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Thingbak A, Capobianco L, Wells A, O'Toole MS. Relationships between metacognitive beliefs and anxiety and depression in children and adolescents: A meta-analysis. J Affect Disord 2024; 361:36-50. [PMID: 38815761 DOI: 10.1016/j.jad.2024.05.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/23/2024] [Accepted: 05/24/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND As hypothesized in the Self-Regulatory Executive Function (S-REF) model, metacognitive beliefs are associated with anxiety and depression in adults. An important question is the extent to which such effects are present in children and adolescents, with the implication that the model may also apply to young people. The aim of this meta-analysis was to synthesize results on the nature and magnitude of associations between metacognitive beliefs and anxiety and depression in children and adolescents. METHODS Systematic searches were conducted to identify studies that investigated: (1) group differences in metacognitive beliefs in clinical compared to non-clinical samples or (2) correlations between metacognitive beliefs and symptoms of anxiety and depression. RESULTS Forty papers were identified comprising a total sample of 9,887 participants aged 7-18 years. Meta-analyses revealed that clinical samples endorsed significantly elevated metacognitive beliefs on four out of the five domains measured (i.e., negative beliefs about worry, cognitive confidence, need for control, and cognitive self-consciousness, with the only exception being positive beliefs about worry) compared to non-clinical samples with a small to large effect (Hedges' gs = 0.45-1.22). Moreover, all five domains of metacognitive beliefs were significantly and positively correlated with symptoms of anxiety and depression of a small to large effect (rs = .24-.53). Negative beliefs about worry showed the strongest relationship with clinical status and the magnitude of symptoms. LIMITATIONS The number of studies did not allow for an evaluation of metacognitive beliefs at a disorder-specific level. CONCLUSIONS In line with the S-REF model, our findings provide evidence of robust cross-sectional relationships between metacognitions and both anxiety and depression in childhood and adolescence.
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Affiliation(s)
- Anne Thingbak
- Department of Psychology and Behavioural Sciences, Aarhus University, Denmark.
| | - Lora Capobianco
- School of Psychological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester & Greater Manchester Mental Health NHS Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Adrian Wells
- School of Psychological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester & Greater Manchester Mental Health NHS Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Mia Skytte O'Toole
- Department of Psychology and Behavioural Sciences, Aarhus University, Denmark
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Moradi-Joo E, Barouni M, Vali L, Mahmoudian S. Qualitative Analysis of Newborn Hearing Screening Program in Iran. Med J Islam Repub Iran 2024; 38:23. [PMID: 38783982 PMCID: PMC11114198 DOI: 10.47176/mjiri.38.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Indexed: 05/25/2024] Open
Abstract
Background Early diagnosis of hearing loss and timely interventions are important to minimize the consequences of this condition, especially for children. This research was conducted to analyze the newborn hearing loss screening program in Iran. Methods This qualitative study was conducted using the content analysis method and based on the CIPP model in 2023. The snowball method was used to recruit a sample with maximum diversity. The criteria for selecting people for interviews included having at least three years of experience in the newborn hearing loss screening program and sufficient knowledge in the field. To ensure the reliability of the results, four criteria proposed by Lincoln and Guba were used. Data analysis was conducted by MAXQDA2022 software. Results In the current research, using content analysis in the form of the CIPP model, based on the viewpoints of the interviewees (40 people), the management requirements of the newborn hearing loss screening program were categorized into the four main categories of context (texture), input, process, and output. Eight subcategories were identified in the context dimension, four subcategories in the input dimension, seven subcategories in the process dimension, and four subcategories in the output dimension. Conclusion According to the findings of this research, in order to properly implement the newborn hearing loss screening program, there is a need to conduct pilot studies, need assessments, evidence-based programs, and epidemiological studies and to prioritize services and resources. Also, communication between service delivery levels needs to be improved, and attention should be paid to personnel motivation and screening programs.
