Metacognitive beliefs and their relationship with anxiety and depression in physical illnesses: A systematic review

Exploring potential influencing factors of inadherence to specialist aftercare and long-term medication in patients with acromegaly

PURPOSE

To improve the understanding of adherence as one major factor of disease control in acromegaly patients, we systematically assessed patients' motivations to adhere to advised follow-up schedules and recommended medication for acromegaly.

METHODS

Cross-sectional, postal questionnaire study on adult patients with acromegaly, operated upon a growth hormone producing pituitary adenoma more than 1 year ago in two tertiary treatment centers. We assessed demographic and clinical characteristics, disease status, adherence to acromegaly medication and/or aftercare, and the five dimensions defined by the World Health Organization influencing adherence. Wherever applicable, we included validated short scales. The answers of 63 patients (33 f, 30 m; mean age 56.1 y) were analyzed.

RESULTS

Patients with problems in adherence to aftercare had a significantly lower subjective symptomload than those adherent to aftercare (p = 0.026) and a lower perceived need for treatment (p = 0.045). Patients with adherence problems to medication had a higher subjective symptomload than those without (p = 0.056). They also tended to have shorter consultations, were significantly more often dissatisfied with the duration of their medical consultations (42% vs 4.8%, p = 0.019) and tended to find that their physician explained potential difficulties with adherence less well than patients without adherence problems (p = 0.089).

CONCLUSIONS

To our knowledge, this is the first study which explored adherence to medication and aftercare in patients with acromegaly, taking into account potential influencing factors from all areas defined by the WHO model of adherence. Of the modifiable factors of adherence, patient-doctor relationship seemed to play a crucial role and could be one leverage point to improve adherence.

Patterns of cognitive-emotional change after cognitive-behavioural treatment in emotional disorders: A 12-month longitudinal cluster analysis

INTRODUCTION

The aim of this study was to use cluster analysis based on the trajectory of five cognitive-emotional processes (worry, rumination, metacognition, cognitive reappraisal and expressive suppression) over time to explore differences in clinical and performance variables in primary care patients with emotional symptoms.

METHODS

We compared the effect of adding transdiagnostic cognitive-behavioural therapy (TD-CBT) to treatment as usual (TAU) according to cluster membership and sought to determine the variables that predicted cluster membership. 732 participants completed scales about cognitive-emotional processes, anxiety and depressive symptoms, functioning, and quality of life (QoL) at baseline, posttreatment, and at 12 months. Longitudinal cluster analysis and logistic regression analyses were carried out.

RESULTS

A two-cluster solution was chosen as the best fit, named as "less" or "more" improvement in cognitive-emotional processes. Individuals who achieved more improvement in cognitive-emotional processes showed lower emotional symptoms and better QoL and functioning at all three time points. TAU+TD-CBT, income level, QoL and anxiety symptoms were significant predictors of cluster membership.

CONCLUSIONS

These results underscore the value of adding TD-CBT to reduce maladaptive cognitive-emotional regulation strategies. These findings highlight the importance of the processes of change in therapy and demonstrate the relevance of the patient's cognitive-emotional profile in improving treatment outcomes.

Association of Rumination and Metacognition with Posttraumatic Growth in Parents of Children with Cancer

OBJECTIVE

The primary objective of this study was to examine the association of rumination, metacognition, and posttraumatic with growth in parents of children diagnosed with cancer.

DATA SOURCES

The study adopted a descriptive correlational design, and participants (N = 103) were parents of children with cancer. The study was conducted online through the social media platforms of three cancer associations. Data were collected using the Metacognitions Questionnaire-30, the Event Related Rumination Inventory, and the Posttraumatic Growth Inventory.

CONCLUSION

The findings revealed a positive correlation between deliberate rumination and metacognition with posttraumatic growth, while a negative correlation was observed between intrusive rumination and posttraumatic growth. Furthermore, deliberate rumination, intrusive rumination, and metacognition collectively accounted for 30% of the variance in posttraumatic growth among parents of children with cancer. These results underscore the significant influence of rumination and metacognition in facilitating posttraumatic growth in this specific population. Consequently, interventions aimed at fostering deliberate rumination hold substantial potential for promoting posttraumatic growth among parents of children diagnosed with cancer.

IMPLICATIONS FOR NURSING PRACTICE

This research guides nurses in addressing rumination, metacognition, and posttraumatic growth in parents of children with cancer. By adopting a holistic approach, nurses can enhance parents' well-being and resilience in the face of a child's cancer diagnosis.

The Relationship Between Mental health, Metacognition, and Emotion Regulation in Older People

OBJECTIVES

It is unclear if using emotion regulation strategies can help manage the effects of anxiety and depression on metacognitive strategies in older people. This study aimed to verify the effect of emotion regulation in the interaction between mental disorders and metacognition.

METHODS

A mediation analysis was performed to assess the role of emotion regulation in the interaction between mental disorders and metacognition in older people.

RESULTS

Without mediator control, higher scores indicating mental disorder are associated with reduced metacognition scores. When mediators are added to the model, the mediation effect was significant. An indirect effect of anxiety and depression on metacognition was mediated by cognitive reappraisal to a greater extent than emotional suppression.

CONCLUSIONS

Cognitive reappraisal reduced the impact of anxiety and depression on metacognition in older adults.

CLINICAL IMPLICATIONS

Including cognitive reappraisal techniques in anxiety and depression intervention plans can be beneficial for improving older people's metacognition functioning.

Emotion dysregulation and Internet gaming disorder in young people: Mediating effects of negative affect and metacognitions

BACKGROUND

Recent studies have found that emotion dysregulation, negative affect, and metacognitions about online gaming are risk factors for Internet gaming disorder (IGD). However, few studies investigated the mechanisms underlying these interactions. The present study aimed to explore the relationships between emotion dysregulation and IGD, and the mediating effects of negative affect and metacognitions about online gaming.

METHODS

An online survey was conducted with young people (aged 10-24 years) who played video games. 1768 participants were included in this study. Observed variables, including emotion dysregulation, IGD, depression, anxiety, and metacognitions, were measured with self-report scales. Structural equation modeling (SEM) was used to analyze the relationships among the variables.

