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.

Examining the Longitudinal Relationship Between Metacognitive Beliefs and Psychological Distress in an Adolescent Population: A Preliminary Analysis

Adolescence is a period marked by significant vulnerability to the onset of mental health concerns. Within adults, the metacognitive model of psychological disorders advocates for the involvement of metacognitive beliefs in the onset, and maintenance, of psychopathology. The current study aimed to assess the applicability of the metacognitive model in adolescence by exploring the relationship, as well as the trajectory, between metacognitive beliefs and psychological distress. The longitudinal prospective cohort study investigated data from a community-based sample of participants aged 12 to 13. Self-report assessment measures of metacognitive beliefs, psychological distress, and somatic distress are reported across four time-points. Baseline assessments are reported for 70 participants, which reduced to 53 participants at time-point four. Correlational analyses demonstrated a significant relationship between overall metacognition, as well as negative metacognitive beliefs, and psychological distress at each of the four time-points. Generalised Estimating Equations found a significant association between metacognitive predictors and psychological distress over the four time-points. These results indicate that negative metacognitive beliefs, positive metacognitive beliefs, metacognitive beliefs related to superstition, punishment, and responsibility, low perceived levels of cognitive confidence and cognitive self-consciousness predict psychological distress over 12 months in adolescents aged 12 to 13. The strongest longitudinal correlational structure was found for the model of negative metacognitive beliefs and psychological distress. These findings provide preliminary evidence for the positive linear relationship between metacognitive beliefs and psychological distress in adolescence. The study provides an important contribution to understanding the role of metacognitive beliefs in the aetiology and perpetuation of psychological distress in adolescence.

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.

Metacognitive beliefs and anxiety symptoms could serve as mediators between fear of missing out and gaming disorder in adolescents

Given the vulnerability to and prevalence of emotional problems and Internet gaming disorder (IGD) in adolescents, this study aimed to test the effects of fear of missing out (FoMO) on IGD and the mediating roles of metacognitive beliefs and anxiety symptoms based on the self-regulatory executive function (S-REF) model. At a Chinese high school, 283 participants (M_age = 16.89 years old; girls = 42.0%) with past-year gaming experience voluntarily completed an anonymous paper-and-pencil questionnaire. FoMO showed significant, positive associations with IGD, anxiety symptoms, and metacognitive beliefs. Results of path analysis showed a significant direct effect of FoMO on IGD, whereas anxiety symptoms mediated the relationship between FoMO and IGD. The indirect effects of FoMO on IGD via serial mediations of three negative metacognitive beliefs (i.e., negative beliefs about worry, low cognitive confidence, and beliefs regarding need for control) and anxiety symptoms were also statistically significant. These findings demonstrated that maladaptive metacognitive beliefs and anxiety are risk-enhancing mediators in the relationship between FoMO and IGD. Therefore, metacognitive therapy, particularly for regulating those three specific significant metacognitive beliefs, is recommended for treating IGD and anxiety, especially for those with higher levels of FoMO.

Post-Traumatic Stress Disorder and Alcohol Use Disorder During the COVID-19 Outbreak: Do Dissociation and Emotional Metacognitive Beliefs Mediate the Role of Emotion Dysregulation?

OBJECTIVE

Despite the well-documented relationship between emotion dysregulation and both post-traumatic stress disorder (PTSD) and alcohol use disorder symptoms, no studies investigated this issue in the context of the outbreak. Moreover, additional research investigating the role of mediators intervening in these pathways is required. Dissociation and emotional beliefs are two factors that may explain such relationships. However, a poor number of studies empirically tested their role.

METHODS

A cross-sectional study on a sample of 719 community participants (32.5% males; Mage=34.36, standard deviation=14.38 years) was conducted. Participants fulfilled a battery of self-report questionnaires measuring levels of PTSD outbreak-related symptoms, alcohol use disorder, emotion dysregulation, emotional beliefs, and dissociation.

RESULTS

Partial r-Pearson correlations showed that PTSD symptoms' level was positively and significantly related to all variables investigated in the study whereas alcohol use disorder level was positively and significantly associated with emotion dysregulation and only some dimension of emotional beliefs and dissociation. Results drawn from a structural equation model highlight the mediating role of both emotional belief and dissociation in the relationship linking emotion dysregulation and alcohol use disorder whereas only dissociation, but not emotional beliefs, mediated the link between emotion dysregulation and PTSD symptoms.

CONCLUSION

Most of the hypotheses have been supported stressing the relevance of both dissociation and emotional beliefs in PTSD and alcohol use disorder symptoms. These two variables appear important framework from which deepen the impact of emotion dysregulation in psychopathology.

