Comparing the effectiveness of metacognitive therapy and Barlow transdiagnostic treatment on cognitive emotion regulation in patients with generalized anxiety disorder

Document Type : Research Paper

Authors

1 Ph.D. in clinical psychology, Department of Psychology, Bojnourd Branch, Islamic Azad University, Bojnourd, Iran.

2 Assistant professor of clinical psychology, Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.

Abstract

Introduction: Regarding to high prevalence of anxiety disorders and importance of emotional regulation in these disorders, the present study aimed to comparing the effectiveness of metacognitive therapy and Barlow transdiagnostic treatment on cognitive emotion regulation in patients with generalized anxiety disorder.
Materials and Methods: The statistical community of this study consisted of all patients with clinical symptoms of generalized anxiety disorder referred to consultancy centers of Mashhad-Iran in 2020-2021. Among them, 45 patients were selected by the convenient sampling method and divided into three groups randomly (metacognitive therapy, and Barlow transdiagnostic treatment, and the control group). The experimental groups received treatment in 8 ninety-minute sessions. The research instruments included the Brief Measure for Assessing Generalized Anxiety Disorder (GAD-7) and Difficulties in Emotion Regulation Scale (DERS). The data were analyzed through the descriptive statistics, Kolmogrov-Smirnov test, Mauchely sphericity test, and covariance analysis.     
Results: The findings revealed that both interventions reduced difficulty in emotional regulation significantly, but the transdiagnostic treatment had higher effect size than metacognitive treatment (0.449 vs 0.141).
Conclusion: The present study showed that both treatment approaches of metacognitive therapy and transdiagnostic treatment can significantly reduce difficulty in emotional regulation in patients with generalized anxiety disorder, although transdiagnostic treatment has more effectiveness than metacognitive therapy.

