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Holden ML, Gooi CH, Antognelli S, Joubert A, Sabel I, Stavropoulos L, Newby JM. Symptom Attributions in Illness Anxiety Disorder. J Clin Psychol 2025; 81:237-248. [PMID: 39792360 PMCID: PMC11890152 DOI: 10.1002/jclp.23765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 08/14/2024] [Accepted: 12/18/2024] [Indexed: 01/12/2025]
Abstract
OBJECTIVES A major characteristic of health anxiety is the tendency to attribute benign bodily sensations to serious illnesses. This has been supported by empirical research in non-clinical samples, and samples of individuals diagnosed with Hypochondriasis. However, no study to date has explored symptom attribution styles of individuals with the DSM-5 diagnosis of Illness Anxiety Disorder. METHODS Sixty-one participants, including a clinical Illness Anxiety Disorder (n = 35) and healthy control (n = 26) sample, completed self-report measures of health anxiety and an Attribution Task, whereby they were presented with eight common bodily sensations and asked to generate possible explanations for them. RESULTS Results showed that relative to healthy controls, participants with Illness Anxiety Disorder overall were more likely to make more serious, 'catastrophic' somatic attributions to symptoms, and less likely to generate non-threatening normalising explanations. These results also extended to their initial attributions, conceptualised as the 'jumping to conclusions' bias, and as an exploratory index of flexibility, they were also found to make less attributions overall compared to healthy controls. CONCLUSIONS Findings provide support for the cognitive behavioural theory of health anxiety, and highlight the importance of assessing and addressing symptom attributions with clients with illness anxiety disorder.
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Affiliation(s)
| | - Chien H. Gooi
- School of PsychologyUniversity of New South WalesSydneyNSWAustralia
| | | | - Amy Joubert
- Black Dog InstituteUniversity of New South WalesSydneyNSWAustralia
| | - Isaac Sabel
- School of PsychologyUniversity of New South WalesSydneyNSWAustralia
| | | | - Jill M. Newby
- School of PsychologyUniversity of New South WalesSydneyNSWAustralia
- Black Dog InstituteUniversity of New South WalesSydneyNSWAustralia
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2
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Bailey R, Oba EC, Allen R. The role of metacognitive beliefs in generalised anxiety disorder in men who have sex with men living with HIV in Nigeria. J Health Psychol 2025:13591053251314989. [PMID: 39972452 DOI: 10.1177/13591053251314989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2025] Open
Abstract
Men who have sex with men (MSM) living with HIV tend to experience a range of mental health issues, in particular generalised anxiety disorder (GAD), often caused and maintained by psychosocial variables including HIV stigma, discrimination, self-esteem issues, substance abuse and loneliness. This is particularly problematic in countries like Nigeria where same sex activity is illegal and can result in up to 14 years imprisonment. An important psychological variable that may contribute to the experience of GAD are metacognitive beliefs. Participants (N = 311) completed measures to examine the relationship between these variables. Results indicated that metacognition was associated with, and significantly predicted, GAD in this population. Moderation analysis showed that the effect of HIV stigma on GAD was explained by the proposed interaction with metacognition. Findings suggest that metacognition may be an important variable in explaining GAD symptoms in MSM living with HIV in Nigeria.
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Affiliation(s)
- Robin Bailey
- School of Psychology, Deane Road, University of Bolton, Bolton, UK
| | | | - Rosie Allen
- School of Psychology, Deane Road, University of Bolton, Bolton, UK
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3
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Schultz K, Kannis-Dymand L, Jamieson D, McLoughlin LT, Loughnan S, Allen A, Hermens DF. Examining the Longitudinal Relationship Between Metacognitive Beliefs and Psychological Distress in an Adolescent Population: A Preliminary Analysis. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01611-z. [PMID: 37831288 DOI: 10.1007/s10578-023-01611-z] [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: 09/16/2023] [Indexed: 10/14/2023]
Abstract
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.
