A Prospective Test of the Metacognitive Model of Depression in Previously Depressed Individuals
- 12 Downloads
Metacognitive theory proposes that depression is caused by excessive rumination, which is in turn maintained by maladaptive positive and negative beliefs about rumination (“metacognitions”) and reduced executive control. Moreover, the metacognitive model asserts that metacognitions are maintained by prolonged depression symptoms. However, no studies have tested the metacognitive model of depression prospectively in a clinical population. Currently remitted adults with recurrent depressive disorder (N = 105) reported depression symptoms at five time points over a 12-month period. Based on this data, we used latent growth modelling to estimate depression levels and symptom trajectories. Positive metacognitions were associated with rumination, while negative metacognitions and rumination predicted higher depression levels, but not symptom recurrence. Moreover, depression levels and symptom recurrence predicted positive and negative metacognitions, as well as rumination. There was no association between metacognitions and reduced executive control. The present study lends partial support for the metacognitive model, but raises questions of the relevance of metacognitions as a proximal vulnerability marker for symptom recurrence.
KeywordsMetacognitions Metacognitive beliefs Depression Executive control
We want to thank the following research assistants: Inger Marie Andreassen, Adrian Dahl Askelund, Dani Beck, Sandra Aakjær Bruun, Jenny Tveit Kojan, Nils Eivind Holth Landrø, Elise Solbu Kleven and Julie Wasmuth. Further, we thank Kari Agnes Myhre and Senior Consultant, Research leader; MD, Phd Erlend Bøen at Diakonhjemmet Hospital, Division of Psychiatry, for help and support during the recruiting period. We also thank our external recruitment sites, Unicare, Coperiosenteret AS, Torgny Syrstad, MD, Synergi Helse AS and Lovisenberg Hospital.
This work was supported by grants from the Research Council of Norway, Norges Forskningsråd (NO) project number 247372 (NIL) and The South East Norway Health Authority Research Funding, Helse Sør-Øst RHF project number 2015052 (NIL). The Department of Psychology, University of Oslo has also supported the project.
Compliance with Ethical Standards
Conflict of interest
Nils Inge Landrø has received consultancy fees and travel expenses from Lundbeck. Brage Kraft, Rune Jonassen, Vidar Ulset and Tore Stiles declare that they have no conflict of interest.
All procedures in the present study were in accordance with the ethical standards of the national research committee in Norway and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual subjects participating in the study.
Research Involving Animal Rights
This article does not contain any studies with animals performed by any of the authors.
- Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck Depression Inventory–II. San Antonio, TX: Psychological Corporation.Google Scholar
- De Raedt, R., & Koster, E. H. (2010). Understanding vulnerability for depression from a cognitive neuroscience perspective: A reappraisal of attentional factors and a new conceptual framework. Cognitive, Affective, & Behavioral Neuroscience, 10(1), 50–70. https://doi.org/10.3758/CABN.10.1.50.CrossRefGoogle Scholar
- Delis, D. C., Kaplan, E., & Kramer, J. (2001). Delis-Kaplan executive function system. San Antonio: Psychological Corporation.Google Scholar
- Hagen, R., Hjemdal, O., Solem, S., Kennair, L. E. O., Nordahl, H. M., Fisher, P., & Wells, A. (2017). Metacognitive therapy for depression in adults: A waiting list randomized controlled trial with six months follow-up. Frontiers in Psychology. https://doi.org/10.3389/fpsyg.2017.00031.CrossRefPubMedPubMedCentralGoogle Scholar
- Halvorsen, M., Hagen, R., Hjemdal, O., Eriksen, M. S., Sørli, Å. J., Waterloo, K., … Wang, C. E. (2015). Metacognitions and thought control strategies in unipolar major depression: A comparison of currently depressed, previously depressed, and never-depressed individuals. Cognitive Therapy and Research, 39(1), 31–40. https://doi.org/10.1007/s10608-014-9638-4.CrossRefGoogle Scholar
- Hjemdal, O., Hagen, R., & Solem, S. (2016). A prospective study of metacognitive and cognitive predictors of depressive symptoms. Paper presented at the The 3rd International Conference of Metacognitive Therapy, Milan, Italy. http://www.mctconference.no//2016/MCT%20Conference%20Abstract%20Booklet.pdf.
- Koster, E. H. W., De Lissnyder, E., Derakshan, N., & De Raedt, R. (2011). Understanding depressive rumination from a cognitive science perspective: The impaired disengagement hypothesis. Clinical Psychology Review, 31(1), 138–145. https://doi.org/10.1016/j.cpr.2010.08.005.CrossRefPubMedGoogle Scholar
- Luminet, O. (2004). Assessment and measurement of rumination. In C. Papageorgiou & A. Wells (Eds.), Rumination: Nature, theory, and treatment of negative thinking in depression (pp. 187–215). Chichester: Wiley.Google Scholar
- Majer, M., Ising, M., Kunzel, H., Binder, E. B., Holsboer, F., Modell, S., & Zihl, J. (2004). Impaired divided attention predicts delayed response and risk to relapse in subjects with depressive disorders. Psychological Medicine, 34(8), 1453–1463. https://doi.org/10.1017/S0033291704002697.CrossRefPubMedGoogle Scholar
- Matthews, G., & Wells, A. (2004). Rumination, depression, and metacognition: The S-REF model. In C. Papageorgiou & A. Wells (Eds.), Depressive rumination (pp. 125–151). West Sussex: Wiley.Google Scholar
- Miyake, A., Friedman, N. P., Emerson, M. J., Witzki, A. H., Howerter, A., & Wager, T. D. (2000). The unity and diversity of executive functions and their contributions to complex “frontal lobe” tasks: A latent variable analysis. Cognitive Psychology, 41(1), 49–100. https://doi.org/10.1006/cogp.1999.0734.CrossRefPubMedGoogle Scholar
- Nolen-Hoeksema, S., & Morrow, J. (1991). A prospective study of depression and posttraumatic stress symptoms after a natural disaster: The 1989 Loma Prieta earthquake. Journal of Personality and Social Psychology, 61(1), 115–121. https://doi.org/10.1037/0022-35184.108.40.206.CrossRefPubMedGoogle Scholar
- Sheehan, D. V., Lecrubier, Y., Sheehan, K. H., Amorim, P., Janavs, J., Weiller, E., … Dunbar, G. C. (1998). The Mini-International Neuropsychiatric Interview (M.I.N.I.): The development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. Journal of Clinical Psychiatry, 59(Suppl 20), 22–33 (quiz 34–57).PubMedGoogle Scholar
- Wells, A. (2011). Metacognitive therapy for anxiety and depression. New York: Guilford press.Google Scholar