Transient Autobiographical Memory Enhancement to Improve Everyday Cognitive Skills

Depression affects almost 20% of adults. If you don't experience depression yourself, it's likely that someone you care about does. The best psychological 'talking therapy' for depression is Cognitive Behavioural Therapy - commonly referred to as 'CBT'. Although CBT helps with depression, around half of people who complete a course of CBT still have depressive symptoms. This has a huge impact on the individuals' quality of life, their families, and the economy. It is therefore vitally important that we improve psychological therapies like CBT so that more people can beat depression.

One way of trying to improve CBT is to use experimental, cognitive psychology to find out what stops CBT working. Research has shown that certain styles of remembering or thinking about things interfere with how well people respond to CBT. If we can find a way to change these 'cognitive problems', then CBT should work better at shifting depression. One such cognitive problem occurs when people struggle to remember details about events from their past - what we call autobiographical memories. Being able to easily bring to mind detailed autobiographical memories is very important for a number of everyday mental skills essential to our psychological health. We need good access to detailed autobiographical memories to successfully solve everyday problems, to make accurate judgements about ourselves and the world around us, and to see both positive and negative things that might happen whenever we plan how to deal with a challenging experience (e.g., working hard to meet a deadline at work).

When someone experiences depression, the autobiographical memories they bring to mind are often very vague and broad and negative (e.g., my life has always been awful). People with depression find it very hard to reach those detailed autobiographical memories that they need to navigate everyday life, which keeps their depression going. How does this relate to CBT? Well, those everyday skills of problem-solving, sound judgement, and careful planning that require good access to autobiographical memories, are the very same skills we need in order to successfully engage with CBT. For instance, a common task in CBT for depression is to identify the negative thoughts that keep depression going (e.g., I never do well at anything) and then gather 'evidence' from the person's life to show that the thoughts aren't true (e.g. last week I cooked a nice meal). However, this evidence-gathering critically relies on being able to remember past events that contradict the thoughts. So, problems with autobiographical memory may not only keep depression going, but may also interfere with CBT that is designed to treat depression.

In this project we want to develop and test a new technique that can temporarily boosts people's ability to access their detailed autobiographical memories. We will then determine that improving autobiographical memory in this way then improves those problem-solving, judgement and planning skills that depend on autobiographical memories. Finally, we will test whether this booster technique improves depressed people's ability to do tasks that are similar to CBT, such as challenging negative thoughts. If our technique works, in the future we could provide depressed people a way to 'switch on' a detailed way of remembering things that they can use before a CBT session in order to get the most out of therapy. In this way, this project will use laboratory work with depressed volunteers to explore a new technique that could help to improve treatments for depression in the future.

Our key goals, then, are to: 1) Develop a technique to boost access to detailed autobiographical memories in depressed people; 2) Evaluate whether this memory booster technique improves both a) everyday mental skills like solving problems, and planning, and b) depressed people's ability to successfully complete the sorts of tasks that they would be asked to do in CBT.

As this project is at the interface between experimental and clinical psychology, the findings will be of wide interest with implications for those with mental health disorders and the practitioners and systems which aim to mitigate the effect of mental illness on individuals, society, and the economy. An extensive programme of impact activities has been planned to ensure maximum impact.

INDIVIDUALS WITH DEPRESSION: Approximately 50% of individuals with mental health disorders begin cognitive therapy and are disheartened to realise that the treatment is not working for them. The results of this project will offer an explanation as to why cognitive therapy can feel so hard. More broadly, the results will demonstrate the role of memory in why individuals might find it hard to solve problems or to come up with explanations that differ from their usual, unhelpful way of seeing things. Understanding the cause of these difficulties is likely to empower individuals and improve hope in the effectiveness of psychological-based intervention. Extensive dissemination has been planned to ensure that the results reach as many depressed individuals as possible. To ensure co-production of knowledge, individuals with lived experience of depression have been involved in planning this research, and will co-facilitate dissemination of results. Ultimately, the aim of this project is to use experimental psychology to take early but vitally important steps toward improving the efficacy of psychological treatment, and thereby quality of life for the one in four individuals affected by mental illness around the world.

COMMUNITY: The results are likely to also be of interest to the families and friends of those affected by depression. In particular, further knowledge of the cognitive difficulties that depressed individuals experience will increase understanding of how their daily functioning is reduced by depression. A public Q&A session co-facilitated by individuals with loved ones with depression will enhance impact in this area.

MENTAL HEALTH CARE PRACTITIONERS: Clinicians providing psychological treatment in public, private, and not-for-profit organisations will benefit from the increased understanding that this project will provide regarding why some individuals struggle to complete cognitive-based therapy. Demonstrating the role that autobiographical memory plays in the completion of cognitive-based tasks, and in predicting psychological treatment response, will allow recommendations to be made regarding how a clinician can refine their delivery of cognitive therapy (e.g., by supplementing therapy with memory-based techniques). This will improve patient engagement, and thereby treatment response. Two training workshops for clinicians have been included in the programme of impact activities to ensure that the findings are used to this effect.

PUBLIC HEALTH SYSTEMS AND POLICY MAKERS: Improving treatment of mental health issues is a key priority for the UK government and health organisations around the world. Identifying cognitive barriers to treatment effects, and using experimental psychology to elicit the mechanisms through which these barriers impact treatment, is important if we are to improve and advance psychological intervention. In this way, this project will indicate the utility of using autobiographical memory to inform a personalised treatment approach. In such an approach, those individuals experiencing trouble with autobiographical memory retrieval could be offered adjunctive treatment techniques that can be combined with current evidence-based practice to improve treatment effects for the individual. Importantly, autobiographical memory-based techniques would offer a low-cost and low-resource addition to treatment. This work will therefore offer important implications for the role that experimental psychology can play in innovating and improving care options.