiological (i.e., event related potentials), and (c) self-report (i.e., perceived ability to shift and focus attention). They also will examine early signs of treatment efficacy of AR-ERT and SPT and target validation (i.e., whether changes in attentional/cognitive control correlate with changes in RNT and associated symptoms). Participants will receive assessments of these target and outcome measures at baseline (week 0), mid-treatment (week 4), post-treatment (week 8), and 3-month follow-up (week 20). While most of these procedures are conducted virtually (e.g., therapy sessions), some (e.g., eye tracking and electrophysiological assessments) will be performed in-person. Findings could help identify a cross-cutting target that can be engaged to optimize treatment response for individuals with elevated RNT.

Enrollment: 87 patients

Sex: All

Ages: 18 to 60 years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Adults ages 18-60 years old
• Right-handed
• Living in Massachusetts
• Repetitive Negative Thinking (RNT) in the form of mental rituals, worries, and/or depressive ruminations is the primary reason for seeking treatment
• RNT significant enough to warrant intervention
• Fluent in English, willing to provide informed consent, and willing to comply with the study protocol
• Access to a device with an internet connection, camera, and microphone (e.g., computer, smart phone, tablet)
• Comfortable and capable of using a computer and completing reaction-time tasks

Exclusion criteria

• History of head injury or neurologic disease, mental retardation, or borderline intellectual functioning that would interfere with ability to participate in the study.
• Impaired (or uncorrected) vision, medical illness, or medical treatment that would interfere with participation.
• Active suicidal or homicidal ideation or any features requiring a higher level of care.
• Lifetime psychotic disorder or bipolar disorder
• Substance or alcohol use disorder that would interfere with treatment.
• Current Attention Deficit Hyperactivity Disorder (ADHD) that would interfere with attentional tasks.
• Unstable dose of psychotropic medications or recent discontinuation of psychotropic medication.
• Current psychotherapy or plans to initiate such treatment during the study.
• Previous course of treatment with cognitive behavioral therapy and/or mindfulness/meditation for obsessive compulsive disorder (OCD), generalized anxiety disorder (GAD), or depression.

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Parallel Assignment

Masking: Single Blind

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87 participants in 2 patient groups

Emotion Regulation Therapy - Attention Regulation (AR-ERT)

Experimental group

Description:

Individuals with repetitive negative thinking receiving Emotion Regulation Therapy - Attention Regulation.

Treatment:

Behavioral: Emotion Regulation Therapy - Attention Regulation (AR-ERT)

Supportive Psychotherapy (SPT)

Active Comparator group

Description:

Individuals with repetitive negative thinking receiving Supportive Psychotherapy.

Treatment:

Behavioral: Supportive Psychotherapy (SPT)