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Thingbak A, Capobianco L, Wells A, O'Toole MS. Relationships between metacognitive beliefs and anxiety and depression in children and adolescents: A meta-analysis. J Affect Disord 2024; 361:36-50. [PMID: 38815761 DOI: 10.1016/j.jad.2024.05.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 05/23/2024] [Accepted: 05/24/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND As hypothesized in the Self-Regulatory Executive Function (S-REF) model, metacognitive beliefs are associated with anxiety and depression in adults. An important question is the extent to which such effects are present in children and adolescents, with the implication that the model may also apply to young people. The aim of this meta-analysis was to synthesize results on the nature and magnitude of associations between metacognitive beliefs and anxiety and depression in children and adolescents. METHODS Systematic searches were conducted to identify studies that investigated: (1) group differences in metacognitive beliefs in clinical compared to non-clinical samples or (2) correlations between metacognitive beliefs and symptoms of anxiety and depression. RESULTS Forty papers were identified comprising a total sample of 9,887 participants aged 7-18 years. Meta-analyses revealed that clinical samples endorsed significantly elevated metacognitive beliefs on four out of the five domains measured (i.e., negative beliefs about worry, cognitive confidence, need for control, and cognitive self-consciousness, with the only exception being positive beliefs about worry) compared to non-clinical samples with a small to large effect (Hedges' gs = 0.45-1.22). Moreover, all five domains of metacognitive beliefs were significantly and positively correlated with symptoms of anxiety and depression of a small to large effect (rs = .24-.53). Negative beliefs about worry showed the strongest relationship with clinical status and the magnitude of symptoms. LIMITATIONS The number of studies did not allow for an evaluation of metacognitive beliefs at a disorder-specific level. CONCLUSIONS In line with the S-REF model, our findings provide evidence of robust cross-sectional relationships between metacognitions and both anxiety and depression in childhood and adolescence.
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Affiliation(s)
- Anne Thingbak
- Department of Psychology and Behavioural Sciences, Aarhus University, Denmark.
| | - Lora Capobianco
- School of Psychological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester & Greater Manchester Mental Health NHS Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Adrian Wells
- School of Psychological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester & Greater Manchester Mental Health NHS Trust, Manchester Academic Health Science Centre, Manchester, United Kingdom
| | - Mia Skytte O'Toole
- Department of Psychology and Behavioural Sciences, Aarhus University, Denmark
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Li F, Yuan D, Gao C, Xiong K, Geng F, Zhang L. Validity and Reliability of the Metacognitions Questionnaire-30 (MCQ-30) among Chinese Adolescents. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01625-7. [PMID: 37917240 DOI: 10.1007/s10578-023-01625-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 11/04/2023]
Abstract
This study aimed to examine the psychometric properties of the Metacognitions Questionnaire-30 (MCQ-30) in a sample of Chinese adolescents (1382 boys, 1445 girls) aged 11 to 18 years. Confirmatory factor analysis was performed to assess factor structure, as well as, measurement invariance across demographic groups and clinical symptoms. The results of confirmatory factor analyses supported the original five-factor model. Configural, metric and scalar invariance of the five-factor model were also supported by gender, age, ethnicity, residence, parental education level, depression and anxiety status. Furthermore, all five subscales demonstrated good internal consistency (Cronbach alphas > 0.75) and test-retest reliability (intra-class correlation coefficients > 0.45). Finally, the five factors were positively related to symptoms of depression, anxiety, and irritability and negatively related to positive childhood experiences and life satisfaction, indicating excellent validity. The findings provide initial evidence that the MCQ-30 is a valid measure for use in Chinese adolescents.
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Affiliation(s)
- Fan Li
- School of Psychology, Jiangxi Normal University, 99 Ziyang Ave, Nanchang, 330022, Jiangxi, China
| | - Danyan Yuan
- School of Psychology, Jiangxi Normal University, 99 Ziyang Ave, Nanchang, 330022, Jiangxi, China
| | - Chang Gao
- School of Psychology, Jiangxi Normal University, 99 Ziyang Ave, Nanchang, 330022, Jiangxi, China
| | - Kaixin Xiong
- School of Psychology, Jiangxi Normal University, 99 Ziyang Ave, Nanchang, 330022, Jiangxi, China
| | - Fulei Geng
- School of Psychology, Jiangxi Normal University, 99 Ziyang Ave, Nanchang, 330022, Jiangxi, China
| | - Lan Zhang
- School of Psychology, Jiangxi Normal University, 99 Ziyang Ave, Nanchang, 330022, Jiangxi, China.
