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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] [What about the content of this article? (0)] [Affiliation(s)] [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] [What about the content of this article? (0)] [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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Carter JD, Helliwell E, Jordan J, Woolcock C, Bell C, Gilbert C. Group Metacognitive Therapy for Obsessive-Compulsive Disorder in a Routine Clinical Setting: An Open Trial. Behav change. [DOI: 10.1017/bec.2022.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Obsessive-compulsive disorder (OCD) is often a chronic disorder characterised by uncontrollable, reoccurring thoughts (obsessions), and/or behaviours (compulsions). Accumulating evidence suggests that metacognitive beliefs may underlie many of the processes implicated in the formation and perpetuation of OCD. Metacognitive therapy (MCT) for OCD aims to modify these maladaptive metacognitive beliefs and processes to treat this debilitating disorder. The current study examines the outcome of a pilot trial of MCT for OCD in 26 (17 females; 9 males) adults (18–64 years) referred to a specialist outpatient service. Results were promising, with significant decreases in OCD and depression symptoms, which were maintained at the 3-month follow-up. The improvement in Yale-Brown Obsessive-Compulsive Scale scores between pre-treatment and follow-up in the completer sample (n=22) was large (d=1.29), and comparable to outcomes of well-established treatments. These encouraging results add to early empirical support for the effectiveness of group MCT as an OCD treatment alternative, as well as reinforcing the role of metacognitions contributing to this disorder.
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Wolenski R, Vaclavik D, Rey Y, Pettit JW. Metacognitive Beliefs Predict Cognitive Behavioral Therapy Outcome in Children with Anxiety Disorders. Int J Cogn Ther 2021; 14:687-703. [DOI: 10.1007/s41811-021-00119-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Sookman D, Phillips KA, Anholt GE, Bhar S, Bream V, Challacombe FL, Coughtrey A, Craske MG, Foa E, Gagné JP, Huppert JD, Jacobi D, Lovell K, McLean CP, Neziroglu F, Pedley R, Perrin S, Pinto A, Pollard CA, Radomsky AS, Riemann BC, Shafran R, Simos G, Söchting I, Summerfeldt LJ, Szymanski J, Treanor M, Van Noppen B, van Oppen P, Whittal M, Williams MT, Williams T, Yadin E, Veale D. Knowledge and competency standards for specialized cognitive behavior therapy for adult obsessive-compulsive disorder. Psychiatry Res 2021; 303:113752. [PMID: 34273818 DOI: 10.1016/j.psychres.2021.113752] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/21/2021] [Indexed: 12/19/2022]
Abstract
Obsessive-Compulsive Disorder (OCD) is a leading cause of disability world-wide (World Health Organization, 2008). Treatment of OCD is a specialized field whose aim is recovery from illness for as many patients as possible. The evidence-based psychotherapeutic treatment for OCD is specialized cognitive behavior therapy (CBT, NICE, 2005, Koran and Simpson, 2013). However, these treatments are not accessible to many sufferers around the world. Currently available guidelines for care are deemed to be essential but insufficient because of highly variable clinician knowledge and competencies specific to OCD. The phase two mandate of the 14 nation International OCD Accreditation Task Force (ATF) created by the Canadian Institute for Obsessive Compulsive Disorders is development of knowledge and competency standards for specialized treatments for OCD through the lifespan deemed by experts to be foundational to transformative change in this field. This paper presents knowledge and competency standards for specialized CBT for adult OCD developed to inform, advance, and offer a model for clinical practice and training for OCD. During upcoming ATF phases three and four criteria and processes for training in specialized treatments for OCD through the lifespan for certification (individuals) and accreditation (sites) will be developed based on the ATF standards.
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Affiliation(s)
- Debbie Sookman
- Department of Psychology, McGill University Health Center, 1025 Pine Ave W, Montreal, Quebec, H3A 1A1, Canada; Department of Psychiatry, McGill University, 845 Sherbrooke St W, Montreal, Quebec, H3A 0G4, Canada.
| | - Katharine A Phillips
- Department of Psychiatry, Weill Cornell Medicine, 1300 York Ave, New York, NY 10065, United States.
| | - Gideon E Anholt
- Department of Psychology, Marcus Family Campus, Ben-Gurion University of the Negev, Beer Sheva, P.O.B. 653 Beer-Sheva, 8410501, Israel.
| | - Sunil Bhar
- Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, 1 John St, Hawthorn, Victoria, 3122, Australia.
| | - Victoria Bream
- Oxford Health Specialist Psychological Interventions Clinic and Oxford Cognitive Therapy Centre, Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - Fiona L Challacombe
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AF, United Kingdom.
| | - Anna Coughtrey
- Great Ormond Street Hospital for Children, London WC1N 3JH, United Kingdom; UCL Great Ormond Street Institute of Child Health, 30 Guilford St, Holborn, London, WC1N 1EH, United Kingdom.
| | - Michelle G Craske
- Anxiety and Depression Research Center, Depression Grant Challenge, Innovative Treatment Network, Staglin Family Music Center for Behavioral and Brain Health, UCLA Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, Box 951563, 1285 Franz Hall, Los Angeles, CA, United States.
| | - Edna Foa
- Center for the Treatment and Study of Anxiety, University of Pennsylvania Perelman SOM, 3535 Market Street, Philadelphia, PA 19104, United States.
| | - Jean-Philippe Gagné
- Department of Psychology, Concordia University, 7141 Sherbrooke St, West, Montreal, Quebec H4B 1R6, Canada.
| | - Jonathan D Huppert
- Department of Psychology, The Hebrew University of Jerusalem, Mt. Scopus, Jerusalem, 91905, Israel.
| | - David Jacobi
- Rogers Behavioral Health, 34700 Valley Road, Oconomowoc, WI, 53066, United States.
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Rd, Manchester, M13 9PL, United Kingdom; Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M13 9PL, United Kingdom.
| | - Carmen P McLean
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, 94025, United States; Department of Psychiatry and Behavioral Sciences, Stanford University, 450 Serra Mall, Stanford, CA, 94305, United States.
| | - Fugen Neziroglu
- Bio-Behavioral Institute, 935 Northern Boulevard, Suite 102, Great Neck, NY, 11021, United States.
| | - Rebecca Pedley
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, United Kingdom.
| | - Sean Perrin
- Department of Psychology, Lund University, Box 213, 22100, Lund, Sweden.
| | - Anthony Pinto
- Zucker School of Medicine at Hofstra/Northwell, Zucker Hillside Hospital - Northwell Health, 265-16 74th Avenue, Glen Oaks, NY, 11004, United States.
| | - C Alec Pollard
- Center for OCD and Anxiety-Related Disorders, Saint Louis Behavioral Medicine Institute, 1129 Macklind Ave, St. Louis, MO, 63110, United States; Department of Family and Community Medicine, Saint Louis University School of Medicine, Saint Louis, MO, 63110, United States.
| | - Adam S Radomsky
- Department of Psychology, Concordia University, 7141 Sherbrooke St, West, Montreal, Quebec H4B 1R6, Canada.
| | - Bradley C Riemann
- 34700 Valley Road, Rogers Behavioral Health, Oconomowoc, WI, 53066, United States.
