Kun je je brein trainen om een depressie op afstand te houden?
Wie hersteld is van een depressie, loopt een groot risico om te hervallen. Kan een computertraining van telkens een kwartier dat helpen voorkomen? Voor mijn masterproef volgde ik zes mensen dag na dag: voor, tijdens en na zo’n training. Het antwoord is geen simpele ja of nee. Bij sommigen daalden de klachten, bij anderen niet, en bij enkelen pas toen de training al voorbij was.
Kun je je brein trainen als een spier? Beeld: Pixabay.
Het gaat eindelijk beter. De sombere gedachten zijn gaan liggen, je slaapt weer en de dagen krijgen opnieuw kleur. Toch blijft er één vraag knagen: wat als het terugkomt?
Die angst is niet uit de lucht gegrepen. Na een eerste depressie hervallen ongeveer zes op de tien mensen. Na een tweede zijn dat er zeven op de tien, na drie of meer zelfs negen op de tien. Met elke depressie wordt het risico dus groter. Therapie en medicatie helpen mensen uit een depressie, maar beschermen te weinig tegen een volgende. Daarom zoeken onderzoekers naar manieren om herval te voorkomen.
Rekenen tegen herval
Eén spoor is het brein trainen. Preciezer: de cognitieve controle, het vermogen om je aandacht te sturen en storende informatie opzij te zetten. Bij mensen met een depressie hapert dat vaker: het lukt hen minder goed om hun aandacht weg te halen van wat negatief is. Dat blijft vaak zo, ook wanneer hun stemming al hersteld is. Net die blijvende kwetsbaarheid vergroot de kans op herval.
De training die ik onderzocht, klinkt verrassend eenvoudig. Een stem noemt cijfers op en jij telt telkens de laatste twee bij elkaar op. Drie, vijf: acht. Dan volgt een twee: zeven, en dus niet tien. Je vorige antwoord moet je meteen loslaten. Na vier juiste antwoorden op rij gaat het tempo omhoog, na vier fouten omlaag. Zo blijft de taak voor iedereen net moeilijk genoeg.
Beter leren rekenen is niet het doel. Je oefent om je aandacht te sturen en los te laten.
De deelnemers deden tien sessies van een kwartier, gespreid over twee weken, gewoon thuis aan de computer.
Elke avond om zes uur een sms
De meeste studies meten klachten vlak voor en vlak na de trainingsperiode, en soms nog eens maanden later. Wat er tussenin gebeurt, blijft onzichtbaar. Net dat wilde ik zien.
Zes mensen deden mee: vier vrouwen en twee mannen, gemiddeld 45 jaar. Ze waren op dat moment hersteld van hun laatste depressie, al hadden ze nog restklachten. Gemiddeld hadden ze al meer dan vijf depressies achter de rug. Zes tot acht weken lang kregen ze elke avond om zes uur een sms met een korte vragenlijst. Op een schuifbalk van 0 tot 100 gaven ze aan hoeveel last ze die dag hadden van negen klachten, zoals somberheid, vermoeidheid, slecht slapen en concentratieproblemen. Ze noteerden ook wat hen die dag stress had bezorgd. Zo kon ik nagaan of stress mee verklaart waarom klachten stegen of daalden.
Niet iedereen begon tegelijk te trainen. Het lot bepaalde wie na twee, drie of vier weken startte. Dalen de klachten telkens net op het moment dat iemand begint, dan wijst dat op de training, eerder dan op toeval of de tijd die verstrijkt.
De opzet van het onderzoek: drie groepjes van elk twee deelnemers startten op een ander moment met de training.
Zes mensen, zes verhalen
Als de training werkt zoals gehoopt, zakken de klachten zodra iemand begint te trainen. Dat gebeurde bij twee van de zes deelnemers. Bij twee anderen daalden de klachten ook, maar pas in de twee weken nadat de training was afgelopen. Bij de overige twee bleef een effect uit, of namen de klachten tijdelijk zelfs toe.
Zes deelnemers, drie verschillende patronen.
Nog iets viel op. Bij niemand zakten de klachten geleidelijk, sessie na sessie. Bij één deelnemer schoten ze zelfs plots omhoog op het moment dat de training stopte, ook als je rekening houdt met de stress van die dagen. Misschien is het wegvallen van de training voor sommige mensen een kwetsbaar moment, en bouw je ze beter geleidelijk af. Maar het gaat om één persoon, dus voorzichtigheid is hier op haar plaats.
Niet te vroeg juichen, niet te vroeg afschrijven
Die late dalingen zijn intrigerend. Eerdere onderzoeken zagen dat het effect van deze training soms pas maanden later duidelijk wordt. Wie alleen meet tijdens of vlak na een behandeling, mist dat.
Een behandeling die op het eerste gezicht weinig doet, is daarom nog niet waardeloos.
Toch moet ik eerlijk zijn: mijn studie bewijst niet dat de training vertraagd werkt. Zes mensen zijn daarvoor te weinig, en twee weken opvolging is te kort.
Waarom dan verder zoeken? Omdat een bundeling van eerdere studies gemiddeld wél een klein effect vindt. Concreet: van elke zes mensen die de training volgen, heeft er één baat bij die dat zonder training niet had gehad. Dat is vergelijkbaar met wat andere studies vinden voor antidepressiva en gesprekstherapie. Bovendien is de training volledig digitaal. Volgens eerder onderzoek is ze ook goedkoop. Dat maakt ze toegankelijk als aanvulling op een behandeling, niet als vervanging.