The network structure of dysfunctional metacognition: Analysis of the MCQ-30

The Metacognitive Control System (MCS) model gives central importance to maladaptive metacognition in psychological vulnerability and disorder. The metacognitions questionnaire 30 (MCQ-30) is widely used to assess such metacognitions and to establish their effects. Previous studies consistently demonstrate that the MCQ-30 consists of five latent factors, with some factors showing wide-ranging positive associations with symptoms and some demonstrating more specific symptom links. Questions remain concerning relationships between MCQ-items (or domains) and the most central of these outside of the latent-factor model. In the present study we set out to explore the internal structure of the MCQ-30 using network analysis and estimated two graphical Gaussian models, one with items- and one with domains, in an unselected sample (N = 1080). The robustness and stability of the networks, as well as the node predictability were assessed. Among our observations was that the items of the MCQ-30 appeared to cluster in meaningful substructures, corresponding to metacognitive theory. Furthermore, "need for control" was the most centrally placed domain, suggesting it plays an important role in the network and that its activation has a strong influence on other nodes. The theoretical and clinical implications of the current findings are discussed in light of the metacognitive model of psychological disorder.

Association between Metacognitive Beliefs and COVID-19 phobia in a community population: a cross-sectional study

This study aims to investigate the relationship between metacognitive beliefs and COVID-19 phobia. The sample included 514 Turkish adults, 295 of whom are women (57,4%), and 219 are men (42,6%). Their ages ranged between 18 and 70 years (M = 32.96, SD = 10.79). COVID-19 Phobia Scale (C19P-S) and Metacognitions Questionnaire-30 (MCQ-30) were administered. Our analysis showed that women reported significantly higher COVID-19 phobia. The participants with chronic illnesses showed significantly higher COVID-19 phobia and MCQ-30 scores. It was found that C19P-S total score positively correlated with negative beliefs about worry concerning uncontrollability of thoughts, the need to control thoughts, cognitive self-consciousness, positive beliefs, cognitive confidence, and MCQ-30 total score respectively (r = .47, p < .001; r = .33, p < .001; r = .30, p < .001; r = .29, p < .001; r = .12, p < .001; r = .44, p < .001). Then, hierarchical multiple regression was conducted, and the relationships were tested via structural equation modeling. To sum up, it can be concluded that negative beliefs about worry concerning the uncontrollability of thoughts contribute to COVID-19 phobia. However, explained variance was small suggesting that there are additional factors involved. These results provided preliminary findings relating to the association between metacognitive beliefs and coronavirus phobia symptoms. Further longitudinal research is necessary to determine the causal direction of these findings.

Difficulties in emotion regulation: The role of repetitive negative thinking and metacognitive beliefs

BACKGROUND

Using the Self-Regulatory Executive Function model as a basis, this study explored whether, in both general population and clinical samples, metacognitive beliefs and repetitive negative thinking (i.e., rumination and worry) are associated with higher levels of emotion dysregulation.

METHODS

395 participants from the general population and 388 outpatients seeking psychological treatment were recruited. Emotion dysregulation, metacognitive beliefs, rumination, worry, anxiety, depression, personality disorders were assessed. ANOVA and Welch's tests, correlation and path analyses were run.

RESULTS

Repetitive negative thinking was found to play a mediating role in the relationship between metacognitive beliefs and emotion dysregulation in both general population and clinical samples. Moreover, metacognitive beliefs were found to be directly associated to emotion dysregulation.

LIMITATIONS

The cross-sectional design.

CONCLUSIONS

Emotion dysregulation appears to be associated with the tendency to engage in repetitive negative thinking and metacognitive beliefs. Repetitive negative thinking and metacognitive beliefs could be a suitable therapeutic target to reduce difficulties in emotion regulation.

The effects of computerised metacognitive cognitive bias modification training on the development of adaptive metacognitive beliefs and post-traumatic stress disorder symptoms

BACKGROUND AND OBJECTIVES

Maladaptive metacognitive beliefs are associated with the development of post-traumatic stress disorder (PTSD) symptoms following trauma, however it remains unclear whether training people to adopt healthy metacognitive beliefs helps to protect against the development of PTSD symptoms. We developed and tested a new cognitive bias modification training protocol (CBM_Metacog) that aimed to prevent analogue PTSD by training people to adopt healthy metacognitive beliefs prior to watching a distressing film.

METHODS

Participants (N = 135) received CBM_Metacog or a control CBM training and then watched a trauma film. We assessed participants' metacognitive appraisal style/beliefs, analogue PTSD symptoms, including intrusions and meta-awareness of their intrusions.

RESULTS

CBM_Metacog led participants to adopt healthier metacognitive beliefs relative to the control training. Importantly, CBM_Metacog participants reported fewer film intrusions over a 7-day period compared to the control group. CBM_Metacog did not increase participants' meta-awareness of their intrusions.

