Patient motivation and adherence in metacognitive therapy for major depressive disorder: an observational study

Figures & data

Figure 1. Illustration of the utilized coding system (MISC 2.5; Houck et al., 2011). CT and ST scores were summed for each category, as displayed. CT: change talk; ST: sustain talk; +: CT; −: ST. *The variables included in analyses. ¹use of distraction and thought control, which are considered components of the cognitive attentional syndrome in MCT for depression.

Table 1. Sample demographic and diagnostic characteristics at pre-treatment (N = 37).

	n	%
Female	22	59.46
Norwegian ethnicity	34	91.89
College/university degree	18	48.65
Single	14	37.84
Social welfare	11	29.73
Employed (full time)	12	32.43
Employed (part time)	8	21.62
Student	8	21.62
Previously psychiatric outpatient	20	54.05
Previously psychiatric inpatient	3	8.11
Previously psychiatric treatment by general practitioner	28	75.68
Comorbidity
Generalized anxiety disorder	9	24.32
Panic disorder	2	5.41
Social Phobia	1	2.70
Hypochondria	1	2.70
Trichotillomania	1	2.70
Binge eating disorder	1	2.70
Eating disorder not otherwise specified	1	2.70
Personality disorders
Avoidant	3	8.11
Obsessive-compulsive	10	27.03

Estimates above 100% were due to participants filling the criteria for several categories simultaneously. Social welfare: disability benefits, unemployment benefits, and work assessment allowance.

Table 2. Descriptive statistics (N = 37).

	Session 1		Session 4		Session 7
Variable	M	SD	M	SD	M	SD
Change talk	57.03	22.56	41.81	22.67	47.14	20.93
Sustain talk	18.03	7.08	19.38	13.95	28.32	20.01
Taking steps	0.54	1.17	6.19	13.47	2.57	19.06
Commitment	3.08	3.83	6.30	7.02	5.57	5.75
Ability	−3.11	5.94	−0.65	8.72	−2.51	7.87
Reason	14.59	10.58	1.49	6.12	9.86	10.79
Desire	3.03	4.28	2.00	4.26	1.22	2.16
Need	1.78	2.55	0.86	2.65	0.78	2.95
Other	19.32	12.32	6.95	6.91	1.27	2.22
Treatment adherence					3.29	0.51
	BDI
	N	M	SD
Pre-treatment	37	27.41	6.22
Session 1	31	24.06	7.74
Session 4	37	15.51	8.40
Session 7	35	10.74	8.02
Post-treatment	37	5.54	6.47
3-year follow-up raw data	32	6.28	5.52
3-year follow-up expectation-maximization	37	7.00	5.63
3-year follow-up multiple imputation	37	7.04	5.70

BDI: Beck Depression Inventory; EM: Expectation-Maximization algorithm applied to impute missing values; MI: Multiple imputation applied to impute missing values. Motivational strength scores are reported.

Table 3. Predicting depressive symptoms at 3-year follow-up using motivation and adherence (N = 37).

	F	p	R^2adj.	R^2cha.	β	SE	t	p
Model 1
1. BDI pre	10.44	.003	.21	.23**
2. Adherence T7	7.94	.001	.28	.09*
3. Change talk T7	6.18	.002	.30	.04
4. Sustain talk T7	7.69	<.001	.43	.13**
Predictors in final step
BDI pre					.29	0.03	2.12	.042
Adherence T7					.15	0.57	0.72	.476
Change talk T7					−.28	0.01	−1.42	.167
Sustain talk T7					.46	0.01	2.86	.007
Model 2
1. BDI pre	10.44	.003	.21	.23**
2. Adherence T7	7.94	.001	.28	.09*
3. Taking Steps T4	6.30	.002	.30	.05
4. Taking Steps T7	8.01	<.001	.43	.14**
Predictors in final step
BDI pre					.27	0.03	1.96	.059
Adherence T7					.03	0.44	0.19	.852
Taking Steps T4					−.08	0.02	−0.60	.553
Taking Steps T7					−.54	0.01	−2.95	.006

BDI: Beck Depression Inventory. The presented results are based on imputation using expectation-maximization. Results diverged marginally in sensitivity analyses based on raw data (model 1 and 2: R² change was no longer significant for adherence; see supplemental table 5). *p < .05, **p < .01.

Figure 2. Graphs of estimated marginal means of motivational utterances in sessions 1, 4, and 7 for recovered and non-recovered patients. Dependent variable: MISC strength-scores.

Houck, J. M., Moyers, T. B., Miller, W. R., Glynn, L. H., & Hallgren, K. A. (2011). Motivational Interviewing Skill Code (MISC) 2.5. https://casaa.unm.edu/download/misc25.pdf

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Data availability statement

The data that support the findings of this study are available from the corresponding author, ERL, upon reasonable request.