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      The Scope of Metacognitive Therapy in the Treatment of Psychiatric Disorders

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      Journal: Cureus
      Publisher: Cureus
      Keywords: worry, rumination, metacognitive beliefs, cognitive-attentional syndrome, metacognitive therapy

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          Abstract

          Metacognitive therapy (MCT) is a novel and promising transdiagnostic psychotherapy intervention based on the Self-Regulatory Executive Function model of conceptualizing emotional disorders. It was developed by Adrian Wells in 2009. Its therapeutic response occurs by reducing dysfunctional metacognitive beliefs regarding worry and rumination, often seen in patients with psychiatric disorders. Since its inception, it has been increasingly applied to a wide spectrum of psychiatric illnesses, but mainly focusing on mood and anxiety disorders. To our knowledge, no study has detailed its existing therapeutic scope in psychiatry. In this comprehensive narrative review, we describe the various psychiatric illnesses in which MCT has been used, the advantages of MCT, and the limitations of the MCT research. In addition, we propose some solutions to systematically examine its place in psychiatry. We encountered its potential role in treating trauma and stress-related disorders, obsessive-compulsive spectrum disorders, personality disorders, psychotic disorders, substance use disorders, and sexual disorders.

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          Prevalence of depression, anxiety, and adjustment disorder in oncological, haematological, and palliative-care settings: a meta-analysis of 94 interview-based studies.

          Alex J Mitchell, Melissa Chan, Henna Bhatti … (2011)
          Substantial uncertainty exists about prevalence of mood disorders in patients with cancer, including those in oncological, haematological, and palliative-care settings. We aimed to quantitatively summarise the prevalence of depression, anxiety, and adjustments disorders in these settings. We searched Medline, PsycINFO, Embase, and Web of Knowledge for studies that examined well-defined depression, anxiety, and adjustment disorder in adults with cancer in oncological, haematological, and palliative-care settings. We restricted studies to those using psychiatric interviews. Studies were reviewed in accordance with PRISMA guidelines and a proportion meta-analysis was done. We identified 24 studies with 4007 individuals across seven countries in palliative-care settings. Meta-analytical pooled prevalence of depression defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) criteria was 16·5% (95% CI 13·1-20·3), 14·3% (11·1-17·9) for DSM-defined major depression, and 9·6% (3·6-18·1) for DSM-defined minor depression. Prevalence of adjustment disorder alone was 15·4% (10·1-21·6) and of anxiety disorders 9·8% (6·8-13·2). Prevalence of all types of depression combined was of 24·6% (17·5-32·4), depression or adjustment disorder 24·7% (20·8-28·8), and all types of mood disorder 29·0% (10·1-52·9). We identified 70 studies with 10,071 individuals across 14 countries in oncological and haematological settings. Prevalence of depression by DSM or ICD criteria was 16·3% (13·4-19·5); for DSM-defined major depression it was 14·9% (12·2-17·7) and for DSM-defined minor depression 19·2% (9·1-31·9). Prevalence of adjustment disorder was 19·4% (14·5-24·8), anxiety 10·3% (5·1-17·0), and dysthymia 2·7% (1·7-4·0). Combination diagnoses were common; all types of depression occurred in 20·7% (12·9-29·8) of patients, depression or adjustment disorder in 31·6% (25·0-38·7), and any mood disorder in 38·2% (28·4-48·6). There were few consistent correlates of depression: there was no effect of age, sex, or clinical setting and inadequate data to examine cancer type and illness duration. Interview-defined depression and anxiety is less common in patients with cancer than previously thought, although some combination of mood disorders occurs in 30-40% of patients in hospital settings without a significant difference between palliative-care and non-palliative-care settings. Clinicians should remain vigilant for mood complications, not just depression. None. Copyright © 2011 Elsevier Ltd. All rights reserved.
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            Modelling cognition in emotional disorder: the S-REF model.

            Anjanette A Wells, Alexander G. de G. Matthews (2015)
            Cognitive therapy techniques are applied to an ever-increasing range of psychological disorders. However, both basic methods and general theory of therapy have evolved more slowly. Although cognitive therapy is based on experimentally testable concepts derived from cognitive psychology, an integration of these areas capable of explaining cognitive-attentional phenomena and offering treatment Implications remains to be achieved. In this paper, we outline the Self-Regulatory Executive Function (S-REF) model of emotional disorder, which integrates information processing research with Beck's schema theory. The model advances understanding of the roles of stimulus-driven and voluntary control of cognition, procedural knowledge (beliefs), and of the interactions between different levels of information-processing. It also accounts for cognitive bias effects demonstrated in the experimental psychopathology literature. The model presents implications concerning not only what should be done in cognitive therapy, but how cognitive change may be most effectively accomplished.
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              The Efficacy of Metacognitive Therapy: A Systematic Review and Meta-Analysis

              Nicoline Normann, Nexhmedin Morina (2018)
              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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                Author and article information

                Journal
                Journal ID (nlm-ta): Cureus
                Journal ID (iso-abbrev): Cureus
                Journal ID (issn): 2168-8184
                Title: Cureus
                Publisher: Cureus (Palo Alto (CA) )
                ISSN (Electronic): 2168-8184
                Publication date (Electronic, pub): 23 March 2022
                Publication date (Electronic, collection): March 2022
                Volume: 14
                Issue: 3
                Electronic Location Identifier: e23424
                Affiliations
                [1 ] Psychiatry, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
                Author notes
                Article
                DOI: 10.7759/cureus.23424
                PMC ID: 9030663
                SO-VID: cafd51a8-ecd3-4f02-b568-28bd6987524e
                Copyright © Copyright © 2022, Sharma et al.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                Date received : 26 February 2022
                Date accepted : 23 March 2022
                Categories
                Subject: Psychiatry
                Subject: Psychology

                Keywords: worry,rumination,metacognitive beliefs,cognitive-attentional syndrome,metacognitive therapy
                Data availability:
                Keywords: worry, rumination, metacognitive beliefs, cognitive-attentional syndrome, metacognitive therapy

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