RESULTS

The results showed that emotion dysregulation positively predicted IGD through a fully mediated model which included the independent mediating effects of negative affect and metacognitions about online gaming and their sequential mediating effect. The model explained 76.1 % of the variance in IGD.

LIMITATIONS

This was a cross-sectional study which could not infer causality.

CONCLUSIONS

This study emphasizes that negative affect and metacognitions about online gaming mediate the effect of emotion dysregulation on IGD; moreover, metacognition may be a proximal factor of IGD. Thus, improving emotional regulation and modifying maladaptive metacognitions in young people may improve the prevention and treatment of IGD.

A multi-study examination of the relevance of the metacognitive beliefs about uncontrollability in emotion regulation and clinical symptoms

Transdiagnostic approaches to psychopathology have postulated that factors related to perceived control are particularly relevant to mental health. Here we focused on a specific perceived control-related construct: metacognitive beliefs about uncontrollability. Evidence suggests that dysfunctional metacognitive beliefs play a role in the activation and maintenance of maladaptive emotion regulation strategies and emotional distress. Metacognitive beliefs about the uncontrollability and danger of worry are the most strongly associated with psychopathology. In this multi-study research, we hypothesized that metacognitive beliefs about uncontrollability make a specific contribution to emotion regulation strategies and clinical symptoms. We tested our hypotheses in four different studies, both cross-sectionally and longitudinally (N = 2224). Participants completed measures of metacognitive beliefs, maladaptive strategies (e.g., worry, thought suppression), and clinical symptoms (e.g., generalized anxiety, emotional distress, depressive and anxiety symptoms). Our results showed that uncontrollability beliefs were the strongest variable associated with maladaptive emotion regulation strategies and clinical symptoms (cross-sectionally), and the only ones that predicted them in the long term. We discuss the theoretical and clinical implications of these results in the light of the metacognitive model and control-related theories.

Metacognitions in patients with chronic obstructive pulmonary disease: a psychometric study of the metacognitions questionnaire-30

The metacognitions questionnaire-30 (MCQ-30) was developed for the assessment of metacognitive beliefs and processes that are central components of the metacognitive model of emotional disorders. Anxiety and depression commonly occur in patients with chronic obstructive pulmonary disease (COPD). Testing such a model for anxiety and depression in patients with COPD is warranted. However, the psychometric properties of the MCQ-30 in COPD patients are unknown. Therefore, in this study we aimed to examine these properties in COPD patients. The MCQ-30 was administered to 203 COPD patients referred to a rehabilitation unit in respiratory medicine. Confirmatory factor analysis (CFA) was used to test the five-factor as well as the bi-factor models of MCQ-30. Exploratory factor analyses were also performed. Both models did not meet the criteria for an acceptable fit on Comparative Fit Index (CFI) of 0.810 and 0.858 vs. criterion of ≥0.9, but the Root Mean Square Error of Approximation (RMSEA) criterion ≤0.08 was acceptable for both models with RMSEA = 0.074 and 0.066, respectively. The factors were mostly moderately correlated (0.41-0.58) with acceptable reliability coefficients (0.73-0.87). The exploratory factor analysis identified three of the five factors originally described in the five-factor model of the MCQ-30. These data show that the factor structure of the MCQ-30 appears to differ from that of the original instrument in COPD patients and further studies are needed to confirm its validity and reliability in this patient group.

A scale to measure the worry level in Gastrointestinal Endoscopy with sedation: Development, reliability, and validity

Objective

This study aims to develop a scale to measure the worry level of patients who will undergo gastrointestinal (GI) endoscopy with deep sedation, and to provide scientific references to alleviate their worries.

Method

Based on literature review, panel discussion, patient interview and expert consultation, we developed the first version of the scale. After two pre-investigations, the formal version of the scale was formed, and the reliability and validity were tested on 1389 respondents. Reliability was assessed by Cronbach's alpha. Construct validity was tested by confirmatory factor analysis (CFA) and the Spearman correlations analysis.

Results

The scale was composed of four dimensions: financial and time costs, sedation, examination, and psychology. It has 15 items. Reliability and validity were acceptable. The Cronbach's alpha of the whole scale was 0.959 and all the factor loadings were > 0.50. The Spearman correlations of the inter-dimensions ranged from 0.614 to 0.836, and the correlation coefficients between the dimensions and the total score were 0.795 to 0.957. The correlation coefficient between the total scale score and the APAIS was 0.833.

Conclusions

This scale has good validity and reliability, which is useful for physicians and medical institutions to take appropriate measures to reduce patients' worries.

Worry, rumination and negative metacognitive beliefs as moderators of outcomes of Transdiagnostic group cognitive-behavioural therapy in emotional disorders

BACKGROUND

Despite the relevance of cognitive processes such as rumination, worry, negative metacognitive beliefs in emotional disorders, the existing literature about how these cognitive processes moderate the effect of treatment in treatment outcomes is limited. The aim of the present study was to explore the potential moderator effect of baseline cognitive processes-worry, rumination and negative metacognitive beliefs-on the relationship between treatment allocation (transdiagnostic cognitive-behavioural therapy -TD-CBT plus treatment as usual-TAU vs. TAU alone) and treatment outcomes (anxiety and depressive symptoms, quality of life [QoL], and functioning) in primary care patients with emotional disorders.

METHODS

A total of 631 participants completed scales to evaluate worry, rumination, negative metacognitive beliefs, QoL, functioning, and anxiety and depressive symptoms.

RESULTS

Worry and rumination acted as moderators on the effect of treatment for anxiety (b = -1.25, p = .003; b = -0.98, p = .048 respectively) and depressive symptoms (b = -1.21, p = .017; b = -1.34, p = .024 respectively). Individuals with higher baseline levels of worry and rumination obtained a greater reduction in emotional symptoms from the addition TD-CBT to TAU. Negative metacognitive beliefs were not a significant moderator of any treatment outcome.

LIMITATIONS

The study assesses cognitive processes over a relatively short period of time and uses self-reported instruments. In addition, it only includes individuals with mild or moderate anxiety or depressive disorders, which limits generalization to other populations.