Zelf denk ik dat het brein trainen een goed spoor is, al weet ik niet of een rekentaak met cijfers het beste middel is. Andere trainingen oefenen rechtstreeks met negatieve en positieve informatie. Ook die verdienen onderzoek, net als de training in combinatie met therapie of medicatie.
Voor wie, wanneer en hoe?
Kun je je brein trainen om een depressie op afstand te houden? Sommige mensen misschien wel. Helaas niet iedereen, niet op dezelfde manier en niet op hetzelfde moment. Een wondermiddel is deze training dus niet. Ze is wel een reden om beter te kijken: dag per dag, mens per mens.
In mijn onderzoek leken deelnemers met meer klachten bij de start vaker een effect te tonen. Toch zijn onderzoekers het er nog niet over eens wat voorspelt wie baat heeft bij deze training. De volgende stap is daarom niet alleen onderzoeken óf ze werkt, maar vooral voor wie, wanneer en hoe. Want wie hersteld is van een depressie, verdient meer dan afwachten of ze terugkomt.
Bibliografie
Referenties
Abramson, L. Y., Metalsky, G. I., & Alloy, L. B. (1989). Hopelessness depression: A theory-based subtype of depression. Psychological Review, 96(2), 358–372. https://doi.org/10.1037/0033-295X.96.2.358
Ahern, E., Kinsella, S., & Semkovska, M. (2017). Clinical efficacy and economic evaluation of online cognitive behavioral therapy for major depressive disorder: A systematic review and meta-analysis. Expert Review of Pharmacoeconomics & Outcomes Research, 18(1), 25–41. https://doi.org/10.1080/14737167.2018.1407245
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
Anderson, R. J., Freedland, K. E., Clouse, R. E., & Lustman, P. J. (2001). The prevalence of comorbid depression in adults with diabetes. Diabetes Care, 24(6), 1069–1078. https://doi.org/10.2337/diacare.24.6.1069
Beck, A. T. (1967). Depression: Clinical, experimental, and theoretical aspects. Harper & Row.
Beck, A. T., Rush, A. J., Shaw, B. F., & Emery, G. (1979). Cognitive therapy of depression. Guilford Press.
Belmaker, R., & Agam, G. (2008). Major depressive disorder. New England Journal of Medicine, 358(1), 55–68. https://doi.org/10.1056/NEJMra073096
Bockting, C. L., Hollon, S. D., Jarrett, R. B., Kuyken, W., & Dobson, K. (2015). A lifetime approach to major depressive disorder: The contributions of psychological interventions in preventing relapse and recurrence. Clinical Psychology Review, 41, 16–26. https://doi.org/10.1016/j.cpr.2015.02.003
Borsboom, D. (2017). A network theory of mental disorders. World Psychiatry, 16(1), 5–13. https://doi.org/10.1002/wps.20375
Breedvelt, J. J. F., Warren, F. C., Segal, Z., Kuyken, W., & Bockting, C. L. H. (2024). An individual participant data meta-analysis of psychological interventions for preventing depression relapse. Nature Mental Health. https://doi.org/10.1038/s44220-023-00178-x
Calkins, A. W., McMorran, K. E., Siegle, G. J., & Otto, M. W. (2014). The Effects of Computerized Cognitive Control Training on Community Adults with Depressed Mood. Behavioural And Cognitive Psychotherapy, 43(5), 578–589. https://doi.org/10.1017/s1352465814000046
Cipriani, A., Furukawa, T. A., Salanti, G., Chaimani, A., Atkinson, L. Z., Ogawa, Y., ... Geddes, J. R. (2018). Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: A systematic review and network meta-analysis. The Lancet, 391(10128), 1357–1366. https://doi.org/10.1016/S0140-6736(17)32802-7
Claes, S. J. (2010). Stress en depressie: Klinisch, neurobiologisch en genetisch perspectief. Tijdschrift voor Psychiatrie, 52(6), 415–425
Clarke, D. M., & Currie, K. C. (2009). Depression, anxiety and their relationship with chronic diseases: A review of the epidemiology, risk and treatment evidence. The Medical Journal of Australia, 190(S7). https://doi.org/10.5694/j.1326-5377.2009.tb02471.x
Cohen, N., Margulies, D., Ashkenazi, S., Schaefer, A., Taubert, M., Henik, A., Villringer, A., & Okon-Singer, H. (2016). Using executive control training to suppress amygdala reactivity to aversive information. NeuroImage, 125, 1022–1031. https://doi.org/10.1016/j.neuroimage.2015.10.069
Cuijpers, P., de Wit, L., Weitz, E., Andersson, G., & Huibers, M. J. H. (2015). The combination of psychotherapy and pharmacotherapy in the treatment of adult depression: A comprehensive meta-analysis. Journal of Evidence-Based Psychotherapies, 15(2), 145–159.
