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Köcher LM, Schlömer-Böttner S, Christiansen H. Metacognitive Transmission Between Parents and Children in the Context of Anxiety Disorders. Child Psychiatry Hum Dev 2025; 56:507-519. [PMID: 37501041 PMCID: PMC11928357 DOI: 10.1007/s10578-023-01577-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 07/29/2023]
Abstract
One in ten children is affected by an anxiety disorder. Current state of research shows that transgenerational transmission as well as positive (POS) and negative (NEG) metacognitive beliefs are relevant in the context of anxiety disorders in youth. We investigated whether transgenerational transmission is also evident in conjunction with POS and NEG and cross-sectionally surveyed POS, NEG, anxiety symptoms and worry in 8-16-year-old children and adolescents with anxiety disorders (n = 71) and non-clinical controls (n = 40) and one of their parents. Our results revealed significant transgenerational correlations for NEG in both samples, and for POS in the non-clinical sample only. Mediation analysis showed that children's NEG did at least partly mediate the relationship between parents' NEG and children's anxiety and worry. Children's and parents' POS did not correlate in either sample with children's anxiety and worry. Further research on the transgenerational transmission of metacognition and longitudinal data is needed.
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Affiliation(s)
- Laura Marie Köcher
- Clinical Child and Adolescent Psychology, Department of Psychology, Philipps-Universität Marburg, Frankfurter Straße 35, 35037, Marburg, Germany.
| | - Silke Schlömer-Böttner
- Psychotherapy Practice for Children and Adolescents, Alter Kirchhainer Weg 5, 35039, Marburg, Germany
| | - Hanna Christiansen
- Clinical Child and Adolescent Psychology, Department of Psychology, Philipps-Universität Marburg, Frankfurter Straße 35, 35037, Marburg, Germany
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Thingbak A, Capobianco L, Wells A, O'Toole MS. Relationships between metacognitive beliefs and anxiety and depression in children and adolescents: A meta-analysis. J Affect Disord 2024; 361:36-50. [PMID: 38815761 DOI: 10.1016/j.jad.2024.05.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/23/2024] [Accepted: 05/24/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND As hypothesized in the Self-Regulatory Executive Function (S-REF) model, metacognitive beliefs are associated with anxiety and depression in adults. An important question is the extent to which such effects are present in children and adolescents, with the implication that the model may also apply to young people. The aim of this meta-analysis was to synthesize results on the nature and magnitude of associations between metacognitive beliefs and anxiety and depression in children and adolescents. METHODS Systematic searches were conducted to identify studies that investigated: (1) group differences in metacognitive beliefs in clinical compared to non-clinical samples or (2) correlations between metacognitive beliefs and symptoms of anxiety and depression. RESULTS Forty papers were identified comprising a total sample of 9,887 participants aged 7-18 years. Meta-analyses revealed that clinical samples endorsed significantly elevated metacognitive beliefs on four out of the five domains measured (i.e., negative beliefs about worry, cognitive confidence, need for control, and cognitive self-consciousness, with the only exception being positive beliefs about worry) compared to non-clinical samples with a small to large effect (Hedges' gs = 0.45-1.22). Moreover, all five domains of metacognitive beliefs were significantly and positively correlated with symptoms of anxiety and depression of a small to large effect (rs = .24-.53). Negative beliefs about worry showed the strongest relationship with clinical status and the magnitude of symptoms. LIMITATIONS The number of studies did not allow for an evaluation of metacognitive beliefs at a disorder-specific level. CONCLUSIONS In line with the S-REF model, our findings provide evidence of robust cross-sectional relationships between metacognitions and both anxiety and depression in childhood and adolescence.