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Affiliation(s)
- Katie Schultz
- School of Health, University of the Sunshine Coast, Maroochydore DC, QLD, Australia
| | - Lee Kannis-Dymand
- School of Health, University of the Sunshine Coast, Maroochydore DC, QLD, Australia
| | - Daniel Jamieson
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia
| | - Larisa T McLoughlin
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia
| | - Siobhan Loughnan
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia
- Stillbirth Centre of Research Excellence, Mater Research Institute, South Brisbane, QLD, Australia
| | - Andrew Allen
- School of Health, University of the Sunshine Coast, Maroochydore DC, QLD, Australia.
| | - Daniel F Hermens
- Thompson Institute, University of the Sunshine Coast, Birtinya, QLD, Australia
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Abstract
Interpretation bias (i.e. the selective negative interpretation of ambiguous stimuli) may contribute to the development and maintenance of health anxiety. However, the strength of the empirical evidence for this association remains a topic of debate. This study aimed to estimate the association between health anxiety and interpretation bias and to identify potential moderators of this association. Chinese-language databases (CNKI, VIP, and Wanfang), English-language databases (Web of Science, PubMed, PsycINFO, and Scopus), and German-language databases (Psyndex and PubPsych) were searched for relevant studies. There were 36 articles (39 studies) identified by this search (N = 8984), of which 32 articles (34 studies) were included in the meta-analysis (N = 8602). Results revealed a medium overall effect size (g = 0.67). Statistically equivalent effect sizes were observed for patients diagnosed with clinical health anxiety (g = 0.58) and subclinical health anxiety (g = 0.72). The effect sizes for threat stimuli that were health related (g = 0.68) and not health related (g = 0.63) did not differ significantly. The effect size for studies using an offline paradigm (g = 0.75) was significantly higher than that for studies using an online paradigm (g = 0.50). It is concluded that health anxiety is significantly and robustly associated with interpretation bias. These findings are of central importance for the advancement of models and treatment of health anxiety.
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Affiliation(s)
- Xiayu Du
- Key Laboratory of Adolescent Cyberpsychology and Behavior (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, National Intelligent Society Governance Experiment Base (Education), School of Psychology, Central China Normal University, Wuhan, China
| | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Tao Zhang
- Key Laboratory of Adolescent Cyberpsychology and Behavior (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, National Intelligent Society Governance Experiment Base (Education), School of Psychology, Central China Normal University, Wuhan, China
| | - Congrong Shi
- Key Laboratory of Adolescent Cyberpsychology and Behavior (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, National Intelligent Society Governance Experiment Base (Education), School of Psychology, Central China Normal University, Wuhan, China
| | - Zhihong Ren
- Key Laboratory of Adolescent Cyberpsychology and Behavior (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, National Intelligent Society Governance Experiment Base (Education), School of Psychology, Central China Normal University, Wuhan, China
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5
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Mohammadkhani S, Akbari M, Shahbahrami M, Seydavi M, Kolubinski DC. Metacognitions About Health in Relation to Coronavirus Anxiety: The Mediating Role of Cognitive Attentional Syndrome and Distress Tolerance. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2023; 41:222-236. [PMID: 35789751 PMCID: PMC9244087 DOI: 10.1007/s10942-022-00467-x] [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] [Accepted: 06/14/2022] [Indexed: 11/29/2022]
Abstract
The current study aimed to investigate the mediating role of cognitive attentional syndrome (CAS) and distress tolerance in the relationship between health-related metacognitions and coronavirus anxiety. The sample of this study consisted of 462 participants (381 female). Participants voluntarily completed self-report questionnaires on each of the variables mentioned above. The results of the structural modeling analysis showed that health-related metacognitions have a significant effect on the mediator variable of distress tolerance and CAS. Also, health-related metacognitions had a direct effect on coronavirus anxiety. Also, based on the results of the bootstrap test, it can be argued that health-related metacognitive beliefs, apart from their direct effect, play an important role in coronavirus anxiety, with CAS acting as a mediator. This study provides insights into the relationships among metacognitive beliefs, coronavirus anxiety, CAS, and distress tolerance. In particular, dysfunctional metacognitive beliefs, including an individual's beliefs about the uncontrollability of disease-related thoughts, are risk factors that could negatively affect mental health, leading to coronavirus anxiety. In addition, the association of dysfunctional beliefs with maladaptive behaviors resulting from the cognitive attentional syndrome is also involved in predicting and causing coronavirus anxiety. Given the insignificant role of emotional distress tolerance in the psychopathology of COVID-19 anxiety, the findings emphasize the importance of cognitive factors in this context.