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Affiliation(s)
- Ehsan Moradi-Joo
- Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohsen Barouni
- School of Management and Medical Informatics, Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Leila Vali
- Faculty of Management and Medical Information Sciences, Kerman University of Medical Sciences, Kerman, Iran
| | - Saeid Mahmoudian
- ENT and Head and Neck Research Center, The Five Senses Health Institute, School of Medicine, Iran University of Medical Sciences
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Temple J, Gemma Cherry M, Gray V, Jones A, Fisher P. Experience sampling methodology study of anxiety and depression in adolescents with epilepsy: The role of metacognitive beliefs and perseverative thinking. Epilepsy Behav 2024; 151:109599. [PMID: 38160577 DOI: 10.1016/j.yebeh.2023.109599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/10/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
Emotional distress is common in young people with epilepsy (YPwE). According to the Self-Regulatory Executive Function (S-REF) model, maladaptive metacognitive beliefs and perseverative thinking are fundamental in the development and maintenance of emotional distress. As emotional distress and perseverative thinking can highly fluctuate over short intervals in YPwE, it is important to account for this variability when testing the utility of psychological models. Experience sampling methodology (ESM) was therefore used to explore the momentary relationship between metacognitive beliefs, perseverative thinking, and emotional distress in YPwE. Eighteen participants diagnosed with epilepsy (aged 12-17 years) completed the 10-day ESM period. Participants were prompted to complete the ESM assessment five times daily. The ESM assessment assessed participant's momentary levels of metacognitive beliefs, perseverative thinking (i.e., worry and rumination), and emotional distress (i.e., anxiety and depression). A series of multilevel regression analyses indicated that metacognitive beliefs were significantly positively associated with worry, rumination, anxiety and depression. After controlling for worry and rumination, respectively, metacognitive beliefs did not account for additional variance in anxiety or depression. Findings provide preliminary support for the utility of the S-REF model for emotional distress in YPwE. Metacognitive therapy, which is underpinned by the S-REF model, may be an appropriate intervention for emotional distress in YPwE. Future studies should assess the mediational relationship between metacognitive beliefs, perseverative thinking, and emotional distress using time-lagged models.
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Affiliation(s)
- James Temple
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK; Mersey Care NHS Foundation Trust, Liverpool, UK
| | - Mary Gemma Cherry
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK; Clinical Health Psychology Service, Liverpool University NHS Foundation Trust, Liverpool, UK.
| | - Victoria Gray
- Psychological Services (Paediatrics), Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Andrew Jones
- Department of Psychology, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | - Peter Fisher
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK; Clinical Health Psychology Service, Liverpool University NHS Foundation Trust, Liverpool, UK
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Wells A, Carter K, Hann M, Shields G, Wallis P, Cooper B, Capobianco L. Youth Metacognitive Therapy (YoMeta): protocol for a single-blind randomised feasibility trial of a transdiagnostic intervention versus treatment as usual in 11–16-year-olds with common mental health problems. Pilot Feasibility Stud 2022; 8:207. [PMID: 36096940 PMCID: PMC9465896 DOI: 10.1186/s40814-022-01162-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/25/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Mental health disorders in children and young people (CYP) are increasing but the provision of current evidence-based treatment for common mental health problems is limited. Treatment effects vary widely with no clear superiority of a single treatment approach. Further evaluation of contemporary and effective treatments in CYP is needed. Metacognitive therapy (MCT) has shown enhanced efficacy over ‘gold standard’ approaches in adult mental health, but so far has not been evaluated in a randomised trial of CYP. As such, we aim to assess the acceptability and feasibility of group-MCT for CYP with common mental health problems in comparison to usual treatment within Child and Adolescent Mental Health Services (CAMHS).
