Evaluating the Effect of Metacognitive Training (MCT-Silver) as a Community-Based Program on Outcomes of Depressive Symptoms in Older Adults

MCT-Silver is a psychotherapeutic approach aimed to reduce depressive symptoms and improving thinking styles commonly associated with depression in older adults. MCT-Silver takes an educational approach, helping participants gain (metacognitive) distance from the cognitive biases and thinking styles thought to underlie the maintenance of depression, with particular focus on later-life experiences and symptomatology (i.e., geriatric depression). MCT-Silver is run via videoconferencing with 8 x 1 hour sessions, bi-weekly (i.e., 2 sessions per week). Participants complete each session from home with a facilitator videoconferencing remotely. Attendance to sessions is recorded for each participant. Facilitators have at least an honours degree in psychology and undergo a six hour online training certification at least 2 weeks prior to their first session, to facilitate MCT-Silver via a manualised structure. MCT-Silver consists of 8 modules, each explaining either a cognitive bias associated with depression (mental filters, black and white thinking, magnification/ minimisation, rumination/ withdrawal, jumping to conclusions) or a common ageing experience (memory, values, self-esteem). The fundamental components of all modules are 1) an educational summary, 2) a demonstration of the negative consequences of the cognitive bias via examples and exercises, and 3) participants are offered an alternative thinking strategy which they practice in-session, using their own example. Each module follows this stepped approach that is guided by a facilitator and ends with a summary of learning points. Examples of exercises undertaken by participants include being asked to describe a situation they'd used an unhelpful cognitive bias, what was it in their behaviour/ situation that hints towards that cognitive bias, and what an alternative thought/ action may be. Other examples include brainstorming daily activities enjoyed by the participants and what values reflect that activity, and drawing a picture of how they view themselves vs drawing a picture of their ideal self. Each session has a presentation that is screen-shared for the participant to follow and provides a summary of the information presented by the facilitator, instructions for activities and reference points to the workbook. A workbook is provided to participants that further explains and accompanies the information provided by the facilitator in-session. The workbook is used in-session where participants follow the demonstrations mirroring the on-screen content and complete the exercises. The workbook used in this study is an adaptation of the workbook used in the parent study by Schneider et al. (2018) (see public notes). The original workbook can be sourced at https://clinical-neuropsychology.de/metacognitive-training-for-depression-mct-silver/ . The workbook has been adapted and re-designed specifically for this study. MCT-Silver is adapted to be run individually (participant + facilitator), or in small groups (3-4 participants + facilitator). Participants are given the choice of delivery preference and discuss this option with a facilitator prior to undertaking the program. MCT-Silver is also adapted such that sessions do not need to be run on the same day/ time each week, as long as 2 sessions per week is adhered to.