Metacognitive Therapy Versus Prolonged Exposure in Adults with Chronic Post-traumatic Stress Disorder: A Parallel Randomized Controlled Trial
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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.
KeywordsPosttraumatic stress disorder Clinical trials Cognitive-behavior therapy Metacognitive therapy Prolonged exposure
Conflict of Interest
Adrian Wells, Deborah Walton, Karina Lovell and Dawn Proctor declared that they have no conflict of interest.
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.
No animal studies were carried out by the authors for this article.
- Beck, A. T., & Steer, R. A. (1987). Manual for the Beck anxiety inventory. San Antonio, TX: The Psychological Corporation.Google Scholar
- Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Manual for the Beck depression inventory II. San Antonio, TX: The Psychological Corporation.Google Scholar
- 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.Google Scholar
- Cohen, J. (1988). Statistical power analysis for the behavioral sciences. Hillsdale, NJ: Erlbaum.Google Scholar
- 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).Google Scholar
- Foa, E. B. (1995). Posttraumatic stress diagnostic scale manual. USA: National Computer Systems.Google Scholar
- 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.PubMedCrossRefGoogle Scholar
- Hedges, L. V., & Olkin, I. (1985). Statistical methods for meta-analysis. New York: Academic Press.Google Scholar
- 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.Google Scholar
- Warda, G., & Bryant, R. A. (1998). Thought control strategies in acute stress disorder. Behaviour Research and Therapy, 36, 1171–1175.Google Scholar
- Wells, A. (2009). Metacognitive therapy for anxiety and depression. New York: Guilford Press.Google Scholar