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Volume 26, Issue 1 (Spring 2024)
Advances in Cognitive Sciences 2024, 26(1): 1-17 |
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Ethics code: IR.KHU.REC.1401.024
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Yavarzadeh H, Moradi A, Hasani J, David John Hallford D J H. Designing a computer program for memory specificity training: Investigating its effectiveness in enhancing autobiographical memory and emotional characteristics for caregivers of people with cancer. Advances in Cognitive Sciences 2024; 26 (1) :1-17
URL: http://icssjournal.ir/article-1-1651-en.html
URL: http://icssjournal.ir/article-1-1651-en.html
1- PhD Student of Health Psychology, Kharazmi University, Tehran, Iran
2- Professor of Clinical Psychology, Institute for Cognitive Science Studies, Tehran, Iran/ Professor of Clinical Psychology, Department of Clinical Psychology, Kharazmi University, Tehran, Iran
3- Professor of Clinical Psychology, Department of Clinical Psychology, Kharazmi University, Tehran, Iran
4- Professor of Clinical Psychology, School of Psychology, Deakin University, Melbourne, Australia
2- Professor of Clinical Psychology, Institute for Cognitive Science Studies, Tehran, Iran/ Professor of Clinical Psychology, Department of Clinical Psychology, Kharazmi University, Tehran, Iran
3- Professor of Clinical Psychology, Department of Clinical Psychology, Kharazmi University, Tehran, Iran
4- Professor of Clinical Psychology, School of Psychology, Deakin University, Melbourne, Australia
Abstract: (1258 Views)
Introduction
Individuals experiencing psychological distress symptoms (such as anxiety, mental pressure, depression) and post-traumatic stress often struggle with autobiographical memory and rumination, necessitating psychological interventions. Interventions such as computerized competitive memory training and computerized memory specificity training are available options for psychologists to enhance the condition of these individuals, potentially improving emotional and cognitive symptoms, including autobiographical memory. Cancer caregivers are a population that frequently experiences numerous emotional issues, including anxiety, mental pressure, depression, and post-traumatic stress. The responsibility of assuming the caregiver role and associated feelings of guilt can intensify the pressure on caregivers of children with cancer. Given the constraints of the recent epidemic, it is crucial to offer methods that can effectively improve these individuals’ mental health. Considering the history of Memory Specificity Training (MeST)-based interventions in alleviating depression and post-traumatic stress disorder, the computerized design and localization of this intervention method can be beneficial during epidemic periods when face-to-face activities are limited. The present study aimed to develop an online Persian version of MeST-based training and to assess the content validity and effectiveness of this program.
Methods
This study was conducted to develop a computerized version of the MeST training intervention sessions using mobile phone software. The tools used in this study included the Structured Clinical Interview for DSM-5 Mental Disorders Clinical Version, DASS-21 scale, Autobiographical Memory Test (AMT), and therapeutic intervention: Memory Specificity Training or MeST.
The main structure of this software was designed and localized by adapting the software of Hallford et al. The Persian protocol, compatible with the Android version, was designed and modified by the working group. During the process of compiling the computerized version, the researchers collaborated with several clinical psychologists, computer specialists, software development experts, and patient caregivers. The classical form previously presented by Farhi Menesh et al. was used to prepare the Persian version of the protocol. With the help of the PHP programming language, the management panel and software were written based on React Native, and other sub-languages were also used for coding.
In the second stage, the content validity of the intervention program was evaluated based on the necessity of each section’s existence and the relevance of the content to each section’s goals. This evaluation was conducted by ten psychologists and faculty members of Kharazmi University who were experienced in the field of cognitive sciences and familiar with the MeST tool. The content validity of the Farsi MeST protocol was calculated by evaluating the Content Validity Ratio (CVR) and Content Validity Index (CVI).
Then, to check for bugs and changes in the content and notifications, modifications were made in the software’s space based on feedback from a small sample of applicants. Initially, a semi-structured interview was conducted separately by two trained psychologists, and if signs of psychological distress were observed, the individual was included in the study. The selected samples were randomly divided into two groups: an intervention group (15 people) and a control group (15 people). Individuals in the intervention group received seven treatment sessions based on the MeST intervention, held weekly, while no intervention was conducted in the control group. In the end, the effectiveness of the specific computerized memory intervention in reducing pathological symptoms and autobiographical memory of caregivers was investigated.
