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Metacognitive awareness and prevention of relapse in depression: Empirical evidence
Open accessAbstract
Metacognitive awareness is a cognitive set in which negative thoughts/feelings are experienced as mental events, rather than as the self. The authors hypothesized that (a) reduced metacognitive awareness would be associated with vulnerability to depression and (b) cognitive therapy (CT) and mindfulness-based CT (MBCT) would reduce depressive relapse by increasing metacognitive awareness. They found (a) accessibility of metacognitive sets to depressive cues was less in a vulnerable group (residually depressed patients) than in nondepressed controls; (b) accessibility of metacognitive sets predicted relapse in residually depressed patients; (c) where CT reduced relapse in residually depressed patients, it increased accessibility of metacognitive sets; and (d) where MBCT reduced relapse in recovered depressed patients, it increased accessibility of metacognitive sets. CT and MBCT may reduce relapse by changing relationships to negative thoughts rather than by changing belief in thought content.
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In the citing paper
“Teatment studies have shown that decentering increases across both CBT (Fresco, Segal, Buis, & Kennedy, 2007) and Mindfulness-Based Cognitive Therapy (MBCT; Teasdale et al., 2002) for depression relapse prevention”
From Changes in Decentering Across Cognitive Behavioral Group Therapy for Social Anxiety Disorder (2018) · cites this paper as Teasdale et al., 2002
In the citing paper
“decentering increases across both CBT (Fresco, Segal, Buis, & Kennedy, 2007) and Mindfulness-Based Cognitive Therapy (MBCT; Teasdale et al., 2002) for depression relapse prevention”
From Examining the Interrelation Among Change Processes: Decentering and Anticipatory Processing Across Cognitive Behavioral Therapy for Social Anxiety Disorder. (2019) · cites this paper as Teasdale et al., 2002
In the citing paper
“Teasdale and colleagues (2002) found that MBCT resulted in larger increases in decentering as compared to treatment-as-usual.”
From United we stand: emphasizing commonalities across cognitive-behavioral therapies. (2013) · cites this paper as Teasdale et al., 2002
In the citing paper
“William’s therapist may also talk about how mindfulness, particularly mindfulness exercises directed towards promoting decentering, or the ability to observe thoughts and feelings as objective events rather than personally over-identifying with them (Teasdale, Moore, Hayhurst, Pope, Williams, & Segal, 2002), can help increase willingness.”
From An Acceptance-Based Behavioral Therapy for Individuals With Generalized Anxiety Disorder (2013) · cites this paper as Teasdale, Moore, Hayhurst, Pope, Williams, & Segal, 2002
In the citing paper
“Preliminary evidence suggests that mindfulness training leads to increases in metacognitive awareness (Hargus et al., 2010; Teasdale et al., 2002) and reductions in rumination (Jain et al., 2007; Ramel, Goldin, Carmona, & McQuaid, 2004), and that increased metacognitive awareness, or decentering, may in turn predict better clinical outcomes such as lower rates of depressive relapses (Fresco, Segal”
From Effects of mindfulness on psychological health: A review of empirical studies (2011) · cites this paper as Teasdale et al., 2002
In the citing paper
“Decentering is a metacognitive capacity of individuals to observe items that arise in the mind (e.g., thoughts, feelings, memories, etc.) as mere psychological events (Fresco, Moore, et al., 2007; Fresco, Segal, Buis, & Kennedy, 2007; Teasdale et al., 2002).”
From Change in Decentering Mediates Improvement in Anxiety in Mindfulness-Based Stress Reduction for Generalized Anxiety Disorder (2015) · cites this paper as Teasdale et al., 2002
In the citing paper
“initial research on treatments for depression have shown that Mindfulness-based Stress Reduction (MBSR) and MBCT lead to increases in decentering (Bieling et al., 2012; Teasdale et al., 2002)”
From Decentering as a potential common mechanism across two therapies for generalized anxiety disorder (2015) · cites this paper as Teasdale et al., 2002
In the citing paper
“Adding further support for the consistency of this proposed mechanism, this finding is similar to reported findings on the role of decentering in treatment studies focusing on Mindfulness-Based Stress Reduction and Mindfulness-Based Cognitive Therapy (Bieling et al., 2012; Carmody, Baer, Lykins & Oldendzki, 2009; Teasdale et al., 2002) and Acceptance and Commitment Therapy (Zettle et al., 2011).”
