- Depression is characterized by low mood resulting from a problem of over-thinking or rumination.
- New treatment approach for depression using metacognitive therapy (MCT) focuses on reducing the ruminative or thinking process.
- MCT helps depressed individuals to reduce negative thought processes and get them under control.
A new treatment approach has been developed to treat depression that has produced encouraging results.
Depressed individuals "don't need to worry and ruminate," says Professor Roger Hagen, at the Norwegian University of Science and Technology's (NTNU) Department of Psychology. "Just realizing this is liberating for a lot of people."
In the study, researchers describe the treatment of depression using metacognitive therapy (MCT). This therapy focuses on lessening the ruminative process.
In CBT, patients engage in analyzing the content of their thoughts to challenge their validity and reality test them. But only 40-58% of patients receiving CBT recover at post-treatment. Relapse rates are as high as between 40% to 60% within a period of 2 years. The efficacy of anti-depressant medications is also not as high.
Depression is the most common psychiatric disorders, with a high degree of comorbidity. Depression is predicted to be the second-leading cause of disease burden worldwide after HIV/AIDS, by 2030.
It is therefore necessary to develop new treatments that have greater short-term and long-term efficacy.
The new study shows that learning to reduce rumination may be very helpful for patients with depressive symptoms.
It is common among depressed individual to engage in rumination consisting of repeatedly analyzing negative feelings, past failures and mistakes.
"Anxiety and depression give rise to difficult and painful negative thoughts. Many patients have thoughts of mistakes, past failures or other negative thoughts. Metacognitive therapy addresses thinking processes," Hagen says, rather than the thought content.
Depression can be described as low mood resulting from a problem of over-thinking or rumination and social withdrawal and reduction in activity.
"Some people experience their persistent ruminative thinking as completely uncontrollable, but individuals with depression can gain control over it," says Hagen.
This persistent thinking is referred to as 'depressive rumination.' Rather than ruminating so much on negative thoughts, MCT helps patients to reduce negative thought processes and get them under control.
Patients learn to take control of their own thoughts, by becoming aware of what happens when they start to ruminate .
As Hagen explains, "Instead of reacting by repeatedly ruminating and thinking 'how do I feel now?' you can try to encounter your thoughts with what we call 'detached mindfulness.' You can see your thoughts as just thoughts, and not as a reflection of reality. Most people think that when they think a thought, it must be true. For example, if I think that I'm stupid, this means I must be stupid. People strongly believe that their thoughts reflect reality."
Thirty-nine patients with depression were randomly assigned to immediate MCT (10 sessions) or a 10-week wait list period (WL).
The participants in the WL-group received 10 sessions of MCT after the waiting period.
Participants receiving MCT improved significantly more than the WL group. After six months, 80% of the participants had achieved full recovery from their depression diagnosis.
"The follow-up after six months showed the same tendency," says Hagen. "The relapse rate in our study is much lower. Only a few percent experienced a depressive relapse," Hagen adds.
"The patients come in thinking they're going to talk about all the problems they have and get to the bottom of it," says Hagen, "but instead we try to find out how their mind and thinking processes work. You can't control what you think, but you can control how you respond to what you think."
"When the national guidelines for the treatment of depression were changed five or six years ago," Hagen says, "MCT had not been empirically tested." Given the results of the NTNU and Danish studies, he recommends that professionals in the field consider whether this form of therapy should become the first choice for treating depression in people suffering from this mental disorder. "Many professionals in Norway have expertise in metacognitive therapy," says Hagen.
The results suggest that MCT is a promising treatment for depression.
The findings are published in Frontiers in Psychology.
- Roger Hagen et al. Metacognitive Therapy for Depression in Adults: A Waiting List Randomized Controlled Trial with Six Months Follow-Up. Frontiers in Psychology; (2017) doi.org/10.3389/fpsyg.2017.00031