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Exploring mechanisms of change in the metacognitive training for depression

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Abstract

The Metacognitive Training for Depression (D-MCT) is a highly structured group therapy that has been shown to be effective in reducing depressive symptoms. First evidence suggests that need for control represents a mechanism of change. However, more research is needed to evaluate the mode of action of each module and identify predictors of treatment response. Two sequential studies (one naturalistic pilot study [study I, N = 45] and one randomized controlled trial [study II, N = 32]) were conducted to evaluate the session-specific effects and predictors of D-MCT in patients with depression. The D-MCT was conducted over eight weeks, and patients answered a questionnaire on dysfunctional beliefs (e.g., negative filter) and depressive symptoms (e.g., lack of energy, self-esteem) before and after each session. Linear mixed-effects models showed that several dysfunctional beliefs and symptoms improved over the course of the treatment; three modules were able to evoke within-session effects, but no between-session effects were found. The improvement in lack of energy in one module was identified as a relevant predictor in study I via lasso regression but was not replicated in study II. Exploratory analyses revealed further predictors that warrant replication in future studies. The identified predictors were inconclusive when the two studies were compared, which may be explained by the different instruments administered. Even so, the results may be used to revise questionnaires and improve the intervention.

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Availability of data and material

The data supporting the results and analyses presented in the paper are available upon request from first author.

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Acknowledgements

We thank Sophie Banasiak, Judith Oehme, Frederica Wallraf, and Kathrin Simon-Kutscher for their help with recruitment for the RCT.

Funding

The RCT was financed by the Asklepios-Kliniken Hamburg GmbH’s internal research funding.

Author information

Authors and Affiliations

  1. Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany

    Franziska Miegel, Mona Dietrichkeit, Amir H. Yassari, Alicia Balzar, Jakob Scheunemann & Lena Jelinek

  2. Department of Psychology and Sports Science, Justus Liebig University Giessen, Giessen, Germany

    Julian Rubel

  3. Department of Psychiatry and Psychotherapy, Asklepios Clinic North, Hamburg, Germany

    Mona Dietrichkeit & Marion Hagemann-Goebel

Authors
  1. Franziska Miegel
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  2. Julian Rubel
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  4. Marion Hagemann-Goebel
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  5. Amir H. Yassari
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  6. Alicia Balzar
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  7. Jakob Scheunemann
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  8. Lena Jelinek
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Contributions

LJ conducted the pilot study, and LJ and MHG designed the RCT, wrote the protocol, and acquired the funding. MD and MHG conducted the RCT, and FM and JR conducted the statistical analysis. JS and AB helped with the statistical analyses. AY helped with writing the introduction. FM wrote the first draft of the manuscript; all authors edited the manuscript. All authors substantially contributed to and have approved the final article.

Corresponding author

Correspondence to Franziska Miegel.

Ethics declarations

Conflict of interest

Metacognitive Training for Depression was developed by one of the authors (LJ). JS and FM are paid to give workshops on metacognitive training.

Consent to participate

All participants gave written informed consent for participation.

Consent for publication

All participants consented to publish their data.

Ethics approval

The study was approved by the ethics committee of the German Psychological Association (Deutsche Gesellschaft für Psychologie).

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Miegel, F., Rubel, J., Dietrichkeit, M. et al. Exploring mechanisms of change in the metacognitive training for depression. Eur Arch Psychiatry Clin Neurosci 274, 739–753 (2024). https://doi.org/10.1007/s00406-023-01604-y

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  • DOI: https://doi.org/10.1007/s00406-023-01604-y

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