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Köcher LM, Schlömer-Böttner S, Christiansen H. Metacognitive Transmission Between Parents and Children in the Context of Anxiety Disorders. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01577-y. [PMID: 37501041 DOI: 10.1007/s10578-023-01577-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2023] [Indexed: 07/29/2023]
Abstract
One in ten children is affected by an anxiety disorder. Current state of research shows that transgenerational transmission as well as positive (POS) and negative (NEG) metacognitive beliefs are relevant in the context of anxiety disorders in youth. We investigated whether transgenerational transmission is also evident in conjunction with POS and NEG and cross-sectionally surveyed POS, NEG, anxiety symptoms and worry in 8-16-year-old children and adolescents with anxiety disorders (n = 71) and non-clinical controls (n = 40) and one of their parents. Our results revealed significant transgenerational correlations for NEG in both samples, and for POS in the non-clinical sample only. Mediation analysis showed that children's NEG did at least partly mediate the relationship between parents' NEG and children's anxiety and worry. Children's and parents' POS did not correlate in either sample with children's anxiety and worry. Further research on the transgenerational transmission of metacognition and longitudinal data is needed.
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Affiliation(s)
- Laura Marie Köcher
- Clinical Child and Adolescent Psychology, Department of Psychology, Philipps-Universität Marburg, Frankfurter Straße 35, 35037, Marburg, Germany.
| | - Silke Schlömer-Böttner
- Psychotherapy Practice for Children and Adolescents, Alter Kirchhainer Weg 5, 35039, Marburg, Germany
| | - Hanna Christiansen
- Clinical Child and Adolescent Psychology, Department of Psychology, Philipps-Universität Marburg, Frankfurter Straße 35, 35037, Marburg, Germany
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Emotion Regulation Scale and Mindfulness Scale in School Aged Children: Construction and Validation of French Versions. Child Psychiatry Hum Dev 2022; 53:1004-1017. [PMID: 33966150 DOI: 10.1007/s10578-021-01182-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/25/2021] [Indexed: 10/21/2022]
Abstract
Few measuring scales seem to evaluate Mindfulness and emotion regulation in school aged children. This article aims to present four studies describing the construction and validation of two French measuring scales for children: French Emotion Regulation Scale for Children (FERS-C) and Mindfulness Scale for Children French version (MSC-F). We discuss the elaboration and choice of the items for each measure, examine their phrasing and comprehensibility from the children's standpoint. The main sample consisted of 421 non-clinical, 6 to 12 years old children, who consented to fill out the measuring scales in order to test the factor structure. Additionally, we assessed and confirmed temporal stability and determined convergent validity. Results support that both scales appear to be reliable emotion regulation and mindfulness measures for school aged children. Results also reveal a relevant factor structure for both measures. The results of these studies support that the two scales are appropriate and useful measures of mindfulness and emotion regulation capacities for school aged children. In conclusion, we call for further research to improve and develop measures assessing child mindfulness skills in both clinical and research contexts.
