Managing Worrying About Worrying with Metacognitive Restructuring Versus Metacognitive Defusion

Process-based cognitive behavioral therapy (PB-CBT) seeks to identify kernels that are equally efficacious in treating various disorders. While both metacognitive therapy (MCT) and acceptance and commitment therapy (ACT) represent evidence-based interventions for generalized anxiety disorder (GAD), it remains unclear if there are specific components within each that are comparable in managing meta-worrying characteristic of GAD. A subclinical sample of college students received a brief session targeting a single, personally relevant meta-worry of either metacognitive restructuring as practiced in MCT or an extension of ACT defusion exercises. Both were equally effective in impacting believability, distress, and willingness ratings of the targeted worry as well as untargeted worries. However, significantly longer metacognitive defusion sessions suggest that metacognitive restructuring may represent a more cost-effective option. Levels of generalized anxiety, dispositional worrying, and depression did not moderate treatment responsivity. Implications of findings for PB-CBT research and practice are discussed within the context of study limitations.