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Cited by 54Anxiety, Depression, Psychometrics, Treatment, Cognitive ProcessesPsychological Treatments and AssessmentsPsychotherapy Techniques and Applications

Group metacognitive therapy for repetitive negative thinking in primary and non-primary generalized anxiety disorder: An effectiveness trial

Open access
McEvoy, Peter M., Erceg-Hurn, David M., Anderson, Rebecca A., Campbell, Bruce N.C., Swan, Amanda, Saulsman, Lisa M., Summers, Mark, Nathan, Paula R.·2015·Journal of Affective Disorders
DOI 10.1016/j.jad.2014.12.046
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Abstract

Background Generalized anxiety disorder (GAD) is a common and highly comorbid anxiety disorder characterized by repetitive negative thinking (RNT). Treatment trials tend to exclude individuals with non-primary GAD, despite this being a common presentation in real world clinics. RNT is also associated with multiple emotional disorders, suggesting that it should be targeted regardless of the primary disorder. This study evaluated the acceptability and effectiveness of brief group metacognitive therapy (MCT) for primary or non-primary GAD within a community clinic. Methods Patients referred to a specialist community clinic attended six, two-hour weekly sessions plus a one-month follow-up (N=52). Measures of metacognitive beliefs, RNT, symptoms, positive and negative affect, and quality of life were completed at the first, last, and follow-up sessions. Results Attrition was low and large intent-to-treat effects were observed on most outcomes, particularly for negative metacognitive beliefs and RNT. Treatment gains increased further to follow-up. Benchmarking comparisons demonstrated that outcomes compared favorably to longer disorder-specific protocols for primary GAD. Limitations No control group or independent assessment of protocol adherence. Conclusions Brief metacognitive therapy is an acceptable and powerful treatment for patients with primary or non-primary GAD. © 2014 Elsevier B.V.

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Crossref · 10.1016/j.jad.2014.12.046

Cites

67 of 67 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

5 of 63 cited sources checked · 3 supported · 0 flagged · accuracy not yet measured

  • Study design and conductcitation

    The present study satisfied multiple effectiveness-trial criteria involving representative patients, therapists, and services.

    “This study met several criteria for an effectiveness trial, including clinically representative patients (various primary disorders, highly comorbid, severe, referred by health practitioners), therapists (broad caseload, various levels of experience), and services (naturalistic community mental health clinic, Stewart & Chambless, 2009).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Stewart & Chambless, 2009 source
  • Premisecitation

    Meta-analytic evidence on routine-care outcomes supports the idea that treatments shown to work in trials can also work well in non-research settings.

    “Meta-analyses investigating the effectiveness of treatments under real world conditions have supported the proposition that efficacious protocols can be highly effective outside of research trials (Stewart & Chambless, 2009).”
    Quote in the paperSubstantial claim1 of 1 sources checked
    • cites Stewart & Chambless, 2009 source
  • Premisecitation

    Newman et al.'s (2011) integrated 14-session cognitive behavioral and interpersonal plus emotional processing therapy produced effect sizes comparable to this study.

    “Newman et al.'s (2011) evaluation of an integrated, 14-session CBT and interpersonal plus emotional processing therapy also resulted in comparable effect sizes to our study.”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Newman et al.'s (2011) source
  • Findingown data

    Including a subsample with non-primary generalized anxiety disorder did not adversely affect change in the primary therapeutic targets.

    “The findings of this study suggest that including a subsample with non-primary GAD did not adversely affect change in the primary therapeutic targets, which is important because many community clinics may not receive enough referrals to run groups based on primary disorders.”
    Quote in the paperSubstantial claim
    • Rests on an assumption: Many community clinics may not receive enough referrals to run groups based on primary disorders.
  • Findingown data

    Group metacognitive therapy was associated with significant and substantial improvements in symptoms.

