Psychological Mindedness and Alexithymia Predict Symptom Reduction in Cognitive Behavior Therapy for Major Depressive Disorder

Cognitive behavior models present major depressive disorder (MDD) as a failure in emotional processing associated with disrupted metacognitive skills. Self-observation, a metacognitive ability, plays a vital role in emotion regulation. Studies have noted the role of mindfulness in cognitive behavioral therapy (CBT); however, few address psychological mindedness, the interest and ability to understand behaviors, thoughts, and feelings, or alexithymia, the inability to identify and describe emotions. Seventy-one depressed outpatients with mean age M = 42.5; (SD = 13.7) received 14 CBT sessions. Longitudinal regression showed that baseline psychological mindedness significantly predicted symptom reduction across the course of treatment (β = − 8.43, 95% CI − 14.33, − 2.52, p = 0.01). Baseline alexithymia was unrelated to remission, yet positively correlated with symptom reduction through treatment. Treatment response may correlate more strongly with analytical than affective metacognitive ability, though affective skills increased during treatment. Further research can improve our understanding of processing affective information in depression and disruptions in emotion regulation and inform the selection of CBT strategies.