Document Type : Original Article
Authors
Department of Epidemiology and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract
BACKGROUND: Metacognitive therapy (MCT) is a new psychotherapy for depression. This
study was conducted to compare the effectiveness of citalopram and MCT on major depressive
disorders (MDDs).
MATERIALS AND METHODS: A total of 36 patients with MDD were randomly assigned into three
groups of citalopram (n = 12), MCT (n = 16), and control (n = 8). MCT group received ten sessions
of metacognition therapy. Citalopram group received 20–40 mg citalopram, and the control group
did not receive any interventions. Outcomes were measured using the Beck Depression Inventory‑II,
Metacognition Questionnaire‑30, and Cognitive‑Emotion Regulation (CER) Questionnaire. Data were
analyzed with ANCOVA using SPSS version 18.
RESULTS: Depression score reduction was significant in both citalopram and metacognitive
groups (P < 0.05). However, there was only a statistically significant difference between MCT and
control group in CER and metacognition.
CONCLUSION: MCT and citalopram both are effective in symptom reduction in MDD. Furthermore,
MCT could lead to more improvement in metacognition, depression symptoms, and CER than
citalopram, when treating MDDs.
Keywords
1. World Health Organization. World Health Organization
Depression Fact Sheet No. 369. World Health Organization; 2012.
2. Sharifi V, Amin‑Esmaeili M, Hajebi A, Motevalian A,
Radgoodarzi R, Hefazi M, et al. Twelve‑month prevalence and
correlates of psychiatric disorders in Iran: The Iranian mental
health survey, 2011. Arch Iran Med 2015;18:76‑84.
3. Joormann J, Gotlib IH. Emotion regulation in depression: Relation
to cognitive inhibition. Cogn Emot 2010;24:281‑98.
4. Calkins SD. Commentary: Conceptual and methodological
challenges to the study of emotion regulation and psychopathology.
J Psychopathol Behav Assess 2010;32:92‑5.
5. Garnefski N, Kraaij V. Specificity of relations between adolescents’
cognitive emotion regulation strategies and symptoms of
depression and anxiety. Cogn Emot 2018;32:1401‑8.
6. Campbell‑Sills, L., and Barlow, D. H. (2007). Incorporating
Emotion Regulation into Conceptualizations and Treatments of
Anxiety and Mood Disorders. In J. J. Gross (Ed.), Handbook of
Emotion Regulation (pp. 542‑559). New York: Guilford Press.
disorder
7. Garnefski N, Kraaij V, Spinhoven P. Negative life events, cognitive
emotion regulation and emotional problems. Pers Individ Dif
2001;30:1311‑27.
8. Kraaij V, Garnefski N, Schroevers MJ. Coping, goal adjustment,
and positive and negative affect in definitive infertility. J Health
Psychol 2009;14:18‑26.
9. Garnefski N, Kraaij V. Specificity of relations between adolescents’
cognitive emotion regulation strategies and symptoms of
depression and anxiety. Cogn Emot 2016;32 (7):1401‑1408.
10. Liu Q, He H, Yang J, Feng X, Zhao F, Lyu J, et al. Changes in the
global burden of depression from 1990 to 2017: Findings from
the global burden of disease study. J Psychiatr Res 2019. pii:
S0022‑3956(19)30738‑1.
11. Hiroi S, Yamabe K, Inoue S, Kobayashi M. Study on
cost‑effectiveness analysis for treatment of major depression
disease: A systematic review of literature from 2004‑2014 value
in health. J Int Soc Pharmacoecon Outcomes Res 2015;18:A410.
12. Parker GB, Crawford J, Hadzi‑Pavlovic D. Quantified superiority
of cognitive behaviour therapy to antidepressant drugs:
A challenge to an earlier meta‑analysis. Acta Psychiatr Scand
2008;118:91‑7.
13. RushAJ, TrivediMH, Wisniewski SR, Nierenberg AA, StewartJW,
Warden D, et al. Acute and longer‑term outcomes in depressed
outpatients requiring one or several treatment steps: A STAR*D report. Am J Psychiatry 2006;163:1905‑17.