| | - Roz Shafran
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Hospital Institute of Child Health, Holborn, London, WC1N 1EH, United Kingdom.
| | - Gregoris Simos
- Department of Educational and Social Policy, University of Macedonia, 156 Egnatia Street, 54636 Thessaloniki, Greece.
| | - Ingrid Söchting
- Departments of Psychology, University of British Columbia, 2136 West Mall, Vancouver, British Columbia, V6T 1Z4, Canada.
| | - Laura J Summerfeldt
- Department of Psychology, Trent University, 1600 West Bank Drive, Peterborough, K9L 0G2 Ontario, Canada.
| | - Jeff Szymanski
- International OCD Foundation, 18 Tremont Street, #308, Boston MA, 02108, United States.
| | - Michael Treanor
- Anxiety and Depression Research Center, University of California, Los Angeles, Box 951563, 1285 Franz Hall, Los Angeles, CA, United States.
| | - Barbara Van Noppen
- Clinical Psychiatry and Behavioral Sciences, OCD Southern California, 2514 Jamacha Road Ste, 502-35 El Cajon, CA, 92019, United States; Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, 2250 Alcazar Street, Suite 2200, Los Angeles, CA, 90033, United States.
| | - Patricia van Oppen
- Department of Psychiatry, Amsterdam UMC, location VUmc, Netherlands; Amsterdam Public Health Research Institute - Mental Health, Netherlands; GGZ inGeest Specialized Mental Health Care, Netherlands.
| | - Maureen Whittal
- Vancouver CBT Centre, 302-1765 W8th Avenue, Vancouver, British Columbia, V6J5C6, Canada; Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Monnica T Williams
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Pvt, Ottawa, K1N 6N5, Ontario, Canada.
| | - Timothy Williams
- Department of Psychology, University of Reading, PO Box 217, Reading, Berkshire, RG6 6AH, United Kingdom.
| | - Elna Yadin
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 2nd Floor, Philadelphia, PA 19104, United States.
| | - David Veale
- South London and the Maudsley NHS Foundation Trust & King's College London, Denmark Hill, London, SE5 8 AZ, United Kingdom.
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Miegel F, Demiralay C, Sure A, Moritz S, Hottenrott B, Cludius B, Jelinek L. The Metacognitive Training for obsessive-compulsive disorder: A pilot study. Curr Psychol 2020. [DOI: 10.1007/s12144-020-01158-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AbstractMore than 50% of patients with obsessive-compulsive disorder (OCD) do not receive first-line psychological treatment such as cognitive-behavioral therapy with exposure and response prevention. To narrow this treatment gap, there is an urgent need for therapies that are easy to disseminate and highly accepted by patients. The aim of the present pilot study was to evaluate the effectiveness of the Metacognitive Group Training for OCD (MCT-OCD). Fifty patients with OCD participated in the MCT-OCD for 4 weeks during their inpatient stay in a single-arm pilot trial. Patients were assessed before and after the intervention and filled out an online survey 6 months after post assessment. Results showed a decrease in obsessive compulsive symptoms according to the Yale-Brown Obsessive Compulsive Scale (primary outcome) from baseline to post assessment with a large effect size. Symptom reduction remained stable over 6 months and was positively correlated with appraisal ratings of the training. The reduction in frequency of obsessive compulsive symptoms, distress due to obsessive compulsive symptoms, cognitive biases, and depressive symptoms remained stable over 6 months after the intervention. Our findings tentatively imply that the MCT-OCD is a promising treatment for OCD patients. A randomized controlled trial is thus warranted to further clarify the efficacy of the MCT-OCD. Trial Registration: German Clinical Trials Register (DRKS-ID: DRKS00012531), date of registration: 16.06.2017.
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Normann N, Reinholdt-Dunne ML, Stolpe Andersen M, Esbjørn BH. Assessment of the cognitive attentional syndrome in children: an adaptation of the CAS-1. Behav Cogn Psychother 2021; 49:340-51. [PMID: 33172517 DOI: 10.1017/S135246582000082X] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [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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Rizvi M, Smilansky H, Porth R, Myers N, Geller D, Small BJ, McGuire JF, Wilhelm S, Storch EA. The moderating effect of age on the associations of cognitive and metacognitive beliefs with pediatric OCD symptoms. Cogn Behav Ther 2020; 50:104-120. [PMID: 33073722 DOI: 10.1080/16506073.2020.1819866] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Although considerable research has highlighted the importance of cognitive and metacognitive beliefs in adult obsessive-compulsive disorder (OCD), there has been limited investigation of these beliefs in pediatric OCD. The present study investigated the clinical correlates of cognitive and metacognitive beliefs in pediatric OCD. Previous studies found positive relations between OCD symptoms and these beliefs in pediatric patients, and we hypothesized these beliefs would also be positively related to pediatric OCD symptom severity. We additionally hypothesized age would moderate these relationships in consideration of previous studies highlighting age differences in symptom presentation and self-reported beliefs. We also explored age differences in belief endorsements. Youth aged 7-17 (n = 142) diagnosed with OCD completed self-report scales to measure cognitive and meta-cognitive beliefs. OCD severity was assessed using self-report and clinician-rated measures. Pearson correlations, moderation analyses, and independent-samples t-tests were used to test our hypotheses and aims. Significant positive relationships were observed between cognitive and metacognitive beliefs and self-reported OCD severity, although age did not moderate these relationships. Age differences were found in belief endorsements. In conclusion, cognitive and metacognitive beliefs appear clinically relevant to pediatric OCD cases, and we recommend clinicians assess these beliefs and incorporate cognitive components to corresponding evidence-based treatment.
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Affiliation(s)
- Myles Rizvi
- Psychology Section, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine , Houston, TX, USA
| | - Hannah Smilansky
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School , Boston, MA, United States
| | - Rachel Porth
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School , Boston, MA, United States
| | - Nicholas Myers
- Psychiatry and Behavioral Sciences - Child and Adolescent Psychiatry, Johns Hopkins School of Medicine , Baltimore, MD, USA
| | - Daniel Geller
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School , Boston, MA, United States
| | - Brent J Small
- School of Aging Studies, University of South Florida , Tampa, FL, USA
| | - Joseph F McGuire
- Psychiatry and Behavioral Sciences - Child and Adolescent Psychiatry, Johns Hopkins School of Medicine , Baltimore, MD, USA
| | - Sabine Wilhelm
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School , Boston, MA, United States
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine , Houston, TX, USA
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Johnco C, McGuire JF, Roper T, Storch EA. A meta-analysis of dropout rates from exposure with response prevention and pharmacological treatment for youth with obsessive compulsive disorder. Depress Anxiety 2020; 37:407-417. [PMID: 31778595 DOI: 10.1002/da.22978] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/15/2019] [Accepted: 11/03/2019] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Beliefs that exposure with response prevention (ERP) is excessively distressing and will result in client dropout from treatment are commonly-cited reasons for clinicians not providing evidence-based treatment. This meta-analysis examined treatment attrition for ERP for youth with obsessive compulsive disorder (OCD) compared with other treatment modalities. METHOD A systematic literature search identified 11 randomized controlled trials (RCTs) comparing ERP to active or waitlist control conditions, 9 comparing pharmacotherapy to control, and 3 comparing ERP to pharmacotherapy for youth with OCD. RESULTS Attrition rates were low for ERP (10.24%) compared to pharmacotherapy (17.29%), active control (e.g., relaxation, metacognitive therapy; 20.63%), and pill placebo (23.49%). ERP had lower risk of attrition compared to active control conditions (RR = 0.60; p = .02), and was not significantly different to waitlist (RR = 0.80; p = .59). In head-to-head trials, there was no difference between the risk of attrition from ERP and pharmacotherapy (RR = 1.26; p = .74). Of the pharmacotherapy trials, risk of attrition from serotonin reuptake inhibitors treatment was not significantly different compared to placebo (RR = 0.94; p = .76), with no difference between antidepressants and clomipramine (p = .19). Attrition from ERP was primarily for logistical reasons, compared to lack of efficacy for relaxation and/or adverse reactions from pharmacotherapy. CONCLUSIONS Attrition from ERP is low, and is generally lower than non-ERP interventions. Given favorable attrition and efficacy data, there is little justification for appropriately-trained clinicians not to offer ERP as a first-line treatment for youth with OCD.