    “Group MCT had low attrition and was associated with significant and substantial improvements in RNT, metacognitions, higher-order dimensions of positive and negative affect, symptoms, and quality of life.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. 30
  • May combine two claims. 43
  • The quote only partly states this claim. 1

  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    More effectiveness studies in routine settings may be required before clinicians regard efficacy trials as helpful for their practice.

    “However, recent evidence suggests that more real world effectiveness trials are needed before clinicians are likely to perceive efficacy trials as being useful for guiding their clinical interventions (Gyani, Shafran, Myles, & Rose, 2014).”
    Quote in the paperNot a substantial claim1 of 1 sources checked
    • cites Gyani, Shafran, Myles, & Rose, 2014 source

      The Results section (headed “INSERT TABLE 2 ABOUT HERE”; no page number available) reports that therapists used controlled studies less often than several other sources of clinical guidance. The Discussion says therapists’ objections concern how research translates into practice. Neither passage says that more real-world effectiveness trials are needed before clinicians will find efficacy trials useful. (LLM, conf=0.83)

      Experimental — accuracy not yet measured

  • May combine two claims.

    Premisecitation

    Four subsequent trials of Intolerance of Uncertainty Therapy failed to replicate the magnitude of Ladouceur et al.'s effects; those trials still found the therapy effective, but their effect sizes were smaller than for the brief group metacognitive therapy evaluated in this study.

    “Importantly, four subsequent trials of IUT failed to replicate the magnitude of Ladouceur et al.'s (2000) effects and, although they still found IUT to be effective, the effect sizes were smaller than for the brief group MCT protocol evaluated in this study (Dugas et al., 2003;Dugas et al., 2010;Gosselin, 2006;van der Heiden et al., 2012).”
    Quote in the paperSubstantial claim1 of 3 sources checked
    • cites Dugas et al., 2003 source
    • cites Dugas et al., 2010 source

      Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

      Experimental — accuracy not yet measured
    • cites Gosselin, 2006 source

  • May combine two claims.

    Findingown data

    Roughly two-thirds (35 patients, 67%) had taken psychiatric medication long term, median one year (interquartile range six months to four years), without adequate response.

    “About two-thirds of patients were taking psychiatric medication (N = 35, 67%) for an extended period of time (median 1 year; interquartile range 6 months to 4 years) without responding adequately.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Findingown data

    For most participants, the current episode had lasted more than a year (39 patients, 75%), with a median of three years.

    “The duration of the current mental disorder episode exceeded a year for most of the sample (n = 39, 75%), with a median duration of three years.”
    Quote in the paperNot a substantial claim

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    Findingown data

    A notable minority had self-harmed, attempted suicide, or been admitted to a psychiatric hospital.

    “A significant minority of the sample had self-harmed, attempted suicide, or spent time as an inpatient at a psychiatric hospital.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Effect sizes were extremely large for negative metacognitions, worry, and repetitive negative thinking.

    “Effect sizes were extremely large on the measures of negative metacognitions, worry, and RNT.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Most patients (46, 88%) attended at least five treatment sessions, and all but one attended at least four.

    “Most patients attended at least five treatment sessions (N = 46, 88%), and all except one attended at least four.”
    • Also stated in: § Abstract · plain
      “Attrition was low”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    Engagement in repetitive negative thinking significantly and substantially reduced during treatment, with very large effect sizes on the RTQ and PSWQ and large effect sizes on the RRS-Brooding subscale.

    “Engagement in RNT significantly and substantially reduced during treatment, with very large effect sizes on the RTQ and PSWQ, and large effect sizes on the RRS-Brooding subscale.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    During the 12-14 week waitlist period, mean PSWQ scores rose by .025 points (d = .03), suggesting stability without treatment.

    “Mean PSWQ total scores increased by .025points (d = .03)during the waitlist period (12-14 weeks), suggesting that scores were stable without treatment.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    At post-treatment, no patient had reliably deteriorated, 86% had reliably improved, and 74% had recovered.

