1- Faculty of Welfare and Health Social Sciences, Tehran Branch, Islamic Azad University Medical Sciences, Tehran, Iran 2- Nowshahr Branch, Payame Noor University, Nowshahr, Iran 3- Ardabil Branch, Islamic Azad University, Ardabil, Iran
Abstract: (782 Views)
Background and Purpose: Anxiety disorders in children are among the most prevalent mental health issues, with widespread negative impacts on their emotional, cognitive, and social development. These disorders can significantly disrupt children's academic performance and interpersonal relationships. The present study was conducted to examine the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) on metacognition, depression, and self-concept in children showing symptoms of anxiety disorders. Method: This quasi-experimental study employed a pretest-posttest control group design. The statistical population consisted of childrenwith anxiety disorders aged 10 to 15 in District 6 of Tehran Province in 2024. A purposive sampling method was used to select thirty-six children, who were then randomly assigned to experimental and control groups. Data collection instruments included the Spence Children’s Anxiety Scale (SCAS; Spence, 1997), the Metacognitions Questionnaire for Children (MQC; Bacow et al, 2009), the Children Depression Inventory (CDI; Kovacs et al, 1997), and the Children’s Self-Concept Scale (CSCS; Piers & Harris, 1969). The experimental group received eight 90-minute sessions of MBCT based on the protocol by Segal et al. (2012). Data was analyzed using multivariate analysis of covariance in SPSS 27. Results: Findings showed that MBCT significantly improved positive beliefs about worry (F=32.41), negative beliefs about worry (F=33.40), cognitive monitoring (F=51.94), and components of suspicion, punishment, and responsibility (F=49.81). It also led to a significant increase in self-concept (F=43.76) and a decrease in depressive symptoms (F=53.27) among children with symptoms of anxiety disorders (p< 0.01). Conclusion: Based on the findings of this study, it can be concluded that MBCT, through emphasizing awareness of thoughts and non-judgmental acceptance, led to a reduction in dysfunctional metacognitive beliefs and better emotion regulation. Therefore, this approach is recommended for psychological interventions targeting children with anxiety disorders.
Type of Study: Research |
Subject: General Received: 2025/05/23 | Accepted: 2025/07/6 | Published: 2025/07/16
References
1. Rapee RM, Creswell C, Kendall PC, Pine DS, Waters AM. Anxiety disorders in children and adolescents: A summary and overview of the literature. Behavior Research and Therapy. 2023; 168:104376. [Link] [DOI:10.1016/j.brat.2023.104376]
2. Brookman R, Bird F, Harris CB, Grant KA. Social anxiety disorder: associations with peer-liking, discrimination, and prejudicial feelings in early adolescent girls. Child Psychiatry & Human Development. 2023;54(5):1231-41. [Link] [DOI:10.1007/s10578-022-01336-5]
3. Dona SW, McKenna K, Ho TQ, Mudiyanselage SB, Seymour M, Le H, Gold L. Health-related quality of life, service utilisation and costs for anxiety disorders in children and young people: a systematic review and meta-analysis. Social Science & Medicine. 2025:118023. [Link] [DOI:10.1016/j.socscimed.2025.118023]
4. Steinsbekk S, Ranum B, Wichstrøm L. Prevalence and course of anxiety disorders and symptoms from preschool to adolescence: A 6‐wave community study. Journal of Child Psychology and Psychiatry. 2022;63(5):527-34. [Link] [DOI:10.1111/jcpp.13487]