Method
YoMeta is a multicentre, two-arm, single-blind randomised feasibility trial comparing group-MCT to usual care in CYP with common mental health problems in CAMHS. CYP (target sample n = 100) with a common mental health problem will be recruited across at least three CAMHS services in the UK. Participants in the intervention arm will receive up to eight sessions of group-MCT delivered by a CAMHS mental health practitioner. The control arm will receive usual care in CAMHS which includes individual or group-based therapy. Feasibility will be assessed by the success of recruitment, retention, and data quality. Acceptability of the intervention will be assessed by the number of sessions attended and through qualitative interviews aimed at exploring CYP acceptability and understanding of the intervention. Symptoms of psychological distress will be assessed using the Revised Children Anxiety and Depression Scale (RCADS) at 20 weeks. We will also assess psychological well-being, symptoms of depression, metacognitive beliefs, quality of life, and measures to support economic evaluation (health status and health and social care use). Qualitative interviews will be conducted to understand practitioner’s views on training and delivery of group-MCT.
Discussion
The trial is designed to evaluate the acceptability and feasibility of group-MCT for CYP with common mental health problems. Group-MCT may aid in improving access to treatment, reduce waiting times, and improve outcomes for CYP with common mental health disorders. The study will provide important information and data to evaluate future research potential and confirm sample size estimation for a definitive large-scale RCT to test the effectiveness and cost-effectiveness of group-MCT in CYP.
Trial registration
NCT05260060; ISCTRN18335255
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Sharma V, Sagar R, Kaloiya G, Mehta M. The Scope of Metacognitive Therapy in the Treatment of Psychiatric Disorders. Cureus 2022; 14:e23424. [PMID: 35475111 PMCID: PMC9030663 DOI: 10.7759/cureus.23424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 03/23/2022] [Indexed: 12/17/2022] Open
Abstract
Metacognitive therapy (MCT) is a novel and promising transdiagnostic psychotherapy intervention based on the Self-Regulatory Executive Function model of conceptualizing emotional disorders. It was developed by Adrian Wells in 2009. Its therapeutic response occurs by reducing dysfunctional metacognitive beliefs regarding worry and rumination, often seen in patients with psychiatric disorders. Since its inception, it has been increasingly applied to a wide spectrum of psychiatric illnesses, but mainly focusing on mood and anxiety disorders. To our knowledge, no study has detailed its existing therapeutic scope in psychiatry. In this comprehensive narrative review, we describe the various psychiatric illnesses in which MCT has been used, the advantages of MCT, and the limitations of the MCT research. In addition, we propose some solutions to systematically examine its place in psychiatry. We encountered its potential role in treating trauma and stress-related disorders, obsessive-compulsive spectrum disorders, personality disorders, psychotic disorders, substance use disorders, and sexual disorders.
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Affiliation(s)
- Vandita Sharma
- Psychiatry, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Rajesh Sagar
- Psychiatry, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | | | - Manju Mehta
- Psychiatry, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
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Do Metacognitions of Children and Adolescents with Anxiety Disorders Change after Intensified Exposure Therapy? CHILDREN 2022; 9:children9020168. [PMID: 35204889 PMCID: PMC8869889 DOI: 10.3390/children9020168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/17/2022]
Abstract
Metacognitive beliefs have repeatedly proven to play a role in anxiety disorders in children and adolescents, but few studies have investigated whether they change after cognitive behavioral therapy. This longitudinal intervention study explores whether positive and negative metacognitive beliefs in particular change after exposure-focused treatment, and if metacognitive changes predict reductions in anxiety symptoms. A sample of 27 children between 8 and 16 years of age with a primary diagnosis of specific phobia, separation-anxiety disorder or social phobia completed assessments of anxiety symptoms, metacognitive beliefs, worry and repetitive negative thoughts before and after 11 sessions of intensified exposure treatment. Metacognitive beliefs did not change significantly after intensified exposure, but post-hoc power analysis revealed a lack of power here. Change in negative metacognitive beliefs correlated with a change in anxiety symptoms, but did not independently contribute as a predictor variable. Differences between subsamples showed that patients with separation-anxiety disorder scored higher on negative metacognitive beliefs than those with specific or social phobia. Consideration of metacognition, and negative metacognitive beliefs in particular could help us further improve the understanding and treatment of anxiety disorders in children and adolescents and should therefore receive more attention in psychotherapy research.
