Metacognitive Therapy for Unipolar Major Depressive Disorder:: Should It Be the Treatment or Choice?

Abstract

Depression is one of the most prevalent psychiatric disorders, being extremely disabling for the individual and burdensome for the community. There are effective treatments for depression, but nonetheless, this is a disorder which carry with it great chances of relapse and recurrence. Theoretical foundations for the original treatments were formulated in the 1970s, and contemporary research now brings important information on psychological factors which might help improve psychotherapy for depression. The factors which have been proven essential are executive deficits, rumination and reduced problem solving ability, and research implies that these are important mechanisms of change. They are strongly inter-related, and the complexity of their cause-effect relationship becomes relevant to the choice of intervention techniques. This paper attempts to assess whether Metacognitive Therapy (MCT) should be the treatment of choice for depression. Such an assessment requires an evaluation of how well MCT incorporates the factors of executive deficits, rumination and reduced problem solving into its theoretical framework and treatment manual. This also includes a question of whether the metacognitive intervention techniques are sufficient enough to cover and handle the heterogeneity of depression. Four hypothetical cases will be included to illustrate the strengths and limitations of this treatment manual. Research on MCT for depression reveals a strong theoretical framework together with encouraging evidence of an effective treatment manual. MCT seems to be unique in having a strong theoretical relationship with modern cognitive psychology and cognitive neuroscience, incorporating some important psychological factors of depression into its workings. However, there are patient-related factors which make the steady progress of this intensive 6-8 hour psychotherapy problematic. MCT might be the treatment of choice for a certain subtype of depressed patients.