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Affiliation(s)
- Shahram Mohammadkhani
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, No. 43, South Mofatteh Ave., Tehran, Iran
| | - Mehdi Akbari
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, No. 43, South Mofatteh Ave., Tehran, Iran
| | - Maede Shahbahrami
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, No. 43, South Mofatteh Ave., Tehran, Iran
| | - Mohammad Seydavi
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, No. 43, South Mofatteh Ave., Tehran, Iran
| | - Daniel C Kolubinski
- Division of Psychology, School of Applied Sciences, London South Bank University, London, UK
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6
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Aydın O, Obuća F, Çakıroğlu E, Ünal-Aydın P, Esen-Danacı A. The effect of mindfulness and metacognition on anxiety symptoms: a case-control study. MIDDLE EAST CURRENT PSYCHIATRY 2022. [DOI: 10.1186/s43045-022-00260-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Background
Anxiety disorders (ADs) are associated with numerous psychiatric disorders; despite the efforts in psychotherapy models targeting their etiology, novel treatment strategies are still developing. We aimed to assess whether mindfulness and metacognition differ between patients with ADs and healthy controls (HCs) and whether the symptom severity of ADs is related to mindfulness and metacognition among patients. Two-hundred participants were enrolled in this study. Structured clinical interview, sociodemographic form, Five Facet Mindfulness Questionnaire-Short Form, Metacognition Questionnaire-30, and Hamilton Anxiety Rating Scale were administered. Multivariate analysis of covariance was conducted to compare the groups in terms of mindfulness and metacognition. Correlation and multiple linear regression analyses were performed to measure the association between the variables.
Results
The main finding indicates that positive beliefs about worry are associated with reduced symptom severity of ADs. Furthermore, HCs have more positive beliefs about worry and nonjudging of inner experience compared to patients with ADs, who utilize negative beliefs about uncontrollability and danger and need to control thoughts to a greater extent.
Conclusions
This study demonstrates that dysfunctional metacognitive beliefs may influence the anxiety severity of adult patients. We suggest that focusing on reducing maladaptive metacognitions may be supportive of AD improvement.
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Keen E, Kangas M, Gilchrist PT. A systematic review evaluating metacognitive beliefs in health anxiety and somatic distress. Br J Health Psychol 2022; 27:1398-1422. [PMID: 35746856 PMCID: PMC9796692 DOI: 10.1111/bjhp.12609] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Accepted: 05/30/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE Increasing evidence suggests metacognitive beliefs may underpin transdiagnostic mechanisms maintaining psychopathology. The objective of this systematic review was to evaluate published studies investigating the role of metacognitive beliefs in somatic distress in adult samples. METHOD A systematic review was conducted, spanning five data bases. Studies meeting eligibility criteria were qualitatively synthesized. RESULTS Thirty-six studies (N = 12,390) met inclusion criteria with results suggesting a relatively consistent positive relationship between metacognitive beliefs and somatic distress. Both general and syndrome-specific metacognitive beliefs demonstrated relationships with not only emotional distress, but also physical symptoms themselves. CONCLUSIONS Results are discussed in terms of conceptualizing somatic distress through the Self-Regulatory Executive Function (S-REF) Model. Future research into metacognitive therapy for somatic populations is recommended.