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Capobianco L, Nordahl H. A Brief History of Metacognitive Therapy: From Cognitive Science to Clinical Practice. COGNITIVE AND BEHAVIORAL PRACTICE 2021. [DOI: 10.1016/j.cbpra.2021.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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8
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Walczak M, Austgulen E, Kirsten L, Breinholst S. Examining Changes in the Cognitive Attentional Syndrome and Attentional Control Following Metacognitive Therapy for Children with Generalized Anxiety Disorder. Int J Cogn Ther 2021. [DOI: 10.1007/s41811-021-00124-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Köcher LM, Schneider K, Christiansen H. Thinking about worry: A systematic review and meta-analysis on the assessment of metacognitions in children and adolescents. World J Psychiatry 2021; 11:635-658. [PMID: 34631466 PMCID: PMC8474992 DOI: 10.5498/wjp.v11.i9.635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/04/2021] [Accepted: 07/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The metacognitive model of generalized anxiety disorder identifies three forms of metacognition: Positive metacognitive beliefs about worry (POS), negative metacognitive beliefs about worry (NEG), and meta-worry. Though this model was originally developed relying on adult samples, it has since been applied to children and youth in different studies, and results mostly support its validity for this group. As the roles of POS, meta-worry, and age-effects do not appear to be fully clarified for children and adolescents yet, an integration of studies on children and adolescents and the metacognitive model is both timely and worthwhile.
AIM To summarize the current research on relationships, age-effects, and measurements for POS, NEG, and meta-worry in childhood and youth.
METHODS We carried out a literature search in the electronic databases PsycINFO, PubMed, PSYNDEX, and ERIC in 2017 and updated in 2020. Empirical research in German or English language on metacognition was included with child and adolescent samples diagnosed with anxiety disorders or healthy controls if POS, NEG, or meta-worry were measured. Studies were included for meta-analysis if they reported correlations between these metacognitions and anxiety or worry. Consensus rating for eligibility was done for 20.89% of full-texts with 90.32% agreement. Risk of bias was assessed with the appraisal tool for cross-sectional studies and consensus rating of appraisal tool for cross-sectional studies for 20.83% of included studies attaining agreement of intraclass correlation = 0.898. Overall, correlations between metacognitions, anxiety and worry were calculated with RevMan 5.4.1, assuming random-effects models. Meta-regressions with mean age as the covariate were performed via the online tool MetaMar 2.7.0. PROSPERO-ID: CRD42018078852.
RESULTS Overall, k = 763 records and k = 78 additional records were identified. Of those, k = 48 studies with 12839 participants were included and of those, k = 24 studies were included for meta-analysis. Most studies showed consistent NEG correlations with worry and anxiety, as well as higher values for clinical than for non-clinical samples. POS findings were less consistent. Meta-analysis revealed large effects for NEG correlating with worry and anxiety, small to medium effects for POS correlating with worry and anxiety, as well as small to medium effects for POS correlating with NEG. Meta-regressions did not reveal mean age as a significant covariate. Meta-worry was assessed in only one study. We identified eight questionnaires and one interview-format that assess metacognition about worry in children and adolescents.
CONCLUSION POS and NEG are measurable from the age of seven upwards and correlate with anxiety and worry without influences by age. Meta-worry requires further investigation.
