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Depression

Do the benefits of metacognitive therapy for depression last?

Solem S, Kennair LEO, Hagen R, et al. · Frontiers in psychology · 2019

Open access · cc by · source: Europe PMC

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.

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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

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Key findings

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.

Methodology

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.

Limitations

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.

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