Currie, S. R., Patten, S. B., Williams, J. V., Wang, J., Beck, C. A., El-Guebaly, N., & Maxwell, C. (2005). Comorbidity of major depression with substance use disorders. The Canadian Journal of Psychiatry, 50(10), 660–666. https://doi.org/10.1177/070674370505001013
De Maat, S. M., Dekker, J., Schoevers, R. A., & De Jonghe, F. (2006). Relative efficacy of psychotherapy and combined therapy in the treatment of depression: A meta-analysis. European Psychiatry, 22(1), 1–8. https://doi.org/10.1016/j.eurpsy.2006.10.008
Demeester, D., Zwalmen, Y. V., Baeken, C., Verhaeghe, N., Hoorelbeke, K., & Koster, E. H. (2025). Towards Targeted Prevention of Depression: A Phase II Trial on just-in-time Application of Cognitive Control Training with Booster Sessions. Journal Of Cognitive Enhancement, 9(4), 423–438. https://doi.org/10.1007/s41465-025-00339-z
De Vaus, J., Hornsey, M. J., Kuppens, P., & Bastian, B. (2017). Exploring the East–West divide in prevalence of affective disorder: A case for cultural differences in coping with negative emotion. Personality and Social Psychology Review, 22(3), 285–304. https://doi.org/10.1177/1088868317736222
Disner, S. G., Beevers, C. G., Haigh, E. A. P., & Beck, A. T. (2011). Neural mechanisms of the cognitive model of depression. Nature Reviews Neuroscience, 12(8), 467–477. https://doi.org/10.1038/nrn3027
Donker, T., Batterham, P., Warmerdam, L., Bennett, K., Bennett, A., Cuijpers, P., Griffiths, K., & Christensen, H. (2013). Predictors and moderators of response to internet-delivered interpersonal psychotherapy and cognitive behavior therapy for depression. Journal of Affective Disorders, 151(1), 343–351. https://doi.org/10.1016/j.jad.2013.06.020
Drevets, W. C., Thase, M. E., Moses-Kolko, E. L., Price, J., Frank, E., Kupfer, D. J., & Mathis, C. (2007). Serotonin-1A receptor imaging in recurrent depression: Replication and literature review. Nuclear Medicine and Biology, 34(7), 865–877. https://doi.org/10.1016/j.nucmedbio.2007.06.008
Eriksen, B. A., & Eriksen, C. W. (1974). Effects of noise letters upon the identification of a target letter in a nonsearch task. Perception & Psychophysics, 16(1), 143–149. https://doi.org/10.3758/BF03203267
Etkin, A., Patenaude, B., Song, Y. J. C., Usherwood, T., Rekshan, W., Schatzberg, A. F., Rush, A. J., & Williams, L. M. (2014). A Cognitive–Emotional Biomarker for Predicting Remission with Antidepressant Medications: A Report from the iSPOT-D Trial. Neuropsychopharmacology, 40(6), 1332–1342. https://doi.org/10.1038/npp.2014.333
Fan, Z. J., Bonauto, D. K., Foley, M. P., Anderson, N. J., Yragui, N. L., & Silverstein, B. A. (2012). Occupation and the prevalence of current depression and frequent mental distress, WA BRFSS 2006 and 2008. American Journal of Industrial Medicine, 55(10), 893–903. https://doi.org/10.1002/ajim.22094
Felix, L. M., Mansur-Alves, M., Teles, M., Jamison, L., & Golino, H. (2021). Longitudinal impact and effects of booster sessions in a cognitive training program for healthy older adults. Archives of gerontology and geriatrics, 94, 104337. https://doi.org/10.1016/j.archger.2021.104337
Felten, A., Montag, C., Markett, S., Walter, N. T., & Reuter, M. (2011). Genetically determined dopamine availability predicts disposition for depression. Brain and Behavior, 1(2), 109–118. https://doi.org/10.1002/brb3.20
Gautam, M., Tripathi, A., Deshmukh, D., & Gaur, M. (2020). Cognitive behavioral therapy for depression. Indian Journal of Psychiatry, 62(8), 223. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_772_19
Geller, B., Zimerman, B., Williams, M., Bolhofner, K., & Craney, J. L. (2001). Adult psychosocial outcome of prepubertal major depressive disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 40(6), 673–677. https://doi.org/10.1097/00004583-200106000-00012
Goodman, S. H., Rouse, M. H., Connell, A. M., Broth, M. R., Hall, C. M., & Heyward, D. (2011). Maternal depression and child psychopathology: A meta-analytic review. Clinical Child and Family Psychology Review, 14(1), 1–27. https://doi.org/10.1007/s10567-010-0080-1
Gronwall, D. M. A. (1977). Paced auditory serial-addition task: A measure of recovery from concussion. Perceptual and Motor Skills, 44(2), 367–373. https://doi.org/10.2466/pms.1977.44.2.367
Gotlib, I. H., & Joormann, J. (2010). Cognition and depression: Current status and future directions. Annual Review of Clinical Psychology, 6, 285–312. https://doi.org/10.1146/annurev.clinpsy.121208.131305
Gutiérrez-Rojas, L., Porras-Segovia, A., Dunne, H., Andrade-González, N., & Cervilla, J. A. (2020). Prevalence and correlates of major depressive disorder: A systematic review. Brazilian Journal of Psychiatry, 42(6), 657–672. https://doi.org/10.1590/1516-4446-2020-0650
Heim, C., Newport, D. J., Mletzko, T., Miller, A. H., & Nemeroff, C. B. (2008). The link between childhood trauma and depression: Insights from HPA axis studies in humans. Psychoneuroendocrinology, 33(6), 693–710. https://doi.org/10.1016/j.psyneuen.2008.03.008
Hoorelbeke, K., Koster, E. H., Vanderhasselt, M. A., Callewaert, S., & Demeyer, I. (2015). The influence of cognitive control training on stress reactivity and rumination in response to a lab stressor and naturalistic stress. Behaviour Research and Therapy, 69, 1–10. https://doi.org/10.1016/j.brat.2015.03.010
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
Hoorelbeke, K., Van den Bergh, N., De Raedt, R., Wichers, M., & Koster, E. H. W. (2021). Preventing recurrence of depression: Long-term effects of a randomized controlled trial on cognitive control training for remitted depressed patients. Clinical Psychological Science. https://doi.org/10.1177/2167702620979775
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