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Affiliation(s)
- Carly Johnco
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Joseph F McGuire
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tegan Roper
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Rupp C, Gühne D, Falke C, Doebler P, Andor F, Buhlmann U. Comparing effects of detached mindfulness and cognitive restructuring in obsessive-compulsive disorder using ecological momentary assessment. Clin Psychol Psychother 2019; 27:193-202. [PMID: 31881096 DOI: 10.1002/cpp.2418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 12/15/2019] [Accepted: 12/15/2019] [Indexed: 11/08/2022]
Abstract
Ecological momentary assessment (EMA) has been shown to be a valid and sensitive measure of treatment effects in obsessive-compulsive disorder (OCD). As part of a clinical trial, this EMA study deals with a comparison of two treatment conditions, that is, cognitive restructuring (CR) and detached mindfulness (DM). EMA data from n = 39 OCD patients were available from a randomized clinical trial on the effectiveness of CR and DM. Smartphone-based EMA sampling spread over 4 days each before and after treatment, with 10 random prompts per day and a 2-week intervention of either CR or DM. We tracked CR strategies (e.g., questioning an appraisal by re-evaluating risk), DM strategies (e.g., allowing one's thoughts to come and go), and application of newly learned strategies during Post-Treatment EMA. Although there was a trend towards DM strategies being applied more often during Pre-Treatment EMA than CR strategies, we did not find differences during Post-Treatment EMA between CR and DM regarding frequency or difficulty of application and experienced relief. As expected, we found a clear pre-post increase for all CR and DM behaviours except for one DM item. However, we did not find a treatment-specific increase of CR and DM behaviours; that is, both interventions equally well promoted a seemingly general treatment effect. Despite the ecological validity of EMA, however, social desirability effects cannot be ruled out, so that this conclusion must be handled cautiously. Further research is needed to replicate and generalize our results.
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Affiliation(s)
- Christian Rupp
- Institute of Psychology, Westfälische Wilhelms-University Münster, Münster, Germany.,Christoph-Dornier-Stiftung, Münster, Germany
| | - Daniela Gühne
- Department of Statistics, TU Dortmund University, Dortmund, Germany
| | - Charlotte Falke
- Institute of Psychology, Westfälische Wilhelms-University Münster, Münster, Germany.,Christoph-Dornier-Stiftung, Münster, Germany
| | - Philipp Doebler
- Department of Statistics, TU Dortmund University, Dortmund, Germany
| | | | - Ulrike Buhlmann
- Institute of Psychology, Westfälische Wilhelms-University Münster, Münster, Germany
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Reinholdt-Dunne ML, Blicher A, Nordahl H, Normann N, Esbjørn BH, Wells A. Modeling the Relationships Between Metacognitive Beliefs, Attention Control and Symptoms in Children With and Without Anxiety Disorders: A Test of the S-REF Model. Front Psychol 2019; 10:1205. [PMID: 31231273 PMCID: PMC6568246 DOI: 10.3389/fpsyg.2019.01205] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 05/07/2019] [Indexed: 01/04/2023] Open
Abstract
In the metacognitive model, attentional control and metacognitive beliefs are key transdiagnostic mechanisms contributing to psychological disorder. The aim of the current study was to investigate the relative contribution of these mechanisms to symptoms of anxiety and depression in children with anxiety disorders and in non-clinical controls. In a cross-sectional design, 351 children (169 children diagnosed with a primary anxiety disorder and 182 community children) between 7 and 14 years of age completed self-report measures of symptoms, attention control and metacognitive beliefs. Clinically anxious children reported significantly higher levels of anxiety, lower levels of attention control and higher levels of maladaptive metacognitive beliefs than controls. Across groups, lower attention control and higher levels of maladaptive metacognitive beliefs were associated with stronger symptoms, and metacognitions were negatively associated with attention control. Domains of attention control and metacognitions explained unique variance in symptoms when these were entered in the same model within groups, and an interaction effect between metacognitions and attention control was found in the community group that explained additional variance in symptoms. In conclusion, the findings are consistent with predictions of the metacognitive model; metacognitive beliefs and individual differences in self-report attention control both contributed to psychological dysfunction in children and metacognitive beliefs appeared to be the strongest factor.
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Affiliation(s)
| | - Andreas Blicher
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Nordahl
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Nicoline Normann
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | | | - Adrian Wells
- School of Psychological Sciences, University of Manchester and Greater Manchester Mental Health NHS Trust, Manchester, 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Melchior K, Franken I, Deen M, van der Heiden C. Metacognitive therapy versus exposure and response prevention for obsessive-compulsive disorder: study protocol for a randomized controlled trial. Trials 2019; 20:277. [PMID: 31109349 PMCID: PMC6528220 DOI: 10.1186/s13063-019-3381-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Accepted: 04/24/2019] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The recommended psychological treatment of choice for obsessive-compulsive disorder (OCD) is exposure with response prevention (ERP). However, recovery rates are relatively modest, so better treatments are needed. This superiority study aims to explore the relative efficacy of metacognitive therapy (MCT), a new form of cognitive therapy based on the metacognitive model of OCD. DESIGN AND METHOD In a randomized controlled trial, we will compare MCT with ERP. One hundred patients diagnosed with OCD will be recruited in an outpatient mental health center in Rotterdam (the Netherlands). The primary outcome measure is OCD severity, measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Data are assessed at baseline, after treatment, and at 6 and 30 months follow-up. DISCUSSION By comparing MCT with ERP we hope to provide an indication whether MCT is efficacious in the treatment of OCD and, if so, whether it has the potential to be more efficacious than the current "gold standard" psychological treatment for OCD, ERP. TRIAL REGISTRATION Dutch Trial Register, NTR4855 . Registered on 21 October 2014.
