Metacognitive Therapy for Common Mental Health Problems in Autistic CYP: A Case Series

NCT ID: NCT05980143

Last Updated: 2024-03-28

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

5 participants

Study Classification

INTERVENTIONAL

Study Start Date

2023-10-25

Study Completion Date

2024-04-30

Brief Summary

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Anxiety and Depression are common in young people (CYP) and especially in CYP with a diagnosis of Autism. Autistic people often say therapy has not been adapted to meet their needs. A recent treatment called metacognitive therapy (MCT) is proving to be helpful, but the investigators do not know how autistic CYP will find MCT, or what changes to the delivery of therapy may be needed to meet their needs. This study hopes to explore whether MCT can help treat anxiety and/or depression in autistic young people.

This study aims to offer five autistic CYP MCT. To take part, they must be between 11-16 years old and have depression and/or anxiety symptoms. The study will involve completing questionnaires at the start, during therapy, at the end and after 6 months. Therapy will be scheduled for at least eight sessions. Therapy involves working on what we think about our worry, rather than on specific worries. What we think about our worry can be positive or negative. For example, 'worrying helps me cope' and 'worrying could make me go mad'. This can affect where our attention goes and how we think. At the end of therapy, participants will be asked to take part in an interview about how they found the therapy.

The questionnaires will help test how useful the measures are, suggest how helpful the therapy might be and whether benefits continue after the therapy has ended. Information will also be gathered through a post treatment interview about how the young people found the therapy. This will help understand whether any changes to the therapy are needed to meet the needs of autistic people. This information is necessary for planning a large-scale trial for autistic CYP. Such studies may improve treatment options and service provision for mental health problems in this population.

Primary Question:

• Is MCT a feasible and acceptable treatment for treating anxiety and depression in autistic CYP?

Secondary Questions:

* Is MCT associated with clinically significant change in outcome measures following the introduction of treatment for autistic CYP?
* Are improvements associated with MCT maintained at 6 month follow up?
* Are improvements associated with MCT replicable across autistic CYP?
* Do the investigators need to modify how MCT is delivered to autistic CYP?

Detailed Description

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This study is a systematic replication case series utilising an AB design with follow up to deliver MCT to autistic CYP who experience symptoms of anxiety and/or depression. Allocation to baseline lengths will not be randomised, natural baselines will be utilised whereby participants complete the primary outcome measure weekly until they demonstrate stability. Stability will be defined as an absence of decreasing trend of at least three consecutive data points prior to the introduction of treatment.

Recruitment:

Participants will be identified by CAMHS clinicians during routine clinical practice. Potential participants will be provided with information about the study, including the participant information sheet. Those who are identified as eligible and are interested in taking part or finding out more about the study will consent to their details being shared with the researcher. The details will be securely sent to the researcher using the eligibility form. The researcher will then contact potential participants to confirm whether the like to participate and answer any questions they have about the study.

Screening:

Those who wish to participate will then be invited to attend a screening appointment with the researcher. Written consent will be obtained from participants (and parents/guardians where appropriate). Once consent has been obtained, demographic information, baseline measures will be administered.

Baseline:

During the baseline phase, participants will be asked to complete the Personal Rating Scale and the YoCas-1 once a week for a minimum of 3 weeks, until stability is achieved. Only the Personal Rating Scale will be used to measure stability. Stability is defined as the absence of a decreasing trend on three consecutive data points prior to the introduction of treatment. All other outcome measures will be completed at the end of the baseline phase prior to starting treatment.

Intervention:

Participants will be offered a minimum of eight weekly sessions of MCT at their local CAMHS. Each session will last approximately an hour. This will be applied flexibly, and sessions can be extended in response to client progress. This will provide information about whether the investigators need to modify the delivery of MCT to autistic CYP. Participants will be asked to complete sessional measures.

Post Intervention interview:

Participants will be asked to take part in the post intervention interview to gather information about how they found the intervention. This will consider factors such as components of the intervention that were well received, and those which were less well received.

Follow up:

Participants will be asked to complete follow up measures 6 months after the final treatment session.

Conditions

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Anxiety Depression

Study Design

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Allocation Method

NA

Intervention Model

SINGLE_GROUP

Primary Study Purpose

TREATMENT

Blinding Strategy

NONE

Study Groups

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Metacognitive Therapy

MCT will be delivered in accordance with the MCT-PATHWAY treatment manual.

Group Type EXPERIMENTAL

Metacognitive Therapy

Intervention Type OTHER

The transdiagnostic Metacognitive model suggests that psychological difficulties arise from the activation of a thinking style called the CAS (Cognitive Attentional Syndrome). Metacognitive Therapy (MCT) aims to bring the CAS under control. The therapist helps the patient to learn new ways of relating to stressful thoughts.

