A Comparative Study of the Effectiveness of Metacognitive Therapy with Neurofeedback Training on Metacognitive Beliefs and Anxiety Symptoms in Female Students with Social Anxiety Disorder (single subject)

Authors
fatemeh ghayourkazemi
zohreh sepehri shamloo
ali mashhadi
ali ghanaei
frozan pasalar
Abstract
The aim of this research was to compare the effectiveness of MCT and Neurofeedback on metacognitive believes and symptoms of SAD. This research was a single subject study with volunteer sampling method. 7 students from Ferdowsi and Farhangian universities with diagnosis of SAD have been matched and assigned into one of the three groups (control, MCT and Neurofeedback).DSM-IV structured interview,Conner's Social Phobia Inventory, Watson and Friend's social anxiety questionnair, metacognition questionnair have been used before and after intervention and in 45 days follow-up. Conner's Inventory also had been answered 2 times within the treatment. 8 session per week for MCT and 16 sessions 3 times each week for neurofeedback has been performed. Percent recovery is used for data analysis. Results showed MCT and neurofeedback were effective in treating SAD with different range of percent recovery in each one of the subjects. But the mean of percent recoveries weren't different between the two interventions. Although metacognitive believes changed more in MCT. Percent recovery has improved in the follow up. In general, MCT and Neurofeedback are both effective in reducing SAD but MCT was more effective in milder SAD and Neurofeedback was more effective in more severe SAD than MCT.
Keywords
Social anxiety disorder
anxiety
Metacognitive therapy
Neurofeedback
Abdi, R. Interpretation Bias in Social Anxiety Disorder. (2003). [M. A. Dissertation in Clinical Psychology]. Psychiatry Institue of Tehran Medical Sciences university. [In Persian]
Abolghasemi, A., Kiamarsi, A. (2009).The Relationship between Metacognition and Cognitive Impairment in the Elderly. Advances in Cognitive Science,11(1):8-15. [In Persian]
Akbari, E., Khanjani, Z., Poursharifi, H., Mahmoud-Alilou, M., Azimi, Z. (2012).Comparative Efficacy of Transactional Analysis Versus Cognitive Behavioral Therapy for Pathological Symptoms of Emotional Breakdown in Students. Journal of Clinical Psychology, 4(3):87-101. [In Persian]
American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders. (5th Ed.). Washington, DC.
Bahadori. MH., Jahanbakhsh. M., Kalantari, M., Molavi, H. (2011). Effects of Meta-Cognitive Therapy on Symptoms of Social Phobia Patients. Journal of Armaghane Danesh,16(1):21-30. [In Persian]
Bahadori. MH., Jahanbakhsh. M., Kajbaf, M., Faramarzi, S. (2012).The Effectiveness of Meta-Cognitive Therapy on Meta cognitive beliefs and trust in patients with social anxiety disorder. Journal of Clinical Psychology, 4(1):33-41. [In Persian]
Bahadori. MH., Jahanbakhsh. M., Jamshidi, A., Askari Mobarake. K.(2012). The Effect of Meta-cognitive Therapy on Anxiety Symptoms of Social Phobia Disorder Patients. Knowledge & Research in Applied Psychology, 12(4,46): 12-19. [In Persian]
Beijesh, A. R. (2012). Mindfullness Based Cognitive Therapy (MBCT) for Social Anxiety Disorder. International Journal of Psychosocial Research, 44-48.
Budzynski, T. H., Budzynski, H. K., Evans, J. R. and Abarbanel, A. (2009). Introduction to Quantitive EEG and Neurofeedback: Advanced Theory and Applications. Elsevier’s Science & Technology, Oxford, UK, p. 453-472.
Connor, K. M., Davidson, J. R. T., Churchil, L. R., Sherwood, A., Foa, E., & Weisler, R. H. (2000). Psychometric properties of the Social Phobia Inventory (SPIN): New self-rating scale. British Journal of Psychiatry,176: 379-386.
Crome, E. Grove, R. Baillie, A. J. Sunderland, M., Teesson, M., Slade, T.(2015). DSM-IV and DSM-5 Social Anxiety Disorder in the Australian Community. Australian and New Zealand Journal of Psychiatry, 49(3):227-235.
