The effect of cognitive behavioral therapy on future thinking in patients with major depressive disorder: A randomized controlled trial

Mizuki Amano; Nariko Katayama; Satoshi Umeda; Yuri Terasawa; Hajime Tabuchi; Toshiaki Kikuchi; Takayuki Abe; Masaru Mimura; Atsuo Nakagawa

doi:10.3389/fpsyt.2023.997154

The effect of cognitive behavioral therapy on future thinking in patients with major depressive disorder: A randomized controlled trial

Front Psychiatry. 2023 Jan 25:14:997154. doi: 10.3389/fpsyt.2023.997154. eCollection 2023.

Authors

Mizuki Amano¹, Nariko Katayama¹, Satoshi Umeda², Yuri Terasawa², Hajime Tabuchi¹, Toshiaki Kikuchi¹, Takayuki Abe³, Masaru Mimura¹, Atsuo Nakagawa^{1

4}

Affiliations

¹ Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.
² Department of Psychology, Faculty of Letters, Keio University, Tokyo, Japan.
³ Graduate School of Data Science, Yokohama City University, Yokohama, Japan.
⁴ Department of Neuropsychiatry, St. Marianna University School of Medicine, Kawasaki, Japan.

Abstract

Background: Pessimistic thinking about the future is one of the cardinal symptoms of major depression. Few studies have assessed changes in pessimistic thinking after undergoing cognitive behavioral therapy (CBT). A randomized clinical trial (RCT) was conducted with patients diagnosed with major depressive disorder (MDD) to determine whether receiving a course of CBT affects pessimistic future thinking using a future thinking task.

Methods: Thirty-one patients with MDD were randomly assigned to either CBT (n = 16) or a talking control (TC) (n = 15) for a 16-week intervention. The main outcomes were the change in response time (RT) and the ratio of the responses for positive valence, measured by the future thinking task. Secondary outcomes included the GRID-Hamilton Depression Rating Scale, the Beck Depression Inventory-Second Edition (BDI-II), the Dysfunctional Attitude Scale (DAS), and the word fluency test (WFT).

Results: Regarding the main outcomes, the CBT group showed reduced RT for the positive valence (within-group Cohen's d = 0.7, p = 0.012) and negative valence (within-group Cohen's d = 0.6, p = 0.03) in the distant future condition. The ratio of positive valence responses in both groups for all temporal conditions except for the distant past condition increased within group (distant future: CBT: Cohen's d = 0.5, p = 0.04; TC: Cohen's d = 0.8, p = 0.008; near future: CBT: Cohen's d = 1.0, p < 0.001; TC: Cohen's d = 1.1, p = 0.001; near past: CBT: Cohen's d = 0.8, p = 0.005; TC: Cohen's d = 1.0, p = 0.002). As for secondary outcomes, the CBT group showed greater improvement than the TC group regarding the need for social approval as measured by the DAS (p = 0.012).

Conclusion: Patients with MDD who received CBT showed a reduced RT for the positive and negative valence in the distant future condition. RT in the future thinking task for depressed patients may be a potential objective measure for the CBT treatment process. Because the present RCT is positioned as a pilot RCT, a confirmatory trial with a larger number of patients is warranted to elucidate the CBT treatment process that influences future thinking.

Clinical trial registration: https://center6.umin.ac.jp/cgi-open-bin/icdr_e/ctr_view.cgi?recptno=R000021028, identifier UMIN000018155.

Keywords: cognitive behavioral therapy; future thinking; future thinking task; major depressive disorder; response time.

Grants and funding

This research was supported by the Japan Agency for Medical Research and Development (AMED Grant Nos. JP20dk0307084 and JP20dm0307102) and a Commissioned Research of the National Institute of Information and Communications Technology Grant. It was also supported in part by the Japan Society for the Promotion of Science (KAKENHI Grant Nos. JP24120518, JP24330210, JP26780396, JP17K04452, JP17K04482, JP20H01772, and JP21K15717), the MGH-SAFER grant, Inogashira Hospital Grants for Psychiatry Research, and Keio University School of Medicine Department of Neuropsychiatry Research Grant.