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Depression

How does metacognitive training ease depression in older adults?

Schneider BC, Veckenstedt R, Karamatskos E, et al. · Frontiers in psychology · 2023

Open access · cc by · source: Europe PMC

For older adults with depression, a group metacognitive training programme reduced rumination and negative beliefs more than a brain-training control, and these changes statistically accounted for later improvements, though which one mattered depended on who rated the depression.

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Study at a glance

Design
RCT — Secondary analysis of an RCT (1:1 randomisation, blinded raters) comparing 8 weekly sessions of group MCT-Silver with computerised cognitive remediation; parallel mediation models (PROCESS, 5,000 bootstraps) with mediator change from baseline to post and depression change from baseline to 3-month follow-up
N
N=66 · 66 trial participants with complete baseline data (a subsample of the full RCT); missing post and follow-up data imputed with expectation-maximisation.
Population
Adults aged 60 and over in Germany with current major depression, recurrent depression or dysthymia, mostly mild to moderate
Outcome
Clinician-rated depression (Hamilton scale) and self-rated depression (BDI-II) at 3-month follow-up; mediators were dysfunctional attitudes (DAS-18B), positive metacognitive beliefs (MCQ-30 subscale) and rumination (RRS-10)

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Key findings

Compared with the control, the training produced larger reductions in rumination, negative beliefs and positive metacognitive beliefs by the end of treatment. It reduced self-rated depression at follow-up but not clinician-rated depression, matching the main trial. Reduced rumination mediated the effect on clinician-rated depression, while reduced negative beliefs mediated the effect on self-rated depression. Positive metacognitive beliefs did not mediate either outcome, and results held after controlling for age of depression onset and number of episodes.

Methodology

The authors re-analysed data from their randomised trial in which adults aged 60 or older with depression attended either 8 weekly group sessions of Metacognitive Training-Silver (a CBT-based programme that teaches people to notice thinking biases) or weekly computerised brain-training sessions as an active control. They measured three possible mechanisms at the start and end of treatment: dysfunctional negative beliefs, positive beliefs about worrying, and rumination. They then tested whether changes in these mechanisms explained changes in depression from baseline to a 3-month follow-up, rated both by clinicians and by patients themselves.

Limitations

Mediators and outcomes were measured over overlapping periods with only three time points, so the study cannot establish that changes in rumination or beliefs came before and caused the drop in depression. The mediators differed for clinician-rated and self-rated depression, so no single mechanism can be named with confidence. The analysis used a subsample of the trial with imputed missing data, and participants mostly had mild to moderate, often chronic symptoms, so results may not apply to severe depression. The main trial found no significant treatment effect on clinician-rated depression, so that mediation result is an indirect effect without a total effect.

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