Hoorelbeke, K., Vervaeke, J., Siegle, G. J., Baeken, C., & Koster, E. H. (2022). Individual differences associated with treatment adherence and transfer effects following gamified web-based cognitive control training for repetitive negative thinking. Internet Interventions, 27, 100507. https://doi.org/10.1016/j.invent.2022.100507
Hunt, G. E., Malhi, G. S., Lai, H. M. X., & Cleary, M. (2020). Prevalence of comorbid substance use in major depressive disorder in community and clinical settings, 1990–2019: Systematic review and meta-analysis. Journal of Affective Disorders, 266, 288–304. https://doi.org/10.1016/j.jad.2020.01.141
Ikani, N., Tyborowska, A., Kohn, N., Günther, N., Siegle, G. J., Schene, A. H., Vorstman, J. A. S., Harmer, C. J., Kas, M. J., Vrijsen, J. N., & Ruhé, H. G. (2025). 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. BMC Psychiatry, 25(1), 445. https://doi.org/10.1186/s12888-025-06860-x
Insel, T. R. (2013). The NIMH experimental medicine initiative. JAMA, 310(19), 2021–2022. https://doi.org/10.1001/jama.2013.283212
Jaeger, J., Berns, S., Uzelac, S., & Davis-Conway, S. (2006). Neurocognitive deficits and disability in major depressive disorder. Psychiatry Research, 145(1), 39–48. https://doi.org/10.1016/j.psychres.2005.11.011
Jakobsen, J. C., Hansen, J. L., Simonsen, S., Simonsen, E., & Gluud, C. (2011). Effects of cognitive therapy versus interpersonal psychotherapy in patients with major depressive disorder: A systematic review of randomized clinical trials with meta-analyses and trial sequential analyses. Psychological Medicine, 42(7), 1343–1357. https://doi.org/10.1017/S0033291711002236
Jonker, H., Duveau, C., Charafeddine, R., Gisle, L., & Demarest, S. (2025). Samenvatting van de BELHEALTH-resultaten – Waves 1 tot 6. Gegevens over geestelijke gezondheid bij Belgische volwassenen na COVID-19: September 2022 – Juni 2024 (Rapportnummer D/2025.14.440/19). Sciensano. https://doi.org/10.25608/r1yg-9d95
Joormann, J., & D’Avanzato, C. (2010). Emotion regulation in depression: Examining the role of cognitive processes. Cognition & Emotion, 24(6), 913–939. https://doi.org/10.1080/02699931003784939
Judd, L. L., Akiskal, H. S., Maser, J. D., Zeller, P. J., Endicott, J., Coryell, W., … & Keller, M. B. (1998). Major depressive disorder: A prospective study of residual subthreshold depressive symptoms as predictor of rapid relapse. Journal of Affective Disorders, 50(2–3), 97–108. https://doi.org/10.1016/S0165-0327(98)00138-4
Kazdin, A. E. (2011). Single-case research designs: Methods for clinical and applied settings (2nd ed.). Oxford University Press.
Kelly, M. E., Loughrey, D., Lawlor, B. A., Robertson, I. H., Walsh, C., & Brennan, S. (2014). The impact of cognitive training and mental stimulation on cognitive and everyday functioning of healthy older adults: a systematic review and meta-analysis. Ageing research reviews, 15, 28–43. https://doi.org/10.1016/j.arr.2014.02.004
Keshavan, M. S., Vinogradov, S., Rumsey, J., Sherrill, J., & Wagner, A. (2014). Cognitive Training in Mental Disorders: Update and Future Directions. American Journal Of Psychiatry, 171(5), 510–522. https://doi.org/10.1176/appi.ajp.2013.13081075
Kessler, R. C. (2012). The costs of depression. Psychiatric Clinics of North America, 35(1), 1–14. https://doi.org/10.1016/j.psc.2011.11.005
Kessler, R. C., & Bromet, E. J. (2013). The epidemiology of depression across cultures. Annual Review of Public Health, 34, 119–138. https://doi.org/10.1146/annurev-publhealth-031912-114409
Kessler, R. C., Greenberg, P. E., Mickelson, K. D., Meneades, L. M., & Wang, P. S. (2006). The effects of chronic medical conditions on work impairment. Psychological Medicine, 31(5), 957–967. https://doi.org/10.1017/S0033291701004036
Kirchner, W. K. (1958). Age differences in short-term retention of rapidly changing information. Journal of Experimental Psychology, 55(4), 352–358. https://doi.org/10.1037/h0043688
Köhler, C. A., Evangelou, E., Stubbs, B., Solmi, M., Veronese, N., Belbasis, L., Bortolato, B., Melo, M. C., Coelho, C. A., Fernandes, B. S., Olfson, M., Ioannidis, J. P., & Carvalho, A. F. (2018). Mapping risk factors for depression across the lifespan: An umbrella review of evidence from meta-analyses and Mendelian randomization studies. Journal of Psychiatric Research, 103, 189–207. https://doi.org/10.1016/j.jpsychires.2018.05.020
Koster, E. H., Hoorelbeke, K., Onraedt, T., Owens, M., & Derakshan, N. (2017). Cognitive control interventions for depression: A systematic review of findings from training studies. Clinical Psychology Review, 53, 79–92. https://doi.org/10.1016/j.cpr.2017.02.002
Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2001). The PHQ-9. Journal Of General Internal Medicine, 16(9), 606–613. https://doi.org/10.1046/j.1525-1497.2001.016009606.x
Lee, A. S. (2003). Better outcomes for depressive disorders? Psychological Medicine, 33(5), 769–774. https://doi.org/10.1017/S003329170300802X
Lehto, J. E., Juujärvi, P., Kooistra, L., & Pulkkinen, L. (2003). Dimensions of executive functioning: Evidence from children. British Journal of Developmental Psychology, 21(1), 59–80. https://doi.org/10.1348/026151003321164627
Lepine, J. P., & Briley, M. (2011). The increasing burden of depression. Journal of Affective Disorders, 133(1–2), 1–13. https://doi.org/10.1016/j.jad.2010.10.034
Lewinsohn, P. M., Rohde, P., Seeley, J. R., Klein, D. N., & Gotlib, I. H. (2000). Natural course of adolescent major depressive disorder in a community sample: Predictors of recurrence in young adults. American Journal of Psychiatry, 157(10), 1584–1591. https://doi.org/10.1176/appi.ajp.157.10.1584
Lingiardi, V., & McWilliams, N. (Eds.). (2017). Psychodynamic diagnostic manual (2e ed.). Guilford Press.
