Abstract
A parallel randomized controlled trial compared metacognitive therapy (MCT) with prolonged exposure (PE) in 32 patients with PTSD of ≥3 months duration. Participants were assigned to; eight sessions of therapy (MCT or PE) or an 8-week wait period (WL). There was only one drop-out from each treatment. Both active treatments were effective, resulting in significantly lower symptoms of PTSD, anxiety and depression compared with the WL. At post-treatment MCT was superior to PE on self-report symptoms of PTSD and superior to WL on objective measures of hyper-arousal (heart-rate). Recovery rates and reliable improvement in both MCT and PE were high. MCT exerted effects more rapidly and within group effect sizes in MCT were much larger than those in PE at the end of treatment. Clinical gains remained evident at follow-up by which time the treated groups did not differ. In conclusion; both treatments were effective but MCT had a clear advantage. The clinical implications and suggestions for future research are discussed.
Similar content being viewed by others
References
Beck, A. T., & Steer, R. A. (1987). Manual for the Beck anxiety inventory. San Antonio, TX: The Psychological Corporation.
Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck depression inventory II. San Antonio, TX: The Psychological Corporation.
Benish, S. G., Imel, Z. E., & Wampold, B. E. (2008). The relative efficacy of bona fide psychotherapies for treating post-traumatic stress disorders: A meta-analysis of direct comparisons. Clinical Psychology Review, 28, 746–758.
Bennett, H., & Wells, A. (2010). Metacognition, memory disorganization and rumination in posttraumatic stress symptoms. Journal of Anxiety Disorders, 24, 318–325.
Bradley, R., Greene, J., Russ, E., Dutra, L., & Westen, D. (2005). A multi-dimensional meta analysis of psychotherapy for PTSD. American Journal of Psychiatry, 162, 214–227.
Cahill, S. P., & Foa, E. B. (2004). A glass half empty or half full? Where we are and directions for future research in the treatment of PTSD. In S. Taylor (Ed.), Advances in the treatment of posttraumatic stress disorder: Cognitive behavioral perspectives (pp. 267–313). New York: Springer.
Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Hillsdale, NJ: Erlbaum.
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (2002). Structured clinical interview for DSM-IV-TR axis I disorders, research version-patient edition (SCID-I/P). New York: Biometrics Research Department, New York State Psychiatric Institute (revision: January, 2004).
Foa, E. B. (1995). Posttraumatic stress diagnostic scale manual. USA: National Computer Systems.
Foa, E. B., Hembree, E. A., Cahill, S. P., Rauch, S. A. M., Riggs, D. S., & Freeny, N. C. (2005). Randomized trial of prolonged exposure for posttraumatic stress disorder with and without cognitive restructuring: Outcome at academic and community clinics. Journal of Consulting and Clinical Psychology, 73, 953–964.
Foa, E. B., Molnar, C., & Cashman, L. (1995). Change in rape narratives during exposure therapy for posttraumatic stress disorder. Journal of Traumatic Stress, 8, 675–690.
Fydrich, T., Dowdall, D., & Chambless, D. L. (1992). Reliability and validity of the Beck anxiety inventory. Journal of Anxiety Disorders, 6, 55–61.
Guthrie, R., & Bryant, R. (2000). Attempting suppression of traumatic memories over extended periods in acute stress disorder. Behavior Research and Therapy, 38, 899–907.
Hedges, L. V., & Olkin, I. (1985). Statistical methods for meta-analysis. New York: Academic Press.
Holeva, V., Tarrier, N., & Wells, A. (2001). Prevalence and predcitors of acute stress disorder and PTSD following road traffic accidents: Thought control strategies and social support. Behavior Therapy, 32, 65–83.
Horowitz, M., Wilner, N., & Alvarez, W. (1979). Impact of Events Scale: A measure of subjective stress. Psychosomatic Medicine, 41, 209–218.
Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.
