Journal Article

Smartphone-based Monitoring and cognition Modification Against Recurrence of Depression (SMARD): An RCT of Memory Bias Modification Training vs. Cognitive Control Training vs. Attention Bias Modification Training in remitted recurrently depressed patients with 1.5 year follow-up

Ikani, N., Ruhé, H. G., Schene, A. H., Vrijsen, J. N., Vorstman, J. A. S., Siegle, G J., Kohn, N., Harmer, C. J., Tyborowska, A., Günther, N., Kas, M. J.

2025

Overview

Background Major Depressive Disorder (MDD) has a 50–80% recurrence rate highlighting the urgent need for more efficient recurrence prevention programs. Currently, recurrences are often identified too late, while existing preventive strategies may not sufficiently address ethio-patho-physiological mechanisms for recurrence. Negative memory bias (the tendency to better remember negative than positive events), negative attention bias (selective attention favoring mood-congruent information), and cognitive control deficits are important factors involved in the onset, maintenance, and recurrence of depressive episodes. Methods Here we describe the protocol for the Smartphone-based Monitoring and cognition Modification Against Recurrence of Depression (SMARD) study, aiming to investigate different forms of cognitive training programs administered via smartphones, in order to develop a second-generation recurrence prevention program. In addition, we will gather Experience Sampling Method (ESM) assessments during a 6-day period, and during the follow-up period we will obtain behavioral data on (social) activities with BEHAPP, a smartphone-based Mobile Passive Monitoring application for remote behavioral monitoring to identify behavioral changes indicative of an imminent depressive episode. In a randomized controlled trial, SMARD will compare the effects of a smartphone-based Memory Bias Modification Training (MBT), Cognitive Control Training (CCT), and Attention Bias Modification Training (ABT) versus cognitive domain-specific (active-) sham trainings in 120 remitted MDD-patients with recurrent-MDD. Over the course of three weeks, participants receive multiple daily training sessions. Thereafter, participants will be followed up for 1.5 years with 3-monthly interviews to assess recurrences. Discussion The SMARD study aims to 1. assess the effects of the cognitive training programs versus their training-specific (active-) sham conditions on changes in memory, cognitive control dysfunction and attention; 2. relate training effects to neural networks previously identified in (recurrence of) MDD (therefore we obtain functional Magnetic Resonance Imaging ((f)MRI) scans before and after the training in a subset of participants); 3. link baseline and change in memory, cognitive control, attention and neural functioning, and ESM data to prospective recurrences; 4. examine whether passive smartphone-use monitoring can be used for prediction of recurrences. Trial registration NL-OMON26184 and NL-OMON27513. Registered 12 August 2021—Retrospectively registered,  https://onderzoekmetmensen.nl/en/trial/26184 en https://onderzoekmetmensen.nl/en/trial/27513 .

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Analysis / Attention / Attentional Bias / Behavior / Bias / Brain research / Care and treatment / Cognition & reasoning / Cognitive Behavioral Therapy - methods / Cognitive bias / Cognitive therapy / Cognitive training / Demographic aspects / Development and progression / Diseases / Female / Follow-Up Studies / Functional magnetic resonance imaging / Health aspects / Humans / Information processing / Magnetic resonance imaging / Major depressive disorder / Major Depressive Disorder - prevention & control / Major Depressive Disorder - psychology / Major Depressive Disorder - therapy / Male / Medicine / Medicine & Public Health / Memory / Mental depression / Mobile Applications / Neural networks / Neurosciences / Prevalence studies (Epidemiology) / Prevention programs / Psychiatry / Psychotherapy / Randomized Controlled Trials as Topic / Recurrence / Relapse / Remission (Medicine) / Secondary Prevention - methods / Smart phones / Smartphone / Smartphone-based mobile passive monitoring and modification / Smartphones / Study Protocol / Technology application