Group Metacognitive Therapy for Generalized Anxiety Disorder: A Pilot Feasibility Trial

Background: Individual metacognitive therapy (MCT) for generalized anxiety disorder (GAD) is well established, but only one study has investigated the effectiveness of Group MCT (g-MCT) for GAD. The aim of the current study was therefore to evaluate the feasibility and effectiveness of g-MCT for GAD within a community mental health setting whilst addressing limitations evident in the previous study.Methods: The study used an open trial design, and 23 consecutively referred adults with GAD completed 10 sessions (90 min) of g-MCT, delivered by two therapists trained in MCT. Diagnoses were assessed by trained raters using the Anxiety Disorder Interview Schedule-IV. All patients but one had previous psychosocial treatment, and 17 (73.9%) had at least one comorbid axis-I disorder. Self-reported symptoms were assessed using the Penn State Worry Questionnaire, the Generalized Anxiety Disorder-7, and the Patient Health Questionnaire-9 at pre- and post-treatment as well as 3-month follow-up. Feasibility was assessed using rates of patients who declined group treatment in favor of individual treatment, patients not able to attend due to pre-scheduled dates for sessions, and drop-out rate.Results: Of 32 eligible participants, six patients (19%) declined g-MCT in favor of individual MCT, and three (9%) were unable to attend due to scheduling conflicts. No patients dropped out during treatment, but two patients did not complete the self-report questionnaires at 3-month follow-up. g-MCT was associated with significant reductions in worry, anxiety, depression, metacognitive beliefs, and maladaptive coping. According to the standardized Jacobson criteria for recovery, 65.3% were recovered at post-treatment, whereas 30.4% were improved and 4.3% showed no change. At 3-month follow-up, the recovery rate increased to 78.3%. Moreover, recovery rates were comparable for patients with- and without comorbidity. Number of therapist hours per patient was 6.5 and the treatment has now been implemented as a standard treatment option at the clinic.Conclusion: g-MCT for GAD is an acceptable treatment which may offer a cost-effective alternative approach to individual MCT. Recovery rates and effect sizes suggested that g-MCT could be just as efficient as individual MCT and cognitive behavioral therapy

Metakognitiv gruppeterapi for pasienter med generalisert angstlidelse

I den senere tid har studier vist at metakognitiv terapi (MCT) er en effektiv behandlingsform for pasienter med generalisert angstlidelse (GAD), men få studier har undersøkt effekten av denne behandlingsformen gitt i gruppeformat. Ved Nidaros DPS, St. Olavs hospital, er det nå gjennomført et større prosjekt hvor pasienter med GAD ble behandlet i grupper med utgangspunkt i MCT. Målet med denne studien var å evaluere effektiviteten av denne behandlingsformen for de fem første gruppene i dette prosjektet. Totalt 27 deltagere fikk tilbud om 10 gruppesesjoner med behandling. Ingen deltagere droppet ut av behandlingen. Resultatene viser signifikante reduksjoner i bekymring, angst, depresjon, negative og positive metakognisjoner, sikringsstrategier og unngåelse. Effektene var sammenlignbare med tidligere studier av gruppebasert MCT for GAD, mens kun 11-15% ikke viste endring. Effektene var også stabile ved 3-måneders oppfølging. Reduksjon i symptomer sammenfalt med endring i metakognisjoner og sikringsstrategier. Resultatene fra denne studien viser at MCT i gruppeformat var en akseptabel og effektiv behandlingsform for pasienter med GAD, og som også var kostnadseffektiv med kun 5.6 terapeut-timer per pasient. Det er behov for videre evalueringer av denne behandlingsformen i randomiserte kontrollerte studier