From Decentering as a potential common mechanism across two therapies for generalized anxiety disorder (2015) · cites this paper as Teasdale et al., 2002
In the citing paper
“and empirical research has shown that decentering increases across therapy (e.g., Teasdale et al., 2002).”
From Decentering as a potential common mechanism across two therapies for generalized anxiety disorder (2015) · cites this paper as Teasdale et al., 2002
In the citing paper
“This suggests third-wave behavioural therapies, such as acceptance and commitment therapy (ACT) and mindfulness-based therapy (MBT) may be beneficial55,56.”
From The experience of Anxiety for people with Parkinson’s disease (2023) · cites this paper as [56]
In the citing paper
“One possibility is that an ability to decenter actively protects individuals against, and promotes recovery from, anxiety and depression symptoms7,52–54.”
From Decentering as a core component in the psychological treatment and prevention of youth anxiety and depression: a narrative review and insight report (2021) · cites this paper as [52]
In the citing paper
“In adults seeking treatment for anxiety and depression, medium-large increases in self-rated decentering are reported following CBT (d = 0.7–0.82) (~43 years)52,73, mindfulness-based interventions (d = 0.6–1.01) (34.49–53.30 years)26,52,74–76 and acceptance-based therapies (d = 0.32–1.85) (37.00–46.40 years)73,77–80.”
From Decentering as a core component in the psychological treatment and prevention of youth anxiety and depression: a narrative review and insight report (2021) · cites this paper as [52]
In the citing paper
“In adults experiencing remission from depression, earlier relapse was predicted by baseline difficulties in decentering from recent negative memories (43.7 ± 9.60 years)52.”
From Decentering as a core component in the psychological treatment and prevention of youth anxiety and depression: a narrative review and insight report (2021) · cites this paper as [52]
In the citing paper
“high levels of cognitive fusion at baseline predicted earlier relapse in subjects who had recently suffered from major depression (Teasdale et al., 2002)”
From Psychological variables implied in the therapeutic effect of ayahuasca: A contextual approach (2018) · cites this paper as Teasdale et al., 2002
In the citing paper
“Research examining the effectiveness of cognitive restructuring (CR) has suggested disengaging from one's thoughts while doing CR tasks may actually relate more to the improvements in therapy, rather than changing the content of one's thoughts (Teasdale et al., 2002).”
From Acceptance and commitment therapy for the treatment of music performance anxiety: A pilot study with student vocalists (2017) · cites this paper as Teasdale et al., 2002
In the citing paper
“Indeed, mindfulness training has been associated with increased decentering and metacognitive awareness [44–46].”
From Testing the mindfulness-to-meaning theory: Evidence for mindful positive emotion regulation from a reanalysis of longitudinal data (2017) · cites this paper as [44]
In the citing paper
“Teasdale et al. (2002) found that metacognitive awareness (or decentering; viewing one’s thoughts as mere mental phenomena rather than as reality) increased following CBT and mindfulness-based interventions when therapy was effective in reducing depression relapse.”
From Common Factors of Meditation, Focusing, and Cognitive Behavioral Therapy: Longitudinal Relation of Self-Report Measures to Worry, Depressive, and Obsessive-Compulsive Symptoms Among Nonclinical Students (2015) · cites this paper as Teasdale et al. 2002
In the citing paper
“Decentering, or metacognitive awareness, is considered a core product of mindfulness practice [2], [52] and one of the main objectives of Mindfulness-Based Cognitive Therapy [61].”
In the citing paper
“Enhanced flexibility of thinking and capacity to generate alternative perspectives can be connected to different concepts and types of psychotherapy, e.g. 'metacognition' and 'decentration' for cognitive-behavioural prevention of depression relapse [28,29], and development of 'reflective functioning' in psychoanalytically informed treatment of borderline personality disorder [30].”
