Metacognition and cognition in inpatient MCT and CBT for comorbid anxiety disorders: A study of within-person effects.

Johnson, Sverre Urnes; Hoffart, Asle; Nordahl, Hans M.; Ulvenes, Pål; Vrabel, KariAnne; Wampold, Bruce E.

doi:10.1037/cou0000226

Cited by 25 publications

(26 citation statements)

References 58 publications

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“…Usually, they are different. In an earlier randomized controlled trial (Johnson, Hoffart, Nordahl, & Wampold, 2017), we measured anxiety-related cognitions, metacognitions, and anxiety repeatedly during trans-diagnostic MCT and disorder-specific CBT for comorbid anxiety disorders (Johnson et al, 2018). Using repeated measurements gave us the opportunity to disaggregate the within-person components of the scores from the between-person components and thus to study the therapy-relevant within-person relationships between the mechanism variables and anxiety.…”

Section: Introductionmentioning

confidence: 99%

Mechanisms of change in metacognitive and cognitive behavioral therapy for treatment-resistant anxiety

Hoffart¹,

Johnson

Nordahl

et al. 2018

Journal of Experimental Psychopathology

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Metacognitive therapy (MCT) has shown promising outcomes across disorders, but, currently, little is known about the mechanisms of change in MCT as well as their specificity compared to those of cognitive behavioral therapy (CBT). The main purpose of this study was to examine the within-person relationships between features of the cognitive attentional syndrome (CAS)-the thinking style supposed to maintain clinical disorders according to the MCT model-and anxiety over the course of MCT and CBT for comorbid anxiety disorders. Seventy-four inpatients had been randomized to either MCT or CBT and actually started treatment. CAS features and anxiety were assessed weekly during treatment. These measures were disaggregated to their within-and between-person components and used as predictors in mixed models. All CAS features-coping activities, negative metacognitive beliefs, and positive metacognitive beliefsdecreased over the course of treatment. Negative and positive beliefs decreased more in MCT than in CBT. Time-specific changes in positive metacognitive beliefs predicted variations in subsequent anxiety across the two treatments (within-person effect). The finding of a within-person relationship between positive metacognitive beliefs and subsequent anxiety has the clinical implication that reduction in these beliefs may be important for treatment response. KeywordsCognitive attentional syndrome, cognitive behavioral therapy, comorbid anxiety disorders, metacognitive therapy, within-person mechanism outcome relationships Date

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Section: Introductionmentioning

confidence: 99%

Mechanisms of change in metacognitive and cognitive behavioral therapy for treatment-resistant anxiety

Hoffart¹,

Johnson

Nordahl

et al. 2018

Journal of Experimental Psychopathology

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“…However, to the best of our knowledge, the influence of these environmental factors on co-variation of OCS and psychosis has not yet been investigated. Within-subject associations might further be due to symptom interaction, where increase in one type of symptom causes the other [37, 38]. This proposed mechanism might specifically apply to the observed unidirectional time-lagged association between increase/decrease in depressive symptoms and subsequent increase/decrease in OCS 4 weeks later.…”

Section: Discussionmentioning

confidence: 99%

Obsessive–compulsive symptoms in psychotic disorders: longitudinal associations of symptom clusters on between- and within-subject levels

Schirmbeck

Konijn

Hoetjes

et al. 2018

Eur Arch Psychiatry Clin Neurosci

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Obsessive-compulsive symptoms (OCS) are frequently reported in patients with schizophrenia and have been associated with subjective distress and higher impairment. Recent studies suggest fluctuation in co-occurring OCS and associations with the course of psychotic symptoms. Current evidence is limited by few studies with long assessments intervals and a sole focus on between-subject comparisons. The aim of this study was to specifically investigate co-variation of symptom domains over time within individuals. Patients with a psychotic disorder (n = 56) and un-affected siblings (n = 49) completed monthly assessments of clinical and subclinical symptoms over 6 months. Mixed-model multilevel analyses examined the variability and relationship between OCS and positive, negative, and depressive symptoms on the between- and within-subject level. Symptom domains were associated across subjects and assessment times, in patients and siblings, with the strongest association between OCS and (subclinical) positive symptoms. Within-subjects, substantial variability and co-variation of all symptom domains was found. Particularly, between-subject differences in positive symptoms and within-subject change in depressive symptoms predicted subsequent OCS in patients 1 months later. This is the first prospective study disaggregating between and within-subject associations between co-occurring OCS and symptom cluster of psychosis. Differences on these two levels suggest different underlying mechanisms. The association between depressive symptoms and subsequent increase/decrease of OCS within patients may have important treatment implications.

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“…The materials of this paper come from a randomized controlled trial (RCT) comparing MCT and CBT and are thoroughly described in two other papers (Johnson et al, 2017, 2018).…”

Section: Methodsmentioning

confidence: 99%

“…Several studies have investigated the role of metacognitions and cognitions in anxiety disorders (Smits et al, 2012; Johnson et al, 2018). Most of the studies have been conducted on at between-person level.…”

Section: Introductionmentioning

confidence: 99%

“…Therapists, however, are mainly interested in the within-person level, that is, if deviations from the persons own mean on a mechanism variable, are related to personal change on an outcome variable. Two studies have investigated if metacognitions predict anxiety on a within-person level, which requires repeated assessments points (Hoffart et al, 2018; Johnson et al, 2018). To our knowledge no studies have investigated MCT and CBT on a network of symptoms and mechanisms separating the within- and between person effects.…”

Section: Introductionmentioning

confidence: 99%

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Metacognitive Therapy Versus Cognitive Behavioral Therapy:A Network Approach

Johnson

Hoffart

2018

Front. Psychol.

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A network perspective on mental problems represents a new alternative to the latent variable perspective. Diagnoses are assumed to refer to a causal network of observable mental problems or symptoms (observables). The observable symptoms that traditionally have been considered indicators of latent traits (disorders) are taken to be directly related causal entities. Few studies have investigated how different therapies affect a network-structure of symptoms and processes. In this study, three anxiety symptoms, three depression symptoms and mechanisms in the form of cognitions, metacognitions, worry and threat monitoring were selected. The network structure over the course of therapy for metacognitive therapy (MCT) and Cognitive behavioral therapy (CBT) was investigated. It was hypothesized that worry, attention, and metacognition would be important nodes in MCT and that cognitions would be important in CBT. The data used in the analysis are from a RCT where 74 patients with comorbid anxiety disorders were randomized to either transdiagnostic MCT or disorder-specific CBT. Symptoms and mechanisms were measured every week. The data was analyzed using the multilevel vector autoregressive (mlVAR) model, which is currently the most developed method to analyze multivariate time series in multiple subjects and construct networks. The results indicate that there were different networks of symptoms and mechanisms in MCT and CBT. Central nodes in both treatments are worry and attention, however, the node of negative metacognitive beliefs about uncontrollability was more central in the MCT treatment. The results are consistent with predictions from the S-REF model.

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Metacognition and cognition in inpatient MCT and CBT for comorbid anxiety disorders: A study of within-person effects.

Cited by 25 publications

References 58 publications

Mechanisms of change in metacognitive and cognitive behavioral therapy for treatment-resistant anxiety

Mechanisms of change in metacognitive and cognitive behavioral therapy for treatment-resistant anxiety

Obsessive–compulsive symptoms in psychotic disorders: longitudinal associations of symptom clusters on between- and within-subject levels

Metacognitive Therapy Versus Cognitive Behavioral Therapy:A Network Approach

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