14. Apler A. Citalopram for major depressive disorder in
adults: A systematic review and meta‑analysis of published
placebo‑controlled trials. BMJ Open 2011;1:e000106.
15. Cuijpers P. The challenges of improving treatments for depression.
JAMA 2018;320:2529‑30.
16. Wells A, Fisher P, Myers S, Wheatley J, Patel T, Brewin CR.
Metacognitive therapy in recurrent and persistent depression:
A multiple‑baseline study of a new treatment. Cognit Ther Res
2009;33:291‑300.
17. Hagen R, Hjemdal O, Solem S, Kennair LE, Nordahl HM, Fisher P,
et al. Metacognitive therapy for depression in adults: A waiting
list randomized controlled trial with six months follow‑up. Front
Psychol 2017;8:31.
18. Callesen P, Jensen AB, Wells A. Metacognitive therapy in recurrent
depression: A case replication series in Denmark. Scand J Psychol
2014;55:60‑4.
19. Wells A, Fisher P, Myers S, Wheatley J, Patel T, Brewin CR.
Metacognitive therapy in treatment‑resistant depression:
A platform trial. Behav Res Ther 2012;50:367‑73.
20. Nordahl H, Nordahl HM, Vogel PA, Wells A. Explaining
depression symptoms in patients with social anxiety disorder:
Do maladaptive metacognitive beliefs play a role? Clin Psychol
Psychother 2018;25:457‑64.
21. Simmons KL, Smith JA, Bobb KA, Liles LL. Adjustment to
colostomy: Stoma acceptance, stoma care self‑efficacy and
interpersonal relationships. J Adv Nurs 2007;60:627‑35.
22. Yılmaz AE, Gençöz T, Wells A. The temporal precedence of
metacognition in the development of anxiety and depression
symptoms in the context of life‑stress: A prospective study.
J Anxiety Disord 2011;25:389‑96.
23. Normann N, van Emmerik AA, Morina N. The efficacy of
metacognitive therapy for anxiety and depression: Ameta‑analytic
review. Depress Anxiety 2014;31:402‑11.
24. Jordan J, Carter JD, McIntosh VV, Fernando K, Frampton CM,
Porter RJ, et al. Metacognitive therapy versus cognitive
behavioural therapy for depression: A randomized pilot study.
Aust N Z J Psychiatry 2014;48:932‑43.
25. Dammen T, Papageorgiou C, Wells A. An open trial of group
metacognitive therapy for depression in norway. Nord J
Psychiatry 2015;69:126‑31.
26. Norman N, Van emerrik AAP, Morina N. The efficacy of meta
cognitive therapy for anxiety and depression: A meta analytic
review. Depression and anxiety 2014;31:402-11.
27. Groves SJ, Porter RJ, Jordan J, Knight R, Carter JD, McIntosh VV,
et al. Changes in neuropsychological function after treatment
with metacognitive therapy or cognitive behavior therapy for
depression. Depress Anxiety 2015;32:437‑44.
28. Nordahl HM. Effectiveness of brief metacognitive therapy versus
cognitive‑behavioral therapy in a general outpatient setting. Int J
Cognit Ther 2009;2:152‑9.
29. Stefan‑Dabson K, Mohammadkhani P, Massah‑Choulabi O.
Psychometrics characteristic of beck depression inventory‑II in
patients with magor depressive disorder. Arch Rehabil 2007;8:82.
30. Dargahian R, Mohammadkhani S, Hasani J. The efficacy of
metacognitive therapy on depression symptoms reduction,
cognitive attentional syndrome components and maladaptive
coping styles in patients with major depression. Neurosci J
Shefaye Khatam 2014;2:45‑52.
31. Li L, Li S, Wang Y, Yang Y, Zhu X. Factor structure and
measurement invariance for the Cognitive Emotion Regulation
Questionnaire (CERQ) among women newly diagnosed with
breast cancer. Front Psychol 2019;10:1132.