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Affiliation(s)
- Anne Thingbak
- Department of Psychology and Behavioural Sciences, Aarhus University, Denmark.
| | - Lora Capobianco
- School of Psychological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester & Greater Manchester Mental Health NHS Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Adrian Wells
- School of Psychological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester & Greater Manchester Mental Health NHS Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Mia Skytte O'Toole
- Department of Psychology and Behavioural Sciences, Aarhus University, Denmark
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Schultz K, Kannis-Dymand L, Jamieson D, McLoughlin LT, Loughnan S, Allen A, Hermens DF. Examining the Longitudinal Relationship Between Metacognitive Beliefs and Psychological Distress in an Adolescent Population: A Preliminary Analysis. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01611-z. [PMID: 37831288 DOI: 10.1007/s10578-023-01611-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/16/2023] [Indexed: 10/14/2023]
Abstract
Adolescence is a period marked by significant vulnerability to the onset of mental health concerns. Within adults, the metacognitive model of psychological disorders advocates for the involvement of metacognitive beliefs in the onset, and maintenance, of psychopathology. The current study aimed to assess the applicability of the metacognitive model in adolescence by exploring the relationship, as well as the trajectory, between metacognitive beliefs and psychological distress. The longitudinal prospective cohort study investigated data from a community-based sample of participants aged 12 to 13. Self-report assessment measures of metacognitive beliefs, psychological distress, and somatic distress are reported across four time-points. Baseline assessments are reported for 70 participants, which reduced to 53 participants at time-point four. Correlational analyses demonstrated a significant relationship between overall metacognition, as well as negative metacognitive beliefs, and psychological distress at each of the four time-points. Generalised Estimating Equations found a significant association between metacognitive predictors and psychological distress over the four time-points. These results indicate that negative metacognitive beliefs, positive metacognitive beliefs, metacognitive beliefs related to superstition, punishment, and responsibility, low perceived levels of cognitive confidence and cognitive self-consciousness predict psychological distress over 12 months in adolescents aged 12 to 13. The strongest longitudinal correlational structure was found for the model of negative metacognitive beliefs and psychological distress. These findings provide preliminary evidence for the positive linear relationship between metacognitive beliefs and psychological distress in adolescence. The study provides an important contribution to understanding the role of metacognitive beliefs in the aetiology and perpetuation of psychological distress in adolescence.
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Affiliation(s)
- Katie Schultz
- School of Health, University of the Sunshine Coast, Maroochydore DC, QLD, Australia
| | - Lee Kannis-Dymand
- School of Health, University of the Sunshine Coast, Maroochydore DC, QLD, Australia
| | - Daniel Jamieson
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia
| | - Larisa T McLoughlin
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia
| | - Siobhan Loughnan
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia
- Stillbirth Centre of Research Excellence, Mater Research Institute, South Brisbane, QLD, Australia
| | - Andrew Allen
- School of Health, University of the Sunshine Coast, Maroochydore DC, QLD, Australia.
| | - Daniel F Hermens
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia
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Fan H, Gershman SJ, Phelps EA. Trait somatic anxiety is associated with reduced directed exploration and underestimation of uncertainty. Nat Hum Behav 2023; 7:102-113. [PMID: 36192493 DOI: 10.1038/s41562-022-01455-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 08/26/2022] [Indexed: 02/01/2023]
Abstract
Anxiety has been related to decreased physical exploration, but past findings on the interaction between anxiety and exploration during decision making were inconclusive. Here we examined how latent factors of trait anxiety relate to different exploration strategies when facing volatility-induced uncertainty. Across two studies (total N = 985), we demonstrated that people used a hybrid of directed, random and undirected exploration strategies, which were respectively sensitive to relative uncertainty, total uncertainty and value difference. Trait somatic anxiety, that is, the propensity to experience physical symptoms of anxiety, was inversely correlated with directed exploration and undirected exploration, manifesting as a lesser likelihood for choosing the uncertain option and reducing choice stochasticity regardless of uncertainty. Somatic anxiety is also associated with underestimation of relative uncertainty. Together, these results reveal the selective role of trait somatic anxiety in modulating both uncertainty-driven and value-driven exploration strategies.
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Affiliation(s)
- Haoxue Fan
- Department of Psychology, Harvard University, Cambridge, MA, USA
| | - Samuel J Gershman
- Department of Psychology, Harvard University, Cambridge, MA, USA
- Center for Brain Science, Harvard University, Cambridge, MA, USA
- Center for Brains, Minds and Machines, Cambridge, MA, USA
| | - Elizabeth A Phelps
- Department of Psychology, Harvard University, Cambridge, MA, USA.