Marks, I., Lovell, K., Noshirvani, H., Livanou, M., & Thrasher, S. (1998). Treatment of post traumatic stress disorder by exposure and/or cognition restructuring—A controlled study. Archives of General Psychiatry, 55, 317–325.
Nassif, Y., & Wells, A. (2014). Attention training reduces intrusive thoughts cued by a narrative of stressful life events: A controlled study. Journal of Clinical Psychology, 70, 510–517.
Nolen-Hoeksema, S., & Morrow, J. (1991). A prospective study of depression and posttraumatic stress symptoms after a natural disaster: The 1989 Loma Prieta earthquake. Journal of Personality and Social Psychology, 61, 115–121.
Powers, M. B., Halpern, J. M., Ferenschak, M. P., Gillihan, S. J., & Foa, E. B. (2010). A meta-analytic review of prolonged exposure for posttraumatic stress disorder. Clinical Psychology Review, 30, 635–641.
Reynolds, M., & Wells, A. (1999). The thought control questionnaire: Psychometric properties in a clinical sample and relationship with PTSD and depression. Psychological Medicine, 29, 1089–1099.
Rosenthal, R. (1991). Meta-analytic procedures for social research. Newbury Park, CA: Sage.
Roussis, P., & Wells, A. (2008). Psychological factors predicting stress symptoms: Metacognition, thought control and varieties of worry. Anxiety, Stress and Coping, 21, 213–225.
Schwartz, C. E., Chesney, M. A., Irvine, M. J., & Keefe, F. J. (1997). The control group dilemma in clinical research: Applications for psychosocial and behavioral medicine trials. Psychosomatic Medicine, 59, 362–371.
Van Etten, M. L., & Taylor, S. (1998). Comparative efficacy of treatments for post-traumatic stress disorder: A meta-analysis. Clinical Psychology Review, 5, 126–144.
Warda, G., & Bryant, R. A. (1998). Thought control strategies in acute stress disorder. Behaviour Research and Therapy, 36, 1171–1175.
Wells, A. (2009). Metacognitive therapy for anxiety and depression. New York: Guilford Press.
Wells, A., & Colbear, J. S. (2012). Treating posttraumatic stress disorder with metacognitive therapy: A preliminary controlled trial. Journal of Clinical Psychology, 68, 373–381.
Wells, A., & Papageorgiou, C. (1995). Worry and the incubation of intrusive images following stress. Behaviour Research and Therapy, 33, 579–583.
Wells, A., & Sembi, S. (2004a). Metacognitive-focused therapy for PTSD: A preliminary investigation of a new brief treatment. Journal of Behavior Therapy and Experimental Psychiatry, 35, 307–318.
Wells, A., & Sembi, S. (2004b). Metacognitive-focused therapy for PTSD: A core treatment manual. Cognitive and Behavioral Practice, 11, 365–377.
Wells, A., Welford, M., Fraser, J., King, P., Mendel, E., Wisely, J., et al. (2008). Chronic PTSD treated with metacognitive therapy: An open trial. Cognitive and Behavioral Practice, 15, 85–92.
Conflict of Interest
Adrian Wells, Deborah Walton, Karina Lovell and Dawn Proctor declared that they have no conflict of interest.
Informed Consent
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000(5). Informed consent was obtained from all patients before being included in the study.
Animal Rights
No animal studies were carried out by the authors for this article.
Author information
Authors and Affiliations
Corresponding author
Additional information
International Clinical Trials Registry Platform NHSTCT Register: ISRCTN63706856.
Rights and permissions
About this article
Cite this article
Wells, A., Walton, D., Lovell, K. et al. Metacognitive Therapy Versus Prolonged Exposure in Adults with Chronic Post-traumatic Stress Disorder: A Parallel Randomized Controlled Trial. Cogn Ther Res 39, 70–80 (2015). https://doi.org/10.1007/s10608-014-9636-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10608-014-9636-6