Metacognitive Therapy for Depression

Meta-cognitive therapy is an approach based on the metacognitive model where psychological disorders result from an inflexible and maladaptive response pattern to cognitive events labeled the Cognitive Attentional Syndrome. According to the metacognitive model of depression, rumination and worry is maintained by metacognitions and not by changes in mood or events.

This is an important study for coaches because MCT uses many of the techniques that we use with our clients. So this study offers some evidence, albeit indirect, that our approaches work.

Meta-cognitive therapy uses behavioural experiments and verbal reattribution targeted at metacognitive change together with specific techniques such as attention training, detached mindfulness and postponement of rumination.

In this study, the thirty-nine participants had either a recurrent depression diagnosis or a current depressive episode. They were randomly assigned to immediate MCT of 10 sessions, or a 10-week waitlist after which they received MCT. The MCT treatment consisted of (1) increasing meta-awareness by identifying thoughts that act as triggers for rumination, learning about metacognitive control using attention training; (2) challenging beliefs about the uncontrollability of rumination and worry; (3) challenging beliefs about threat monitoring and dangers of rumination and worry; (4) modification of positive beliefs about rumination and worry; and (5) relapse prevention.

Immediately following completion of the trial and at six-month follow-up, about 80% of the MCT group had recovered from depression, compared to only 5% of waitlist patients during the waiting period. 


Hagen, R., Hjemdal, O., Solem, S., Kennair, L., Nordahl, H., Fisher, P., & Wells, A. (2017). Metacognitive Therapy for Depression in Adults: A Waiting List Randomized Controlled Trial with Six Months Follow-Up. Frontiers in Psychology8, 31. doi:10.3389/fpsyg.2017.00031

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