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Li D, Wang D, Ren H, Tian Y, Chen J, Zhu R, Li Y, Wang L, Zhang XY. Association between rumination and drug craving in Chinese male methamphetamine use disorder patients with childhood trauma. CHILD ABUSE & NEGLECT 2023; 144:106357. [PMID: 37459735 DOI: 10.1016/j.chiabu.2023.106357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/18/2023] [Accepted: 07/12/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND In China, males make up the majority of methamphetamine (MA) dependent individuals and the majority of treatment seekers. Childhood trauma (CT) and rumination are associated with an increased risk of MA use. However, the association between CT, rumination, and drug craving remains largely unknown. OBJECTIVE The present study aims to explore the association between rumination and drug craving in methamphetamine use disorder (MAUD) patients with CT. PARTICIPANTS AND SETTING This study recruited 404 male participants with MAUD from a male drug rehabilitation center in Southwest China. METHODS Patients with CT were identified by the short form of Childhood Trauma Questionnaire (CTQ-SF). Rumination and drug craving were assessed by the Ruminative Responses Scale (RRS) and the Obsessive Compulsive Drug Use Scale (OCDUS), respectively. RESULTS 188 patients (46.5 %) experienced CT. Patients who had experienced CT showed significantly higher RRS symptom rumination score and OCDUS total score than those who had not. In patients with CT, RRS total and all subscale scores were positively associated with OCDUS interference of drug. Furthermore, the RRS brooding (β = 0.34, p < 0.001) and total scores (β = 0.38, p < 0.001) were determined to be separate contributors to the OCDUS total score in patients with CT. CONCLUSIONS Our study suggests that CT is common in male MAUD patients, and those who have suffered CT may exhibit higher levels of rumination and drug craving. Moreover, CT may play an influential role in the association between rumination and drug craving in patients with MAUD.
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Affiliation(s)
- Deyang Li
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Dongmei Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
| | - Hengqin Ren
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yang Tian
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Jiajing Chen
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Rongrong Zhu
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Yuqing Li
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Li Wang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China
| | - Xiang-Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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Dammen T, Tunheim K, Munkhaugen J, Papageorgiou C. The Attention Training Technique Reduces Anxiety and Depression in Patients With Coronary Heart Disease: A Pilot Feasibility Study. Front Psychol 2022; 13:948081. [PMID: 35967654 PMCID: PMC9363691 DOI: 10.3389/fpsyg.2022.948081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 06/20/2022] [Indexed: 11/26/2022] Open
Abstract
Background and Objectives Depression and anxiety symptoms are highly prevalent in coronary heart disease (CHD) patients and associated with poor outcome. Most psychological treatments have shown limited effectiveness on anxiety and depression in these patients. This study evaluates the feasibility of the attention training technique (ATT) in CHD patients with symptoms of anxiety and/or depression. Methods Five consecutive CHD patients with significant depression and anxiety symptoms with Hospital Anxiety and Depression rating scale (HADS) -anxiety or -depression subscale score > 8 received 6 weekly group-sessions of ATT in an open trial. Outcomes included feasibility and symptoms measured by HADS, at baseline, post-treatment and at 6 months follow-up. We also assessed psychiatric diagnoses, type D personality, insomnia, worry, and rumination. Results The sample comprised five men with a mean age of 59.9 (SD 4.4) years. Four of the patients attended all six sessions, and one patient attended all but one session. Mean HADS-A scores at baseline, post-treatment, and follow-up were 9.4 (SD 3.0), 4.2 (SD 3.0), and 4.0 (SD 2.5), and for HADS-D 8.6 (SD 3.3), 3.0 (SD 3.7), and 1.6 (SD 1.5), respectively. The results showed clinically significant changes in anxiety, depression, psychiatric disorders, insomnia, worry, and rumination. Statistically significant changes were found from pre- to post-treatment scores for HADS-A and worry, which were maintained at follow-up, and HADS-D scores significantly decreased from pre-treatment to 6-months follow-up. Conclusions ATT in a group format appears to be a feasible stand-alone metacognitive treatment for CHD patients. An adequately powered randomized controlled trial is warranted.
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Affiliation(s)
- Toril Dammen
- Department of Behavioural Medicine, Faculty of Medicine, Insitute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Division of Mental Health and Addiction, Department of Research and Innovation, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kristoffer Tunheim
- Department of Behavioural Medicine, Faculty of Medicine, Insitute of Basic Medical Sciences, University of Oslo, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department of Medicine, Drammen Hospital, Drammen, Norway
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Pedersen H, Grønnæss I, Bendixen M, Hagen R, Kennair LEO. Metacognitions and brooding predict depressive symptoms in a community adolescent sample. BMC Psychiatry 2022; 22:157. [PMID: 35232425 PMCID: PMC8887018 DOI: 10.1186/s12888-022-03779-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/08/2022] [Indexed: 02/01/2023] Open
Abstract
Depressive symptoms are prevalent in adolescence, and girls have higher levels of depressive symptoms and depressive disorder than boys. Rumination and especially brooding, seem to be a central maintaining factor of depressive symptoms, where metacognitions about rumination play a prominent role in maintaining depressive rumination. There is a sex difference in adults in depressive disorder. The current investigation of a high school / community sample of adolescents aged 16-20 from Norway (N = 1198, 62.2% women) found that adolescent women had higher scores than men on all relevant measures: Depressive symptoms, negative and positive metacognitions, pondering, and brooding. A path model for predicting depressive symptoms showed that the major factors for both sexes were negative metacognitions and brooding. The predictors of depressive symptoms were invariant across sex and age groups, suggesting similar underlying mechanisms across these groups. The overall findings suggest that metacognitive therapy may be an efficient intervention for depressive symptoms among adolescents.
