Metacognitive therapy for generalized anxiety disorders in group: A case study

Abstract

ObjectivesIn Metacognitive therapy (MCT), homework is used, for example, to increase awareness of thoughts and thought processes, to challenge metacognitive beliefs in real‐life situations, and to practice new ways of processing thoughts, feelings, and symptoms. All MCT treatment manuals include homework assignments to be given between each session.MethodThe following study provides a detailed description of the implementation of homework in a group‐based MCT treatment for generalized anxiety disorder (GAD) at an outpatient clinic in Norway. The treatment described in this case consisted of 10 weekly group sessions (7 patients) lasting two hours.ResultsThis case study demonstrates that group‐based MCT can be used to treat GAD and describes how the use of homework can facilitate therapeutic change.ConclusionOverall, the effectiveness of MCT was found to be high. Homework gives patients the opportunity to take charge of their therapy and develop a sense of responsibility for their own progress, both during and after treatment.

Between‐session homework and processes of change

“…The case study on group MCT (Hammersmark et al, 2023) illustrate some important considerations in the use of BSH when shifting from individual-to group therapy. Although GAD typically involves worry that involves different domains (e.g., health, work, fear of making mistakes, etc.…”

“…Several authors commented on potential barriers and obstacles to client engagement with BSH. For example, lack of engagement could be due to limited socialization to the treatment model and frustration, especially in the early phase of treatment (e.g., Hammersmark et al, 2023;Murphy et al, 2023), which highlight the need to have a continuous emphasis on the rationale for the treatment and BSH specifically (Callan et al, 2019). Emotional barriers, such as worry and distress (Hammersmark et al, 2023;Magistrale et al, 2023;Warwar, 2023), or difficulties with identifying emotions and anxiety levels (Church et al, 2023) were other potential barriers.…”

“…For example, lack of engagement could be due to limited socialization to the treatment model and frustration, especially in the early phase of treatment (e.g., Hammersmark et al, 2023;Murphy et al, 2023), which highlight the need to have a continuous emphasis on the rationale for the treatment and BSH specifically (Callan et al, 2019). Emotional barriers, such as worry and distress (Hammersmark et al, 2023;Magistrale et al, 2023;Warwar, 2023), or difficulties with identifying emotions and anxiety levels (Church et al, 2023) were other potential barriers. Again, authors recommended devoting sufficient time to ensure that clients had understood the rational underlying a specific BSH, by asking for feedback, in-session practice, discussing potential barriers and difficulties to BSH, and writing down specific tasks and rationale.…”

“…Warwar (2023), on the other hand, noted how the therapeutic relationship always has priority over the achievement of specific therapeutic task (e.g., BSH), consistent with the notion that the therapeutic relationship is a facilitative curative factor within humanistic-experiential approaches. Frustration and resistance on the part of clients related to BSH (including the use of forms and portfolio; "felt like going back to school") was noted by several authors, in particular in the early phase of treatment (e.g., Hammersmark et al, 2023;Murphy et al, 2023). Clients may need time to realize the importance of BSH, but even then some clients may demonstrate increased resistance toward the use of BSH, despite motivational efforts on the part of the therapist (Hammersmark et al, 2023).…”

“…Third, Hammersmark et al (2023) presented a case of group metacognitive therapy (MCT) for seven clients with generalized anxiety disorder (GAD). The case illustrates how so-called third-wave cognitive behavioral treatment (CBT) deviate from the traditional focus on thought-content in CBT (e.g., examination of negative automatic beliefs), and rather emphasizes perseverative thinking styles (e.g., worry, rumination), threat-focused attentional processes, and maladaptive coping strategies as maintaining factors in GAD.…”