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Do Metacognitions of Children and Adolescents with Anxiety Disorders Change after Intensified Exposure Therapy? CHILDREN 2022; 9:children9020168. [PMID: 35204889 PMCID: PMC8869889 DOI: 10.3390/children9020168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/24/2022] [Accepted: 01/25/2022] [Indexed: 11/17/2022]
Abstract
Metacognitive beliefs have repeatedly proven to play a role in anxiety disorders in children and adolescents, but few studies have investigated whether they change after cognitive behavioral therapy. This longitudinal intervention study explores whether positive and negative metacognitive beliefs in particular change after exposure-focused treatment, and if metacognitive changes predict reductions in anxiety symptoms. A sample of 27 children between 8 and 16 years of age with a primary diagnosis of specific phobia, separation-anxiety disorder or social phobia completed assessments of anxiety symptoms, metacognitive beliefs, worry and repetitive negative thoughts before and after 11 sessions of intensified exposure treatment. Metacognitive beliefs did not change significantly after intensified exposure, but post-hoc power analysis revealed a lack of power here. Change in negative metacognitive beliefs correlated with a change in anxiety symptoms, but did not independently contribute as a predictor variable. Differences between subsamples showed that patients with separation-anxiety disorder scored higher on negative metacognitive beliefs than those with specific or social phobia. Consideration of metacognition, and negative metacognitive beliefs in particular could help us further improve the understanding and treatment of anxiety disorders in children and adolescents and should therefore receive more attention in psychotherapy research.
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Walczak M, Austgulen E, Kirsten L, Breinholst S. Examining Changes in the Cognitive Attentional Syndrome and Attentional Control Following Metacognitive Therapy for Children with Generalized Anxiety Disorder. Int J Cogn Ther 2021. [DOI: 10.1007/s41811-021-00124-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Salguero JM, Ramos-Cejudo J, García-Sancho E, Arbulu I, Zaccagnini JL, Bjureberg J, Gross JJ. Testing the impaired disengagement hypothesis: The role of attentional control and positive metacognitive beliefs in depression. Behav Res Ther 2021; 146:103961. [PMID: 34543923 DOI: 10.1016/j.brat.2021.103961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 07/01/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
The impaired disengagement hypothesis holds that people ruminate - and thus increase their risk for depression - due to impaired attentional control and conflict signaling. We tested this hypothesis by examining the role of attentional control and conflict signaling (operationalized as positive metacognitive beliefs) in rumination and depressive symptoms. We expected that attentional control and positive metacognitive beliefs would be associated with depressive symptoms and that these associations would be cross-sectionally mediated by rumination. We tested two community samples (Study 1, N = 289; Study 2, N = 292), assessing attentional control, positive metacognitive beliefs, rumination, and depressive symptoms. In both studies, attentional control and positive metacognitive beliefs were significantly associated with rumination and depression, and path analyses corroborated the proposed mediation model. Our findings support the impaired disengagement hypothesis, and suggest that attentional control and positive metacognitive beliefs may be informative in the personalization of depression assessment and treatment.
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Affiliation(s)
- José M Salguero
- Department of Personality, Evaluation and Psychological Treatment, University of Malaga, Spain.
| | | | | | - Ilyana Arbulu
- Department of Personality, Evaluation and Psychological Treatment, Complutense University of Madrid, Spain
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Köcher LM, Schneider K, Christiansen H. Thinking about worry: A systematic review and meta-analysis on the assessment of metacognitions in children and adolescents. World J Psychiatry 2021; 11:635-658. [PMID: 34631466 PMCID: PMC8474992 DOI: 10.5498/wjp.v11.i9.635] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 05/04/2021] [Accepted: 07/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The metacognitive model of generalized anxiety disorder identifies three forms of metacognition: Positive metacognitive beliefs about worry (POS), negative metacognitive beliefs about worry (NEG), and meta-worry. Though this model was originally developed relying on adult samples, it has since been applied to children and youth in different studies, and results mostly support its validity for this group. As the roles of POS, meta-worry, and age-effects do not appear to be fully clarified for children and adolescents yet, an integration of studies on children and adolescents and the metacognitive model is both timely and worthwhile.
AIM To summarize the current research on relationships, age-effects, and measurements for POS, NEG, and meta-worry in childhood and youth.
METHODS We carried out a literature search in the electronic databases PsycINFO, PubMed, PSYNDEX, and ERIC in 2017 and updated in 2020. Empirical research in German or English language on metacognition was included with child and adolescent samples diagnosed with anxiety disorders or healthy controls if POS, NEG, or meta-worry were measured. Studies were included for meta-analysis if they reported correlations between these metacognitions and anxiety or worry. Consensus rating for eligibility was done for 20.89% of full-texts with 90.32% agreement. Risk of bias was assessed with the appraisal tool for cross-sectional studies and consensus rating of appraisal tool for cross-sectional studies for 20.83% of included studies attaining agreement of intraclass correlation = 0.898. Overall, correlations between metacognitions, anxiety and worry were calculated with RevMan 5.4.1, assuming random-effects models. Meta-regressions with mean age as the covariate were performed via the online tool MetaMar 2.7.0. PROSPERO-ID: CRD42018078852.