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Affiliation(s)
- Helene Pedersen
- grid.5947.f0000 0001 1516 2393Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Ingrid Grønnæss
- grid.5947.f0000 0001 1516 2393Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mons Bendixen
- grid.5947.f0000 0001 1516 2393Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Roger Hagen
- grid.5947.f0000 0001 1516 2393Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway ,grid.5510.10000 0004 1936 8921Department of Psychology, University of Oslo, Oslo, Norway ,grid.5510.10000 0004 1936 8921Research institute, Modum Bad, Vikersund, Norway
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Carter JD, Jordan J, McIntosh VV, Frampton CM, Lacey C, Porter RJ, Mulder RT. Long-term efficacy of metacognitive therapy and cognitive behaviour therapy for depression. Aust N Z J Psychiatry 2022; 56:137-143. [PMID: 34250846 DOI: 10.1177/00048674211025686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine the two-year outcomes for depression, anxiety, cognitive and global social functioning after cognitive behavioural therapy (CBT) and metacognitive therapy (MCT) for depression. METHOD Participants were 31 adults with a diagnosis of major depressive disorder in a randomised pilot study comparing MCT and CBT. Therapy modality differences in change in depression and anxiety symptoms, dysfunctional attitudes, metacognitions, rumination, worry and global social functioning were examined at the two-year follow-up for those who completed therapy. RESULTS Significant improvements, with large effect sizes, were evident for all outcome variables. There were no significant differences in outcome between CBT and MCT. The greatest change over time occurred for depression and anxiety. Large changes were evident for metacognitions, rumination, dysfunctional attitudes, worry and global social functioning. Sixty-seven percent had not experienced a major depression and had been well during all of the past year, prior to the follow-up assessment. CONCLUSION The finding at end treatment, of no modality specific differences, was also evident at two-year follow-up. Although CBT and MCT targeted depression, improvements were much wider, and although CBT and MCT take different approaches, both therapies produced positive change over time across all cognitive variables. CBT and MCT provide treatment options, that not only improve the longer-term outcome of depression, but also result in improvements in anxiety, global social functioning and cognitive status.
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Affiliation(s)
- Janet D Carter
- School Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Virginia Vw McIntosh
- School Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | | | - Cameron Lacey
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard J Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Roger T Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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Cano-López JB, García-Sancho E, Fernández-Castilla B, Salguero JM. Empirical Evidence of the Metacognitive Model of Rumination and Depression in Clinical and Nonclinical Samples: A Systematic Review and Meta-Analysis. COGNITIVE THERAPY AND RESEARCH 2021. [DOI: 10.1007/s10608-021-10260-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
AbstractRumination is considered a cognitive vulnerability factor in the development and maintenance of depression. The metacognitive model of rumination and depression suggests that the development of rumination and its association with depression partly depends on metacognitive beliefs. Two metacognitive beliefs about rumination have been identified: positive beliefs about its utility and negative beliefs about the uncontrollability and its negative social consequences. We conducted a systematic review and meta-analysis aimed: (1) to analyze the associations between metacognitive beliefs and rumination and depression; (2) to test the metacognitive model, using a Two-Stage Structural Equation Modeling approach (TSSEM). Literature search retrieved 41 studies. These 41 studies (N = 10,607) were included in the narrative synthesis and meta-analysis, and 16 studies (N = 4477) were comprised for the TSSEM. Results indicated metacognitive beliefs are associated with rumination and depression. Measures on metacognitive beliefs about rumination indicated that positive beliefs showed moderate associations with rumination (r = 0.50), and low with depression (r = 0.27); whereas negative beliefs showed moderate associations with both rumination (r = 0.46) and depression (r = 0.49). These results were consistent across studies using different instruments to measure metacognitive beliefs, and in both clinical and nonclinical samples. Moreover, results of the TSSEM analyses showed that the metacognitive model had a good fit. In sum, our results are in line with the metacognitive model of rumination and depression, highlighting that metacognitive beliefs are relevant factors to understand why people ruminate and get depressed. Future directions and clinical implications are discussed.
