Group Metacognitive Therapy for Generalized Anxiety Disorder: A Pilot Feasibility Trial

Abstract

Background: Individual metacognitive therapy (MCT) for generalized anxiety disorder (GAD) is well established, but only one study has investigated the effectiveness of Group MCT (g-MCT) for GAD. The aim of the current study was therefore to evaluate the feasibility and effectiveness of g-MCT for GAD within a community mental health setting whilst addressing limitations evident in the previous study. Methods: The study used an open trial design, and 23 consecutively referred adults with GAD completed 10 sessions (90 min) of g-MCT, delivered by two therapists trained in MCT. Diagnoses were assessed by trained raters using the Anxiety Disorder Interview Schedule-IV. All patients but one had previous psychosocial treatment, and 17 (73.9%) had at least one comorbid axis-I disorder. Self-reported symptoms were assessed using the Penn State Worry Questionnaire, the Generalized Anxiety Disorder-7, and the Patient Health Questionnaire-9 at pre- and post-treatment as well as 3-month follow-up. Feasibility was assessed using rates of patients who declined group treatment in favor of individual treatment, patients not able to attend due to pre-scheduled dates for sessions, and drop-out rate. Results: Of 32 eligible participants, six patients (19%) declined g-MCT in favor of individual MCT, and three (9%) were unable to attend due to scheduling conflicts. No patients dropped out during treatment, but two patients did not complete the self-report questionnaires at 3-month follow-up. g-MCT was associated with significant reductions in worry, anxiety, depression, metacognitive beliefs, and maladaptive coping. According to the standardized Jacobson criteria for recovery, 65.3% were recovered at post-treatment, whereas 30.4% were improved and 4.3% showed no change. At 3-month follow-up, the recovery rate increased to 78.3%. Moreover, recovery rates were comparable for patients with- and without comorbidity. Number of therapist hours per patient was 6.5 and the treatment has now been implemented as a standard treatment option at the clinic. Conclusion: g-MCT for GAD is an acceptable treatment which may offer a cost-effective alternative approach to individual MCT. Recovery rates and effect sizes suggested that g-MCT could be just as efficient as individual MCT and cognitive behavioral therapy.

Establishing the Feasibility of Group Metacognitive Therapy for Anxiety and Depression in Cardiac Rehabilitation: A Single-Blind Randomized Pilot Study

“…MCT has also shown promising results when delivered using a group format in mental health settings. To date there have been nine studies evaluating Group-MCT across various disorders including obsessive compulsive disorder ( 20 , 21 ), generalized anxiety disorder ( 22 – 24 ), depression ( 25 , 26 ), and in mixed disorder groups ( 27 , 28 ). No studies to date have compared Group-MCT with individual MCT, but a preliminary comparison of Group-MCT with group mindfulness based stress reduction in mixed anxiety and depression groups found that both were feasible and acceptable, with large within-subject effects ( 27 ).…”

Change in interpersonal problems and metacognitive beliefs as predictors of improvement in patients with generalized anxiety disorder

“…However, even though change in anxiety accounted for independent variance in change in trait‐worry, change in negative metacognitive beliefs accounted for substantial more variance, which is in line with the metacognitive model of GAD (Wells, 1995) and a previous prospective study (Thielsch et al, 2015). Large improvements in trait‐worry in patients with GAD after Metacognitive therapy where metacognitions are modified have also been reported (Haseth et al, 2019; Normann & Morina, 2018).…”

Metacognitive therapy for generalized anxiety disorders in group: A case study

“…MCT is a recommended treatment for GAD according to the National Institute for Health and Clinical Excellence guidelines (National Institute for Health and Clinical Excellence, 2011), and several studies have shown it to be an effective treatment for GAD, both in terms of short‐term (Nordahl et al, 2018; Normann & Morina, 2018; Wells & King, 2006) and long‐term results (Solem et al, 2021). Fewer studies have examined group‐based MCT, but there is evidence that group‐based MCT is also an effective treatment for GAD (Haseth et al, 2019; Van der Heiden et al, 2013). Most of the existing literature regarding MCT treatment for GAD is based on outcome studies, and there are fewer qualitative pragmatic studies describing the treatment.…”