32. Abdi S, Taban S, Ghaemian A. Cognitive emotion regulation
questionnaire: Validity and reliability of Persian translation of
CERQ‑36 item. Procedia Soc Behav Sci 2012;32 Suppl C:2‑7.
33. Gertsik L, Poland RE, Bresee C, Rapaport MH. Omega‑3 fatty acid
augmentation of citalopram treatment for patients with major
depressive disorder. J Clin Psychopharmacol 2012;32:61‑4.
34. Nazari H, Saki M, Sohrabi P, Tarrahi M, Movahedi M,
Badrizadeh A. Comparing the efficacy and adverse effects
of citalopram with nortriptylinee in the treatment of major
depressive disorder. Yafteh 2007;9:21‑7.
35. Hjemdal O, Hagen R, Solem S, Nordahl H, Kennair LE, Ryum T,
et al. Metacognitive therapy in major depression: An open trial
of comorbid cases. Cognit Behav Pract 2017;24 (3):312‑318.
36. Reynolds M, Wells A . T h e t h o u g h t c o n t r o l
questionnaire – Psychometric properties in a clinical sample,
and relationships with PTSD and depression. Psychol Med
1999;29:1089‑99.
37. Zemestani M, Davoudi I, Mehrabizade M, Zargar Y. Effectiveness
of group behavior activation on depression, anxiety and
rumination in patients with depression and anxiety. J Clinic
Psychol 2014;5:73‑84.
38. Aldao A, Nolen‑Hoeksema S. Specificity of cognitive emotion
regulation strategies: A transdiagnostic examination. Behav Res
Ther 2010;48:974‑83.
39. Watkins ER, Mullan E, Wingrove J, Rimes K, Steiner H,
Bathurst N, et al. Rumination‑focused cognitive‑behavioural
therapy for residual depression: Phase II randomised controlled
trial. Br J Psychiatry 2011;199:317‑22.
40. Nolen‑Hoeksema S, Stice E, Wade E, Bohon C. Reciprocal
relations between rumination and bulimic, substance abuse, and
depressive symptoms in female adolescents. J Abnorm Psychol
2007;116:198‑207.
41. Wells A, Matthews G. Attention and Emotion: A Clinical
Perspective. Hove, UK: Erlbaum/Psychology Press; 1994.
42. Wells A, Matthews G. Modelling cognition in emotional disorder:
The S‑REF model. Behav Res Ther 1996;34:881‑8.
43. Wells A. Advances in metacognitive therapy. Int J Cognit Ther
2013;6:186‑201.
44. Wells A. Metacognitive Therapy for Anxiety and Depression.
New York The Guilford Press A Division of Guilford Publications,
2009.
Depression Fact Sheet No. 369. World Health Organization; 2012.
2. Sharifi V, Amin‑Esmaeili M, Hajebi A, Motevalian A,
Radgoodarzi R, Hefazi M, et al. Twelve‑month prevalence and
correlates of psychiatric disorders in Iran: The Iranian mental
health survey, 2011. Arch Iran Med 2015;18:76‑84.
3. Joormann J, Gotlib IH. Emotion regulation in depression: Relation
to cognitive inhibition. Cogn Emot 2010;24:281‑98.
4. Calkins SD. Commentary: Conceptual and methodological
challenges to the study of emotion regulation and psychopathology.
J Psychopathol Behav Assess 2010;32:92‑5.
5. Garnefski N, Kraaij V. Specificity of relations between adolescents’
cognitive emotion regulation strategies and symptoms of
depression and anxiety. Cogn Emot 2018;32:1401‑8.
6. Campbell‑Sills, L., and Barlow, D. H. (2007). Incorporating
Emotion Regulation into Conceptualizations and Treatments of
Anxiety and Mood Disorders. In J. J. Gross (Ed.), Handbook of
Emotion Regulation (pp. 542‑559). New York: Guilford Press.
disorder
7. Garnefski N, Kraaij V, Spinhoven P. Negative life events, cognitive
emotion regulation and emotional problems. Pers Individ Dif
2001;30:1311‑27.