- Center for Brain Science, Harvard University, Cambridge, MA, USA.
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Do Metacognitions of Children and Adolescents with Anxiety Disorders Change after Intensified Exposure Therapy? CHILDREN 2022; 9:children9020168. [PMID: 35204889 PMCID: PMC8869889 DOI: 10.3390/children9020168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/17/2022]
Abstract
Metacognitive beliefs have repeatedly proven to play a role in anxiety disorders in children and adolescents, but few studies have investigated whether they change after cognitive behavioral therapy. This longitudinal intervention study explores whether positive and negative metacognitive beliefs in particular change after exposure-focused treatment, and if metacognitive changes predict reductions in anxiety symptoms. A sample of 27 children between 8 and 16 years of age with a primary diagnosis of specific phobia, separation-anxiety disorder or social phobia completed assessments of anxiety symptoms, metacognitive beliefs, worry and repetitive negative thoughts before and after 11 sessions of intensified exposure treatment. Metacognitive beliefs did not change significantly after intensified exposure, but post-hoc power analysis revealed a lack of power here. Change in negative metacognitive beliefs correlated with a change in anxiety symptoms, but did not independently contribute as a predictor variable. Differences between subsamples showed that patients with separation-anxiety disorder scored higher on negative metacognitive beliefs than those with specific or social phobia. Consideration of metacognition, and negative metacognitive beliefs in particular could help us further improve the understanding and treatment of anxiety disorders in children and adolescents and should therefore receive more attention in psychotherapy research.
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Walczak M, Austgulen E, Kirsten L, Breinholst S. Examining Changes in the Cognitive Attentional Syndrome and Attentional Control Following Metacognitive Therapy for Children with Generalized Anxiety Disorder. Int J Cogn Ther 2021. [DOI: 10.1007/s41811-021-00124-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Köcher LM, Schneider K, Christiansen H. Thinking about worry: A systematic review and meta-analysis on the assessment of metacognitions in children and adolescents. World J Psychiatry 2021; 11:635-658. [PMID: 34631466 PMCID: PMC8474992 DOI: 10.5498/wjp.v11.i9.635] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/04/2021] [Accepted: 07/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The metacognitive model of generalized anxiety disorder identifies three forms of metacognition: Positive metacognitive beliefs about worry (POS), negative metacognitive beliefs about worry (NEG), and meta-worry. Though this model was originally developed relying on adult samples, it has since been applied to children and youth in different studies, and results mostly support its validity for this group. As the roles of POS, meta-worry, and age-effects do not appear to be fully clarified for children and adolescents yet, an integration of studies on children and adolescents and the metacognitive model is both timely and worthwhile.
AIM To summarize the current research on relationships, age-effects, and measurements for POS, NEG, and meta-worry in childhood and youth.
METHODS We carried out a literature search in the electronic databases PsycINFO, PubMed, PSYNDEX, and ERIC in 2017 and updated in 2020. Empirical research in German or English language on metacognition was included with child and adolescent samples diagnosed with anxiety disorders or healthy controls if POS, NEG, or meta-worry were measured. Studies were included for meta-analysis if they reported correlations between these metacognitions and anxiety or worry. Consensus rating for eligibility was done for 20.89% of full-texts with 90.32% agreement. Risk of bias was assessed with the appraisal tool for cross-sectional studies and consensus rating of appraisal tool for cross-sectional studies for 20.83% of included studies attaining agreement of intraclass correlation = 0.898. Overall, correlations between metacognitions, anxiety and worry were calculated with RevMan 5.4.1, assuming random-effects models. Meta-regressions with mean age as the covariate were performed via the online tool MetaMar 2.7.0. PROSPERO-ID: CRD42018078852.
