Current developments of metacognitive concepts and their clinical implications: mindfulness-based cognitive therapy for depression
High relapse and recurrence rate of depression put financial pressure on already stretched resources for health care. Therefore, the demand for the development of prophylactic treatments in order to keep patients well, once recovered, has increased during the last decade. The development of a new therapy manual for group interventions, 'Mindfulness-based Cognitive Therapy for Depression' (MBCT), appears to be one of the first major developments in this direction. MBCT represents an adaptation of the mindfulness meditation approach into a group programme for relapse prevention of depression. This paper links the mindfulness approach into current metacognitive concepts and models of emotional disorders by firstly exploring the limitations of Beck's schema theory and then describing a more recent multilevel model (interacting cognitive sub-systems, or ICS) which represents the theoretical foundation for the mindfulness approach. A description of the MBCT manual is followed by looking at the methodological limitations of the mindfulness construct and its implications for future therapeutic interventions. Despite its methodological problems, MBCT appears to be an advanced and cost-efficient approach to prophylactic interventions to prevent recovered depressed patients from relapse. Further developments and methodological testing is still required to give the approach an even more robust foundation.