5. Salari N, Heidarian P, Hassanabadi M, Babajani F, Abdoli N, Aminian M, Mohammadi M. Global prevalence of social anxiety disorder in children, adolescents, and youth: a systematic review and meta-analysis. Journal of Prevention. 2024;45(5):795-813. [Link] [DOI:10.1007/s10935-024-00789-9]
6. Vishwanathan A, Kashyap H, Reddy RP, Philip M, Thippeswamy H, Desai G. Neurocognition and metacognition in anxiety disorders. Indian Journal of Psychological Medicine. 2022;44(6):558-66. [Link] [DOI:10.1177/02537176211072408]
7. Nordahl H, Vollset T, Hjemdal O. An empirical test of the metacognitive model of generalized anxiety disorder. Scandinavian Journal of Psychology. 2023;64(3):263-7. [Link] [DOI:10.1111/sjop.12884]
8. Köcher LM, Schlömer-Böttner S, Christiansen H. Metacognitive transmission between parents and children in the context of anxiety disorders. Child Psychiatry & Human Development. 2025;56(2):507-19. [Link] [DOI:10.1007/s10578-023-01577-y]
9. Ünal‐Aydın P, Özkan Y, Öztürk M, Aydın O, Spada MM. The role of metacognitions in cyberbullying and cybervictimization among adolescents diagnosed with major depressive disorder and anxiety disorders: A case-control study. Clinical Psychology & Psychotherapy. 2023;30(3):659-70. [Link] [DOI:10.1002/cpp.2826]
10. Köcher LM, Pflug V, Schneider S, Christiansen H. Do metacognitions of children and adolescents with anxiety disorders change after intensified exposure therapy? Children. 2022;9(2):168. [Link] [DOI:10.3390/children9020168]
11. Gleason MM, Thompson LA. Depression and anxiety disorders in children and adolescents. JAMA Pediatrics. 2022;176(5):532. [Link] [DOI:10.1001/jamapediatrics.2022.0052]
12. Śniadach J, Szymkowiak S, Osip P, Waszkiewicz N. Increased depression and anxiety disorders during the COVID-19 pandemic in children and adolescents: a literature review. Life. 2021;11(11):1188. [Link] [DOI:10.3390/life11111188]
13. Narmandakh A, Roest AM, de Jonge P, Oldehinkel AJ. Psychosocial and biological risk factors of anxiety disorders in adolescents: a TRAILS report. European child & adolescent psychiatry. 2021;30(12):1969-82. [Link] [DOI:10.1007/s00787-020-01669-3]
14. Bandelow B, Allgulander C, Baldwin DS, Costa DL, Denys D, Dilbaz N, Domschke K, Eriksson E, Fineberg NA, Hättenschwiler J, Hollander E. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for treatment of anxiety, obsessive-compulsive, and posttraumatic stress disorders-Version 3. Part I: Anxiety disorders. The World Journal of Biological Psychiatry. 2023;24(2):79-117. [Link] [DOI:10.1080/15622975.2022.2086295]
15. Tanrıverdi Ç, Başay Ö, Kara İ, Demirdöğen EY, Özgeriş FB, Akgül BN. Elevated serum angiotensin ii levels in children and adolescents with anxiety disorders. Psychoneuroendocrinology. 2025; 176:107430. [Link] [DOI:10.1016/j.psyneuen.2025.107430]
16. Mills JA, Mendez E, Strawn JR. The impact of development on antidepressant and placebo response in anxiety disorders: A bayesian hierarchical meta-analytic examination of randomized controlled trials in children, adolescents, and adults. Journal of Child and Adolescent Psychopharmacology. 2024;34(7):302-9. [Link] [DOI:10.1089/cap.2024.0016]
17. Brumariu LE, Waslin SM, Gastelle M, Kochendorfer LB, Kerns KA. Anxiety, academic achievement, and academic self-concept: Meta-analytic syntheses of their relations across developmental periods. Development and psychopathology. 2023;35(4):1597-613. [Link] [DOI:10.1017/S0954579422000323]
