A randomized, controlled pilot trial of the Emotional Faces Memory Task: a digital therapeutic for depression

• Published in: NPJ digital medicine 2018-06, Vol.1 (1), Article 21
• Main Authors: Iacoviello, Brian M., Murrough, James W., Hoch, Megan M., Huryk, Kathryn M., Collins, Katherine A., Cutter, Gary R., Iosifescu, Dan V., Charney, Dennis S.
• Format: Article
• Language: English
• Subjects: 692/308/409; 692/700/565; Biomedicine; Biotechnology; Digital technology; Health informatics; Intervention; Medicine; Medicine & Public Health; Memory; Mental depression
• ISSN: 2398-6352; 2398-6352
• DOI: 10.1038/s41746-018-0025-5

There is an urgent need for more effective treatments for major depressive disorder (MDD). Digital therapeutics, such as computerized cognitive–emotional training interventions, represent a promising new strategy for treating MDD. Here we report a replication of efficacy of a digital cognitive–emotional training intervention designed to enhance cognitive control for emotional information-processing. In a randomized, double-blind, controlled study design, 51 participants with MDD in a current major depressive episode were randomly assigned to participate in a digital cognitive–emotional training regimen (Emotional Faces Memory Task (EFMT); n  = 28) involving 18 sessions over 6 weeks, or an active control condition (CT; n  = 23) involving computerized working memory training. MDD symptoms were assessed weekly using a clinician-rated measure (Hamilton Depression Rating Scale; Ham-D); and neurocognition (working memory), at baseline and study outcome. Mixed-effects model for repeated measures (MMRM) analysis of all participants randomized revealed a significantly greater reduction in MDD symptom severity (Ham-D) from baseline to outcome in the EFMT group (8.65 points) compared to the CT group (4.77 points) ( F (6,205) = 3.23, p  = .005, d  = 0.46). Ten of 28 EFMT participants achieved clinical response (≥50% reduction in symptoms) compared to 4 of 23 in CT. Both groups exhibited similar, small improvements in working memory. This replicated the preliminary efficacy of a digital cognitive–emotional training approach for the treatment of MDD. EFMT may be a feasible and effective intervention strategy for MDD, but future studies to elucidate its mechanism of action are warranted. This study is registered with Clinicaltrials.gov (NCT: 01934491). Digital therapy: An effective intervention for depression A computerized cognitive–emotional training program significantly reduces symptom severity in patients with Major Depressive Disorder (MDD). The Emotional Faces Memory Task (EFMT) in which patients are asked to identify and remember the emotions displayed in a series of faces, has been designed to activate brain regions involved in emotion processing and cognitive control simultaneously. A study led by Brian Iacoviello, Icahn School of Medicine at Mount Sinai, involving 51 non-medicated participants with MDD shows that after 6 weeks EFMT reduced both clinician-rated and self-reported measures of MDD symptoms. These findings suggest that digital therapies that can mo