    “At post-treatment no patients had reliably deteriorated, 86% had reliably improved, CI [77%, 96%], p < .001,and 74% had recovered, CI [62%, 86%], p <.001.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    At follow-up, effect sizes for negative metacognitions, worry, and repetitive negative thinking were very large and exceeded two standard deviations.

    “The effect sizes for negative metacognitions, worry and RNT were very large at follow up, exceeding two standard deviations.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    At pre-treatment, patients endorsed fewer positive metacognitive beliefs than negative metacognitive beliefs, producing a floor effect.

    “It is notable that at pre-treatment patients endorsed fewer positive metacognitive beliefs, resulting in a floor effect, compared to negative metacognitive beliefs.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingown data

    The one-month follow-up was attended by 37 patients (71%).

    “The one month follow-up was attended by 37 patients (71%).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    Using a lower PSWQ cutoff of 53, 85% and 90% showed reliable improvement at post-treatment and follow-up, respectively, and 65% recovered at both points.

    “When a lower PSWQ cutoff of 53 was used, which has been applied in some recent studies, 85% and 90% achieved reliable improvement at post-treatment and follow-up, respectively, and 65% recovered at both post-treatment and follow-up.”
    Quote in the paperSubstantial claim

  • May combine two claims. The quote only partly states this claim.

    Findingown data

    The same reliable improvement and recovery percentages were found at follow-up.

    “The percentages were the same at follow up.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingown data

    The RTQ was equally sensitive to change as the PSWQ and more sensitive to change than the RRS subscales.

    “Our findings suggest that it was equally sensitive to change as the PSWQ and more so than the RRS subscales.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Findingreasoning

    The frequency of specific depressive and anxious negative thoughts reduced during treatment even though negative automatic thoughts were not directly addressed in the protocol.

    “Interestingly, the frequency of specific depressive and anxious negative thoughts also reduced during treatment despite the fact that negative automatic thoughts were not directly addressed during the protocol.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    The S-REF model proposes that favorable beliefs about repetitive negative thinking encourage people to engage in it more.

    “Wells and Matthews' (1996) Self-Regulatory Executive Function (S-REF) model is a metacognitive account of emotional disorders, which suggests that positive beliefs about RNT (e.g., RNT is helpful) motivate an individual to engage more fully in RNT.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Wells and Matthews' (1996) source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    An experienced clinical psychologist in emotional disorder assessment and treatment administered the MINI.

    “at which the MINI was completed by a Clinical Psychologist experienced in both the assessment and treatment of emotional disorders.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    Large groups may have weakened treatment effects and increased dropout in van der Heiden et al. (2013).

    “However, the large group sizes may have diluted treatment effects and contributed to the high attrition.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites van der Heiden et al.'s (2013) source

  • May combine two claims.

    Premisecitation

    van der Heiden et al. (2013) tested 14 group metacognitive therapy sessions in 33 primary GAD patients and observed greater dropout (27% versus 11%) and weaker outcomes than individual metacognitive therapy.

    “van der Heiden, Melchior, and de Stigter (2013) subsequently evaluated 14 sessions of group MCT for primary GAD (N = 33), but found higher dropout (27% vs. 11%) and poorer outcomes than van der Heiden et al.'s (2012) trial of individual MCT.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites van der Heiden, Melchior, and de Stigter (2013) source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Generalized anxiety disorder ranks among the most prevalent anxiety conditions and frequently co-occurs with other disorders.

    “Generalized anxiety disorder (GAD) is one of the most common and highly comorbid anxiety disorders (Kessler, Chiu, Demler, & Walters, 2005;McEvoy, Grove, & Slade, 2011).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Kessler, Chiu, Demler, & Walters, 2005 source
    • cites McEvoy, Grove, & Slade, 2011 source

  • May combine two claims.

    Premisecitation

    The groups in van der Heiden et al. (2013) were fairly large, with 10 to 14 patients each, which was more efficient than individual treatment.

