2026 ECNP Congress

PS03-3118

Functional outcomes following cognitive remediation (INCREM) versus psychoeducation in a multicentre study: the role of site heterogeneity

Muriel Vicent-Gil — J. Carrasco-Hernández, T. Legido, G. Vall, J. Vera, L. Gawron, C.D.M. Bonnin, C. Alemany, N. Cardoner, J. De Diego-Adeliño, J. Trujols, M.J. Portella · IR Sant Pau, Mental Health Research Group- Department of Psychiatry, Barcelona, Spain

2026 ECNP Congress

Introduction

Cognitive remediation has emerged as a promising intervention to address cognitive difficulties in Major Depressive Disorder (MDD). However, evidence remains inconsistent, partly due to heterogeneity in intervention designs and limited personalization [1], [2]. The Integral Cognitive REMediation program (INCREM) was developed as a structured intervention combining group-based functional remediation with computerized cognitive training adapted to individual performance, integrating both restorative and compensatory strategies. A previous pilot study demonstrated its feasibility and suggested beneficial effects on cognitive and functional outcomes [3].

Aims

The primary aim of this study was to evaluate the effectiveness of the INCREM program compared to a Psychoeducation-based intervention in improving functional outcomes over time in individuals with MDD. Secondary objectives were to examine differences in the magnitude of functional improvement between groups using percentage change from baseline to follow-up, to compare rates of functional recovery at follow-up, and to explore the influence of variability across study sites on treatment outcomes.

Methods

Sixty-six participants were recruited across three clinical sites and allocated to INCREM intervention (n = 37) or Psychoeducation program (n = 29). Functional outcomes were assessed using the Functioning Assessment Short Test (FAST) at baseline, post-treatment, and follow-up. Baseline differences across sites were examined using one-way ANOVA. Repeated measures ANOVA was conducted with time as within-subject factor and intervention and site as between-subject factors. Secondary analyses included paired comparisons, percentage change, and recovery rates.

Results

Significant baseline differences between sites were observed in sociodemographic and clinical variables, including depression severity, functioning, and cognitive performance (all p ≤ .007). These findings indicate substantial heterogeneity in patient profiles between sites. A significant main effect of time was observed (Pillai’s Trace = .233, F (2,61) = 9.24, p < .001), indicating overall improvement in functioning. No significant time × intervention interaction was found (p = .592), whereas a significant time × site interaction emerged (p = .006), indicating variability across sites. Both groups improved from baseline to post-treatment (INCREM: p < .001; Psychoeducation: p = .001). From post-treatment to follow-up, continued improvement was observed in the INCREM group (p = .007), but not in the Psychoeducation group (p = .330). Percentage change analyses showed greater improvement in INCREM (−35.9%) compared to Psychoeducation (−22.7%), although not statistically significant (p = .170). Recovery rates were higher in INCREM (45.9%) compared to Psychoeducation (24.1%), representing a clinically meaningful difference, although this did not reach statistical significance (χ² = 3.34, p = .068).

Conclusions

Both interventions were associated with functional improvement, with no significant differences between INCREM and Psychoeducation. However, consistent trends favouring cognitive remediation were observed in sustained improvement and recovery rates. The presence of significant site-related variability and baseline differences suggests that site heterogeneity may influence treatment outcomes. These findings highlight the importance of considering contextual and patient-related factors in multicenter trials targeting functional outcomes in MDD.

References

  1. Mokhtari, S., Mokhtari, A., Bakizadeh, F., Moradi, A., Shalbafan, M., 2023. Cognitive rehabilitation for improving cognitive functions and reducing the severity of depressive symptoms in adult patients with major depressive disorder: A systematic review and meta-analysis of randomized controlled clinical trials. BMC Psychiatry 23, 77.
  2. Goldberg, Z., Kuslak, B., Kurtz, M.M., 2023. A meta-analytic investigation of cognitive remediation for mood disorders: Efficacy and the role of study quality, sample and treatment factors. J. Affect. Disord. 330, 74–82.
  3. Vicent-Gil, M., González-Simarro, S., Raventós, B., Vera, J., Marín Martínez, E.D., Sabaté-Cao, C., Pérez-Blanco, J., Puigdemont, D., de Diego-Adeliño, J., Alemany, C., Serra-Blasco, M., Cardoner, N., Portella, M.J., 2022. Randomized clinical trial of integral cognitive remediation program for major depression (INCREM). J. Affect. Disord. 310, 189–197.