(PS3-D98) Metacognitive Therapy for Children and Adolescents with Anxiety and Depression: A Pilot Uncontrolled Trial of Effects and Mediators over Time

Background: Metacognitive therapy (MCT) is an effective treatment for adults suffering from anxiety and depressive disorders. Although there is a growing body of evidence supporting the use of MCT within children and adolescents, the effectiveness of MCT in targeting both anxiety and depressive disorders in children and adolescents remains unknown.

Aim: In the present study, we aimed at investigating whether MCT is associated with reductions in symptoms of anxiety and depression in children and adolescents, and whether treatment gains are temporally preceded by change in metacognitive beliefs and attention control as proposed by metacognitive theory.

Design: In an open trial design, 97 self-referred children and adolescents aged 10-17 (82% girls, mean age of 12.85 ± 1.9) and their parents were included in the study. Treatment consisted of eight weekly group sessions of manual-based MCT for adults with GAD (Wells, 2009) with slight modifications for use with children. Children and adolescents were diagnostically evaluated before and after treatment to assess changes in diagnostic status following treatment. In addition, to establish mediators of treatment effect, we assessed child symptoms, metacognitive beliefs, and attention control at baseline, weekly throughout treatment, after treatment, and at 3 and 6 months follow-up.

Results: Following treatment, 74% of the children and adolescents were free of their primary disorder and 70% were free of all their anxiety disorders. Taken together, 68% were free of all their anxiety and depressive disorders following treatment. We found that improvements in symptoms were mediated by several domains of metacognitive beliefs and attention control.



Discussion: Our study demonstrates that MCT delivered to children and adolescents with anxiety and depressive disorders is feasible and associated with significant improvements in anxiety and depression. Moreover, we found preliminary evidence of metacognitive beliefs and attention control as potential drivers of change. In the paper, we discuss the implications for treatment of anxiety and depression in this age group. In conclusion, our study contributes to our theoretical and clinical understanding of using MCT in anxiety and depression in childhood and adolescence and provides initial data on mechanisms that appear to contribute to change.