    “It is notable that van der Heiden et al.'s (2013) groups were relatively large (10-14 patients/group), which represents a considerable efficiency over individual treatment.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites van der Heiden et al.'s (2013) source

  • Classified as probably not a substantial claim.

    Premisecitation

    Metacognitive therapy addresses both favorable and unfavorable metacognitive beliefs that sustain the Cognitive Affective Syndrome.

    “Whereas more traditional cognitive behavior therapy targets the content of negative automatic thoughts, MCT targets positive and negative metacognitive beliefs that maintain the CAS.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    The van der Heiden et al. (2013) authors concluded that group metacognitive therapy may be less effective and acceptable than individual therapy, perhaps because less time was available to address each patient's unique metacognitive beliefs.

    “The authors concluded that group MCT might be less effective and acceptable than individual MCT, possibly due to there being less time to challenge each individual's idiosyncratic metacognitive beliefs.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites van der Heiden, Melchior, and de Stigter (2013) source

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    The S-REF model proposes that as repetitive negative thinking increases, it reinforces beliefs that such thinking is uncontrollable and dangerous, leading people to give up helpful reduction efforts and use extreme overcontrol.

    “This escalation of RNT strengthens negative beliefs about the uncontrollability and dangerousness of thoughts and, continuing the cycle, leads individuals to abandon functional attempts to reduce their engagement in RNT and instead to use more extreme and dysfunctional overcontrol strategies.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Wells and Matthews' (1996) source

  • Classified as probably not a substantial claim.

    Study design and conductcitation

    Diagnoses of anxiety and/or depressive disorders were established with a structured interview, the Mini International Diagnostic Interview.

    “A structured diagnostic interview (Mini International Diagnostic Interview, Lecrubier et al., 1997;Sheehan et al., 1998) was used to establish the presence of anxiety and/or depressive disorders.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Lecrubier et al., 1997 source
    • cites Sheehan et al., 1998

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Major depressive disorder co-occurs with GAD at especially high rates, with some estimates reaching 67%.

    “Comorbidity with major depressive disorder is particularly high, with estimates up to 67% (Judd et al., 1998).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Judd et al., 1998 source

  • May combine two claims.

    Premisecitation

    Evidence indicates metacognitive therapy helps with several primary emotional disorders besides GAD, including depression, social anxiety disorder, and obsessive-compulsive disorder.

    “there is evidence that MCT is effective for a range of primary emotional disorders in addition to GAD, such as depression (Dammen, Papageorgiou, and Wells, in press;Papageorgiou & Wells, in press;Wells et al., 2012), social anxiety disorder (McEvoy, Mahoney, Perini, & Kingsep, 2009), and obsessive compulsive disorder (Rees & van Koesveld, 2008).”
    Quote in the paperSubstantial claim0 of 3 sources checked
    • cites Dammen, Papageorgiou, and Wells, in press

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Papageorgiou & Wells, in press

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

    • cites Wells et al., 2012 source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Every case was discussed at weekly clinic meetings for diagnostic and treatment planning.

    “In addition, all cases were presented at weekly clinic meetings where diagnoses and treatment plans were discussed.”
    Quote in the paperNot a substantial claim

  • Classified as probably not a substantial claim.

    Premisecitation

    One possible barrier to spreading evidence-based treatments is the belief that trial samples do not represent real-world patients.

    “One potential obstacle to the dissemination of evidence-based treatments is the perception that real world samples are not reflected within treatment trials (Barlow, Levitt, & Bufka, 1999).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Barlow, Levitt, & Bufka, 1999 source

  • May combine two claims.

    Premisecitation

    Two early metacognitive therapy studies had encouraging results but only ten participants each, leaving their generalizability uncertain.