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Affiliation(s)
- Laura M Köcher
- Department of Psychology, University of Marburg, Marburg 35037, Germany
| | - Kai Schneider
- Department of Clinical Child and Adolescent Psychology, University of Landau, Landau 76829, Germany
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10
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Metacognitive Beliefs Predict Cognitive Behavioral Therapy Outcome in Children with Anxiety Disorders. Int J Cogn Ther 2021. [DOI: 10.1007/s41811-021-00119-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Whiteside SPH, Brennan E, Biggs BK, Vickers K, Hathaway J, Seifert SJ, Kramer KM, Hofschulte DR. The feasibility of verbal and virtual reality exposure for youth with academic performance worry. J Anxiety Disord 2020; 76:102298. [PMID: 32937260 DOI: 10.1016/j.janxdis.2020.102298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/28/2020] [Accepted: 08/30/2020] [Indexed: 12/17/2022]
Abstract
With exposure emerging as a key ingredient in anxiety treatment for childhood anxiety disorders (CADs), expansion of exposure techniques is a promising avenue for improving treatment efficacy. The present study examined use of imaginal exposure (IE), a technique understudied in the treatment of CADs. Specifically, the study tested whether two forms of exposure to worries (verbal IE and virtual reality exposure therapy, VRET) would be effective and acceptable forms of exposure with youth. Twenty youth with fears of academic failure completed both types of worry exposure, presented in randomized order. Regardless of order of presentation, both verbal IE and VRET elicited moderate anxiety that decreased to mild over the span of the exposures. Both were found to be acceptable by youth and neither was associated with negative side effects. Youth found VRET to be slightly more interesting and novel, but noted that verbal IE was more realistic and individualized. The present study supports the use of standalone worry exposure as an effective and acceptable treatment for general worries in youth and suggests VRET could be more effective with improved realism.
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Affiliation(s)
| | - Elle Brennan
- Department of Psychiatry and Psychology, Mayo Clinic, United States
| | - Bridget K Biggs
- Department of Psychiatry and Psychology, Mayo Clinic, United States
| | - Kristin Vickers
- Department of Psychiatry and Psychology, Mayo Clinic, United States; Office of Patient Education, Mayo Clinic, United States
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Assessment of the cognitive attentional syndrome in children: an adaptation of the CAS-1. Behav Cogn Psychother 2020; 49:340-351. [PMID: 33172517 DOI: 10.1017/s135246582000082x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Research suggests that the metacognitive model is applicable to clinical child populations. However, few measures related to the model are available for younger age groups. A key concept of the model is the cognitive attentional syndrome (CAS), which encompasses the individual's worry and rumination, maladaptive coping strategies, and metacognitive beliefs. While the CAS has been successfully measured in adults, this has not yet been attempted in children. AIMS The aim of this study was to adapt a measure of the CAS for use with children and investigate the measure's associations with anxiety, worry, depression and metacognitions. METHODS Our study included 127 children with anxiety disorders aged 7-13 years. The adult measure of CAS was adapted for use with children and administered at pre- and post-treatment. We examined the correlations between variables and the ability of the CAS measure to explain variance in anxious symptomatology, as well as the measure's sensitivity to treatment change. RESULTS The adapted measure, CAS-1C, displayed strong associations with overall anxiety, depression, worry and metacognitions. The CAS-1C explained an additional small amount of variance in anxiety and worry symptoms after accounting for metacognitions, which may be due to the measure also assessing thinking styles and coping strategies. Furthermore, the measure displayed sensitivity to treatment change. CONCLUSIONS The child measure of the CAS is a brief tool for collecting information on metacognitive beliefs and strategies that maintain psychopathology according to the metacognitive model, and it can be used to monitor treatment changes in these components.
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Metakognitive und mentalisierungsbasierte Konzepte und Behandlungsmodelle: Implikationen für die Kinder- und Jugendpsychiatrie. Prax Kinderpsychol Kinderpsychiatr 2020; 69:252-271. [DOI: 10.13109/prkk.2020.69.3.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Thorslund J, McEvoy PM, Anderson RA. Group metacognitive therapy for adolescents with anxiety and depressive disorders: A pilot study. J Clin Psychol 2020; 76:625-645. [PMID: 31916590 DOI: 10.1002/jclp.22914] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE(S) The metacognitive model suggests that beliefs about cognition maintain repetitive negative thinking (RNT), a transdiagnostic process that underlies commonly comorbid, emotional disorders. To date, there has been the limited application of metacognitive therapy (MCT) to adolescents. This study aimed to evaluate a six-session group transdiagnostic MCT program for adolescents with anxiety and/or depressive disorders. METHOD Participants (N = 10; 3 male, 7 female; average age 15.2 years) completed measures of metacognition and RNT at assessment, baseline period, during treatment, and at 1- and 3-month follow-ups. RESULTS Nine participants attended all six treatment sessions and one discontinued after four sessions. At posttreatment and follow-ups, the majority of participants no longer met diagnostic criteria for anxiety or depressive disorders and evidenced a clinically significant or reliable change in metacognitions and RNT. CONCLUSIONS Results suggest that group MCT is promising in terms of acceptability and effectiveness for adolescents with anxiety and/or depressive disorders.
