Efficacy and moderators of metacognitive training for depression in older adults (MCT-Silver): A randomized controlled trial

TY - JOUR

T1 - Efficacy and moderators of metacognitive training for depression in older adults (MCT-Silver): A randomized controlled trial

AU - Schneider, Brooke C

AU - Veckenstedt, Ruth

AU - Karamatskos, Evangelos

AU - Ahlf-Schumacher, Jana

AU - Gehlenborg, Josefine

AU - Schultz, Josephine

AU - Moritz, Steffen

AU - Jelinek, Lena

N1 - Copyright © 2023 Elsevier B.V. All rights reserved.

PY - 2024/1/15

Y1 - 2024/1/15

N2 - BACKGROUND: Up to 79 % of older adults with depression do not receive treatments commensurate with guideline recommendations. Metacognitive Training-Silver (MCT-Silver) is a low-intensity group training, which aims to reduce depressive symptoms by targeting (meta)cognitive beliefs.METHODS: A randomized controlled trial comparing MCT-Silver (n = 41) to cognitive remediation (n = 39) was conducted with older adults with major depressive disorder and/or dysthymia. Clinician-rated depression (Hamilton Depression Rating Scale [HDRS, primary outcome]), self-reported depression (Beck Depression Inventory-II [BDI-II]), negative cognitive beliefs, positive metacognitive beliefs, rumination, health status, quality of life, and neurocognitive functioning were assessed at baseline, eight weeks (post) and three months (follow-up).RESULTS: Both groups demonstrated moderate to large reductions in depression. No superior effects of MCT-Silver on clinician-rated depression (HDRS) were detected. MCT-Silver led to greater reductions in self-reported depression and rumination at post- and follow-up. Despite this, scores at post- and follow-up assessments were similar for both groups. MCT-Silver's effect on depressive symptoms was moderated by baseline rumination, positive metacognitive beliefs and previous treatment experience. MCT-Silver was evaluated as superior according to patient appraisals.LIMITATIONS: Conclusions are limited by divergent findings on measures of depression and that the study was conducted during the COVID-19 pandemic.CONCLUSIONS: Whereas no superior effect of MCT-Silver was found for the primary outcome, there was a significant effect of MCT-Silver for self-reported depression and rumination. Patients endorsing rumination and positive metacognitive beliefs as well as those without previous psychological treatment may benefit more from MCT-Silver.

AB - BACKGROUND: Up to 79 % of older adults with depression do not receive treatments commensurate with guideline recommendations. Metacognitive Training-Silver (MCT-Silver) is a low-intensity group training, which aims to reduce depressive symptoms by targeting (meta)cognitive beliefs.METHODS: A randomized controlled trial comparing MCT-Silver (n = 41) to cognitive remediation (n = 39) was conducted with older adults with major depressive disorder and/or dysthymia. Clinician-rated depression (Hamilton Depression Rating Scale [HDRS, primary outcome]), self-reported depression (Beck Depression Inventory-II [BDI-II]), negative cognitive beliefs, positive metacognitive beliefs, rumination, health status, quality of life, and neurocognitive functioning were assessed at baseline, eight weeks (post) and three months (follow-up).RESULTS: Both groups demonstrated moderate to large reductions in depression. No superior effects of MCT-Silver on clinician-rated depression (HDRS) were detected. MCT-Silver led to greater reductions in self-reported depression and rumination at post- and follow-up. Despite this, scores at post- and follow-up assessments were similar for both groups. MCT-Silver's effect on depressive symptoms was moderated by baseline rumination, positive metacognitive beliefs and previous treatment experience. MCT-Silver was evaluated as superior according to patient appraisals.LIMITATIONS: Conclusions are limited by divergent findings on measures of depression and that the study was conducted during the COVID-19 pandemic.CONCLUSIONS: Whereas no superior effect of MCT-Silver was found for the primary outcome, there was a significant effect of MCT-Silver for self-reported depression and rumination. Patients endorsing rumination and positive metacognitive beliefs as well as those without previous psychological treatment may benefit more from MCT-Silver.

U2 - 10.1016/j.jad.2023.10.118

DO - 10.1016/j.jad.2023.10.118

M3 - SCORING: Journal article

C2 - 37865342

VL - 345

SP - 320

EP - 334

JO - J AFFECT DISORDERS

JF - J AFFECT DISORDERS

SN - 0165-0327

ER -