Efficacy of a Combined Cognitive Training and Structural-Systemic Family Therapy Protocol in Reducing Depressive Symptoms and Enhancing Cognitive Flexibility and Inhibitory Control

Authors
Parisa Pakari
Zahra Kavousian
Faezeh Ziaei
Zeinab Hassani Asl
parisa hosein zadeh yazdi
Abstract
This study aimed to investigate the efficacy of a combined adaptive cognitive training and structural-systemic family therapy protocol in reducing depressive symptoms and improving cognitive flexibility and inhibitory control. In a quasi-experimental design with pre-test, post-test, and two-month follow-up assessments and a control group, 32 adults (16 per group) diagnosed with mild-to-moderate depression were randomly assigned to either the experimental or control condition from three reputable family therapy clinics in Tehran. The experimental group received 12 sessions of standard structural-systemic family therapy plus 12 sessions of adaptive cognitive training focused on task-switching, set-shifting, response inhibition, and Stroop exercises; the control group received family therapy alone. Measures included the Beck Depression Inventory-II, Cognitive Flexibility Inventory, and computerized Stroop Color-Word Test. Repeated-measures multivariate analysis of variance revealed that the combined intervention produced highly significant reductions in depressive symptoms and substantial improvements in cognitive flexibility and inhibitory control at post-test and two-month follow-up (p < .001), with very large effect sizes (η² ranging from 0.586 to 0.923). Improvement in inhibitory control remained fully stable at follow-up. Adding adaptive cognitive training to structural-systemic family therapy constitutes a highly effective, clinically meaningful third-generation combined protocol for treating mild-to-moderate depression that not only alleviates emotional symptoms but also directly remediates persistent cognitive deficits, thereby enhancing relapse-prevention potential. This approach is particularly recommended for collectivist cultures and systemic treatment contexts.
Keywords
depression
Adaptive cognitive training
Structural-systemic family therapy
Cognitive Flexibility
inhibitory control
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