LIMITATIONS

As this was the first study to manipulate metacognitive beliefs related to an analogue trauma via CBM, we chose to use a healthy participant sample. Therefore, further research is needed before these results can be generalised to clinical samples.

CONCLUSIONS

Overall, these results suggest that training people to adopt healthy metacognitive beliefs, prior to trauma exposure, may help reduce vulnerability to PTSD.

Metacognition, cognition and social anxiety: A test of temporal and reciprocal relationships

Cognitive models of social anxiety give prominence to dysfunctional schemas about the social self as the key underlying factors in maladaptive self-processing strategies and social anxiety symptoms. In contrast, the metacognitive model argues that beliefs about cognition represent a central belief domain underlying psychopathology and cognitive schemas as products of a thinking style regulated by metacognition. The present study therefore evaluated the temporal and reciprocal relations between metacognitive beliefs, social self-beliefs, and social anxiety symptoms to shed light on possible causal relationships among them. Eight hundred and sixty-eight individuals gathered at convenience participated in a four-wave online survey with each measurement wave 6 weeks apart. Using autoregressive cross-lagged panel models, we found significant temporal and reciprocal relations between metacognition, social self-beliefs (schemas), and social anxiety. Whilst social self-beliefs prospectively predicted social anxiety this relationship was reciprocal. Metacognitive beliefs prospectively predicted both social interaction anxiety and social self-beliefs, but this was not reciprocal. The results are consistent with metacognitive beliefs causing social anxiety and social self-beliefs and imply that negative social self-beliefs might be a product of metacognition. The clinical implications are that metacognitive beliefs should be the central target in treatments of social anxiety.

Unusual experiences and their association with metacognition: investigating ASMR and Tulpamancy

BACKGROUND

Unusual experiences in Tulpamancer and Autonomous Sensory Meridian Response (ASMR) communities are generally positive and sought after, unlike hallucinations and delusions in clinical populations. Metacognition, the ability to reflect on self-referential experiences, may aid sense-making around unusual experiences, reducing distress. This study investigated group differences in hallucination-proneness, delusion-proneness, and metacognition in these communities compared to controls, and whether metacognition predicted unusual experiences.

METHODS

243 participants reporting ASMR, Tulpamancy, or neither, with no history of psychosis, took part in an online observational study. Participants completed the Beck Cognitive Insight Scale, Metacognitions Questionnaire-30, and Brief Core Schema Scales to capture metacognition. A Tulpamancer+ (reporting ASMR) group was identified and included in analyses. ANCOVAs highlighted group differences in hallucination-proneness, with Tulpamancer+ scoring higher, and metacognitive beliefs, with Tulpamancers reporting lower metacognitive belief endorsement. There were no group differences in delusion-proneness, self-reflection, or self-schemas. Stepwise regression demonstrated metacognition does influence unusual experiences in the non-clinical population, and this influence varies across groups.

CONCLUSIONS

In non-clinical populations, unusual sensory experiences are not associated with increased metacognitive beliefs, but having multiple unusual experiences is associated with higher hallucination-proneness. Results suggest improving metacognition in clinical groups may help reduce distress related to unusual sensory experiences.

The psychological correlates of fatigue in Parkinson's disease: Contribution of maladaptive metacognitive beliefs

INTRODUCTION

Psychological factors can underlie fatigue in neurological disorders, but its relationship to fatigue in Parkinson's disease (PD) has not been explored. We assessed the association between maladaptive metacognitive beliefs and presence of fatigue in PD.

METHODS

Ninety-eight consecutive outpatients with PD (61% male; median age: 66.50 years) were assessed in terms of demographic, clinical, medication treatment, cognitive, or behavioural characteristics including metacognitive beliefs (Metacognitions Questionnaire-30 or MCQ). Fatigue was ascertained by PD-related diagnostic criteria. Univariate statistical approach (Mann-Whitney and Pearson chi-square tests) was used to compare PD patients with (f-PD) or without (nf-PD) fatigue in terms of demographic, clinical, medication treatment, cognitive, behavioural, and metacognitive measures.

RESULTS

Twenty-one PD patients (21%) displayed fatigue. The f-PD group scored higher on the MCQ-total score, MCQ-Cognitive Confidence subscale, and all behavioral measures (p_s < 0.01) relative to nf-PD. They also had a more advanced Hoehn and Yahr stage and Unified Parkinson's Disease Rating Scale-III score.

CONCLUSION

Maladaptive metacognitive beliefs such as the lack of cognitive confidence may play a key role to trigger and maintain fatigue in PD. Future studies, using a multivariate statistical approach, are needed to confirm these preliminary findings in a larger sample of patients with fatigue and to assess if modification of such metacognitive beliefs has the potential to ameliorate fatigue in PD.

