Metacognitive therapy in recurrent depression: a case replication series in Denmark.

Metacognitive therapy (MCT) for depression is derived from the Wells and Matthews (1994) self-regulatory model, in which a Cognitive-Attentional Syndrome (CAS) is the cause of psychological disorders. MCT for depression focuses on identifying patients' CAS and helps them to stop it. The CAS consists of worry, rumination and dysfunctional coping strategies. The focus in MCT is on removing the CAS by challenging positive and negative metacognitive beliefs and eliminating dysfunctional behaviors. In this case series, MCT was delivered to four depressed Danes and treatment was evaluated in 5-11 sessions of up to one hour each. An A-B design with follow-up at 3 and 6 months was conducted and the primary outcome was Beck's Depression Inventory II (BDI-II). We measured CAS processes with the Major depressive Disorder Scale (MDD-S). The results of the case series showed clinically significant improvements in depressive symptoms, rumination and metacognitive beliefs and the effects were still present at follow-up for all patients. The small number of patients and decreasing baselines observed in some cases limits the conclusions. However, the results suggest that this treatment is feasible and was associated with large improvements in symptoms when delivered away from its point of origin and in a Danish help-seeking sample.