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Affiliation(s)
- Kim Melchior
- Outpatient Treatment Centre PsyQ & Erasmus University Rotterdam, Max Euwelaan 70, 3062 MA, Rotterdam, the Netherlands.
| | - Ingmar Franken
- Erasmus University Rotterdam, Burgermeester Oudlaan, 3062 PA, Rotterdam, the Netherlands
| | - Mathijs Deen
- Parnassia Psychiatric Institute & Leiden University, Monsterseweg 83, 2553 RJ, Den Haag, the Netherlands
| | - Colin van der Heiden
- Outpatient Treatment Centre PsyQ & Erasmus University Rotterdam, Max Euwelaan 70, 3062 MA, Rotterdam, the Netherlands
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Rupp C, Jürgens C, Doebler P, Andor F, Buhlmann U. A randomized waitlist-controlled trial comparing detached mindfulness and cognitive restructuring in obsessive-compulsive disorder. PLoS One 2019; 14:e0213895. [PMID: 30893353 PMCID: PMC6426247 DOI: 10.1371/journal.pone.0213895] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2018] [Accepted: 03/04/2019] [Indexed: 11/19/2022] Open
Abstract
Objective Whereas research has demonstrated the efficacy of cognitive restructuring (CR) for obsessive-compulsive disorder (OCD), little is known about the efficacy of specific metacognitive interventions such as detached mindfulness (DM). Therefore, this study compared the efficacy of CR and DM as stand-alone interventions. Design We conducted a randomized waitlist-controlled trial. n = 43 participants were randomly assigned to either DM or CR. Out of those participants, n = 21 participants had been previously assigned to a two-week waitlist condition. Materials and methods In both conditions, treatment comprised four double sessions within two weeks. Assessment took place at baseline (Pre1), after treatment (Post) and four weeks after the end of treatment (FU). There was a second baseline assessment (Pre2) in the waitlist group. Independent evaluators were blinded concerning the active condition. Adherence and competence ratings for the two therapists were obtained from an independent rater. Results 40 patients completed the treatment. Two patients dropped out because of exacerbated depression. There were no further adverse events. Both CR and DM were shown to be superior to waitlist and equally effective at reducing OCD symptoms from pre to post assessment as measured with the Y-BOCS (CR: d = 1.67, DM: d = 1.55). In each of the two treatment conditions, eight patients (40%) exhibited a clinical significant change at post assessment. Conclusions The results of this clinical trial suggest the potential efficacy of DM as a stand-alone intervention for OCD, however, our findings need to be interpreted with caution. Results indicate that both CR and DM should be considered as possible alternative treatments for OCD, whereas the working mechanisms of DM have yet to be elucidated.
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Affiliation(s)
- Christian Rupp
- Institute of Psychology, Westfälische Wilhelms-University Münster, Fliednerstrasse 21, Münster, Germany
- Christoph-Dornier-Stiftung, Schorlemerstrasse 26, Münster, Germany
| | - Charlotte Jürgens
- Institute of Psychology, Westfälische Wilhelms-University Münster, Fliednerstrasse 21, Münster, Germany
- Christoph-Dornier-Stiftung, Schorlemerstrasse 26, Münster, Germany
| | - Philipp Doebler
- Department of Statistics, TU Dortmund University, Dortmund, Germany
| | - Fabian Andor
- Christoph-Dornier-Stiftung, Schorlemerstrasse 26, Münster, Germany
| | - Ulrike Buhlmann
- Institute of Psychology, Westfälische Wilhelms-University Münster, Fliednerstrasse 21, Münster, Germany
- * E-mail:
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
New-wave behavioral therapies in obsessive-compulsive disorders (OCDs) comprise of third-wave therapies and newer cognitive therapies (CTs). This review covers outcome studies published in English until December 2017. A total of forty articles on mindfulness-based CT, metacognitive therapy, acceptance and commitment therapy, and danger ideation reduction therapy in the form of single-case studies, case series, open-label trials, two-group comparison studies, and randomized controlled studies were included. Results show that studies on these therapies are limited in number. Methodological limitations including lack of active control groups, randomized controlled trials, small sample sizes, and short follow-up periods were also noted. However, the available literature demonstrates the feasibility and utility of these therapies in addressing the issues unresolved by exposure and response prevention (ERP) and cognitive behavior therapy (CBT). These therapies were often combined with traditional ERP and CBT based on the profile and response of the client; hence, it is unclear whether they can be used as standalone therapies in the larger segment of the OCD population. Supplementary use of these strategies alongside established therapies could provide better utilization of resources. In view of the need for such integration, further research is warranted. The use of sound methodologies and establishing the mechanism of action of these therapies would assist in choosing the techniques for integration.
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Affiliation(s)
- M. Manjula
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Paulomi M. Sudhir
- Department of Clinical Psychology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Abstract
Zusammenfassung. Theoretischer Hintergrund: Das metakognitive Modell legt nahe, dass dysfunktionale Metakognitionen für die Entwicklung und Aufrechterhaltung verschiedener emotionaler Störungen eine Rolle spielen. Diese Annahme konnte in Studien sowohl für Erwachsene als auch für Kinder und Jugendliche bestätigt werden. Fragestellung: Struktur und psychometrische Eigenschaften einer deutschen Version des Meta-cognitions Questionnaire – Adolescent Version (MCQ-A) zur Erfassung störungsrelevanter Metakognitionen wurden untersucht. Methode: Nach Erhebung von Daten an einer nicht-klinischen Stichprobe ( N = 221) wurde eine konfirmatorische Faktorenanalyse durchgeführt. Interne Konsistenz, Test-Retest-Reliabilität sowie konvergente Validität wurden ermittelt. Ergebnisse: Die Struktur der englischen Originalversion konnte repliziert werden. Die deutschsprachigen Skalen des MCQ-A weisen gute Reliabilitäts- und Validitätskennwerte auf. Schlussfolgerungen: Die vorliegende deutsche Version des MCQ-A kann vorläufig als ein reliables und valides Instrument zur Erfassung dysfunktionaler Metakognitionen betrachtet werden.
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Esbjørn BH, Normann N, Christiansen BM, Reinholdt-Dunne ML. The efficacy of group metacognitive therapy for children (MCT-c) with generalized anxiety disorder: An open trial. J Anxiety Disord 2018; 53:16-21. [PMID: 29145078 DOI: 10.1016/j.janxdis.2017.11.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 11/08/2017] [Accepted: 11/08/2017] [Indexed: 02/07/2023]
Abstract
Metacognitive therapy is an effective treatment for anxiety disorders in adults. Studies have demonstrated that the underlying theoretical model is also supported in children. It has therefore been suggested that metacognitive therapy for children may be effective. Our study is an open trial of metacognitive therapy for children with generalized anxiety as their primary disorder. Therapy was provided in groups. Families were interviewed with the Anxiety Disorders Interview Schedule - child/parent versions. They reported on the child's anxiety levels using the Revised Childrens Anxiety and Depression Scale - child/parent versions. Children reported on metacognitive beliefs using the Metacognitions Questionnaire for Children - 30 item version. Fourty-four children aged 7-13 years (50% girls) were enrolled, and one family dropped out during treatment. Fifty percent of the children had received counseling or psychological treatment for their anxiety disorder previously. Following treatment, 86.4% of the children were free of their primary disorder and 72.7% were free of all anxiety disorders, the corresponding figures were 75% and 65.9% at 6-months follow-up. The effect sizes were large for all measures and clinically significant improvements were obtained for 70% of the children at posttest and 77% at follow-up. Our study suggests that metacognitive therapy for children with generalized anxiety disorder may be a highly promising treatment approach.