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Nordahl H, Hjemdal O, Wells A. Metacognitive Beliefs Uniquely Contribute to Interpersonal Problems: A Test Controlling for Adult Attachment, Big-5 Personality Traits, Anxiety, and Depression. Front Psychol 2021; 12:694565. [PMID: 34539491 PMCID: PMC8440874 DOI: 10.3389/fpsyg.2021.694565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/09/2021] [Indexed: 11/13/2022] Open
Abstract
Interpersonal difficulties are common across psychological disorders and are a legitimate target of treatment. Psychotherapeutic models differ in their understanding of interpersonal problems and how these problems are formulated and treated. It has been suggested that they are both the cause and effect of emotional distress symptoms, that they result from early attachment experiences, and that they are related to personality dimensions. However, the metacognitive model of psychopathology predicts that emotion disorder symptoms and interpersonal problems are linked to a common set of factors involving dysfunctional metacognition. In support of this view, metacognitive therapy has substantially reduced interpersonal problems in patients with anxiety and depression even though interpersonal problems are not directly targeted, indicating a role for metacognitive change. Nevertheless, the relationship between interpersonal problems and metacognitive beliefs remains underexplored, and the statistical control of emotion symptoms, personality, and attachment is important in substantiating any metacognition effects. The aim of the present study was therefore to test metacognitive beliefs as statistical predictors of interpersonal problems while controlling for anxiety/depression, adult attachment, and the Big-5 personality dimensions. In a cross-sectional study, 296 participants completed a battery of self-report questionnaires. We found that positive- and negative-metacognitive beliefs, cognitive confidence, and cognitive self-consciousness accounted for significant and unique variance in interpersonal problems together with avoidant attachment and conscientiousness when the overlap between all predictors was controlled. These findings support the notion that metacognitive beliefs are relevant to interpersonal problems with the potential implication that metacognitive therapy could have particularly broad effects on both emotion disorder symptoms and interpersonal problems.
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Affiliation(s)
- Henrik Nordahl
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Odin Hjemdal
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Adrian Wells
- School of Psychological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
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Zahedian E, Bahreini M, Ghasemi N, Mirzaei K. Group meta-cognitive therapy and depression in women with breast cancer: a randomized controlled trial. BMC Womens Health 2021; 21:111. [PMID: 33736617 PMCID: PMC7977266 DOI: 10.1186/s12905-021-01258-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 03/10/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Breast cancer is one of the most common cancers in Iranian women. They will experience a mental health problem like depression before, during or after treatment. This study aimed to determine the effectiveness of group metacognitive therapy on depression, cognitive-emotional regulation, and meta-cognitive beliefs in women with breast cancer. METHODS In this randomized controlled clinical trial, a total of 24 depressed patients with breast cancer were randomly allocated to experimental and control groups. The experimental group received meta-cognitive therapy in 8 weekly sessions, but the control group received treatment as usual. Beck Depressive Inventory, cognitive emotion regulation questionnaire, and meta-cognitions questionnaire were completed before, after and one month after the intervention. Data were analyzed using Wilcoxon and Chi-square tests. RESULTS The mean score of depression in the experimental group was reduced from 21.6 ± 4.83 in the pre-test to 13.83 ± 8.12 in one-month follow-up (p = 0.16); however, there was no significant difference in the control group. The mean score of cognitive emotion regulation did not show a significant change in the two groups during the study and follow-up period. The mean score of meta-cognitive beliefs reached 68.75 ± 15.74 from 79.51 ± 10.72 in the experimental group during the follow-up period (p = 0.006); however, there was no significant difference in the control group in the score of metacognitive beliefs. CONCLUSION These findings support the efficacy of meta-cognitive therapy as a viable psychosocial intervention in depressed patients with breast cancer. Trial registration IRCT201606288473N5. Registered on: 05/09/2016 https://www.irct.ir/trial/8946 .
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Affiliation(s)
- Elham Zahedian
- Nursing and Midwifery School, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Masoud Bahreini
- Nursing and Midwifery School, Bushehr University of Medical Sciences, Bushehr, Iran
| | - Nezamaddin Ghasemi
- Department of Psychology, Salman Farsi University of Kazerun, Kazerun, Iran
| | - Kamran Mirzaei
- Community Medicine, Medical School, Bushehr University of Medical Sciences, Bushehr, Iran
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Kowalski J, Wierzba M, Wypych M, Marchewka A, Dragan M. Effects of attention training technique on brain function in high- and low-cognitive-attentional syndrome individuals: Regional dynamics before, during, and after a single session of ATT. Behav Res Ther 2020; 132:103693. [PMID: 32688045 DOI: 10.1016/j.brat.2020.103693] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/10/2020] [Accepted: 06/26/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE Attention Training Technique (ATT) is a key therapeutic tool in metacognitive therapy. There are numerous studies on the behavioral effects of ATT, however the neural mechanisms at work in the training are yet to be uncovered. To date there have been no controlled fMRI studies of ATT. METHOD We conducted a randomized double-blind controlled study of two groups with varying levels of cognitive-attentional syndrome (CAS). Groups with high (n = 43) and low (n = 46) levels of CAS underwent a single session of ATT or a control condition (CON) in an MRI scanner. Participants underwent resting state functional MRI (rsfMRI) sessions and rumination induction sessions both pre- and post-intervention Functional connectivity analyses and inter-subject correlations analyses were computed. We also collected data on emotion and attention functioning pre- and post-intervention. RESULTS We did not observe any behavioral effects of ATT. However, direct comparison between ATT and CON sessions revealed greater inter-subject correlations in almost all hubs belonging to the studied functional networks. Moreover, subjects who received ATT showed diminished connectivity in the fronto-parietal network during ruminations and diminished connectivity of the precuneus with lateral occipital cortices and the intraparietal sulcus in abstract thinking and rsfMRI, respectively. Furthermore, some of the observed effects in functional connectivity and inter-subject correlations were specific to different levels of CAS. CONCLUSIONS Our results may support a proposed neural mechanism for ATT: disengagement of attention from CAS-type processing in either low- or high-CAS individuals. It is also possible that some neural effects of ATT are specific to individuals with different levels of CAS.