    “Two preliminary studies demonstrated promising effects, but small samples (Ns = 10) raise questions about the generalizability of the findings (Wells et al., 2010;Wells & King, 2006).”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites Wells et al., 2010 source
    • cites Wells & King, 2006 source

  • Classified as probably not a substantial claim.

    Premisecitation

    Wells (2013) contends that negative beliefs about repetitive negative thinking exert unusually broad and strong effects in psychological disorder, producing acute danger, hopelessness, and inefficacy.

    “Wells (2013) argues that negative beliefs about RNT have the “...most pervasive and powerful influences in psychological disorder...giving rise to a sense of acute danger, hopelessness, and inefficacy (p.188-189).””
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Wells (2013) source

  • Classified as probably not a substantial claim.

    Premisecitation

    The S-REF model holds that unfavorable beliefs about repetitive negative thinking produce unhelpful cognitive and behavioral responses.

    “Once RNT is commenced, negative beliefs about RNT (e.g., RNT is dangerous and uncontrollable) then lead to a range of counterproductive cognitive (e.g., suppression, threat monitoring) and behavioral (e.g., avoidance, alcohol use) changes”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Wells and Matthews' (1996) source

  • May combine two claims.

    Premisecitation

    Most MCT studies have used very small samples, with exceptions being van der Heiden et al. (2012, N=61) and van der Heiden et al. (2013, N=33), which examined individual and group MCT respectively.

    “Although most studies of MCT have used very small samples, two exceptions are van der Heiden et al. (2012, N = 61) and van der Heiden et al. (2013, N = 33), who evaluated individual and group MCT, respectively.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites van der Heiden et al. (2012) source
    • cites van der Heiden et al. (2013) source

  • May combine two claims.

    Interpretationown data

    The frequency of negative thoughts reduced as a side effect of targeting metacognitive beliefs, and the content of specific negative thoughts may not need to be directly addressed.

    “This finding suggests that the frequency of negative thoughts reduced as a side effect of targeting metacognitive beliefs and, as such, the content of specific negative thoughts may not need to be directly addressed.”
    Quote in the paperSubstantial claim

  • Classified as probably not a substantial claim.

    Study design and conductnone given

    All analyses followed an intent-to-treat approach.

    “All analyses were intent-to-treat (ITT) and were conducted using the statistical software R version 3.0.1 (R Core Team, 2013).”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites R Core Team, 2013

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Internal consistency was high for all symptom and quality-of-life measures in this sample (alpha .85 to .94).

    “Cronbach's alphas for all symptom and quality of life measures were high (αs=.85-.94).”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The MCQ positive subscale assesses favorable beliefs about worry, while the negative subscale assesses beliefs that worry is uncontrollable and dangerous.

    “The MCQ-POS is a measure of positive beliefs about worry, while the MCQ-NEG measures negative beliefs about the uncontrollability and dangerousness of worry.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Wells & Cartwright-Hatton, 2004 source

  • May combine two claims.

    Interpretationown data

    Group metacognitive therapy was acceptable to patients, as indicated by most attending five or six of the six sessions.

    “Most patients attended 5 or 6 sessions of the six-session program, suggesting that they found MCT an acceptable way of targeting their RNT.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The RTQ-10 is a transdiagnostic repetitive negative thinking measure with a strong unidimensional structure, it separates clinical from non-clinical groups, and it correlates at r = .95 with the full 27-item version.

    “The RTQ-10 (Mahoney, McEvoy, & Moulds, 2012;McEvoy, Mahoney, & Moulds, 2010) is a transdiagnostic measure of RNT that has a robust unidimensional structure, distinguishes between clinical and non-clinical populations, and correlates very highly (r = .95)with the full 27-item scale (McEvoy et al., 2010;McEvoy, Thibodeau, & Asmundson, 2014).”
    Quote in the paperNot a substantial claim0 of 3 sources checked
    • cites Mahoney, McEvoy, & Moulds, 2012 source
    • cites McEvoy, Mahoney, & Moulds, 2010 source
    • cites McEvoy et al., 2010 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Every senior therapist had substantial group facilitation experience, and most had worked on earlier effectiveness studies.

