| dc.description.abstract | Objective: Anxiety disorders are wide-spread and often long-lasting and highly debilitating to sufferers. Therefore, it is important to make efficient therapeutic efforts to alleviate them. Therapeutic efforts may be more efficient if directed at mechanisms underlying anxiety disorders. The main objective of this longitudinal study is to elucidate the relation between schemas, a proposed underlying cognitive structure, and symptoms in complex anxiety disorders. More specifically, the relation of schemas to symptoms are investigated concurrently and prospectively. It is examined whether the relationship between schemas and symptoms is still significant when including another proposed cognitive foundation, namely metacognition, in the analyses. Lastly, the relative efficiency of the current treatment conditions in producing changes in metacognitions, schemas and symptoms is investigated. Methods: Data in the current study are part of an RCT comparing the effects of metacognitive therapy (MCT) and cognitive behavioural therapy (CBT) for complex anxiety disorders. Participants were recruited from the Department of anxiety disorders at Modum Bad in Norway. The participants were randomised to either diagnosis-specific CBT or transdiagnostic MCT. Current analyses are based on computer-administered self-report questionnaires at pre-treatment, post-treatment, and 1-year follow-up. Schemas, meta- cognitions and symptoms were assessed by the Young Schema Questionnaire-Short Form (YSQ-S1), Metacognitions Questionnaire-30 (MCQ-30), and Beck Anxiety Inventory (BAI), respectively. Multilevel models were used to analyse the data. Data were disaggregated into within- and between person effects when applicable. The current study is the first to compare between- and within-person effects of schemas and metacognitions on anxiety symptoms. Results and conclusions: Schemas are related to anxiety symptoms in complex anxiety disorders. There were significant concurrent between- and within-person relationships between symptoms and schema-endorsement. The within-person relationship of schema- endorsement and concurrent anxiety symptoms upheld even when between- and within person effects of metacognitions were included in the analysis. The within-person effect of metacognitions was also significant. This indicates that within-person changes in both EMSs and metacognitions uniquely impact concurrent anxiety symptoms. Treatment condition significantly impacted the degree of decline in symptoms and metacognitions during treatment, and showed a trend towards affecting decline in EMSs in the same direction. In these analyses, patients receiving MCT showed greater declines than those receiving CBT. However, this effect was not apparent in analyses across treatment and follow-up. In conclusion, the significant concurrent within-person relationships in this study indicate that changing both schemas and metacognitions can cause symptom-relief. The lack of lasting difference between treatment conditions imply that both EMSs and metacognitions can be changed by different interventions. | eng |