The effectiveness of metacognitive therapy on emotional distress tolerance and medication adherence in patients with generalized anxiety disorder: Clinical trial study

Background Generalized Anxiety Disorder (GAD) is one of the most common mental disorders. Current treatments often emphasize symptom reduction while neglecting key factors such as emotional distress tolerance and medication adherence. Metacognitive Therapy (MCT) provides a distinct approach by targeting maladaptive metacognitive beliefs that sustain anxiety and worry. This study aimed to evaluate the effectiveness of MCT in improving emotional distress tolerance and medication adherence among patients with GAD, with the goal of facilitating its clinical use by psychologists and psychiatrists. Method This quasi-experimental design-experimental study utilized a pre-test/post-test design with a control group. The sample included 32 outpatients aged 18–40 years diagnosed with GAD at Zareh Hospital’s psychotherapy clinic. Participants were randomly assigned to an experimental group (n = 16) and a control group (n = 16). The experimental group received eight sessions of MCT, while the control group received no intervention. Data were collected using the Generalized Anxiety Disorder Scale, the Distress Tolerance Scale, and the Medication Adherence Measure. Data analysis was performed with SPSS version 26 using MANCOVA. Results MCT significantly improved emotional distress tolerance (70.49%) and medication adherence (155.23%) in GAD patients (p < 0.001). The effect sizes were 0.797 and 0.917, respectively. Conclusion MCT effectively enhances both emotional and behavioral outcomes in GAD. Its application in clinical practice can help mental health professionals address major challenges such as distress intolerance and poor medication adherence, ultimately reducing patient distress and promoting long-term engagement in treatment. Trial registration Iranian Registry of Clinical Trials (IRCT), IRCT20231128060213N1, registered on 05 January 2024 (retrospectively registered).