Results
The content validity review of the Persian version of the MeST online training software indicated that the CVI value for all items was more than 0.6, demonstrating the importance and necessity of the questions in the designed scale. A content validity index higher than 0.8 was achieved, indicating a satisfactory correlation of all items with the objectives of the constructed tool. However, the CVR and CVI were not appropriate for the materials providing the desired results and the timing of the sessions. Moreover, the content validity review of the session content indicated that the CVR index for all sessions was 0.99, and the CVI index for all sessions was equal to or higher than 0.8. Therefore, the relevance and necessity of the concepts used in the sessions were confirmed. The two groups were homogeneous in terms of variables such as gender, caregiver’s education level, and history of psychiatric diseases (P>0.05). The comparison of DASS-21 indices and autobiographical memory for the two groups is shown in Table 1. The results of the within-andbetween-group variance analysis for the variables of depression, anxiety, stress, and autobiographical memory are shown in Table 5. The results of the within-andbetween-group variance analysis show that no significant effect was observed in the state of depression over time (P=0.51, F=0.43). The interactive effect of the time groupwas also not significant, indicating no significant difference between the two groups (P=0.84, F=0.03). The results of the between-group comparison for the depression variable showed no significant difference between the two groups (P=0.14, F=2.27). The within-group analysis of the anxiety variable (P=0.18, F=1.82) and stress (P=0.27, F=1.23) also indicated the absence of a significant effect. The interactive effect of the time groupwas also not significant for the two variables of anxiety (P=0.96, F=0.001) and stress (P=0.19, F=1.73). The between-group comparison for the variables of anxiety (P=0.45, F=0.58) and stress (P=0.92, F=0.008) indicated no significant difference. Besides, the results of the within-group variance analysis showed that no significant effect was observed in the state of autobiographical memory. The interactive effect of the time groupwas also not significant (P=0.13, F=2.49). The results of the between-group comparison for the autobiographical memory variable also showed no significant difference between the two groups (P=0.78, F=0.07).
Table 1. Comparison of DASS-21 Indices and Autobiographical Memory Between Two Groups
* t-test ** Mann-Whitney U test
Conclusion
This study introduced an online version of the MeST intervention in Persian and confirmed its validity. Although validating the reliability and validity of the questionnaire is a lengthy, multi-step process, challenging the content of research tools aids in better understanding, using, and critiquing the content of a tool with a precise approach. Evidently, the MeST-based intervention has a short-term effect on reducing symptoms of depression. Previous studies have demonstrated that the MeST-based intervention positively impacts post-traumatic stress and depression symptoms. However, this study showed that these effects were transient, and the follow-up assessment largely lost the benefits of MeST over control groups. Other findings from this study indicated that online memory specificity training leads to short-term improvement in autobiographical memory. Other studies have also shown that specific memory training significantly improves specific memory. Nevertheless, this intervention does not impact stress and anxiety levels. Given that the MeST-based intervention is effective, easy, and inexpensive, it can be presented alongside traditional interventions. Although MeST is promising as a new intervention, future studies with larger samples and control groups are recommended to investigate the mechanism of MeST’s action due to its transitory effect.
Ethical Consideration
Compliance with ethical guideline
The research plan was approved by the Ethics Committee of Kharazmi University (Approval number: IR.KHU.REC.1401.024). Informed consent was obtained from all participants. Data were recorded using coded checklists to maintain confidentiality. Participation in the intervention was voluntary for the caregivers of people with cancer, and participants were free to withdraw from the research at any time.
Authors’ contributions
All authors participated in topic selection, study design, and concepts definition. Hanieh Yavarzadeh collected and analyzed the data. Alireza Moradi was responsible for correcting the article, supervising the project, and reviewing the final content. Jafar Hasani supervised the analysis and results. David Hallford collaborated in the design and development of the software. All authors discussed the results and participated in editing the final version of the paper.
Funding
This research was conducted with the financial support of the Cognitive Science and Technologies Council.
Acknowledgments
The authors extend their heartfelt thanks to everyone who participated in this study. A special gratitude goes to Raheleh Miri from the Blood Borne Infections Research Center at the Academic Center for Education, Culture, and Research (ACECR) in Mashhad, Iran, for providing excellent facilities and creating a supportive environment for both the team and clients.