CONCLUSIONS

These results underscore the generalization of the TD-CBT to individuals with emotional disorders in primary care with different cognitive profiles, especially those with high levels of worry and rumination.

Relationship Between Post-Traumatic Stress Symptoms and Caregiver Burden In Breast Cancer Patients: The Mediating Role of Anxiety and Depression

Breast cancer impacts not only the physical and mental health of patients but also the people around them-especially their caregivers. This study examined the relationship between post-traumatic stress symptoms (PTSS) and caregiver burden in breast cancer patients through the mediating pathway of anxiety and depression.

METHODS

A total of 236 breast cancer patients from China completed the Chinese Version of the Posttraumatic Stress Disorder Symptom Scale (PSS), the Chinese version of the Patient Health Questionnaire (PHQ-9), the Chinese version of the General Anxiety Symptoms Scale (GAD-7). In addition, caregivers of these breast cancer patients were surveyed by the Caregiver Self-Assessment Questionnaire (CSAQ).

RESULTS

Structural equation model showed that our model fitted well [χ2 /df = 1.966, TLI = 0.959, CFI = 0.994, RMSEA (90% CI) = 0.065 (0-0.12)] and revealed that anxiety, but not depression, mediated the relationship between PTSS in breast cancer patients and caregiver burden.

CONCLUSION

The level of PTSS was positively correlated with anxiety and depression in breast cancer patients, and the level of anxiety and depression was positively related to caregiver burden. The PTSS of patients positively predicted caregiver burden and this relationship appears to be mediated by the patient's anxiety.

Do metacognitive beliefs predict rumination and psychological distress independently of illness representations in adults with diabetes mellitus? A prospective mediation study

OBJECTIVE

Adults with Diabetes Mellitus (DM) experience high levels of depression and anxiety that are not always effectively ameliorated by current therapeutic approaches. The Self-Regulatory Executive Function (S-REF) model, which underpins metacognitive therapy (MCT), posits that depression and anxiety become persistent when stored metacognitive beliefs guide an individual to respond to common thoughts and feelings in a certain way. We hypothesized that (i) metacognitive beliefs would predict depression and anxiety independently of participants' representations of their illness; and (ii) rumination would mediate independent prediction of depression and anxiety by metacognitive beliefs.

DESIGN

A prospective mediation study.

METHODS

Four hundred and forty-one adults with DM (Types 1 and 2) completed a two time-point survey. Metacognitive beliefs, illness representations and rumination were measured at baseline, and depression and anxiety measured at baseline and 6-months later. Data were analysed using structural equation modelling. Baseline illness representations, depression and anxiety were used as control variables.

RESULTS

A structural equation analysis showed potential mediation, by baseline rumination, of any effects of baseline metacognitive variables on 6-month distress in Type 1 and 2 diabetes samples. Significant standardized coefficients for relationships between the metacognitive latent variable and rumination were .67 (Type 1) and .75 (Type 2) and between rumination and distress of .36 and .43, respectively. These effects were independent of direct and independent effects of illness representation variables.

CONCLUSIONS

Findings are consistent with metacognitive beliefs playing a key role in depression and anxiety by increasing the likelihood of rumination in adults with DM. MCT may be an effective intervention for this population, subsequent to further longitudinal testing of the S-REF model.

The relationship between childhood trauma, eating behaviours, and the mediating role of metacognitive beliefs

Disordered eating poses a significant risk to psychological and physical health. The experience of childhood trauma has been linked to the development of disordered eating behaviours, but the causal psychological mechanisms remain unclear. The metacognitive model holds promise as a potential framework for understanding the mediating psychological processes that explain how childhood trauma may lead to disordered eating. The purpose of this study was to examine the role of metacognitive beliefs mediating the relationship between childhood trauma and disordered eating behaviours. Adults from the Australian community (N = 461) completed an online self-report survey measuring childhood maltreatment (Childhood Trauma Questionnaire - Short Form), disordered eating behaviour (Three Factor Eating Questionnaire - Revised 21), and metacognitive beliefs (Metacognitive Questionnaire 30). Hierarchical multiple regression analyses revealed no independent associations between any forms of childhood maltreatment and cognitive restraint, while childhood emotional abuse was uniquely associated with uncontrolled eating and emotional eating. Through bootstrapping tests, the mediating effect between childhood trauma and uncontrolled and emotional eating consistently involved the metacognitive beliefs that thoughts are uncontrollable and dangerous. Future longitudinal research is required to confirm causal relationships.

Metacognition vulnerabilities in time of crisis: Who to protect from suicidal risk?

INTRODUCTION

During stressful events, we are all trying to cope. We may not be equal depending on our emotional, psychological, and mental states. During the COVID-19 pandemic, we could try to avoid negative information processing and anxiogenics content to prevent unhealthy thinking processes. One of the processes we can observe regarding our way of thinking and its impact on our psychological well-being is Metacognition.

METHODS

We recruited 104 outpatients in 2018. In 2020, during the pandemic, we recruited 216 outpatients and 176 healthy controls. We assessed their level of metacognition with the MCQ30 scale together with Suicidal risk and Hopelessness.

RESULTS

All three groups showed significant differences, with the nonclinical sample having higher scores in MCQ30. Regression revealed the different profiles where Hopelessness was the only predictor for the clinical sample, whereas metacognition was an adjunctive predictor of suicidal risk for the nonclinical sample.

CONCLUSION

Our results showed that the COVID-19 crisis influenced metacognitive levels for the nonclinical sample but not for the clinical population. Moreover, Hopelessness predicted suicide risk for both populations, but Metacognition was also a predictive factor for the nonclinical sample. We conclude with the possible impact of preventive measures based on Metacognitive work that can be created out of these results.

The effect of mindfulness and metacognition on anxiety symptoms: a case-control study

Background

Anxiety disorders (ADs) are associated with numerous psychiatric disorders; despite the efforts in psychotherapy models targeting their etiology, novel treatment strategies are still developing. We aimed to assess whether mindfulness and metacognition differ between patients with ADs and healthy controls (HCs) and whether the symptom severity of ADs is related to mindfulness and metacognition among patients. Two-hundred participants were enrolled in this study. Structured clinical interview, sociodemographic form, Five Facet Mindfulness Questionnaire-Short Form, Metacognition Questionnaire-30, and Hamilton Anxiety Rating Scale were administered. Multivariate analysis of covariance was conducted to compare the groups in terms of mindfulness and metacognition. Correlation and multiple linear regression analyses were performed to measure the association between the variables.

