Metacognitive Therapy for Depression

Frontiers | Metacognitive Therapy for Depression in Adults: A Waiting List Randomized Controlled Trial with Six Months Follow-Up | Psychology for Clinical Settings – January 2017

This small study (39 patients) shows this type of therapy is effective for depression.

This randomized controlled trial examines the efficacy of metacognitive therapy (MCT) for depression.

Participants receiving MCT improved significantly more than the WL group.  

Thirty-nine patients with depression were randomly assigned to immediate MCT (10 sessions) or a 10-week wait list period (WL). The WL-group received 10 sessions of MCT after the waiting period. Two participants dropped out from WL and none dropped out of immediate MCT treatment.

Large controlled effect sizes were observed for both depressive (d = 2.51) and anxious symptoms (d = 1.92).

Approximately 70–80% could be classified as recovered at post-treatment and 6 months follow-up following immediate MCT, whilst 5% of the WL patients recovered during the waiting period.

The results suggest that MCT is a promising treatment for depression. Future controlled studies should compare MCT with other active treatments.


Metacognitive therapy was associated with large improvements in depressive symptoms.

Comorbid disorders and symptoms were also improved.

Treatment gains were large and sustained for 6 months follow-up.

There were no significant differences in treatment effect for patients with moderate- or severe recurrent depression.

These results support MCT as a potentially effective treatment for depression that could lead to improved outcomes.

Below is a quick description of this kind of therapy:

Metacognitive therapy – Wikipedia

The goals of MCT are to

  1. first discover what patients believe about their own thoughts and how their mind works (called metacognitive beliefs),
  2. then show the patient how these beliefs lead to unhelpful responses to thoughts that serve to unintentionally prolong or worsen symptoms, and
  3. finally to provide alternative ways of responding to thoughts in order to allow a reduction of symptoms.

the model was designed to be transdiagnostic (meaning it focuses on common psychological factors thought to maintain all psychological disorders).

The metacognitive model of mental disorder

symptoms are caused by a set of psychological processes called the cognitive attentional syndrome (CAS).

The CAS includes three main processes, each of which constitutes extended thinking in response to negative thoughts.

These three processes are:

  1. Worry/rumination
  2. Threat monitoring
  3. Coping behaviours that backfire

All three are controlled by patients’ metacognitive beliefs, including the belief that such processes will help address their problems (although the processes all ultimately have the unintentional consequence of prolonging distress).

Therapeutic intervention

MCT is a time-limited therapy which usually takes place between 8–12 sessions.

The therapist uses discussions with the patient to discover their metacognitive beliefs, experiences and strategies.

The therapist then shares the model with the patient, pointing out how their particular symptoms are caused and maintained.

Therapy then proceeds with the introduction of techniques tailored to the patient’s difficulties aimed at changing how the patient relates to thoughts and that bring extended thinking under control.


Meta-cognitions questionnaire – Wikipedia

The metacognitions questionnaire is a self-report scale assessing different dimensions of metacognitive beliefs (beliefs about thinking).

Examples of metacognitive beliefs are; “Worry is uncontrollable”, “I have little confidence in my memory for words and names”, and “I am constantly aware of my thinking”

There are two versions of the metacognitions questionnaire.

  1. The Metacognitions questionnaire (MCQ) first developed by Sam Cartwright-Hatton and Adrian Wells (1997)
  2. The Metacognitions questionnaire 30 (MCQ-30; Wells & Cartwright-Hatton, 2004) is a 30-item version of the MCQ

These questionnaires have established reliability and validity, are widely used and have informed research on the importance of metacognitive beliefs and metacognitive knowledge in psychological disorders

Read more about metacognition and metacognitive therapy on

For more information about this study:  Tackling depression by changing the way you think



4 thoughts on “Metacognitive Therapy for Depression

  1. lawhern

    One of the things I didn’t see in the original report was the proportion of the wait-listed control group which declared that they had improved after six months on the wait list. Many studies were conducted in the 1950s and 60s of people with depression sufficiently severe to prompt their being referred for in-patient programs under voluntary commitment. In all of those studies that I’ve seen reported, about half of all wait-listed patients reported improvement in their conditions at the end of six months. Unfortunately, the same ratio prevailed in all of the forms of in-patient therapy attempted: Freudian Analysis, Adlerian therapy, and Jungian therapy all seemed to help about half of those who underwent them twice a week for six months. There were no differences of outcomes between the modalities of therapy. In these studies, follow-up was generally not attempted.

    Also not explicit in the report are the differences between MCT and standard RCT. The latter doesn’t have a particularly good record in patients with moderate to severe depression.

    Parenthetically, it is not accidental that depression and anxiety tend to be grouped together in most patients. The criteria for these “disorders” are so imprecise in the DSM-5 that it is almost impossible to deferentially diagnose them. As a result, when patients are medicated for these disorders, they may receive a potent combination of anti-depressants and benzodiazepine class drugs — a combination which often produces significant side effects and which makes some people suicidal.

    Liked by 1 person

    1. Zyp Czyk Post author

      You make good points. In general, psychotherapy is almost impossible to study scientifically because of the symptom measurement problem (just like pain).

      We try to apply “hard science” to problems that don’t have precise parameters to objectively measure, and I think this often confuses matters. Depression and pain cannot be objectively measured, so I question all these studies – though I have no suggestions for making them better.

      It really boils down to the effects on a particular individual at a particular time and situation. I don’t care how “effective” a treatment is for 99% of the population because the ONLY thing that matters is if it helps me.

      Statistical effectiveness is NOT clinical effectiveness and that’s really all that matters. Statistical effectiveness only suggests options worth trying, but individual experimentation is the only way to truly discover a therapy’s clinical effectiveness – and only for a specific individual and at a specific time. (My body’s reaction to medications has changed over the years)


  2. Kathy C

    Perhaps this is one more “Study” meant to deceive or promote a Book or a Practitioner. There is no “Control Group” and a very small number of “Self Selected Subjects” The determination are so vague for these disorders that the Subjects could and most likely are Middle to upper Middle Class, and dealing with the Angst of existence. If they had Cherry Picked another group, the “Results’ might have been less significant. They must be really happy the DSMV broadened the descriptions, Now virtually anyone with any kind of “Distress” can be “Diagnosed as “Anxious and/or Depressed.” There is not much distinction between a life long pattern of Depressive behavior, or a person dealing with a transitory situation. The 6 Month “Follow Up” is also telling. Since the “Symptoms” are reliant on Self Reporting, that brings up another area of questions. There really is not much “Peer Review” anymore, and they will Publish virtually anything. To the casual observer this “Study” will appear meaningful, and in Psychology, Corporate Media and Advertising, that is enough.


    1. Zyp Czyk Post author

      Yes, scientific study is a big mess these days, as is everything else that can be influenced by money. Unrestrained capitalism is destroying civilization as we descend into a system of barbaric “survival of the richest”.



Other thoughts?

Fill in your details below or click an icon to log in: Logo

You are commenting using your account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s