Comparing the Effectiveness of Dialectical Behavior Therapy and Metacognitive Therapy on Cognitive Fusion and Self-Criticism in Women with Generalized Anxiety Disorder

Masoomeh Atashin Jabin; Alireza Zolfaghari; Mohammad Abbasi; Mehryar Anasseri

Authors

Masoomeh Atashin Jabin Department of Psychology, Ar.C., Islamic Azad University, Arak, Iran. Author https://orcid.org/0000-0002-9623-5001
Alireza Zolfaghari Department of Psychology, Tu.C., Islamic Azad University, Tuyserkan, Iran. Corresponding Author https://orcid.org/0000-0002-8183-8440
Mohammad Abbasi Department of Psychology, Ar.C., Islamic azad University, Arak, Iran. Author https://orcid.org/0000-0002-0801-148X
Mehryar Anasseri Department of Psychology, Ash.C., Islamic Azad University, Arak, Iran. Author https://orcid.org/0000-0002-1677-7012

Keywords:

Generalized Anxiety Disorder, Cognitive Fusion, Self-Criticism, Metacognitive

Abstract

Objective: This study aimed to compare the effectiveness of dialectical behavior therapy (DBT) and metacognitive therapy (MCT) in reducing cognitive fusion and self-criticism among women diagnosed with generalized anxiety disorder (GAD).

Methods and Materials: The study employed a quasi-experimental pretest–posttest control-group design with a two-month follow-up. The statistical population consisted of women diagnosed with GAD who attended Avaye Daroon and Tarannom-e Zendegi clinics in Tehran between March and May 2025. Using purposive sampling based on the study inclusion criteria, 45 eligible women were selected and randomly assigned to three groups: DBT, MCT, and control, with 15 participants in each group. The experimental groups received their respective therapeutic interventions, whereas the control group received no intervention during the study period. Data were collected at pretest, posttest, and follow-up using the Cognitive Fusion Questionnaire developed by Gillanders et al. (2014) and the Levels of Self-Criticism Scale developed by Thompson and Zuroff (2004). Inferential analyses were conducted using repeated-measures analysis of variance followed by the Bonferroni post hoc test.

Findings: Repeated-measures analysis demonstrated significant differences among the groups in changes in cognitive fusion and comparative self-criticism across the assessment phases. Bonferroni comparisons indicated that DBT produced significantly greater reductions in cognitive fusion and comparative self-criticism than MCT (p < .05). However, the difference between DBT and MCT in reducing internalized self-criticism was not statistically significant (p > .05). The therapeutic advantages observed for DBT in cognitive fusion and comparative self-criticism were maintained at the two-month follow-up assessment.

Conclusion: Both therapeutic approaches can be useful for addressing maladaptive cognitive processes in women with GAD; however, DBT appears to have greater effectiveness than MCT in reducing cognitive fusion and comparative self-criticism. Its multidimensional, skills-based emphasis may therefore provide particular clinical benefits for reducing rigid cognitive involvement and socially comparative forms of self-criticism in this population.

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