Patients with a diagnosis of major depressive disorder, who are currently either euthymic or mildly depressed, will be recruited for this study. 40 participants (ages 19-55) will be recruited from the community from two outpatient sites. 20 patients will be recruited at University of British Columbia (UBC) and 20 patients will be recruited at Simon Fraser University (SFU). Patients will complete an initial virtual assessment to assess eligibility, after which patients will complete the bWell cognitive assessment session. This session will include rating scales for current symptoms of depression/anxiety, subjective cognitive functioning, global/occupational functioning and a validated computerized neuropsychological test battery to assess objective cognitive functioning. Participants will complete a brief VR training session with the VR equipment. Subsequently, the bWell cognitive assessment program will be administered, followed by scales assessing tolerability and enjoyability/engagement.
Patients will then be randomized in a 1:1 ratio to receive bWell cognitive remediation or to a control group in which they passively experience various VR scenes. Randomization will occur separately in inpatient and outpatient groups. Patients are told that either method is hypothesized to have effects on their cognition and are therefore blinded to whether they are in the 'active' treatment group. Assessors for outcomes that are not self-reported or self-administered will also be blinded to group assignment. Participants randomized to the bWell cognitive remediation program will complete 40-minute remediation sessions using bWell twice a week for 8 weeks; the other group will view VR scenes in bWell without any instructed cognitive tasks. EEG recordings will be administered at baseline, at midpoint, and after completing the 8 weeks. At the end of the 8 weeks, measures of subjective cognitive functioning, global/occupational functioning and the computerized objective cognitive testing battery will also be repeated. Patients will also undergo 2 MRI scans including a resting state fMRI and a structural MRI; these sessions will be scheduled once at baseline and once in the two following weeks after the last remediation/VR experience session. Patients will also complete tolerability and enjoyment/engagement scales during the remediation procedure. Patients will be debriefed at the end of their participation about their treatment groups. Patients randomized to bWell remediation group will also have the option of participating in a parallel study with the eBrain Lab at Simon Fraser University assessing neurophysiology of different brain regions using transcranial magnetic stimulation combined with electroencephalography (TMS-EEG).
In addition to MDD participants recruited and randomized, we will be recruiting 70 healthy individuals of the same age range (19-55) to complete the assessment session. Following phone screen, they will come in and complete the SCID, bWell-D assessment, session CNS vital signs, and rating scales for current symptoms of depression/anxiety, subjective cognitive functioning, global/occupational functioning and engagement and tolerability scales. This session will take approximately 3 hours, and participants will receive $60 for their participation.