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Bauer A, Schneider S, Waldorf M, Braks K, Huber TJ, Adolph D, Vocks S. Selective Visual Attention Towards Oneself and Associated State Body Satisfaction: an Eye-Tracking Study in Adolescents with Different Types of Eating Disorders. J Abnorm Child Psychol 2017; 45:1647-1661. [DOI: 10.1007/s10802-017-0263-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Vloet TD, Herpertz-Dahlmann B, Simons M. [New developments in the psychotherapeutic and pharmacological treatment of pediatric obsessivecompulsive disorder]. Z Kinder Jugendpsychiatr Psychother 2017; 45:9-22. [PMID: 27299378 DOI: 10.1024/1422-4917/a000445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Den Goldstandard in der Behandlung von Zwangsstörungen im Kindes- und Jugendalter stellen die kognitiv-behaviorale Therapie sowie die Medikation mit selektiven Serotonin-Wiederaufnahmehemmern dar. In den letzten Jahren wurden vermehrt auch alternative psychotherapeutische und v. a. psychopharmakologische Behandlungsstrategien untersucht, die möglicherweise bei therapieresistenten Zwangsstörungen erfolgreich sein könnten. Die vorliegende Übersichtsarbeit fasst diese neuen Entwicklungen zusammen, wobei ein Schwerpunkt auf expositionsbezogene psychotherapeutische bzw. pharmakologische Ansätze im glutamatergen System gelegt wurde. Hinsichtlich neuer pharmakologischer Behandlungsoptionen bei Kindern und Jugendlichen unterstreicht die derzeitige Datenlage, v. a. im Hinblick auf den Grad der nachgewiesenen Evidenz sowie mögliche unerwünschte Nebenwirkungen, die Bedeutung einer optimal durchgeführten Kombinationstherapie. Dabei kann diese einer Monotherapie mit kognitiv-behavioraler Therapie im Einzelfall überlegen sein. Eine grundsätzliche Überlegenheit der Kombinationstherapie ist derzeit allerdings nicht nachgewiesen.
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Affiliation(s)
- Timo D Vloet
- 1 Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Universitätsklinikum der RWTH Aachen
- 2 Lehr- und Forschungsgebiet Klinische Neuropsychologie des Kindes- und Jugendalters an der Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes und Jugendalters, Universitätsklinikum der RWTH Aachen
| | - Beate Herpertz-Dahlmann
- 1 Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Universitätsklinikum der RWTH Aachen
| | - Michael Simons
- 1 Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Universitätsklinikum der RWTH Aachen
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Abstract
Metacognitive therapy (MCT) is a further development of cognitive therapy and was developed by Adrian Wells in the 1990s to treat adults suffering from anxiety disorders and depression. For the first time, this paper introduces a transdiagnostic adaptation of MCT to children and adolescents. Instead of focusing on the content of thoughts or beliefs, as in cognitive therapy, the treatment focuses on reducing negative perseverating thought processes as well as maladaptive attention strategies and coping behaviors. The empirical verification of MCT for children and adolescents is still in a very early stage.
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Affiliation(s)
- Michael Simons
- 1 Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Uniklinik der RWTH Aachen
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Lee EB, Bistricky S, Milam A, Wetterneck CT, Björgvinsson T. Thought Control Strategies and Symptom Dimensions in Obsessive-Compulsive Disorder: Associations With Treatment Outcome. J Cogn Psychother 2016; 30:177-189. [PMID: 32755923 DOI: 10.1891/0889-8391.30.3.177] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Treatment effectiveness of exposure and response prevention for obsessive-compulsive disorder (OCD) might be attenuated in part because of the complex, heterogeneous nature of OCD. Previous studies have indicated relationships between thought control strategies and OCD severity. This study replicates and extends these findings by using a dimensional measure of OCD and examining changes in thought control strategies across treatment. Participants included 49 patients with OCD attending residential and intensive outpatient treatment. Statistical analyses revealed significant reduction in worry and punishment thought control strategies from pre- to posttreatment as well as relationships between reduced use of specific thought control strategies and specific types of OCD symptomatology. Findings suggest that developing and employing modified forms of treatment more aligned with individuals' specific OCD symptomatology could be worthwhile to improve treatment of OCD.
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Affiliation(s)
| | | | | | | | - Thröstur Björgvinsson
- Houston OCD Program, Texas.,McLean Hospital, Belmont, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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Rosa-alcázar AI, Sánchez-meca J, Rosa-alcázar Á, Iniesta-sepúlveda M, Olivares-rodríguez J, Parada-navas JL. Psychological Treatment of Obsessive-Compulsive Disorder in Children and Adolescents: a Meta-Analysis. Span J Psychol 2015; 18. [DOI: 10.1017/sjp.2015.22] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
AbstractAlthough several meta-analyses have investigated the efficacy of psychological treatments for pediatric obsessive-compulsive disorder (OCD), there is not yet a consensus on the most efficacious treatment components. A meta-analysis was carried out to examine the efficacy of the different treatment techniques used in the psychological interventions of pediatric OCD. An exhaustive literature search from 1983 to February 2014 enabled us to locate 46 published articles that applied some kind of cognitive-behavioral therapy (CBT). For each group the effect size was the standardized pretest-posttest mean change, and it was calculated for obsessive-compulsive symptoms and for other outcome measures. The results clearly showed large effect sizes for CBT in reducing obsessive-compulsive symptoms and, to a lesser extent, other outcome measures (d+ = 1.860; 95% CI: 1.639; 2.081). The most promising treatments are those based on multicomponent programs comprising ERP, cognitive strategies, and relapse prevention. The analysis of other potential moderator variables and the implications for clinical practice are discussed.
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Bortolon C, Larøi F, Stephan Y, Capdevielle D, Yazbek H, Boulenger JP, Gely-Nargeot MC, Raffard S. Further insight into the role of metacognitive beliefs in schizophrenia and OCD patients: testing a mediation model. Psychiatry Res 2014; 220:698-701. [PMID: 25150921 DOI: 10.1016/j.psychres.2014.07.081] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 07/26/2014] [Accepted: 07/31/2014] [Indexed: 11/28/2022]
Abstract
This study explored the mediation effect of metacognitive beliefs on the relationship between intrusive thoughts and emotional distress in schizophrenia (N=49) and obsessive-compulsive disorder (OCD) (N=35). Intrusive thoughts impact on anxiety and depression through beliefs about uncontrollability and danger of thoughts in schizophrenia. Negative beliefs in general mediated the effect of intrusive thoughts on anxiety in obsessive-compulsive disorder. The results suggest that metacognitive beliefs may be a vulnerability factor for emotional and psychological disorder.