Conflict of Interest
The authors have no conflict of interest.
Individuals experiencing psychological distress symptoms (such as anxiety, mental pressure, depression) and post-traumatic stress often struggle with autobiographical memory and rumination, necessitating psychological interventions. Interventions such as computerized competitive memory training and computerized memory specificity training are available options for psychologists to enhance the condition of these individuals, potentially improving emotional and cognitive symptoms, including autobiographical memory. Cancer caregivers are a population that frequently experiences numerous emotional issues, including anxiety, mental pressure, depression, and post-traumatic stress. The responsibility of assuming the caregiver role and associated feelings of guilt can intensify the pressure on caregivers of children with cancer. Given the constraints of the recent epidemic, it is crucial to offer methods that can effectively improve these individuals’ mental health. Considering the history of Memory Specificity Training (MeST)-based interventions in alleviating depression and post-traumatic stress disorder, the computerized design and localization of this intervention method can be beneficial during epidemic periods when face-to-face activities are limited. The present study aimed to develop an online Persian version of MeST-based training and to assess the content validity and effectiveness of this program.
Methods
This study was conducted to develop a computerized version of the MeST training intervention sessions using mobile phone software. The tools used in this study included the Structured Clinical Interview for DSM-5 Mental Disorders Clinical Version, DASS-21 scale, Autobiographical Memory Test (AMT), and therapeutic intervention: Memory Specificity Training or MeST.
The main structure of this software was designed and localized by adapting the software of Hallford et al. The Persian protocol, compatible with the Android version, was designed and modified by the working group. During the process of compiling the computerized version, the researchers collaborated with several clinical psychologists, computer specialists, software development experts, and patient caregivers. The classical form previously presented by Farhi Menesh et al. was used to prepare the Persian version of the protocol. With the help of the PHP programming language, the management panel and software were written based on React Native, and other sub-languages were also used for coding.
In the second stage, the content validity of the intervention program was evaluated based on the necessity of each section’s existence and the relevance of the content to each section’s goals. This evaluation was conducted by ten psychologists and faculty members of Kharazmi University who were experienced in the field of cognitive sciences and familiar with the MeST tool. The content validity of the Farsi MeST protocol was calculated by evaluating the Content Validity Ratio (CVR) and Content Validity Index (CVI).
Then, to check for bugs and changes in the content and notifications, modifications were made in the software’s space based on feedback from a small sample of applicants. Initially, a semi-structured interview was conducted separately by two trained psychologists, and if signs of psychological distress were observed, the individual was included in the study. The selected samples were randomly divided into two groups: an intervention group (15 people) and a control group (15 people). Individuals in the intervention group received seven treatment sessions based on the MeST intervention, held weekly, while no intervention was conducted in the control group. In the end, the effectiveness of the specific computerized memory intervention in reducing pathological symptoms and autobiographical memory of caregivers was investigated.
Results
The content validity review of the Persian version of the MeST online training software indicated that the CVI value for all items was more than 0.6, demonstrating the importance and necessity of the questions in the designed scale. A content validity index higher than 0.8 was achieved, indicating a satisfactory correlation of all items with the objectives of the constructed tool. However, the CVR and CVI were not appropriate for the materials providing the desired results and the timing of the sessions. Moreover, the content validity review of the session content indicated that the CVR index for all sessions was 0.99, and the CVI index for all sessions was equal to or higher than 0.8. Therefore, the relevance and necessity of the concepts used in the sessions were confirmed. The two groups were homogeneous in terms of variables such as gender, caregiver’s education level, and history of psychiatric diseases (P>0.05). The comparison of DASS-21 indices and autobiographical memory for the two groups is shown in Table 1. The results of the within-andbetween-group variance analysis for the variables of depression, anxiety, stress, and autobiographical memory are shown in Table 5. The results of the within-andbetween-group variance analysis show that no significant effect was observed in the state of depression over time (P=0.51, F=0.43). The interactive effect of the time groupwas also not significant, indicating no significant difference between the two groups (P=0.84, F=0.03). The results of the between-group comparison for the depression variable showed no significant difference between the two groups (P=0.14, F=2.27). The within-group analysis of the anxiety variable (P=0.18, F=1.82) and stress (P=0.27, F=1.23) also indicated the absence of a significant effect. The interactive effect of the time groupwas also not significant for the two variables of anxiety (P=0.96, F=0.001) and stress (P=0.19, F=1.73). The between-group comparison for the variables of anxiety (P=0.45, F=0.58) and stress (P=0.92, F=0.008) indicated no significant difference. Besides, the results of the within-group variance analysis showed that no significant effect was observed in the state of autobiographical memory. The interactive effect of the time groupwas also not significant (P=0.13, F=2.49). The results of the between-group comparison for the autobiographical memory variable also showed no significant difference between the two groups (P=0.78, F=0.07).