RESULTS Overall, k = 763 records and k = 78 additional records were identified. Of those, k = 48 studies with 12839 participants were included and of those, k = 24 studies were included for meta-analysis. Most studies showed consistent NEG correlations with worry and anxiety, as well as higher values for clinical than for non-clinical samples. POS findings were less consistent. Meta-analysis revealed large effects for NEG correlating with worry and anxiety, small to medium effects for POS correlating with worry and anxiety, as well as small to medium effects for POS correlating with NEG. Meta-regressions did not reveal mean age as a significant covariate. Meta-worry was assessed in only one study. We identified eight questionnaires and one interview-format that assess metacognition about worry in children and adolescents.
CONCLUSION POS and NEG are measurable from the age of seven upwards and correlate with anxiety and worry without influences by age. Meta-worry requires further investigation.
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Affiliation(s)
- Laura M Köcher
- Department of Psychology, University of Marburg, Marburg 35037, Germany
| | - Kai Schneider
- Department of Clinical Child and Adolescent Psychology, University of Landau, Landau 76829, Germany
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9
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Cohen LD, Yavin LL, Rubinsten O. Females' negative affective valence to math-related words. Acta Psychol (Amst) 2021; 217:103313. [PMID: 33930625 DOI: 10.1016/j.actpsy.2021.103313] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 03/10/2021] [Accepted: 04/15/2021] [Indexed: 09/30/2022] Open
Abstract
Emotional perceptions of math-related information can have profound effects on attitudes about math, which, in turn, may lead to decreased math achievements. A large body of research has documented that females have less positive attitudes and more negative affectivity to math than males. This study examined emotional valence ratings of math-related verbal stimuli among adults and performed a pioneering investigation of gender differences in emotional perceptions. A random sample of 290 adults completed a battery of online affect questionnaires designated to measure the relations of various math-related words to the field of mathematics (i.e., math loading) and compared the emotional valence of these words to words known to have negative and neutral valence. Results revealed that: (1) math-related words were rated as less threatening than words with negative valence, but more threatening than neutral words; (2) math loading ratings were the strongest and most significant predictor of the emotional valence ratings of math-related words; and (3) females rated math-related words and words with negative, but not neutral, valence as more threatening than males. The study concludes that negative affective valence is linked with math-related information, especially among females, and this finding has implications for researchers, parents, and educators.
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10
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Kokoç M. The mediating role of attention control in the link between multitasking with social media and academic performances among adolescents. Scand J Psychol 2021; 62:493-501. [PMID: 33963571 DOI: 10.1111/sjop.12731] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 03/12/2021] [Indexed: 12/30/2022]
Abstract
Prevalence of using social media services while learning, studying and doing homework is increasing rapidly among adolescents in the digital age. Although there is evidence for negative consequences of multitasking with social media, little is known about impact of social media multitasking from perspective attention control of self-regulation. This study examined the mediating role of attention control as a component of self-regulation in the link between social media multitasking and academic performances in a sample of adolescents who were recruited from high school students (N = 637). A correlational research design was used in the study. To examine study hypothesis, a mediation model was tested using simple mediation analysis in macro PROCESS (model 4). Results have revealed that attention control of self-regulation mediated the negative relationship between multitasking with social media and academic performances of the students. Multitasking with social media was a negatively significant predictor of academic performance, whereas attention control positively predicted academic performance. It implies that more frequent multitasking behavior with social media had lower attention control and poorer academic performances. The conclusions of the study suggest a critical role for attention control in decreasing negative effect of multitasking with social media on academic performances of adolescents in high school setting. Implications and suggestions for future studies are proposed.
