The Efficacy of Metacognitive Therapy: A Systematic Review and Meta-Analysis

Abstract

Background: Metacognitive therapy (MCT) continues to gain increased ground as a treatment for psychological complaints. During the last years, several clinical trials on the efficacy of MCT have been published. The aim of the current study was to provide an updated meta-analytic review of the effect of MCT for psychological complaints.Methods: We conducted a systematic search of trials on MCT for young and adult patients with psychological complaints published until January 2018, using PsycINFO, PubMed, the Cochrane Library, and Google Scholar. Trials with a minimum of 10 participants in the MCT condition were included.Results: A total of 25 studies that examined a variety of psychological complaints met our inclusion criteria, of which 15 were randomized controlled trials. We identified only one trial that was conducted with children and adolescents. In trials with adult patients, large uncontrolled effect size estimates from pre- to post-treatment and follow-up suggest that MCT is effective at reducing symptoms of the targeted primary complaints, anxiety, depression, and dysfunctional metacognitions. The comparison with waitlist control conditions also resulted in a large effect (Hedges' g = 2.06). The comparison of MCT to cognitive and behavioral interventions at post-treatment and at follow-up showed pooled effect sizes (Hedges' g) of 0.69 and 0.37 at post-treatment (k = 8) and follow-up (k = 7), respectively.Conclusions: Our findings indicate that MCT is an effective treatment for a range of psychological complaints. To date, strongest evidence exists for anxiety and depression. Current results suggest that MCT may be superior to other psychotherapies, including cognitive behavioral interventions. However, more trials with larger number of participants are needed in order to draw firm conclusions.

Breaking the Cybernetic Code: Understanding and Treating the Human Metacognitive Control System to Enhance Mental Health

“…Full MCT treatment was first developed for generalized anxiety disorder (Wells, 1995(Wells, , 1997 and subsequently other disorders (Wells, 2000(Wells, , 2009. In meta-analyses, MCT demonstrates large treatment effects and appears potentially more effective or more efficient than cognitive behavioral approaches (Normann et al, 2014;Normann and Morina, 2018). In a direct test of transdiagnostic MCT against disorder-specific CBT across anxiety disorders, outcomes favoring MCT were reported (Johnson et al, 2017) and potential mechanisms of change could be distinguished (Johnson and Hoffart, 2018).…”

Metacognitive Therapy for Depression: A 3-Year Follow-Up Study Assessing Recovery, Relapse, Work Force Participation, and Quality of Life

“…Rumination seems to exacerbate negative mood and could trigger and prolong depression (e.g., Nolen-Hoeksema et al, 2008). MCT could therefore be beneficial for people with depression as suggested by several treatment studies with recovery rates ranging around 70-80% (e.g., Wells et al, 2009Wells et al, , 2012Dammen et al, 2016;Hagen et al, 2017;Normann and Morina, 2018).…”

Metacognition, perseverative thinking, and pain catastrophizing: A moderated‐mediation analysis

“…This is a central component in Metacognitive Therapy (MCT) for anxiety and depression (Wells, 2009); however MCT has never been studied in people with chronic pain or elevated PC. Our findings provide a strong rationale for adapting this treatment, which is in some cases more effective than CBT in treating anxiety and depression (Normann & Morina, 2018), for people with chronic pain. This notion of including metacognition as a therapeutic target in pain treatments echoes calls from another recent study which found significant associations between negative metacognition, PC and other pain outcomes (Ziadni et al, 2018).…”