RESULTS Overall, k = 763 records and k = 78 additional records were identified. Of those, k = 48 studies with 12839 participants were included and of those, k = 24 studies were included for meta-analysis. Most studies showed consistent NEG correlations with worry and anxiety, as well as higher values for clinical than for non-clinical samples. POS findings were less consistent. Meta-analysis revealed large effects for NEG correlating with worry and anxiety, small to medium effects for POS correlating with worry and anxiety, as well as small to medium effects for POS correlating with NEG. Meta-regressions did not reveal mean age as a significant covariate. Meta-worry was assessed in only one study. We identified eight questionnaires and one interview-format that assess metacognition about worry in children and adolescents.
CONCLUSION POS and NEG are measurable from the age of seven upwards and correlate with anxiety and worry without influences by age. Meta-worry requires further investigation.
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Affiliation(s)
- Laura M Köcher
- Department of Psychology, University of Marburg, Marburg 35037, Germany
| | - Kai Schneider
- Department of Clinical Child and Adolescent Psychology, University of Landau, Landau 76829, Germany
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Russell JK, Strodl E, Kavanagh DJ. Correlates of distress in young people with cystic fibrosis: the role of self-efficacy and metacognitive beliefs. Psychol Health 2020; 36:1497-1513. [PMID: 33370209 DOI: 10.1080/08870446.2020.1861280] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES While significantly elevated distress is repeatedly found amongst young people with cystic fibrosis, their determinants remain largely unknown. This study explored whether metacognitive beliefs and self-efficacy for emotion regulation were associated with anxiety and depression after control for physical functioning, age and gender. DESIGN Cross-sectional study using a 110-item online questionnaire. METHODS An online survey was undertaken by 147 young people with CF aged 10-18 from five countries. Associations of Hospital Anxiety and Depression Scale scores with gender, age, physical functioning, Metacognitive Beliefs Questionnaire for Children (MCQ-C) subscales and Self-Efficacy for Emotion Regulation (SE-ER) were examined using hierarchical multiple linear regressions. RESULTS Physical functioning, gender and age accounted for 31% of the variance in anxiety and 39% in depression. The MCQ-C and SE-ER added another 45% to the variance of anxiety and 32% to depression. At the final step of both analyses, physical functioning, SE-ER, MCQ-C Negative Meta-Worry and Superstition, Punishment & Responsibility contributed significantly. Older age was also significantly associated with depression. CONCLUSIONS Self-efficacy for emotion regulation, concern about worrying and shame may be particularly important foci for interventions aimed at ameliorating anxiety and depression in young people with CF.
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Affiliation(s)
- Jeremy K Russell
- Centre for Children's Health Research, Institute of Health & Biomedical Innovation, and School of Psychology & Counselling, Queensland University of Technology, Brisbane, Australia
| | - Esben Strodl
- School of Psychology & Counselling, Queensland University of Technology, Brisbane, Australia
| | - David J Kavanagh
- Centre for Children's Health Research, Institute of Health & Biomedical Innovation, and School of Psychology & Counselling, Queensland University of Technology, Brisbane, Australia
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Golombek K, Lidle L, Tuschen-Caffier B, Schmitz J, Vierrath V. The role of emotion regulation in socially anxious children and adolescents: a systematic review. Eur Child Adolesc Psychiatry 2020; 29:1479-1501. [PMID: 31201527 DOI: 10.1007/s00787-019-01359-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 05/27/2019] [Indexed: 01/04/2023]
Abstract
While numerous studies suggest that emotion dysregulation is important in maintaining social anxiety among adults, the role of emotion regulation in children and adolescents with social anxiety is not yet well understood. In this systematic review, we use the process model of emotion regulation as a framework for understanding emotion regulation in children and adolescents with social anxiety. We performed a systematic literature search in the electronic data bases Medline and PsycINFO. Additional studies were identified by hand search. We identified 683 studies, screened their titles and abstracts, viewed 142 studies, and included 55 of these. Study results indicate that children and adolescents with social anxiety disorder or high social anxiety show emotion dysregulation across all five domains of emotion regulation, such as enhanced social avoidance, more safety behaviors, repetitive negative thinking, biased attention and interpretation of social information, and reduced emotional expression. While enhanced social avoidance seems to be specific to childhood social anxiety, other maladaptive emotion regulation strategies, such as repetitive negative thinking, seem to occur transdiagnostically across different childhood anxiety disorders. Implications for current theory, interventions and future research are discussed.
