Metacognitive therapy for generalized anxiety disorder: An open trial

University of Manchester, Academic Division of Clinical Psychology, Rawnsley Building, MRI, Manchester M13 9WL, UK.
Journal of Behavior Therapy and Experimental Psychiatry (Impact Factor: 2.23). 10/2006; 37(3):206-12. DOI: 10.1016/j.jbtep.2005.07.002
Source: PubMed


Generalized anxiety disorder (GAD) responds only modestly to existing cognitive-behavioural treatments. This study investigated a new treatment based on an empirically supported metacognitive model [Wells, (1995). Metacognition and worry: A cognitive model of generalized anxiety disorder. Behavioural and Cognitive Psychotherapy, 23, 301-320; Wells, (1997). Cognitive therapy of anxiety disorders: A practice manual and conceptual guide. Chichester, UK: Wiley]. Ten consecutive patients fulfilling DSM-IV criteria for GAD were assessed before and after metacognitive therapy, and at 6, and 12-month follow-up. Patients were significantly improved at post-treatment, with large improvements in worry, anxiety, and depression (ESs ranging from 1.04-2.78). In all but one case these were lasting changes. Recovery rates were 87.5% at post treatment and 75% at 6 and 12 months. The treatment appears promising and controlled evaluation is clearly indicated.

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Available from: Adrian Wells, Apr 20, 2015
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    • "Metacognitive theory has previously been applied in the conceptualisation and treatment of anxiety and depression with success [12,13]. However, the application to EDs has been limited thus far, with integrated cognitive and metacognitive therapy used only with BN [8]. "
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    ABSTRACT: Background There is a need for qualitative research to help develop case conceptualisations to guide the development of Metacognitive Therapy interventions for Eating Disorders. Method A qualitative study informed by grounded theory methodology was conducted involving open-ended interviews with 27 women aged 18–55 years, who were seeking or receiving treatment for a diagnosed ED. Results The categories identified in this study appeared to be consistent with a metacognitive model including constructs of a Cognitive Attentional Syndrome and metacognitive beliefs. These categories appear to be transdiagnostic, and the interaction between the categories is proposed to explain the maintenance of EDs. Conclusions The transdiagnostic model proposed may be useful to guide the development of future metacognitive therapy interventions for EDs with the hope that this will lead to improved outcomes for individuals with EDs.
    International Journal of Eating Disorders 07/2013; 1(1):24. DOI:10.1186/2050-2974-1-24 · 3.13 Impact Factor
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    • "A series of investigations has shown that individuals with GAD scan the environment for cues suggesting threat;27 develop worrying in an attempt to solve problems;28 may use worrying to avoid physical symptoms of anxiety;29 find it hard to tolerate uncertainty or ambiguity;30 and “worry about worrying”.31 A functional MRI study found evidence of increased anticipatory activity in the dorsal amygdala after cues indicating forthcoming aversive and neutral pictures, suggesting an “overall enhanced anticipatory emotional responsiveness in GAD” (that is, preparing for difficult challenges ahead).32 "
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    ABSTRACT: A PREVIOUS REVIEW SUMMARIZED WHAT WAS THEN KNOWN ABOUT THE POTENTIAL ROLE OF PREGABALIN IN THE TREATMENT OF PATIENTS WITH GENERALIZED ANXIETY DISORDER (GAD): this review provides an update on its pharmacological properties and presumed mechanism of action, the liability for abuse, and efficacy and tolerability in patients with GAD. Pregabalin has a similar molecular structure to the inhibitory neurotransmitter gamma amino butyric acid (GABA) but its mechanism of action does not appear to be mediated through effects on GABA. Instead, its anxiolytic effects may arise through high-affinity binding to the alpha-2-delta sub-unit of the P/Q type voltage-gated calcium channel in "over-excited" presynaptic neurons, thereby reducing the release of excitatory neurotransmitters such as glutamate. The findings of randomized controlled trials and meta-analyses together indicate that pregabalin is efficacious in both acute treatment and relapse prevention in GAD, with some evidence of an early onset of effect, and broad efficacy in reducing the severity of psychological and physical symptoms of anxiety. It also has efficacy as an augmenting agent after non-response to antidepressant treatment in GAD. Continuing vigilance is needed in assessing its potential abuse liability but the tolerability profile of pregabalin may confer some advantages over other pharmacological treatments in the short term for treatment in patients with GAD.
    Neuropsychiatric Disease and Treatment 06/2013; 9:883-92. DOI:10.2147/NDT.S36453 · 1.74 Impact Factor
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    • "However, worry is used as inflexible means of coping, and worry turns out a problem when negative beliefs concerning the uncontrollability and the dangers of worrying. These positive and negative beliefs about worry may lead unhelpful vacillation in attempts to avoid or engage in worry [4]. Some studies about metacognition have focused on knowledge and beliefs about memory that is known as ''meta memory'' [5]. "
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    ABSTRACT: PurposeThe metacognitive model of generalized anxiety disorder in young adults involves positive beliefs about worrying and negative beliefs concerning the uncontrollability and the dangers of worrying. Many older adults are believed to have a decline and less control over their memory. Thus, metamemory should be another cause in elder patients with generalized anxiety disorder. The aim of the study was to investigate the metacognitive constructs of elder patients with generalized anxiety disorder.Method Thirty-three elder patients and 38 young adults with generalized anxiety disorder and 37 healthy elder individuals from Turkey enrolled in the study. All participants were asked to fill out the Meta-cognitions questionnaire, the Beck Depression Inventory (BDI) and Anxiety Inventory (BAI).ResultsThe mean anxiety score in young patients was significantly higher than both elder patient and healthy groups (P < 0.0001, for both). The total MCQ-30 score was significantly high in elder patients than healthy controls (P = 0.002) while it was insignificant between elder and young patients (P = 0.976). The mean negative belief sub score was significantly higher in elder patients than healthy elder controls (P < 0.0001). Cognitive confidence was significantly higher in elder patients than elder controls (P = 0.024).Conclusion For the first time we compared metacognitive differences between older patients with generalized anxiety and healthy elders. Impairments in two domains, that were different from metacognitive model of anxiety in young adults, as cognitive confidence and need to control of thoughts, seem to contribute in the development of anxiety that may be attributed as a result of aging.
    European geriatric medicine 06/2013; 4(3):150–153. DOI:10.1016/j.eurger.2012.12.001 · 0.73 Impact Factor
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