Anxiety
Do worry and metacognition drive anxiety during therapy?
Open access · cc by · source: Europe PMC
In patients treated for stubborn anxiety disorders, worry and constantly scanning for threat sat at the centre of the week-to-week web of symptoms in both therapies, more than the specific catastrophic thoughts that CBT targets.
Study at a glance
- Design
- Other — Secondary analysis of weekly questionnaire data from a randomised trial; multilevel vector autoregressive (mlVAR) network models estimated separately for each therapy arm
- N
- N=74 · 74 patients who started treatment (38 CBT, 36 MCT); 67 completed all sessions
- Population
- Adults with treatment-resistant PTSD, social phobia or panic disorder at a specialised inpatient anxiety unit in Norway, heavily comorbid
- Outcome
- Structure and centrality of temporal, contemporaneous and between-person networks linking 11 weekly-rated anxiety, depression, cognition and metacognition items
Structured fields used in claim comparison tables when every cited study has a complete layer.
Key findings
In the MCT network, the belief that one's thoughts are uncontrollable predicted later threat-monitoring, and worry was the most central node. The CBT network had more connections; a bodily symptom (heart pounding) was central, but worry, sleep problems and threat-monitoring also had high influence. Neither catastrophic cognition had strong outgoing influence in the CBT network, which runs against what CBT theory would predict. Across all network types, worry and threat-monitoring were consistently central, which fits the self-regulatory executive function (S-REF) model behind MCT.
Methodology
The authors reused data from a trial in which 74 patients with treatment-resistant anxiety disorders were randomised to metacognitive therapy (MCT) or disorder-specific cognitive behavioural therapy (CBT). Every week patients rated questionnaire items, and the authors picked 11 of them covering anxiety and depression symptoms, catastrophic cognitions, worry, threat-monitoring and the belief that thoughts are uncontrollable. They then fitted network models, separately for each therapy, showing which items predicted which others from one week to the next, within the same week, and across people.
Limitations
The two therapies' networks were never statistically compared with each other, so the claim that they differ rests on visual inspection. No correction was made for the many significance tests, there was no replication sample, and network stability could not be checked with the sample available. The items were picked from general questionnaires, so two anxiety-inventory items stand in for 'catastrophic cognitions' and a single belief item stands in for 'metacognition', which limits how well each theory's mechanisms were measured. Network edges show which items predict one another over time, but that does not prove one symptom causes another.
How this study connects
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