Comparing the effectiveness of metacognitive therapy and Barlow transdiagnostic treatment on the severity of clinical symptoms and experiential avoidance 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 the prevalence rate of Generalized Anxiety Disorder (GAD) and the importance of effective psychological interventions on treatment outcome, the present study aimed to compare the effectiveness of metacognitive therapy and Barlow transdiagnostic treatment on the severity of clinical symptoms and experiential avoidance in patients with generalized anxiety disorder.
 
Materials and Methods: This cross-sectional study was done in 2020-2021. The samples were selected among patients diagnosed with GAD based on structured clinical interviews by clinical psychologists, who referred to three consultancy centers in Mashhad-Iran. Among these patients, 45 female patients with GAD diagnosis were selected by the convenience sampling method and divided randomly into three equal groups: Barlow transdiagnostic treatment, metacognitive therapy, and a control group. The experimental groups received the interventions in 12 forty-five-minute sessions (twice a week). The participants fulfilled The Seven-Item General Anxiety Disorder Scale (GAD-7) and Acceptance and Action Questionnaire-II (AAQ-II). The data were analyzed through descriptive statistics, covariance analysis, t-test, and SPSS version 21.
 
Results: The effect size of metacognitive therapy on experiential avoidance in patients with generalized anxiety disorder was 0.022, while this effect size was 0.255 in the transdiagnostic treatment. Also, the effect size of metacognitive therapy on anxiety in patients with generalized anxiety disorder was 0.019, while this effect size was 0.141 in the transdiagnostic treatment.
 
Conclusion: Based on the findings, both metacognitive therapy and transdiagnostic treatment reduced anxiety and experiential avoidance in patients with generalized anxiety disorder, but transdiagnostic treatment decreased these symptoms more than metacognitive therapy.

