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
    • "For example, research exploring the nature of metacognitive beliefs has demonstrated that these play a role in the severity of clinical presentations in problem drinkers (Hoyer, Hacker and Lindenmeyer, 2007; Spada and Wells, 2008, 2009, 2010; Spada, Caselli and Wells, 2013; Spada, Moneta and Wells, 2007; Spada, Zandvoort and Wells, 2007) and tobacco users (Nikčevi´c and Spada, 2008, 2010, Spada, Nikčevi´c, Moneta and Wells, 2007). Furthermore, ineffective " metacognitive monitoring " (the monitoring of cognitive-affective change and proximity to goals during the engagement in addictive behaviour) has been linked to both problem drinking and tobacco use perseveration (Nikčevi´c and Spada, 2010; Spada and Wells, 2006). More recently, a preliminary study undertaken by Lindberg and colleagues (Lindberg, Fernie and Spada, 2011) found that metacognitive beliefs (negative beliefs about thoughts concerning uncontrollability and danger, and beliefs about the need to control thoughts) predicted gambling behaviour independently of anxiety and depression. "

    No preview · Article · Sep 2015 · Behavioural and Cognitive Psychotherapy
    • "Evidence-based interventions targeting childhood worry are lacking, and the behavioral techniques, which are the focus of current treatment approaches for child anxiety, may be ineffective against worry (Cartwright-Hatton, 2006). In contrast, metacognitive therapy, based on the metacognitive model (MCM) of GAD (Wells, 1995), has proven to be an effective treatment for adults suffering from excessive worry (Sugiura, 2004;van der Heiden, Muris, & van der Molen, 2012;Wells & King, 2006;Wells et al., 2010). THE METACOGNITIVE MODEL OF GAD IN ADULTS A main tenet of the metacognitive model is that a Cognitive-Attentional Syndrome (CAS) underlies all emotional disorders (Wells & Matthews, 1996). "
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    ABSTRACT: The metacognitive model has increased our understanding of the development and maintenance of generalized anxiety disorders in adults. It states that the combination of positive and negative beliefs about worry creates and sustains anxiety. A recent review argues that the model can be applied to children, but empirical support is lacking. The aim of the 2 presented studies was to explore the applicability of the model in a childhood sample. The first study employed a Danish community sample of youth (n = 587) ages 7 to 17 and investigated the relationship between metacognitions, worry and anxiety. Two multiple regression analyses were performed using worry and metacognitive processes as outcome variables. The second study sampled Danish children ages 7 to 12, and compared the metacognitions of children with a GAD diagnosis (n = 22) to children with a non-GAD anxiety diagnosis (n = 19) and nonanxious children (n = 14). In Study 1, metacognitive processes accounted for an additional 14% of the variance in worry, beyond age, gender, and anxiety, and an extra 11% of the variance in anxiety beyond age, gender, and worry. The Negative Beliefs about Worry scale emerged as the strongest predictor of worry and a stronger predictor of anxiety than the other metacognitive processes and age. In Study 2, children with GAD have significantly higher levels of deleterious metacognitions than anxious children without GAD and nonanxious children. The results offer partial support for the downward extension of the metacognitive model of generalized anxiety disorders to children.
    No preview · Article · Feb 2014 · Journal of Clinical Child & Adolescent Psychology
    • "" My rumination is uncontrollable " ). Metacognitive therapy has been evaluated in the treatment of, generalized anxiety (Wells & King, 2006), traumatic stress (Wells & Sembi, 2004;Wells, Wellford, Fraser et al., 2008), obsessive-compulsive disorder (Fisher & Wells, 2008) and more recently depression (Wells, Fisher, Myers, Wheatley, Patel & Brewin, 2012). So far it has been shown to be as effective as CBT in anxiety disorders and more effective than CBT in generalized anxiety. "
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    ABSTRACT: Metacognitive therapy (MCT) for depression is derived from the Wells and Matthews (1994) self-regulatory model, in which a Cognitive-Attentional Syndrome (CAS) is the cause of psychological disorders. MCT for depression focuses on identifying patients' CAS and helps them to stop it. The CAS consists of worry, rumination and dysfunctional coping strategies. The focus in MCT is on removing the CAS by challenging positive and negative metacognitive beliefs and eliminating dysfunctional behaviors. In this case series, MCT was delivered to four depressed Danes and treatment was evaluated in 5-11 sessions of up to one hour each. An A-B design with follow-up at 3 and 6 months was conducted and the primary outcome was Beck's Depression Inventory II (BDI-II). We measured CAS processes with the Major depressive Disorder Scale (MDD-S). The results of the case series showed clinically significant improvements in depressive symptoms, rumination and metacognitive beliefs and the effects were still present at follow-up for all patients. The small number of patients and decreasing baselines observed in some cases limits the conclusions. However, the results suggest that this treatment is feasible and was associated with large improvements in symptoms when delivered away from its point of origin and in a Danish help-seeking sample.
    No preview · Article · Nov 2013 · Scandinavian Journal of Psychology
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