Metacognitive awareness is one where negative feelings occur as mental actions instead of as a self-aspect. It has been hypothesized that a decrease in Metacognitive awareness causes vulnerability and further depression, and through cognitive therapy (CT) and mindfulness, based cognitive therapy (MBCT), the depressive relapses can be reduced as it increases metacognitive awareness.
This study tests the above hypotheses in three parts. The 1st study investigates whether vulnerability to depression is related to reduction inaccessibility of the metacognitive sets inducing negative thoughts. The 2nd study investigates the depression related to reduction inaccessibility of the metacognitive sets with respect to depression-related cues. The degree to which baseline metacognitive awareness can predict the danger of relapse in depressed patients is also measured. It also determines whether CT can increase the accessibility of the metacognitive sets. The 3rd study examines the psychological interventions, which can reduce relapse and increase metacognitive awareness. If the treatment program is directed towards changing the patient’s relationship with their negative feelings, then it was predicted that this could reduce relapse and increase their metacognitive awareness.
The first study used depressed patients as participants between 20-65 years of age who displayed major depression criteria in the last 18 months, had a minimum residual symptom of eight on the 17-item Hamilton Rating Scale for Depression (HRSD), and nine on the Beck Depression Inventory (BDI). The patients also took antidepressant medication for at least eight weeks, with a daily dose in at least four weeks that was equal to 125 mg of amitryptiline. In the 2nd test, 158 psychiatric patients with major depression received antidepressant medicines, clinical management, and CT group for 20 weeks, while the CT group got an extra 16 CT sessions. Metacognitive awareness was also assessed before the treatment and 20 weeks after it by MACAM. In the 3rd test, 100 patients between 18-65 years from community health care facilities were treated for seven weeks, who were either in recovery from depression or were continuing with treatment. They had to meet the enhanced DSM-III-R criteria and score below ten on the 17-item HRSD.
The HRSD is a 17-item interview, and BDI is a 21-item self-reports both measuring depressive symptoms. The MATLAB or Measure of Awareness and Coping in Autobiographical Memory measures metacognitive awareness. The participants rate their bad feelings from 0-100, with 0 being not bad. The interviewer then rates Metacognitive awareness as 1, minimal discrimination, 2, discrimination of various negative feelings, 3, certain discrimination of self reactions, 4, discrimination of self from own feelings, and 5, extensive or persistent distancing from feelings. MATLAB also has two versions. The first study used only version 1, while the third study received both versions randomly.
The studies concluded that the patients who recovered after being treated for depression by CT showed a lesser chance of relapse and a decreased need for further treatment than those who recovered using antidepressant medicines. It also found that CT reduced the depression relapses in residually depressed patients, whereas MBCT reduced the depression relapses in recovered patients, increasing their accessibility of the Metacognitive sets. The study also found lesser Metacognitive awareness within the memories recalled by the depressed patients to the depression-related cues, which had a high possibility of relapse, than in the memories that were recalled by gender or age-matched, non-depressed controls.
Work Cited
Teasdale, John D. Richard G. Moore, Hazel Hayhurst, Marie Pope, Susan Williams, Zindel V. Segal; “Metacognitive Awareness and Prevention of Relapse in Depression: Empirical Evidence”; Journal of Consulting and Clinical Psychology; 2002, Vol. 70, No. 2, 275–287; American Psychological Association, Inc, 2002.