Results

The main finding indicates that positive beliefs about worry are associated with reduced symptom severity of ADs. Furthermore, HCs have more positive beliefs about worry and nonjudging of inner experience compared to patients with ADs, who utilize negative beliefs about uncontrollability and danger and need to control thoughts to a greater extent.

Conclusions

This study demonstrates that dysfunctional metacognitive beliefs may influence the anxiety severity of adult patients. We suggest that focusing on reducing maladaptive metacognitions may be supportive of AD improvement.

A systematic review evaluating metacognitive beliefs in health anxiety and somatic distress

PURPOSE

Increasing evidence suggests metacognitive beliefs may underpin transdiagnostic mechanisms maintaining psychopathology. The objective of this systematic review was to evaluate published studies investigating the role of metacognitive beliefs in somatic distress in adult samples.

METHOD

A systematic review was conducted, spanning five data bases. Studies meeting eligibility criteria were qualitatively synthesized.

RESULTS

Thirty-six studies (N = 12,390) met inclusion criteria with results suggesting a relatively consistent positive relationship between metacognitive beliefs and somatic distress. Both general and syndrome-specific metacognitive beliefs demonstrated relationships with not only emotional distress, but also physical symptoms themselves.

CONCLUSIONS

Results are discussed in terms of conceptualizing somatic distress through the Self-Regulatory Executive Function (S-REF) Model. Future research into metacognitive therapy for somatic populations is recommended.

The role of family functioning: How the Big Five affect metacognitions about smartphone use

The present study aimed to explore the relationship between the Big Five and metacognitions about smartphone use and the mediating role of family functioning. A cohort of 470 Chinese college students was selected as subjects based on the second edition of the Big Five Inventory-2, the Chinese version of the Metacognitions about Smartphone Use Questionnaire, and the general functioning subscale of Family Assessment Device. The results showed that only neuroticism was significantly and positively correlated with positive metacognition, while the correlation between other personality traits and positive metacognition was not statistically significant. Except for openness, the correlation between other personality traits and negative metacognition was statistically significant. In addition, conscientiousness, extraversion, and neuroticism were found to directly affect negative metacognitions about smartphone use and indirectly affect the negative metacognitions about smartphone use through family functioning. Findings provide insights into the design of interventions aimed at improving metacognitions about smartphone use and preventing smartphone addiction among college students.

The effect of hyperandrogenism and obesity on mindfulness and metacognition in adolescents with polycystic ovary syndrome

The aim of this study was to determine whether serum androgen levels have an effect on mindfulness and metacognition in adolescents with polycystic ovary syndrome (PCOS). Adolescents diagnosed with PCOS were asked to answer a questionnaire that included socio-demographic information and two scales: the Mindful Attention Awareness Scale (MAAS) and the Metacognition Scale Child and Adolescent form (MCQ-C). The patients were divided into two groups, the hyperandrogenism group and the non-hyperandrogenism group, according to serum androgen levels. The scores of MAAS and MCQ-C were compared between the groups. The study sample consisted of 70 adolescents. Of these, 44 had hyperandrogenism according to a blood test. No statistically significant difference was found in MAAS scores between the hyperandrogenism and the non-hyperandrogenism groups (p = 0.79). However, the level of mindfulness was found to be lower in participants with a higher modified Ferriman-Gallwey score (mFGS) (r = 0.26, p = 0.02). Mindfulness levels were also lower for obese patients with PCOS compared to non-obese patients with PCOS (p = 0.02). Cognitive monitoring (MCQ-C-CM), one of the MCQ-C sub-scales, was significantly higher in the non-hyperandrogenism group (p = 0.03), and similarly, a positive correlation was detected between higher androgen levels and the positive meta-worry (MCQ-C-PM) sub-scale of the MCQ-C (for total testosterone; r = 0.348, p = 0.03, and for androstenedione; r = 0.35, p = 0.03). High serum androgen levels in PCOS had no effect on mindfulness, but as the modified Ferriman Gallwey score increased, mindfulness levels decreased. For the sub-scales of MCQ-C,MCQ-C-CM, and MCQ-C-PM, the scores increased as androgen levels increased. In line with the results of the present study, evaluating mindfulness in PCOS patients with increased hair growth and metacognition in PCOS patients with serum hyperandrogenism may contribute well-being in adulthood by reducing the psychological burden caused by the disease.

Parenting in a Pandemic: Parental stress, anxiety and depression among parents during the government-initiated physical distancing measures following the first wave of COVID-19

Drawing on the tenets of family stress theory, the aim of this study is to examine parents' perceived stress, symptoms of anxiety, depression, and associated risk- and protective factors across demographic subgroups during in the first wave of the COVID-19 pandemic. Norwegian parents (N = 2868; 79.5% mothers) with >1 child under 18 years of age completed an online survey two weeks after the implementation of government-initiated distancing measures. The survey includes measures of COVID-related risk factors (parental stress, burnout, depression, anxiety, anger of parents towards children, difficulty working from home, and positive beliefs about worry) and protective factors (self-efficacy and social support). Mothers, parents living with more than one child, and parents with a psychiatric diagnosis reported greater levels of parental stress, more burnout, and more anger towards their children, as well as less social support. Almost 25% of the parents reported anxiety and depression that are clinically significant. Parents who followed distancing measures reported significantly higher distress. Anger of parents towards children explains 41% of the variation in parental stress. These findings indicate that parents have experienced symptoms of deteriorated mental health due to the COVID- 19 pandemic, including parental stress, anxiety, and depression. The study presents practical implications for meso- and macro-level policymaking and offers support to further the potential aims of public health and clinical interventions. Future studies to monitor long-term aversive mental health outcomes among parents are warranted.

