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.
Highlights
IntroductionTreatment of Anxiety Disorders in Children and Adolescents
38.7% (n = 12) of children were diagnosed with separation‐anxiety disorder, 38.7% (n = 12) with specific phobia, and 22.6% (n = 7) with social phobia
One child with primary specific phobia had a comorbid generalized anxiety disorder (GAD) diagnosis. 30 children filled out information about their social‐economic‐status in FAS; most (64.5%) of the children live in a wealthy family while 19.4% of children’s families were of moderate and 12.9% low wealth
Summary
Treatment of Anxiety Disorders in Children and Adolescents. A recent meta‐analysis showed that these numbers have risen even more since the Covid‐19 pandemic began, and that every fifth child exhibits clinically relevant symptoms of an anxiety disorder [2]. The most prevalent anxiety disorder in children and adolescents is specific phobia (5.4%–5.6%), followed by separation anxiety disorder (2.0%–3.2%) and social phobia (0.1%–3.7%) [1,3]. Anxiety disorders often persist into adulthood [5], and often go along with later development of mental disorders such as other anxiety disorders, depression or substance use disorders [6,7], more problems in the family, more chronic stress, and less life satis‐ faction [7]
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