Comparison of the Effectiveness of Metacognitive Therapy and Behavioral Activation on Executive Functions of Elderly People with Type 2 Diabetes

Document Type : Original Article


1 Department of Psychology, Semnan Branch, Islamic Azad University, Semnan, Iran.

2 Department of Psychology, Faculty of Psychology, Allameh Tabataba'i University, Tehran, Iran.


Background: Diabetes mellitus is a metabolic disorder in the body whose prevalence is constantly increasing.
Objectives: The aim of this study was to compare the effectiveness of metacognitive therapy and behavioral activation on executive functions of elderly people with type 2 diabetes.
Methods: This study was a quasi-experimental study with pretest, posttest, and control group design, and a three-month follow-up. The statistical population included people with type 2 diabetes who were referred to five endocrine clinics located in area 11 and were at least 60 years old and 75 years old at most. Forty-five women and men participated in this study through a purposeful and voluntary sampling method. Wisconsin card was used for data collection. Data were analyzed using descriptive statistics such as mean and standard deviation and inferential statistics by analysis of covariance and repeated measure ANOVA with SPSS.25 software.
Results: The results showed that show that there is no statistically significant difference between metacognitive and behavioral activation groups in the subscales of executive function, and the mean post-test of the groups is almost equal (p <0.05). Correct reaction time, first patterns attempt were significantly different compared to the control group (P>0.05).
Conclusion: It can be concluded that meta-cognitive therapy and behavioral activation increased effective executive functions.