    “All senior therapists had extensive experience at facilitating group interventions, with most participating in previous treatment effectiveness studies.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Metacognitive therapy has a large impact on diagnosis-specific measures of worry and rumination and on transdiagnostic measures of repetitive negative thinking.

    “This finding suggests that MCT has a large impact on diagnosis-specific (i.e., worry and rumination) and transdiagnostic measures of RNT.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductnone given

    Sessions were not recorded to evaluate protocol adherence and therapist competence, and diagnoses were not confirmed by a second assessor.

    “Secondly, sessions were not recorded to evaluate protocol adherence and therapist competence, and diagnoses were not confirm by a second assessor.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    A treatment manual containing detailed therapist notes, worksheets, and client handouts helped support fidelity.

    “Treatment fidelity was supported by the use of a treatment manual that included detailed therapist notes, worksheets, and client handouts.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Premisecitation

    Ladouceur et al. (2000) evaluated a 16-week Intolerance of Uncertainty Therapy protocol in a relatively small sample of 26 people with primary generalized anxiety disorder based on the Intolerance of Uncertainty Model.

    “Ladouceur et al. (2000) evaluated a 16-week Intolerance of Uncertainty Therapy (IUT) protocol in a relatively small sample (N = 26) with primary GAD based on the Intolerance of Uncertainty Model.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Ladouceur et al. (2000) source

  • May combine two claims.

    Interpretationown data

    Brief group metacognitive therapy appears acceptable and highly effective for people whose GAD is either primary or non-primary.

    “Brief metacognitive therapy is an acceptable and powerful treatment for patients with primary or non-primary GAD.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Dugas et al. (2003) group treatment averaged 5.6 therapy hours and 11.2 therapist hours per patient.

    “Using similar calculations,Dugas et al.'s (2003) groups included used an average of 5.6 therapy hours/patient and 11.2 therapist hours/patient.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Dugas et al. (2003) source

  • May combine two claims.

    Premisecitation

    Van der Heiden et al. (2012) delivered group treatment to 10-14 patients in 14 sessions of 90 minutes, which averaged 1.91 therapy hours and 3.82 therapist hours per patient.

    “Van der Heiden et al.'s (2012) groups included 10-14 patients over 14, 90-minute sessions, resulting in an average of 1.91 therapy hours/patient and 3.82 therapist hours/patient”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites van der Heiden et al. (2012) source

  • May combine two claims.

    Interpretationreasoning

    Transdiagnostic group treatments may be an effective, efficient, and pragmatic way of offering treatment to a broader array of individuals.

    “Transdiagnostic group treatments may be an effective, efficient, and pragmatic way of offering treatment to a broader array of individuals.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    One hundred imputations were produced with a robust model-based imputation algorithm.

    “One hundred imputations were generated using the robust model based imputation algorithm (Templ, Kowarik, & Filzmoser, 2011) implemented in the R package VIM (Templ, Alfons, Kowarik, & Prantner, 2013).”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites Templ, Kowarik, & Filzmoser, 2011 source
    • cites Templ, Alfons, Kowarik, & Prantner, 2013

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • May combine two claims.

    Interpretationcitation

    Ladouceur et al. found a slightly larger effect size than this study at follow-up, and outcomes may be comparable 16 weeks after starting the brief metacognitive therapy protocol.

    “These researchers found a slightly larger effect size than ours at follow-up and, again, outcomes may be comparable 16-weeks after commencement of our brief MCT protocol.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Ladouceur et al. (2000) source

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Internal consistency was high for all Cognitions Checklist and Metacognitions Questionnaire subscales in this sample (alpha .73 to .96).

    “In this study Cronbach's alphas were high for all CCL and MCQ subscales (αs=.73-.96).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Study design and conductown data

    The study lacked a control group and independent checks of protocol adherence.

