Skip to main content
×
×
Home

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

  • Hans M. Nordahl (a1), Thomas D. Borkovec (a2), Roger Hagen (a3), Leif E. O. Kennair (a3), Odin Hjemdal (a3), Stian Solem (a4), Bjarne Hansen (a5), Svein Haseth (a6) and Adrian Wells (a7)...
Abstract
Background

Cognitive–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.

Aims

We aimed to compare metacognitive therapy (MCT) with the gold standard treatment, CBT, in patients with GAD (clinicaltrials.gov identifier: NCT00426426).

Method

A 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.

Results

Both 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.

Conclusions

MCT 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 interest

A.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.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Metacognitive therapy versus cognitive–behavioural therapy in adults with generalised anxiety disorder
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Metacognitive therapy versus cognitive–behavioural therapy in adults with generalised anxiety disorder
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Metacognitive therapy versus cognitive–behavioural therapy in adults with generalised anxiety disorder
      Available formats
      ×
Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Correspondence: Professor Hans M. Nordahl, Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, PO Box 8905, N-7006 Trondheim, Norway. Email: hans.nordahl@ntnu.no
References
Hide All
1Tyrer, P, Baldwin, D. Generalized anxiety disorder. Lancet 2006; 368: 2156–66.
2Lieb, R, Becker, E, Altamura, C. The epidemiology of generalized anxiety disorder in Europe. Eur Neuropsychopharmacol 2005; 15: 445–52.
3Wittchen, HU. Generalized anxiety disorder: prevalence, burden and cost to society. Depress Anxiety 2002; 16: 162–71.
4Gould, RA, Otto, MW, Pollack, MH, Yap, L. Cognitive-behavioural and pharmacological treatment of generalized anxiety disorder: a preliminary meta-analysis. Behav Ther 1997; 28: 285305.
5Mitte, K. A meta-analysis of cognitive behavioural treatments for generalized anxiety Disorder: a comparison with pharmacotherapy. Psychol Bull 2005; 131: 785–95.
6Haby, MM, Donnelly, M, Corry, J, Vos, T. Cognitive behavioural therapy for depression, panic disorder and generalised anxiety disorder: a meta-regression of factors that may predict outcome. Aust New Zea J Psychiatry 2006; 40: 919.
7Hunot, V, Churchill, R, de Lima, S, Teixeira, V. Psychological therapies for generalized anxiety disorder. Cochrane Database Syst Rev 2007; 1: CD001848.
8Siev, J, Chambless, DL. Specificity of treatment effects: cognitive therapy and relaxation for generalized anxiety and panic disorders. J Consult Clin Psychol 2007; 75: 513–22.
9Covin, R, Ouimet, AJ, Seed, PM, Dozois, DJA. A meta-analysis of CBT for pathological worry among clients with GAD. J Anxiety Dis 2008; 22: 108–16.
10Hanrahan, F, Field, AP, Jones, FW, Davey, GCL. A meta-analysis of cognitive therapy for worry in generalized anxiety disorder. Clin Psychol Rev 2013; 33: 120–32.
11Cuijpers, P, Sijbrandij, M, Koole, S, Huibers, M, Berking, M, Andersson, G. Psychological treatment of generalized anxiety disorder: a meta-analysis. Clin Psychol Rev 2014; 34: 130–40.
12Gonzalves, DC, Byrne, GJ. Interventions for generalized anxiety disorders in older adults: systematic review and meta-analysis. J Anxiety Dis 2012; 26: 111.
13Kishita, N, Laidlaw, K. Cognitive behavior therapy for generalized anxiety disorder; Is CBT equally efficacious in adults of working age and older adults? Clin Psychol Rev 2017; 52: 124–36.
14Borkovec, TD, Costello, E. Efficacy of applied relaxation and cognitive-behavioral therapy in the treatment of generalized anxiety disorder. J Consult Clin Psychol 1993; 61: 611–9.
