Abstract
Metacognitive Training for Depression (D-MCT), a low-threshold group intervention, has been shown to improve depressive symptoms. It aims at the reduction of depression by changing dysfunctional cognitive as well as metacognitive beliefs. The purpose of the present study was to investigate whether the mechanisms of change in D-MCT are cognitive (and thus primarily concern the content of cognition) or metacognitive in nature. Eighty-four outpatients with depression were included in a randomized controlled trial comparing D-MCT to an active control intervention. Level of depression, dysfunctional cognitive beliefs (DAS), and metacognitive beliefs (MCQ subscales: Positive Beliefs, Negative Beliefs, Need for Control) were assessed before (t0) and after treatment (t1). Severity of depression was also assessed 6 months later (t2). Linear regression analyses were used to determine whether change in depression from t0 to t2 was mediated by change in cognitive vs. metacognitive beliefs from t0 to t1. D-MCT’s effect on change in depression was mediated by a decrease in dysfunctional metacognitive beliefs, particularly ‘need for control’. Our findings underline that one of the key mechanisms of improvement in D-MCT is the change in metacognitive beliefs. The current study provides further support for the importance of metacognition in the treatment of depression.
Highlights
We recently reported the efficacy of D-MCT compared with an active control intervention in a randomized controlled trial (RCT) regarding depression, dysfunctional beliefs, and quality of life with medium effect sizes[9, 10], but little is known about the mechanisms of change
In our recent trial[10], we reported a larger decrease in dysfunctional cognitive beliefs in the D-MCT compared to a control group over time; change in metacognitive beliefs, were not reported, and mechanisms of change were not investigated
Our study provides initial insight into how D-MCT exerts its effects on depression
Summary
In line with cognitive behavioral models of depression[1], which assume that maladaptive cognitive beliefs are involved in the development and maintenance of depressive symptoms[3, 4], we expected that a better outcome 6 months after D-MCT treatment would be mediated by an improvement in dysfunctional cognitions To this end, and to conclusively address the specific cognitions that the D-MCT training affects, we explored treatment effects over the course of treatment on two types of dysfunctional cognitions: cognitive beliefs (i.e., the content of cognitions as measured by the Dysfunctional Attitude Scale) and metacognitive beliefs (as assessed by the Metacognition Questionnaire). Variable Age (years) Gender (female/male) Years of formal school education Verbal intelligence (T-Score) Job status (working/sick leave/unemployed) Alcohol consumption per week (in g) Number of MDE (including present) Medication antidepressant antipsychotic combination none
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