Think Less to Overcome Depression, New Treatment Paradigm Suggests (Why You Should Know About Metacognitive Therapy)

A new study by psychologist Pia Callesen, published in the reputable journal Scientific Reports in Nature (2020), shows that Metacognitive Therapy is way more effective in treating depression than usual treatment.

The study is interesting as the treatment represents a whole new way of understanding and treating depression, which is why I refer to it as a new treatment paradigm.

I will go through the research findings at the bottom of this post. First, let me introduce you to Metacognitive Therapy (MCT). You can jump to the findings now or continue reading.

MCT is based on Drs. Adrian Wells and Gerald Matthews’ 1994 research on attention and emotion. The MCT-model states that it is the same psychological mechanisms and mental strategies that underlie mental illness in all its forms.

The present evidence base of MCT shows that it is an effective treatment for a range of psychological problems (see meta-analysis by Normann & Morina, 2018)

In essence, psychological problems are caused by overthinking (worry and rumination), avoidance and threat-monitoring, which the MCT-model refers to as the Cognitive-Attentional Syndrome (CAS).

The CAS involves that a person’s attention is biased to negative/unpleasant thoughts, emotions and bodily sensations, which contributes to repetitive negative thinking and stress. Therefore, CAS contributes to the development, maintenance and relapse of psychological disorders.

In the MCT-model, it is the time spent using these strategies that explain psychological problems. Everyone uses CAS to some extent, but not everyone gets psychological problems.

Research (Wells, 2008) shows that the driving force behind CAS is metacognitive beliefs. For instance, whether or not it is useful to anticipate danger by worrying AND whether one is able to stop worrying or ruminating. In other words, it is beliefs (and habits), not one’s background, gender, intelligence, or other variables, that drive CAS, and consequently psychological problems.

MCT offers techniques to overcome the CAS by challenging the metacognitive beliefs. In a MCT-session, you will learn to get control over the CAS by increasing mental awareness, attentional flexibility and control over worry and rumination as responses to stress.

If you want to learn more about MCT, you can take a look at the official MCT website . Also, I would like to share with you a 5-min video which introduces the concepts of MCT by Adrian Wells himself, the originator of MCT.

For professionals, I would like to recommend Adrian Well’s own book “Metacognitive Therapy for Anxiety and Depression” (2008) which introduces concepts, different techniques and entire step-by-step treatment protocols. It is a need-to-have book if you intend to practice or understand the theory of MCT in greater detail.

For laymen, I would like to recommend the first written practical book on MCT “Live More Think Less: Overcoming Depression and Sadness with Metacognitive Therapy” (2020) by Pia Callesen, the originator of the above-mentioned study. The book presents guidance, case studies, exercises and tips from the therapy room.

The research findings

The study “Metacognitive Therapy versus Cognitive Behavior Therapy in Adults with Major Depression: A Parallel Single-Blind Randomized Trial” was recently published, and I will now jump to the conclusion:

Following MCT, 74% of the patients no longer met formal criteria for major depression compared with 52% in the CBT condition (usual treatment) – a difference of 22%. At 6-month follow-up, the proportions were 74% in the MCT condition compared with 56% recovery in the CBT condition.

In the abstract of the study, the author Pia Callesen writes:

“We assessed the clinical efficacy of MCT compared to current best psychotherapy practice, CBT in adults with major depressive disorder. A parallel randomized single-blind trial was conducted in a primary care outpatient setting.

A total 174 adults aged 18 years or older meeting diagnostic criteria for major depressive disorder were eligible and consented to take part. 85 were randomly allocated to MCT and 89 to CBT.

The co-primary outcome measures were assessor-rated symptom severity on the HDRS (Hamilton Rating Scale for Depression) and self-reported symptom severity on the Beck Depression Inventory (BDI-II) at post treatment. Treated groups in the trial were very similar on most baseline characteristics.

Limitations of the study include the use of only two therapists where one treated 69% of patients, possible allegiance effects as the study was conducted in an established CBT clinic and the chief investigator is the originator of MCT and group differences in time under therapy.”

In summary, the study shows very promising results for treatment of depression and metacognitive therapy.

With respect to treatment outcomes, it is thought-provoking that there have been no major advances in treatment effects for many years . Evidence shows that about 50% of all patients respond to CBT, and CBT is the most established treatment for depression at this point in time.

The present study, however, suggests that it might be time for an advancement.