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Affiliation(s)
- Mehmet Kokoç
- Department of Management Information Systems, Trabzon University, School of Applied Sciences, Trabzon, Turkey
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11
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van Son D, Marin CE, Boutris P, Rey Y, Lebowitz ER, Pettit JW, Silverman WK. Attending to the Attentional Control Scale for Children: Confirming its factor structure and measurement invariance. J Anxiety Disord 2021; 80:102399. [PMID: 33892347 PMCID: PMC8141040 DOI: 10.1016/j.janxdis.2021.102399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 03/30/2021] [Accepted: 04/13/2021] [Indexed: 11/25/2022]
Abstract
The Attentional Control Scale for Children (ACS-C) is a widely used self-report questionnaire that measures attentional control in youth. Previous research examined factor-structure and validation of the ACS-C and yielded a 2-factor structure with Attentional Focusing and Attentional Shifting subscales. This study used a confirmatory factor analysis in a large, ethnically diverse sample of clinic-referred anxious youth (N = 442, ages 7-16 years) to compare model fit of three models, the original two-factor model of the ACS-C, a two-factor model of a modified ACS-C (two items re-assigned from Attentional Focusing to Attentional Shifting, three items removed from Attentional Focusing, and two items removed from Attentional Shifting), and a single-factor model. Results reveal best model fit for the two-factor modified ACS-C. This model had strong factorial invariance across sex, partial invariance across ethnicity, and was variant across age. Also, total and subscale scores for the two-factor modified ACS-C correlated with anxiety and depression symptom scale scores, supporting its concurrent validity. Findings confirm the two-factor structure of the modified ACS-C. Future research implications relating to attentional control in children are discussed.
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Affiliation(s)
- Dana van Son
- Yale University Child Study Center, New Haven, USA
| | | | | | - Yasmin Rey
- Florida International University, Miami, USA
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12
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Tutelman PR, Heathcote LC. Fear of cancer recurrence in childhood cancer survivors: A developmental perspective from infancy to young adulthood. Psychooncology 2020; 29:1959-1967. [PMID: 33068463 DOI: 10.1002/pon.5576] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/08/2020] [Accepted: 10/09/2020] [Indexed: 12/13/2022]
Abstract
AIMS Fear of cancer recurrence (FCR) is among the most prevalent and distressing concerns reported by cancer survivors. While younger age is the most consistent predictor of elevated FCR, research to date has focused almost exclusively on adult cancer survivors. This is despite the fact that children with cancer are more likely to survive compared to adults, and will become regular, lifelong users of the medical system to mitigate the effects of toxic treatment. The early experience of cancer yields unique challenges and circumstances that may impact children's capacity for and experience of FCR across the developmental trajectory. The aim of this paper is to present a developmental perspective of FCR from infancy to young adulthood. METHODS Drawing on the developmental science literature and recent theoretical advancements in FCR, we outline cognitive and social factors that may influence children's capacity for and experience of FCR across the developmental trajectory. RESULTS First, distinct developmental groups that fall under the classification of "childhood cancer survivor," and that all require attention, are summarized. Using the structure of these groupings, we centrally provide a developmental perspective of FCR that offers a useful starting point for research in pediatric populations. Key research gaps, including the need for validated assessment tools to measure FCR in child and adolescent survivors, are highlighted. CONCLUSIONS Consideration of the unique context of childhood is needed to guide the identification of childhood cancer survivors at risk for FCR as well as the development of effective FCR interventions for this population.
