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Culturally adapted metacognitive training for depression (CA-D-MCT)

The Culturally Adapted Metacognitive Training for Depression (CA-D-MCT) is designed for asylum seekers who are suffering from depression. The focus of this interpreter-supported treatment for people who speak Arabic or Persian (Farsi/Dari) are the thinking styles that, according to various studies, are involved in the development and maintenance of depression. The group training consists of 8 sessions that last between 60 and 90 minutes, and the training can also be used for individual therapy. The training was developed in a study funded by Asklepios Proresearch in a cooperative effort between the Prevention Research working group of the Department of Medical Psychology and the Clinical Neuropsychology Unit of the Clinic for Psychiatry and Psychotherapy at the University Medical Center Hamburg-Eppendorf (UKE) and the Psychiatric-Psychotherapeutic Outpatient Center of Asklepios Clinic Nord–Ochsenzoll.

For treatment materials (beta version), please see below.

Those treating the need-based psychosocial health care of refugees face particular language, cultural, and structural barriers. It is therefore important to offer refugees low-threshold, culturally sensitive therapies in order to facilitate their access to psychotherapeutic care. As part of a feasibility study (proof of concept), the Metacognitive Training for Depression (D-MCT) was adapted and tested for the treatment of asylum seekers with depression. The D-MCT is a group therapy method developed in Germany that addresses depression-specific thinking distortions and coping strategies from a metacognitive perspective and provides participants with targeted exercises to help them cope (further information on the D-MCT can be found here).

As part of the study, the treatment material was translated and adapted to mitigate the cultural and linguistic challenges of working with asylum seekers. For this purpose, expert rounds were held in which possible linguistic and cultural understanding difficulties were discussed and suggestions for changes were developed. The results of the subsequent evaluation were incorporated into the therapy material. In an uncontrolled pilot study, the culturally adapted D-MCT (CA-D-MCT) in ​​Persian (Dari/Farsi) and Arabic were tested on a random sample of patients in the Psychiatric-Psychotherapeutic Outpatient Center of Asklepios Nord-Ochsenzoll and evaluated by means of surveys in terms of acceptance, therapy motivation, and feasibility. This feedback was also incorporated into the treatment material.

A preliminary evaluation of the data found initial indications of improvement in symptoms (Uhr et al., in preparation). The aim of the study was to develop a treatment that is suitable for asylum seekers suffering from depression, that is accepted by this group of patients, and that can also be used by German-speaking therapists with the support of an interpreter. The data from the study are currently being evaluated. As soon as the study results have been published, they will be posted here.

We hope that as many refugees suffering from depression as possible can benefit from our research, and we are therefore making the training available online as a beta version free of charge. We recommend that all practitioners read the German training manual for the D-MCT, which the CA-D-MCT is based on. The German training manual and accompanying materials have been published by Beltz Verlag; a free short version in English can be found here and an online e-learning program for the D-MCT here.

The slides used in the training can be downloaded in Persian (suitable for Dari/Farsi) and in Arabic via the following links. We will also soon have a short manual available. If you are interested in the German translation of the adaptation, please contact us. Below you can find the English short version of the manual along with the modules.


The translation is based on the original Farsi translation  of the D-MCT by Dr. Saied Malihialzackerini (saied.malihi@kiau.ac.ir, website: https://symia.ir/). The expanded culturally adapted version was translated by Sorosh Ahmadi.

Translators and coauthors: Heba Alkailani and Basel Al Ghazali.

If you use the CA-D-MCT, we would like to hear about your experience. You can reach us at m.dietrichkeit@asklepios.com.

Please also note that we have developed e-learning programmes for the MCT and D-MCT: www.uke.de/e-mct | www.uke.de/e-dmct

Main Developers

  • Cornelia Uhr (Asklepios Clinic Nord–Ochsenzoll)
  • Dr. Franka Metzner (Prevention Research working group of the Department of Medical Psychology, UKE)
  • Dr. Mona Dietrichkeit (Asklepios Clinic Nord–Ochsenzoll)
  • Prof. Dr. Lena Jelinek (Clinical Neuropsychology Unit, UKE)
  • PD Dr. Silke Pawils (Prevention Research working group of the Department of Medical Psychology, UKE)
  • Heba Alkailani (Prevention Research working group of the Department of Medical Psychology, UKE)
  • Basel Al Ghazali (Asklepios Clinic Nord–Ochsenzoll)
  • Sorosh Ahmadi (Asklepios Clinic Nord–Ochsenzoll)
  • Nona Mohammadi Imir (Asklepios Clinic Nord–Ochsenzoll)
  • Morzal Goia (Asklepios Clinic Nord–Ochsenzoll)

Cooperation Partners

  • Dr. Marion Hagemann-Goebel (Asklepios Clinic Nord–Ochsenzoll)
  • Sarang D. Thakkar (Asklepios Clinic Nord–Ochsenzoll)
  • Prof. Dr. Nexhmedin Morina (Clinical Psychology and Psychotherapy, University of Münster)

Dietrichkeit, M., Hagemann-Goebel, M., Nestoriuc, Y., Moritz, S., & Jelinek, L. (2021). Side effects of the Metacognitive Training for Depression compared to a cognitive remediation training in patients with depression. Scientific Reports.

Dietrichkeit, M., Moritz, S., & Jelinek, L. (2020). Die Behandlung psychischer Störungen mittels metakognitiver Interventionen am Beispiel des Metakognitiven Trainings für Depression (D-MKT). [The treatment of mental disorders using metacognitive interventions using the example of Metacognitive Training for Depression (D-MKT)]. Zeitschrift für Psychiatrie, Psychologie und Psychotherapie, 68, 160–170.

Jelinek, L., Faissner, M., Moritz, S., & Kriston, L. (2019). Long-term efficacy of Metacognitive Training for Depression (D-MCT): a randomized controlled trial. British Journal of Clinical Psychology, 58, 245–259.

Jelinek, L., Hauschildt, M., & Moritz, S. (2015). Metakognitives Training bei Depression. Weinheim: Beltz.

Jelinek, L., Hauschild, M., Wittekind, C. E., Schneider, B. C., Kriston, L., & Moritz, S. (2016). Efficacy of Metacognitive Training for Depression (D-MCT): a randomized controlled trial. Psychotherapy and Psychosomatics, 85, 231–234.

Jelinek, L., Moritz, S., & Hauschildt, M. (2017a). Patients’ perspective on treatment with Metacognitive Training for Depression (D-MCT): results on acceptability. Journal of Affective Disorders, 221, 17–24.

Jelinek, L., Otte, C., Arlt, S., & Hauschildt, M. (2013). Denkverzerrungen erkennen und korrigieren: Eine Machbarkeitsstudie zum Metakognitiven Training bei Depressionen (D-MKT). [Identifying and correcting cognitive biases: a pilot study on the Metacognitive Training for Depression (D-MCT)]. Zeitschrift für Psychiatrie, Psychologie und Psychotherapie, 61, 1–8.

Jelinek, L., Van Quaquebeke, N., & Moritz, S. (2017b). Cognitive and metacognitive mechanisms of change in Metacognitive Training for Depression. Scientific Reports, 7, 3449.

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