Online versus face-to-face metacognitive educational counseling program on anxiety and meta-worry in women with a history of miscarriage: A randomized clinical trial

BACKGROUND

In the COVID-19 outbreak, women with a history of miscarriage need more mental health. Anxiety and meta-worry as consequences of miscarriage, besides concerns due to pregnancy during coronavirus, show the necessity of appropriate online and face-to-face educational counseling. This study aimed to evaluate the effectiveness of online metacognitive educational counseling versus face-to-face method on anxiety and meta-worry in these women.

MATERIALS AND METHODS

In this randomized clinical trial, 80 women with a history of miscarriage, anxiety, and meta-worry referred to Imam Jafar Sadegh hospital (labor, women ward and women clinic), Meybod, Iran, were selected conveniently and randomly assigned into two groups (n = 20/each). The participants received 8-session metacognitive educational counseling package online or face-to-face. Data were collected by Beck Anxiety Inventory, Wellz meta-worry questionnaire at baseline, week eight, and follow up as primary outcomes and analyzed via SPSS software (Anova and Repeated measure statistic tests).

RESULTS

Anxiety in the 12^th week (online group 13.75 ± 3.59 vs. face to face 18.25 ± 5.91, P = 0.04) was statistical significantly less than baseline (respectively 22.15 ± 5.67 vs. 22.35 ± 4.93, P = 0.56); with fewer anxiety scores in the online group. Meta-worry in the 12^th week (online group 11.90 ± 2.59 vs. face to face 15.70 ± 4.06, P = 0.03) was statistically significant compared to baseline (respectively 17.15 ± 2.70 vs. 18.50 ± 3.47, P = 0.36); with fewer meta-worry scores in the online group. Belief about worry in 12^th week (online group 66.50 ± 14.60 vs. face to face 78.45 ± 9.27, P = 0.01) was statistical significantly less than baseline (respectively 85.50 ± 8.87 vs. 86.05 ± 8.85, P = 0.96); with less score of belief about worry in the online group.

CONCLUSION

Online and face-to-face metacognitive educational counseling methods decreased anxiety, meta-worry, and belief about worry in women with miscarriage. But online educational counseling was more effective. Distance online counseling in COVID-19 can help the mental health of women with miscarriage.

Inappropriate Metacognitive Status Increases State Anxiety in Genetic Counseling Clients

Background

Many genetic counseling (GC) studies have focused on anxiety status because clients of GC often feel anxious during their visits. Metacognition is known to be one of the causes of having an inappropriate thinking style. In this study, we examined the relationship between anxiety and the metacognitive status of GC clients according to their characteristics.

Methods

The participants were 106 clients who attended their first GC session in our hospital from November 2018 to March 2021. The survey items were the clients’ characteristics, anxiety status at the time of the visit, and metacognitive status.

Results

High state anxiety and high trait anxiety were observed in 34.9 and 11.3% of clients, respectively. Clients who were a relative or had a family history were significantly more likely to have high state anxiety. As for metacognitive status, only negative beliefs about thoughts concerning uncontrollability and danger were associated with having an anxiety status. Furthermore, multivariate analysis showed that negative beliefs about thoughts concerning uncontrollability and danger were an independent determinant of higher state anxiety, but not being a relative or having a family history. Metacognitive status scores were significantly lower in clients than in the control group.

Conclusion

State anxiety was shown to be more dependent on negative beliefs about thoughts concerning uncontrollability and danger of GC clients than their characteristics such as being a relative or having a family history. The results of this study will contribute to the development of new GC psychosocial support measures to address the anxiety of GC clients.

Path analysis from COVID-19 perceptions to psychological health: The roles of critical distance and mastery

OBJECTIVE

The Coronavirus disease 2019 (COVID-19) pandemic was previously associated with psychopathological symptoms. However, the psychological mechanisms underlying these associations are largely unexplored. Previous studies suggested associations between metacognitive abilities (e.g., mastery) and symptomatology, which may have impacts on COVID-19 perceptions. This study aims to explore, using path analysis, the mediational role of Critical Distance (differentiation and decentration abilities) and Mastery on the relationships between COVID-19 perceptions and psychological well-being and distress.

METHODS

In a cross-sectional design, 227 participants (M = 34.21, SD = 10.9) filled self-report questionnaires.

RESULTS

Metacognitive abilities were negatively correlated with psychopathological symptoms. Both Critical Distance and Mastery mediated the path from COVID-19 perceived severity and anxiety to psychological distress and well-being. Critical Distance seems to augment Mastery which tends to increase psychological well-being and limited psychological distress.

CONCLUSIONS

Metacognition seems to play a mediational role on the relationship between COVID-19 perceptions and mental health. Clinical psychologists and psychotherapists may enhance psychological interventions regarding COVID-19 psychopathological symptomatology by working on metacognitive Critical Distance and Mastery abilities.

Efficacy of metacognitive training for depression as add-on intervention for patients with depression in acute intensive psychiatric inpatient care: A randomized controlled trial

BACKGROUND

Metacognitive training for depression (D-MCT) is a novel low-intensity group training for economic treatment of depression. Previous studies demonstrate its efficacy in moderately depressed outpatients. The present study evaluated efficacy and patients' perspective of the D-MCT in severely depressed psychiatric inpatients.

METHODS

In a randomized-controlled trial, 75 individuals with a major depressive disorder (MDD) were allocated to D-MCT versus euthymic therapy as add-on (twice a week) to cognitive-behavioural-based (CBT) inpatient-care. Depressive symptoms (HDRS, BDI), dysfunctional (meta)cognition (DAS, MCQ-30) and subjective appraisal were assessed at baseline, 4 weeks (post) and 3 months (follow-up).

RESULTS

Participants in both conditions showed a large decline in depression at post and follow-up-assessment. No superior add-effect of D-MCT versus active control emerged for depression severity on top of the inpatient care. However, among patients with a diagnosis of MDD with no (vs. at least one) comorbidity, D-MCT participants showed a larger decline in depressive (meta-)cognition at follow-up with medium-to-large effect sizes. D-MCT was evaluated as superior in overall appraisal, treatment preference, motivation and satisfaction.

