Applying metacognitive therapy for generalized anxiety disorder to adolescents: results from an open trial with 3- and 6-months follow-up.

Introduction: In adults, Metacognitive therapy (MCT) for Generalized anxiety disorder (GAD) has demonstrated to be an effective treatment, and even superior to comparisons in randomized controlled trials. One explanation for these results can be that MCT directly modifies dysfunctional metacognitive beliefs (including beliefs about worry as uncontrollable) which in the metacognitive model are assumed to be the underlying mechanisms in excessive worrying and emotional distress. However, MCT for GAD has not been specifically evaluated in adolescents, which we therefore aimed to do in the current study. Methods: Ten adolescents with primary GAD were treated in a Norwegian Specialist Mental Health Care Setting by trained MCT therapists. Diagnoses were evaluated at pre- and post-treatment. Adolescent and parental self-report measures were used at pre- and post-treatment, and at 3- and 6-month follow-up. In addition, distress, metacognitive strategies and beliefs were reported on a sessional basis. Results: At post-treatment, nine out of 10 patients no longer met the diagnostic criteria for GAD, and several patients also recovered from comorbid disorders. The effect sizes from pre- to post-treatment on symptom measures and dysfunctional metacognitive beliefs were large and maintained at follow-up. Session-to-session descriptive data indicated a linear decrease in distress and metacognitive strategies and beliefs. Conclusion: These results provide preliminary evidence that MCT is associated with positive effects for adolescents with GAD and supports larger scale evaluations.