Introduction

A nxiety disorders, with a prevalence of about 5 to 25%, be considered the most common disorders in children and adolescents [2], which, if not treated, will have serious consequences throughout life. It is necessary to design treatments to reduce them. For example, these disorders are related to a variety of emotional and externalized disorders such as depression, substance abuse, etc[3,4]. For this reason and considering the severe consequences of anxiety, it is necessary to understand the effective factors in the occurrence of these disorders and design treatments to reduce them [4,5].

The concept of metacognition means personal awareness of one's own cognitive processes, that is, thinking about thinking, monitoring and controlling thoughts and responding to them through this monitoring and control [7,8]. studies show that it is one of the factors affecting anxiety disorders in children [3]. For example, compared to non-anxious children, anxious children usually report higher levels of positive and negative metacognitive beliefs [10,11]. studies also show that change in metacognitions is an important predictor in the treatment of psychological disorders. For example, changes in metacognitions play an important role in improving the symptoms of patients suffering from social phobia and other anxiety disorders [3,12]. Worry also means future-oriented thoughts about how to deal with upcoming demands and challenges, and the evidence indicates that these recurring negative thoughts are related to anxiety [3].

In the field of treatment, cognitive behavioral therapies have been used as effective treatments for the treatment of children's anxiety and their effectiveness has been proven [14].

Therefore, according to the mentioned issues, the current research aims to investigate whether school-based cognitive behavioral therapy has the ability to be effective on metacognitive beliefs and worry as well as anxiety symptoms in anxious children?

Materials and Methods: The present study was a Single-subject study with Multiple Baseline. The statistical sample of this study included all children aged 9 to 13 referred to the health centers of Qom city and according to the research literature in the field of single subject designs, 3 subjects were considered for the implementation of the treatment protocol.

at the same time, coordination were made with the Deputy of Research and Technology of Qom University of Medical Sciences in order to obtain permission to implement the treatment protocol in children referring to the health centers of Qom city, and 3 anxious children were clinically interviewed and the treatment protocol was based on It was run on them.

Data was collected using the Kiddie schedule for Affective Disorder and Schizophrenia- Present and Lifetime Version (K-SADS-PL), Metacognitions Questionnaire in Children (MCQ-C), Spence Children's Anxiety Scale (SCAS) and The Penn State Worry Questionnaire for Children (PSWQ-C). The treatment protocol included 8 weekly individual sessions with children and 2 sessions with parents too. Data was analyzed using visual analysis, percentage of improvement and effect size (Cohen's d).

Results: The amount of change in metacognitive beliefs, worry and anxiety of all three subjects is shown in graphs 1,2 and 3. The findings indicate that this treatment has reduced the amount of metacognitive beliefs, worry and anxiety in all three subjects.

Metacognitive beliefs have also started to decrease with the start of treatment in all three subjects, so that the metacognitive beliefs of the second subject has changed from (61) to (51). The second subject showed this decrease in worry (22 to 12). the results of Table 1 show that school-based cognitive behavioral therapy with the effect size (d=3.73) and (d=4.17) in an effective therapy in reducing metacognitive beliefs and worry.

Conclusion: The aim of the current study was to investigate the effectiveness of school-based cognitive behavioral therapy on improving attentional control and reducing attention bias towards threats in children. The results of this study, in line with previous studies [14,22,23,24], showed that this treatment is an effective treatment in reducing metacognitive beliefs, worry and anxiety symptoms. In explaining the effectiveness of school-based cognitive-behavioral therapy, it can be said that the use of a variety of coping and cognitive restructuring strategies, anxiety surfing and social skills training techniques to identify and change non-adaptive thought patterns that affect emotions and behavior and identify relationships Thinking and feeling as important factors of vulnerability to anxiety disorders are one of the reasons for the effectiveness of this treatment[14].

Keywords: School-Based Cognitive-Behavioral Therapy, Attention, Attentional Control, Attention Bias, Anxiety disorders

Research limitations: This research was also associated with limitations. First, the results confirm the initial applicability of this treatment in children, but due to the small sample size, the generalization of the results should be done with caution, and more research in clinical samples is necessary to confirm this effectiveness. Also, according to the findings of this research, it is recommended to use this treatment protocol in order to reduce the metacognitive beliefs in public and private counseling centers.

Ethical Considerations

Compliance with ethical guidelines

The ethical principles observed in the article, such as the informed consent of the participants, the confidentiality of information, the permission of the participants to cancel their participation in the research. Ethical approval was obtained from the Research Ethics Committee of the Qom University of Medical Sciences. (IR.MUQ.REC.1400.058).

Funding

This study was extracted from the Ph.D. thesis of Corresponding Author and has no financial support.

Authors' contribution

Authors contributed equally in preparing this article.

Conflict of interest

The authors declared no conflict of interest.