Abstract
Background & Objectives: Major depressive disorder (MDD) is the classic condition within the group of mood disorders and is considered one of the most common psychiatric illnesses. In many cases, depression is a recurrent or chronic condition, and the presence of previous depressive episodes can predict future relapses. Improving the outcomes of depression treatment is highly important, as fewer than one–third of patients achieve remission after treatment, and the relapse rate is estimated to be 50% within 2 years. Given the moderate initial response to treatment and the high rate of relapse after therapy, there is a pressing need to develop treatments with more rapid and lasting effects. Metacognitive therapy of depression can be effective in treating depression by affecting metacognitive knowledge and metacognitive beliefs that feed rumination and cognitive–attentional syndrome, as well as emotionally–focused therapy by adjusting or changing emotions can affect patients' narratives. Therefore, the present study compared the effectiveness of metacognitive therapy and emotion–focused therapy on mood, early maladaptive schemas, and relapse in people with MDD.
Methods: The current research design was quasi–experimental, with a pretest–posttest and 3–month follow–up, and a control group. The statistical population included all depressed people who referred to counseling and psychotherapy centers in Gachsaran City, Iran. Of whom, 51 eligible volunteer patients were randomly assigned to two intervention groups and one control group (17 people in each group) using a random number table. The experimental groups include the metacognitive therapy group and the emotionally–focused therapy group; each group had 17 people with symptoms and signs of MDD, and the control group was the same as the experimental groups and had signs and symptoms of MDD. The inclusion criteria for the subjects in the research were as follows: a minimum age of 18 years; at least having a third year of middle school (cycle); having diagnosed with MDD in a clinical interview by both a psychiatrist and a clinical psychologist; lacking any psychiatric diagnoses other than MDD, not using substance or dependence, not having immediate suicide risk or psychosis; no psychological disorders co–occurring with MDD; and no specific medical disorders, such as hypothyroidism, hyperthyroidism, or other medical conditions that cause major psychological symptoms and signs. Exclusion criteria for the research subjects were unwillingness to continue cooperating at any stage of the study and use of any other psychotherapy or counseling services during the study. In this research, metacognitive therapy for depression was performed in eight 45–minute sessions, and emotionally–focused therapy in eight 1–hour sessions. The research tools include the Beck Depression Inventory–II (Beck et al., 1996), the Difficulty Emotion Regulation Scale (Gratz & Roemer, 2004), the Positive metacognitive Beliefs Scale (Papageorgiou &Wells, 2001), the Positive and Negative Beliefs about Rumination Scales (Papageorgiou & Wells, 2001), and the Young Schemas Questionnaire–Short Form (Young, 1998). They were implanted in all sample subjects under almost identical, controlled conditions during the pretest, posttest, and 3–month follow–up. The data were analyzed using 1–way analysis of variance, repeated–measures analysis of variance, and the Bonferroni post hoc test at a significance level of 0.05 using SPSS software version 21.
Results: At posttest and follow–up, the treatment groups (metacognitive therapy and emotionally–focused therapy) showed improvement in depressive symptoms and signs compared with the control group (p<0.001). Also, the improvement in depressive symptoms and signs was greater in emotionally–focused therapy compared to metacognitive therapy, and the difference was significant (p<0.001). At posttest, the interventions of the treatment groups had a significant effect on reducing early maladaptive schemas compared to the control group. The reduction in early maladaptive schemas in emotionally–focused therapy was greater than in metacognitive therapy, and the difference was significant (p<0.001). At follow–up, metacognitive therapy (p=0.002) and emotionally–focused therapy (p<0.001) had a significant effect on reducing early maladaptive schemas compared to the control group, and the reduction in early maladaptive schemas in emotionally–focused therapy was greater than in metacognitive therapy, with the difference significant (p<0.001).
Conclusion: The results show that metacognitive and emotionally–focused therapies reduce the signs and symptoms of depression and early maladaptive schemas. However, the emotionally–focused therapy showed a greater reduction and a lower degree of relapse than metacognitive therapy.