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Affiliation(s)
| | - Peter M McEvoy
- School of Psychology, Curtin University, Perth, Australia.,Centre for Clinical Interventions, Perth, Australia
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Acceptance and Commitment Therapy Focused on Repetitive Negative Thinking for Child Depression: A Randomized Multiple-Baseline Evaluation. PSYCHOLOGICAL RECORD 2020. [DOI: 10.1007/s40732-019-00362-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Myers SG, Solem S, Wells A. The Metacognitions Questionnaire and Its Derivatives in Children and Adolescents: A Systematic Review of Psychometric Properties. Front Psychol 2019; 10:1871. [PMID: 31551843 PMCID: PMC6737041 DOI: 10.3389/fpsyg.2019.01871] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 07/30/2019] [Indexed: 01/16/2023] Open
Abstract
Background: The Metacognitions Questionnaire (MCQ) and its derivatives have been instrumental in research examining the Self-Regulatory Executive Function Model in adults. Studies testing whether findings are applicable to children and adolescents have been increasing and several different measures adapting the MCQ for younger populations have been developed. The current study aimed to systematically review the psychometric properties of MCQ measures or derivatives used in young people (aged 18 or less), to help assess current findings in this population and to guide future research in this growing area of investigation. Method: Systematic searches were carried out on PubMed and PsycINFO of studies published up to June 2018. Additional studies were identified through Google Scholar and article references. Validity, reliability, range and responsiveness of measures were examined as well as analyses of age and gender differences on scores. Results: Forty-five articles were identified. The total sample consisted of 7,803 children and adolescents (6,922 non-clinical, 881 clinical) aged 7-18. Studies used one of seven versions of the questionnaire, five adapted from the MCQ for younger populations: (1) The Metacognitions Questionnaire-Adolescent version; (2) The Metacognitions Questionnaire-Child version; (3) The Metacognitions Questionnaire-Child Version-Revised; (4) The Metacognitions Questionnaire-Child-30; and (5) The Metacognitions Questionnaire-65 Positive Beliefs Scale Revised; and two adult versions used without adaptation: (1) The Metacognitions Questionnaire-30 and (2) The Cognitive Self Consciousness Scale-Expanded. The validity and reliability of the Metacognitions Questionnaire-Adolescent version had the most extensive support. Other questionnaires had either mixed psychometrics or promising initial findings but more limited data. Conclusions: It is recommended that studies using adolescents (age 12-18) consider using the Metacognitions Questionnaire-Adolescent version. Based on initial data, it is suggested studies using younger populations should consider the Metacognitions Questionnaire-Child-30 but further psychometric research into this and other measures is needed.
