Group metacognitive therapy for students with anxiety: an uncontrolled pre-post study of feasibility and associated outcomes

Background Group-based Metacognitive Therapy (gMCT) has shown promising results for anxiety, but research specifically targeting student populations is limited. By addressing maladaptive metacognitions, gMCT aims to reduce core symptoms such as anxiety, excessive worry, and rumination. More research is needed in university settings to determine whether gMCT can be successfully applied to students. Method: We investigated the feasibility and examined a gMCT treatment course with an uncontrolled pre-post design with a 3-month booster follow-up. The design reflects the available data material and the limitations of the real-world clinic setting. Participants were students with a score =10 on GAD-7 assessment, or diagnosed with anxiety disorders, including Generalized Anxiety Disorder (GAD), Social Anxiety Disorder (SAD), and Panic Disorder (PD). Patients presenting with additional conditions that would necessitate alternative interventions/treatment were excluded and not eligible for this study. The generic MCT treatment model was delivered as part of routine care by therapists at the Oslo Student Welfare Organization (SiO Helse) who had relevant MCT training. Data material was collected at pre-treatment, post-treatment, and booster follow-ups. Feasibility was assessed using attendance, dropout, and number of completers. Missing data were handled using multilevel modelling and mean imputation at the item level. The primary outcome was GAD-7, and depressive symptoms (secondary outcome) with the PHQ-9. Worry and Metacognitive beliefs were assessed. Analyses included paired sample t-tests, clinically significant change analysis, and multilevel modelling (MLM) to evaluate change over time. Results Treatment adherence was high, with participants attending an average of 7.1 out of 8 sessions. Significant reductions were observed across all measures from pre- to post-assessment, with large effect sizes for the primary outcome (GAD-7) and for worry (CAS-1), negative metacognitions (MCQ-30), and depressive symptoms (PHQ-9). These improvements were maintained at the 3-month booster follow-up. Conclusion gMCT is feasible for treating student populations with anxiety and depression symptoms. Overall, 77.3% of participants improved or recovered after post-assessment. The results should be cautiously interpreted due to the single-site setting, few patients and short follow-up period, but suggest that other student welfare organizations may benefit from implementing gMCT to treat anxiety- and worry-related problems in student populations.