Frontiers | Metacognitive Therapy for Depression in Adults: A Waiting List Randomized Controlled Trial with Six Months Follow-Up | PsychologyA new treatment approach to depression that has produced encouraging results is metacognitive therapy (MCT; Wells, 2009). This approach is based on the metacognitive model where psychological disorder results from an inflexible and maladaptive response pattern to cognitive events labeled the Cognitive Attentional Syndrome (CAS; Wells, 2000; Wells and Matthews, 1994, 1996). The CAS consists of persistent worry and rumination, threat monitoring and ineffective coping strategies that contribute to the maintenance of emotional disorder. Rumination in depression is seen as a coping strategy which follows an initial negative thought labeled a ‘trigger thought’. The depressed individual engages in rumination consisting of repeatedly analyzing negative feelings, past failures and mistakes. Depression is therefore understood as an extension of low mood resulting from a problem of overthinking (e.g., worry and rumination) and withdrawal of active coping. (e.g., social withdrawal and reduction in activity). According to the metacognitive model of depression, rumination and worry is maintained by metacognitions and not by changes in mood or events. Further, this response to triggers extends negative thinking, leads to reduced attentional flexibility and involves a failure to exercise appropriate control over negative affective experiences (Wells, 2009). According to the metacognitive model metacognitive beliefs control, monitor and appraise the CAS (Wells, 2009). There are both positive and negative metacognitive beliefs. Positive metacognitions are concerned with the benefits of worry and rumination, while negative metacognitions are concerned with the uncontrollability and danger of thoughts. Positive metacognitions related to depression may be exemplified by statements like: “Analyzing the causes of my sadness will give me an answer to the problem”, and “Thinking the worst will make me snap out of it”. Such positive metacognitive beliefs lead to repeated and/or prolonged engagement in ruminative thinking. Negative metacognitions are activated as the rumination process leads to distress and/or as a result of what the individual learns about depression. Examples of negative metacognitions are: “I can’t control my thinking”, “My thoughts are caused by my defective brain”, “Sleeping more will sort out my mind”. and “Thinking like this means I could have a mental breakdown”. Negative metacognitions lead to more distress and to unhelpful behaviors that reduce effective coping.