Metacognitive beliefs and emotional eating in adolescents

PURPOSE

Metacognition refers to how people think about their own thoughts. Existing studies have found that compared to healthy controls, individuals with eating disorders manifest elevated levels of dysfunctional metacognitive beliefs. No studies to date have investigated what role metacognitive beliefs play in the manifestation of emotional eating, a well-known risk factor for the development of eating disorders. The purpose of the current study was to assess the associations between metacognitive beliefs and emotional eating in a community sample of adolescents.

METHODS

Participants were 135 middle school students (Mean age = 13.62 years; SD = 0.57) who completed the Emotional Eating Scale Adapted for Children and Adolescents-Short-Form, Metacognition Questionnaire for Children, Positive and Negative Affect Schedule for Children, and a demographic questionnaire.

RESULTS

Participants classified as high emotional eaters reported statistically significant higher negative metacognitive beliefs (Mean = 15.56; SD = 4.22) compared to participants classified as low emotional eaters (Mean = 12.85; SD = 4.31; p ≤ 0.001; t =  - 3.69). There was a significant positive association between emotional eating and negative metacognitive beliefs in the hierarchical multiple linear regression analysis (standardized beta coefficient = 0.25; p < 0.05) after controlling for socio-demographic variables and negative affect.

CONCLUSIONS

The current findings provide preliminary evidence that negative metacognitive beliefs may play a role in the manifestation of emotional eating in adolescents. Future prospective studies are needed to elucidate the temporal associations between emotional eating and negative metacognitive beliefs in this population.

LEVEL OF EVIDENCE

Level III, case-control analytic study.

Testing the impaired disengagement hypothesis: The role of attentional control and positive metacognitive beliefs in depression

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.

Group meta-cognitive therapy and depression in women with breast cancer: a randomized controlled trial

Background

Breast cancer is one of the most common cancers in Iranian women. They will experience a mental health problem like depression before, during or after treatment. This study aimed to determine the effectiveness of group metacognitive therapy on depression, cognitive-emotional regulation, and meta-cognitive beliefs in women with breast cancer.

Methods

In this randomized controlled clinical trial, a total of 24 depressed patients with breast cancer were randomly allocated to experimental and control groups. The experimental group received meta-cognitive therapy in 8 weekly sessions, but the control group received treatment as usual. Beck Depressive Inventory, cognitive emotion regulation questionnaire, and meta-cognitions questionnaire were completed before, after and one month after the intervention. Data were analyzed using Wilcoxon and Chi-square tests.

Results

The mean score of depression in the experimental group was reduced from 21.6 ± 4.83 in the pre-test to 13.83 ± 8.12 in one-month follow-up (p = 0.16); however, there was no significant difference in the control group. The mean score of cognitive emotion regulation did not show a significant change in the two groups during the study and follow-up period. The mean score of meta-cognitive beliefs reached 68.75 ± 15.74 from 79.51 ± 10.72 in the experimental group during the follow-up period (p = 0.006); however, there was no significant difference in the control group in the score of metacognitive beliefs.

Conclusion

These findings support the efficacy of meta-cognitive therapy as a viable psychosocial intervention in depressed patients with breast cancer.

Trial registration IRCT201606288473N5. Registered on: 05/09/2016 https://www.irct.ir/trial/8946.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12905-021-01258-9.

Toward a better understanding of the influence of repetitive negative thinking in alcohol use disorder: An examination of moderation effect of metacognitive beliefs and gender

Repetitive negative thinking (RNT), the most studied forms of which are depressive ruminations and anxious worry, is a unique transdiagnostic process responsible for the development and maintenance of many mental disorders. Over the past decade, studies have shown that RNT could be involved in the development and maintenance of alcohol use disorder (AUD). However, to date, little is known about the factors that can influence this relationship, even though some theoretical and empirical arguments suggest that variables such as gender or metacognitive beliefs may determine the role of RNT in the onset of symptoms. The aim of the present study was to test the moderation effect of metacognitive beliefs and gender in the relationship between RNT and AUD. Eighty-one AUD patients were administered measures of AUD severity, RNT, metacognitive beliefs about thinking and alcohol use, anxiety, and depression. Results indicated that the 'capture mental resources' factor of RNT is a significant predictor of AUD severity, independent from anxiety and depression, and that this effect is moderated by metacognitive beliefs and gender. RNT is a significant predictor of AUD severity only for people with high negative beliefs about thoughts regarding uncontrollability and danger. Furthermore, RNT was found to predict AUD severity only for men with high beliefs about the need to control thoughts and for men with high positive beliefs about emotional self-regulation. Treatments that reduce attentional impairments caused by RNT and modify dysfunctional metacognitive beliefs could be promising for some patients with AUD.