1. Sacco WP, Bykowski CA. Depression and hemoglobin A1c in type 1 and type 2 diabetes: the role of self-efficacy. 
Diabetes research and clinical practice. 2010;90(2):141-6. 
2. Wang J, He M, Zhao X. Depressive symptoms, family functioning and quality of life in Chinese patients with type 
2 diabetes. Canadian journal of diabetes. 2015;39(6):507-12. 
3. Owens-Gary MD, Zhang X, Jawanda S, Bullard KM, Allweiss P, Smith BD. The Importance of Addressing 
Depression and Diabetes Distress in Adults with Type 2 Diabetes. Journal of General Internal Medicine. 
4. Basu S, Sharma N. Diabetes self-care in primary health facilities in India-challenges and the way forward. World 
journal of diabetes. 2019;10(6):341. 
5. Kim MY, Lee EJ. Factors affecting self-care behavior levels among elderly patients with type 2 diabetes: A 
quantile regression approach. Medicina. 2019;55(7):340. 
6. Owens-Gary MD, Zhang X, Jawanda S, Bullard KM, Allweiss P, Smith BD. The Importance of Addressing 
Depression and Diabetes Distress in Adults with Type 2 Diabetes. Journal of General Internal Medicine. 
7. Schinckus L, Dangoisse F, Van den Broucke S, Mikolajczak M. When knowing is not enough: Emotional 
distress and depression reduce the positive effects of health literacy on diabetes self-management. Patient education 
and counseling. 2018 Feb 1;101(2):324-30. 
8. Bottonari KA, Roberts JE, Thomas SN, Read JP. Stop thinking and start doing: Switching from cognitive therapy 
to behavioral activation in a case of chronic treatmentresistant depression. Cognitive and Behavioral Practice. 
2008 Nov 1;15(4):376-86. 
9. Daughters SB, Braun AR, Sargeant MN, Reynolds EK, Hopko DR, Blanco C, Lejuez CW. Effectiveness of a 
brief behavioral treatment for inner-city illicit drug users with elevated depressive symptoms: the life enhancement 
treatment for substance use (LETS Act!). Journal of Clinical Psychiatry. 2008 Jan 1;69(1):122. https://doi.
org/10.4088/JCP.v69n0116 24
10. Baruch DE, Kanter JW, Bowe WM, Pfennig SL. Improving homework compliance in career counseling 
with a behavioral activation functional assessment procedure: a pilot study. Cognitive and Behavioral Practice. 
2011 May 1;18(2):256-66. 
11. Hagen R, Hjemdal O, Solem S, Kennair LE, Nordahl HM, Fisher P, Wells A. Metacognitive therapy 
for depression in adults: a waiting list randomized controlled trial with six months follow-up. Frontiers in 
psychology. 2017 Jan 24;8:31. 
12. Normann N, van Emmerik AA, Morina N. The efficacy of metacognitive therapy for anxiety and depression: 
A meta‐analytic review. Depression and Anxiety. 2014 May;31(5):402-11. 
13. Jelinek L, Van Quaquebeke N, Moritz S. Cognitive and metacognitive mechanisms of change in metacognitive 
training for depression. Scientific reports. 2017 Jun 14;7(1):3449. 
14. Wells A, Fisher P, Myers S, Wheatley J, Patel T, Brewin CR. Metacognitive therapy in recurrent and persistent 
depression: A multiple-baseline study of a new treatment. Cognitive Therapy and Research. 2009 Jun 1;33(3):291-
15. Dimidjian S, Barrera Jr M, Martell C, Munoz RF, Lewinsohn PM. The origins and current status of 
behavioral activation treatments for depression. Annual review of clinical psychology. 2011 Apr 27;7:1-38. https:// 
16. Dichter GS, Felder JN, Smoski MJ. The effects of brief behavioral activation therapy for depression on cognitive 
control in affective contexts: an fMRI investigation. Journal of affective disorders. 2010 Oct 1;126(1-2):236-
17. Rochat L, Manolov R, Billieux J. Efficacy of metacognitive therapy in improving mental health: A 
meta‐analysis of single‐case studies. Journal of clinical psychology. 2018 Jun;74(6):896-915. https://doi.
18. Wells A, Colbear JS. Treating posttraumatic stress disorder with metacognitive therapy: a preliminary 
controlled trial. Journal of Clinical Psychology. 2012 Apr;68(4):373-81. 
19. Fisher PL, Byrne A, Fairburn L, Ullmer H, Abbey G, Salmon P. Brief metacognitive therapy for emotional 
distress in adult cancer survivors. Frontiers in psychology. 2019;10. 
20. Pagoto S, Schneider KL, Whited MC, Oleski JL, Merriam P, Appelhans B, Ma Y, Olendzki B, Waring ME, 
Busch AM, Lemon S. Randomized controlled trial of behavioral treatment for comorbid obesity and depression 
in women: the Be Active Trial. International journal of obesity. 2013 Nov;37(11):1427.
21. Hopko DR, Magidson JF, Lejuez CW. Treatment failure in behavior therapy: Focus on behavioral activation 
for depression. Journal of clinical psychology. 2011 Nov;67(11):1106-16. 
22. Nordahl HM, Wells A. Metacognitive Therapy of Early Traumatized Patients With Borderline Personality 
Disorder: A Phase-II Baseline Controlled Trial. Frontiers in psychology. 2019 Jul 30;10:1694.
23. Normann N, Morina N. The efficacy of metacognitive therapy: a systematic review and meta-analysis. Frontiers 
in Psychology. 2018;9:2211. 
24. Strand ER, Hagen R, Hjemdal O, Kennair LE, Solem S. Metacognitive Therapy for Depression Reduces 
Interpersonal Problems: Results From a Randomized Controlled Trial. Frontiers in psychology. 2018;9:1415. 
25. Jakupcak M, Wagner A, Paulson A, Varra A, McFall M. Behavioral activation as a primary care‐based treatment 
for PTSD and depression among returning veterans. Journal of Traumatic Stress. 2010 Aug;23(4):491-5. 
26. Chen J, Liu X, Rapee RM, Pillay P. Behavioural activation: A pilot trial of transdiagnostic treatment 
for excessive worry. Behaviour Research and Therapy. 2013 Sep 1;51(9):533-9.
27. Bot M, Brouwer IA, Roca M, Kohls E, Penninx BW, Watkins E, Van Grootheest G, Cabout M, Hegerl U, Gili 
M, Owens M. Effect of multinutrient supplementation and food-related behavioral activation therapy on prevention 
of major depressive disorder among overweight or obese adults with subsyndromal depressive symptoms: the 
MooDFOOD randomized clinical trial. Jama. 2019 Mar 5;321(9):858-68. 
28. Reynolds EK, MacPherson L, Tull MT, Baruch DE, Lejuez CW. Integration of the brief behavioral activation 
treatment for depression (BATD) into a college orientation program: Depression and alcohol outcomes. Journal of 
counseling psychology. 2011 Oct;58(4):555. 
29. Jordan J, Carter JD, McIntosh VV, Fernando K, Frampton CM, Porter RJ, Mulder RT, Lacey C, Joyce PR. 
Metacognitive therapy versus cognitive behavioural therapy for depression: a randomized pilot study. Australian & New Zealand Journal of Psychiatry. 2014 Oct;48(10):932-43.