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Affiliation(s)
- Joachim Kowalski
- Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183, Warsaw, Poland; Institute of Psychology, Polish Academy of Sciences, Stefana Jaracza 1, 00-378, Warsaw, Poland.
| | - Małgorzata Wierzba
- Laboratory of Brain Imaging, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Pasteur Street 3, 02-093, Warsaw, Poland
| | - Marek Wypych
- Laboratory of Brain Imaging, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Pasteur Street 3, 02-093, Warsaw, Poland
| | - Artur Marchewka
- Laboratory of Brain Imaging, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Pasteur Street 3, 02-093, Warsaw, Poland
| | - Małgorzata Dragan
- Faculty of Psychology, University of Warsaw, Stawki 5/7, 00-183, Warsaw, Poland
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Titus CE, DeShong HL. Thought control strategies as predictors of borderline personality disorder and suicide risk. J Affect Disord 2020; 266:349-355. [PMID: 32056898 DOI: 10.1016/j.jad.2020.01.163] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Revised: 12/03/2019] [Accepted: 01/28/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND Borderline Personality Disorder (BPD) is characterized by a pattern of instability in interpersonal relationships, affect, self-image and is marked by behavioral impulsivity including suicidal ideation and attempts. Additionally, individuals with BPD tend to engage in maladaptive ruminative thinking that is also related to suicidal ideation and attempts. Given these relations, this study aims to understand the 5 strategies of thought control (distraction, punishment, reappraisal, worry, and social control) as predictors of BPD symptoms and suicide risk. METHODS The sample was collected at a Southeastern University using a convenience sample of undergraduate participants. The final sample (n = 403) had an age range of 18 to 27 (M = 19.67, SD = 1.45), was 74.4% female and 25.6% male, and was primarily Caucasian (69.7%) and African American (24.8%). RESULTS Results demonstrate that distraction was negatively associated with BPD and suicide risk while worry and punishment were positively associated with BPD and suicide risk across three different measures of BPD. Social control was negatively associated with suicide risk and BPD but only on one of the BPD measures. Lastly, reappraisal was positively related to BPD symptoms on two measures. LIMITATIONS Given the sample characteristics, there may be limitations in the generalizability of the findings. CONCLUSIONS The findings represent a first step towards examining thought control strategies as possible predictors of BPD symptoms and suicide that can inform clinical interventions designed to increase or decrease utilization of these specific strategies.
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Affiliation(s)
- Caitlin E Titus
- Mississippi State University, Mississippi State, MS 39762, P.O. Box 6161, United States
| | - Hilary L DeShong
- Mississippi State University, Mississippi State, MS 39762, P.O. Box 6161, United States.
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Wells A. Breaking the Cybernetic Code: Understanding and Treating the Human Metacognitive Control System to Enhance Mental Health. Front Psychol 2019; 10:2621. [PMID: 31920769 PMCID: PMC6920120 DOI: 10.3389/fpsyg.2019.02621] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 11/06/2019] [Indexed: 01/14/2023] Open
Abstract
The self-regulatory executive function (S-REF) model explains the role of strategic processes and metacognition in psychological disorder and was a major influence on the development of metacognitive therapy. The model identifies a universal style of perseverative negative processing termed the cognitive attentional syndrome (CAS), comprised of worry, rumination, and threat monitoring in the development of disorder. The CAS is linked to dysfunctional metacognitions that include beliefs and plans for regulating cognition. In this paper, I extend the theoretical foundations necessary to support further research on mechanisms linking metacognition to cognitive regulation and effective treatment. I propose a metacognitive control system (MCS) of the S-REF that can be usefully distinguished from cognition and is comprised of multiple structures, information, and processes. The MCS monitors and controls activity of the cognitive system and regulates the behavior of neural networks whose activities bias the way cognition is experienced. Metacognitive information involved in the regulation of on-line processing includes metacognitive beliefs, metacognitive procedural commands, and more transient cybernetic code. Separation of the cognitive and metacognitive systems and modeling their relationship presents major implications concerning what should be done in therapy and how it should be done. The paper concludes with an in-depth consideration of methods that strengthen the psychological basis of psychotherapy and aid in understanding and applying metacognitive therapy in particular. Finally, limitations of the model and implications for future research on self-awareness, self-regulation, and metacognition are discussed.
