Metacognitive therapy versus cognitive–behavioural therapy in adults with generalised anxiety disorder

Abstract

BackgroundCognitive–behavioural therapy (CBT) is the treatment of choice for generalised anxiety disorder (GAD), yielding significant improvements in approximately 50% of patients. There is significant room for improvement in the outcomes of treatment, especially in recovery.AimsWe aimed to compare metacognitive therapy (MCT) with the gold standard treatment, CBT, in patients with GAD (clinicaltrials.gov identifier: NCT00426426).MethodA total of 246 patients with long-term GAD were assessed and 81 were randomised into three conditions: CBT (n = 28), MCT (n = 32) and a wait-list control (n = 21). Assessments were made at pre-treatment, post-treatment and at 2 year follow-up.ResultsBoth CBT and MCT were effective treatments, but MCT was more effective (mean difference 9.762, 95% CI 2.679–16.845, P = 0.004) and led to significantly higher recovery rates (65% v. 38%). These differences were maintained at 2 year follow-up.ConclusionsMCT seems to produce recovery rates that exceed those of CBT. These results demonstrate that the effects of treatment cannot be attributed to non-specific therapy factors.Declaration of interestA.W. wrote the treatment protocol in MCT and several books on CBT and MCT, and receives royalties from these. T.D.B. wrote the protocol in CBT and has published several articles and chapters on CBT and receives royalties from these. All other authors declare no competing interests.

Breaking the Cybernetic Code: Understanding and Treating the Human Metacognitive Control System to Enhance Mental Health

“…Several trials have evaluated the effects of MCT against CBT for generalized anxiety. In each case MCT was superior (Van der Heiden et al, 2010;Wells et al, 2010;Nordahl et al, 2018). More naturalistic studies of less highly selected patients also support positive treatment effects of the full MCT package (e.g.…”

The Efficacy of Metacognitive Therapy: A Systematic Review and Meta-Analysis

“…Eleven of the eligible studies were from the 2014 search (of which nine were included in the analyses), whereas the additional 14 studies were identified through the updated search. Two of these (Wells et al, 2015 ; Nordahl et al, 2018 ) were peer-reviewed publications of trials that were included in the first meta-analysis, which at that time only were available as dissertations. With the exception of one study (Esbjørn et al, 2018 ), all other studies that fulfilled our inclusion criteria were conducted with adult populations.…”

“…Although the subanalyses of studies conducted by the originator vs. those by other researchers did not show clear indications of allegiance bias, the author groups may still have favored MCT. One noticeable exception was the study by Nordahl et al ( 2018 ), which had a balanced author group with regard to allegiance, as the originators of both the CBT protocol and MCT protocol took part in the study.…”

Cognitive‐behavioral therapy (CBT) for generalized anxiety disorder: Contrasting various CBT approaches in a randomized clinical trial

“…However, other more recent theoretical and therapeutic models of GAD exist, such as the intolerance of uncertainty model (Ladouceur et al, ; see also Ellis, and his concept of frustration intolerance), the metacognitive model (Wells & King, ), or acceptance‐based behavior therapy (Roemer & Orsillo, ). For instance, a recent study (Nordahl et al, ) compared Cognitive Therapy/Borkovec's treatment package (CT/BTP) with metacognitive therapy (MCT) for GAD, and the results showed MCT to be more effective than CT/BTP, with higher recovery rates, maintained at follow‐up. Still, this result is preliminary and needs replication before we can consider it established, especially taking into account the large confidence interval around the effect size.…”