The Effectiveness of Metacognitive Therapy Compared to Behavioral Activation for Severely Depressed Outpatients: A Single-Center Randomized Trial

Abstract

<b><i>Introduction:</i></b> Major depressive disorder (MDD) is a highly prevalent and disabling disorder. This study examines two psychotherapy methods for MDD, behavioral activation (BA), and metacognitive therapy (MCT), when applied as outpatient treatments to severely affected patients. <b><i>Methods:</i></b> The study was conducted in a tertiary outpatient treatment center. Patients with a primary diagnosis of MDD (<i>N</i> = 122) were included in the intention-to-treat sample (55.7% female, mean age 41.9 years). Participants received one individual and one group session weekly for 6 months (M). Assessments took place at baseline, pretreatment, mid-treatment (3 M), post-treatment (6 M), and follow-up (12 M). The primary outcome was depressive symptomatology assessed by the Hamilton Rating Scale for Depression at 12 M follow-up. Secondary outcomes included general symptom severity, psychosocial functioning, and quality of life. <b><i>Results:</i></b> Linear mixed models indicated a change in depressive symptoms (<i>F</i>(2, 83.495) = 12.253, <i>p</i> < 0.001) but no between-group effect (<i>F</i>(1, 97.352) = 0.183, <i>p</i> = 0.670). Within-group effect sizes were medium for MCT (post-treatment: <i>d</i> = 0.610; follow-up: <i>d</i> = 0.692) and small to medium for BA (post-treatment: <i>d</i> = 0.636, follow-up: <i>d</i> = 0.326). In secondary outcomes, there were improvements (<i>p</i> ≤ 0.040) with medium to large within-group effect sizes (<i>d</i> ≥ 0.501) but no between-group effects (<i>p</i> ≥ 0.304). Response and remission rates did not differ between conditions at follow-up (response MCT: 12.9%, BA: 13.3%, remission MCT: 9.7%, BA: 10.0%). The deterioration rate was lower in MCT than in BA (χ<sup>2</sup><sub>1</sub> = 5.466, <i>p</i> = 0.019, NTT = 7.4). <b><i>Discussion:</i></b> Both MCT and BA showed symptom reductions. Remission and response rates were lower than in previous studies, highlighting the need for further improvements in adapting/implementing treatments for severely affected patients with MDD.

The relationship between sleep disturbance and obsessive– compulsive symptoms: the mediation of repetitive negative thinking and the moderation of experiential avoidance

“…In a study with 95 OCD patients, participants who received group metacognitive therapy (MCT) improved significantly more than those who received CBT ( Papageorgiou et al, 2018 ). In addition, deterioration rate was lower with MCT than behavioral activation (BA) for other outpatients ( Schaich et al, 2023 ).…”

Say farewell to bland regression reporting: Three forest plot variations for visualizing linear models

“…To illustrate this, we surveyed all 2022 and 2023 issues of Psychotherapy and Psychosomatics which ranks among the highest-impact psychology journals (Impact Factor 2023: 26.617). We found that of 17 studies that reported results of regression analyses [22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38], only six made use of at least one of these visualizations [22][23][24][25][26][27]. One of them applied a forest plot variant [22].…”

Effects of a Web-Based Behavioral Activation Intervention on Depressive Symptoms, Activation, Motivation, and Volition: Results of a Randomized Controlled Trial

“…A recent review and meta-analysis of 53 RCTs found BA to be superior to treatment as usual (TAU) with a standardized mean difference (SMD) of 0.78, and equally as effective as cognitive behavioral therapy (SMD = 0.12) in reducing depressive symptoms [2]. BA is cost-effective [4] and can successfully be applied in various contexts, e.g., different cultural settings [5], age groups [6,7], group and outpatient settings [8,9], and in people with chronic diseases [10]. Aside from reducing depressive symptoms, BA also has the potential to increase BA 1 and quality of life, as well as improving anxiety symptoms [11].…”