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Affiliation(s)
- Adrian Wells
- School of Psychological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
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Nordahl H, Ødegaard IH, Hjemdal O, Wells A. A test of the goodness of fit of the generic metacognitive model of psychopathology symptoms. BMC Psychiatry 2019; 19:288. [PMID: 31533677 PMCID: PMC6751802 DOI: 10.1186/s12888-019-2266-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 08/29/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Common mental disorders such as depression and anxiety frequently co-occur and may share etiological mechanisms. The metacognitive model is based on the principle that there are common pathological mechanisms across disorders that account for comorbidity and therefore can be conceptualized in one generic model. A central prediction of the model is that particular metacognitive beliefs concerning the value of worry, and the uncontrollability and danger of cognition are positively correlated with psychopathology symptoms. In the present study, we set out to test the overall fit of this model by assessing generic metacognitive beliefs and judgements of attention control capacity as predictors of common and frequently co-occurring emotional distress symptoms. METHODS In a cross-sectional design, 645 participants gathered at convenience completed a battery of self-report questionnaires. RESULTS Structural equation modelling indicated a good model fit for the generic metacognitive model, and the predictors accounted for 93% of the variance in distress consisting of depression-, generalized- and social anxiety symptoms. CONCLUSIONS This finding supports the generic model and the implication that it can be used as a basis to formulate and treat multiple presenting problems.
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Affiliation(s)
- Henrik Nordahl
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway. .,St. Olavs Hospital, Division of Psychiatry, Trondheim University Hospital, Trondheim, Norway.
| | | | - Odin Hjemdal
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Adrian Wells
- School of Psychological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK
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12
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Hjemdal O, Solem S, Hagen R, Kennair LEO, Nordahl HM, Wells A. A Randomized Controlled Trial of Metacognitive Therapy for Depression: Analysis of 1-Year Follow-Up. Front Psychol 2019; 10:1842. [PMID: 31440193 PMCID: PMC6694776 DOI: 10.3389/fpsyg.2019.01842] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 07/25/2019] [Indexed: 11/13/2022] Open
Abstract
This paper reports the 1-year follow-up results from a randomized controlled trial (RCT), which examined the efficacy of metacognitive therapy (MCT) for unipolar depression compared to a waiting condition. Thirty-nine patients with major depression were offered MCT and were divided into two conditions; immediate MCT with 10 weekly sessions or a waiting period that had a 10-week delayed MCT start. Two participants dropped out during the waiting condition. Thirty-four patients participated in the follow-up assessment. Based on the intent-to-treat sample and all patients, 67% were classified as recovered, 13% improved, and 20% were unchanged at 1-year follow-up. For the completers sample 73% recovered, 12% improved, and 15% were unchanged. Five of the 31 patients (13%) that were in remission at post-treatment experienced relapse at 1-year follow-up. Within-group effect sizes were large for reductions in symptoms of depression (d = 2.09) and anxiety (d = 1.16) at 1-year. Treatment response was associated with reductions in rumination, worry, and metacognitive beliefs as predicted by the metacognitive model, but reductions in metacognitions independently predicted reductions in depression scores from pre-treatment to 1-year follow-up. The results suggest that treatment gains are stable at 1-year follow-up. The study sets the stage for future research, which should evaluate MCT over a longer term and compare it with active treatments using suitably powered RCTs.
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Affiliation(s)
- Odin Hjemdal
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Solem
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Roger Hagen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | | | - Hans M Nordahl
- Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway.,Nidaros DPS, Division of Psychiatry, St. Olavs Hospital, Trondheim, Norway
| | - Adrian Wells
- Division of Clinical and Health Psychology, The University of Manchester, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Prestwich, United Kingdom
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Normann N, Morina N. The Efficacy of Metacognitive Therapy: A Systematic Review and Meta-Analysis. Front Psychol 2018; 9:2211. [PMID: 30487770 PMCID: PMC6246690 DOI: 10.3389/fpsyg.2018.02211] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/25/2018] [Indexed: 12/14/2022] Open
Abstract
Background: Metacognitive therapy (MCT) continues to gain increased ground as a treatment for psychological complaints. During the last years, several clinical trials on the efficacy of MCT have been published. The aim of the current study was to provide an updated meta-analytic review of the effect of MCT for psychological complaints. Methods: We conducted a systematic search of trials on MCT for young and adult patients with psychological complaints published until January 2018, using PsycINFO, PubMed, the Cochrane Library, and Google Scholar. Trials with a minimum of 10 participants in the MCT condition were included. Results: A total of 25 studies that examined a variety of psychological complaints met our inclusion criteria, of which 15 were randomized controlled trials. We identified only one trial that was conducted with children and adolescents. In trials with adult patients, large uncontrolled effect size estimates from pre- to post-treatment and follow-up suggest that MCT is effective at reducing symptoms of the targeted primary complaints, anxiety, depression, and dysfunctional metacognitions. The comparison with waitlist control conditions also resulted in a large effect (Hedges' g = 2.06). The comparison of MCT to cognitive and behavioral interventions at post-treatment and at follow-up showed pooled effect sizes (Hedges' g) of 0.69 and 0.37 at post-treatment (k = 8) and follow-up (k = 7), respectively. Conclusions: Our findings indicate that MCT is an effective treatment for a range of psychological complaints. To date, strongest evidence exists for anxiety and depression. Current results suggest that MCT may be superior to other psychotherapies, including cognitive behavioral interventions. However, more trials with larger number of participants are needed in order to draw firm conclusions.