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Affiliation(s)
- Edwina Keen
- School of Psychological SciencesMacquarie UniversitySydneyNSWAustralia,Centre for Emotional HealthMacquarie UniversitySydneyNSWAustralia
| | - Maria Kangas
- School of Psychological SciencesMacquarie UniversitySydneyNSWAustralia,Centre for Emotional HealthMacquarie UniversitySydneyNSWAustralia
| | - Philippe T. Gilchrist
- School of Psychological SciencesMacquarie UniversitySydneyNSWAustralia,Centre for Emotional HealthMacquarie UniversitySydneyNSWAustralia
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Kowalski J, Gawęda Ł. Cognitive-Attentional Syndrome Moderates the Relationship Between Fear of Coronavirus and Symptoms of Coronavirus-Specific Health Anxiety. Int J Cogn Ther 2022; 15:492-503. [PMCID: PMC9593970 DOI: 10.1007/s41811-022-00147-9] [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: 10/10/2022] [Indexed: 11/26/2022]
Abstract
This study was aimed at exploring the possible roles of the cognitive attentional syndrome (CAS) and metacognitive beliefs in moderating the relationships between fear of coronavirus during the pandemic and health anxiety. Because some symptoms of health anxiety may overlap with symptoms of other anxiety disorders, we also tried to ascertain whether our hypothesized relations would be maintained when taking other anxiety disorder symptoms into account. We hypothesized that CAS strategies and meta-beliefs would play a role in the progression from fears of the coronavirus to coronavirus health anxiety. The method done was a cross-sectional study with n = 783 participants who completed questionnaires on fear of coronavirus, coronavirus-specific health anxiety, CAS, and symptoms of anxiety disorders. Fear of coronavirus and coronavirus health anxiety are correlated with medium effect size. CAS and metacognitive beliefs moderate the relationship between fear of coronavirus and symptoms of coronavirus-specific health anxiety. CAS predicts a unique part of health anxiety symptoms variance above symptoms of other anxiety disorders. The results of this cross-sectional study preclude causal inferences but tentatively suggest that CAS strategies may play a role in moderating the relationship between fear of coronavirus and coronavirus-related health anxiety. These relationships were obtained after controlling for variance shared with agoraphobia, social phobia, and general physical symptoms of anxiety.
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Affiliation(s)
- Joachim Kowalski
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Jaracza 1, 00-378 Warsaw, Poland
| | - Łukasz Gawęda
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Jaracza 1, 00-378 Warsaw, Poland
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9
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Akin-Sari B, Inozu M, Haciomeroglu AB, Trak E, Tufan D, Doron G. Cognitive training using a mobile app as a coping tool against COVID-19 distress: A crossover randomized controlled trial. J Affect Disord 2022; 311:604-613. [PMID: 35636516 PMCID: PMC9137239 DOI: 10.1016/j.jad.2022.05.118] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/22/2022] [Accepted: 05/25/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The COVID-19 pandemic has been suggested to constitute a broad base stressor with severe mental health consequences. mHealth applications are accessible self-help tools that can be used to reduce psychological distress during the pandemic. This randomized controlled trial evaluated the effects of mobile-based cognitive training exercises on COVID-19 related distress and maladaptive cognitions. METHODS Following initial screening (n = 924), participants scoring 1 standard deviations above the mean of the COVID-19 Distress Scale were randomized into two groups. Participants in the immediate-app group (iApp; n = 25) started using the application at baseline (T0) for 12 days (from T0 to T1). Participants in the delayed-app group (dApp; n = 22) started using the mobile application at T1 (crossover) and used it for the following 12 days (T1 to T2). RESULTS Intention to treat analyses indicated that the iApp group exhibited lower COVID-19 distress, lower depression, fewer intolerance of uncertainty and obsessive beliefs than the dApp group at T1. In addition, using the app for 12 consecutive days was associated with large effect-size reductions (Cohen's d ranging from 0.81 to 2.35) in COVID-19 distress and related maladaptive cognitions in the iApp group (from T0 to T1) and the dApp group (from T1 to T2). Moreover, these reductions were maintained at the follow-up. LIMITATIONS This study was a crossover trial with a relatively limited sample size and mainly female participants. CONCLUSION Our findings underscore the usefulness of brief, low-intensity, portable interventions in alleviating the negative effects of the pandemic on mental health.
