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

Hoffart, Asle; Johnson, Sverre Urnes; Nordahl, Hans M.; Wells, Adrian

doi:10.1177/2043808718787414

Cited by 33 publications

(29 citation statements)

References 24 publications

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“…The model predicts that recovery from depression requires reductions in rumination, worry, and dysfunctional metacognitions, as well as changes in metacognitive beliefs (Wells, 2009). Clarifying the mechanisms of change in MCT may help expand and elaborate understanding of depression and refine the delivery of treatment (Hoffart et al, 2018). Studies should therefore explore if the effects of MCT for depression are related to changes in the hypothesized causal variables.…”

Section: Introductionmentioning

confidence: 99%

A Randomized Controlled Trial of Metacognitive Therapy for Depression: Analysis of 1-Year Follow-Up

et al. 2019

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This paper reports the 1-year follow-up results from a randomized controlled trial (RCT), which examined the efficacy of metacognitive therapy (MCT) for unipolar depression compared to a waiting condition. Thirty-nine patients with major depression were offered MCT and were divided into two conditions; immediate MCT with 10 weekly sessions or a waiting period that had a 10-week delayed MCT start. Two participants dropped out during the waiting condition. Thirty-four patients participated in the follow-up assessment. Based on the intent-to-treat sample and all patients, 67% were classified as recovered, 13% improved, and 20% were unchanged at 1-year follow-up. For the completers sample 73% recovered, 12% improved, and 15% were unchanged. Five of the 31 patients (13%) that were in remission at post-treatment experienced relapse at 1-year follow-up. Within-group effect sizes were large for reductions in symptoms of depression ( d = 2.09) and anxiety ( d = 1.16) at 1-year. Treatment response was associated with reductions in rumination, worry, and metacognitive beliefs as predicted by the metacognitive model, but reductions in metacognitions independently predicted reductions in depression scores from pre-treatment to 1-year follow-up. The results suggest that treatment gains are stable at 1-year follow-up. The study sets the stage for future research, which should evaluate MCT over a longer term and compare it with active treatments using suitably powered RCTs.

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Section: Introductionmentioning

confidence: 99%

A Randomized Controlled Trial of Metacognitive Therapy for Depression: Analysis of 1-Year Follow-Up

et al. 2019

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“…Consequently, the disruptive belief of mortality salience is stimulated, and subsequent destructive cycles of detrimental feelings (death anxiety) and negative attitudes and behaviors (ageism), which maintain and exacerbate disruptive beliefs, are activated (Ben-Harush et al 2017 ). These maladaptive dysfunctional cognitive and behavioral responses expressed by nurses caring for older adults can be easily targeted with CBT (Ben-Harush et al 2017 ), as CBT focuses on identifying and changing the function, content, and structure of cognition associated with these dysfunctional behavioral responses (Hoffart et al 2018 ). In a recent study, CBT was shown to help nurses learn alternative methods of thinking or behavior modification (Tanoue et al 2018 ).…”

Section: Discussionmentioning

confidence: 99%

Testing the Effectiveness of Cognitive Behavioral Therapy in Relieving Nurses’ Ageism Toward Older Adults: A Randomized Controlled Trial

et al. 2020

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Background Although cognitive-behavioral therapy (CBT) techniques are well known for targeting psychological distresses, to date, no study has investigated their effectiveness in relieving death anxiety and ageism among nurses. Methods A parallel randomized controlled trial was conducted according to the CONSORT guidelines during October 2019 at the university hospital. A total of 110 nurses were selected through proportional stratified sampling and randomly assigned to the experimental and control groups. The intervention consisted of six two-hour training sessions delivered over five modules with the integration of different CBT exercises. The effect of CBT was assessed by measuring the differences in the students' responses to a series of validated questionnaires of study variables pre-test (before the training sessions) and post-test (after the training sessions). Clinical registration was completed at ClinicalTrial.gov (ID: NCT04319393). Results Overall, using CBT techniques led to significant improvements in the study outcomes. At postintervention, the nurses who had received CBT training had significantly better self-esteem and interpersonal relationships, a greater sense of symbolic immortality, and less death anxiety and ageism than the nurses in the control group. Conclusions CBT is an effective evidence-based psychological intervention for relieving nurses' ageism towards older adults. The psychological well-being of nurses caring for older adults is crucial, and new techniques should be adopted to relieve nurses' accumulated stress and decrease their death anxiety. Future studies which investigate the effectiveness of CBT on other forms of discrimination, such as racism and sexism in healthcare settings, are recommended.

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“…In a study conducted by our group (Hoffart, Johnson, Nordahl, & Wells, 2018), the latent-trait-state model was adhered to in an examination of a metacognitive model of comorbid anxiety disorders (Wells, 2009). Seventy-four patients who met criteria for a principal disorder of posttraumatic stress disorder (PTSD), SAD, or panic disorder with or without agoraphobia as defined in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM–IV ; APA, 1994) and had failed at least one structured psychological treatment were randomized to 8-week residential metacognitive therapy (MCT) or CBT (see the Supplemental Material available online for details of the sample and treatment).…”

Section: The Latent-trait-state Approachmentioning

confidence: 99%

Latent Trait, Latent-Trait State, and a Network Approach to Mental Problems and Their Mechanisms of Change

Hoffart

Johnson

2020

Clinical Psychological Science

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In this theoretical study, we examined whether and how a latent trait, a latent-trait state, and a network conceptualization of mental problems account for their descriptive features and causal mechanisms. The latent-trait approach is restricted to between-persons relations and thus provides no direct tests of mechanisms, which involve within-persons relations. The latent-trait-state approach can address within-persons relations, but the assumption of independence between latent constructs is often violated. Moreover, the focus on latent states results only in global clinical recommendations. In the network approach, clinical disorders are viewed as causal networks of observable mental problems and symptoms. The network approach has so far not addressed the episodic clusters of reactions surrounding every symptom. We propose an extended network approach, which identifies mechanistic relationships with the causal interactions among the reactions of these clusters. This approach is associated with differentiated clinical models and leads to specific clinical recommendations.

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

Cited by 33 publications

References 24 publications

A Randomized Controlled Trial of Metacognitive Therapy for Depression: Analysis of 1-Year Follow-Up

A Randomized Controlled Trial of Metacognitive Therapy for Depression: Analysis of 1-Year Follow-Up

Testing the Effectiveness of Cognitive Behavioral Therapy in Relieving Nurses’ Ageism Toward Older Adults: A Randomized Controlled Trial

Latent Trait, Latent-Trait State, and a Network Approach to Mental Problems and Their Mechanisms of Change

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