Metacognitive beliefs in individuals at risk for psychosis: a systematic review and meta-analysis of sex differences

BACKGROUND

Sex differences were found in several domains in individuals at ultra-high risk for psychosis, but no previous work has systematically reviewed and analysed possible sex differences in metacognition in this population. However, alterations in metacognitive beliefs have been shown in the at-risk mental state for psychosis population. Our aim was to qualitatively review and quantitatively analyse the existing literature for data on sex differences in metacognitive beliefs-mainly depicted by the Metacognitions Questionnaire (MCQ) and its short form (MCQ-30)-in individuals with at-risk mental states.

METHODS

We performed a systematic review of the literature on metacognition in help-seeking adolescents and young adults at ultra-high risk for psychosis. We included peer-reviewed articles that included a high-risk for psychosis group assessed with operationalised criteria and instruments. For the quantitative meta-analysis, only studies comparing MCQ data in high-risk individuals were included. A fixed-effect meta-model was used and forest plots drawn for each subscale and overall score. The studies were weighted according to the inverse variance method in order to calculate pooled confidence intervals and p values.

RESULTS

No article on metacognitive beliefs in individuals at increased risk for psychosis explicitly reported possible sex differences. Our meta-analysis of 234 (57% male) individuals' scores in the MCQ yielded no significant sex difference.

CONCLUSIONS

Currently, no sex differences in metacognition can be described in the at-risk population; however, data are insufficient and heterogeneous with regard to thoroughly answering the question whether sex differences in clinical high-risk populations are mirrored in the metacognitive domain.

A test of the goodness of fit of the generic metacognitive model of psychopathology symptoms

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.

The evaluation of metacognitive beliefs and emotion recognition in panic disorder and generalized anxiety disorder: effects on symptoms and comparison with healthy control

Background: The impairments in metacognitive functions and emotion recognition are considered as liable factors in anxiety disorders. Aims: The better understanding of these cognitive abilities might lead to develop more accurate treatment methods for patients who suffer from anxiety. Methods: Forty-four patients with panic disorder (PD), 37 individuals with generalized anxiety disorder (GAD) and 44 healthy control (HC) were participated in our study. Metacognition questionnaire-30 (MCQ-30), Reading The Mind From The Eyes Test and symptom severity tests were administered. Results: Statistical analyses estimated the dysfunctional metacognitive beliefs and disrupted emotion recognition in patients relative to HC. The 'need to control thoughts' aspect of metacognitive beliefs was accounted for symptom severity in GAD. Improper metacognitive beliefs were significantly predicted the PD and GAD. In addition, impoverished emotion recognition predicted the GAD. Conclusions: Our study revealed the role of inconvenient metacognitive beliefs and distorted emotion recognition in PD and GAD. These findings might facilitate the treatment management in cognitive therapies of anxiety disorders via pointing out more reasonable targets across improper cognitive fields.

Beliefs about memory decline in aging do not impact judgments of learning (JOLs): A challenge for belief-based explanations of JOLs

The cue-utilization framework (Koriat, 1997) and the analytic processing theory (Dunlosky, Mueller, & Tauber, 2015) identify people's beliefs about their memory as central to how judgments of learning (JOLs) are made. This assumption is supported by ample evidence. However, researchers have almost exclusively explored the impact of participants' beliefs about the materials or the learning task, and none have evaluated the impact of beliefs about a person on JOLs. Thus, to inform JOL theory, we evaluated the degree to which JOLs are related to the belief that "memory declines with aging in adulthood." In seven experiments, college-aged participants studied words, made JOLs, and took a memory test. Participants made JOLs predicting memory performance for an average younger adult (i.e., 18-21 years old) or for an average older adult (i.e., 65+ years old). Most important, beliefs about aging in adulthood were not always sufficient to produce cue effects on JOLs, which contrasts with expectations from the aforementioned theories. An important challenge for future research will be to discover factors that moderate belief effects. To guide such explorations, we discuss possible explanations for why beliefs about aging would have demonstrated little to no relationship with people's JOLs.

The effect of worrying on intolerance of uncertainty and positive and negative beliefs about worry

BACKGROUND AND OBJECTIVES

The effect of a worry manipulation on the clinical constructs intolerance of uncertainty (IU), negative beliefs about the consequences of worry (NCOW), positive beliefs about the consequences of worry (PCOW), in addition to the emotions anxiety and sadness, was examined.

