Cognitive control training refers to interventions aimed at improving cognitive control, defined as the ability to adapt thoughts and behavior to align with internal goals flexibly. It involves executive functions like working memory, attention, and inhibitory control.
Cognitive control training typically uses computerized tasks that adaptively adjust the difficulty level based on individual performance, requiring participants to regularly update information held in mind, focus attention, and override dominant response tendencies.
Popular training tasks include variants of the n-back working memory task, attentional blink task, Stroop task, and the Paced Auditory Serial Addition Task (PASAT). Repeated practice aims to strengthen cognitive control networks in the brain and transfer benefits to untrained tasks to support mental health and functioning.
Hoorelbeke, K., Van den Bergh, N., De Raedt, R., Wichers, M., Albers, C. J., & Koster, E. H. W. (2023). Regaining control of your emotions? Investigating the mechanisms underlying effects of cognitive control training for remitted depressed patients. Emotion, 23(1), 194–213. https://doi.org/10.1037/emo0001067
Key Points
- The study found that cognitive control training impacted the deployment of rumination over time in remitted depressed patients, with less rumination when in a more positive affective state.
- Cognitive control training increased the efficacy of rumination, with a stronger negative impact of rumination on affect compared to the active control group.
- No significant immediate effects of cognitive control training were found on self-reported cognitive complaints, depressive symptoms, or resilience in daily life.
- The study highlights the complex interplay between cognitive control, emotion regulation, residual symptoms, and resilience in remitted depression.
Rationale
Previous research suggests cognitive control training may have beneficial effects as a preventive strategy for depression, including reduced maladaptive emotion regulation and symptoms (Hoorelbeke & Koster, 2017).
However, the mechanisms underlying these effects are not well understood.
This study aimed to model the direct impact of cognitive control training on emotion regulation dynamics and daily functioning in remitted depressed patients to elucidate working mechanisms.
Method
- Design: Single-blind randomized controlled trial with two conditions – cognitive control training (adaptive PASAT) and active control training (adaptive speed of processing task).
- Cognitive control training challenges complex executive functions like continuously updating working memory and performing mental calculations. This aims to bolster cognitive control brain networks (this is the experimental group).
- Active control tasks adapt the difficulty to performance but do not heavily tax control processes. It controls for motivational/performance aspects and general attention without focused executive function training (the is the control group).
- Participants: 92 remitted depressed patients recruited via advertisements.
- Materials: MINI clinical interview, questionnaires, nonadaptive PASAT task, online cognitive training tasks, experience sampling assessments via smartphone (rumination, positive appraisal, cognitive complaints, depressive symptoms, resilience, affect).
- Procedure: Screening, baseline assessment, 4-week experience sampling period with 10 days of online training (weeks 2-3), analysis of training effects on emotion regulation dynamics and daily functioning.
Sample
- 92 remitted depressed patients (51% on antidepressants).
- Age range 23-65 years old.
- 69% female.
Statistical Analysis
- Hierarchical linear modeling to test the effects of training conditions on emotion regulation dynamics (deployment, efficacy) and daily functioning (complaints, symptoms, resilience).
- Network analysis to model relationships over time between emotion regulation, residual symptoms, and resilience.
Results
- Participants in both conditions reported lower affect when engaging in rumination in the moment.
- Training impacted deployment of rumination dependent on affect – less rumination over time when mood is more positive but not when there is a more negative mood.
- Training increased negative impact of rumination on later affect compared to the control group: Rumination had an increasingly negative effect on self-reported affect over time in the cognitive control training group, but not in the active control group.
- No effects found on cognitive complaints, depressive symptoms, and resilience in daily life.
Insight
This innovative study combined experimental manipulation of cognitive control with extensive experience sampling to model effects on emotion regulation dynamics.
The mood dependent effects highlight that boosted cognitive control may not fully override habitual emotion regulation tendencies when distressed.
The training may not provide enough practice in implementing alternative regulation strategies to counter rumination, specifically when distressed.
Interestingly, increased efficacy of rumination could account for a lack of broad transfer effects, as participants still strongly relied on this maladaptive strategy which more profoundly disrupted their mood.
Overall, the immediate impact of training was limited to nuanced shifts in emotion regulation, reiterating the need to support transfer to flexible use of more adaptive regulation strategies in daily life. Still, this approach shows considerable promise in unboxing working mechanisms.
Strengths
- Rigorous experimental design with active control condition
- Experience sampling methodology to capture daily life effects
- Novel network analysis approach to model dynamics
- Strong theoretical grounding
Limitations
- Small convenience sample limits generalizability
- Brief assessment periods (1 week pre/post training)
- Self-report measures only
- Did not test longer-term effects
Implications
The findings inform cognitive models linking deficits to depression vulnerability and highlight that remediating such impairments through training may not directly translate to desired behavioral change.
Potentially, boosted cognitive control enabled stronger perseveration on negative content during bouts of depressive, ruminative thinking. Rather than being a protective factor here, honed cognitive abilities resulted in an intensification of rumination’s detrimental consequences.
This runs counter to assumptions that improved control necessarily confers emotion regulatory benefits. The findings highlight that remitted depressed individuals may require explicit guidance in redirecting freed-up mental capacities toward more constructive regulation strategies.
Alternatively, targeting metacognitions around the perceived usefulness of rumination could mitigate unintended backfiring effects.
For example, depressed mood often involves more rigid, persistent thinking patterns, so extra control resources could actually facilitate greater elaboration of negative content instead of flexible redirection of attention – like fuel added to the fire.
As such, combined approaches explicitly targeting regulation strategy use could prove more effective for resilient outcomes.
Here are some examples of potential next steps for further research in this field:
- Conduct longer training trials with multiple post-assessment time-points to map trajectories of effects over time. For instance, does the impact on emotion regulation dynamics persist or consolidate with continued practice?
- Test whether combined training paradigms (e.g., cognitive control + emotion regulation strategies) lead to broader transfer effects in daily life functioning.
- Incorporate multiple measures in network models (behavioral, biological) to derive a more integrated understanding of mechanisms.
- Using growth modeling, examine individual differences (e.g., rumination levels, motivation) as moderators of training effectiveness.
References
Hoorelbeke, K., & Koster, E. H. W. (2017). Internet-delivered cognitive control training as a preventive intervention for remitted depressed patients: Evidence from a double-blind randomized controlled trial study. Journal of Consulting and Clinical Psychology, 85(2), 135–146. https://doi.org/10.1037/ccp0000128
Keep Learning
- What additional statistical tests or visualizations could provide further insights into the effects observed in this study?
- How might the type or dose of training influence the extent of transfer effects to emotion regulation and daily functioning?
- Would effects differ in an unmedicated depressed sample relative to this remitted sample on antidepressants? How so?
- Could network analysis help identify moderators of training effectiveness at the individual level?
