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

Abstract

Introduction Generalized anxiety disorder (GAD) is characterized by persistent worry and anxiety, often with a chronic course. We tested the role of two suggested underlying factors in GAD, interpersonal problems and negative metacognitive beliefs, as predictors of trait‐worry and trait‐anxiety. Methods The sample consisted of 56 patients with a primary diagnosis of GAD from a randomized controlled trial. We first estimated the proportion of variance lying between the higher level of the data structure to account for potential therapists' effects. Two hierarchical regression analyses were conducted testing change in interpersonal problems and negative metacognitive beliefs as predictors of change in trait‐worry and trait‐anxiety following treatment. Change in depression and anxiety symptoms was controlled. Results Change in negative metacognitive beliefs was the strongest predictor of improvement of both trait‐worry and trait‐anxiety. Change in interpersonal problems was not a unique predictor of change in trait‐worry but did make a significant and unique contribution to trait‐anxiety. Conclusions Negative metacognitive beliefs may be important targets to improve trait‐worry and trait‐anxiety in GAD. Interpersonal problems may be relevant for trait‐anxiety but could also be a surface marker of higher order vulnerability factors. Implications for treatment are discussed.

Do Patient's Interpersonal Problems Improve Following Metacognitive Therapy? A Systematic Review and Meta‐Analysis

“…Taken together with empirical evidence showing that metacognitive beliefs are significantly related to interpersonal problems in both clinical (e.g., Strand, Nordahl, et al. 2023) and nonclinical (H. Nordahl, Hjemdal, and Wells 2021) populations even after controlling for co‐occurring psychiatric symptoms and other identified vulnerability factors such as insecure attachment, personality traits and negative cognitions, this provides support for the metacognitive model as a framework to conceptualize and treat interpersonal problems. However, more clinical trials and empirical research with larger populations are needed before more firm conclusions can be drawn.…”

“…In a clinical context, change in metacognitions is associated with change in interpersonal problems in patients with social phobia and avoidant personality disorder above and beyond social anxiety symptoms and social phobic cognitions (Strand, Nordahl, et al. 2023). Metacognitive beliefs have also been found to be significantly increased in patients with a personality disorder characterized by interpersonal dysfunction compared to patients without a personality disorder supporting the notion that dysfunctional metacognitive beliefs can be relevant for poorer interpersonal functioning (Spada et al.…”