METHODS

A non-clinical sample was split into two groups, a worry group (n = 29), who were asked to generate 20 potential worries about a hypothetical scenario, and a control group (n = 28), who were asked to generate 2 potential worries about the same scenario. Subsequently, participants were asked to complete measures of IU, NCOW, PCOW, sadness and anxiety.

RESULTS

The worry group scored significantly higher than the control group on measures of IU, NCOW and PCOW but not on measures of sadness and anxiety.

LIMITATIONS

Possible limitations of the current study include the use of a student sample and the use of a hypothetical worry scenario.

CONCLUSIONS

The results suggest that engaging in worry can increase scores on measures of the beliefs and thought patterns often used to causally explain worry. The results are in line with recent research showing bidirectionality between anxiety related symptoms and their associated clinical constructs, and are consistent with an approach which sees anxiety symptoms as part of an evolved integrated threat management system that alerts the individual to threats to goals or challenges, and coordinates cognitive, behavioral, and affective reactions to enable effective responding to these threats and challenges.

Moving toward a metacognitive conceptualization of cyberchondria: Examining the contribution of metacognitive beliefs, beliefs about rituals, and stop signals

Cyberchondria refers to the repeated use of the Internet to search for health information that leads to negative consequences. The present set of studies examined the tenability of a proposed metacognitive conceptualization of cyberchondria that includes metacognitive beliefs about health-related thoughts, beliefs about rituals, and stop signals. The contribution of those variables to cyberchondria was examined among 330 undergraduate students from a U.S. university in Study 1 and 331 U.S. community respondents in Study 2. All participants reported using the Internet to search for health information. Across both studies, metacognitive beliefs, beliefs about rituals, and stop signals shared positive bivariate associations with cyberchondria and accounted for unique variance in cyberchondria scores in multivariate analyses. Beliefs about rituals and stop signals emerged as relatively specific to cyberchondria versus health anxiety in multivariate analyses. Results provide preliminary support for a metacognitive conceptualization of cyberchondria, with extensions of the present findings discussed.

Role of rumination in the relationship between metacognition and shyness

AIM

To explore the association between metacognitive beliefs, rumination and shyness in a non-clinical sample of adults.

METHODS

One hundred and three healthy subjects from the general population were enrolled in the study. Shyness was evaluated using the Revised Cheek and Buss Shyness Scale, rumination was assessed using the Ruminative Response Scale, metacognition was evaluated using the Meta-Cognitions Questionnaire 30, and anxiety levels were measured using the State Trait Anxiety Inventory form Y. Correlation analyses, mediation models and 95% bias-corrected and accelerated (BCaCI) bootstrapped analyses were performed. Mediation analyses were adjusted for sex and anxiety.

RESULTS

Shyness, rumination and metacognition were significantly correlated (P < 0.05). The relationship between metacognition and shyness was fully mediated by rumination (Indirect effect: 0.20; 95% BCaCI: 0.08-0.33).

CONCLUSION

These findings suggest an association between metacognition and shyness. Rumination mediated the relationship between metacognition and shyness, suggesting that rumination could be a cognitive strategy for shy people. Future research should explore the relationship between these constructs in more depth.

Metacognitive beliefs and illness perceptions are associated with emotional distress in people with epilepsy

PURPOSE

Emotional distress is common in people with epilepsy (PWE) for which efficacious interventions are required. Developing evidence-based treatments should be based on testable models of the psychological mechanisms maintaining psychopathology. The Self-Regulatory Executive Function (S-REF) model proposes that maladaptive metacognitive beliefs and processes are central to the development and maintenance of emotional distress. Although preliminary support exists for the role of metacognitive beliefs in emotional distress in PWE, their role has yet to be tested when controlling for the contribution made by illness perceptions.

METHODS

Four hundred and fifty-seven PWE completed an online survey, which assessed anxiety, depression, metacognitive beliefs, illness perceptions, general demographic factors, and epilepsy characteristics.

RESULTS

Hierarchical regression analyses demonstrated that metacognitive beliefs and illness perceptions were both associated with anxiety and depression when controlling for the influence of demographic variables and epilepsy characteristics. However, metacognitive beliefs accounted for more variance in anxiety and depression than illness perceptions.

CONCLUSION

Metacognitive beliefs appear to make a greater contribution to anxiety and depression in PWE than illness perceptions. Prospective studies are now needed to establish the causal role of metacognitive beliefs in both the development and persistence of emotional distress.

The contribution of illness perceptions and metacognitive beliefs to anxiety and depression in adults with diabetes

AIMS

Anxiety and depression are highly prevalent in people with diabetes (PwD). The most widely used psychological model to explain anxiety and depression in PwD is the Common-Sense Model, which gives a central role to illness perceptions. The Self-Regulatory Executive Function (S-REF) model proposes metacognitive beliefs are key to understanding the development and maintenance of emotional disorders. To test the potential utility of the S-REF model in PwD, the study explored if metacognitive beliefs explained additional variance in anxiety and depression after controlling for demographic and illness perceptions.

