Effectiveness of Metacognitive Therapy in Patients With Depression and Comorbid Anxiety Symptoms: A Case Series From India

Abstract

Metacognitive therapy (MCT) is a transdiagnostic intervention used to treat different psychiatric disorders. This intervention is based on the concept that persistent emotional distress is a consequence of a particular way of responding to negative thoughts and emotions. MCT for depression and anxiety aims at targeting rumination, worry, and the dysfunctional metacognitive beliefs underlying these thought processes. The purpose of this study was to explore MCT as a treatment for adult patients with depression (either major depressive disorder (MDD) or recurrent depressive disorder, dysthymia, or mixed anxiety depressive disorder) with comorbid anxiety symptoms. Four men diagnosed with depressive disorder with comorbid anxiety symptoms seeking treatment from the outpatient clinic of the Department of Psychiatry at the All India Institute of Medical Sciences, New Delhi, were recruited for the study. Each patient received 10 individual weekly sessions of MCT, lasting up to 1 hour each. Participants were assessed at baseline, post-intervention (right after completing MCT), and at one-month and two-month follow-ups. Primary outcome measures were a reduction in the severity of depression, anxiety, worry, and rumination. Secondary outcome measures were changes in dysfunctional metacognitive beliefs about worry and rumination. All outcomes were assessed via self-report using standardized questionnaires at baseline, post-intervention, one-month, and two-month follow-up. Data for all the outcome measures (at baseline, post-intervention, one month, and two-month follow-up) were plotted on a graph for visual examination. Additionally, we calculated clinically significant change (≥50% reduction in symptom severity and one other standardized criteria for clinically significant changes) for all the primary outcome measures across the above-mentioned four time points. All four men were single, well-educated, and had a mean age of 25.5±4.79 years. Their mean illness duration was 21±0.64 months. None of them had ever received any psychotherapy for their current illness. They had severe depressive and anxiety symptoms at baseline. Three participants had high scores on the rumination and worry scales. At post-intervention, all the participants had significant improvement on all the primary outcome measures, and they maintained their gains on follow-up assessments. Our study generated preliminary evidence supporting the effectiveness of MCT in treating depressive disorders with comorbid anxiety symptoms in the Indian context.

Keywords: anxiety; depression; dysfunctional metacognitive beliefs; metacognitive therapy; rumination; worry.

Figure 1. Scores of case A on BDI-II, BAI, RRS, AnTi, MCQ-30, PBRS, and NBRS across baseline, post-intervention, one-month follow-up and two-month follow-up

BDI-II: Beck's depression inventory-II, BAI: Beck’s anxiety inventory, RRS: Ruminative Response scale, AnTi: anxious thoughts inventory, MCQ-30: metacognitions questionnaire-30, PBRS: Positive Beliefs about Rumination scale, NBRS: Negative Beliefs about Rumination scale

Figure 2. Scores of case B on BDI-II, BAI, RRS, AnTi, MCQ-30, PBRS, and NBRS across baseline, post-intervention, one-month follow-up and two-month follow-up

BDI-II: Beck's depression inventory-II, BAI: Beck’s anxiety inventory, RRS: Ruminative Response scale, AnTi: anxious thoughts inventory, MCQ-30: metacognitions questionnaire-30, PBRS: Positive Beliefs about Rumination scale, NBRS: Negative Beliefs about Rumination scale

Figure 3. Scores of case C on BDI-II, BAI, RRS, AnTi, MCQ-30, PBRS, and NBRS across baseline, post-intervention, one-month follow-up and two-month follow-up

BDI-II: Beck's depression inventory-II, BAI: Beck’s anxiety inventory, RRS: Ruminative Response scale, AnTi: anxious thoughts inventory, MCQ-30: metacognitions questionnaire-30, PBRS: Positive Beliefs about Rumination scale, NBRS: Negative Beliefs about Rumination scale

Figure 4. Scores of Case D on BDI-II, BAI, RRS, AnTi, MCQ-30, PBRS, and NBRS across baseline, post-intervention, one-month follow-up and two-month follow-up

BDI-II: Beck's depression inventory-II, BAI: Beck’s anxiety inventory, RRS: Ruminative Response scale, AnTi: anxious thoughts inventory, MCQ-30: metacognitions questionnaire-30, PBRS: Positive Beliefs about Rumination scale, NBRS: Negative Beliefs about Rumination scale