Interventions

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Metacognitive Therapy

The transdiagnostic Metacognitive model suggests that psychological difficulties arise from the activation of a thinking style called the CAS (Cognitive Attentional Syndrome). Metacognitive Therapy (MCT) aims to bring the CAS under control. The therapist helps the patient to learn new ways of relating to stressful thoughts.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Age between 11-16 years
* Consent given
* Formal diagnosis of Autism Spectrum Disorder
* Fluent in English
* Seeking treatment for emotional disorder symptoms (i.e., generalised anxiety disorder, panic disorder, agoraphobia, post-traumatic stress disorder, obsessive compulsive disorder, social anxiety; and/or depression)
* Medication for mental health problems permitted but participants must be stabilised for 6 weeks

Exclusion Criteria

* Presence of significant risk or safeguarding concerns
* Head injury/organic impairment
* Attention Deficit Hyperactivity Disorder (formal diagnosis or under assessment)
* Eating Disorder
Minimum Eligible Age

11 Years

Maximum Eligible Age

16 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Manchester University NHS Foundation Trust

OTHER_GOV

Sponsor Role collaborator

Pennine Care NHS Foundation Trust

OTHER_GOV

Sponsor Role collaborator

University of Manchester

OTHER

Sponsor Role lead

Responsible Party

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Adrian Wells

Professor

Responsibility Role PRINCIPAL_INVESTIGATOR

Locations

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Manchester University NHS Foundation Trust

Manchester, , United Kingdom

Site Status NOT_YET_RECRUITING

Pennine Care NHS Foundation Trust

Manchester, , United Kingdom

Site Status RECRUITING

Countries

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United Kingdom

Central Contacts

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Kathryn Wood

Role: CONTACT

0161 529 4180

Facility Contacts

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Dr Paul Wallis

Role: primary

Dr Gordon Milson

Role: primary

References

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Ebesutani C, Reise SP, Chorpita BF, Ale C, Regan J, Young J, Higa-McMillan C, Weisz JR. The Revised Child Anxiety and Depression Scale-Short Version: scale reduction via exploratory bifactor modeling of the broad anxiety factor. Psychol Assess. 2012 Dec;24(4):833-45. doi: 10.1037/a0027283. Epub 2012 Feb 13.

Reference Type BACKGROUND
PMID: 22329531 (View on PubMed)

Cartwright-Hatton S, Mather A, Illingworth V, Brocki J, Harrington R, Wells A. Development and preliminary validation of the Meta-cognitions Questionnaire-Adolescent Version. J Anxiety Disord. 2004;18(3):411-22. doi: 10.1016/S0887-6185(02)00294-3.

Reference Type BACKGROUND
PMID: 15125986 (View on PubMed)

Stevens K. Valuation of the Child Health Utility 9D Index. Pharmacoeconomics. 2012 Aug 1;30(8):729-47. doi: 10.2165/11599120-000000000-00000.

Reference Type BACKGROUND
PMID: 22788262 (View on PubMed)

Wells, A. (2009). Metacognitive Therapy for Anxiety and Depression. New York: Guilford Press

Reference Type BACKGROUND

Wells A, Matthews G. Modelling cognition in emotional disorder: the S-REF model. Behav Res Ther. 1996 Nov-Dec;34(11-12):881-8. doi: 10.1016/s0005-7967(96)00050-2.

Reference Type BACKGROUND
PMID: 8990539 (View on PubMed)

Wells A. Breaking the Cybernetic Code: Understanding and Treating the Human Metacognitive Control System to Enhance Mental Health. Front Psychol. 2019 Dec 12;10:2621. doi: 10.3389/fpsyg.2019.02621. eCollection 2019.

Reference Type BACKGROUND
PMID: 31920769 (View on PubMed)

Simonoff E, Pickles A, Charman T, Chandler S, Loucas T, Baird G. Psychiatric disorders in children with autism spectrum disorders: prevalence, comorbidity, and associated factors in a population-derived sample. J Am Acad Child Adolesc Psychiatry. 2008 Aug;47(8):921-9. doi: 10.1097/CHI.0b013e318179964f.

Reference Type BACKGROUND
PMID: 18645422 (View on PubMed)

Normann N, Morina N. The Efficacy of Metacognitive Therapy: A Systematic Review and Meta-Analysis. Front Psychol. 2018 Nov 14;9:2211. doi: 10.3389/fpsyg.2018.02211. eCollection 2018.

Reference Type BACKGROUND
PMID: 30487770 (View on PubMed)

Cooper K, Loades ME, Russell AJ. Adapting Psychological Therapies for Autism - Therapist Experience, Skills and Confidence. Res Autism Spectr Disord. 2018 Jan 1;45:43-50. doi: 10.1016/j.rasd.2017.11.002.

Reference Type BACKGROUND
PMID: 30245739 (View on PubMed)

Barlow, D. H., Nock, M., & Hersen, M. (2008). Single case research designs: Strategies for studying behaviour change.

Reference Type BACKGROUND

Other Identifiers

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320925

Identifier Type: -

Identifier Source: org_study_id

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