Denkverzerrungen erkennen und korrigieren: Eine Machbarkeitsstudie zum Metakognitiven Training bei Depression (D-MKT)
Abstract
Dysfunktionalen kognitiven Strategien und Verzerrungen wird eine wichtige Rolle bei der Entstehung und Aufrechterhaltung von Depression zugeschrieben. Diese beziehen sich einerseits auf die in der kognitiven Verhaltenstherapie aufgegriffenen «Denkfehler» (z. B. übertriebene Verallgemeinerung), aber auch auf depressionstypische Verzerrungen, die im Rahmen der neuropsychologischen Grundlagenforschung objektiviert wurden (z. B. Gedächtnispräferenz für negatives Material). Letztere werden in bestehenden psychotherapeutischen Behandlungsangeboten jedoch bislang kaum berücksichtigt. Das Metakognitive Training bei Depression (D-MKT) beabsichtigt diese Lücke zu schließen. Ziel der vorliegenden Pilotstudie war es, die Machbarkeit und Akzeptanz sowie die Effektivität dieses Behandlungsansatzes als Gruppentraining zu evaluieren. Insgesamt 104 Patienten mit Depression nahmen an einer offenen Studie teil, von denen 72 in einer per protocol Analyse berücksichtigt werden konnten. Neben soziodemographischen Daten wurden die depressive Symptomatik, der Selbstwert, das Grübeln sowie allgemeine und depressionstypische Denkverzerrungen über Selbstbeurteilungsinstrumente erfasst. Subjektive Bewertungen durch die Patienten sowie etwaige inhaltliche Redundanzen mit anderen therapeutischen Angeboten wurden zusätzlich erfragt. In der Auswertung zeigte sich eine signifikante Abnahme der depressiven Symptomatik mit mittlerer Effektstärke (Cohen's d = 0.73). Außerdem ergaben sich eine signifikante Abnahme der Denkverzerrungen und des Grübelns sowie eine signifikante Zunahme des Selbstwertes (Effektstärken zwischen d = 0.32 und 0.64). Die Machbarkeit, Akzeptanz und Effektivität des D-MKT ist nach den Ergebnissen der Pilotstudie als positiv zu bewerten.
Dysfunctional beliefs and cognitive biases play an important role in the formation and maintenance of depression according to current cognitive theories. These refer to ‘thinking errors’ as conceptualized in cognitive behavioural interventions (e. g., over-generalization), but also to depression-specific, cognitive biases as identified by basic research (e. g., mood-congruent recall). The latter is hardly picked up by existing treatment approaches. The Metacognitive Training for Depression (D-MCT) was designed to fill this gap. Aim of the current pilot study was to investigate the feasibility, acceptance, as well as outcome of the treatment program. One hundred and four patients with depression participated in an open-label pilot study. Per protocol analysis included 72 patients. Sociodemographic data, depressive symptoms, self-esteem, rumination, as well as general metacognitive and depression-specific cognitive biases were assessed by a range of self-rating instruments. Subjective appraisal of the training as well as potential overlap with other treatments regarding content was additionally inquired. Analyses revealed a significant decrease of depressive symptoms with a medium effect (Cohen's d = 0.73). Moreover, cognitive biases and rumination were significantly reduced and self-esteem was increased at the same time (with effect sizes between d = 0.32 and 0.64). According to the results of the present pilot study, the D-MCT represents a promising new group treatment in terms of feasibility, acceptance, and outcome.
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