Do the benefits of metacognitive therapy for depression last?
Three years after just 10 sessions of metacognitive therapy, most depressed patients were still recovered and many had moved off benefits and back into work, though there was no comparison group at follow-up.
Source
Metacognitive Therapy for Depression: A 3-Year Follow-Up Study Assessing Recovery, Relapse, Work Force Participation, and Quality of Life
Study at a glance
- Design
- Cohort — Uncontrolled 3-year follow-up of a randomised wait-list trial; both arms had received 10 sessions of MCT, so they were pooled and analysed by intention to treat.
- N
- N=39 · 39 patients originally enrolled; 31 attended the follow-up interview, 3 returned only questionnaires and 5 could not be contacted (missing data imputed).
- Population
- Adults with primary unipolar major depression (mostly recurrent) treated at a Norwegian university outpatient clinic
- Outcome
- Depression recovery and relapse (BDI, HRSD-17, SCID diagnosis) plus anxiety, rumination, worry, metacognitive beliefs, interpersonal problems, work status and life satisfaction
Structured fields used in claim comparison tables when every cited study has a complete layer.
What they did
The researchers followed up the 39 patients from an earlier trial in which people with depression received 10 sessions of metacognitive therapy (MCT), a treatment that targets rumination, worry and beliefs about these thinking habits. About three years later, patients were re-interviewed for diagnoses and depression severity and completed questionnaires on symptoms, rumination, metacognitive beliefs, interpersonal problems and life satisfaction. They were also asked about new depressive episodes, further treatment, negative life events and their work situation.
What they found
Depending on the definition used, 69.2% to 97.4% of patients counted as recovered at three years, and only one person met criteria for major depression. Sixty percent reported no new depressive episode since therapy ended, while 40% had at least one; among those recovered straight after treatment, 11% to 15% were no longer recovered. Improvements in rumination, worry, metacognitive beliefs and interpersonal problems were maintained, and 8 of the 13 patients on benefits before treatment were now working full time.
The limits
What it doesn't show
There was no control group at follow-up, so the study cannot show that MCT itself, rather than time, natural recovery or other help, produced the lasting gains; the authors call for a randomised comparison with other therapies. The sample was small and selected (63% of people interviewed for the trial were excluded), the originator of MCT supervised the therapy, and the diagnostic interview was only partly repeated. The study also lacks information on how severe or long any new depressive episodes were, and comparisons with other therapies' relapse rates across different studies are only rough.
Key terms
- Metacognitive therapy (MCT)
- A psychological treatment that targets beliefs about thinking and trains people to disengage from rumination and worry rather than challenging the content of negative thoughts.
- Rumination
- Repetitive, passive dwelling on one's distress and its causes and consequences, thought to trigger and prolong depression.
- Cognitive attentional syndrome
- The MCT term for a style of worry, rumination, threat monitoring and unhelpful coping that maintains emotional disorders.
- Relapse
- The return of depression after a period of recovery; here measured both as new episodes and as recovered patients no longer meeting recovery criteria.
- Intention-to-treat analysis
- Analysing everyone who was enrolled, including those who dropped out or were lost to follow-up, usually by estimating missing data.
- Wait-list control
- A comparison group that receives treatment after a delay, allowing a short-term comparison with people treated immediately.
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Common questions
Was this a randomised controlled trial?
The original study was a randomised wait-list trial, but by the follow-up both groups had received MCT, so the 3-year data are effectively a single uncontrolled cohort.
Why report four different recovery rates?
Studies define recovery differently, for example by diagnosis plus a questionnaire cut-off, an interview score, or a 50% symptom drop. Reporting several lets readers compare with other studies and shows how much the rate depends on the definition.
Did stressful life events cause relapse?
In this sample, 70% of patients reported serious negative life events, but these were not linked to depression scores or new episodes at follow-up.
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