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Reducing State Anxiety Using Working Memory Maintenance
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Managing Worrying About Worrying with Metacognitive Restructuring Versus Metacognitive Defusion.

Robert D Zettle1, Huan Quan1, Jonathan M Larson1

  • 1Department of Psychology, Wichita State University, 1845 Fairmount, Wichita, KS 67260, USA.

Behavioral Sciences (Basel, Switzerland)
|May 4, 2026
PubMed
Summary

Metacognitive restructuring and acceptance and commitment therapy defusion exercises equally reduced meta-worrying in college students. Metacognitive restructuring may be more cost-effective for generalized anxiety disorder (GAD) treatment.

Keywords:
generalized anxiety disordermetacognitive defusionmetacognitive restructuringprocess-based cognitive behavioral therapy

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Area of Science:

  • Psychology
  • Clinical Psychology
  • Cognitive Behavioral Therapy

Background:

  • Generalized anxiety disorder (GAD) is often characterized by meta-worrying.
  • Metacognitive therapy (MCT) and acceptance and commitment therapy (ACT) are evidence-based treatments for GAD.
  • The comparability of specific components within MCT and ACT for managing meta-worrying requires further investigation.

Purpose of the Study:

  • To compare the efficacy of metacognitive restructuring (MCT) and acceptance and commitment therapy (ACT) defusion exercises in managing meta-worrying.
  • To explore the cost-effectiveness of these interventions.
  • To examine the moderating effects of generalized anxiety, dispositional worrying, and depression on treatment response.

Main Methods:

  • A subclinical sample of college students received a brief intervention targeting a single meta-worry.
  • Interventions included either metacognitive restructuring (MCT) or ACT defusion exercises.
  • Believability, distress, willingness ratings, generalized anxiety, dispositional worrying, and depression were assessed.

Main Results:

  • Both metacognitive restructuring and ACT defusion exercises were equally effective in reducing believability, distress, and willingness ratings for targeted and untargeted worries.
  • Metacognitive restructuring sessions were significantly shorter than ACT defusion sessions, suggesting greater cost-effectiveness.
  • Generalized anxiety, dispositional worrying, and depression did not moderate treatment outcomes.

Conclusions:

  • Metacognitive restructuring and ACT defusion exercises show comparable efficacy in reducing meta-worrying.
  • Metacognitive restructuring may offer a more cost-effective approach for managing meta-worrying in GAD.
  • Findings support process-based cognitive behavioral therapy (PB-CBT) research and practice.