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Affiliation(s)
- Catherine Bortolon
- Epsylon Laboratory, EA 4556, Montpellier, France; University Department of Adult Psychiatry, CHU Montpellier, 39 Avenue Charles Flahault, 34295 Montpellier Cedex 5, France.
| | - Frank Larøi
- Department of Psychology, FAPSE, University of Liège, 4000 Liège, Belgium
| | | | - Delphine Capdevielle
- University Department of Adult Psychiatry, CHU Montpellier, 39 Avenue Charles Flahault, 34295 Montpellier Cedex 5, France; French National Institute of Health and Medical Research (INSERM), U1061Pathologies of the Nervous System: Epidemiological and Clinical Research, La Colombiere Hospital, 34093 Montpellier Cedex 5, France
| | - Hanan Yazbek
- University Department of Adult Psychiatry, CHU Montpellier, 39 Avenue Charles Flahault, 34295 Montpellier Cedex 5, France
| | - Jean-Philippe Boulenger
- University Department of Adult Psychiatry, CHU Montpellier, 39 Avenue Charles Flahault, 34295 Montpellier Cedex 5, France; French National Institute of Health and Medical Research (INSERM), U1061Pathologies of the Nervous System: Epidemiological and Clinical Research, La Colombiere Hospital, 34093 Montpellier Cedex 5, France
| | | | - Stéphane Raffard
- Epsylon Laboratory, EA 4556, Montpellier, France; University Department of Adult Psychiatry, CHU Montpellier, 39 Avenue Charles Flahault, 34295 Montpellier Cedex 5, France
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Sánchez-Meca J, Rosa-Alcázar AI, Iniesta-Sepúlveda M, Rosa-Alcázar A. Differential efficacy of cognitive-behavioral therapy and pharmacological treatments for pediatric obsessive-compulsive disorder: a meta-analysis. J Anxiety Disord 2014; 28:31-44. [PMID: 24334214 DOI: 10.1016/j.janxdis.2013.10.007] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Revised: 10/29/2013] [Accepted: 10/29/2013] [Indexed: 10/26/2022]
Abstract
The aim of this paper is to present a meta-analysis about the differential efficacy of cognitive-behavioral therapy (CBT), pharmacological and combined treatment for pediatric obsessive-compulsive disorder (OCD). The literature research and the application of the inclusion criteria enabled us to locate 18 studies, yielding a total of 24 independent comparisons between a treated (10 pharmacological, 11 CBT, and 3 combined interventions) and a control group. All types of interventions were efficacious in reducing obsessive-compulsive symptoms, with effect sizes adjusted by the type of control group of d=1.203 for CBT, d=0.745 for pharmacological treatments, and d=1.704 for mixed treatments. Depression, anxiety and other secondary responses were also improved, especially with CBT interventions. The analysis of moderator variables showed that the CBT protocol and the total of intervention hours exhibited a significant influence on the effect size. Within pharmacological treatment, clomipramine (d=1.305) was more efficacious than selective serotonin reuptake inhibitors (d=0.644), but its adverse effects were more severe. Finally, the clinical implications of the results are discussed.
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Affiliation(s)
- Julio Sánchez-Meca
- Faculty of Psychology, Espinardo Campus, University of Murcia, 30100 Murcia, Spain.
| | - Ana I Rosa-Alcázar
- Faculty of Psychology, Espinardo Campus, University of Murcia, 30100 Murcia, Spain.
| | - Marina Iniesta-Sepúlveda
- Faculty of Health Sciences, Campus de Los Jerónimos, Catholic University of Murcia, 30107 Murcia, Spain.
| | - Angel Rosa-Alcázar
- Faculty of Psychology, Espinardo Campus, University of Murcia, 30100 Murcia, Spain.
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Abstract
Die metakognitive Therapie (MCT) wurde von Adrian Wells als generische Therapieform emotionaler Störungen entwickelt. In der MCT gelten kognitive Prozesse sowie deren Steuerung durch metakognitive Überzeugungen als transdiagnostische Störungsdeterminanten. Die auf dem metakognitiven Modell emotionaler Störungen basierende metakognitive Therapie ist eine Kurzzeittherapie mit einem empfohlenen Umfang von fünf bis zwölf Sitzungen. Entsprechend der theoretischen Annahmen stellen die Infragestellung und Modifikation dysfunktionaler Metakognitionen und die Flexibilisierung von Denk- und Aufmerksamkeitsprozessen zentrale therapeutische Strategien dar. Die Wirksamkeit der metakognitiven Therapie wurde in Einzelfalluntersuchungen, unkontrollierten Studien und ersten randomisiert-kontrollierten Studien bestätigt. Die Störungstheorie, das praktisch-therapeutische Vorgehen und die bisherige Studienlage werden im vorliegenden Artikel beschrieben und kritisch diskutiert.
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Affiliation(s)
- Tobias Teismann
- Abteilung für Klinische Psychologie und Psychotherapie, Ruhr-Universität Bochum
| | - Michael Simons
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes-und Jugendalters, RWTH Aachen
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Abstract
Die Metakognitive Therapie nach Wells wird den neueren Entwicklungen der kognitiven Verhaltenstherapie zugerechnet und befasst sich mit metakognitiven Überzeugungen und Regulationsprozessen, welchen eine zentrale Rolle bei der Pathogenese psychischer Störungen beigemessen wird. Die vorliegende Arbeit stellt zunächst das Self-Regulatory Executive Function-Modell (S-REF-Modell) vor, das den theoretischen Hintergrund der Metakognitiven Therapie bildet, und gibt einen Überblick über zentrale Komponenten dieses Therapieansatzes. Empirische Befunde zum S-REF-Modell sowie zur Metakognitiven Therapie werden vorgestellt. Es wurden Arbeiten eingeschlossen, welche sich mit der vollständigen Metakognitiven Therapie oder der Aufmerksamkeitstrainingstechnik, einer Komponente der Metakognitiven Therapie, befassen.
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Gearing RE, Schwalbe CSJ, Lee R, Hoagwood KE. The effectiveness of booster sessions in CBT treatment for child and adolescent mood and anxiety disorders. Depress Anxiety 2013; 30:800-8. [PMID: 23596102 DOI: 10.1002/da.22118] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Revised: 03/11/2013] [Accepted: 03/22/2013] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND To investigate the effects of booster sessions in cognitive behavioral therapy (CBT) for children and adolescents with mood or anxiety disorders, whereas controlling for youth demographics (e.g., gender, age), primary diagnosis, and intervention characteristics (e.g., treatment modality, number of sessions). METHODS Electronic databases were searched for CBT interventions for youth with mood and anxiety disorders. Fifty-three (k = 53) studies investigating 1,937 youth met criteria for inclusion. Booster sessions were examined using two case-controlled effect sizes: pre-post and pre-follow-up (6 months) effect sizes and employing weighted least squares (WLSs) regressions. RESULTS Meta-analyses found pre-post studies with booster sessions had a larger effect size r = .58 (k = 15; 95% CI = 0.52-0.65; P < .01) than those without booster sessions r = .45 (k = 38; 95% CI = 0.41-0.49; P < .001). In the WLS regression analyses, controlling for demographic factors, primary diagnosis, and intervention characteristics, studies with booster sessions showed larger pre-post effect sizes than those without booster sessions (B = 0.13, P < .10). Similarly, pre-follow-up studies with booster sessions showed a larger effect size r = .64 (k = 10; 95% CI = 0.57-0.70; P < .10) than those without booster sessions r = .48 (k = 20; 95% CI = 0.42-0.53; P < .01). Also, in the WLS regression analyses, pre-follow-up studies showed larger effect sizes than those without booster sessions (B = 0.08, P < .01) after accounting for all control variables. CONCLUSIONS Result suggests that CBT interventions with booster sessions are more effective and the effect is more sustainable for youth managing mood or anxiety disorders than CBT interventions without booster sessions.
