EFFICACY OF METACOGNITIVE THERAPY This thesis submitted to the University of Manchester for the degree of Doctor of Philosophy (PhD) In the Faculty of Biology, Medicine and Health 2016 PIA CALLESEN SCHOOL OF PSYCHOLOGICAL SCIENCES LIST OF CONTENTS LIST OF APPENDICES .............................................................................................. 10 LIST OF TABLES ........................................................................................................ 11 LIST OF FIGURES ...................................................................................................... 13 ABSTRACT ................................................................................................................... 14 DECLARATION ........................................................................................................... 15 COPYRIGHT STATEMENT ...................................................................................... 16 ACKNOWLEDGEMENTS .......................................................................................... 17 LIST OF ABBREVIATIONS ...................................................................................... 18 1.1 INTRODUCTION ............................................................................................ 19 1.1.1 Effectiveness and efficacy .......................................................................... 20 1.1.2 Outline of this thesis: .................................................................................. 20 1.1.3 The history of depression ............................................................................ 22 1.1.4 Assessment and diagnosis of Major Depressive Disorder (MDD) ............. 23 1.2.1 Models of Major depressive Disorder ......................................................... 25 1.2.2 Beck’s cognitive model of depression ........................................................ 25 1.2.3 The Cognitive Triad .................................................................................... 25 1.2.4 Schemas ...................................................................................................... 26 1.2.5 Cognitive errors ........................................................................................... 27 1.2.6 The meta-cognitive model of depression: The Self-regulatory Executive function (S-REF) model .......................................................................................... 28 1.2.7 The S-REF model explained ....................................................................... 28 1.2.8 The Cognitive Attentional Syndrome - CAS .............................................. 30 1.2.9 The three components of the CAS .............................................................. 30 1.2.10 Metacognition ........................................................................................... 32 1.2.11 Rumination ................................................................................................ 32 2 of 229 1.2.12 Worry ........................................................................................................ 33 1.3 Conclusions ....................................................................................................... 33 2 STUDY 1: A SYSTEMATIC REVIEW OF META-ANALYSES INVESTIGATING PSYCHOLOGICAL TREATMENTS FOR MAJOR DEPRESSIVE DISORDER ......................................................................................... 34 2.1 Abstract ............................................................................................................. 34 2.1.1 Background ................................................................................................. 34 2.1.2 Methods ....................................................................................................... 34 2.1.3 Conclusion .................................................................................................. 34 2.2 Introduction ...................................................................................................... 35 2.2.1 Method ........................................................................................................ 36 2.2.2 Search Strategy ........................................................................................... 36 2.2.3 Eligibility Criteria ....................................................................................... 37 2.2.4 Selection of Meta-Analytic Reviews .......................................................... 37 2.2.5 Data Extraction ........................................................................................... 38 2.2.6 Review Selection & Objectives .................................................................. 40 2.2.7 Characteristics of Meta-analytic Reviews ................................................... 50 2.2.8 Treatment Comparisons .............................................................................. 50 2.2.9 Diagnosis & Patient Samples ...................................................................... 54 2.2.10 Mean pre-treatment severity of patients in included studies ..................... 54 2.2.11 Treatment Sessions & Overall Duration of Therapy ................................ 55 2.2.12 Definitions of Outcome ............................................................................. 56 2.2.13 Post-treatment Outcomes of Meta-analysis .............................................. 56 2.2.14 Psychotherapy vs. Controls ....................................................................... 57 2.2.15 Psychotherapy vs. Psychotherapy ............................................................. 57 2.2.16 Psychotherapy vs. Medication .................................................................. 58 3 of 229 2.2.17 Psychotherapy vs. Combined therapy ....................................................... 58 2.2.18 Follow-up results ....................................................................................... 58 2.2.19 Psychotherapy vs. Controls ....................................................................... 59 2.2.20 Psychotherapy vs. Psychotherapy ............................................................. 59 2.2.21 Psychotherapy vs. ADM ........................................................................... 59 2.2.22 Psychotherapy vs. Combined therapy ....................................................... 59 2.2.23 Conclusions ............................................................................................... 60 2.2.24 Within Review Risk of Bias ...................................................................... 61 2.2.25 Assessments of Review Biases ................................................................. 61 2.2.26 Search ........................................................................................................ 61 2.2.27 Eligibility criteria ...................................................................................... 62 2.2.28 Assessments of study validity ................................................................... 62 2.2.29 Synthesis methods ..................................................................................... 63 2.2.30 Summary of Risk of Bias .......................................................................... 64 2.2.31 Across Review Risk of Bias ...................................................................... 64 2.2.32 Treatment integrity .................................................................................... 64 2.2.33 Treatment duration .................................................................................... 65 2.2.34 Pre-treatment severity ............................................................................... 66 2.2.35 Definitions of treatment outcome ............................................................. 66 2.3 Overall Discussion ............................................................................................ 67 2.3.1 Discussion of efficacy of treatments ........................................................... 68 2.3.2 Psychotherapeutic efficacy at post-treatment ............................................. 68 2.3.3 Comparison of psychotherapy with medication .......................................... 69 2.3.4 Comparison of psychotherapy alone & combined with medication ........... 70 2.3.5 Discussion of the Risk of Bias Across Reviews ......................................... 71 4 of 229 2.4 Concluding Remarks ....................................................................................... 74 3 STUDY 2: METACOGNITIVE THERAPY IN RECURRENT DEPRESSION - A CASE REPLICATION SERIES IN DENMARK .................................................. 75 3.1 Abstract ............................................................................................................. 75 3.1.1 Background ................................................................................................. 75 3.1.2 Methods ....................................................................................................... 75 3.1.3 Conclusion .................................................................................................. 75 3.2 Introduction ...................................................................................................... 76 3.3 Research question............................................................................................. 79 3.4 Methods ............................................................................................................