8. Kraaij V, Garnefski N, Schroevers MJ. Coping, goal adjustment,
and positive and negative affect in definitive infertility. J Health
Psychol 2009;14:18‑26.
9. Garnefski N, Kraaij V. Specificity of relations between adolescents’
cognitive emotion regulation strategies and symptoms of
depression and anxiety. Cogn Emot 2016;32 (7):1401‑1408.
10. Liu Q, He H, Yang J, Feng X, Zhao F, Lyu J, et al. Changes in the
global burden of depression from 1990 to 2017: Findings from
the global burden of disease study. J Psychiatr Res 2019. pii:
S0022‑3956(19)30738‑1.
11. Hiroi S, Yamabe K, Inoue S, Kobayashi M. Study on
cost‑effectiveness analysis for treatment of major depression
disease: A systematic review of literature from 2004‑2014 value
in health. J Int Soc Pharmacoecon Outcomes Res 2015;18:A410.
12. Parker GB, Crawford J, Hadzi‑Pavlovic D. Quantified superiority
of cognitive behaviour therapy to antidepressant drugs:
A challenge to an earlier meta‑analysis. Acta Psychiatr Scand
2008;118:91‑7.
13. RushAJ, TrivediMH, Wisniewski SR, Nierenberg AA, StewartJW,
Warden D, et al. Acute and longer‑term outcomes in depressed
outpatients requiring one or several treatment steps: A STAR*D report. Am J Psychiatry 2006;163:1905‑17.
14. Apler A. Citalopram for major depressive disorder in
adults: A systematic review and meta‑analysis of published
placebo‑controlled trials. BMJ Open 2011;1:e000106.
15. Cuijpers P. The challenges of improving treatments for depression.
JAMA 2018;320:2529‑30.
16. Wells A, Fisher P, Myers S, Wheatley J, Patel T, Brewin CR.
Metacognitive therapy in recurrent and persistent depression:
A multiple‑baseline study of a new treatment. Cognit Ther Res
2009;33:291‑300.
17. Hagen R, Hjemdal O, Solem S, Kennair LE, Nordahl HM, Fisher P,
et al. Metacognitive therapy for depression in adults: A waiting
list randomized controlled trial with six months follow‑up. Front
Psychol 2017;8:31.
18. Callesen P, Jensen AB, Wells A. Metacognitive therapy in recurrent
depression: A case replication series in Denmark. Scand J Psychol
2014;55:60‑4.
19. Wells A, Fisher P, Myers S, Wheatley J, Patel T, Brewin CR.
Metacognitive therapy in treatment‑resistant depression:
A platform trial. Behav Res Ther 2012;50:367‑73.
20. Nordahl H, Nordahl HM, Vogel PA, Wells A. Explaining
depression symptoms in patients with social anxiety disorder:
Do maladaptive metacognitive beliefs play a role? Clin Psychol
Psychother 2018;25:457‑64.
21. Simmons KL, Smith JA, Bobb KA, Liles LL. Adjustment to
colostomy: Stoma acceptance, stoma care self‑efficacy and
interpersonal relationships. J Adv Nurs 2007;60:627‑35.
22. Yılmaz AE, Gençöz T, Wells A. The temporal precedence of
metacognition in the development of anxiety and depression
symptoms in the context of life‑stress: A prospective study.
J Anxiety Disord 2011;25:389‑96.
23. Normann N, van Emmerik AA, Morina N. The efficacy of
metacognitive therapy for anxiety and depression: Ameta‑analytic
review. Depress Anxiety 2014;31:402‑11.
24. Jordan J, Carter JD, McIntosh VV, Fernando K, Frampton CM,
Porter RJ, et al. Metacognitive therapy versus cognitive
behavioural therapy for depression: A randomized pilot study.
Aust N Z J Psychiatry 2014;48:932‑43.
25. Dammen T, Papageorgiou C, Wells A. An open trial of group
metacognitive therapy for depression in norway. Nord J
Psychiatry 2015;69:126‑31.