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Affiliation(s)
| | - Mujgan Inozu
- Department of Psychology, Hacettepe University, Ankara, Turkey
| | | | - Ezgi Trak
- Department of Psychology, Hacettepe University, Ankara, Turkey
| | - Damla Tufan
- Department of Psychology, Hacettepe University, Ankara, Turkey
| | - Guy Doron
- Interdisiplinary Center of Herzliya to: Reichman University (IDC) Herzliya, Tel Aviv, Israel
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Nadeem F, Malik NI, Atta M, Ullah I, Martinotti G, Pettorruso M, Vellante F, Di Giannantonio M, De Berardis D. Relationship between Health-Anxiety and Cyberchondria: Role of Metacognitive Beliefs. J Clin Med 2022; 11:jcm11092590. [PMID: 35566713 PMCID: PMC9101818 DOI: 10.3390/jcm11092590] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 02/01/2023] Open
Abstract
Purpose: The current study was designed to examine the relationship between health anxiety, cyberchondria (its constructs), and metacognitive beliefs. In addition, it also evaluated the moderating role of metacognitive beliefs in this relationship. Design and Method: The present study used the purposive sampling technique to acquire a sample of (N = 500) adults, among them (N = 256) women and (N = 244) men, and the age of the sample ranged from 20 to 50 years. Short Health Anxiety Inventory, Cyberchondria Severity Scale, and Metacognitions Questionnaire–Health Anxiety were used to operationalize the present study variables. Findings: The descriptive statistics revealed that all instruments have good psychometric properties, as Cronbach’s alpha coefficients for all scales are ≥0.70. In addition to this, the Pearson correlation showed that all variables of the present study have a significant positive correlation with each other. Furthermore, the regression analysis described that health anxiety and metacognitive beliefs (biased thinking and beliefs about uncontrollable thoughts) were the significant positive predictors of cyberchondria. Moreover, moderation analysis showed that metacognitive beliefs significantly strengthened the association between health anxiety and cyberchondria and its constructs. Practical Implications: The present study will help medical practitioners to understand how metacognitive beliefs and health anxiety can cause an increase in cyberchondria. This will help them to design better treatment plans for people with cyberchondria.
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Affiliation(s)
- Faiza Nadeem
- Department of Psychology, University of Sargodha, Sargodha 40100, Pakistan; (F.N.); (N.I.M.); (M.A.)
| | - Najma Iqbal Malik
- Department of Psychology, University of Sargodha, Sargodha 40100, Pakistan; (F.N.); (N.I.M.); (M.A.)
| | - Mohsin Atta
- Department of Psychology, University of Sargodha, Sargodha 40100, Pakistan; (F.N.); (N.I.M.); (M.A.)
| | - Irfan Ullah
- Kabir Medical College, Gandhara University, Peshawar 25000, Pakistan;
| | - Giovanni Martinotti
- Department of Neurosciences and Imaging, Chair of Psychiatry, University “G. D’Annunzio”, 66100 Chieti, Italy; (G.M.); (M.P.); (F.V.); (M.D.G.)
| | - Mauro Pettorruso
- Department of Neurosciences and Imaging, Chair of Psychiatry, University “G. D’Annunzio”, 66100 Chieti, Italy; (G.M.); (M.P.); (F.V.); (M.D.G.)