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Affiliation(s)
- Perri R Tutelman
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada.,Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Lauren C Heathcote
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
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Capobianco L, Faija C, Husain Z, Wells A. Metacognitive beliefs and their relationship with anxiety and depression in physical illnesses: A systematic review. PLoS One 2020; 15:e0238457. [PMID: 32911486 PMCID: PMC7500039 DOI: 10.1371/journal.pone.0238457] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 08/17/2020] [Indexed: 02/06/2023] Open
Abstract
Anxiety and depression are common among patients with chronic physical illnesses
and have a significant impact on morbidity, quality of life, and health service
utilisation. Psychological treatment of anxiety and depression has small to
moderate efficacy in this group and is not commonly based on a model of causal
mechanisms. A novel approach to understanding and improving mental health
outcomes in physical illnesses is needed. One approach may be to explore the
role of metacognitive beliefs which are reliably associated with anxiety and
depression in individuals with mental health difficulties. The current
systematic review aimed to evaluate the contribution of metacognitive beliefs to
anxiety and depression across physical illnesses. Systematic searches were
conducted on Web of Science, PsychINFO, MEDLINE, Embase, and CINAHL of studies
published between 1997 and January 2019. 13 eligible studies were identified
that in sum comprised 2851 participants. Metacognitive beliefs were found to
have reliable, moderate, positive and significant associations with anxiety and
depression symptoms across a range of physical illnesses. There appeared to be
commonality and some specificity in the relationships. Negative metacognitive
beliefs concerned with uncontrollability and danger of worry were associated
with both anxiety and depression across all physical illnesses assessed, whilst
more specific associations emerged for individual medical conditions where
positive beliefs about worry, cognitive confidence and cognitive
self-consciousness were unique correlates. Negative metacognitive beliefs of
uncontrollability and danger significantly and positively predicted symptoms of
anxiety and depression after controlling for factors including age, gender,
disease factors and cognition (illness perceptions and intolerance of
uncertainty). The results suggest that the metacognitive model of psychological
disorder is applicable to psychological symptoms of anxiety and depression
across a range of chronic medical conditions, implying that metacognitive
therapy might be helpful in improving outcomes in multiple morbidities that
involve poor mental and medical health.
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Affiliation(s)
- Lora Capobianco
- Research and Innovation, Greater Manchester Mental Health NHS Foundation
Trust, Manchester, United Kingdom
- * E-mail:
| | - Cintia Faija
- Division of Nursing, Midwifery & Social Work, Faculty of Biology,
Medicine and Health, Manchester Academic Health Science Centre, The University
of Manchester, Manchester, United Kingdom
| | - Zara Husain
- Research and Innovation, Greater Manchester Mental Health NHS Foundation
Trust, Manchester, United Kingdom
| | - Adrian Wells
- Research and Innovation, Greater Manchester Mental Health NHS Foundation
Trust, Manchester, United Kingdom
- Faculty of Biology, Medicine and Health, School of Psychological
Sciences, Manchester Academic Health Science Centre, The University of
Manchester, Manchester, United Kingdom
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Heitland I, Barth V, Winter L, Jahn N, Burak A, Sinke C, Krüger THC, Kahl KG. One Step Ahead-Attention Control Capabilities at Baseline Are Associated With the Effectiveness of the Attention Training Technique. Front Psychol 2020; 11:401. [PMID: 32296360 PMCID: PMC7136490 DOI: 10.3389/fpsyg.2020.00401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 02/21/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Attentional control has been observed to play an important role in affective disorders by impacting information processing, the ability to exert top-down control in response to distracting stimuli, and by affecting emotional regulation. Prior studies demonstrated an association between attentional control and response to psychotherapy, thereby identifying attentional control as an interesting prognostic pre-treatment factor. Improving attentional control and flexibility is a cornerstone in metacognitive therapy (MCT), which is trained by the use of the Attentional Training Technique (ATT). However, as of yet, it remains unclear if pre-treatment attentional control is related to the effect of ATT. METHODS An aggregated sample of 139 healthy participants [study 1: 85 participants, mean age 23.7 years, previously published (Barth et al., 2019); study 2: 54 participants, mean age 33.7 years, not previously published] performed an attentional performance test battery before and after applying ATT. Before ATT was administered, attentional control was measured using a well-established self-report instrument, i.e., the Attentional Control Scale (ACS; Derryberry and Reed, 2002). ATT was given in 2, 4, or 15 doses and compared to sham ATT. The test battery comprised a selection of established neurocognitive tasks: emotional dot probe, Stroop, 2-back, and dichotic listening. RESULTS Sham ATT showed no interaction with ACS score on performance outcome in all tests. At four doses of ATT, ACS score was associated with training response, i.e., subjects with high self-reported attentional control before training showed the largest improvements post-training (all P-values <0.05; see Figure 3). At 2 and 15 doses of ATT, the ACS score was unrelated to training response. CONCLUSION This is a first attempt in understanding the optimal dosage in which ATT should be administered dependent on the individual characteristics of each subject pre-training. The current data suggest self-reported attentional control pre-training as a marker to determine an optimal individual ATT training profile. Future studies should investigate if other domains of metacognitions also interact with training outcome and evaluate the extent to which this relationship transfers to clinical samples. If successful, assessing attentional control prior to treatment in clinical samples could be of use regarding personalized therapy plans and treatment outcome.