Dargahyan,R., Mohamadkhani,Sh., Hasani, J., Shams, J.(2011). Effectiveness of metacognitive therapy to improve metacognitive beliefs, rumination and symptoms in depression: a single subject. Studies in Clinical Psychology, 3(1):81-103. [In Persian]
Davidson, J. R. T., Miner, C. M., De Veaugh-Geiss, J., Tupler, L. A., Colket, J. T., & Potts, N. L. S. (1997). The Brief Social Phobia Scale: A psychometric evaluation. Psychological Medicine, 27,161-166.
Dehghani-Arani, F., Rostami, R., Rahimi-Nejad, A. and Akbari- Zardkhane, S. (2008).Effectiveness of Neurofeedback Training on Psychological Health in Opiate Dependent Patients. Research in Psychological Health, 1(4):77-85. [In Persian]
Demos, J., (2005). Getting Started with Neurofeedback. N.Y: Norton & Company Inc.
Evans, J. R.(2007). Handbook of Neurofeedback Dynamics and Clinical Applications. NY: The Haworth Medical Press, Bingharnton, p.123-347.
Farmer, A. S., Kashdan, T. B.(2015). Stress Sensitivity and Stress Generation in Social Anxiety Disorder: A Temporal Process Approach. Journal of Abnormal Psychology, 124(1):102-114.
Fehm, L., Beesdo, k., Jacobi,F., & Fiedler,A. (2008). Social Anxiety disorder Above and Below the Diagnostic Threshold: Prevalence, Comorbidity and Impairment in the General Population. Social Psychiatry and Psychiatric Epidemiology.2008;43, 257-265.
Fisher, C. A. (2010).Anxiety, depression, and sleep disorders: their relationship and reduction with neurotherapy, [PhD Dissertation in Philosophy]. University Of North Texas, p.13-4.
Hammond, D. C.(2005). Neurofeedback treatment of depression and anxiety. Journal of adult development, 12(2):131-8.
Hong, R. Y. Worry and rumination: Differential associations with anxious and depressive symptoms and coping behavior. Behaviour Research and Therapy, 2007; 45:277–90.
Karami, J., Zakiei, A., Rostami, S. (2012).The role of meta-cognitive beliefs and self-efficacy in predicting social phobia in third grade boy students in Kermanshah. Journal of school psychology, 1(1):62-75. [In Persian]
Khorshydzadeh, M., Borjali, A. , Sohrabi , F. Delawar, A. (2012). Effectiveness of schema therapy in the treatment of patients with social anxiety disorder. Research in Clinical and Counseling Psychology,1(2):5-24. [In Persian]
Lampe, L.A. (2009).Social Anxiety Disorder: Recent Developments in Psychological Apptoaches to Conceptualization and Treatment. Australian and New Zealand Journal of Psychiatry, 43, 887-898.
Mahmoodi, M., Goodarzi, MA., Taghavi, SMR., Rahimi, Ch. (2010). A study on the effectiveness of brief psychotherapy focused on metacognition in social phobia, a single-subject design. Journal of Fundamentals of Mental Health, 12(3 &47):630-41. [In Persian]
Moore, N.C. (2000).A Review of EEG Biofeedback Treatment of Anxiety Disorders. Clinical Electroencephalography. 31(1), 1-6.
Moscovitch, D. A., Santesso, D. L., Miskovic, V., McCabe, R. E., Antony, M. M. and Schmidt, L. A. (2011). Frontal EEG asymmetry and symptom response to cognitive behavioral therapy in patients with social anxiety disorder. Biological Psychology, 87:379-85.
Nayynyan, M., Babapoor, J., Groosi Farshi, T., Shaeeri, M. and Rostami, R. (2012). Comparison of the effects of neurofeedback and medications to reduce symptoms of anxiety and quality of life in patients with generalized anxiety disorder. Journal of Clinical Psychology and Personality, Shahed University, 19(7):1-14. [In Persian]
Norton, A. R., Abbott, M. J., Norberg, M. M. and Hunt, C.A.(2015). Systematic Review of Mindfulness and Acceptance-Based Treatments for Social Anxiety Disorder. Journal of Clinical Psychology, 71(4):283-301.
Oei, T. P., Kenna, D., & Evans, L.(1991). The Reliability, Validity, and Utility of the SAD and FNE Scales for Anxiety Disorder Patients. Personality and Individual Differences, 56, 251-260.
Othmer, S. F. (2012).Protocol guide for neurofeedback clinicians. 3ed edi. CA: EEG institute.