    “No control group or independent assessment of protocol adherence.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    Multiple imputation was used to handle missing data.

    “Missing data were handled using multiple imputation (National Research Council Panel on Handling Missing Data in Clinical Trials, 2010).”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites National Research Council Panel on Handling Missing Data in Clinical Trials, 2010

      Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Interpretationnone given

    The brevity of the metacognitive therapy program makes it easier for therapists to schedule and may help minimize attrition without compromising the magnitude of change compared with longer programs.

    “The brevity of the MCT program evaluated in this study makes it easier for therapists to schedule, and may help to minimize attrition without compromising the magnitude of change, compared to longer programs.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisenone given

    The Ruminative Responses Scale measures the tendency to ruminate while feeling sad, blue, or depressed.

    “while the RRS assesses the tendency to ruminate when feeling sad, blue or depressed.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationown data

    Transdiagnostic metacognitive therapy appears to be an acceptable, effective, efficient, and practical intervention for targeting repetitive negative thinking in emotional disorders.

    “Transdiagnostic MCT appears to be an acceptable, effective, efficient, and practical intervention for targeting RNT in emotional disorders.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Interpretationreasoning

    This study's treatment required therapist hours per patient similar to van der Heiden et al.'s (2012) group treatment but substantially fewer than the other comparison treatments.

    “Therefore, the treatment in this study required similar therapist hours per patient tovan der Heiden et al.'s (2012) group treatment but substantially less than the other comparison treatments.”
    Quote in the paperNot a substantial claim
    • Rests on an assumption: Therapist hours per patient is a meaningful and comparable measure of treatment intensity across studies.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductnone given

    Senior therapists held master's and/or doctoral degrees in clinical psychology and took part in weekly peer supervision.

    “Senior therapists had completed masters and/or doctoral degrees in clinical psychology and received weekly peer supervision.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    The Penn State Worry Questionnaire is a 16-item trait measure of pathological worry commonly used as a primary outcome in GAD treatment research.

    “The PSWQ (Meyers, Miller, Metzger, & Borkovec, 1990) is a 16-item trait measure of pathological worry often used as the primary symptom measure in GAD treatment studies”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites Meyers, Miller, Metzger, & Borkovec, 1990 source

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Dropout reasons were session clash (n=3), child's medical appointment (n=1), moved away (n=1), and unexplained dropout (n=4).

    “Figure session (n=3) Clashed with child's medical appointment (n=1)Moved away (n=1) Unexplained dropout (n=4)”
    Quote in the paperNot a substantial claim
62 of 62

  • The paper relies on this without support.

    Before this study, group metacognitive therapy had not been tested in a sample containing both primary and non-primary GAD.

    “No previous study has evaluated group-based MCT in a sample with primary or non-primary GAD.”

  • The paper relies on this without support.

    In many settings, organizing separate groups by primary diagnosis may not be practical.

    “it may be impractical in many settings to run diagnosis-specific groups based on primary disorders”

  • The paper relies on this without support.

    A shorter protocol was expected to lower dropout and the amount of clinician time each patient required.

    “The shorter duration was expected to minimize attrition rates and clinician time per patient”

  • The paper relies on this without support.

    This is the first treatment study to compare the sensitivity to change of the RTQ as a transdiagnostic measure of repetitive negative thinking with diagnosis-specific measures.

    “Although the psychometric properties of the RTQ are now well established (Mahoney et al., 2012;McEvoy et al., 2010;McEvoy et al., 2014), this is the first treatment study to compare the sensitivity to change of the RTQ as a measure of transdiagnostic RNT to diagnosis-specific measures.”

  • The paper relies on this without support.

    This study is the first to evaluate the effectiveness of group metacognitive therapy for a sample with primary or non-primary generalized anxiety disorder in a community mental health clinic.

    “This study is the first to evaluate the effectiveness of group MCT for a sample with primary or non-primary GAD in a community mental health clinic.”

