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Efficacy of Metacognitive therapy

Callesen, Pia

[Thesis]. Manchester, UK: The University of Manchester; 2016.

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Abstract

This PhD investigated the efficacy of individual therapies for depression and went on to test metacognitive therapy (MCT) for major depressive disorder (MDD) in individual therapy and in transdiagnostic groups consisting of a range of disordersStudy 1 included a systematic review of meta-analyses comparing the effects of individual therapy for MDD across studies. The findings show small to moderate effect sizes between g=0.25 to d= 0.69 and recovery rates 34% to 47.9% for ITT analyses. However, studies are biased and lack objective definitions of recovery, remission and clinically meaningful change which makes comparisons across studies challenging. Study 2 aimed to test MCT in a single case study with four depressed Danes in an outpatient setting. Three out of four patients reached recovery levels (BDI-II ≤ 8) in only five to eleven sessions and all four patients were recovered at 6-months follow-up. Study 3 involved a large randomised clinical trial (n= 153) in which the effect of MCT was compared to cognitive behaviour therapy (CBT) for MDD. Patients were allocated to up to 24 sessions of treatment and were assessed at pre, post and 6 months follow-up on primary and secondary measures. The mean number of sessions were significantly lower for MCT (5.5; SD = 2.4 versus 6.7; SD = 4.7) and MCT showed a higher completion rate (73.6% versus 65.4%). Both treatments were associated with significant improvements in depression measured with the HDRS and BDI-II. MCT was superior in its effects on the BDI-II and on secondary measures, showing a clear advantage of MCT. . Large ES were detected in both MCT and CBT. Using Jacobson and Truax (1991) criteria revealed that 76% reached recovery levels at post-treatment in MCT whereas 54% reached recovery in CBT. These findings were maintained for both conditions at 6-months follow-up. Study 4 evaluated the effect of MCT in a 6-week treatment protocol for mixed groups of diagnosis in an open trial (n= 131). Significant improvements were observed in outcomes and 85% of patients were reliably improved at post-treatment as measured on the HADS. These findings were maintained at follow- up and the treatment appeared effective in both anxious and depressed cases.In conclusion existing treatments for depression are effective but there is much room for increasing efficacy. MCT appeared more effective than a current treatment of choice; CBT in depression. MCT was also associated with significant improvement in anxiety and depression in patients in a transdiagnostic group setting. The results support the future study and implementation of MCT as an effective treatment option.