Metacognitive Therapy for Work-Related Stress: A Feasibility Study.

About 25% of EU workers experience work-related stress for all or most of their working time, showing that work-related stress is a major cause of health problems for the EU population. This situation has been worsened even more by the COVID-19 restrictions embraced by employers worldwide. However, a timely and sustainable intervention protocol for treating such issues has not been developed yet. Thus, the present research shows a first effective attempt based on Metacognitive therapy (MCT) to solve this issue. MCT was practiced on four individuals suffering from chronic work-related stress. Primary outcome variables were general mental health, perceived stress, and blood pressure. Participants were assessed at multiple baselines before the start of therapy and then attended a 3- and 6-months follow-up after treatment termination. Results showed significant improvements in general mental health, perceived stress, and blood pressure in each client. Secondary outcome variables improved too-maladaptive coping strategies, avoidance behaviors, and depression symptoms-corroborating the main findings. At 3- and 6-month follow-up, results were maintained. The findings suggest that MCT might be a promising and sustainable intervention for work-related stress, although a metacognitive model for stress and large-scale RCTs need to be developed and carried out to further explore the effect of MCT on stress. Our results represent one of the first attempts to treat work-related stress via Metacognitive Therapy and support the feasibility of the treatment, both in terms of its efficacy and sustainability, in a historical moment in which work-related stress is increased worldwide because of the COVID-19 pandemic. Within such a realm, our feasibility study should be followed by larger and controlled studies that, if successful, would provide various stakeholders-including organizational and institutional decision-makers-with a solid, timely and cost-effective method to help the workforce coping with work-related stress.

Author Correction: Metacognitive Therapy versus Cognitive Behaviour Therapy in Adults with Major Depression: A Parallel Single-Blind Randomised Trial.

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

Metacognitive Therapy versus Cognitive Behaviour Therapy in Adults with Major Depression: A Parallel Single-Blind Randomised Trial.

In the last forty years therapy outcomes for depression have remained the same with approximately 50% of patients responding to treatments. Advances are urgently required. We hypothesised that a recent treatment, metacognitive therapy (MCT), might be more effective, by targeting mental control processes that directly contribute to depression. We assessed the clinical efficacy of MCT compared to current best psychotherapy practice, CBT, in adults with major depressive disorder. A parallel randomized single-blind trial was conducted in a primary care outpatient setting. This trial is registered with the ISCRTN registry, number ISRCTN82799488. In total 174 adults aged 18 years or older meeting Diagnostic and Statistical Manual of Mental Disorders IV criteria for major depressive disorder were eligible and consented to take part. 85 were randomly allocated to MCT and 89 to CBT. Randomisation was performed independently following pre-treatment assessment and was stratified for severity of depression (low < 20 vs high > =20) on the Hamilton Depression Rating Scale (HDRS) and on sex (male/female). Assessors and trial statisticians were blind to treatment allocation. Each treatment arm consisted of up to 24 sessions of up to 60 minutes each, delivered by trained clinical psychologists. The co-primary outcome measures were assessor rated symptom severity on the HDRS and self-reported symptom severity on the Beck Depression Inventory II (BDI-II) at post treatment. Secondary outcomes were scores six months post treatment on these measures and a range of symptom and mechanism variables. A key trial design feature was that each treatment was implemented to maximize individual patient benefit; hence time under therapy and number of sessions delivered could vary. Treated groups in the trial were very similar on most baseline characteristics. Data were analyzed on the basis of intention to treat (ITT). No differences were found on the HDRS at post treatment or follow-up (-0.95 [-2.88 to 0.98], p = 0.336; and -1.61 [-3.65 to 0.43], p = 0.122), but floor effects on this outcome were high. However, a significant difference favouring MCT was found on the BDI-II at post treatment (-5.49 [95% CI -8.90 to -2.08], p = 0.002), which was maintained at six-month follow-up (-4.64 [-8.21 to -1.06], p = 0.011). Following MCT 74% of patients compared with 52% in CBT met formal criteria for recovery on the BDI-II at post treatment (odds-ratio=2.42 [1.20 to 4.92], p = 0.014). At follow-up the proportions were 74% compared to 56% recovery (odds-ratio=2.19 [1.05 to 4.54], p = 0.036). Significant differences favouring MCT, also maintained over time, were observed for most secondary outcomes. The results were robust against controlling for time under therapy and when outcomes were assessed at a common 90 day mid-term time-point. Limitations of the study include the use of only two therapists where one treated 69% of patients, possible allegiance effects as the study was conducted in an established CBT clinic and the chief investigator is the originator of MCT and group differences in time under therapy. Never the less evidence from this study suggests that MCT had considerable beneficial effects in treating depression that may exceed CBT.

A Preliminary Evaluation of Transdiagnostic Group Metacognitive Therapy in a Mixed Psychological Disorder Sample.

Objective: Comorbidity is common among anxiety and depression. Transdiagnostic treatment approaches have been developed to optimize treatment and offer a more unified approach suitable for individuals with comorbidities. Metacognitive therapy (MCT) is a transdiagnostic therapy for psychological disorder and is based on the metacognitive model. The present study is a service evaluation of the outcomes associated with group MCT delivered to unselected patients at a Danish outpatient clinic. Methods: A total of 131 self-diagnosed patients received 6 sessions of group MCT. Symptoms of anxiety and depression were measured by the Hospital Anxiety and Depression scale (HADS) and metacognition was assessed using the Cognitive Attentional Syndrome-1 (CAS-1). Participants were assessed at pre-treatment, post-treatment, and at 6 months follow-up as per usual clinic protocol. Linear mixed-effects regressions were used to assess the transdiagnostic effects of group MCT. Treatment effect sizes are reported for subgroups based on participant's reason for seeking treatment (anxiety, depression, or comorbid). Effect sizes were not conducted for the depression subgroup given the limited number of participants. Clinically significant change is reported for all subgroups. Results: Group MCT was associated with large effect sizes for symptoms of anxiety and depression for patients seeking treatment for anxiety (d = 1.68), or comorbid (1.82). In addition, 66.7% of patients were classified as recovered at post-treatment, and 12.9% were classified as improved. These results were largely maintained at 6-month follow-up. Conclusion: These preliminary findings support the continued use of group MCT in the current outpatient clinic and suggest that it may be an efficacious and cost-effective treatment when delivered in "transdiagnostic" groups.

Metacognitive therapy in recurrent depression: a case replication series in Denmark.

Metacognitive therapy (MCT) for depression is derived from the Wells and Matthews (1994) self-regulatory model, in which a Cognitive-Attentional Syndrome (CAS) is the cause of psychological disorders. MCT for depression focuses on identifying patients' CAS and helps them to stop it. The CAS consists of worry, rumination and dysfunctional coping strategies. The focus in MCT is on removing the CAS by challenging positive and negative metacognitive beliefs and eliminating dysfunctional behaviors. In this case series, MCT was delivered to four depressed Danes and treatment was evaluated in 5-11 sessions of up to one hour each. An A-B design with follow-up at 3 and 6 months was conducted and the primary outcome was Beck's Depression Inventory II (BDI-II). We measured CAS processes with the Major depressive Disorder Scale (MDD-S). The results of the case series showed clinically significant improvements in depressive symptoms, rumination and metacognitive beliefs and the effects were still present at follow-up for all patients. The small number of patients and decreasing baselines observed in some cases limits the conclusions. However, the results suggest that this treatment is feasible and was associated with large improvements in symptoms when delivered away from its point of origin and in a Danish help-seeking sample.