Mobile Cognitive Training for Young Adults with Depressive Symptoms Jeffrey N. Motter, MA1,2, Alice Grinberg, MA, EdM1,2, Joel R. Sneed, Ph.D1,2,3 1The Graduate Center, City University of New York 2Queens College, City University of New York 3Columbia University and the New York State Psychiatric Institute

Background Depression is characterized by: Low mood Loss of interest High lifetime prevalence:16.6% in the US (Kessler et al., 2005) High rates of recurrence: 85% (Mueller et al., 1999) Only 37.5% receive adequate treatment (Wang et al., 2005)

Background Depression manifests with cognitive deficits in multiple domains Attention Working Memory Processing Speed Autobiographical Memory Delayed Verbal Memory Executive Functioning (Ahern & Semkovska, 2017) Cognitive deficits affect quality of life and persist following treatment (Paelecke-Habermann et al., 2005)(Baune et al., 2010)

Background Meta-Analysis of Computerized Cognitive Training (CCT) for Depression Motter et al. (2016)

Background Mechanism remains unclear Processing speed has received little attention Impaired in depressed Underlies higher order functions Not targeted or assessed in CCT for depression Potentially mediates improvement from CCT

Aims and Hypotheses Aim 1: To determine if mobile CCT can lead to changes in mood, cognition, and daily functioning H1: It is hypothesized that there will be improved mood (BDI-II) following CCT H2: It is hypothesized that there will be improved processing speed (WAIS-IV Coding) following CCT H3: It is hypothesized that there will be improved daily functioning (Sheehan Disability Scale) following CCT Aim 2: To determine whether processing speed training leads to greater improvement than verbal ability training H1: It is hypothesized that there will be a greater improvement in mood, cognition, and daily functioning for patients randomized to the processing speed group compared to the verbal group.

Method Participants recruited via online advertisements, listserv announcements, and flyers in the community Inclusion criteria: Age 18-29 Mild depressive symptoms (Hamilton Depression Rating Scale≥10) Own a smartphone Exclusion criteria: Psychiatric comorbidity Neurological history Suicidal intent

Method Clinical and mood assessment Anxiety Disorders Interview Schedule for DSM-IV Hamilton Depression Rating Scale Beck Depression Inventory II Sheehan Disability Scale Neuropsychological testing battery DKEFS Color Word Interference DKEFS Trails DKEFS Verbal Fluency WAIS-IV Coding WAIS-IV Digit Span California Verbal Learning Test-II User Engagement Scale

Method Participants randomized to processing speed games group or verbal games group from the Peak mobile cognitive training app Both groups completed 40 fifteen-minute sessions of CCT over 8 weeks

Method Processing Speed Games Verbal Games

Preliminary Results N=46 recruited N=35 completed 8 weeks of training Mean age: 21.0 (SD 3.7) 81.4% female Race: White: 45.7% Asian: 28.3 % Hispanic: 13.0% Black: 4.2% Other: 8.7% Mean HDRS: 16.3 (SD 5.5)

Preliminary Results: Mood Effect of Time: F=68.7, p<0.001 Time x Group Interaction: F=0.0, p=0.899 Effect of Time: F=40.6, p<0.001 Time x Group Interaction: F=1.0, p=0.336

Preliminary Results: Processing Speed Effect of Time: F=34.6, p<0.001 Time x Group Interaction: F=1.0, p=0.335 Effect of Time: F=14.4, p=0.001 Time x Group Interaction: F=1.1, p=0.304

Preliminary Results: Executive Functioning Effect of Time: F=8.5, p=0.006 Time x Group Interaction: F=2.2, p=0.151 Effect of Time: F=20.1, p<0.001 Time x Group Interaction: F=1.0, p=0.319

Preliminary Results: Daily Functioning Effect of Time: F=7.8, p=0.009 Time x Group Interaction: F=2.0, p=0.163 Effect of Time: F=28.6, p<0.001 Time x Group Interaction: F=0.0, p=0.892

Preliminary Results Significant regression equation predicting BDI-II change based on training time (F(1,32)=6.8, p=0.014), with an R2 of 0.176) Engagement did not predict BDI-II or Coding change Engagement did not differ across groups

Preliminary Results CCT improved: Mood Daily Functioning Processing Speed Executive Functioning Letter Fluency Verbal Memory (Immediate and Delayed) CCT did not improve: Attention Working Memory

Discussion CCT leads to gains in mood, cognition, daily functioning Gains do not depend on module content Magnitude of mood improvement increases with training load Comparable engagement across groups

Discussion Looking forward: Real-time mood measurements during CCT Experimentally modified expectancy and engagement How does CCT compare to other mentally stimulating programs? What functional and structural changes are responsible for CCT’s impact on mood and cognition?

Acknowledgments Special thanks to our trusted RAs: Kevin Nobari Ayelet Abelow Allan Porter Waseem Iqnaibi Dahlia Lieberman

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