long-term efficacy of metacognitive training for depression (d-mct)

Conditions: Unipolar Depression

Summary: aim of the current study is to investigate the long-term efficacy of metacognitive training for depression (d-mct) and to explore whether previously observed effects at the 6-month follow-up of a randomized, controlled, assessor-blind, parallel group trial are maintained at the 3-year follow-up.

dissemination of treatment for depression is still unsatisfying: every second patient does not receive, refuses, or is waiting for treatment. moreover, with a drop-out rate of almost 25% in routine clinical practice, and a 54% relapse rate for treatment responders within the two years after treatment termination, improving treatment is necessary. metacognitive training for depression (d-mct), a low threshold, easy to administer group intervention was designed to fill this gap. it aims at the reduction of depressive symptoms by changing cognitive biases; not only biases targeted in cognitive behavioral therapy but also those identified by basic research. it was positively evaluated with regard to feasibility and acceptance in a non-randomized pilot study. moreover, efficacy of d-mct was suggested in a randomized controlled trail (rct) in comparison to an active control intervention (jelinek et al., in press). in this trial patients with depressive disorder were completing a psychosomatic outpatient treatment program and were randomly assigned to either d-mct or general health training. severity of depression and cognitive biases were assessed at baseline (t0), post treatment (t1) and 6 months (t2) later by raters blind to diagnostic status. intention-to-treat analyses demonstrated that at the end of treatment, as well as 6 months later, improvement in depression was significantly greater in the d-mct relative to the health training group at medium effect sizes. a significantly greater number of patients in the d-mct group were in remission at 6-month follow-up. moreover, the decrease in cognitive biases and increase in psychological well-being/quality of life was larger in the d-mct than the health training group over time. aim of the current study is to investigate the long-term efficacy of d-mct. for this purpose, an additional 3 year follow-up assessment (t3) is conducted. the hamilton depression rating scale (hdrs, 17-item version) total score serves as the primary outcome. self-assessed depression, dysfunctional beliefs, self-esteem, quality of life, and ability to work serve as secondary outcomes.

Eligibility criteria:
inclusion criteria for the current study are: * informed consent * intention-to-treat-sample of the study evaluation of metacognitive training for depression (d-mkt) in psychosomatic rehabilitation, drks-id: drks00007907 (see jelinek et al., in press, psychotherapy and psychosomatics) * age between 18 and 65 years * diagnosis of a single episode or recurrent major depressive disorder (mdd) or dysthymia (verified by the mini). the exclusion criteria were: * lifetime psychotic symptoms (i.e., hallucinations, delusions, or mania), suicidality (suicidal behaviors questionnaire-revised ≥ 7), intellectual disability (estimated iq \< 70).