Keywords


  1. Chang S, Abdin E, Shafie S, Sambasivam R, Vaingankar JA, Ma S, et al. Prevalence and correlates of generalized anxiety disorder in Singapore: Results from the second Singapore Mental Health Study. J Anxiety Disord 2019; 66: 102-6.‏
  2. Ishikawa H, Tachimori H, Tadashi Takeshima T, Umeda M,  Miyamoto K,  Shimoda H, et al. Prevalence, treatment, and the correlates of common mental disorders in the mid 2010′ s in Japan: The results of the world mental health Japan 2nd survey. J Affect Disord 2018; 241: 554-62.‏
  3. Fakhari A, Herizchi S, Sadeghi-Bazargani H, Amiri S, Noorazar SG, Mirzajanzade M, et al. Prevalence of psychiatric disorders in the aging population in the northeastern of Iran. Middle East Current Psychiatry 2023; 30: 25.
  4. O’Connor  E, Henninger  M, Perdue  L, Coppola  EL, Thomas  R, Gaynes  BN. Screening for depression, anxiety, and suicide risk in adults: A systematic evidence review for the US preventive services task force. Evidence Synthesis No. 223. USA: Agency for Healthcare Research and Quality; 2023.
  5. Al-Makinah S, Al-Aithan Z, Al-Quryan A. Prevalence of anxiety and its effect on academic performance among secondary school students in Al-Ahsa city, Eastern Saudi Arabia, 2020: Cross-sectional study. Annals of clinical and analytical medicine 2023; 10(1): 239-51.
  6. Deady M, Collins DAJ, Johnston DA, Glozier N, Calvo RA, Christensen H, et al. The impact of depression, anxiety and comorbidity on occupational outcomes. Occup Med 2022; 72(1): 17-24.‏
  7. Jenkins PE, Ducker I, Gooding R, James M, Rutter-Eley E. Anxiety and depression in a sample of UK college students: A study of prevalence, comorbidity, and quality of life. J Am Coll Health 2021; 69(8): 813-19.‏
  8. Aupperle RL, Paulus MP. Neural systems underlying approach and avoidance in anxiety disorders. Dialogues Clin Neurosci 2010; 12(4): 517-31.
  9. Berman NC, Wheaton MG, McGrath P, Abramowitz JS. Predicting anxiety: The role of experiential avoidance and anxiety sensitivity. J Anxiety Disord 2010; 24(1): 109-13.
  10. Mellick WH, Mills JA, Kroska EB, Calarge CA, Sharp C, Dindo LN. Experiential avoidance predicts persistence of major depressive disorder and generalized anxiety disorder in late adolescence. J Clin Psychiatry 2019; 80(6): 6949.‏
  11. Lehrbach KR, Crane ME, Olino TM, Kendall PC. Anxiety sensitivity and experiential avoidance: Relations with anxiety severity and treatment outcomes in anxious youth. Cognit Ther Res 2023; 47(2): 1-10.‏
  12. Yıldırım JC, Bahtiyar B. The association between metacognitions and worry: The mediator role of experiential avoidance strategies. J Psychol 2022; 156(8): 552-67.‏
  13. Carl E, Witcraft SM, Kauffman BY, Gillespie EM, Becker ES, Cuijpers P, et al. Psychological and pharmacological treatments for generalized anxiety disorder (GAD): A meta-analysis of randomized controlled trials. Cogn Behav Ther 2020; 49(1): 1-21.‏
  14. McEvoy PM. Metacognitive therapy for anxiety disorders: A review of recent advances and future research directions. Curr Psychiatry Rep 2019; 21(5): 1-9.
  15. Nordahl H, Vollset T, Hjemdal O. An empirical test of the metacognitive model of generalized anxiety disorder. Scand J Psychol 2023; 64: 263-7.
  16. Nordahl HM, Borkovec TD, Hagen R, Kennair LE, Hjemdal O, Solem S, et al. Metacognitive therapy versus cognitive–behavioural therapy in adults with generalized anxiety disorder. BJPsych Open 2018; 4: 393-400.
  17. Berking M, Wupperman P, Reichardt A, Pejic A, Dippel A, Znoj H. Emotion-regulation skills as a treatment target in psychotherapy. Behav Res Ther 2008; 46: 1230-7.
  18. Young KS, Sandman CF, Craske MG. Positive and negative emotion regulation in adolescence: Links to anxiety and depression. Brain Sci 2019; 9(4): 76.‏
  19. Sakiris N, Berle D. A systematic review and meta-analysis of the Unified Protocol as a transdiagnostic emotion regulation based intervention. Clin Psychol Rev 2019; 72: 10175119.
  20. Lincoln TM, Schulze L, Renneberg B. The role of emotion regulation in the characterization, development and treatment of psychopathology. Nat Rev Psychol 2022; 1(5): 272-86.‏
  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. Guze SB. Diagnostic and statistical manual of mental disorders. 4th ed. (DSM-IV). Am J Psychiatry 1995; 152(8): 1228.
  23. Hinz A, Klein AM, Bra¨hler E, Glaesmer H, Luck T, Riedel-Heller SG, et al. Psychometric evaluation of the Generalized Anxiety Disorder Screener GAD-7, based on a large German general population sample.  J Affect Disord 2017; 210: 338-44.
  24. Mills SD, Fox RS, Malcarne VL, Roesch SC, Champagne BR, Sadler GR. The psychometric properties of the Generalized Anxiety Disorder-7 Scale in Hispanic Americans with English or Spanish language preference. Cultur Divers Ethnic Minor Psychol 2014; 20(3): 463-8.
  25. Alghadir A, Manzar MD, Anwer S, Albougami A, Salahuddin M. Psychometric properties of the Generalized Anxiety Disorder Scale among Saudi university male students. Neuropsychiatr Dis Treat 2020; 16: 1427-32. 
  26. Dhira TA, Rahman MA, Sarker AR, Mehareen J. Validity and reliability of the Generalized Anxiety Disorder-7 (GAD-7) among university students of Bangladesh. PLoS ONE 2021; 16(12): e0261590.
  27. Naeinian M, Shaeiri M, Sharif M, Hadian M. [To study reliability and validity for a brief measure for assessing Generalized Anxiety Disorder (GAD-7)]. Clinical psychology and personality 2011; 9(1): 41-50. (Persian)
  28. Bond FW, Hayes SC, Baer RA, Carpenter KM, Guenole N, Orcutt HK, et al. Preliminary psychometric properties of the Acceptance and Action Questionnaire-II: A revised measure of psychological inflexibility and experiential avoidance. Behav Ther 2011; 42(4): 676-88.
  29. Abbasi E, Fata L, Moloudi R, Zarabi H. [Psychometric properties of Persian version of Acceptance and Action Questionnaire-II]. Psychological methods and models 2013; 2: 65-80. (Persian)
  30. Abbasi A, Aghaei Jeshvaghani A, Ebrahimi Moghasam H. [Effectiveness of metacognition therapy on the anxiety and psychological wellbeing of the patients with generalized anxiety]. The journal of Medical School of Mashhad University of Medical Sciences 2021; 63(5): 2745-56. (Persian)
  31. Barlow DH, Farchione TJ, Sauer-Zavala S, Latin HM, Ellard KK, Bullis JR, et al. Unified protocol for transdiagnostic treatment of emotional disorders: Therapist guide. Oxford: Oxford University; 2017.
  32. Solem S, Wells A, Kennair LEO, Hagen R, Nordahl H, Hjemdal O. Metacognitive therapy versus cognitive-behavioral therapy in adults with generalized anxiety disorder: A 9-year follow-up study. Brain Behav 2021; 11(10): e2358.
  33. Sadr A, Doustkam M, Shareh H, Bolghan-Abadi M. [Comparison of effectiveness of Barlow's transdiagnostic and Mennin and Fresco’s emotion regulation therapy in the symptoms of generalized anxiety disorder (case study)]. Journal of research in behavioral sciences 2020; 18(1): 11-25. (Persian)
  34. Hasanpoor P, Aghausefi A, Zamir O, Alipour A. [The effectiveness of transdiagnostic treatment on experiential avoidance and cognitive emotion regulation in patients with obsessive-compulsive disorder and its comparison with exposure and prevention response therapy]. Journal of clinical psychology 2019; 11(3): 25-38. (Persian)