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Affiliation(s)
- Robin E Gearing
- Columbia University, 1255 Amsterdam Avenue, New York, NY 10027, USA.
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Hoagwood KE, Jensen PS, Acri MC, Serene Olin S, Eric Lewandowski R, Herman RJ. Outcome domains in child mental health research since 1996: have they changed and why does it matter? J Am Acad Child Adolesc Psychiatry 2012; 51:1241-1260.e2. [PMID: 23200282 DOI: 10.1016/j.jaac.2012.09.004] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Child mental health treatment and services research yields more immediate public health benefit when they focus on outcomes of relevance to a broader group of stakeholders. We reviewed all experimental studies of child and adolescent treatment and service effectiveness published in the last 15 years (1996-2011) and compared the distribution and types of outcome domains to a prior review that focused on studies from the prior 15 years (1980-1995). METHOD Studies were included if they focused on children from birth to 18 years of age with specific or general psychiatric conditions, employed randomized designs, and examined intervention effects with a six-month or longer post-treatment assessment in treatment studies or a 6-month or longer post-baseline assessment for services studies. Two hundred (n=200) studies met criteria. Reported outcome measures were coded into conceptual categories drawn from the 1980-1995 review. RESULTS There was a five-fold increase in the total number of studies (38 versus 200) across the two 15-year time periods, with the largest increase in the number of studies that focused on consumer-oriented outcomes (from eight to 47 studies, an almost sixfold increase); two new domains, parent symptoms and health-related outcomes, were identified. The majority of studies (more than 95%) continued to focus on symptoms and diagnoses as an outcome. Impact ratings were higher among studies examining four or more outcomes versus one to two outcomes in all categories with the exception of Posttraumatic Stress Disorder. CONCLUSIONS Given major shifts in health care policy affecting mental health services, the emergence of health and parent-related outcomes as well as greater attention to consumer perspectives parallels emerging priorities in health care and can enhance the relevance of child outcome studies for implementation in the real world.
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Simons M. Anders denken – Metakognitive Therapie für Kinder und Jugendliche mit Zwangsstörung: Ein Behandlungsplan. Verhaltenstherapie 2012. [DOI: 10.1159/000345228] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Gill AH, Papageorgiou C, Gaskell SL, Wells A. Development and Preliminary Validation of the Thought Control Questionnaire for Adolescents (TCQ-A). Cogn Ther Res 2012. [DOI: 10.1007/s10608-012-9465-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Wolters LH, Hogendoorn SM, Oudega M, Vervoort L, de Haan E, Prins PJM, Boer F. Psychometric properties of the Dutch version of the Meta-Cognitions Questionnaire-Adolescent Version (MCQ-A) in non-clinical adolescents and adolescents with obsessive-compulsive disorder. J Anxiety Disord 2012; 26:343-51. [PMID: 22197341 DOI: 10.1016/j.janxdis.2011.11.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2011] [Revised: 11/03/2011] [Accepted: 11/28/2011] [Indexed: 12/18/2022]
Abstract
Although the meta-cognitive model (Wells, 1997, 2000) for obsessive-compulsive disorder (OCD) has clearly influenced research and treatment of OCD, little research has been performed in youth samples. In the present study the psychometric properties of the Dutch Meta-Cognitions Questionnaire-Adolescent Version (MCQ-A; Cartwright-Hatton et al., 2004) were examined in a clinical sample of adolescents with OCD (N = 40, 12-18 years) and a non-clinical sample (N = 317; 12-18 years). Results provided support for the 5-factor structure, and showed fair to good internal consistency and generally good retest reliability. Overall, adolescents with OCD reported more meta-cognitive beliefs than non-clinical adolescents. Several subscales were associated with self-reported obsessive-compulsive symptoms, anxiety and depression, but not with clinician-rated OCD severity. In conclusion, results suggest that the Dutch MCQ-A is a reliable and valid questionnaire to examine meta-cognitive beliefs in adolescents.
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Affiliation(s)
- Lidewij H Wolters
- Academic Medical Center, Department of Child and Adolescent Psychiatry, Meibergdreef 5, 1105 AZ Amsterdam, The Netherlands.
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Vloet TD, Simons M, Herpertz-Dahlmann B. Psychotherapeutische und medikamentöse Behandlung der kindlichen Zwangsstörung. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie 2012; 40:29-39; quiz 39-40. [DOI: 10.1024/1422-4917/a000147] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Zur Behandlung der kindlichen Zwangsstörung werden kognitiv-verhaltenstherapeutische (KVT) und medikamentöse Interventionen eingesetzt. Insbesondere kombiniert sind diese Behandlungen gut wirksam, dennoch zeigen sich ca. 40 % der Behandelten auch nach der Therapie noch symptomatisch. Die am besten evaluierte Methode der KVT ist die Exposition mit Reaktionsverhinderung, die auf dem Prinzip der Habituation beruht. Neuere kognitive und metakognitive Techniken fokussieren auf die Modifikation von Erwartungen und haben vielleicht das Potential, die Wirksamkeit der Behandlung zu verbessern. Selektive Serotonin-Wiederaufnahme-Hemmer (selective serotonin reuptake inhibitors, SSRIs) stellen die Medikamente der ersten Wahl zur Behandlung der kindlichen Zwangsstörung dar. Wenn die Patienten bei ausreichend langer Gabe nicht auf die Medikation ansprechen, sollte ein Therapieversuch mit einem alternativen SSRI oder mit Clomipramin durchgeführt werden. Bei einem erneuten Scheitern der Behandlung kann eine Augmentation mit einer Kombination zweier SSRIs bzw. einem SSRI und Clomipramin oder einem SSRI und einem (atypischen) Neuroleptikum erfolgen. Nach einer erfolgreichen Behandlung sollte das Ausschleichen der Medikation sehr langsam erfolgen. Erste Studien zum Einsatz neuer Substanzen wie dem Glutamatantagonisten Riluzol liegen für das Kindes- und Jugendalter vor.