Liu, Q., He, H., Yang, J., Feng, X., Zhao, F., & Lyu, J. (2019). Changes in the global burden of depression from 1990 to 2017: Findings from the Global Burden of Disease study. Journal of Psychiatric Research, 126, 134–140. https://doi.org/10.1016/j.jpsychires.2019.08.002
Lorimer, B., Delgadillo, J., Kellett, S., & Brown, G. (2019). Exploring relapse through a network analysis of residual depression and anxiety symptoms after cognitive behavioural therapy: A proof-of-concept study. Psychotherapy Research, 30(5), 650–661. https://doi.org/10.1080/10503307.2019.1650980
Lovejoy, M. C., Graczyk, P. A., O’Hare, E., & Neuman, G. (2000). Maternal depression and parenting behavior: A meta-analytic review. Clinical Psychology Review, 20(5), 561–592. https://doi.org/10.1016/S0272-7358(98)00100-7
Lye, M., Tey, Y., Tor, Y., Shahabudin, A. F., Ibrahim, N., Ling, K., Stanslas, J., Loh, S., Rosli, R., Lokman, K. A., Badamasi, I. M., Faris-Aldoghachi, A., & Razak, N. A. A. (2020). Predictors of recurrence of major depressive disorder. PLoS ONE, 15(3), e0230363. https://doi.org/10.1371/journal.pone.0230363
Maggin, D. M., Swaminathan, H., Rogers, H. J., O’Keeffe, B. V., Sugai, G., & Horner, R. H. (2011). A generalized least squares regression approach for computing effect sizes in single-case research: Application examples. Journal of School Psychology, 49(3), 301–321. https://doi.org/10.1016/j.jsp.2011.03.004
Masuyama, A. (2025). Evolutionary explanations of depression and cognitive control dysfunction: A literature review. Behavioural Brain Research, 500, 116001. https://doi.org/10.1016/j.bbr.2025.116001
Meyer, J. H., & Quenzer, L. F. (2005). Psychopharmacology: Drugs, the brain, and behavior. Sinauer Associates.
Miller, A. H., & Raison, C. L. (2016). The role of inflammation in depression: From evolutionary imperative to modern treatment target. JAMA Psychiatry, 73(12), 1250–1257. https://doi.org/10.1001/jamapsychiatry.2016.2230
Miller, E. K., & Cohen, J. D. (2001). An integrative theory of prefrontal cortex function. Annual Review of Neuroscience, 24, 167–202. https://doi.org/10.1146/annurev.neuro.24.1.167
Moncrieff, J., Cooper, R. E., Stockmann, T., Amendola, S., Hengartner, M. P., & Horowitz, M. A. (2022). The Serotonin Theory of Depression: A Systematic Umbrella Review of the Evidence. Molecular Psychiatry, 24(2), 236–251. https://doi.org/10.1038/s41380-022-01661-0
Monroe, S. M., & Harkness, K. L. (2011). Recurrence in major depression: A conceptual analysis. Psychological Review, 118(4), 655–674. https://doi.org/10.1037/a0025190
Monroe, S. M., & Simons, A. D. (1991). Diathesis-stress theories in the context of life stress research: Implications for the depressive disorders. Psychological Bulletin, 110(3), 406–425. https://doi.org/10.1037/0033-2909.110.3.406
Moraczewski, J., Awosika, A. O., & Aedma, K. K. (2023, augustus 17). Tricyclic antidepressants. National Library of Medicine: National Center for Biotechnology Information. https://www.ncbi.nlm.nih.gov/books/NBK557791
Motter, J. N., Pimontel, M. A., Rindskopf, D., Devanand, D. P., Doraiswamy, P. M., & Sneed, J. R. (2016). Computerized cognitive training and functional recovery in major depressive disorder: A meta-analysis. Journal of Affective Disorders, 189, 184–191. https://doi.org/10.1016/j.jad.2015.09.022
Mueller, T. I., Leon, A. C., Keller, M. B., Solomon, D. A., Endicott, J., Coryell, W., Warshaw, M., & Maser, J. D. (1999). Recurrence after recovery from major depressive disorder during 15 years of observational follow-up. American Journal of Psychiatry, 156(7), 1000–1006. https://doi.org/10.1176/ajp.156.7.1000
Myin-Germeys, I., Kasanova, Z., Vaessen, T., Vachon, H., Kirtley, O., Viechtbauer, W., & Reininghaus, U. (2018). Experience sampling methodology in mental health research: New insights and technical developments. World Psychiatry, 17(2), 123–132. https://doi.org/10.1002/wps.20513
Nguyen, L., Murphy, K., & Andrews, G. (2019). Immediate and long-term efficacy of executive functions cognitive training in older adults: A systematic review and meta analysis. Psychological bulletin, 145(7), 698–733. https://doi.org/10.1037/bul0000196
Nierenberg, A. A., Husain, M. M., Trivedi, M. H., Fava, M., Warden, D., Wisniewski, S. R., Miyahara, S., & Rush, A. J. (2010). Residual symptoms after remission of major depressive disorder with citalopram and risk of relapse: A STAR*D report. Psychological Medicine, 40(1), 41–50. https://doi.org/10.1017/S0033291709006011