Pourfaraj Omran, M.(2011). The Effectiveness of Acceptance and Commitment Group Therapy in Social Phobia of Students. Knowledge & Health, 6(2):1-5. [In Persian]
Roohbakhsh Ilymoghaddam, M. (2013).Effect of sensory integration treatment and neurofeedback training on increasing the ADHD student's attention level. [M. A. Dissertation in Clinical Psychology]. Mashhad: Ferdowsi University, p.29. [In Persian]
Safavi Shamloo, M.(2008). comparing Efficiency and Effectiveness of metacognitive therapy and cognitive-behavior therapy on GAD.[M. A. Dissertation in Clinical Psychology]. Mashhad: Ferdowsi University, 85-86.[ In Persian]
Sahebi, A. (2003).Research Methods in Clinical Psychology. Tehran: the organization of the study and developing humanities universities books. [In Persian]
Salajegheh, S. and Bakhshani, N. (2014).Effectiveness of Combined Group Exposure Therapy and Coping with Stress Skills Training on Social Anxiety Rate of University Students. Knowledge & Research in Applied Psychology,15(2):96-104. [In Persian]
Sattary-Najaf-Abady R., Heidary H.(2015). The Effectiveness of Meta-Cognitive Treatment on Test Anxiety in Students. Journal of Behavior Science, 9(1): 27-32. [In Persian]
Shafie Sang Atash, S., Rafienia, P., Najafi, M.(2012). Efficacy of metacognitive therapy on the meta-cognitive components and anxiety in patients with generalized anxiety disorder. Journal of Clinical Psychology, 4(4):19-30. [In Persian]
Shareh, H., Roeinfard, M., Haghi, E.(2014).The Effectiveness of Heimberg and Becker Cognitive Behavioral Group Therapy in Improving Female Adolescents Social Anxiety and Cognitive Flexibility. Journal of Sabzevar University Medical Sciences, 21(2):226-240. [In Persian]
Sharifi, W. Asaadi, M., Mohammadi, M., Amini, H., Kaviani,H. Semnani, I. et al. (2004).Reliability and ability to execute the Persian version structured diagnostic interview for DSM-IV (SCID). Advances in Cognitive Science, 6(1,2):10-22. [In Persian]
Sharreh, H., Gharaie, B., Aatef Vahid, M.K. (2010).Comparison of Metacognitive Therapy, Fluvoxamine and Combined treatment in Improving Metacognitive Beliefs and Subjective Distress of Patients with Obsessive-Compulsive Disorder. Advances in Cognitive Science, 12(1):1-16. [In Persian]
Stein, M.B., Roy-Byrne, P.P., Craske, M.G., Bystritsky,A., Sullivan,G., Pyne, J.M., Katon, W., Sherbourne, C.D. (2005).Functional impact and health utility of anxiety disorder in primary care outpatients. Medicine Care, 43:1164-70.
Tavoli, A., Allahyari, AA. Azad-Fallh, P. Fathi-Ashtiani, A. Melyani, M.(2013).A Comparison of the effectiveness of interpersonal and cognitive behavioral therapies for social anxiety disorder. Journal of Behavioral Sciences, 7(3):199-206. [In Persian]
Tsai, C.F., Wang, S.J., Juang, K.D., and Fuh, J.L. (2009).Use of the Chinese (Taiwan) version of the Social Phobia Inventory (SPIN) among early adolescents in rural areas: reliability and validity study.Journal of the Chinese Medical Association, 72(8):422-429.
Vaziri, S., Mousavinik, M. (2009).The Relation between Meta Worry and Meta Cognition Beliefs with Phobia. Applied Psychology Journal, 3 (10): 59-70. [In Persian]
Wells, A. (2012).Metacognitive therapy for anxiety and depression.translated by Akbari, M., Mohammadi, A., Hamidpoor, H., Andooz, Z. Tehran: Arjmand publications, p:25-315. [In Persian]
Wells, A. & Cartwright-Hatton, H.(2004). A short form of the metacognitions questionnaire: properties of the MCQ-30. Behavior Research and Therapy, 42: 385-96.
Zargar, Y., Besaknezhad, S., Akhlaghi Jami, L., Zemestani, M.(2014). The Comparison of the Effectiveness of Group Training of Social Skills and Group Cognitive-Behavior Therapy in Reducing Social Anxiety Among Students. Journal of Urmia university Medical Sciences, 25(3):172-181. [In Persian]