LIMITATIONS

The follow-up time interval of 3 months may have been too short to detect long-term effects. There is emerging evidence that modification of (meta)cognition unfolds its full effects only with time. Effects of CBT inpatient-care on outcome parameters cannot be differentiated.

CONCLUSIONS

Although D-MCT as an add-on was not superior in complete case analyses, results suggest greater benefit for patients with MDD and no comorbidity. D-MCT proved feasible in acute-psychiatric inpatient-care and was highly accepted by patients. Future studies should investigate the role of modified (meta)cognition on long-term treatment outcome, including dropout and relapse rates.

Positive beliefs about worry: An evaluation of the Why Worry-II questionnaire in patients with anxiety and mood disorders: Implications for theory and treatment

Positive beliefs about worry are an important factor that has been shown to be associated with the reduction of worry severity with cognitive behavioural therapy. The present study evaluated the psychometric properties of a measure of positive beliefs about worry, the Why Worry Questionnaire II (WW-II; Hebert et al., 2014, 0.1016/j.paid.2013.08.009) with a clinical sample. The present study also compared mean scores on the WW-II in the present clinical sample with scores found in non-clinical samples. Finally, the study compared mean scores on the WW-II between groups with primary diagnoses of generalized anxiety disorder (GAD), major depressive disorder (MDD) and anxiety disorder not otherwise specified (NOS). The confirmatory factor analysis found the five-factor model an adequate to good fit to the data, and the WW-II demonstrated excellent internal consistency within this clinical sample. Additionally, scores on the WW-II in the present sample were significantly higher than scores found by in their non-clinical sample. Finally, no significant mean differences were found between primary diagnoses of GAD, anxiety disorder NOS or MDD. Important theoretical and clinical implications and suggestions for future research are discussed.

Metacognitions in Patients With Frequent Mental Disorders After Diagnosis of Pulmonary Arterial Hypertension

BACKGROUND

The prevalence of mental disorders, particularly adjustment disorder (AD), major depressive disorder (MDD) and panic disorder (PD) is increased in patients with pulmonary arterial hypertension (PAH). However, it is unclear which pathogenic mechanisms determine their development and could therefore be targeted in prevention or therapeutic interventions. Here, we assessed metacognitions in a sample of PAH patients with and without MDD and PD. Moreover, we reconstructed the course of mental illnesses following the PAH diagnosis.

METHODS

Two hundred seventeen PAH patients were included in this cross-sectional study. The prevalence of AD was assessed retrospectively using DSM-V criteria. Current mental disorders were assessed using the structured clinical interview for DSM-V. Additionally, metacognitive beliefs and processes were assessed using established questionnaires (MCQ-30, AnTI).

RESULTS

Patients with an AD consecutive to the PAH diagnosis more frequently developed MDD (37.5 vs. 13.9%, p < 0.001) and PD (26.3 vs. 8.8%, p = 0.001) later on compared to PAH patients without a former AD. Moreover, patients with current MDD/PD displayed more dysfunctional metacognitions than those without current MDD/PD (p < 0.001). Patients with current MDD/PD in the context of former AD had more dysfunctional metacognitive worries and beliefs compared to patients with current MDD/PD without former AD (p = 0.009).

CONCLUSION

Our results suggest that in the context of PAH, dysfunctional metacognitions are associated with MDD and PD. Therefore, a metacognitive approach to treat and prevent those mental illnesses seems promising and should be investigated in future studies.

[Belief updating and mood congruence in depressive disorder]

Depressive disorder is characterized by a polymorphic symptomatology associating emotional, cognitive and behavioral disturbances. One of the most specific symptoms is negative beliefs, called congruent to mood. Despite the importance of these beliefs in the development, the maintenance, and the recurrence of depressive episodes, little is known about the processes underlying the generation of depressive beliefs. In this paper, we detail the link between belief updating mechanisms and the genesis of depressive beliefs. We show how depression alters information processing, generating cognitive immunization when processing positive information, affective updating bias related to the valence of belief and prediction error, and difficultie to disengage from negative information. We suggest that disruption of belief-updating mechanisms forms the basis of belief-mood congruence in depression.

Preoperative morbidity and joint awareness while awaiting hip arthroscopy for femoroacetabular impingement

Purpose

The Forgotten Joint Score (FJS-12) is a valid tool in the evaluation of patients undergoing hip arthroscopy, assessing the unique concept of joint awareness in the setting of a patient’s hip pathology. The preoperative burden on patients’ mental wellbeing of impaired joint function or symptoms is well established. The purpose of this study was to determine patients’ awareness of their hip joint whilst awaiting hip arthroscopy for femoroacetabular impingement, to explore any association between joint awareness and mental health status, and to determine whether this relates to time spent waiting for arthroscopy preoperatively.

Methods

A prospective database of patients undergoing hip arthroscopy between January 2018 and November 2020 was analysed. All patients with a diagnosis of femoroacetabular impingement (FAI) undergoing arthroscopic treatment were included. Questionnaires included the FJS-12, twelve item international hip outcome tool (iHOT-12), EuroQol 5D-5L (EQ-5D-5L) and the Tegner activity score. Pearson’s correlation coefficient was used to assess relationships between continuous variables.

Results

Preoperative functional outcomes were completed by 81 patients (97.5%) prior to undergoing hip arthroscopy. Median preoperative FJS-12 score was 16.67 (IQR 8.33 – 29.68). Forty-four patients reported any level of anxiety/depression preoperatively (54.3%). Preoperative FJS-12 showed a significant negative correlation with worsening mental health status (r = − 0.359, p <  0.001), and a significant positive correlation with EQ-5D-5L (r = 0.445, p <  0.001). The duration of symptoms or time on the waiting list did not correlate with increased joint awareness or worsened mental health.

Conclusion

Joint awareness is high when awaiting hip arthroscopy for FAI. Increasing levels of joint awareness correlate with poorer mental health status and poorer quality of life measures, however these parameters do not seem to be associated with increased duration of symptoms prior to surgery or time on the waiting list for surgery.