15Borkovec, TD, Ruscio, AM. Psychotherapy for generalized anxiety disorder. J Clin Psychiatry 2001; 62(Suppl): s3745.
16Fisher, PL. The efficacy of psychological treatments for generalized anxiety disorder? Predictors of treatment outcome. In Worry and its Psychological Disorders: Theory, Assessment and Treatment (ed. Davey, G, Wells, A): 359–77. Wiley, 2006.
17Wells, A. Metacognitive Therapy for Anxiety and Depression. Guilford Press, 2009.
18Wells, A, Welford, M, King, P, Wisely, J, Mendel, E. A pilot randomized trial of metacognitive therapy versus applied relaxation in the treatment of adults with generalized anxiety disorder. Behav Res Ther 2010; 48: 429–34.
19Van der Heiden, C, Muris, P, van der Molen, HT. Randomized controlled trial on the effectiveness of metacognitive therapy and intolerance-of-uncertainty therapy for generalized anxiety disorder. Behav Res Ther 2012; 37: 206–12.
20Di Nardo, PA, Brown, TA, Barlow, DH. Anxiety Disorder Interview Schedule for DSM-IV: Lifetime version (ADIS-IV-L). Oxford University Press, 1994.
21First, MB, Gibbon, M, Spitzer, RL, Williams, JB, Benjamin, L. Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II). American Psychiatric Association, 1997.
22American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) (4th ed., text rev.). American Psychiatric Association, 2000.
23Meyer, TJ, Miller, ML, Metzger, RL, Borkovec, TD. Development and validation of the Penn State Worry Questionnaire. Behav Res Ther 1990; 28: 487–9.
24Brown, TA, Antony, MM, Barlow, DH. Psychometric properties of the Penn State Worry Questionnaire in a clinical anxiety disorders sample. Behav Res Ther 1992; 30: 33–7.
25Spielberger, CD, Gorsuch, PL, Lushene, RE, Vagg, PR, Jacobs, GA. Manual for the State-Trait Anxiety Inventory. Consulting Psychology Press, 1983.
26Beck, AT, Epstein, N, Brown, G, Steer, RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 1988; 56: 893–7.
27Horowitz, LM, Rosenberg, SE, Baer, BA, Ureno, G, Vilasenor, VS. Inventory of interpersonal problems: psychometric properties and clinical applications. J Consult Clin Psychol 1988; 56: 885–92.
28Horvath, AO, Greenberg, LS. Development and validation of the Working Alliance Inventory. J Councel Psychol 1989; 38: 139–49.
29Borkovec, TD, Nau, SD. Credibility of analogue therapy rationales. J Behav The Exp Psychiatry 1972; 3: 257–60.
30Devilly, GJ, Borkovec, TD. Psychometric properties of the Credibility/Expectancy Questionnaire. J Behav The Exp Psychiatry 2000; 31: 7386.
31Barber, JP, Liese, BS, Adams, MJ. Development of the Cognitive Therapy Adherence and Competency Scale. Psychoter Res 2003; 13: 205–21.
32Nordahl, HM, Wells, A. Metacognitive Therapy Competency Scale (MCT-CS). NTNU University Press, 2009.
33Graham, JW. Missing Data: Analysis and Design. Springer New York, 2012.
34Cohen, J. Statistical Power Analysis for the Behavioral Sciences (2nd edn). Erlbaum, 1988.
35Jacobson, NS, Truax, P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol 1991; 59: 12–9.
36Molina, S, Borkovec, TD. The Penn State Worry Questionnaire: psychometric properties and associated characteristics. In Worrying: Perspectives on Theory, Assessment and Treatment (ed. Davey, GCL, Tallis, FE): 265–83. Wiley, 1994.
37Borkovec, TD, Castonguay, LG. What is the scientific meaning of ‘empirically supported therapy’? J Consult Clin Psychol 1998; 66: 136–42.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Open
  • ISSN: -
  • EISSN: 2056-4724
  • URL: /core/journals/bjpsych-open
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Altmetric attention score

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

  • Hans M. Nordahl (a1), Thomas D. Borkovec (a2), Roger Hagen (a3), Leif E. O. Kennair (a3), Odin Hjemdal (a3), Stian Solem (a4), Bjarne Hansen (a5), Svein Haseth (a6) and Adrian Wells (a7)...
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *