A pilot randomized trial of metacognitive therapy vs applied relaxation in the treatment of adults with generalized anxiety disorder

Metacognitive Therapy (MCT) and Applied Relaxation (AR) were compared in a pilot treatment trial of generalized anxiety disorder (GAD). Twenty outpatients meeting criteria for DSM-IV-TR GAD were assessed before treatment, after treatment and at 6 m and 12 m follow-up. The patients were randomized and treated individually for 8-12 weekly sessions. There was no drop-out from MCT and 10% at 6 m follow-up from AR. At post-treatment and at both follow-up points MCT was superior to AR. Standardized recovery rates for MCT at post-treatment were 80% on measures of worry and trait-anxiety compared with 10% following AR. At 6 m follow-up recovery rates for MCT were 70% on both measures compared with 10% and 20% for AR. At 12 m follow-up recovery rates for MCT were 80% (worry) and 60% (trait-anxiety) compared with 10% and 20% following AR. The recovery rates for MCT are similar to those obtained in an earlier uncontrolled trial (Wells & King, 2006). The effect sizes and standardized recovery rates for MCT suggest that it is a highly effective treatment.     

Randomized controlled trial on the effectiveness of metacognitive therapy and intolerance-of-uncertainty therapy for generalized anxiety disorder

This randomized controlled trial compared the effectiveness of metacognitive therapy (MCT) and intolerance-of-uncertainty therapy (IUT) for generalized anxiety disorder (GAD) in an outpatient context. Patients with GAD (N = 126) consecutively referred to an outpatient treatment center for anxiety disorder were randomly allocated to MCT, IUT, or a delayed treatment (DT) condition. Patients were treated individually for up to 14 sessions. Assessments were conducted before treatment (pretreatment), after the last treatment session (posttreatment), and six months after treatment had ended (follow-up). At posttreatment and follow-up assessments, substantial improvements were observed in both treatment conditions across all outcome variables. Both MCT and IUT, but not DT, produced significant reductions in GAD-specific symptoms with large effect sizes (ranging between 0.94 and 2.39) and high proportions of clinically significant change (ranging between 77% and 95%) on various outcome measures, and the vast majority of the patients (i.e., 91% in the MCT group, and 80% in the IUT group) no longer fulfilled the diagnostic criteria for GAD. Results further indicate that MCT produced better results than IUT. This was evident on most outcome measures, and also reflected in effect sizes and degree of clinical response and recovery.     

Buddhist psychology: A review of theory and practice

This paper gives an account of some of the major aspects of Buddhist psychology. The survey is confined to the texts of Early, or Theravada, Buddhism — that is, the canonical texts and their early Pali commentaries and related expository texts. The importance of psychological concepts in the philosophy and practice of Buddhism is highlighted. The problems inherent in the study of Buddhist psychology are discussed, including the problem of translation and interpretation. The paper then describes and analyzes several key Early Buddhist psychological notions including: basic drives that motivate behavior, perception and cognition, consciousness, personal development and enlightenment, meditation, and behavior change. The relationship between theory and practice in Buddhist psychology is commented on, with special reference to meditative techniques and other behavior change strategies. Finally, comments are made on the possible interaction between Buddhist and modern psychology. An earlier version of this paper was presented at the Annual Conference of the British Psychological Society, St. Andrews, April, 1989.     

Buddhist psychology: A review of theory and practice

This paper gives an account of some of the major aspects of Buddhist psychology. The survey is confined to the texts of Early, or Theravada, Buddhism — that is, the canonical texts and their early Pali commentaries and related expository texts. The importance of psychological concepts in the philosophy and practice of Buddhism is highlighted. The problems inherent in the study of Buddhist psychology are discussed, including the problem of translation and interpretation. The paper then describes and analyzes several key Early Buddhist psychological notions including: basic drives that motivate behavior, perception and cognition, consciousness, personal development and enlightenment, meditation, and behavior change. The relationship between theory and practice in Buddhist psychology is commented on, with special reference to meditative techniques and other behavior change strategies. Finally, comments are made on the possible interaction between Buddhist and modern psychology. An earlier version of this paper was presented at the Annual Conference of the British Psychological Society, St. Andrews, April, 1989.     

Group cognitive behavioural therapy for heterogeneous anxiety disorders

Evidence assessing the outcome of cognitive behavioural therapy for anxiety is based on protocols specifically tailored for individual disorders. To date, there is little research that would assess a mode of delivery that is designed for routine service delivery in typical clinical settings, i.e. group cognitive behavioural therapy for unselected, mixed groups of anxiety disorders. The objective of this pilot study is to use program evaluation methods to assess the immediate and enduring improvements following a 12-week Anxiety Management Group. Group participants had any of 5 anxiety disorders and described related avoidance. The weekly 2-hour group sessions and daily homework tasks were guided by a participant handbook. Patients completed questionnaires at baseline and group completion (n = 70); a subset also provided 6-month follow-up data. The results from post-group scores on 2 self-report measures show immediate reductions equivalent to an effect size of eta = 0.73 (p < 0.001). The effect is maintained at 6-month follow-up. This program evaluation suggests that group cognitive behavioural therapy for heterogeneous anxiety disorders may be effective in a routine clinical setting. A more rigorous study of this heterogeneous format appears justified.     

The psychology of anxiety: A phenomenological description

Abstract

The psychology of anxiety continues to be debated by researchers, as well as therapists. By investigating it with phenomenological methods, I have been able to determine its three existential preconditions; the way in which an anxious situation announces a crisis of one's efforts to surpass one's unacceptable incompleteness; being anxious as being impeded, if not fundamentally blocked, and moving beyond being anxious as either ambivalently reaffirming the viability of the projects and relations in which one was already invested, or as transformatively accepting those projects and relations as fundamentally uncertain and hence, as open to future determination.     

The psychology of anxiety: A phenomenological description

Abstract

The psychology of anxiety continues to be debated by researchers, as well as therapists. By investigating it with phenomenological methods, I have been able to determine its three existential preconditions; the way in which an anxious situation announces a crisis of one's efforts to surpass one's unacceptable incompleteness; being anxious as being impeded, if not fundamentally blocked, and moving beyond being anxious as either ambivalently reaffirming the viability of the projects and relations in which one was already invested, or as transformatively accepting those projects and relations as fundamentally uncertain and hence, as open to future determination.     

Prevention of anxiety disorders: A model for intervention

Anxiety disorders are among the most prevalent of all psychological disorders and are potentially amenable to early intervention and prevention. In this article, we review the various costs associated with anxiety disorders that make early prevention a valuable endeavor. Also, we considered extant data regarding risk factors for anxiety disorders, as knowledge of risk factors permits the targeting of a select group of the population considered to be most likely to develop anxiety disorders. Existing efficacy research on prevention for anxiety disorders is promising, but an overarching model to guide further research and development is lacking. We propose such models to guide high-risk sample selection including the content and format of prevention efforts.     

A Buddhist contribution to the psychoanalytic psychology of self

The author attempts to integrate the concepts of self used in psychoanalytic theory with the understanding of the nature of self as explained within the Buddhist meditative tradition. He divides different concepts of self in psychoanalytic theory into three major levels of consciousness and abstraction: self as experience, representational self and self as system. The representational level is defined as consisting of unconscious organizing structures of interaction: the system level is a hierarchically higher organization of representations, while the experiential level consists of the moment-to-moment flow of consciousness. He argues that for the sake of theoretical clarity these levels should be differentiated in discussions of self. He then describes the Buddhist psychology of self and tries to show how this perspective can enrich psychoanalytic understanding of the experiential self and of narcissism, which in Buddhist language would be described as clinging to (seeking or avoiding) images of self that arise in the mind. Last, he describes a model of therapeutic development using different levels of self and the interrelationship between them, showing how psychoanalytic psychotherapy and Buddhist insight meditation emphasize different levels of self using complementary rather than mutually exclusive methods.     