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Affiliation(s)
- Nicoline Normann
- Department of Psychology, University of Copenhagen, Copenhagen, Denmark
| | - Nexhmedin Morina
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Münster, Münster, Germany
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14
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A Prospective Test of the Metacognitive Model of Depression in Previously Depressed Individuals. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9972-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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15
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Strand ER, Hagen R, Hjemdal O, Kennair LEO, Solem S. Metacognitive Therapy for Depression Reduces Interpersonal Problems: Results From a Randomized Controlled Trial. Front Psychol 2018; 9:1415. [PMID: 30131749 PMCID: PMC6090231 DOI: 10.3389/fpsyg.2018.01415] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 07/20/2018] [Indexed: 11/13/2022] Open
Abstract
Interpersonal problems are significantly elevated in patients with depression. Metacognitive therapy (MCT) for depression does not address interpersonal problems but is associated with large reduction in depressive symptoms. The main aim of the current study was to explore whether MCT leads to improvements in interpersonal problems in patients with depression. The study was a waitlist controlled trial and assessments took place at pre- and post-treatment as well as 6-month follow-up. At pre-treatment, the sample had more interpersonal problems compared to samples from other studies of psychiatric outpatients. MCT was associated with large reductions in interpersonal problems. Level of interpersonal problems were not related to poorer treatment response. MCT, which does not directly target interpersonal problems, worked well for patients with depression and interpersonal problems. Future research should compare MCT with other evidence-based treatments for patients with depression and interpersonal problems.
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Affiliation(s)
- Eivind R Strand
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Roger Hagen
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Odin Hjemdal
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Leif E O Kennair
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Stian Solem
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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16
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Nordahl H, Wells A. Metacognitive Therapy for Social Anxiety Disorder: An A-B Replication Series Across Social Anxiety Subtypes. Front Psychol 2018; 9:540. [PMID: 29706924 PMCID: PMC5906593 DOI: 10.3389/fpsyg.2018.00540] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 03/29/2018] [Indexed: 12/03/2022] Open
Abstract
Cognitive behavioural therapy (CBT) is the treatment of choice for Social anxiety disorder (SAD). However, factors additional to those emphasised in CBT are the primary cause of psychological disorder according to the metacognitive model. Metacognitive Therapy (MCT) aims to target a perseverative thinking style named the cognitive attentional syndrome and its underlying metacognitive beliefs (beliefs about cognition). The present study aimed to explore the effects of generic MCT for SAD. Treatment related effects were evaluated using direct replication single case (A–B) methodology across three patients with different subtypes of SAD; performance type, generalised and generalised plus avoidant personality disorder, representing increasing SAD severity/complexity. All patients responded during treatment and achieved substantial symptom reductions which were largely maintained at 6 months’ follow-up. Metacognitive therapy appears to be a suitable treatment and was associated with positive outcomes for patients with different presentations of SAD.
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Affiliation(s)
- Henrik Nordahl
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.,St. Olavs Hospital, Nidaros DPS, Trondheim University Hospital, Trondheim, Norway
| | - Adrian Wells
- Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester Academic Health Science Centre, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Prestwich, United Kingdom
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17
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Wells A, McNicol K, Reeves D, Salmon P, Davies L, Heagerty A, Doherty P, McPhillips R, Anderson R, Faija C, Capobianco L, Morley H, Gaffney H, Shields G, Fisher P. Improving the effectiveness of psychological interventions for depression and anxiety in the cardiac rehabilitation pathway using group-based metacognitive therapy (PATHWAY Group MCT): study protocol for a randomised controlled trial. Trials 2018; 19:215. [PMID: 29615092 PMCID: PMC5883514 DOI: 10.1186/s13063-018-2593-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 03/13/2018] [Indexed: 12/24/2022] Open
Abstract
Background Anxiety and depression are prevalent among cardiac rehabilitation patients but pharmacological and psychological treatments have limited effectiveness in this group. Furthermore, psychological interventions have not been systematically integrated into cardiac rehabilitation services despite being a strategic priority for the UK National Health Service. A promising new treatment, metacognitive therapy, may be well-suited to the needs of cardiac rehabilitation patients and has the potential to improve outcomes. It is based on the metacognitive model, which proposes that a thinking style dominated by rumination, worry and threat monitoring maintains emotional distress. Metacognitive therapy is highly effective at reducing this thinking style and alleviating anxiety and depression in mental health settings. This trial aims to evaluate the effectiveness and cost-effectiveness of group-based metacognitive therapy for cardiac rehabilitation patients with elevated anxiety and/or depressive symptoms. Methods/Design The PATHWAY Group-MCT trial is a multicentre, two-arm, single-blind, randomised controlled trial comparing the clinical- and cost-effectiveness of group-based metacognitive therapy plus usual cardiac rehabilitation to usual cardiac rehabilitation alone. Cardiac rehabilitation patients (target sample n = 332) with elevated anxiety and/or depressive symptoms will be recruited across five UK National Health Service Trusts. Participants randomised to the intervention arm will receive six weekly sessions of group-based metacognitive therapy delivered by either cardiac rehabilitation professionals or research nurses. The intervention and control groups will both be offered the usual cardiac rehabilitation programme within their Trust. The primary outcome is severity of anxiety and depressive symptoms at 4-month follow-up measured by the Hospital Anxiety and Depression Scale total score. Secondary outcomes are severity of anxiety/depression at 12-month follow-up, health-related quality of life, severity of post-traumatic stress symptoms and strength of metacognitive beliefs at 4- and 12-month follow-up. Qualitative interviews will help to develop an account of barriers and enablers to the effectiveness of the intervention. Discussion This trial will evaluate the effectiveness and cost-effectiveness of group-based metacognitive therapy in alleviating anxiety and depression in cardiac rehabilitation patients. The therapy, if effective, offers the potential to improve psychological wellbeing and quality of life in this large group of patients. Trial registration UK Clinical Trials Gateway, ISRCTN74643496, Registered on 8 April 2015. Electronic supplementary material The online version of this article (10.1186/s13063-018-2593-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Adrian Wells
- School of Psychological Sciences, Faculty of Biology, Medicine and Health, Rawnsley Building, Manchester Royal Infirmary, The University of Manchester, Oxford Road, Manchester, M13 9WL, UK. .,Greater Manchester Mental Health NHS Foundation Trust, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK.
