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  Et kritisk review af evidensen for den metakognitive model og den metakognitive behandling af voksne med generaliseret angst
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 Ophav:
Worsøe, Gry Græsholm1, Forfatter
Nielsen, Sara Kerstine2, Vejleder
Tilknytninger:
1Det Samfundsvidenskabelige Fakultet, Københavns Universitet, København, Danmark, diskurs:7001              
2Institut for Psykologi, Det Samfundsvidenskabelige Fakultet, Københavns Universitet, København, Danmark, diskurs:7012              
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Ukontrollerede emneord: Metakognitiv, generaliseret angst, metakognitive behandling, metakognitive model
 Abstract: Background: Generalized anxiety disorder (GAD) is a common and serious anxiety disorder with a life time prevalence of 4,5%. If left untreated, it can develop into a chronic psychological disorder and cause serious personal and economic consequences. Despite of cognitive behavioural therapy (CBT) being the recommended choice for GAD, CBT is not nearly as efficient in treating GAD as in the treatment of other anxiety disorders such as panic disorder or obsessive-compulsive disorder. It has been suggested that treatment efficiency can be enhanced by the use of diagnosis specific treatment. The metacognitive model of GAD (MCM-GAD) and the metacognitive treatment offers a diagnosis specific model and treatment, which has shown promising results. The MCM-GAD assumes that people with GAD are locked into cycles of pathological worry because they have both positive and negative metacognitive assumptions about worry. Further, the metacognitive hypothesis is that the focus on metacognitions can increase treatment efficiency, and create important theoretical knowledge on the mechanisms inherent to GAD.
Aim: The aim of this master thesis is to examine the empirical support for the MCM-GAD to evaluate whether people with GAD do in fact posses positive and negative metacognitive assumptions, as it is presumed in the MCM-GAD. It is also the aim to investigate whether there is empirical evidence for stating that MCT is the most efficient treatment of GAD.
Method: A critical review of the empirical research and literature concerning both the MCM-GAD, and the metacognitive treatment of GAD.
Conclusion: This thesis finds a lack of empirical support for the MCM-GAD. Particularly, the evidence is not supporting a positive correlation between GAD and positive metacognitive assumptions. There seems, however, to be preliminary evidence for a positive correlation between GAD and negative metacognitive assumptions. The review of the metacognitive treatment shows that MCT is a more efficient treatment for GAD than no treatment, and at least as efficient as CBT, Applied Relaxation and therapy based on the theoretical model of Intolerance of Uncertainty. However, more research is needed to empirically validate the MCM-GAD and to further investigate the efficiency of the metacognitive treatment of GAD.
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2013-04-04
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Bogmærk denne post: https://diskurs.kb.dk/item/diskurs:44857:4
 Type: Speciale
Alternativ titel: A critical review of the empirical evidence for the metacognitive model and the metacognitive treatment of adults with generalized anxiety disorder
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Sprog: Danish - dan
 Datoer: 2013-02-15
 Sider: -
 Publiceringsinfo: København : Københavns Universitet
 Indholdsfortegnelse: Indholdsfortegnelse
1. INTRODUKTION 1
1.2 Psykoterapeutisk behandling af GAD . 3
1.3 Metakognitiv terapi af generaliseret angst .4
2. PROBLEMFORMULERING 6
3. FØRSTE DEL: Det empiriske belæg for den metakognitive model til GAD 7
3.1 The Self-Regulatory Executive Function (S-REF-modellen) 7
3.2 Den metakognitive model til generaliseret angst (MCM-GAD) 8
3.3 Opsummering af teoretiske antagelser i MCM-GAD 10
3.4 Antagelse nr. 1 11
3.41 Diskussion af det empiriske fund under Antagelse nr. 1 . 14
3.5 Antagelse nr. 2 .15
3.51 Empiriske studier af MCM-GAD og positive metaantagelser 16
3.52 Empiriske studier af positive antagelser om bekymringer i andre diagnosespecifikke modeller til GAD . 17
3.53 Diskussion af det empiriske fund under Antagelse nr. 2 . 19
3.6 Antagelse nr. 3 21
3.61 Empiriske studier af MCM-GAD og negative metaantagelser 21
3.62 Empiriske studier af MCM-GAD og Type 2 bekymring . 23
3.63 Diskussion af det empiriske fund under Antagelse nr. 3 25
3.631 Sub-grupper inden for GAD: Somatizers og psychologizers 25
3.632 Metodisk cirkularitet i undersøgelsen af negative metaantagelser hos individer med GAD 26
3.4 Opsamling på Første Del: Antagelse nr. 1, 2 og 3 28
4. ANDEN DEL: Det empiriske belæg for den metakognitive behandling af GAD . 29
4.1 Evidensbaseret psykoterapi 30
4.2 Kriterier for evaluering af det empiriske belæg for MCT-behandlingen af GAD . 32
4.4 Præsentation af effektstudier af MCT-behandling af GAD . 33
4.4 Punkt 1: Forsøgsdesign og kontrolgrupper .34
4.41 Kontrolgrupper .36
4.4 Punkt 2: Statistisk og klinisk signifikans: Effekten af MCT i forhold til venteliste og effekten af andre terapiformer til GAD . 38
4.51 Statistisk signifikans 384.52 Effektstørrelser 40
4.53 Klinisk signifikans . 42
4.54 Follow up . 44
4.6 Punkt 3: Psykologiske tests i effektstudierne . 46
4.61 Metodiske begrænsninger ved de psykologiske tests 49
4.7 Punkt 4: Forsøgsdeltagere og sampling bias 50
4.71 Rekruttering af forsøgsdeltagere 51
4.72 In- og eksklusionskriterier . 53
4.73 Frafald 55
4.74 Randomisering til behandlingskontrolgruppe 56
4.75 Diskussion af intern og ekstern validitet i samplingen 58
4.8 Punkt 5: Intern versus ekstern validitet i effektstudierne . 60
5.1 Supervision og oplæring af terapeuterne 60
5.2 Diagnosticering og interrater-reliabilitet 62
5.3 Behandlingsmanualer og adherence checks . 63
5.4 Efficacy versus effectiveness 63
6. Opsamling på Anden Del: Det empiriske belæg for MCT-behandlingen af GAD 66
7. Sammenknytning af Første og Anden Del . 67
8. KONKLUSION . 69
8.1 Perspektivering . 71
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 Type: Speciale
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