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Affiliation(s)
- Samuel G. Myers
- Division of Psychology, Bar Ilan University, Ramat-Gan, Israel
| | - Stian Solem
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Adrian Wells
- Division of Clinical and Health Psychology, The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Prestwich, United Kingdom
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Walczak M, Breinholst S, Ollendick T, Esbjørn BH. Cognitive Behavior Therapy and Metacognitive Therapy: Moderators of Treatment Outcomes for Children with Generalized Anxiety Disorder. Child Psychiatry Hum Dev 2019; 50:449-458. [PMID: 30406900 DOI: 10.1007/s10578-018-0853-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Although cognitive behavioral therapy (CBT) is effective for childhood anxiety disorders, approximately 40% of youth remain anxious after treatment. Metacognitive therapy (MCT-c) for children with generalized anxiety disorder (GAD) has shown promising effects. The present study aimed to examine if CBT and MCT-c show differential effects in children with primary GAD based on baseline characteristics, in a quasi-experimental design. To investigate which treatment is most beneficial for whom, three potential moderators: age, symptom severity, and comorbid social anxiety were examined. Sixty-three children aged 7-14 completed CBT or MCT-c. Participants were assessed before and after treatment. Both CBT and MCT-c were highly effective in treatment of childhood GAD. None of the selected variables significantly moderated treatment outcomes. Subgroups of children with high symptom severity and social anxiety comorbidity showed trends of responding better to CBT. Methodologically stronger studies are needed to facilitate a better adaptation of treatment for children with GAD.
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Affiliation(s)
- Monika Walczak
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353, Copenhagen, Denmark.
| | - Sonja Breinholst
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353, Copenhagen, Denmark
| | | | - Barbara Hoff Esbjørn
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353, Copenhagen, Denmark
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Abstract
PURPOSE OF REVIEW This review describes (a) key features of the metacognitive model as they relate to anxiety and related disorders, (b) central components of metacognitive therapy (MCT), (c) the current empirical status of MCT, (d) recent developments, (e) controversies and (f) future research directions. RECENT FINDINGS Evidence is accumulating that MCT is effective for anxiety and related disorders. Emerging evidence suggests that MCT may be effective with children and adolescents and compares well to other evidence-supported treatments such as cognitive behaviour therapy and mindfulness-based approaches. Evidence for distinct mechanisms across therapies is mixed. While MCT appears to be effective for anxiety and related disorders, more research is required to evaluate (a) efficacy and unique (vs. common) mechanisms of change compared to other therapies, (b) effectiveness for children and adolescents, (c) alternative delivery methods (e.g., via internet, group vs. individual), (d) transdiagnostic impacts and (e) applications to a broader array of disorders.
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Simons M, Kursawe AL. Metacognitive Therapy for Posttraumatic Stress Disorder in Youth: A Feasibility Study. Front Psychol 2019; 10:264. [PMID: 30837918 PMCID: PMC6389642 DOI: 10.3389/fpsyg.2019.00264] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 01/28/2019] [Indexed: 11/13/2022] Open
Abstract
Metacognitive therapy (MCT) is an effective treatment for posttraumatic stress disorders (PTSD) in adults. However, there is no evidence for the feasibility, acceptability, and efficacy of MCT for PTSD in youth so far. This study is the first to utilize MCT for children and adolescents with PTSD. Twenty-one children and adolescents (aged 8-19 years) who were consecutively referred to the outpatient trauma clinic were treated with MCT. In all patients, treatment was well accepted and regularly attended. At post-treatment, MCT was associated with significant and large reductions in posttraumatic stress symptoms. Depending on the outcome measure, 95 or 85% of the patients were classified as recovered after treatment. Eighteen patients were included in the calculation of the overall outcome. Effect sizes on primary PTSD measures were large (Cohen's d = 3.42 and d = 1.92) and more than comparable to well-established treatments. Only six patients were available at follow-up, but their improvements were found to be stable. Despite the limitations of this uncontrolled study, the results suggest that MCT may be a feasible and promising treatment for traumatized children and adolescents and they justify a controlled trial evaluating the efficacy of MCT versus an already well-established intervention.