Keywords


  1. Antonio Preti A, Demontis R, Cossu G, Kalcev G, Cabras F, Moro MF, et al. The lifetime prevalence and impact of generalized anxiety disorders in an epidemiologic Italian National Survey carried out by clinicians by means of semistructured interviews. BMC Psychiatry 2021; 21: 48-55.
  2. Grenier S, Desjardins F, Raymond B, Payette MC, Rioux ME, Landreville P, et al. Six‐month prevalence and correlates of generalized anxiety disorder among primary care patients aged 70 years and above: Results from the ESA‐services study. International Journal of Geriatric Psychiatry 2018; https://doi.org/10.1002/gps.5023
  3. Mohammadi MR, Pourdehghan P, Mostafavi SA, Hooshyari Z, Ahmadi N, Khaleghi A. Generalized anxiety disorder: Prevalence, predictors, and comorbidity in children and adolescents. J Anxiety Disord 2020; 73: 102234. 
  4. American Psychiatric Association. Diagnostic and statistical manual of mental disorders (5th ed). Washington, DC: American Psychiatric Press; 2013.
  5. Bower ES, Wetherell JL, Mon T, Lenze EJ. Treating anxiety disorders in older adults: Current treatments and future directions. Harvard Review of Psychiatry 2015; 23(5): 329-42.
  6. Aldao A, Nolen-Hoeksema S. Specificity of cognitive emotion regulation strategies: A transdiagnostic examination. Behav Res Ther 2010; 48: 974-983.
  7. Mennin DS, Fresco DM. Emotion regulation therapy. In: Gross JJ. (editor). Handbook of emotion regulation. New York: Guilford; 2014: 469-90.
  8. Johnson SU, Hoffart A, Nordahl HM, Ulvenes PG, Vrabel K, Wampold BE. Metacognition and cognition in inpatient MCT and CBT for comorbid anxiety disorders: A study of within-person effects. J Clin Psychol 2018; 65(1): 86-9.
  9. Fresco DM, Mennin DS, Heimberg RG, Ritter M. Emotion regulation therapy for generalized anxiety disorder. Cognit Behav Pract 2013; 20(3): 282-300. 
  10. Norton PJ, Barrera TL. Transdiagnostic versus diagnosis-specific CBT for anxiety disorders: A preliminary randomized controlled noninferiority trial. Depress Anxiety 2012; 29(10): 874-82. 
  11. Saha S, Lim CCW, Cannon DL, Burton L, Bremner M, Cosgrove P, et al. Co-morbidity between mood and anxiety disorders: A systematic review and meta-analysis. Depress Anxiety 2021; 38(3): 286-306. 
  12. Barlow DH, Farchione TJ, Fairholme  CP, Ellard KK, Boisseau  CL, Allen LB, et al. The unified protocol for transdiagnostic treatment of emotional disorders: Therapist guide. New York: Oxford University Press; 2011.
  13. Sharifi M, Mami S, Mohammadzadeh J, Ahmadi V, Kakabaraei K. [Evaluation of the effectiveness of unified protocol for the transdiagnostic treatment and emotion regulation intervention in patients with generalized anxiety disorder in a military hospital]. Journal of Ibn-e-Sina 2020; 22(3): 73-7. (Persian)
  14. Barlow DH. Psychological treatments. Am Psychol 2004; 59(9): 869-78.
  15. Farchione TJ, Fairholme CP, Ellard KK, Boisseau CL, Thompson-Hollands J, Carl JR, et al. Unified protocol for transdiagnostic treatment of emotional disorders: A randomized controlled trial. Behav Ther 2012; 43(3): 666-78.
  16. Newby JM, Mewton L, Andrews G. Transdiagnostic versus disorder-specific internet-delivered cognitive behaviour therapy for anxiety and depression in primary care. J Anxiety Disord 2017; 46: 25-34. 
  17. Schaeuffele C, Schulz A, Knaevelsrud C, Renneberg B, Boettcher J. CBT at the crossroads: The rise of transdiagnostic treatments. Int J Cognit Ther 2021; 14(1): 86-113.
  18. Naeenian MR, Shaeiri MR, Sharifi M, Hadian M. [Assessing the validity and reliability of the Brief Measure for Assessing Generalized Anxiety Disorder (The GAD-7)]. Clinical psychology and personality 2011; 3(4): 41-52. (Persian)
  19. Ghaderi F, Akrami N, Namdari K, Abedi A. [Comparing the effects of integrated cognitive-behavioral therapy and transdiagnostic treatment on symptoms of patients with generalized anxiety disorder comorbid with depression]. Iranian journal of psychiatry and clinical psychology 2022; 27(4): 440-57. (Persian)
  20. Barlow DH. Clinical handbook of psychological disorders. New York: Guilford; 2014.
  21. Spitzer RL, Kroenke K, Williams JBW, Lo¨we B. A brief measure for assessing generalized anxiety disorder The GAD-7. Arch Intern Med 2006; 166(10):1092-7.
  22. Gratz KL, Roemer L. Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the difficulties in emotion regulation scale. J Psychopathol Behav Assess 2004; 26: 41-54.
  23. Kermani Mamazandi Z,Talepasand S. [Psychometric Characteristics of Difficulties in Emotion Regulation Scale in Semnan University Students]. The scientific journal of education and evaluation 2018; 11: 117-42. (Persian)
  24. Zemestani M, Imani M. [Effectiveness of transdiagnostic treatment on depression/anxiety symptoms and emotion regulation]. Contemporary psychology 2016; 11(1): 21-32. (Persian)
  25. Mansell W, Harvey A, Watkins ED, Shafran R. Conceptual foundations of the transdiagnostic approach to CBT. Journal of Cognitive Psychotherapy. 2009; 23(1): 6-19. 
    26. Wilamowska ZA, Thompson-Hollands J, Fairholme CP, Ellard KK, Farchione TJ, Barlow DH. Conceptual background, development, and preliminary data from the unified protocol for transdiagnostic treatment of emotional disorders. Depression and Anxiety 2010; 27(10): 882-90.