Effectiveness of metacognitive interventions for mental disorders in adults: a systematic review protocol (METACOG)

Effectiveness of metacognitive interventions for mental disorders in adults-A systematic review and meta-analysis (METACOG)

We evaluated the effectiveness and acceptability of metacognitive interventions for mental disorders. We searched electronic databases and included randomized and nonrandomized controlled trials comparing metacognitive interventions with other treatments in adults with mental disorders. Primary effectiveness and acceptability outcomes were symptom severity and dropout, respectively. We performed random-effects meta-analyses. We identified Metacognitive Training (MCTrain), Metacognitive Therapy (MCTherap), and Metacognition Reflection and Insight Therapy (MERIT). We included 49 trials with 2,609 patients. In patients with schizophrenia, MCTrain was more effective than a psychological treatment (cognitive remediation, SMD = -0.39). It bordered significance when compared with standard or other psychological treatments. In a post hoc analysis, across all studies, the pooled effect was significant (SMD = -0.31). MCTrain was more effective than standard treatment in patients with obsessive-compulsive disorder (SMD = -0.40). MCTherap was more effective than a waitlist in patients with depression (SMD = -2.80), posttraumatic stress disorder (SMD = -2.36), and psychological treatments (cognitive-behavioural) in patients with anxiety (SMD = -0.46). In patients with depression, MCTherap was not superior to psychological treatment (cognitive-behavioural). For MERIT, the database was too small to allow solid conclusions. Acceptability of metacognitive interventions among patients was high on average. Methodological quality was mostly unclear or moderate. Metacognitive interventions are likely to be effective in alleviating symptom severity in mental disorders. Although their add-on value against existing psychological interventions awaits to be established, potential advantages are their low threshold and economy.

Course and stability of cognitive and metacognitive beliefs in depression

Maladaptive cognitive beliefs as measured by the Dysfunctional Attitudes Scale (DAS) increase vulnerability to depression. Maladaptive metacognitive beliefs as measured by the Metacognitive Questionnaire-30 (MCQ-30) are also thought to contribute to depression. However, the long-term stability of metacognitive beliefs in depression has not yet been investigated. It is unclear whether metacognitive beliefs can add explanatory power to depression above and beyond maladaptive cognitive beliefs. The aim of the present study was to investigate the role and stability of cognitive and metacognitive maladaptive beliefs in depression. Eighty-four patients with depression were assessed with the DAS, three subscales of the MCQ-30 (positive metacognitive beliefs about worry and rumination [PB]; negative metacognitive beliefs about the uncontrollability of rumination [NB]; metacognitive beliefs concerning the need to control one's thoughts [NFC]), the Hamilton Depression Rating Scale, and the Beck Depression Inventory at baseline and were reassessed 3.5 years later. Analyses using a longitudinal latent growth model showed that change on the DAS and baseline scores and change on the MCQ-30 (NB and NFC) significantly predicted change in self-rated depressive symptoms over 3.5 years. However, the DAS explained more additional variance than the integration of the MCQ-30 subscales. Subscales of the MCQ-30 were more stable than the DAS. Although cognitive and metacognitive maladaptive beliefs were both predictors of depression, the DAS was a better predictor than the MCQ-30 subscales. Nevertheless, because maladaptive metacognitive beliefs were more stable than maladaptive cognitive beliefs, they should be considered an important underlying vulnerability factor for depression.