Mechanisms of change during group metacognitive therapy for repetitive negative thinking in primary and non-primary generalized anxiety disorder

Abstract

Repetitive negative thinking (RNT) is a transdiagnostic process that serves to maintain emotional disorders. Metacognitive theory suggests that positive and negative metacognitive beliefs guide the selection of RNT as a coping strategy which, in turn, increases psychological distress. The aim of this study was to test the indirect effect of metacognitive beliefs on psychological distress via RNT. Patients (N=52) with primary and non-primary generalized anxiety disorder attended a brief, six-week group metacognitive therapy program and completed measures of metacognitive beliefs, RNT, and symptoms at the first and final treatment sessions, and at a one-month follow-up. Prospective indirect effects models found that negative metacognitive beliefs (but not positive metacognitive beliefs) had a significant indirect effect on psychological distress via RNT. As predicted by metacognitive theory, targeting negative metacognitions in treatment appears to reduce RNT and, in turn, emotional distress. Further research using alternative measures at multiple time points during therapy is required to determine whether the absence of a relationship with positive metacognitive beliefs in this study was a consequence of (a) psychometric issues, (b) these beliefs only being relevant to a subgroup of patients, or (c) a lack of awareness early in treatment.

Group Cognitive-Behavior Therapy or Group Metacognitive Therapy for Obsessive-Compulsive Disorder? Benchmarking and Comparative Effectiveness in a Routine Clinical Service

“…The clinically significant results obtained for the group MCT appeared to be better or equal to the group CBT cohort and those typically found in RCTs of CBT for OCD, especially given the low attrition rate in a group for whom 76.8% were prescribed medication. The results of the group MCT also contribute to a growing body of empirical evidence attesting to the effectiveness of this intervention in group formats for generalized anxiety disorder in children (Esbjørn et al, 2018) and adults (Van der Heiden et al, 2013; McEvoy et al, 2015), depression (Dammen et al, 2015), antidepressant and CBT-resistant depression (Papageorgiou and Wells, 2015), and transdiagnostic patient samples (Capobianco et al, 2018).…”

Is perfectionism associated with academic burnout through repetitive negative thinking?

“…This highlights the importance of investigating the efficacy of therapeutic programs targeting Repetitive Negative Thinking for students who have high levels of Academic Burnout (particularly that characterised by Exhaustion) and high levels of Perfectionistic Concerns. Repetitive Negative Thinking can be reduced through targeted interventions ( Watkins, 2018 ), or through metacognitive therapy, and this is associated with improvements in several measures of psychological distress ( Johnson et al., 2017 ; McEvoy et al, 2015 ). The importance of Repetitive Negative Thinking as a treatment for burnout would critically depend upon whether any modification of a student’s Repetitive Negative Thinking is also associated with changes in their experiences of burnout.…”

“…In contrast, higher levels of Perfectionistic Strivings are associated with less Academic Burnout. Given that there are treatment programs which can effectively reduce both Perfectionistic Concerns and Repetitive Negative Thinking ( McEvoy et al, 2015 ; Rozental et al, 2017 ), future research should focus on understanding the extent to which these programs can alleviate Academic Burnout in university students.…”

Group metacognitive therapy for adolescents with anxiety and depressive disorders: A pilot study

“…Indeed, by sessions 3 and 6 some participants experienced an increase in MCQ‐C Pos scores. For example, the scores of participants E and H indicated reliable and clinically significant deterioration (see Figure and Table ), which subsequently reduced to subclinical levels for participant E but not for participant H. Previous research on RNT and metacognitions has shown that the influence of positive metacognitive beliefs appears to be less essential to treatment outcome than that of negative metacognitive beliefs, at least in the short term (McEvoy, Erceg‐Hurn, Anderson, Campbell, & Nathan, ). Scores on the MCQ‐C Neg showed a clearer pattern of change, with eight of the participants' scores in the clinical range at pretreatment and five out of nine showing improvement or recovery by the 3‐month follow‐up.…”