26. Norman N, Van emerrik AAP, Morina N. The efficacy of meta
cognitive therapy for anxiety and depression: A meta analytic
review. Depression and anxiety 2014;31:402-11.
27. Groves SJ, Porter RJ, Jordan J, Knight R, Carter JD, McIntosh VV,
et al. Changes in neuropsychological function after treatment
with metacognitive therapy or cognitive behavior therapy for
depression. Depress Anxiety 2015;32:437‑44.
28. Nordahl HM. Effectiveness of brief metacognitive therapy versus
cognitive‑behavioral therapy in a general outpatient setting. Int J
Cognit Ther 2009;2:152‑9.
29. Stefan‑Dabson K, Mohammadkhani P, Massah‑Choulabi O.
Psychometrics characteristic of beck depression inventory‑II in
patients with magor depressive disorder. Arch Rehabil 2007;8:82.
30. Dargahian R, Mohammadkhani S, Hasani J. The efficacy of
metacognitive therapy on depression symptoms reduction,
cognitive attentional syndrome components and maladaptive
coping styles in patients with major depression. Neurosci J
Shefaye Khatam 2014;2:45‑52.
31. Li L, Li S, Wang Y, Yang Y, Zhu X. Factor structure and
measurement invariance for the Cognitive Emotion Regulation
Questionnaire (CERQ) among women newly diagnosed with
breast cancer. Front Psychol 2019;10:1132.
32. Abdi S, Taban S, Ghaemian A. Cognitive emotion regulation
questionnaire: Validity and reliability of Persian translation of
CERQ‑36 item. Procedia Soc Behav Sci 2012;32 Suppl C:2‑7.
33. Gertsik L, Poland RE, Bresee C, Rapaport MH. Omega‑3 fatty acid
augmentation of citalopram treatment for patients with major
depressive disorder. J Clin Psychopharmacol 2012;32:61‑4.
34. Nazari H, Saki M, Sohrabi P, Tarrahi M, Movahedi M,
Badrizadeh A. Comparing the efficacy and adverse effects
of citalopram with nortriptylinee in the treatment of major
depressive disorder. Yafteh 2007;9:21‑7.
35. Hjemdal O, Hagen R, Solem S, Nordahl H, Kennair LE, Ryum T,
et al. Metacognitive therapy in major depression: An open trial
of comorbid cases. Cognit Behav Pract 2017;24 (3):312‑318.
36. Reynolds M, Wells A . T h e t h o u g h t c o n t r o l
questionnaire – Psychometric properties in a clinical sample,
and relationships with PTSD and depression. Psychol Med
1999;29:1089‑99.
37. Zemestani M, Davoudi I, Mehrabizade M, Zargar Y. Effectiveness
of group behavior activation on depression, anxiety and
rumination in patients with depression and anxiety. J Clinic
Psychol 2014;5:73‑84.
38. Aldao A, Nolen‑Hoeksema S. Specificity of cognitive emotion
regulation strategies: A transdiagnostic examination. Behav Res
Ther 2010;48:974‑83.
39. Watkins ER, Mullan E, Wingrove J, Rimes K, Steiner H,
Bathurst N, et al. Rumination‑focused cognitive‑behavioural
therapy for residual depression: Phase II randomised controlled
trial. Br J Psychiatry 2011;199:317‑22.
40. Nolen‑Hoeksema S, Stice E, Wade E, Bohon C. Reciprocal
relations between rumination and bulimic, substance abuse, and
depressive symptoms in female adolescents. J Abnorm Psychol
2007;116:198‑207.
41. Wells A, Matthews G. Attention and Emotion: A Clinical
Perspective. Hove, UK: Erlbaum/Psychology Press; 1994.
42. Wells A, Matthews G. Modelling cognition in emotional disorder:
The S‑REF model. Behav Res Ther 1996;34:881‑8.
43. Wells A. Advances in metacognitive therapy. Int J Cognit Ther
2013;6:186‑201.
44. Wells A. Metacognitive Therapy for Anxiety and Depression.
New York The Guilford Press A Division of Guilford Publications,
2009.
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