No change in neuropsychological dysfunction or emotional processing during treatment of major depression with cognitive–behaviour therapy or schema therapy R. J. Porter 1 *, C. Bourke 1 , J. D. Carter 2 , K. M. Douglas 1 , V. V. W. McIntosh 1,3 , J. Jordan 1,3 , P. R. Joyce 1 and C. M. A. Frampton 1 1 Department of Psychological Medicine, University of Otago, Christchurch, New Zealand 2 Department of Psychology, University of Canterbury, Christchurch, New Zealand 3 Clinical Research Unit, Canterbury District Health Board, Christchurch, New Zealand Background. Impaired neuropsychological functioning is a feature of major depression. Previous studies have suggested that at least some aspects of neuropsychological functioning improve with successful treatment of major depression. The extent to which medications may affect the degree of normalization of these functions is unclear. The aim of the cur- rent study was to examine the course of neuropsychological functioning during treatment of major depression with cognitive–behaviour therapy (CBT) or schema therapy (ST). Method. A total of 69 out-patients with a primary diagnosis of major depression and 58 healthy controls completed mood ratings, neuropsychological measures, and measures of emotional processing at baseline and after 16 weeks. Participants were randomized after baseline assessment to a year-long course of CBT or ST. Patients reassessed at 16 weeks were medication-free throughout the study. Results. Significant neuropsychological impairment was evident at baseline in depressed participants compared with healthy controls. After 16 weeks of psychotherapy, mean depression rating scores fell more than 50%. However, no neuropsychological measures showed convincing evidence of significant improvement and emotional processing did not change. Conclusions. Persisting impairment in neuropsychological functioning after the first 16 weeks of CBT or ST suggests a need to modify psychological treatments to include components targeting cognitive functioning. Received 11 February 2015; Revised 20 August 2015; Accepted 3 September 2015; First published online 8 October 2015 Key words: Facial emotion processing, major depressive disorder, memory, neuropsychological function, psychological treatment. Introduction Neuropsychological impairment is a core feature of major depression (Porter et al. 2007) and has been associated with impairment in general functioning, in- cluding in occupational and psychosocial domains (McIntyre et al. 2013). There is ongoing debate regarding the relationship between abnormalities of neuropsychological function- ing and clinical state, and, in particular, whether cur- rent treatments for depression adequately address neuropsychological impairment (Porter et al. 2014). A review in this area suggested that neuropsychological domains most sensitive to improvement in clinical state were verbal learning and memory, verbal fluency and psychomotor speed, whereas domains least sensitive to improvement were attention and executive functioning (Douglas & Porter, 2009). Regardless of the domains affected, what has become evident is that a significant degree of neuropsycho- logical impairment remains after the resolution of mood symptoms, at least in a substantial proportion of patients (Bortolato et al. 2014). It is therefore import- ant to search for treatments for major depression that successfully target and improve neuropsychological impairment. The impact of psychological therapy on neuro- psychological functioning remains largely unknown, with only one published psychotherapy study examin- ing this issue (Bastos et al. 2013). This study suggested that psychodynamic psychotherapy, and its combin- ation with fluoxetine, improved specific areas of neuro- psychological functioning, more so than fluoxetine * Address for correspondence: R. Porter, Department of Psychological Medicine, University of Otago, Christchurch, PO Box 4345, Christchurch 8140, New Zealand. (Email: richard.porter@otago.ac.nz) Psychological Medicine (2016), 46, 393–404. © Cambridge University Press 2015 doi:10.1017/S0033291715001907 ORIGINAL ARTICLE