Metacognition in Children and Adolescents With Obsessive-Compulsive Disorder Treated With Cognitive Behavioral Therapy

According to the metacognitive theory, maladaptive metacognition is associated with the development and maintenance of emotional disorders. This study is the first to explore maladaptive metacognition in a sample of children and adolescents (7-17 years) with obsessive-compulsive disorder (OCD) in the context of cognitive behavioral therapy (CBT). A total of 114 children and adolescents were included in the study. Of these 56 were OCD patients who were assessed on metacognition (Metacognitions Questionnaire-Child Version) and OCD symptom severity (Children's Yale-Brown Obsessive Compulsive Scale) before and after 14 sessions of individual CBT. Fifty-eight children and adolescents without any psychiatric diagnoses constituted a control group and were assessed on metacognition temporally corresponding to the OCD group. Results showed that the OCD group had significantly elevated maladaptive metacognition relative to the control group, with the exception of positive beliefs about worry. The maladaptive metacognition in the OCD group was significantly reduced from pre- to posttreatment. Additionally, the reduction in the total level of maladaptive metacognition was significantly larger than that reported by the control group. However, it remained significantly elevated relative to controls at posttreatment. Furthermore, lower posttreatment OCD severity was associated with larger reductions in negative beliefs about worry, beliefs about the need to control thoughts, and cognitive self-consciousness, as well as with a higher pretreatment level of positive beliefs about worry. Overall, age group (children vs adolescents) did not moderate these results. Collectively, the results suggest that amending maladaptive metacognition in children and adolescents with OCD might be important considering the associations between reductions in maladaptive metacognition and favorable treatment outcome.

Psychometric properties of the BALCI Turkish version

The present study aimed to adapt and validate the Beliefs About Losing Control Inventory (BALCI) in the non-clinical Turkish emerging adults sample. The study group consisted of 549 participants from three study phases and aged between 18 and 28 years and mainly women. According to the results of the confirmatory factor analysis (CFA), the BALCI Turkish Version (BALCI-TV) confirmed 21 items in three factors. The network analysis findings showed that the items including the factors were together. The results indicated that configural, metric, scalar, and strict invariance across the gender. Cronbach's α and McDonald's ω of the total BALCI-TV were .90. Test-retest correlation result was .89. All results indicated that the BALCI-TV had good psychometric properties. The BALCI-TV can be provided to measure control and beliefs related to control within obsessive-compulsive disorder for Turkish academics and mental health practitioners.

Thinking about worry: A systematic review and meta-analysis on the assessment of metacognitions in children and adolescents

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.

The Metacognitions Questionnaire and Its Derivatives in Children and Adolescents: A Systematic Review of Psychometric Properties

Background: The Metacognitions Questionnaire (MCQ) and its derivatives have been instrumental in research examining the Self-Regulatory Executive Function Model in adults. Studies testing whether findings are applicable to children and adolescents have been increasing and several different measures adapting the MCQ for younger populations have been developed. The current study aimed to systematically review the psychometric properties of MCQ measures or derivatives used in young people (aged 18 or less), to help assess current findings in this population and to guide future research in this growing area of investigation. Method: Systematic searches were carried out on PubMed and PsycINFO of studies published up to June 2018. Additional studies were identified through Google Scholar and article references. Validity, reliability, range and responsiveness of measures were examined as well as analyses of age and gender differences on scores. Results: Forty-five articles were identified. The total sample consisted of 7,803 children and adolescents (6,922 non-clinical, 881 clinical) aged 7-18. Studies used one of seven versions of the questionnaire, five adapted from the MCQ for younger populations: (1) The Metacognitions Questionnaire-Adolescent version; (2) The Metacognitions Questionnaire-Child version; (3) The Metacognitions Questionnaire-Child Version-Revised; (4) The Metacognitions Questionnaire-Child-30; and (5) The Metacognitions Questionnaire-65 Positive Beliefs Scale Revised; and two adult versions used without adaptation: (1) The Metacognitions Questionnaire-30 and (2) The Cognitive Self Consciousness Scale-Expanded. The validity and reliability of the Metacognitions Questionnaire-Adolescent version had the most extensive support. Other questionnaires had either mixed psychometrics or promising initial findings but more limited data. Conclusions: It is recommended that studies using adolescents (age 12-18) consider using the Metacognitions Questionnaire-Adolescent version. Based on initial data, it is suggested studies using younger populations should consider the Metacognitions Questionnaire-Child-30 but further psychometric research into this and other measures is needed.

Psychometric validation of a Danish version of the Obsessive Beliefs Questionnaire - Child Version (OBQ-CV)

AIM

The aim of the study was to examine the psychometric properties of a Danish version of the Obsessive Beliefs Questionnaire - Child Version (OBQ-CV). The OBQ-CV assesses dysfunctional beliefs concerning responsibility/threat estimation, perfectionism/uncertainty, and importance/control of thoughts, which according to cognitive theories are important in the development and maintenance of obsessive-compulsive disorder (OCD).

METHODS

The study included a pediatric sample (age 7-17 years) consisting of 57 children and adolescents with OCD, 49 children and adolescents with an anxiety disorder (AD), and 58 typically developing (TD) children and adolescents without a psychiatric diagnosis. All participants completed the OBQ-CV and the Child Behavior Checklist - the School Age Scales (CBCL/6-18). The Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) was used to assess OCD symptom severity in the OCD group.

RESULTS

Confirmatory factor analyses supported the three-factor structure and thereby the construct validity of the OBQ-CV. Gender was not associated with subscale scores, whereas age influenced the subscale scores differently in the three groups. Reliability analyses showed acceptable to excellent internal consistency and acceptable test-retest reliability of the instrument. There were significant differences between the OCD group and the TD group, supporting the criterion validity. Results on convergent validity were mixed.

CONCLUSIONS

Overall, results supported the reliability and validity of the Danish OBQ-CV and thus the use of the questionnaire for future clinical and research purposes.