Nöbbelin, L., Bogren, M., Mattisson, C., & Brådvik, L. (2018). Risk factors for recurrence in depression in the Lundby population, 1947–1997. Journal of Affective Disorders, 228, 125–131. https://doi.org/10.1016/j.jad.2017.11.038
Nolen-Hoeksema, S., Wisco, B. E., & Lyubomirsky, S. (2008). Rethinking rumination. Perspectives on Psychological Science, 3(5), 400–424. https://doi.org/10.1111/j.1745-6924.2008.00088.x
Ochsner, K. N., & Gross, J. J. (2005). The cognitive control of emotion. Trends in Cognitive Sciences, 9(5), 242–249. https://doi.org/10.1016/j.tics.2005.03.010
Park, C., Rosenblat, J. D., Lee, Y., Pan, Z., Cao, B., Iacobucci, M., & McIntyre, R. S. (2019). The neural systems of emotion regulation and abnormalities in major depressive disorder. Behavioural Brain Research, 367, 181–188. https://doi.org/10.1016/j.bbr.2019.04.002
Parker, R. I., Vannest, K. J., & Davis, J. L. (2011). Effect size in single-case research: A review of nine nonoverlap techniques. Behavior Modification, 35(4), 303–322.
Paulus, M. P. (2014). Cognitive control in depression and anxiety: out of control? Current Opinion in Behavioral Sciences, 1, 113–120. https://doi.org/10.1016/j.cobeha.2014.12.003
Pinheiro, J., Bates, D., & R Core Team. (2025). nlme: Linear and nonlinear mixed effects models (Version 3.1-168) [R package]. https://CRAN.R-project.org/package=nlme
Pintor, L. (2003). Relapse of major depression after complete and partial remission during a 2-year follow-up. Journal of Affective Disorders, 73(3), 237–244. https://doi.org/10.1016/S0165-0327(01)00480-3
Pintor, L., Torres, X., Navarro, V., Matrai, S., & Gastó, C. (2004). Is the type of remission after a major depressive episode an important risk factor to relapses in a 4-year follow-up? Journal of Affective Disorders, 82(2), 291–296. https://doi.org/10.1016/j.jad.2003.11.008
Pizzagalli, D. A., & Roberts, A. C. (2021). Prefrontal cortex and depression. Neuropsychopharmacology, 47(1), 225–246. https://doi.org/10.1038/s41386-021-01101-7
Pustejovsky, J. E., Chen, M., Grekov, P., & Swan, D. M. (2024). Single-case effect size calculator (Version 0.7.3) [Web application]. https://jepusto.shinyapps.io/SCD-effect-sizes/
Qualtrics. (2024). Qualtrics [Computer software]. https://www.qualtrics.com
R Core Team. (2025). R: A language and environment for statistical computing (Version 4.4.3) [Computer software]. R Foundation for Statistical Computing. https://www.R-project.org/
Rock, P. L., Roiser, J. P., Riedel, W. J., & Blackwell, A. D. (2013). Cognitive impairment in depression: a systematic review and meta-analysis. Psychological Medicine, 44(10), 2029–2040. https://doi.org/10.1017/s0033291713002535
Sacchet, M. D., Levy, B. J., Hamilton, J. P., Maksimovskiy, A., Hertel, P. T., Joormann, J., Anderson, M. C., Wagner, A. D., & Gotlib, I. H. (2016). Cognitive and neural consequences of memory suppression in major depressive disorder. Cognitive Affective & Behavioral Neuroscience, 17(1), 77–93. https://doi.org/10.3758/s13415-016-0464-x
Schildkraut, J. J. (1965). The catecholamine hypothesis of affective disorders: A review of the evidence. American Journal of Psychiatry, 122(5), 509–522. https://doi.org/10.1176/ajp.122.5.509
Scholten, S., Lavallee, K., Velten, J., Zhang, X., & Margraf, J. (2020). The brief daily stressors screening tool: An introduction and evaluation. Stress And Health, 36(5), 686–692. https://doi.org/10.1002/smi.2965
Seligman, M. E. P. (1975). Helplessness: On depression, development, and death. W. H. Freeman.
Semkovska, M., Quinlivan, L., O’Grady, T., Johnson, R., Collins, A., O’Connor, J., Knittle, H., Ahern, E., & Gload, T. (2019). Cognitive function following a major depressive episode: a systematic review and meta-analysis. The Lancet Psychiatry, 6(10), 851–861. https://doi.org/10.1016/s2215-0366(19)30291-3
Serafini, G., Nebbia, J., Cipriani, N., Conigliaro, C., Erbuto, D., Pompili, M., & Amore, M. (2018). Number of illness episodes as predictor of residual symptoms in major depressive disorder. Psychiatry Research, 262, 469–476. https://doi.org/10.1016/j.psychres.2017.09.026
Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., & Dunbar, G. C. (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59(Suppl 20), 22–33.
