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Abstract Identifying components of modularized psychological interventions that contribute to symptom reduction is essential to improving depression treatment. In a secondary analysis of a randomized controlled trial (RCT), session-specific effects of Metacognitive Training-Silver, a group intervention for older adults with depression, were investigated. Thirty-eight older adults with major depressive disorder or dysthymia participated in up to eight sessions of MCT-Silver. A clinical assessment of depressive symptoms (Hamilton Depression Rating Scale) as well as additional interviews and questionnaires administered as part of the RCT were completed at pre- and post-intervention. Depressive symptoms, negative (meta)cognitive beliefs, emotion regulation strategies and attitudes toward aging were assessed pre- and post-session. The rate of change in each variable per module, elevation following the module in which the variable was addressed, and the rate of change post module were examined via linear mixed models. Clinician-rated depressive symptoms were significantly reduced from pre- to post-intervention (Cohens d = 1.31). Self-reported depression and negative mental filter measured within sessions improved significantly over treatment, whereas black-and-white thinking improved after module #3 (Should Statements, All or Nothing Thinking and Acceptance). Module-specific within-session effects were found for overgeneralization (module #1: Mental Filter) and rumination (module #6: Rumination and Social Withdrawal). Improvement in mental filter in module #1 was significantly associated with depression reduction. This study provides initial evidence that MCT-Silver partially meets its aims of reducing depression and specific cognitive variables within and across sessions. Improvement of the instrument used to measure change may improve detection of module-specific effects. Trial registration: NCT03691402.

BackgroundMetacognitive Training for Depression in older adults (MCT-Silver; www.uke.de/mct-silver) is a cognitive-behavioral based group intervention that aims at reducing depression by targeting (meta)cognitive beliefs and rumination. In the present study, it was examined whether negative cognitive beliefs, positive metacognitive beliefs and/or rumination may be implicated as mediators of MCT-Silver’s effects on depression.Materials and methodsWe conducted a secondary analysis of a randomized controlled trial comparing MCT-Silver to an active control intervention (cognitive remediation) including 66 older adults (60 years and older) with complete baseline data. Clinician-rated (Hamilton Depression Rating Scale) and self-reported (Beck Depression Inventory-II) depression, negative cognitive beliefs (Dysfunctional Attitudes Scale-18B), positive metacognitive beliefs (positive beliefs subscale; Metacognition Questionnaire-30) and rumination (10-item Ruminative Response Scale) were assessed before (pre) and after 8 weeks of treatment (post), as well as 3 months later (follow-up). It was examined whether change in depression (pre- to follow-up) was mediated by change in negative cognitive beliefs, positive metacognitive beliefs and/or rumination (pre- to post-assessment).ResultsMediation results differed for self-reported vs. clinician-rated depression. The effect of MCT-Silver on reduction in clinician-rated depression was mediated by a reduction in self-reported rumination, whereas reduction in self-reported depression was mediated by a reduction in negative cognitive beliefs. Positive metacognitive beliefs were not a significant mediator for either outcome.ConclusionThe current study provides initial evidence for the roles of negative cognitive beliefs and rumination in the treatment of depression in later life with MCT-Silver. Given the divergence of findings and lack of causal precedence, mechanisms of change for MCT-Silver cannot yet be equivocally identified.

Superstoichiometric oxygen combustion (i.e. the oxygen content during combustion is larger than required for the complete conversion of the fuel), also called pure-oxy-fuel, is a novel concept to reduce CO2 emissions from the cement clinker production. In the current contribution, we examine in a simulation study the influence of superstoichiometric combustion in combination with the use of refuse-derived fuel (RDF) of different composition and particle size on process parameters and cement clinker quality in the rotary kiln. A comparison with a standard fuel, namely lignite, and a conventional air-fired kiln is presented. The specific models developed to determine the flight and combustion behavior of RDF particles, which are of complex shape and significantly larger than pulverized coal, are described. The simulations conducted show that some RDF fractions react only partially in the gas phase due to their relative large size. Unburnt RDF particles reach the clinker bed, where they continue to react. In addition, for RDF, gas-phase temperature and the clinker temperature are different along the kiln length compared to coal, influencing the local mineralogical reaction in the clinker bed. However, in summary, similar clinker qualities could be obtained also compared to a standard air-fired kiln. [ABSTRACT FROM AUTHOR]