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Affiliation(s)
- Ivo Heitland
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Vincent Barth
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Lotta Winter
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Niklas Jahn
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Alev Burak
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
| | - Christopher Sinke
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
- Division of Clinical Psychology and Sexual Medicine, Hannover Medical School, Hanover, Germany
| | - Tillmann H C Krüger
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
- Division of Clinical Psychology and Sexual Medicine, Hannover Medical School, Hanover, Germany
| | - Kai G Kahl
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hanover, Germany
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Wells A. Breaking the Cybernetic Code: Understanding and Treating the Human Metacognitive Control System to Enhance Mental Health. Front Psychol 2019; 10:2621. [PMID: 31920769 PMCID: PMC6920120 DOI: 10.3389/fpsyg.2019.02621] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 11/06/2019] [Indexed: 01/14/2023] Open
Abstract
The self-regulatory executive function (S-REF) model explains the role of strategic processes and metacognition in psychological disorder and was a major influence on the development of metacognitive therapy. The model identifies a universal style of perseverative negative processing termed the cognitive attentional syndrome (CAS), comprised of worry, rumination, and threat monitoring in the development of disorder. The CAS is linked to dysfunctional metacognitions that include beliefs and plans for regulating cognition. In this paper, I extend the theoretical foundations necessary to support further research on mechanisms linking metacognition to cognitive regulation and effective treatment. I propose a metacognitive control system (MCS) of the S-REF that can be usefully distinguished from cognition and is comprised of multiple structures, information, and processes. The MCS monitors and controls activity of the cognitive system and regulates the behavior of neural networks whose activities bias the way cognition is experienced. Metacognitive information involved in the regulation of on-line processing includes metacognitive beliefs, metacognitive procedural commands, and more transient cybernetic code. Separation of the cognitive and metacognitive systems and modeling their relationship presents major implications concerning what should be done in therapy and how it should be done. The paper concludes with an in-depth consideration of methods that strengthen the psychological basis of psychotherapy and aid in understanding and applying metacognitive therapy in particular. Finally, limitations of the model and implications for future research on self-awareness, self-regulation, and metacognition are discussed.
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Affiliation(s)
- Adrian Wells
- School of Psychological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
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Nordahl H, Ødegaard IH, Hjemdal O, Wells A. A test of the goodness of fit of the generic metacognitive model of psychopathology symptoms. BMC Psychiatry 2019; 19:288. [PMID: 31533677 PMCID: PMC6751802 DOI: 10.1186/s12888-019-2266-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 08/29/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Common mental disorders such as depression and anxiety frequently co-occur and may share etiological mechanisms. The metacognitive model is based on the principle that there are common pathological mechanisms across disorders that account for comorbidity and therefore can be conceptualized in one generic model. A central prediction of the model is that particular metacognitive beliefs concerning the value of worry, and the uncontrollability and danger of cognition are positively correlated with psychopathology symptoms. In the present study, we set out to test the overall fit of this model by assessing generic metacognitive beliefs and judgements of attention control capacity as predictors of common and frequently co-occurring emotional distress symptoms. METHODS In a cross-sectional design, 645 participants gathered at convenience completed a battery of self-report questionnaires. RESULTS Structural equation modelling indicated a good model fit for the generic metacognitive model, and the predictors accounted for 93% of the variance in distress consisting of depression-, generalized- and social anxiety symptoms. CONCLUSIONS This finding supports the generic model and the implication that it can be used as a basis to formulate and treat multiple presenting problems.
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Affiliation(s)
- Henrik Nordahl
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway. .,St. Olavs Hospital, Division of Psychiatry, Trondheim University Hospital, Trondheim, Norway.
| | | | - Odin Hjemdal
- Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
| | - Adrian Wells
- School of Psychological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK
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