The role of metacognitive beliefs in stress sensitisation, self-esteem variability, and the generation of paranoia

A multidimensional model of memory complaints in older individuals and the associated hub regions

Memory complaints are highly prevalent among middle-aged and older adults, and they are frequently reported in individuals experiencing subjective cognitive decline (SCD). SCD has received increasing attention due to its implications for the early detection of dementia. This study aims to advance our comprehension of individuals with SCD by elucidating potential cognitive/psychologic-contributing factors and characterizing cerebral hubs within the brain network. To identify these potential contributing factors, a structural equation modeling approach was employed to investigate the relationships between various factors, such as metacognitive beliefs, personality, anxiety, depression, self-esteem, and resilience, and memory complaints. Our findings revealed that self-esteem and conscientiousness significantly influenced memory complaints. At the cerebral level, analysis of delta and theta electroencephalographic frequency bands recorded during rest was conducted to identify hub regions using a local centrality metric known as betweenness centrality. Notably, our study demonstrated that certain brain regions undergo changes in their hub roles in response to the pathology of SCD. Specifically, the inferior temporal gyrus and the left orbitofrontal area transition into hubs, while the dorsolateral prefrontal cortex and the middle temporal gyrus lose their hub function in the presence of SCD. This rewiring of the neural network may be interpreted as a compensatory response employed by the brain in response to SCD, wherein functional connectivity is maintained or restored by reallocating resources to other regions.

Do intuitive ideas of the qualities that should characterize involuntary and voluntary memories affect their classification?

It is assumed that the difference between voluntary and involuntary autobiographical memories lies in the intentionality to retrieve a memory assigned by the experimenter. Memories that are retrieved when people are instructed to do so in response to cues are considered voluntary (VAMs), those that pop up spontaneously are considered involuntary (IAMs). VAMs and IAMs so classified are also found to differ in terms of phenomenological characteristics, such as perceived accessibility, vividness etc. These differences are assumed to be due to differences in intentionality and the different retrieval processes at play. It is possible, however, that these differences (which are subjective attributions of phenomenological characteristics) are the result of metacognitive beliefs of what IAMs and VAMs should be. In two experiments, we investigated the possible role of these metacognitive beliefs. Participants rated IAMs and VAMs on a number of phenomenological characteristics in two conditions, when these memories were presented in blocks that specified whether they were retrieved in a voluntary or involuntary task, or when presented in a mixed list with no information provided. If metacognitive beliefs influence the reporting of memory properties, then the block presentation would increase the differences between the characteristics of the two types of memories. The results showed that, besides replicating the characteristics of IAMs and VAMs already observed in the literature, there were almost no differences between the blocked and the mixed lists. We discuss the results as supporting the idea that the difference in characteristics attributed to IAMs and VAMs reflect a genuine difference in the nature of the retrieval and is not the result of pre-existing metacognitive belief on what a voluntary and an involuntary memory should be.

Deconstructing the relationships between self-esteem and paranoia in early psychosis: an experience sampling study

Background

No studies have examined the association between self‐esteem and paranoia developmentally across the critical stages of psychosis emergence. The present study fills this gap and extends previous research by examining how different dimensions, measures, and types of self‐esteem relate to daily‐life paranoia across at‐risk mental states for psychosis (ARMS) and first episode of psychosis (FEP) stages. Furthermore, the moderation effects of momentary anxiety and momentary perceived social support on the association between momentary self‐esteem and paranoia were examined.

Design

This study used a multilevel, cross‐sectional design.

Methods

One‐hundred and thirteen participants (74 ARMS and 39 FEP) were assessed repeatedly over seven consecutive days on levels of momentary paranoia, self‐esteem, anxiety and perceived social support using experience sampling methodology. Measures of trait and implicit self‐esteem were also collected.

Results

Global momentary and trait self‐esteem, and their positive and negative dimensions, were related to daily‐life paranoia in both ARMS and FEP groups. Conversely, implicit self‐esteem was not associated with daily‐life paranoia in either group. Anxiety negatively moderated the association between positive self‐esteem and lower paranoia, whereas both feeling close to others and feeling cared for by others strengthened this association. However, only feeling cared for by others moderated the association between negative self‐esteem and higher paranoia.

Conclusions

Different types, measures and dimensions of self‐esteem are differentially related to paranoia in early psychosis and are influenced by contextual factors in daily‐life. This yields a more complex picture of these associations and offers insights that might aid psychological interventions.