  • The paper relies on this without support.

    Many community clinics may not receive enough referrals to run groups based on primary disorders.

    “which is important because many community clinics may not receive enough referrals to run groups based on primary disorders.”

  • The paper relies on this without support.

    Effect sizes from different studies can be validly compared using benchmarking.

    “Benchmarking comparisons found that the brief, 6-week MCT group program evaluated in this study was associated with substantially larger changes in worry than van der Heiden et al.'s (2013) group treatment”

  • The paper relies on this without support.

    Therapist hours per patient is a meaningful and comparable measure of treatment intensity across studies.

    “Therefore, the treatment in this study required similar therapist hours per patient tovan der Heiden et al.'s (2012) group treatment but substantially less than the other comparison treatments.”
8 of 8

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Medication-use median changes between sections

    Minor

    The participant description gives a median medication-use duration of one year, while the discussion gives two years for the same duration.

  • Follow-up reliable-improvement rates disagree

    Minor

    The first account says reliable improvement was 86% at both post-treatment and follow-up. The later account gives 90% at follow-up, although reliable improvement is defined by a seven-point change and does not depend on which recovery cutoff is used.

  • Group-treatment comparison is assigned to the individual-treatment study

    Minor

    The comparison describes the 2012 study as having groups of 10-14 patients. Elsewhere, the paper assigns groups of that size to the 2013 study and identifies the 2012 treatment as individual MCT.

  • Discussion describes positive affect as decreasing

    Minor

    The discussion groups positive affect among the reductions it says were supported, but the reported positive-affect mean increased from 25.47 to 29.24 after treatment.

4 of 4

Cites

Flagged first, then by citations

3 of the 70 references couldn’t be matched to a known paper.

Cited by

Sorted by citations

Related

Authors
McEvoy, P. M., Erceg-Hurn, D. M., Anderson, R. A., Campbell, B. N. C., Swan, A., Saulsman, L. M., Summers, M., & Nathan, P. R.
Affiliations
  • Curtin University (AU)
  • Centre for Clinical Interventions (AU)
  • The University of Western Australia (AU)
Corresponding author
McEvoy, Peter M.
ORCID
Venue
Journal of Affective Disorders
Publisher
Elsevier BV
Published
2015-04
Volume
175
Pages
124-132
ISSN
0165-0327 (ISSN-L)
DOI
10.1016/j.jad.2014.12.046
OpenAlex
W2041123175
Cited by
54
References
70
Citations by year
2026: 4 · 2025: 6 · 2024: 5 · 2023: 4 · 2022: 4 · 2021: 5 · 2020: 7 · 2019: 5 · 2018: 2 · 2017: 7 · 2016: 2 · 2015: 3
FWCI
5.55
Type
journal article
Language
en
Open access
Licence
www.elsevier.com/tdm/userlicense/1.0/ (tdm)
Locations
  • Journal of Affective Disorders (publishedVersion)
  • PubMed (publishedVersion)
  • eSpace (Curtin University) (submittedVersion)
  • UWA Profiles and Research Repository (UWA) (submittedVersion)
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Anxiety, Depression, Psychometrics, Treatment, Cognitive Processes
  • Social Sciences › Psychology › Clinical Psychology › Psychological Treatments and Assessments
  • Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
Keywords
generalized anxiety disorder, repetitive negative thinking, metacognitive therapy, group therapy, metacognitive beliefs, treatment acceptability, community mental health services, quality of life, negative affect
MeSH terms
Adult, Aged, Anxiety, Anxiety Disorders, Emotions, Female, Humans, Male, Middle Aged, Negativism, Patient Acceptance of Health Care, Psychotherapy, Group, Stress Disorders, Post-Traumatic, Thinking, Cognitive Behavioral Therapy, Treatment Outcome

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-01.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-01.

Cited sources are checked by gpt-6-sol.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

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