درمان فراشناختی برای اختلال اضطراب فراگیر: آزمایش باز

Generalized anxiety disorder (GAD) responds only modestly to existing cognitive-behavioural treatments. This study investigated a new treatment based on an empirically supported metacognitive model [Wells, (1995). Metacognition and worry: A cognitive model of generalized anxiety disorder. Behavioural and Cognitive Psychotherapy, 23, 301–320; Wells, (1997). Cognitive therapy of anxiety disorders: A practice manual and conceptual guide. Chichester, UK: Wiley]. Ten consecutive patients fulfilling DSM-IV criteria for GAD were assessed before and after metacognitive therapy, and at 6, and 12-month follow-up. Patients were significantly improved at post-treatment, with large improvements in worry, anxiety, and depression (ESs ranging from 1.04–2.78). In all but one case these were lasting changes. Recovery rates were 87.5% at post treatment and 75% at 6 and 12 months. The treatment appears promising and controlled evaluation is clearly indicated.

Generalized anxiety disorder (GAD) appears moderately responsive to cognitive-behavioural treatments (e.g. Durham & Allan, 1993). In a reanalysis of data from six CBT outcome studies, Fisher and Durham (1999) reported a recovery rate across all treatments of 40% overall based on trait-anxiety scores (Speilberger, Gorsuch, Lushene, Vagg, & Jacobs, 1983). Two treatments, applied relaxation (AR) and individual cognitive behaviour therapy (CBT), did best with recovery rates at post treatment of 17–59% for AR and 26–71% for CBT. At 6-month follow-up one particular study (Borkovec & Costello, 1993) obtained a recovery rate for AR of 81%. In two more recent studies, AR appeared less effective (Arntz, 2003; Ost & Breitholtz, 2000). Ost and Brietholtz obtained small improvements in trait anxiety following AR. Arntz (2003) compared cognitive therapy with applied relaxation. At post treatment he reported that 35% of cognitive therapy patients and 44.4% of applied relaxation patients were recovered. At 6-month follow-up this had increased to 55% of cognitive therapy patients and 53.3% of applied relaxation patients on the basis of the trait-anxiety scale. These data show that the outcomes for AR and CBT show considerable variability, and there is a need for more effective treatments. Recent attempts to improve treatment have combined these treatment elements, and increased the amount of therapy delivered (e.g. Borkovec, Newman, Pincus, & Lytle, 2002; Durham et al., 2004). However, so far treatment outcomes have not improved. Progress might be made by basing treatment on a model of the mechanisms and factors underlying pathological worry, the hallmark of this disorder. The present study reports an initial evaluation of a new form of cognitive therapy (metacognitive therapy (MCT): Wells (1995) and Wells (1997)) that is based on a specific model of GAD. Furthermore, it aims to assess the impact of the treatment on multiple dimensions of worry.