Metacognitive Training for Depression (D-MCT) compared to computerized cognitive remediation in outpatient care: A randomized controlled trial

Metacognitive Training for Depression (D-MCT) is a low-threshold group treatment, with all materials available at no cost in English and many other languages. The present study investigated the efficacy of D-MCT compared to a cognitive remediation (CR) program in outpatient care and examined moderators of outcome. A total of 84 patients with depression were randomized to D-MCT or a CR program (MyBrainTraining). Depressive symptoms were assessed at baseline (t0), 8 weeks later (t1, post), and 6 months after t1 (t2, follow-up). The Quick Inventory of Depressive Symptomatology (QIDS) served as the primary outcome; secondary outcomes included the Beck Depression Inventory (BDI-II) and the Hamilton Depression Rating Scale (HDRS). Intention-to-treat analyses revealed no differences on any of the parameters. Per protocol analyses showed superiority of the D-MCT compared to CR on the BDI-II after 8 weeks. Patients with a more severe course of depression and a higher number of comorbid disorders benefited more from D-MCT than CR according to moderation analyses. Limitations are possible allegiance effects and the small sample size. The study corroborates prior findings showing the efficacy of both D-MCT and CR in improving depressive symptoms. D-MCT was superior in only one secondary outcome measure. In light of the results, we have made several changes to D-MCT to improve treatment outcomes since the study was conducted, including an app (COGITO; www.uke.de/mct_app ) and a program that specifically targets older people with depression. Trial Registration: ClinicalTrials.gov (# NCT03268434 ). • Metacognitive Training for Depression (D-MCT) was compared to cognitive remediation (CR). • Randomized controlled trial in 84 outpatients • No group differences in intention-to-treat analyses • D-MCT superior on BDI-II in per protocol analysis only • Those with severe depression and comorbid disorders benefited more from D-MCT.