Table 1. Comparison of DASS-21 Indices and Autobiographical Memory Between Two Groups
| Variables | Control group (Mean±SD) | Control group (Mean±SD) | P-value | |
| Depression | Before intervention | 24.8±8.5 | 21.4±12.3 | 0.39* |
| After the intervention | 26.6±5.8 | 18.73±13.68 | 0.04* | |
| Follow-up | 23.06±8.03 | 20.5±11.3 | 0.48* | |
| Anxiety | Before intervention | 16.9±10.02 | 15.06±11.7 | 0.64* |
| After the intervention | 17.6±8.04 | 13.4±11.4 | 0.25* | |
| Follow-up | 19.3±9.64 | 17.3±11.7 | 0.61* | |
| Stress | Before intervention | 33.66±11.4 | 19.7±12.4 | 0.506* |
| After the intervention | 21.86±11.07 | 21.2±13.6 | 0.88** | |
| Follow-up | 22.26±7.36 | 24.6±13.02 | 0.55* | |
| Autobiographical memory | Before intervention | 6.14±3.207 | 4.86±3.204 | 0.29* |
| After the intervention | 5.3±3.89 | 7.13±3.27 | 0.02** | |
| Follow-up | 5.73±3.47 | 6.66±3.39 | 0.41* | |
Conclusion
This study introduced an online version of the MeST intervention in Persian and confirmed its validity. Although validating the reliability and validity of the questionnaire is a lengthy, multi-step process, challenging the content of research tools aids in better understanding, using, and critiquing the content of a tool with a precise approach. Evidently, the MeST-based intervention has a short-term effect on reducing symptoms of depression. Previous studies have demonstrated that the MeST-based intervention positively impacts post-traumatic stress and depression symptoms. However, this study showed that these effects were transient, and the follow-up assessment largely lost the benefits of MeST over control groups. Other findings from this study indicated that online memory specificity training leads to short-term improvement in autobiographical memory. Other studies have also shown that specific memory training significantly improves specific memory. Nevertheless, this intervention does not impact stress and anxiety levels. Given that the MeST-based intervention is effective, easy, and inexpensive, it can be presented alongside traditional interventions. Although MeST is promising as a new intervention, future studies with larger samples and control groups are recommended to investigate the mechanism of MeST’s action due to its transitory effect.
Ethical Consideration
Compliance with ethical guideline
The research plan was approved by the Ethics Committee of Kharazmi University (Approval number: IR.KHU.REC.1401.024). Informed consent was obtained from all participants. Data were recorded using coded checklists to maintain confidentiality. Participation in the intervention was voluntary for the caregivers of people with cancer, and participants were free to withdraw from the research at any time.
Authors’ contributions
All authors participated in topic selection, study design, and concepts definition. Hanieh Yavarzadeh collected and analyzed the data. Alireza Moradi was responsible for correcting the article, supervising the project, and reviewing the final content. Jafar Hasani supervised the analysis and results. David Hallford collaborated in the design and development of the software. All authors discussed the results and participated in editing the final version of the paper.
Funding
This research was conducted with the financial support of the Cognitive Science and Technologies Council.
Acknowledgments
The authors extend their heartfelt thanks to everyone who participated in this study. A special gratitude goes to Raheleh Miri from the Blood Borne Infections Research Center at the Academic Center for Education, Culture, and Research (ACECR) in Mashhad, Iran, for providing excellent facilities and creating a supportive environment for both the team and clients.
Conflict of Interest
The authors have no conflict of interest.
Type of Study: Research |
Received: 2024/01/4 | Accepted: 2024/06/27 | Published: 2024/08/28
Received: 2024/01/4 | Accepted: 2024/06/27 | Published: 2024/08/28
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