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Affiliation(s)
- Kristin Golombek
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr 41, Freiburg, 79106, Germany
| | - Leonie Lidle
- Department of Psychology, Clinical Child and Adolescent Psychology, Leipzig University, Leipzig, Germany.,Leipzig Research Center for Early Child Development, Leipzig University, Leipzig, Germany
| | - Brunna Tuschen-Caffier
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr 41, Freiburg, 79106, Germany
| | - Julian Schmitz
- Department of Psychology, Clinical Child and Adolescent Psychology, Leipzig University, Leipzig, Germany.,Leipzig Research Center for Early Child Development, Leipzig University, Leipzig, Germany
| | - Verena Vierrath
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Freiburg, Engelbergerstr 41, Freiburg, 79106, Germany.
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10
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Myers SG, Solem S, Wells A. The Metacognitions Questionnaire and Its Derivatives in Children and Adolescents: A Systematic Review of Psychometric Properties. Front Psychol 2019; 10:1871. [PMID: 31551843 PMCID: PMC6737041 DOI: 10.3389/fpsyg.2019.01871] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 07/30/2019] [Indexed: 01/16/2023] Open
Abstract
Background: The Metacognitions Questionnaire (MCQ) and its derivatives have been instrumental in research examining the Self-Regulatory Executive Function Model in adults. Studies testing whether findings are applicable to children and adolescents have been increasing and several different measures adapting the MCQ for younger populations have been developed. The current study aimed to systematically review the psychometric properties of MCQ measures or derivatives used in young people (aged 18 or less), to help assess current findings in this population and to guide future research in this growing area of investigation. Method: Systematic searches were carried out on PubMed and PsycINFO of studies published up to June 2018. Additional studies were identified through Google Scholar and article references. Validity, reliability, range and responsiveness of measures were examined as well as analyses of age and gender differences on scores. Results: Forty-five articles were identified. The total sample consisted of 7,803 children and adolescents (6,922 non-clinical, 881 clinical) aged 7-18. Studies used one of seven versions of the questionnaire, five adapted from the MCQ for younger populations: (1) The Metacognitions Questionnaire-Adolescent version; (2) The Metacognitions Questionnaire-Child version; (3) The Metacognitions Questionnaire-Child Version-Revised; (4) The Metacognitions Questionnaire-Child-30; and (5) The Metacognitions Questionnaire-65 Positive Beliefs Scale Revised; and two adult versions used without adaptation: (1) The Metacognitions Questionnaire-30 and (2) The Cognitive Self Consciousness Scale-Expanded. The validity and reliability of the Metacognitions Questionnaire-Adolescent version had the most extensive support. Other questionnaires had either mixed psychometrics or promising initial findings but more limited data. Conclusions: It is recommended that studies using adolescents (age 12-18) consider using the Metacognitions Questionnaire-Adolescent version. Based on initial data, it is suggested studies using younger populations should consider the Metacognitions Questionnaire-Child-30 but further psychometric research into this and other measures is needed.
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Affiliation(s)
- Samuel G. Myers
- Division of Psychology, Bar Ilan University, Ramat-Gan, Israel
| | - Stian Solem
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Adrian Wells
- Division of Clinical and Health Psychology, The University of Manchester, Manchester, United Kingdom
- Greater Manchester Mental Health NHS Foundation Trust, Prestwich, United Kingdom
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Abstract
PURPOSE OF REVIEW This review describes (a) key features of the metacognitive model as they relate to anxiety and related disorders, (b) central components of metacognitive therapy (MCT), (c) the current empirical status of MCT, (d) recent developments, (e) controversies and (f) future research directions. RECENT FINDINGS Evidence is accumulating that MCT is effective for anxiety and related disorders. Emerging evidence suggests that MCT may be effective with children and adolescents and compares well to other evidence-supported treatments such as cognitive behaviour therapy and mindfulness-based approaches. Evidence for distinct mechanisms across therapies is mixed. While MCT appears to be effective for anxiety and related disorders, more research is required to evaluate (a) efficacy and unique (vs. common) mechanisms of change compared to other therapies, (b) effectiveness for children and adolescents, (c) alternative delivery methods (e.g., via internet, group vs. individual), (d) transdiagnostic impacts and (e) applications to a broader array of disorders.