Shimoda, K., & Robinson, R. G. (1999). The relationship between poststroke depression and lesion location in long-term follow-up. Biological Psychiatry, 45(2), 187–192. https://doi.org/10.1016/S0006-3223(98)00178-4
Siegle, G. J., Ghinassi, F., & Thase, M. E. (2007). Neurobehavioral therapies in the 21st century: Summary of an emerging field and an extended example of cognitive control training for depression. Cognitive Therapy and Research, 31(2), 235–262. https://doi.org/10.1007/s10608-006-9118-6
Siegle, G. J., Price, R. B., Jones, N. P., Ghinassi, F., Painter, T., & Thase, M. E. (2014). You gotta work at it: Pupillary indices of task focus are prognostic for response to a neurocognitive intervention for rumination in depression. Clinical Psychological Science, 2(4), 455–471. https://doi.org/10.1177/2167702614536160
Smith, M. M., & Hewitt, P. L. (2024). The equivalence of psychodynamic therapy and cognitive behavioral therapy for depressive disorders in adults: A meta‐analytic review. Journal of Clinical Psychology, 80(5), 945–967. https://doi.org/10.1002/jclp.23649
SMSTools. (2024). SMSTools [Computer software]. https://www.smstools.com/
Soleimani, L., Lapidus, K. A., & Iosifescu, D. V. (2010). Diagnosis and treatment of major depressive disorder. Neurologic Clinics, 29(1), 177–193. https://doi.org/10.1016/j.ncl.2010.10.010
Spiegel, D. (1996). Cancer and depression. The British Journal of Psychiatry, 168(S30), 109–116. https://doi.org/10.1192/S0007125000298486
Stoltz, C. M., Baime, M. J., & Yaffe, K. (1999). Depression in the patient with rheumatologic disease. Rheumatic Disease Clinics of North America, 25(3), 687–702. https://doi.org/10.1016/S0889-857X(05)70093-4
Stroop, J. R. (1935). Studies of interference in serial verbal reactions. Journal of Experimental Psychology, 18(6), 643–662. https://doi.org/10.1037/h0054651
Sullivan, P. F., Neale, M. C., & Kendler, K. S. (2000). Genetic epidemiology of major depression: Review and meta-analysis. American Journal of Psychiatry, 157(10), 1552–1562. https://doi.org/10.1176/appi.ajp.157.10.1552
Tanguay-Sela, M., Rollins, C., Perez, T., Qiang, V., Golden, G., Tunteng, J., ... & Margolese, H. C. (2022). A systematic meta-review of patient-level predictors of psychological therapy outcome in major depressive disorder. Journal of Affective Disorders, 317, 307–318. https://doi.org/10.1016/j.jad.2022.08.041
Tate, R. L., & Perdices, M. (2019). Single-case experimental designs for clinical research and neurorehabilitation settings: Planning, conduct, analysis and reporting. Routledge.
Traut, H. J., Guild, R. M., & Munakata, Y. (2021). Why Does Cognitive Training Yield Inconsistent Benefits? A Meta-Analysis of Individual Differences in Baseline Cognitive Abilities and Training Outcomes. Frontiers in Psychology, 12, 662139. https://doi.org/10.3389/fpsyg.2021.662139
Tsapekos, D., Kalfas, M., Schandorff, J. M., Del Mar Bonnin, C., Bowie, C. R., Balanzá‐Martínez, V., Burdick, K. E., Carvalho, A. F., Dols, A., Douglas, K., Gallagher, P., Hasler, G., Kessing, L. V., Kjærstad, H. L., Lafer, B., Lewandowski, K. E., López‐Jaramillo, C., Martinez‐Aran, A., McIntyre, R. S., . . . Miskowiak, K. W. (2025). Predicting Response to Pro‐Cognitive Interventions in Mood Disorders: A Systematic Review by the International Society for Bipolar Disorders Targeting Cognition Task Force. Acta Psychiatrica Scandinavica. https://doi.org/10.1111/acps.70038
Tunnard, C., Rane, L. J., Wooderson, S. C., Markopoulou, K., Poon, L., Fekadu, A., ... & Cleare, A. J. (2013). The impact of childhood adversity on suicidality and clinical course in treatment-resistant depression. Journal of Affective Disorders, 152–154, 122–130. https://doi.org/10.1016/j.jad.2013.06.037
Vandaele, E. (2025). De invloed van boostersessies op de effectiviteit van een cognitieve controletraining bij voorheen depressieve personen: Training aangeboden op kritieke momenten (Masterproef). Universiteit Gent.