METHODS

614 adults with either Type 1 (n = 335) or Type 2 (n = 279) diabetes participated in a cross sectional online survey. All participants completed questionnaires on anxiety, depression, illness perceptions and metacognitive beliefs.

RESULTS

Regression analyses showed that metacognitive beliefs were associated with anxiety and depression in PwD and explained additional variance in both anxiety and depression after controlling for demographics and illness perceptions.

CONCLUSIONS

This is the first study to demonstrate that metacognitive beliefs are associated with anxiety and depression in PwD. The clinical implications of the study are illustrated.

Negative metacognitive beliefs moderate the influence of perceived stress and anxiety in long-term anxiety

Metacognitive theory of emotional disorders (Matthews and Wells, 1994; Wells, 2009) suggests that metacognitive beliefs can play a causal role in the development and maintenance of anxiety symptoms. In this prospective study, we examine the relationships between metacognitive beliefs, perceived stress and anxiety in a non-clinical sample. Participants were 135 undergraduate students who completed a battery of questionnaire at two time points (3- months apart). Results revealed metacognitive beliefs do not predict long-term anxiety independently. However, moderation analyses demonstrated negative beliefs about uncontrollability and danger prospectively moderated the relationship between perceived stress and Time 2 anxiety. Negative metacognitive beliefs also interacted with baseline anxiety to predict the change in anxiety symptoms. The results confirm metacognitions play a causal role in anxiety and have implications for cognitive models and the treatment of anxiety.

Experimental modification of perspective on thoughts and metacognitive beliefs in alcohol use disorder

Metacognitive therapy is designed to impact directly on cognitive monitoring and control processes such that individuals can develop alternative ways of experiencing and regulating thoughts. One technique used for this purpose is 'detached mindfulness' which promotes a decentred perspective to thoughts and decouples repetitive thinking and coping from their occurrence. This study set out to test the effects of detached mindfulness against a control condition, a brief exposure to alcohol-related thoughts. Eight patients diagnosed with alcohol use disorder in an abstinence regime were exposed to detached mindfulness versus brief exposure in a counterbalanced repeated-measures design. Results showed that detached mindfulness led to significantly greater decreases in meta-appraisal and metacognitive beliefs about alcohol-related thoughts compared to a brief exposure. Significantly greater decreases in distress and urge to use alcohol were also observed in detached mindfulness. The clinical implications are discussed.

Metacognitive processes in psychometrically defined schizotypy

Metacognitive abnormalities have been implicated in the experience of psychotic symptoms; however, the process through which this occurs remains unclear. The aim of this study was to clarify the association of self-reported schizotypy with metacognitive beliefs and neural activity related to higher-order cognition. Event-related potentials (ERPs) including the error-related negativity (ERN) and error positivity (Pe) were recorded during a Flanker task in 20 controls and 22 individuals with high self-reported schizotypy on the Schizotypal Personality Questionnaire-Brief Revised (SPQ-BR). Participants continuously evaluated their task performance and completed the Metacognitions Questionnaire-30 (MCQ-30). The high schizotypy group demonstrated higher scores on all subscales of the MCQ-30. In contrast, task performance, accuracy of self-performance evaluation, and amplitudes of the ERN and Pe did not differ between groups. The MCQ-30 factors that measure cognitive confidence and positive beliefs about worry significantly predicted SPQ-BR total score, whereas ERPs did not. High self-reported schizotypy appears to be more associated with dysfunctional metacognitive beliefs than physiological abnormalities in brain areas related to metacognition.

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

BACKGROUND

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

AIMS

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

METHOD

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

RESULTS

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

CONCLUSION

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

Anxiety control and metacognitive beliefs mediate the relationship between inflated responsibility and obsessive compulsive symptoms

Research has indicated that beliefs about inflated responsibility, beliefs about perceived control over anxiety-related events and reactions (anxiety control) and metacognitive beliefs about the need to control thoughts are associated with obsessive compulsive symptoms. In the current study we tested a mediation model of the interactions between these variables in predicting obsessive compulsive symptoms. Thirty-seven individuals with obsessive compulsive disorder and 31 controls completed the following self-report instruments: the Responsibility Attitude Scale, the Anxiety Control Scale, the Beliefs about Need to Control Thoughts sub-scale of the Metacognitions Questionnaire 30, and the Padua Inventory. Mann-Whitney U tests revealed that participants in the clinical group scored significantly higher than those in the non-clinical group on all variables. In the mediation model we found that the relationship between beliefs about inflated responsibility and obsessive compulsive symptoms was fully mediated by anxiety control and beliefs about the need to control thoughts. These findings provide support for the significant role played by beliefs about control in predicting the severity of obsessive compulsive symptoms.