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Affiliation(s)
- Timo D. Vloet
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Medizinische Fakultät, Universitätsklinikum Aachen
- Lehr- und Forschungsgebiet Klinische Neuropsychologie des Kindes- und Jugendalters an der Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Medizinische Fakultät, Universitätsklinikum Aachen
| | - Michael Simons
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Medizinische Fakultät, Universitätsklinikum Aachen
| | - Beate Herpertz-Dahlmann
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Medizinische Fakultät, Universitätsklinikum Aachen
- JARA Translational Brain Medicine, Jülich/Aachen
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Hayes SC, Villatte M, Levin M, Hildebrandt M. Open, aware, and active: contextual approaches as an emerging trend in the behavioral and cognitive therapies. Annu Rev Clin Psychol 2011; 7:141-68. [PMID: 21219193 DOI: 10.1146/annurev-clinpsy-032210-104449] [Citation(s) in RCA: 386] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A wave of new developments has occurred in the behavioral and cognitive therapies that focuses on processes such as acceptance, mindfulness, attention, or values. In this review, we describe some of these developments and the data regarding them, focusing on information about components, moderators, mediators, and processes of change. These "third wave" methods all emphasize the context and function of psychological events more so than their validity, frequency, or form, and for these reasons we use the term "contextual cognitive behavioral therapy" to describe their characteristics. Both putative processes, and component and process evidence, indicate that they are focused on establishing a more open, aware, and active approach to living, and that their positive effects occur because of changes in these processes.
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Affiliation(s)
- Steven C Hayes
- Department of Psychology, University of Nevada, Reno, Nevada 89557, USA.
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Kikul J, Vetter J, Lincoln TM, Exner C. Effects of cognitive self-consciousness on visual memory in obsessive-compulsive disorder. J Anxiety Disord 2011; 25:490-7. [PMID: 21236631 DOI: 10.1016/j.janxdis.2010.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Revised: 12/10/2010] [Accepted: 12/11/2010] [Indexed: 11/30/2022]
Abstract
Previous research has documented high trait cognitive self-consciousness (CSC) in obsessive-compulsive disorder (OCD). It remains unclear whether elevated CSC levels can also explain cognitive performance deficits that have frequently been found in OCD. This study examined whether experimentally heightened CSC affects visual memory performance in OCD. OCD participants and healthy controls completed a complex figure test under three experimental conditions: simultaneously focusing on their thoughts (= CSC condition), simultaneously focusing on acoustic stimuli (= dual-task condition), and without a parallel task (= standard condition). In the OCD sample both the CSC condition and the dual-task condition reduced memory performance compared to the standard condition, whereas in controls only the dual-task condition led to reduced performance. Results indicate that raising CSC in OCD has a deteriorating effect on memory encoding that parallels the effect of a secondary task. High CSC and its effects on cognitive performance might be amenable to meta-cognitive treatment approaches.
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Affiliation(s)
- Julia Kikul
- Schoen Klinik Bad Arolsen, D-34454 Bad Arolsen, Germany.
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Abstract
Worry is a common phenomenon in children and adolescents, with some experiencing excessive worries that cause significant distress and interference. The metacognitive model of generalized anxiety disorder (Wells 1995, 2009) was developed to explain cognitive processes associated with pathological worry in adults, particularly the role of positive and negative beliefs about worry. This review evaluates the application of the model in understanding child and adolescent worry. Other key issues reviewed include the link between cognitive and metacognitive development and worry, and the measurement of worry and metacognitive worry in young people. Implications of these findings and directions for future research are discussed.
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Abstract
While Wells’ metacognitive model of generalized anxiety disorder (GAD) posits that certain metacognitive processes, such as negative meta-worry (negative beliefs about worry), are more strongly associated with symptoms of GAD than other anxiety disorders in adults, research has yet to determine whether the same pattern is true for younger individuals. We examined the relationship between several metacognitive processes and anxiety disorder diagnostic status in a sample of 98 youth aged 7–17 years. Twenty youth with GAD were compared with similarly sized groups of youth with obsessive-compulsive disorder (OCD, n = 18), social phobia (SOC, n = 20), separation anxiety disorder (SAD, n = 20), and healthy controls who were not patients (NONP, n = 20) using a self-report measure of metacognition adapted for use with young people in this age range (Metacognitions Questionnaire for Children). Contrary to expectations, only one specific metacognitive process was significantly associated with an anxiety disorder diagnosis, in that the controls endorsed a greater degree of cognitive monitoring (self-reported awareness of one’s thoughts) than those with SAD. In addition, there was a trend indicating that nonpatients scored higher than youth with GAD on this scale. These surprising results suggest potentially differing patterns in the relationships between symptoms and metacognitive awareness in anxious youth, depending on the type of anxiety disorder presentation.
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Bacow TL, Pincus DB, Ehrenreich JT, Brody LR. The metacognitions questionnaire for children: development and validation in a clinical sample of children and adolescents with anxiety disorders. J Anxiety Disord 2009; 23:727-36. [PMID: 19362445 DOI: 10.1016/j.janxdis.2009.02.013] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Revised: 02/25/2009] [Accepted: 02/26/2009] [Indexed: 01/04/2023]
Abstract
A self-report measure of metacognition for both children and adolescents (ages 7-17) (Metacognitions Questionnaire for Children; MCQ-C) was adapted from a previous measure, the MCQ-A (Metacognitions Questionnaire for Adolescents) and was administered to a sample of 78 children and adolescents with clinical anxiety disorders and 20 non-clinical youth. The metacognitive processes included were (1) positive beliefs about worry (positive meta-worry); (2) negative beliefs about worry (negative meta-worry); (3) superstitious, punishment and responsibility beliefs (SPR beliefs) and (4) cognitive monitoring (awareness of one's own thoughts). The MCQ-C demonstrated good internal-consistency reliability, as well as concurrent and criterion validity, and four valid factors. In line with predictions, negative meta-worry was significantly associated with self-reports of internalizing symptoms (excessive worry and depression). Age-based differences on the MCQ-C were found for only one subscale, with adolescents reporting greater awareness of their thoughts than children. Adolescent girls scored higher on the total index of metacognitive processes than adolescent boys. Overall, these results provide preliminary support for the use of the MCQ-C with a broader age range as well as an association between metacognitive processes and anxiety symptomatology in both children and adolescents, with implications for cognitive behavioral interventions with anxious youth.
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Affiliation(s)
- Terri Landon Bacow
- Boston University, Center for Anxiety and Related Disorders, 648 Beacon Street, 6th Floor, Boston, MA 02215, United States.
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Irak M, Tosun A. Exploring the role of metacognition in obsessive--compulsive and anxiety symptoms. J Anxiety Disord 2008; 22:1316-25. [PMID: 18339516 DOI: 10.1016/j.janxdis.2008.01.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2007] [Revised: 01/23/2008] [Accepted: 01/23/2008] [Indexed: 11/22/2022]
Abstract
This study tests three hypotheses, predicting first that metacognition is highly correlated with anxiety and obsessive-compulsive (O-C) symptoms, second that it mediates the relationship between O-C symptoms and anxiety, and third that the meta-cognitive predictors of anxiety are different from the meta-cognitive predictors of O-C symptoms. The sample of the present study was 850 students selected from various universities in Turkey. Significant correlations between metacognition, O-C symptoms and anxiety were observed. Also, mediation analysis confirmed that metacognition fully mediated the relationship between O-C symptoms and anxiety. Consistent with our hypothesis, trait anxiety and O-C symptoms had different meta-cognitive predictors. Although, we expected that meta-cognitive beliefs would vary based on the sub-type of O-C symptoms, meta-cognitive beliefs did not differ according to the O-C symptom subtypes. We discussed results with reference to the literature of meta-cognition, anxiety and O-C symptoms.
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