18. Morales A, Rodríguez‐Menchón M, Espada JP, Orgilés M. Examining academic self‐concept as a mediator of the relationship between anxiety and depression: A longitudinal study. Child and adolescent mental health. 2023;28(3):354-62. [Link] [DOI:10.1111/camh.12577]
19. Almis H, Orhon FŞ, Bolu S, Almis BH. Self-concept, depression, and anxiety levels of adolescents with polycystic ovary syndrome. Journal of pediatric and adolescent gynecology. 2021;34(3):311-6. [Link] [DOI:10.1016/j.jpag.2020.12.011]
20. Melamed DM, Botting J, Lofthouse K, Pass L, Meiser-Stedman R. The relationship between negative self-concept, trauma, and maltreatment in children and adolescents: A meta-analysis. Clinical child and family psychology review. 2024;27(1):220-34. [Link] [DOI:10.1007/s10567-024-00472-9]
21. Zhou J, Zou F, Gong X. The reciprocal relations between parental psychological control and social anxiety and the mediating role of self-concept clarity among Chinese early adolescents. Journal of Youth and Adolescence. 2024;53(10):2363-77. [Link] [DOI:10.1007/s10964-024-02015-5]
22. Syeda MM, Andrews JJ. Mindfulness-Based cognitive therapy as a targeted group intervention: Examining children's changes in anxiety symptoms and mindfulness. Journal of Child and Family Studies. 2021; 30:1002-15. [Link] [DOI:10.1007/s10826-021-01924-4]
23. Cotton S, Kraemer KM, Sears RW, Strawn JR, Wasson RS, McCune N, Welge J, Blom TJ, Durling M, Delbello MP. Mindfulness‐based cognitive therapy for children and adolescents with anxiety disorders at‐risk for bipolar disorder: A psychoeducation waitlist-controlled pilot trial. Early intervention in psychiatry. 2020;14(2):211-9. [Link] [DOI:10.1111/eip.12848]
24. Shetty R, Kongasseri S, Rai S. Efficacy of mindfulness based cognitive therapy on children with anxiety. Journal of Cognitive Psychotherapy. 2020;34(4):306-18. [Link] [DOI:10.1891/JCPSY-D-20-00014]
25. Peter A, Srivastava R, Agarwal A, Singh AP. The effect of mindfulness-based cognitive therapy on anxiety and resilience of the school going early adolescents with anxiety. Journal of Indian Association for Child and Adolescent Mental Health. 2022;18(2):176-85. [Link] [DOI:10.1177/09731342221127959]
26. Tang G, Chen B, Wu M, Sun L, Fan R, Hou R, Liu W, Kang J, Li Y, Wang M, Zhang Y. Effectiveness of mindfulness-based cognitive therapy for treating generalized anxiety disorder and the moderating influence of abuse during childhood: A randomized controlled trial. Journal of Affective Disorders. 2025; 379:510-8. [Link] [DOI:10.1016/j.jad.2025.02.103]
27. Loftus T, Mathersul DC, Ooi M, Yau SH. The efficacy of mindfulness-based therapy for anxiety, social skills, and aggressive behaviors in children and young people with autism spectrum disorder: a systematic review. Frontiers in Psychiatry. 2023; 14:1079471. [Link] [DOI:10.3389/fpsyt.2023.1079471]
28. Segal ZV, Dimidjian S, Beck A, Boggs JM, Vanderkruik R, Metcalf CA, Gallop R, Felder JN, Levy J. Outcomes of online mindfulness-based cognitive therapy for patients with residual depressive symptoms: a randomized clinical trial. JAMA Psychiatry. 2020;77(6):563-73. [Link] [DOI:10.1001/jamapsychiatry.2019.4693]
29. Taylor A, Wright K, Roberts RM, Proeve M, Turner J, Miller C. Prevention of internalizing difficulties in the middle years: Protocol for a noninferiority randomized trial of Mindfulness‐Based Cognitive Therapy for Children and Cognitive Behavioural Therapy. Early Intervention in Psychiatry. 2024;18(7):547-52. [Link] [DOI:10.1111/eip.13501]