| | - Kirsten McNicol
- Greater Manchester Mental Health NHS Foundation Trust, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
| | - David Reeves
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, The University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK
| | - Peter Salmon
- Institute of Psychology, Health and Society, University of Liverpool, Waterhouse Building, Block B, Brownlow Street, Liverpool, L69 3GL, UK.,The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Prescot Street, Liverpool, L7 8XP, UK
| | - Linda Davies
- Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Anthony Heagerty
- School of Medical Sciences, Core Technology Facility, The University of Manchester, Grafton Street, Manchester, M13 9NT, UK.,Central Manchester Foundation Trust, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
| | - Patrick Doherty
- Department of Health Sciences, University of York, Seebohm Rowntree Building, York, YO10 5DD, UK
| | - Rebecca McPhillips
- Greater Manchester Mental Health NHS Foundation Trust, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
| | - Rebecca Anderson
- Greater Manchester Mental Health NHS Foundation Trust, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
| | - Cintia Faija
- Greater Manchester Mental Health NHS Foundation Trust, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
| | - Lora Capobianco
- Greater Manchester Mental Health NHS Foundation Trust, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
| | - Helen Morley
- School of Biological Sciences, Division of Neuroscience and Experimental Psychology, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Hannah Gaffney
- School of Health Sciences, Division of Psychology and Mental Health, The University of Manchester, Oxford Road, Manchester, M13 9PL, UK
| | - Gemma Shields
- Centre for Health Economics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Jean McFarlane Building, Oxford Road, Manchester, M13 9PL, UK
| | - Peter Fisher
- Institute of Psychology, Health and Society, University of Liverpool, Waterhouse Building, Block B, Brownlow Street, Liverpool, L69 3GL, UK.,The Royal Liverpool and Broadgreen University Hospitals NHS Trust, Prescot Street, Liverpool, L7 8XP, UK
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18
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Nordahl H, Nordahl HM, Vogel PA, Wells A. Explaining depression symptoms in patients with social anxiety disorder: Do maladaptive metacognitive beliefs play a role? Clin Psychol Psychother 2018; 25:457-464. [PMID: 29493054 DOI: 10.1002/cpp.2181] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Revised: 01/03/2018] [Accepted: 01/16/2018] [Indexed: 01/04/2023]
Abstract
Social anxiety disorder (SAD) is a major risk factor for developing symptoms of depression. Severity of social anxiety has previously been identified as a risk factor, and cognitive models emphasize dysfunctional schemas and self-processing as the key vulnerability factors underlying general distress in SAD. However, in the metacognitive model, depressive and other symptoms are related to metacognitive beliefs. The aim of this study was therefore to test the relative contribution of metacognitions when controlling for SAD severity and factors postulated in cognitive models. In a cross-sectional design, 102 patients diagnosed with primary SAD were included. We found that negative metacognitive beliefs concerning uncontrollability and danger and low confidence in memory emerged as the only factors explaining depressive symptoms in the regression model, suggesting that metacognitive beliefs are associated with increased depressive symptoms in SAD patients.
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Affiliation(s)
- Henrik Nordahl
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.,St. Olavs Hospital, Nidaros DPS, Trondheim University Hospital, Trondheim, Norway
| | - Hans M Nordahl
- St. Olavs Hospital, Nidaros DPS, Trondheim University Hospital, Trondheim, Norway.,Department of Mental Health, Norwegian University of Science and Technology, Trondheim, Norway
| | - Patrick A Vogel
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Adrian Wells
- School of Psychological Sciences, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK
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19
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Group Metacognitive Therapy vs. Mindfulness Meditation Therapy in a Transdiagnostic Patient Sample: A Randomised Feasibility Trial. Psychiatry Res 2018; 259:554-561. [PMID: 29179137 DOI: 10.1016/j.psychres.2017.11.045] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 10/25/2017] [Accepted: 11/16/2017] [Indexed: 11/24/2022]
Abstract
Two transdiagnostic therapies for treating psychological disorder are Metacognitive Therapy (MCT) and Mindfulness Based Stress Reduction (MBSR). These two approaches have yet to be compared and therefore the current study aimed to evaluate the feasibility of a study of group MCT and MBSR in treating anxiety and depression. A feasibility trial with 40 participants (aged 19-56) was conducted. Patients were randomly assigned to receive either eight weeks of group MCT or MBSR. The primary outcome was feasibility which included recruitment rates, retention and treatment acceptability. The primary symptom outcome was the Hospital Anxiety and Depression Scale (HADS) total score, which provided an overall measure of distress. Both treatments were found to be acceptable with low attrition and similar ratings of acceptability. Changes in outcomes were analyzed based on the intention-to-treat principle using mixed effect models. Preliminary analyses revealed that MCT was more effective in treating anxiety and depression in comparison to MBSR, and in reducing both positive and negative metacognitive beliefs. Reliable improvement rates favoured MCT at post-treatment and 6-month follow up. Both treatments appeared to be feasible and acceptable in treating transdiagnostic samples; however, a larger, definitive trial is required. The limitations and directions for future research are discussed.