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Lønfeldt NN, Silverman WK, Esbjørn BH. A Systematic Review and Meta-analysis of the Association Between Third-Wave Cognitive Constructs and Youth Anxiety. Int J Cogn Ther 2017. [DOI: 10.1521/ijct.2017.10.2.115] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Esbjørn BH, Normann N, Lønfeldt NN, Tolstrup M, Reinholdt-Dunne ML. Exploring the relationships between maternal and child metacognitions and child anxiety. Scand J Psychol 2017; 57:201-6. [PMID: 27119255 DOI: 10.1111/sjop.12286] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 02/24/2016] [Indexed: 01/26/2023]
Abstract
Research has shown that anxiety may be transmitted through verbal information pathways, for example, when parents share their anxious cognitions with their child. Less is known about the influence of parental metacognitions, that is, beliefs regarding thoughts, on child anxiety. We explored the relations between metacognitions in mothers and their children and anxiety in the children. Our study included 111 non-clinical children aged 8 to 12 years and their mothers. Children rated their metacognitions, worry and anxiety, and mothers rated their metacognitions. Results indicated agreement between maternal and child metacognitions. Maternal metacognitions were positively associated with children's anxiety symptoms and worry, and this relation was mediated by the children's metacognitions. Our results warrant further examination of the role of parental metacognitions in child anxiety.
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Affiliation(s)
| | | | | | - Marie Tolstrup
- Department of Psychology, University of Copenhagen, Denmark
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14
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Development and Preliminary Validation of the Threat Appraisal Questionnaire for Children (TAQ-C). JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2016. [DOI: 10.1007/s10862-016-9584-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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15
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Donovan CL, Holmes MC, Farrell LJ. Investigation of the cognitive variables associated with worry in children with Generalised Anxiety Disorder and their parents. J Affect Disord 2016; 192:1-7. [PMID: 26702733 DOI: 10.1016/j.jad.2015.12.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Revised: 11/30/2015] [Accepted: 12/07/2015] [Indexed: 01/26/2023]
Abstract
BACKGROUND Intolerance of uncertainty (IU), negative beliefs about worry (NBW), positive beliefs about worry (PBW), negative problem orientation (NPO) and cognitive avoidance (CA) have been found to be integral in the conceptualisation of Generalised Anxiety Disorder (GAD) in adults, yet they have rarely been investigated in children with GAD. This study sought to determine (a) whether IU, NBW, PBW, NPO and CA differ between children diagnosed with GAD and non-anxious children and (b) to examine whether IU, NBW, PBW, NPO and CA differ between parents of children diagnosed with GAD and parents of children without an anxiety disorder. METHODS Participants were 50 children (aged 7-12 years), plus one of their parents. The 25 GAD children and 25 non-anxious children were matched on age and gender. Parents and children completed clinical diagnostic interviews, as well as a battery of questionnaires measuring worry, IU, NBW, PBW, NPO and CA. RESULTS Children with GAD endorsed significantly higher levels of worry, IU, NBW, NPO and CA, but not PBW compared to non-anxious children. Parents of children with GAD did not differ from parents of non-anxious children on any of the variables. LIMITATIONS The study was limited by it's use of modified adult measures for some variables and a lack of heterogeneity in the sample. CONCLUSIONS The cognitive variables of IU, NBW, NPO and CA may also be important in the conceptualisation and treatment of GAD in children as they are in adults.