| | - Federica Vellante
- Department of Neurosciences and Imaging, Chair of Psychiatry, University “G. D’Annunzio”, 66100 Chieti, Italy; (G.M.); (M.P.); (F.V.); (M.D.G.)
| | - Massimo Di Giannantonio
- Department of Neurosciences and Imaging, Chair of Psychiatry, University “G. D’Annunzio”, 66100 Chieti, Italy; (G.M.); (M.P.); (F.V.); (M.D.G.)
| | - Domenico De Berardis
- National Health Service, Department of Mental Health, ASL 4, 64100 Teramo, Italy
- Correspondence:
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11
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Childhood Adversity and Illness Appraisals as Predictors of Health Anxiety in Emerging Adults with a Chronic Illness. J Clin Psychol Med Settings 2022; 30:143-152. [PMID: 35461438 PMCID: PMC9034695 DOI: 10.1007/s10880-022-09870-z] [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] [Accepted: 04/05/2022] [Indexed: 11/20/2022]
Abstract
Emerging adults with a chronic medical condition (CMC) are at increased risk for developing health anxiety (HA). Adverse childhood experiences (ACEs) have been linked to developing HA. CMCs and ACEs frequently co-occur among emerging adults. However, no known research has examined ACEs and HA within this critical developmental period. Further, increased negative illness appraisals (e.g., uncertainty, intrusivness) may partially explain the relation between ACEs and HA. The present study examined the following mediation model: ACEs → illness appraisals → HA. Emerging adults (N = 121) with a CMC completed self-report measures of demographics, ACEs, illness appraisals, and HA. Regression analyses were conducted to test each illness appraisal as a mediator between ACEs and HA. Results demonstrated significant indirect effects for both illness appraisals. Findings demonstrate greater ACEs may increase negative illness appraisals which heightens overall HA. Thus, these associations support trauma-informed care approaches to support emerging adults.
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12
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Shi C, Taylor S, Witthöft M, Du X, Zhang T, Lu S, Ren Z. Attentional bias toward health-threat in health anxiety: a systematic review and three-level meta-analysis. Psychol Med 2022; 52:604-613. [PMID: 35341486 DOI: 10.1017/s0033291721005432] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Attentional bias toward health-threat may theoretically contribute to the development and maintenance of health anxiety, but the empirical findings have been controversial. This study aimed to synthesize and explore the heterogeneity in a health-threat related attentional bias of health-anxious individuals, and to determine the theoretical model that better represents the pattern of attentional bias in health anxiety. Four databases (Web of Science, PubMed, PsycINFO, and Scopus) were searched for relevant studies, with 17 articles (N = 1546) included for a qualitative review and 16 articles (18 studies) for a three-level meta-analysis (N = 1490). The meta-analytic results indicated that the health anxiety group, compared to the control group, showed significantly greater attentional bias toward health-threat (g = 0.256). Further analyses revealed that attentional bias type, paradigm, and stimuli type were significant moderators. Additionally, compared to the controls, health-anxious individuals displayed significantly greater attention maintenance (g = 0.327) but nonsignificant attention vigilance to health-threat (g = -0.116). Our results provide evidence for the attention maintenance model in health-anxious individuals. The implications for further research and treatment of elevated health anxiety in the context of coronavirus disease-2019 (COVID-19) were also discussed.