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20
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Hagen K, Solem S, Opstad HB, Hansen B, Hagen R. The role of metacognition and obsessive-compulsive symptoms in psychosis: an analogue study. BMC Psychiatry 2017; 17:233. [PMID: 28662637 PMCID: PMC5492129 DOI: 10.1186/s12888-017-1392-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 06/21/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Several studies have indicated that obsessive-compulsive disorder (OCD) is a common comorbidity in patients with psychotic disorders, but there is sparse knowledge about the relationship between symptoms of OCD and psychotic symptoms. Metacognitions which guides thinking and coping is theorized to be a transdiagnostic component central for development and maintenance of psychological disorders, OCD and psychosis included. The aim of the study was therefore to explore how symptoms of OCD and metacognitions relate to symptoms of psychosis. Our main hypotheses were that metacognitions would be significantly related to all symptoms of psychological distress, and that there is considerable overlap between symptoms of psychosis and OCD. METHODS Community controls (N = 194) completed an internet survey measuring levels of paranoid ideation, predisposition to hallucinations, symptoms of OCD, depression, anxiety, and metacognitions. Correlations and hierarchical multiple linear regression analyses were used to unveil the relationship between symptoms and beliefs. RESULTS Symptoms of OCD showed a strong positive correlation with symptoms of psychosis, and the relationships were still significant after controlling for symptoms of anxiety and depression. Metacognitions also showed strong positive correlations with all symptom measures. Metacognition and OCD-symptoms accounted for 53.8% of the variance in paranoid ideation and 43.8% of predisposition to hallucinations. There was a large overlap between symptoms of psychosis, OCD-symptoms, and metacognitions (30.2-37.3%). CONCLUSIONS In general, the results suggest considerable overlap between paranoid ideation, predisposition to hallucinations, and OCD and metacognitive beliefs in a non-clinical sample. Further experimental- and clinical studies are needed in order to explore metacognitive models of OCD and psychosis.
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Affiliation(s)
- Kristen Hagen
- Hospital of Molde, OCD-team, Molde, Norway. .,Haukeland University Hospital, OCD-team, Bergen, Norway.
| | - Stian Solem
- 0000 0001 1516 2393grid.5947.fDepartment of Psychology, Norwegian University of Science and Technology, Trondheim, Norway ,0000 0004 0627 3560grid.52522.32St. Olavs University Hospital, Trondheim, Norway
| | | | - Bjarne Hansen
- 0000 0000 9753 1393grid.412008.fHaukeland University Hospital, OCD-team, Bergen, Norway ,0000 0004 1936 7443grid.7914.bFaculty of Psychology, University of Bergen, Bergen, Norway
| | - Roger Hagen
- 0000 0001 1516 2393grid.5947.fDepartment of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
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21
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Hagen R, Hjemdal O, Solem S, Kennair LEO, Nordahl HM, Fisher P, Wells A. Metacognitive Therapy for Depression in Adults: A Waiting List Randomized Controlled Trial with Six Months Follow-Up. Front Psychol 2017; 8:31. [PMID: 28174547 PMCID: PMC5258745 DOI: 10.3389/fpsyg.2017.00031] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Accepted: 01/05/2017] [Indexed: 12/02/2022] Open
Abstract
This randomized controlled trial examines the efficacy of metacognitive therapy (MCT) for depression. Thirty-nine patients with depression were randomly assigned to immediate MCT (10 sessions) or a 10-week wait list period (WL). The WL-group received 10 sessions of MCT after the waiting period. Two participants dropped out from WL and none dropped out of immediate MCT treatment. Participants receiving MCT improved significantly more than the WL group. Large controlled effect sizes were observed for both depressive (d = 2.51) and anxious symptoms (d = 1.92). Approximately 70–80% could be classified as recovered at post-treatment and 6 months follow-up following immediate MCT, whilst 5% of the WL patients recovered during the waiting period. The results suggest that MCT is a promising treatment for depression. Future controlled studies should compare MCT with other active treatments.
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Affiliation(s)
- Roger Hagen
- Department of Psychology, Norwegian University of Science and Technology Trondheim, Norway
| | - Odin Hjemdal
- Department of Psychology, Norwegian University of Science and Technology Trondheim, Norway
| | - Stian Solem
- Department of Psychology, Norwegian University of Science and Technology Trondheim, Norway
| | | | - Hans M Nordahl
- Department of Psychology, Norwegian University of Science and Technology Trondheim, Norway
| | - Peter Fisher
- Institute of Psychology Health and Society, University of Liverpool Liverpool, England
| | - Adrian Wells
- School of Psychological Sciences, University of Manchester Manchester, England
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