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Affiliation(s)
- Caroline L Donovan
- School of Applied Psychology and the Menzies Health Institute Queensland, Griffith University, Mount Gravatt Campus, Mount Gravatt 4122, QLD, Australia.
| | - Monique C Holmes
- School of Applied Psychology and the Menzies Health Institute Queensland, Griffith University, Mount Gravatt Campus, Mount Gravatt 4122, QLD, Australia.
| | - Lara J Farrell
- School of Applied Psychology and the Menzies Health Institute Queensland, Griffith University, Gold Coast Campus, Southport 4222, QLD, Australia.
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17
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Esbjørn BH, Normann N, Reinholdt-Dunne ML. Adapting Metacognitive Therapy to Children with Generalised Anxiety Disorder: Suggestions for a Manual. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2015; 45:159-166. [PMID: 26190860 PMCID: PMC4496502 DOI: 10.1007/s10879-015-9294-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The metacognitive model and therapy has proven to be a promising theory and intervention for emotional disorders in adults. The model has also received empirical support in normal and clinical child samples. The purpose of the present study was to adapt metacognitive therapy to children (MCT-c) with generalised anxiety disorder (GAD) and create suggestions for an adapted manual. The adaptation was based on the structure and techniques used in MCT for adults with GAD. However, the developmental limitations of children were taken into account. For instance, therapy was aided with worksheets, practical exercises and delivered in a group format. Overall, the intervention relied heavily on practising MCT techniques in vivo with therapist assistance. A detailed description of how the manual was adapted for this age group is given, and examples from a group of four children are presented in a case series. Findings indicate that the adapted version of the metacognitive techniques and manual for children is feasible.
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Affiliation(s)
- Barbara Hoff Esbjørn
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353 Copenhagen K, Copenhagen, Denmark
| | - Nicoline Normann
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353 Copenhagen K, Copenhagen, Denmark
| | - Marie Louise Reinholdt-Dunne
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353 Copenhagen K, Copenhagen, Denmark
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A Disorder-Specific, Cognitively Focused Group Treatment for Childhood Generalized Anxiety Disorder: Development and Case Illustration of the No Worries! Program. J Cogn Psychother 2015; 29:275-301. [PMID: 32755939 DOI: 10.1891/0889-8391.29.4.275] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Generalized anxiety disorder (GAD) is a highly prevalent, chronic, and costly mental disorder in children, and there is a comparative lack of research on specific treatments for GAD, relative to other anxiety disorders. Furthermore, treatment programs for child GAD, unlike those for adults, are almost uniformly transdiagnostic in nature and do not specifically target the cognitive variables (e.g., intolerance of uncertainty, negative beliefs about worry, cognitive avoidance, and negative problem orientation) demonstrated to be correlated with the disorder. However, helping children to understand and address these rather complex cognitive factors is difficult. This article describes the development of a disorder-specific, cognitively focused group treatment program for child GAD (the No Worries! Program) that aims to target the cognitive variables and symptoms correlated with the GAD. It provides a detailed discussion of the strategies taught to children and highlights some of the challenges involved. A case study is presented to demonstrate the feasibility of achieving successful outcomes with complex presentations.
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Holmes MC, Donovan CL, Farrell LJ, March S. The efficacy of a group-based, disorder-specific treatment program for childhood GAD--a randomized controlled trial. Behav Res Ther 2014; 61:122-35. [PMID: 25193003 DOI: 10.1016/j.brat.2014.08.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Revised: 07/19/2014] [Accepted: 08/01/2014] [Indexed: 02/08/2023]
Abstract
The aim of this study was to provide a preliminary examination of a disorder-specific treatment program for children with generalised anxiety disorder (GAD) that employed strategies targeting underlying cognitive factors. Forty-two children with a primary diagnosis of GAD, aged between 7 and 12 years, were randomly assigned to either a treatment (TX) or waitlist (WLC) condition. Clinical diagnostic interviews as well as parent and child questionnaires were completed at pre- and post-assessment for both conditions, and at 3-month follow-up for the TX group. For the completer analyses at post-treatment, 52.9 % of children in the TX group (0% in the WLC group) were free of their primary GAD diagnosis. By 3-month follow-up, 100% of children in the TX group were free of their GAD diagnosis, 50% were free of all diagnoses. Overall, there is preliminary evidence that a disorder-specific treatment program for children with GAD is effective in treating this chronic and disabling disorder.