Metacognition in addictive behaviors

BACKGROUND

Over the last twenty years metacognitive theory has provided a novel framework, in the form of the Self-Regulatory Executive Function (S-REF) model, for conceptualizing psychological distress (Wells & Matthews, 1994, 1996). The S-REF model proposes that psychological distress persists because of unhelpful coping styles (e.g. extended thinking and thought suppression) which are activated and maintained as a result of metacognitive beliefs.

OBJECTIVE

This paper describes the S-REF model and its application to addictive behaviors using a triphasic metacognitive formulation.

DISCUSSION

Evidence on the components of the triphasic metacognitive formulation is reviewed and the clinical implications for applying metacognitive therapy to addictive behaviors outlined.

A Prospective Study of the Association of Metacognitive Beliefs and Processes with Persistent Emotional Distress After Diagnosis of Cancer

Two hundred and six patients, diagnosed with primary breast or prostate cancer completed self-report questionnaires on two occasions: before treatment (T1) and 12 months later (T2). The questionnaires included: the Hospital Anxiety and Depression Scale; Impact of Events Scale; the Metacognitions Questionnaire-30 (MCQ-30) and the Illness Perceptions Questionnaire-revised. A series of regression analyses indicated that metacognitive beliefs at T1 predicted between 14 and 19 % of the variance in symptoms of anxiety, depression and trauma at T2 after controlling for age and gender. For all three outcomes, the MCQ-30 subscale 'negative beliefs about worry' made the largest individual contribution with 'cognitive confidence' also contributing in each case. For anxiety, a third metacognitive variable, 'positive beliefs about worry' also predicted variance in T2 symptoms. In addition, hierarchical analyses indicated that metacognitive beliefs explained a small but significant amount of variance in T2 anxiety (2 %) and T2 depression (4 %) over and above that explained by demographic variables, T1 symptoms and T1 illness perceptions. The findings suggest that modifying metacognitive beliefs and processes has the potential to alleviate distress associated with cancer.

Further insight into the role of metacognitive beliefs in schizophrenia and OCD patients: testing a mediation model

This study explored the mediation effect of metacognitive beliefs on the relationship between intrusive thoughts and emotional distress in schizophrenia (N=49) and obsessive-compulsive disorder (OCD) (N=35). Intrusive thoughts impact on anxiety and depression through beliefs about uncontrollability and danger of thoughts in schizophrenia. Negative beliefs in general mediated the effect of intrusive thoughts on anxiety in obsessive-compulsive disorder. The results suggest that metacognitive beliefs may be a vulnerability factor for emotional and psychological disorder.

Desire thinking as a predictor of gambling

Desire thinking is a voluntary cognitive process involving verbal and imaginal elaboration of a desired target. A desired target can relate to an object, an internal state or an activity, such as gambling. This study investigated the role of desire thinking in gambling in a cohort of participants recruited from community and clinical settings. Ninety five individuals completed a battery of self-report measures consisting of the Hospital Anxiety and Depression Scale (HADS), the Gambling Craving Scale (GCS), the Desire Thinking Questionnaire (DTQ) and the South Oaks Gambling Screen (SOGS). Correlation analyses revealed that gender, educational level, recruitment source, anxiety and depression, craving and desire thinking were correlated with gambling. A hierarchical multiple regression analysis revealed that both recruitment source and desire thinking were the only independent predictors of gambling when controlling for all other study variables, including craving. These findings are discussed in the light of metacognitive therapy (MCT).

Characteristics of worry in generalized anxiety disorder

BACKGROUND & OBJECTIVES

Groups of clients and community volunteers with Generalized Anxiety Disorder (GAD) and clients with Panic Disorder were compared to a group with elevated worry but without GAD on a range of measures, to identify individual differences beyond a high propensity to worry.

METHOD

Participants completed standardised questionnaires and a behavioural worry task that assesses frequency and severity of negative thought intrusions.

RESULTS

Relative to high worriers, clients with GAD had higher scores on trait anxiety, depression, more negative beliefs about worry, a greater range of worry topics, and more frequent and severe negative thought intrusions. Relative to community volunteers with GAD, clients in treatment reported poorer attentional control. Compared to clients with Panic Disorder, clients with GAD had higher trait anxiety, propensity to worry, negative beliefs and a wider range of worry content.

CONCLUSIONS

Results confirmed expectations of group differences based on GAD diagnostic criteria, but also revealed other differences in mood, characteristics of worry, and perceived attentional control that may play a role in the decision to seek treatment.