Test anxiety and metacognitive skillfulness: Availability versus production deficiencies

Abstract

This paper focuses on the role of metacognition in test anxiety. In two experiments, the metacognitive skillfulness of high vs. low test-anxious secondary school students was contrasted. Low test-anxious subjects exhibited a superior metacognitive skillfulness during math performance relative to high test-anxious subjects. Furthermore, differences in metacognitive skillfulness were performance related. In order to unravel causality in the relation between metacognition and test anxiety, two types of test-anxious students may be distinguished analogous to Naveh-Benjamin (1991). Type-1 students would lack metacognitive skills (availability deficiency), through which they experience failure and develop test anxiety. Type-2 students would experience task irrelevant thoughts, which causes cognitive interference with available metacognitive skills (production deficiency). Results of Study 1 reveal that metacognitive cueing may represent an adequate method for the identification of both types. Due to time-constraints, metacognitive cueing in Study 2 failed to do so.     

Scrutinizing application: An agenda for applied developmental psychology

This paper dissects two views of application. The first is associated with an ontogenetic, general skills perspective which assumes that applications involve bringing to bear general concepts and principles on practical problems, deviant populations and the match between developing individuals and the environment they inhabit and use. However, that ontogenetic view and its associated applications may be flawed. A second functionalist view of application is described which suggests a need to examine the meaning of application and the contexts where applications are appropriate. Two questions might profitably be evaluated simultaneously: How does the developing individual gain access to relevant competencies and adapt them to new circumstances?, and How does the developmentalist decide what is relevant and usable for practice? A particular developmental curriculum fitting these views is described.     

Transdiagnostic Internet treatment for anxiety disorders: A randomized controlled trial

Clinician-guided Internet-based cognitive behavioural therapy (iCBT) programs are clinically effective at treating specific anxiety disorders. The present study examined the efficacy of a transdiagnostic Internet-based cognitive behavioural treatment (iCBT) program to treat more than one anxiety disorder within the same program (the Anxiety Program). Eighty six individuals meeting diagnostic criteria for generalized anxiety disorder (GAD), panic disorder, and/or social phobia were randomly assigned to a treatment group, or to a waitlist control group. Treatment consisted of CBT based online educational lessons and homework assignments, weekly email or telephone contact from a clinical psychologist, access to a moderated online discussion forum, and automated emails. An intention-to-treat model using the baseline-observation-carried-forward principle was employed for data analyses. Seventy-five percent of treatment group participants completed all 6 lessons within the 8 week program. Post-treatment data was collected from 38/40 treatment group and 38/38 control group participants, and 3-month follow-up data was collected from 32/40 treatment group participants. Relative to controls, treatment group participants reported significantly reduced symptoms of anxiety as measured by the Generalized Anxiety Disorder - 7 Item, Social Phobia Screening Questionnaire, and the Panic Disorder Severity Rating Scale - Self Report Scale, but not on the Penn State Worry Questionnaire, with corresponding between-groups effect sizes (Cohen’s d) at post-treatment of 0.78, 0.43, 0.43, and 0.20, respectively. The clinician spent a total mean time of 46 min per person over the program, participants rated the procedure as moderately acceptable, and gains were sustained at follow-up. Modifications to the Anxiety program, based on post-treatment feedback from treatment group participants, were associated with improved outcomes in the control group. These results indicate that transdiagnostic programs for anxiety disorders may be successfully administered via the Internet.     

Individually-tailored, Internet-based treatment for anxiety disorders: A randomized controlled trial

Previous studies on Internet-based treatment with minimal to moderate therapist guidance have shown promising results for a number of specific diagnoses. The aim of this study was to test a new approach to Internet treatment that involves tailoring the treatment according to the patient’s unique characteristics and comorbidities.A total of 54 participants, regardless of specific anxiety diagnosis, were included after an in-person, semi-structured diagnostic interview and randomized to a 10 week treatment program or to a control group. Treatment consisted of a number of individually-prescribed modules in conjunction with online therapist guidance. Significant results were found for all dependent measures both immediately following treatment and at 1 and 2 year intervals. Mean between-group effect size including measures of anxiety, depression and quality of life was Cohen’s d = 0.69 at post-treatment, while the mean within-group effect size was d = 1.15 at post-treatment and d = 1.13 and d = 1.04 at 1 and 2 year follow-up respectively.The tentative conclusion drawn from these results is that tailoring the Internet-based therapy can be a feasible approach in the treatment of anxiety in a homogeneous population.