Van Den Bergh, N., Hoorelbeke, K., De Raedt, R., & Koster, E. H. (2018). Remediation of depression-related cognitive impairment: cognitive control training as treatment augmentation. Expert Review Of Neurotherapeutics, 18(12), 907–913. https://doi.org/10.1080/14737175.2018.1537783
Vander Zwalmen, Y. V., Demeester, D., Hoorelbeke, K., Verhaeghe, N., Baeken, C., & Koster, E. H. W. (2025a). The more, the merrier? Establishing a dose–response relationship for the effects of cognitive control training on depressive symptomatology. Journal Of Consulting And Clinical Psychology, 93(3), 161–175. https://doi.org/10.1037/ccp0000945
Vander Zwalmen, Y. V., Hoorelbeke, K., Liebaert, E., De Mévergnies, C. N., & Koster, E. H. W. (2022). Cognitive remediation for depression vulnerability: Current challenges and new directions. Frontiers in Psychology, 13, 903446. https://doi.org/10.3389/fpsyg.2022.903446
Vander Zwalmen, Y. V., Koster, E. H., Demeester, D., Baeken, C., Verhaeghe, N., & Hoorelbeke, K. (2025b). Predicting preventative effects of cognitive control training in remitted depressed individuals: A machine learning approach. Journal Of Affective Disorders Reports, 20, 100894. https://doi.org/10.1016/j.jadr.2025.100894
Vander Zwalmen, Y. V., Liebaert, E., Hoorelbeke, K., De Mévergnies, C. N., Baeken, C., Verhaeghe, N., & Koster, E. H. W. (2023). Treatment response following adaptive PASAT training for depression vulnerability: A systematic review and meta-analysis. Neuropsychology Review, 34(1), 232–249. https://doi.org/10.1007/s11065-023-09581-8
Van Vliet, I. M., & De Beurs, E. (2007). Het Mini Internationaal Neuropsychiatrisch Interview (MINI): Een kort gestructureerd psychiatrisch interview voor DSM-IV- en ICD-10-stoornissen. Tijdschrift voor Psychiatrie, 49(6), 393–397.
Vaswani, M., Linda, F. K., & Ramesh, S. (2003). Mechanisms of action of antidepressants: From neurotransmitter systems to signaling pathways. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 27(1), 85–102. https://doi.org/10.1016/S0278-5846(02)00338-7
Vervaeke, J., Hoorelbeke, K., Baeken, C., & Koster, E. H. W. (2021). Online Cognitive Control Training for Remitted Depressed Individuals: A Replication and Extension Study. Cognitive Therapy And Research, 45(5), 944–958. https://doi.org/10.1007/s10608-021-10238-0
Vervaeke, J., Van Looy, J., Hoorelbeke, K., Baeken, C., & Koster, E. H. W. (2018). Gamified cognitive control training for remitted depressed individuals: User requirements analysis. JMIR Serious Games, 6(2), Article e6. https://doi.org/10.2196/games.8609
Volkert, J., Schulz, H., Härter, M., Wlodarczyk, O., & Andreas, S. (2012). The prevalence of mental disorders in older people in Western countries: A meta-analysis. Ageing Research Reviews, 12(1), 339–353. https://doi.org/10.1016/j.arr.2012.09.004
Weissman, M. M., & Markowitz, J. C. (2013). Interpersonal psychotherapy: A clinician’s guide (2e ed.). Oxford University Press.
Werson, A. D., Meiser-Stedman, R., & Laidlaw, K. (2022). A meta-analysis of CBT efficacy for depression comparing adults and older adults. Journal of Affective Disorders, 319, 189–201. https://doi.org/10.1016/j.jad.2022.09.020
Whisman, M. A. (2001). The association between depression and marital dissatisfaction. The Clinical Psychologist, 54(3), 9–11. https://doi.org/10.1037/e514672006-003
Wickham, H. (2016). ggplot2: Elegant graphics for data analysis. Springer. https://ggplot2.tidyverse.org
Willner, P., Scheel-Krüger, J., & Belzung, C. (2012). The neurobiology of depression and antidepressant action. Neuroscience & Biobehavioral Reviews, 37(10), 2331–2371. https://doi.org/10.1016/j.neubiorev.2012.12.007
Wilson, S., Vaidyanathan, U., Miller, M. B., McGue, M., & Iacono, W. G. (2014). Premorbid risk factors for major depressive disorder: Are they associated with early onset and recurrent course? Development and Psychopathology, 26(4pt2), 1477–1493. https://doi.org/10.1017/S0954579414001151
Woolf, C., Lampit, A., Shahnawaz, Z., Sabates, J., Norrie, L. M., Burke, D., Naismith, S. L., & Mowszowski, L. (2021). A Systematic Review and Meta-Analysis of Cognitive Training in Adults with Major Depressive Disorder. Neuropsychology Review, 32(2), 419–437. https://doi.org/10.1007/s11065-021-09487-3
World Health Organization. (2023a). Depressive disorder (depression). https://www.who.int/news-room/fact-sheets/detail/depression
World Health Organization. (2023b). Suicide worldwide in 2023. https://www.who.int/news-room/fact-sheets/detail/suicide
Zetsche, U., Bürkner, P., & Schulze, L. (2018). Shedding light on the association between repetitive negative thinking and deficits in cognitive control – A meta-analysis. Clinical Psychology Review, 63, 56–65. https://doi.org/10.1016/j.cpr.2018.06.001
Zetsche, U., Neumann, P., Bürkner, P., Renneberg, B., Koster, E. H., & Hoorelbeke, K. (2024). Computerized cognitive control training to reduce rumination in major depression: A randomized controlled trial. Behaviour Research And Therapy, 177, 104521. https://doi.org/10.1016/j.brat.2024.104521
Zuckerman, H., Pan, Z., Park, C., Brietzke, E., Musial, N., Shariq, A. S., Iacobucci, M., Yim, S. J., Lui, L. M. W., Rong, C., & McIntyre, R. S. (2018). Recognition and Treatment of Cognitive Dysfunction in Major Depressive Disorder. Frontiers in Psychiatry, 9, 655. https://doi.org/10.3389/fpsyt.2018.00655
