Abstract
A major challenge in the treatment of depression has been high relapse rates following treatment. The current study reports results from a 3-year follow-up of patients treated with metacognitive therapy (MCT). Thirty-four of the 39 patients enrolled in the original study attended assessment (participation rate of 87%). There were large reductions in symptoms of depression, anxiety, interpersonal problems, and worry, as well as metacognitive beliefs. Three patients fulfilled diagnostic criteria for axis-I disorders: one with depression and two with generalized anxiety disorder. Sixty percent had not experienced any new depressive episodes in the 3-year follow-up period, and the static relapse rates were low (11–15%). Recovery rates ranged from 69 to 97% depending upon the four different criteria used. Nevertheless, 26% had sought out treatment for depression or other psychological difficulties. Most patients (70%) had experienced negative life events in the follow-up period, but these events did not influence current depression severity. Return to work outcomes were encouraging, as eight out of 13 patients that had been on benefits were no longer receiving benefits. Life satisfaction ratings showed mean scores around 70 (on a 0–100 scale) and showed a moderate to strong negative correlation with depression severity. In conclusion, MCT appears to be promising with respect to long-term effect. Randomized controlled trials should investigate if the long-term effect of MCT surpasses that of other evidence-based treatments for depression.
Highlights
Depression is predicted to become the leading cause of disease burden in 2030
Metacognitive therapy (MCT) could be beneficial for people with depression as suggested by several treatment studies with recovery rates ranging around 70–80% (e.g., Wells et al, 2009, 2012; Dammen et al, 2016; Hagen et al, 2017; Normann and Morina, 2018)
We report recovery rates based on several different criteria, as a range of criteria have been used in the literature: the first method for estimating recovery was based on Frank et al (1991) where recovery was defined as no longer meeting diagnostic criteria for depression and scoring less than or equal to eight on the Beck Depression Inventory (BDI)
Summary
Depression is predicted to become the leading cause of disease burden in 2030 (van Zoonen et al, 2014). MCT is based on the self-regulatory executive function model (S-REF; Wells and Matthews, 1994, 1996). In this model, depression is understood as a consequence of perseverative thinking styles (especially rumination and worry) and other unhelpful self-regulation strategies. Depression is understood as a consequence of perseverative thinking styles (especially rumination and worry) and other unhelpful self-regulation strategies This style of thinking and behaving is called the cognitive attentional syndrome (CAS) and is controlled by positive and negative metacognitive beliefs, as well as maladaptive executive control of attentional processes (Wells and Matthews, 1994). MCT could be beneficial for people with depression as suggested by several treatment studies with recovery rates ranging around 70–80% (e.g., Wells et al, 2009, 2012; Dammen et al, 2016; Hagen et al, 2017; Normann and Morina, 2018)
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