A Randomized Controlled Trial to Evaluate the Effect of Metaphors on Anxiety Symptoms Among Chinese Graduate Students: The Mediation Effect of Worry

Psychotherapists use metaphors frequently regardless of their orientation. However, few studies examined the unique effectiveness of metaphors on anxiety. This randomized controlled trial assigned 94 graduate students at risk of generalized anxiety disorder (GAD) into either a metaphorical group (n = 31), a literal group (n = 33), or a no-intervention control group (n = 30). The metaphorical group used metaphors in the form of metaphorical stories, whereas the literal group used literal language to present the same anxiety-related materials over four 1-hour weekly sessions. All participants received measurements assessing worry, GAD, anxiety symptoms, and life satisfaction at baseline (T1), postintervention (T2), 1-week (T3), and 4-week follow-up (T4). Participants in the two intervention groups freely recalled the four session topics at postintervention. Both the metaphorical (T3 and T4) and the literal groups (T4) significantly enhanced life satisfaction. The metaphorical group significantly alleviated anxiety symptoms (T2 and T3), while the other two groups showed no such improvements. Further, the reduction of worry from baseline to postintervention mediated the relationship between the metaphorical intervention and GAD and anxiety symptoms. The participants in the metaphorical group recalled the session topics more accurately than those in the literal group. The metaphorical intervention alleviated anxiety symptoms and enhanced life satisfaction and memory about the intervention. Worry plays a mediating role between metaphorical intervention and anxiety. Future studies should enhance metaphorical intervention’s effectiveness and explore its effects on worry and memory. © 2022, The International Society for Quality-of-Life Studies (ISQOLS) and Springer Nature B.V.