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Affiliation(s)
- Monique C Holmes
- School of Applied Psychology and the Behavioural Basis of Health, Griffith University, Mount Gravatt Campus, Mount Gravatt, QLD, 4122, Australia.
| | - Caroline L Donovan
- School of Applied Psychology and the Behavioural Basis of Health, Griffith University, Mount Gravatt Campus, Mount Gravatt, QLD, 4122, Australia.
| | - Lara J Farrell
- School of Applied Psychology and the Behavioural Basis of Health, Griffith University, Gold Coast Campus, Southport, QLD, 4222, Australia.
| | - Sonja March
- School of Psychology, Counselling and Community, University of Southern Queensland, Springfield, QLD, 4300, Australia.
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Esbjørn BH, Lønfeldt NN, Nielsen SK, Reinholdt-Dunne ML, Sømhovd MJ, Cartwright-Hatton S. Meta-worry, worry, and anxiety in children and adolescents: relationships and interactions. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2014; 44:145-56. [PMID: 24555865 DOI: 10.1080/15374416.2013.873980] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The metacognitive model has increased our understanding of the development and maintenance of generalized anxiety disorders in adults. It states that the combination of positive and negative beliefs about worry creates and sustains anxiety. A recent review argues that the model can be applied to children, but empirical support is lacking. The aim of the 2 presented studies was to explore the applicability of the model in a childhood sample. The first study employed a Danish community sample of youth (n = 587) ages 7 to 17 and investigated the relationship between metacognitions, worry and anxiety. Two multiple regression analyses were performed using worry and metacognitive processes as outcome variables. The second study sampled Danish children ages 7 to 12, and compared the metacognitions of children with a GAD diagnosis (n = 22) to children with a non-GAD anxiety diagnosis (n = 19) and nonanxious children (n = 14). In Study 1, metacognitive processes accounted for an additional 14% of the variance in worry, beyond age, gender, and anxiety, and an extra 11% of the variance in anxiety beyond age, gender, and worry. The Negative Beliefs about Worry scale emerged as the strongest predictor of worry and a stronger predictor of anxiety than the other metacognitive processes and age. In Study 2, children with GAD have significantly higher levels of deleterious metacognitions than anxious children without GAD and nonanxious children. The results offer partial support for the downward extension of the metacognitive model of generalized anxiety disorders to children.
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Affiliation(s)
- B H Esbjørn
- a Department of Psychology , University of Copenhagen
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Smith KE, Hudson JL. Metacognitive beliefs and processes in clinical anxiety in children. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2013; 42:590-602. [PMID: 23356384 DOI: 10.1080/15374416.2012.755925] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Recent research has explored the role of metacognitive beliefs and processes in clinical anxiety in youth. The aim of this study was to examine the relationship between metacognitions and anxiety in 7- to 12-year-old children with and without clinical anxiety disorders. A secondary aim of the study was to investigate the psychometric properties of the recently developed Metacognitions Questionnaire for Children (MCQ-C). The sample consisted of 83 children (60.2% female; Oceanian 71.1%), comprising 49 children with anxiety disorders and 34 nonclinical children. All children completed self-report measures of anxiety, emotional difficulties, and metacognitions. A subsample of 7- to 8-year-old participants was used to explore whether young children could wholly comprehend all items on the MCQ-C. Positive and negative metacognitive beliefs and cognitive monitoring were significantly correlated with anxiety and emotional difficulties. Clinical children endorsed significantly more negative and more positive metacognitive beliefs than nonclinical children. Each subscale of the MCQ-C had poor internal consistency. Support for the criterion and convergent validity of the MCQ-C was found. The results suggest that certain metacognitions play a role in clinical anxiety in children but that psychometrically and developmentally validated measures of these concepts in younger individuals are needed.
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