From Helpful and hindering factors for remission in dysthymia and panic disorder at 9-year follow-up: A mixed methods study (2008) · cites this paper as [29]
In the citing paper
“Findings indicated that lower levels of baseline metacognitive awareness predicted earlier relapse across both treatment groups.”
From Initial Psychometric Properties of the Experiences Questionnaire: Validation of a Self-Report Measure of Decentering (2007) · cites this paper as Teasdale et al., 2002
In the citing paper
“There was also a larger increase in metacognitive awareness in the cognitive therapy group as compared to the clinical management group.”
From Initial Psychometric Properties of the Experiences Questionnaire: Validation of a Self-Report Measure of Decentering (2007) · cites this paper as Teasdale et al., 2002
In the citing paper
“and predates the recent and extensive interest in the integration of mindfulness and acceptance approaches within psychology (cf. Hayes et al., 1999; Segal et al., 2002; Teasdale et al., 2002).”
From Initial Psychometric Properties of the Experiences Questionnaire: Validation of a Self-Report Measure of Decentering (2007) · cites this paper as Teasdale et al., 2002
In the citing paper
“The neverdepressed group possessed higher metacognitive awareness (Cohen ' s (1988) d =1.08), even after controlling for individual differences in levels of depressive symptoms.”
From Initial Psychometric Properties of the Experiences Questionnaire: Validation of a Self-Report Measure of Decentering (2007) · cites this paper as Teasdale et al., 2002
In the citing paper
“As predicted, MBCT training resulted in larger increases in decentering than TAU, highlighting its potential as a possible mediator.”
From Initial Psychometric Properties of the Experiences Questionnaire: Validation of a Self-Report Measure of Decentering (2007) · cites this paper as Teasdale et al., 2002
In the citing paper
“improve metacognitive awareness among previously depressed adults (Ma and Teasdale 2004; Teasdale et al. 2002)”
From Mindfulness-Based Childbirth and Parenting Education: Promoting Family Mindfulness During the Perinatal Period (2010) · cites this paper as Teasdale et al. 2002
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Metadata
- Authors
- Teasdale, J. D., Moore, R. G., Hayhurst, H., Pope, M., Williams, S., & Segal, Z. V.
- Affiliations
- MRC Cognition and Brain Sciences Unit (GB)
- University of Cambridge (GB)
- Newcastle University (GB)
- Centre for Addiction and Mental Health (CA)
- Venue
- Journal of Consulting and Clinical Psychology
- Published
- 2002
- Volume
- 70
- Issue
- 2
- Pages
- 275-287
- ISSN
- 0022-006X (ISSN-L)
- 1939-2117
- OpenAlex
- W2131833695
- Cited by
- 1,221
- References
- 52
- Citations by year
- 2026: 26 · 2025: 46 · 2024: 34 · 2023: 32 · 2022: 53 · 2021: 62 · 2020: 52 · 2019: 46 · 2018: 59 · 2017: 52 · 2016: 91 · 2015: 82 · 2014: 68 · 2013: 66 · 2012: 77
- FWCI
- 31.70
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- Journal of Consulting and Clinical Psychology (publishedVersion)
- PubMed (publishedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- National Institutes of Health (5r21mh053457-03)
- National Institute of Mental Health (MH53457)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
- Social Sciences › Psychology › Clinical Psychology › Mindfulness and Compassion Interventions
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- metacognitive awareness, depression relapse, depression prevention, cognitive therapy, mindfulness-based cognitive therapy, residual depression, recovered depression, depression vulnerability, negative thinking
- MeSH terms
- Adult, Antidepressive Agents, Awareness, Chronic Disease, Combined Modality Therapy, Major Depressive Disorder, Depressive Disorder, Major, Female, Humans, Internal-External Control, Male, Middle Aged, Recurrence, Self Concept, Set, Psychology, Cognitive Behavioral Therapy
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