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Affiliation(s)
- Michael Simons
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy RWTH Aachen University, Aachen, Germany
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Papageorgiou C, Carlile K, Thorgaard S, Waring H, Haslam J, Horne L, Wells A. Group Cognitive-Behavior Therapy or Group Metacognitive Therapy for Obsessive-Compulsive Disorder? Benchmarking and Comparative Effectiveness in a Routine Clinical Service. Front Psychol 2018; 9:2551. [PMID: 30618972 PMCID: PMC6295517 DOI: 10.3389/fpsyg.2018.02551] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Accepted: 11/28/2018] [Indexed: 12/03/2022] Open
Abstract
Cognitive-behavior therapy (CBT), delivered in an individual or group format, is the recommended treatment of choice for Obsessive-Compulsive Disorder (OCD), but no studies have benchmarked the outcomes for group CBT in real-world clinical settings. The first aim of this evaluation was to benchmark the outcomes for group CBT in a sample of 125 patients who attended a routine clinical service for OCD. The results showed that the outcomes for the group CBT were comparable to those reported in previous treatment studies. However, consistent with the CBT for OCD literature, 28% of patients receiving CBT reported minimal improvement. The second aim of this evaluation was to carry out a benchmarking analysis for group metacognitive therapy (MCT) to determine if this could provide any advantages in a sample of 95 patients who also attended this clinical service over a subsequent period. The clinically significant results obtained for group MCT improved upon or equaled those obtained for group CBT and those typically found in treatment studies. The group MCT cohort improved significantly more than the group CBT cohort even after controlling for important pre-treatment variables including age, gender, number of diagnoses, symptoms of depression, and psychotropic medication. MCT had significantly higher clinical response rates. Based on international expert consensus criteria, 86.3% of patients in the MCT cohort responded compared with 64% in CBT. The implications of these findings are discussed.
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Affiliation(s)
| | - Karen Carlile
- The Priory Hospital Altrincham, Altrincham, United Kingdom
| | - Sue Thorgaard
- The Priory Hospital Altrincham, Altrincham, United Kingdom
| | - Howard Waring
- The Priory Hospital Altrincham, Altrincham, United Kingdom
| | - Justin Haslam
- The Priory Hospital Altrincham, Altrincham, United Kingdom
| | - Louise Horne
- Mersey Care NHS Foundation Trust, Ashworth Hospital, Liverpool, United Kingdom
| | - Adrian Wells
- Greater Manchester Mental Health NHS Foundation Trust, University of Manchester, Manchester, United Kingdom
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Normann N, Morina N. The Efficacy of Metacognitive Therapy: A Systematic Review and Meta-Analysis. Front Psychol 2018; 9:2211. [PMID: 30487770 PMCID: PMC6246690 DOI: 10.3389/fpsyg.2018.02211] [Citation(s) in RCA: 108] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/25/2018] [Indexed: 12/14/2022] Open
Abstract
Background: Metacognitive therapy (MCT) continues to gain increased ground as a treatment for psychological complaints. During the last years, several clinical trials on the efficacy of MCT have been published. The aim of the current study was to provide an updated meta-analytic review of the effect of MCT for psychological complaints. Methods: We conducted a systematic search of trials on MCT for young and adult patients with psychological complaints published until January 2018, using PsycINFO, PubMed, the Cochrane Library, and Google Scholar. Trials with a minimum of 10 participants in the MCT condition were included. Results: A total of 25 studies that examined a variety of psychological complaints met our inclusion criteria, of which 15 were randomized controlled trials. We identified only one trial that was conducted with children and adolescents. In trials with adult patients, large uncontrolled effect size estimates from pre- to post-treatment and follow-up suggest that MCT is effective at reducing symptoms of the targeted primary complaints, anxiety, depression, and dysfunctional metacognitions. The comparison with waitlist control conditions also resulted in a large effect (Hedges' g = 2.06). The comparison of MCT to cognitive and behavioral interventions at post-treatment and at follow-up showed pooled effect sizes (Hedges' g) of 0.69 and 0.37 at post-treatment (k = 8) and follow-up (k = 7), respectively. Conclusions: Our findings indicate that MCT is an effective treatment for a range of psychological complaints. To date, strongest evidence exists for anxiety and depression. Current results suggest that MCT may be superior to other psychotherapies, including cognitive behavioral interventions. However, more trials with larger number of participants are needed in order to draw firm conclusions.
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Affiliation(s)
- Nicoline Normann
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Nexhmedin Morina
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Münster, Münster, Germany
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