Practitioner points

Different measures (trait and momentary) and dimensions (positive and negative) of explicit self‐esteem are distinctly related to paranoia across risk and first‐episode stages of psychosis.

Explicit, but not implicit, self‐esteem is associated with real‐life paranoia in incipient psychosis.

Anxiety boosted the association of poor self‐esteem and paranoia ideation in daily‐life.

Social closeness, but feeling cared for by others in particular, interacts with self‐esteem tempering the expression of paranoia in real life.

Metacognition, Hardiness, and Grit as Resilience Factors in Unmanned Aerial Systems (UAS) Operations: A Simulation Study

Operators of Unmanned Aerial Systems (UAS) face a variety of stress factors resulting from both the cognitive demands of the work and its broader social context. Dysfunctional metacognitions including those concerning worry may increase stress vulnerability, whereas personality traits including hardiness and grit may confer resilience. The present study utilized a simulation of UAS operation requiring control of multiple vehicles. Two stressors were manipulated independently in a within-subjects design: cognitive demands and negative evaluative feedback. Stress response was assessed using both subjective measures and a suite of psychophysiological sensors, including the electroencephalogram (EEG), electrocardiogram (ECG), and hemodynamic sensors. Both stress manipulations elevated subjective distress and elicited greater high-frequency activity in the EEG. However, predictors of stress response varied across the two stressors. The Anxious Thoughts Inventory (AnTI: Wells, 1994) was generally associated with higher state worry in both control and stressor conditions. It also predicted stress reactivity indexed by EEG and worry responses in the negative feedback condition. Measures of hardiness and grit were associated with somewhat different patterns of stress response. In addition, within the negative feedback condition, the AnTI meta-worry scale moderated relationships between state worry and objective performance and psychophysiological outcome measures. Under high state worry, AnTI meta-worry was associated with lower frontal oxygen saturation, but higher spectral power in high-frequency EEG bands. High meta-worry may block adaptive compensatory effort otherwise associated with worry. Findings support both the metacognitive theory of anxiety and negative emotions (Wells and Matthews, 2015), and the Trait-Stressor-Outcome (TSO: Matthews et al., 2017a) framework for resilience.

The effect of thought importance on stress responses: a test of the metacognitive model

Negative metacognitive beliefs are central determinants of distress in the metacognitive model of psychological vulnerability to stress. The current study tested this assertion in 75 undergraduate students assigned to either experimental (metacognitive belief manipulation) or control (no metacognitive belief manipulation) condition. All participants underwent a fake EEG, where they were told that the EEG would detect negative thoughts. The experimental subjects were informed that if they had a negative thought they may be exposed to a contingent burst of loud noise, while the control condition was told that they may be exposed to a burst of loud noise at random. Participants also underwent the Trier Social Stress Test. The results showed that on physiological measures (skin conductance level) there were no significant differences between groups. However, on self-report measures (positive and negative affect) participants in the experimental condition reported greater levels of negative affect and lower levels of positive affect in response to stress and maintained low positive affect at recovery. The results are consistent with the metacognitive model and suggest that metacognitive beliefs impact on positive and negative affect in reaction to and recovery from stress exposure.

Ecological Interventionist Causal Models in Psychosis: Targeting Psychological Mechanisms in Daily Life

Integrated models of psychotic disorders have posited a number of putative psychological mechanisms that may contribute to the development of psychotic symptoms, but it is only recently that a modest amount of experience sampling research has provided evidence on their role in daily life, outside the research laboratory. A number of methodological challenges remain in evaluating specificity of potential causal links between a given psychological mechanism and psychosis outcomes in a systematic fashion, capitalizing on longitudinal data to investigate temporal ordering. In this article, we argue for testing ecological interventionist causal models that draw on real world and real-time delivered, ecological momentary interventions for generating evidence on several causal criteria (association, time order, and direction/sole plausibility) under real-world conditions, while maximizing generalizability to social contexts and experiences in heterogeneous populations. Specifically, this approach tests whether ecological momentary interventions can (1) modify a putative mechanism and (2) produce changes in the mechanism that lead to sustainable changes in intended psychosis outcomes in individuals' daily lives. Future research using this approach will provide translational evidence on the active ingredients of mobile health and in-person interventions that promote sustained effectiveness of ecological momentary interventions and, thereby, contribute to ongoing efforts that seek to enhance effectiveness of psychological interventions under real-world conditions.