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Affiliation(s)
- Congrong Shi
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Steven Taylor
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Michael Witthöft
- Department of Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg University Mainz, Mainz, Germany
| | - Xiayu Du
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Tao Zhang
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Shan Lu
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
| | - Zhihong Ren
- Key Laboratory of Adolescent Cyberpsychology and Behaviour (Ministry of Education), Key Laboratory of Human Development and Mental Health of Hubei Province, School of Psychology, Central China Normal University, Wuhan, China
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13
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Gorday JY, Bardeen JR. The Interactive Effect of Anxiety Sensitivity and Metacognitive Beliefs on Anxiety. J Cogn Psychother 2022; 36:60-69. [PMID: 35121679 DOI: 10.1891/jcpsy-d-20-00054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Anxiety sensitivity (AS) has been identified as a contributing factor to the development and maintenance of anxiety. Individuals with high AS are sensitive to bodily cues and anxiety-related thoughts and often misinterpret these stimuli as catastrophic or dangerous. Similarly, negative and positive metacognitive beliefs (i.e., beliefs about thinking) are believed to increase internal threat monitoring and the use of maladaptive coping strategies, which may increase the impact of AS on anxiety. As such, the purpose of the present study was to examine the moderating role of metacognitive beliefs on the relationship between anxiety sensitivity and anxiety. Adult participants (N = 417), recruited through an online crowdsourcing website, completed a battery of measures assessing the constructs of interest. Results from multiple linear regression indicated that the relationship between AS and anxiety became significantly stronger as negative and positive metacognitive beliefs increased, thus suggesting that negative and positive metacognitive beliefs may exacerbate the effect of AS on anxiety. The development of risk profiles that incorporate AS and negative and positive metacognitive beliefs may be beneficial for early identification of individuals at high risk for the development of anxiety.
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14
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Culture and musculoskeletal pain: strategies, challenges, and future directions to develop culturally sensitive physical therapy care. Braz J Phys Ther 2022; 26:100442. [PMID: 36209626 PMCID: PMC9550611 DOI: 10.1016/j.bjpt.2022.100442] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 07/13/2022] [Accepted: 08/25/2022] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND Pain experience has a multidimensional nature. Assessment and treatment recommendations for pain conditions suggest clinicians use biopsychosocial approaches to treat pain and disability. The current pain research is overwhelmingly skewed towards the study of biological and psychological factors including interventions, whereas, cultural factors are often ignored. OBJECTIVE The aims of this Masterclass is threefold: (1) to discuss cultural influences on pain, (2) to provide strategies for delivering appropriate pain education and exercises in culturally diverse people with chronic pain, and (3) to present challenges and future directions to clinicians and researchers. DISCUSSION Cultural factors have a relevant influence on the way individuals experience and manage health and illness. Thus, people with different cultural experience perceive, respond, communicate and manage their pain in different ways. In this aspect, the contents of pain education should be presented using different culturally appropriate examples, metaphors, images, and delivery methods that may enhance the impact of the message. Efforts should be made to produce and spread culturally adapted evidence-based materials and resources. In addition, a culturally sensitive approach may help to introduce patients to graded activities, so that they can apply these strategies in culturally acceptable and meaningful ways. Future studies should investigate the effectiveness of culturally-adapted interventions in pain-related outcomes in different pain conditions in patients with different cultural backgrounds.
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15
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Nasiri M, Mohammadkhani S, Akbari M, Alilou MM. The structural model of cyberchondria based on personality traits, health-related metacognition, cognitive bias, and emotion dysregulation. Front Psychiatry 2022; 13:960055. [PMID: 36699479 PMCID: PMC9869141 DOI: 10.3389/fpsyt.2022.960055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 12/16/2022] [Indexed: 01/12/2023] Open
Abstract
INTRODUCTION Cyberchondria is excessive seeking for online health-related information related to increasing health anxiety and distress levels. The current study investigated the mediating role of health-related metacognition, cognitive bias, and emotion dysregulation in the relationship between personality traits and cyberchondria. METHODS Participants were 703 individuals 18+ years old who had access to the internet (males = 43.8%, mean age = 33.82 ± 10.09 years and females = 56.2%, mean age = 34.37 ± 11.16 years). They voluntarily completed a questionnaire package that included the Cyberchondria Severity Scale (CSS), the revised NEO Personality Inventory (NEO-PI-R), the Difficulties in Emotion Regulation Scale (DERS), the Meta-Cognitions about Health Questionnaire (MCQ-HA), and the Health Cognitions Questionnaire (HCQ). RESULTS The initial evaluation of the model demonstrated that the personality traits of openness to experience, agreeableness, and conscientiousness had no significant relationship with other variables in the structural model, and the effects of neuroticism and extroversion were the only significant results. Rerunning the model with the removal of non-significant variables revealed a full mediation of health-related metacognition, cognitive bias, and emotion dysregulation in the relation between personality traits (neuroticism and extraversion) and cyberchondria. Fit indices demonstrated the acceptable fit of the model with the collected data (χ2 = 979.24, p <.001; NFI = 0.92, CFI = 0.93, GFI = 0.90, IFI = 0.93, RMSEA = 0.071, and SRMR = 0.063). The results indicated that the present model could explain R 2 = 54% of cyberchondria variance. DISCUSSION These findings suggest that health-related metacognition, cognitive bias, and emotion dysregulation could demonstrate a full mediating role in the correlation between personality traits and cyberchondria.