30. Weintraub MJ, Denenny D, Ichinose MC, Zinberg J, Morgan-Fleming G, Done M, Brown RD, Bearden CE, Miklowitz DJ. A randomized trial of telehealth mindfulness-based cognitive therapy and cognitive behavioral therapy groups for adolescents with mood or attenuated psychosis symptoms. Journal of consulting and clinical psychology. 2023;91(4):234. [Link] [DOI:10.1037/ccp0000782]
31. Aldiqs M, Mansour AH, Nowwara A, Alhusamiah B, Abuhashish YH, Amer NR. Using mindfulness-based cognitive therapy to reduce anxiety symptoms among individuals diagnosed with substance use disorder. Advances in Dual Diagnosis. 2025;18(1):14-25. [Link] [DOI:10.1108/ADD-09-2024-0028]
32. Sheykhangafshe FB, Abbaspour A, Savabi Niri V, Bikas Yekani M, Keramati S. The effectiveness of mindfulness-based cognitive therapy (MBCT) on alexithymia, pain intensity, and emotional regulation in children with irritable bowel syndrome. J Child Ment Health 2024; 11(2): 6. [Persian] [Link] [DOI:10.61186/jcmh.11.2.7]
33. Spence SH. Structure of anxiety symptoms among children: a confirmatory factor-analytic study. Journal of Abnormal Psychology. 1997 ;106(2):280. [Link] [DOI:10.1037//0021-843X.106.2.280]
34. Nosouhi Dehnavi M, Ghazanfari A, Ahmadi R. Comparison of the Effectiveness of Kendall's Coping Cat Group Program and Parent Management Training on Anxiety and Resilience of Elementary School Students. J Child Ment Health 2023; 9 (4):11. [Persian] [Link] [DOI:10.61186/jcmh.9.4.12]
35. Bacow TL, Pincus DB, Ehrenreich JT, Brody LR. The metacognitions questionnaire for children: Development and validation in a clinical sample of children and adolescents with anxiety disorders. Journal of Anxiety Disorders. 2009;23(6):727-36. [Link] [DOI:10.1016/j.janxdis.2009.02.013]
36. Golmohammadi K, Aflakseir A, Imani M, Hadianfard H. The Investigation of Psychometric Properties of the Metacognitions Questionnaire in 9-13-Year-Old Children. Qom Univ Med Sci J. 2022; 16 (7):592-601. [Persian] [Link] [DOI:10.32598/qums.16.7.2714.1]
37. Kovacs M, Obrosky DS, Gatsonis C, Richards C. First-episode major depressive and dysthymic disorder in childhood: Clinical and sociodemographic factors in recovery. Journal of the American Academy of Child & Adolescent Psychiatry. 1997;36(6):777-84. [Link] [DOI:10.1097/00004583-199706000-00014]
38. Dehshiri GH, Najafi MA, Shikhi M, Habibi Askarabad M. Investigating primary psychometric properties of children's depression inventory (CDI). J Fam Res. 2009;5(2):159-77. [Persian] [Link]
39. Piers E, Harris D. Children's Self Concept Scale. Nashville, Tenn.: Counselor Recordings and Tests. 1969. [Link]
40. Mohammadi Y, Savabi Niri V, Shayanfar S. The Effectiveness of Child-Centered Mindfulness Therapy on Emotion Regulation and Self-Concept Improvement in Children with Divorced Parents. J Child Ment Health 2023; 10 (2): 4. [Persian] [Link] [DOI:10.61186/jcmh.10.2.5]
41. Segal Z, Williams M, Teasdale J. Mindfulness-based cognitive therapy for depression. Guilford Press; 2012. [Link]
Mazaheri M, Saeedi Farid N, Asgari Toorzani N, Habashi Varnosfaderani F, Rahimi Niyar P. The effectiveness of mindfulness-based cognitive therapy on metacognition, depression, and self-concept of children with anxiety disorders. J Child Ment Health 2025; 12 (2) : 1 URL: http://childmentalhealth.ir/article-1-1504-en.html