Unhelpful metacognitive beliefs in early psychosis are associated with affective symptoms and childhood social adjustment

BACKGROUND

Previous studies have shown that individuals with schizophrenia exhibit higher levels of unhelpful metacognitive beliefs than healthy controls, but no studies have explored metacognitive beliefs in early psychosis.

AIMS

We examined i) differences in levels of unhelpful metacognitive beliefs between psychosis spectrum disorders, and healthy controls, and ii) to what extent demographic and clinical characteristics predicted levels of metacognitive beliefs in the early treated phases of psychotic disorders.

METHOD

Patients were included within two years of first treatment for a psychotic disorder (N=92). They were assessed on premorbid adjustment, psychotic symptoms, anxiety/depression, and self-reported metacognitive beliefs (MCQ-30). Ninety-seven controls also completed MCQ-30. Predictors of metacognitive beliefs were explored with multiple linear regression analyses.

RESULTS

Patients scored significantly higher than controls on all metacognitive subscales except positive beliefs about worry. The regression model explained 14-38% of the variance on each metacognitive subscale. Current affective symptoms explained a significant amount of variance on all subscales, except positive beliefs about worry. Childhood (premorbid) social adjustment predicted a significant amount of the variance on all subscales, except cognitive confidence. Duration of untreated psychosis contributed significantly to more unhelpful beliefs about cognitive confidence. Negative symptoms predicted lower scores on cognitive self-consciousness.

CONCLUSION

Affective symptoms and childhood social adjustment could be important predictors of unhelpful metacognitive beliefs in the early treated phases of psychosis, indicating potential psychopathological relationships that warrant further investigation for clinical relevance.

Longitudinal relations between symptoms, neurocognition, and self-concept in schizophrenia

Objective: Cognitive models suggest that the self-concept of persons with psychosis can be fundamentally affected. Self-concepts were found to be related to different symptom domains when measured concurrently. Longitudinal investigations to disentangle the possible causal associations are rare.

Method: We examined a sample of 160 people with a diagnosis of schizophrenia who took part in a psychotherapy study. All participants had the DSM-IV diagnosis of a schizophrenia and pronounced negative symptoms. Neurocognition, symptoms, and self-concepts were assessed at two time points 12 months apart. Structural equation modeling was used to test whether symptoms influence self-concepts (scar-model) or self-concepts affect symptoms (vulnerability model).

Results: Negative symptoms correlated concurrently with self-concepts. Neurocognitive deficits are associated with more negative self-concepts 12 months later. Interpersonal self-concepts were found to be relevant for paranoia.

Conclusion: The findings implicate that if deficits in neurocognition are present, fostering a positive self-concept should be an issue in therapy. Negative interpersonal self-concept indicates an increased risk for paranoid delusions in the course of 1 year. New aspects for cognitive models in schizophrenia and clinical implications are discussed.

Testing an mHealth momentary assessment Routine Outcome Monitoring application: a focus on restoration of daily life positive mood states

BACKGROUND

Routine Outcome Monitoring (ROM) is used as a means to enrich the process of treatment with feedback on patient outcomes, facilitating patient involvement and shared decision making. While traditional ROM measures focus on retrospective accounts of symptoms, novel mHealth technology makes it possible to collect real life, in-the-moment ambulatory data that allow for an ecologically valid assessment of personalized and contextualized emotional and behavioural adjustment in the flow daily life (mROM).

METHOD

In a sample of 34 patients with major depressive disorder, treated with antidepressants, the combined effect of treatment and natural course was examined over a period of 18 weeks with Ecological Momentary Assessment (EMA). EMA consisted of repeated, within-subject, mini-measurements of experience (eg positive affect, negative affect, medication side effects) and context (eg stressors, situations, activities) at 10 unselected semi-random moments per day, for a period of six days, repeated three times over the 18-week period (baseline, week 6 and week 18).

RESULTS

EMA measures of emotional and behavioural adjustment were sensitive to the effects of treatment and natural course over the 18-week period, particularly EMA measures focussing on positive mood states and the ability to use natural rewards (impact of positive events on positive mood states), with standardized effect sizes of 0.4-0.5. EMA measures of activities, social interaction, stress-sensitivity and negative mood states were also sensitive to change over time.

CONCLUSION

This study supports the use of mROM as a means to involve the patient in the process of needs assessment and treatment. EMA data are meaningful to the patient, as they reflect daily life circumstances. Assessment of treatment response with mROM data allows for an interpretation of the effect of treatment at the level of daily life emotional and social adjustment--as an index of health, obviating the need for an exclusive focus on traditional measures of 'sickness'.

