Ending the cycle of negative thought rumination is the premise of a depression treatment called metacognitive therapy. New findings suggest that it may be more beneficial in stopping depression relapse than other more commonly used methods.

Depression is a huge global health issue. As the leading cause of disability in the United States for those between the ages of 15 and 44 years, it has a significant effect on individuals and society as a whole.

With more than 300 million people currently living with depression, finding a long lasting treatment is vital. Unfortunately, relapses are common.

Treatments, which include cognitive behavioral therapy (CBT) and medication, can work well in the short term, but many people's symptoms return either within a few months or later on in life.

In fact, only about 30% of people with depression have not relapsed 18 months after the end of their treatment.

The findings of the new study, which features in Frontiers in Psychology, provide early evidence of the benefits of metacognitive therapy.

Not only is recovery more likely using this treatment method, according to the authors, but people may find it less taxing.

Learning not to ruminate

While CBT requires a person to delve into their previous worries, metacognitive therapy teaches people not to concentrate on negative thoughts.

"Most of us have negative thoughts; we think we're not good enough, or we don't accomplish what we want to," explains Prof. Odin Hjemdal, who works in the department of psychology at Norwegian University of Science and Technology in Trondheim.

"But only [a] few people get clinically depressed because most of us can put aside our repeating thoughts, rather than getting stuck in them."

"What perpetuates depression," he adds, "is that you get stuck in a thought pattern and ruminate about the same thing over and over."

By becoming aware of this process, people can choose a different and less damaging path to tread.

Significant improvements

In the study, the researchers offered 39 participants with major depression 10 sessions of metacognitive therapy.

They then divided the participants into two groups. The participants in the first group received metacognitive therapy immediately, whereas those in the second group had to wait 10 weeks to begin treatment.

During this waiting period, two people dropped out. A total of 34 participants took part in a follow-up assessment a year later, which involved filling out a questionnaire at home.

The assessment showed that 1 year after metacognitive therapy, the team still classified between 67% and 73% of the participants as recovered.

Different measuring techniques — one taking into account all of the original participants and the other one only analyzing those who completed the questionnaire — provided the two different percentages.

The researchers also noted significant recovery among those with severe symptoms. Of those with severe depression, 79% had recovered at the follow-up, compared with 60% of those with moderate depression.

Only 15% of the participants had seen no change a year after treatment, while just 13% of recovered individuals had relapsed within the year.

The rest saw some signs of improvement. There was also a notable reduction in anxiety among the overall group.

What we still do not know

"We're a little surprised, but we're really happy that it's turned out this way," says Prof. Hjemdal. "To us, it seems that when patients crack the code and manage to change their thinking styles and patterns, they stay healthy."

"But," he adds, "there's still more we need to know." For example, researchers will need to study the long term effects of metacognitive therapy and compare it with other available treatments, as well as ensuring that diagnostic criteria are in place for follow-up assessments.

Although the study included an almost equal number of men and women (59% of the participants were female), its small sample size means that larger scale studies are necessary before scientists can form any strong conclusions.

Despite all this, Prof. Hjemdal believes that "[a]s a society, we could save a lot of money and spare people a lot of personal suffering if we provide metacognitive therapy treatment to help individuals with depression."