The Role of Emotional and Meta-Emotional Intelligence in Pre-adolescents' Well-Being and Sociometric Status

The study examined the relationships among emotional and meta-emotional intelligence, well-being, and sociometric status in 105 pre-adolescents. Emotional and meta-emotional intelligence were measured using the Intelligenza Emotiva: Abilità, Credenze e Concetto di Sé Meta-Emotivo (IE-ACCME) test (D’Amico, 2013), allowing to measure ability emotional intelligence (EI), emotional self-concept, meta-emotional knowledge, meta-emotional ability in self-evaluation, and meta-emotional beliefs. Meta-emotional dimensions refer to the awareness of individuals about their emotional abilities and to their beliefs about the functioning of emotions in everyday life. Eudemonic well-being and sociometric status were, respectively, measured using the well-known Psychological Well-Being (PWB) scale by Ryff’s (1989) and registering the levels of acceptance/rejection from peers (Moreno, 1960). Results demonstrated that: pre-adolescents’ meta-emotional beliefs are positively associated to eudemonic well-being: pre-adolescents with higher levels of ability EI, meta-emotional knowledge and meta-emotional self-evaluation are more accepted by others while those that overestimate their emotional abilities are more refused by peers. These results evidence that meta-emotional variables may play a crucial role in well-being and sociometric status, encouraging future studies on this issue.

The associations between metacognition problems, childhood trauma and internalizing symptoms in healthcare workers working directly with patients infected with COVID-19

Healthcare workers (HCWs) providing medical support while facing one of the highest levels of adverse and potentially fatal outcomes due to COVID-19 are put in a vulnerable position leading to the development of mental health problems. The development of any prevention and intervention programs to reduce this risk is possible with better understanding and knowledge of possible vulnerability factors. The aim of the present study is to investigate psychological effect of working directly with patients infected with COVID-19 (WD) and possible individual vulnerability factors for the development of psychological problems in HCWs. The data used in this cross-sectional study were collected using online self-reported questionnaires from 290 HCWs aged 21-61 years old. The mean score of the scales of 145 HCWs-WD and 145 HCWs not WD (HCWs-NWD) were compared by independent sample t test. Associations between childhood traumas, metacognitive dysfunctional beliefs and internalizing symptoms were analyzed using structural equation modelling (SEM). The depression, anxiety, stress symptoms levels, somatization and sleep problem levels were found to be higher in HCWs-WD compared to HCWs-NWD. SEM revealed that childhood trauma levels was associated with the increased risk of internalizing problems, and metacognitive dysfunctional beliefs had a partial mediator role between childhood traumas and internalizing symptoms in HCWs-WD. Improving metacognitive abilities may hence need to be considered in prevention programs for the HCWs. The findings can also be used to set up further research on the specific interventions on the HCWs who are at a risk as their profession entails them being in such traumatic situations.

ConquerFear-group: Feasibility study with pilot results of a psychological intervention for fear of cancer recurrence delivered in groups

OBJECTIVE

ConquerFear has been found to effectively reduce fear of cancer recurrence (FCR). Group interventions may be particularly effective for the treatment of FCR and could lower overall costs. Our objectives were therefore to adapt ConquerFear into a group format (ConquerFear-Group, CF-G), and to evaluate its feasibility, acceptability, and preliminary efficacy.

METHODS

Eligible patients had completed treatment for breast cancer 3 months to 5 years previously, were ≥18 years, and scored ≥22 on the Fear of Cancer Recurrence Inventory-Short Form (FCRI-SF). The manual was first evaluated with seven patients (Pilot 1), adjusted in accordance with feedback from the patients, therapists, and the original ConquerFear developers. After further evaluation with eight patients (Pilot 2), and subsequent adjustments, the preliminary efficacy of the final manual was evaluated with 27 patients, randomized in blocks to CF-G (N = 13) or active control (AC) (relaxation training) (N = 14) (Pilot 3). The primary outcome was the FCRI total score. Secondary outcomes included general distress, quality-of-life, and process outcomes pertaining to metacognitions, decentering, and worry. All measures were completed at baseline, post-treatment, and at 3 and 6 months follow-up.

RESULTS

Adjustments of the original ConquerFear manual (Pilot 1 and 2) included changes in the order of treatment components, simplified exercises, and shortened homework. Compared with ACs, CF-G participants reported greater reductions in FCRI total scores from baseline to post-treatment (Hedges's g = 0.59, p = 0.004), 3 months (g = 0.50, p = 0.026), and 6 months later (g = 0.93, p = 0.043). Differences corresponding to medium-to-large effect sizes (Pilot 3). Although non-significant, group differences concerning reductions in general distress and maladaptive metacognitions corresponded to small-to-medium effect sizes (g = 0.40-0.61; ps = 0.40-0.61).

CONCLUSIONS

CF-G appears feasible and potentially efficacious in treating FCR in a breast cancer population. These preliminary results are promising but need to be confirmed in a larger randomized trial.

The metacognitive model of post-traumatic stress disorder and metacognitive therapy for post-traumatic stress disorder: A systematic review

The metacognitive model of post-traumatic stress disorder (PTSD) implicates metacognitive beliefs, meta-memory beliefs and metacognitive control strategies in perpetuating and maintaining symptoms of PTSD. Despite this expanding area of research, the evidence for the metacognitive model of PTSD has not been reviewed. A systematic review according to the PRISMA statement was conducted. Searches across MEDLINE, PubMed and PsycNET, as well as reference lists of the included studies (2004 to March 2020), yielded 221 records. Two independent reviewers screened articles, which were included where the impact of the constructs of interest on PTSD symptoms was investigated within the framework of the metacognitive model for PTSD. Eighteen articles were included in the review. Eleven studies were determined to have good methodological robustness. Metacognitive therapy for PTSD demonstrated reductions in symptoms from pretreatment to post-treatment, which were maintained at follow-up. Predictors of greater PTSD symptom severity included metacognitive beliefs, meta-memory beliefs, and worry, punishment, thought suppression, experiential avoidance, and rumination. Overall, support was found for the validity of the metacognitive model of PTSD.