Metacognitive awareness of cognitive problems in schizophrenia: exploring the role of symptoms and self-esteem

BACKGROUND

People with a diagnosis of schizophrenia have limited metacognitive awareness of their symptoms. This is also evident for cognitive difficulties when neuropsychological assessments and self-reports are compared. Unlike for delusions and hallucinations, little attention has been given to factors that may influence the mismatch between objective and subjectively reported cognitive problems. Symptom severity, and also self-esteem and social functioning, can have an impact on cognitive problem perception and help to explain the gap between objective and subjective cognitive assessments in psychosis.

METHOD

One-hundred participants with a diagnosis of schizophrenia were recruited and assessed with a comprehensive neuropsychological battery, a measure of awareness of cognitive problems and measures of psychotic symptoms, social and behavioural functioning and self-esteem. Regression was used to investigate the influence of symptoms, social functioning and self-esteem, and patients with different levels of cognitive problem awareness were contrasted.

RESULTS

Simple correlation analysis replicated the lack of association between objective cognitive measures and metacognitive awareness of cognitive problems. However, the results of the regression analyses highlight that self-esteem and negative symptoms predict metacognitive awareness. When significant predictors were controlled, individuals with better awareness had more impaired working memory but higher IQ.

CONCLUSIONS

Poor self-esteem and high negative symptoms are negatively associated with metacognitive awareness in people with schizophrenia. Interventions that aim to improve cognition should consider that cognitive problem reporting in people with schizophrenia correlates poorly with objective measures and is biased not only by symptoms but also by self-esteem. Future studies should explore the causal pathways using longitudinal designs.

The relevance of self-esteem and self-schemas to persecutory delusions: a systematic review

BACKGROUND

Self-esteem is frequently targeted in psychological approaches to persecutory delusions (PD). However, its precise role in the formation and maintenance of PD is unclear and has been subject to a number of theories: It has been hypothesized that PD function to enhance self-esteem, that they directly reflect negative conceptualizations of the self, that self-esteem follows from the perceived deservedness of the persecution (poor-me versus bad-me-paranoia) and that the temporal instability of self-esteem is relevant to PD. In order to increase our understanding of the relevance of self-esteem to PD, this article systematically reviews the existing research on self-esteem in PD in the light of the existing theories.

METHODS

We performed a literature search on studies that investigated self-esteem in PD. We included studies that either investigated self-esteem a) within patients with PD or compared to controls or b) along the continuum of subclinical paranoia in the general population. We used a broad concept of self-esteem and included paradigms that assessed implicit self-esteem, specific self-schemas and dynamic aspects of self-esteem.

RESULTS

The literature search identified 317 studies of which 52 met the inclusion criteria. The reviewed studies consistently found low global explicit self-esteem and negative self-schemas in persons with PD. The studies therefore do not support the theory that PD serve to enhance self-esteem but underline the theory that they directly reflect specific negative self-schemas. There is evidence that low self-esteem is associated with higher perceived deservedness of the persecution and that PD are associated with instable self-esteem. Only few studies investigated implicit self-esteem and the results of these studies were inconsistent.

CONCLUSIONS

We conclude by proposing an explanatory model of how self-esteem and PD interact from which we derive clinical implications.

Cognitive-self consciousness and metacognitive beliefs: Stress sensitization in individuals at ultra-high risk of developing psychosis

OBJECTIVE

Metacognitive beliefs (MCB) may guide information and attention processes, increasing affective and symptomatic reactions to stressful events. Cognitive self-consciousness (CSC; i.e., a preoccupation with one's thoughts) may increase awareness of MCB, potentially triggering the onset of psychotic symptoms. This study tested the hypotheses that (1), MCB would moderate affective and symptomatic reactions to stress in individuals at ultra-high risk (UHR) of developing psychosis, and (2), greater CSC would precede worsening in psychotic symptoms in individuals with strong MCB.

METHOD

Twenty-seven individuals at UHR of developing psychosis completed a self-report diary when prompted by an electronic wristwatch several times each day for 6 days (experience sampling).

RESULTS

MCB moderated the association between affective, but not symptomatic, responses to social stress. CSC preceded the subsequent occurrence of hallucinations in individuals who reported strong beliefs about the need to control their thoughts.

CONCLUSIONS

The data suggest that MCB sensitize an individual to social stressors. CSC may represent times where an individual is aware that their thoughts are uncontrollable, and therefore contradicting their MCB, motivating them to make an external attribution. The findings have implications for improving the effectiveness of interventions for people experiencing hallucinations.