Negative cognitive beliefs, positive metacognitive beliefs, and rumination as mediators of metacognitive training for depression in older adults (MCT-Silver)

Brooke C Schneider; Ruth Veckenstedt; Evangelos Karamatskos; Lara Guedes Pinho; Bruno Morgado; César Fonseca; Steffen Moritz; Lena Jelinek

doi:10.3389/fpsyg.2023.1153377

Negative cognitive beliefs, positive metacognitive beliefs, and rumination as mediators of metacognitive training for depression in older adults (MCT-Silver)

Front Psychol. 2023 Mar 22:14:1153377. doi: 10.3389/fpsyg.2023.1153377. eCollection 2023.

Authors

Brooke C Schneider¹, Ruth Veckenstedt¹, Evangelos Karamatskos¹, Lara Guedes Pinho^{2

3}, Bruno Morgado⁴, César Fonseca^{2

3}, Steffen Moritz¹, Lena Jelinek¹

Affiliations

¹ Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
² Nursing Department, University of Évora, Évora, Portugal.
³ Comprehensive Health Research Centre (CHRC), University of Évora, Évora, Portugal.
⁴ University Rovira i Virgili, Tarragona, Spain.

Abstract

Background: Metacognitive Training for Depression in older adults (MCT-Silver; www.uke.de/mct-silver) is a cognitive-behavioral based group intervention that aims at reducing depression by targeting (meta)cognitive beliefs and rumination. In the present study, it was examined whether negative cognitive beliefs, positive metacognitive beliefs and/or rumination may be implicated as mediators of MCT-Silver's effects on depression.

Materials and methods: We conducted a secondary analysis of a randomized controlled trial comparing MCT-Silver to an active control intervention (cognitive remediation) including 66 older adults (60 years and older) with complete baseline data. Clinician-rated (Hamilton Depression Rating Scale) and self-reported (Beck Depression Inventory-II) depression, negative cognitive beliefs (Dysfunctional Attitudes Scale-18B), positive metacognitive beliefs (positive beliefs subscale; Metacognition Questionnaire-30) and rumination (10-item Ruminative Response Scale) were assessed before (pre) and after 8 weeks of treatment (post), as well as 3 months later (follow-up). It was examined whether change in depression (pre- to follow-up) was mediated by change in negative cognitive beliefs, positive metacognitive beliefs and/or rumination (pre- to post-assessment).

Results: Mediation results differed for self-reported vs. clinician-rated depression. The effect of MCT-Silver on reduction in clinician-rated depression was mediated by a reduction in self-reported rumination, whereas reduction in self-reported depression was mediated by a reduction in negative cognitive beliefs. Positive metacognitive beliefs were not a significant mediator for either outcome.

Conclusion: The current study provides initial evidence for the roles of negative cognitive beliefs and rumination in the treatment of depression in later life with MCT-Silver. Given the divergence of findings and lack of causal precedence, mechanisms of change for MCT-Silver cannot yet be equivocally identified.

Keywords: depression; intervention; metacognitive beliefs; metacognitive training; negative cognitions; older adults; rumination.