Maladaptive metacognitive beliefs mediated the effect of intolerance of uncertainty on depression

Both elevated intolerance of uncertainty (IU) and maladaptive metacognitive beliefs (MBs) were associated with depression. However, the relationship between MBs and IU in clinical depression is unclear. The current study aimed to investigate the putative impairment of MBs and IU in major depressive disorder (MDD) and explore the relationship between these two factors with depressive symptoms. Metacognition Questionnaire-30 Items (MCQ-30), Intolerance of Uncertainty Scale-Short Form (IUS-12) and clinical rating scales were administered to 53 patients with MDD and 56 healthy controls (HCs). Stepwise regressions were performed to explore independent contributions of MBs and IU on depression. Mediation analysis was used to examine associations among variables. Patients with MDD reported higher IUS-12 and MCQ-30 scores than HCs. Stepwise regressions revealed a unique contribution of negative MBs concerning the consequences of not controlling thoughts (MCQ-NC) on depression symptoms while controlling the effects of age, gender, anxiety symptoms and IU. MCQ-NC and negative MBs concerning the uncontrollability and danger of negative thinking (MCQ-NEG) completely mediated the effects of IU on depression and anxiety symptoms. Our results provided clear evidence that maladaptive negative MBs are directly associated with depression symptoms, and mediated the effect of IU on depression and anxiety symptoms, suggesting that IU and MBs influence clinical symptoms in a hierarchical manner.

The Association Between Maladaptive Metacognitive Beliefs and Emotional Distress in People Living With Amyotrophic Lateral Sclerosis

OBJECTIVE

Approximately half of all people living with amyotrophic lateral sclerosis (ALS) experience persistent or recurrent emotional distress, yet little is known about the psychological processes that maintain emotional distress in this population. The self-regulatory executive functioning (S-REF) model specifies that maladaptive metacognitive beliefs and processes are central to the development and maintenance of emotional distress. This study explored whether maladaptive metacognitive beliefs are associated with emotional distress after controlling for demographic factors, time since diagnosis, and current level of physical functioning.

DESIGN

In a cross-sectional design, 75 adults with a diagnosis of ALS completed self-report questionnaires. Participants had a mean age of 60.40 years, mean duration of symptoms 63.92 months, and male:female gender ratio of 14:11.

MAIN OUTCOME MEASURES

Questionnaires assessed emotional distress (HADS, adapted for ALS), physical functioning (ALSFRS-R), repetitive negative thinking (RTQ-10), metacognitive beliefs (MCQ-30), and demographic factors.

RESULTS

Maladaptive metacognitive beliefs explained additional variance in emotional distress after controlling for age, gender, time since diagnosis, physical functioning, and repetitive negative thinking. Repetitive negative thinking partially mediated the relationships between positive and negative metacognitive beliefs and emotional distress.

CONCLUSIONS

These data support the utility of the metacognitive model in understanding emotional distress in people with ALS. Examination of the temporal relationship between maladaptive metacognitive beliefs and emotional distress in people living with ALS may help to guide the development of therapeutic approaches.

Adults' Adherence to Growth Hormone Replacement in Relation to Medication-Related Beliefs, Coping and Quality of Life - An Exploratory Analysis

INTRODUCTION

Little is known about psychological reasons associated with adherence to growth hormone (GH) replacement therapy (GHRx) in adults. As in other chronic diseases, medication-related beliefs, coping strategies and disease impact on quality of life (QoL) might play an important role. We thus explored these psychological factors in relation to adherence in patients with GH deficiency (GHD) in order to find leverage points for the improvement of adherence.

PATIENTS AND METHODS

Cross-sectional analysis including 107 adult GHD patients on GHRx who completed self-assessment inventories on health-related QoL (Short-Form SF-36), coping style (Freiburg questionnaire on coping with illness, FKV-LIS) and medication beliefs (Beliefs about Medicine questionnaire, BMQ). Results were correlated to general and GH-specific adherence to medication.

RESULTS

In the BMQ, 92.5% of the patients (n=99) reported a strong belief in the need for their medication, which correlated significantly with general adherence (r_s = 0.325). Active coping was significantly related to general (r_s = 0.307) and GH-specific adherence (r_s = 0.226). Better mental QoL (r_s = 0.210) but worse physical QoL (r_s = -0.198; all p < 0.05) were related to higher GH-specific adherence. Older age was associated with a higher degree of active coping, a higher belief in the necessity of medication and worse physical QoL.

CONCLUSION

We provide preliminary data that most GHD patients on GHRx are strongly convinced of their need for medication and that adherence to GHRx is influenced by coping strategies and QoL. Patients with impaired psychological QoL are less able to translate their convictions into good adherence, a phenomenon to be addressed in future research.

Tinnitus and Metacognitive Beliefs-Results of a Cross-Sectional Observational Study

Recent research has highlighted the role of metacognitions as a moderator for psychological distress in patients with chronic diseases. The present study investigates the role of metacognitions and worry in the association between tinnitus distress, anxiety, and depression. A cross-sectional study was carried out with a sample of tinnitus-outpatients who completed the Tinnitus-Handicap Inventory, Beck Anxiety Inventory, Beck Depression Inventory, Metacognition Questionnaire-30, Penn-State-Worry-Questionnaire. Associations of metacognitions, worries, tinnitus distress, anxiety and depression were investigated using structural equation models (SEMs). A sample of n = 107 patients was included in the study. In the first SEM, tinnitus distress significantly predicted depression (β = 0.68, p < 0.001) and anxiety (β = 0.47, p < 0.001). In the second model, worries and meta-cognitions were added as moderators. The explained variance substantially increased for depression (46 to 53%) and anxiety (22 to 35%) and the association of tinnitus distress with depression (β = 0.57, p < 0.001) and anxiety was weakened (β = 0.32, p < 0.001). Negative beliefs significantly predicted worries (β = 0.51, p < 0.001) and explained 41% of its variance. A good model fit for the final model was found (comparative fit index (CFI) = 0.98; (Tucker Lewis index) TLI = 0.96; root mean square error of approximation (RMSEA) = 0.067). Anxiety and depression in tinnitus patients might be influenced by worries, which is mainly predicted by negative beliefs about uncontrollability and danger of worries. Thus, psychotherapeutic approaches focused on alterations of metacognitions in patients with tinnitus should be investigated in future studies.3 (List three to ten pertinent keywords specific to the article yet reasonably common within the subject discipline.)