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Affiliation(s)
- Mohammad Nasiri
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| | - Shahram Mohammadkhani
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| | - Mehdi Akbari
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| | - Majid Mahmoud Alilou
- Department of Psychology, Faculty of Psychology and Educational Sciences, University of Tabriz, Tabriz, Iran
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16
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Akbari M, Spada MM, Nikčević AV, Zamani E. The relationship between fear of COVID-19 and health anxiety among families with COVID-19 infected: The mediating role of metacognitions, intolerance of uncertainty and emotion regulation. Clin Psychol Psychother 2021; 28:1354-1366. [PMID: 34110670 DOI: 10.1002/cpp.2628] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/24/2021] [Accepted: 06/03/2021] [Indexed: 01/18/2023]
Abstract
The current study aimed to investigate the mediating role of metacognitions, intolerance of uncertainty and emotion regulation in the relationship between fear of COVID-19 (FC-19) and health anxiety, among families with COVID-19 infected. Participants were 541 individuals from family members of patients with COVID-19 (F = 52.3%, mean age = 41.3 ± 13.2 years). Data were collected with a packet including sociodemographic and risk factors, the Fear of COVID-19 Scale, the Short Health Anxiety Inventory, the Metacognitions Questionnaire 30, the Intolerance of Uncertainty Scale-12 and the Emotion Regulation Questionnaire. Structural equation modelling analyses revealed a full mediation of metacognitions (i.e., positive beliefs about worry, negative beliefs about thoughts concerning uncontrollability and danger, cognitive confidence and beliefs about the need to control thoughts), intolerance of uncertainty and expressive suppression in the relation between FC-19 and health anxiety. Moreover, the strongest indirect links were found between FC-19 and health anxiety through negative beliefs about thoughts concerning uncontrollability and danger and intolerance of uncertainty. These associations were independent of gender and risk status. The final model accounted for 71% of the variance of health anxiety. These findings suggest that particularly metacognitions, intolerance of uncertainty and expressive suppression play a full mediational role in the relation between FC-19 and health anxiety.
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Affiliation(s)
- Mehdi Akbari
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
| | - Marcantonio M Spada
- Division of Psychology, School of Applied Sciences, London South Bank University, London, UK
| | - Ana V Nikčević
- Department of Psychology, School of Law, Social and Behavioural Sciences, Kingston University, Kingston upon Thames, UK
| | - Elahe Zamani
- Department of Clinical Psychology, Faculty of Psychology and Education, Kharazmi University, Tehran, Iran
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17
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Zhang YB, Wang PC, Ma Y, Yang XY, Meng FQ, Broadley SA, Sun J, Li ZJ. Using eye movements in the dot-probe paradigm to investigate attention bias in illness anxiety disorder. World J Psychiatry 2021; 11:73-86. [PMID: 33747805 PMCID: PMC7953363 DOI: 10.5498/wjp.v11.i3.73] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 12/23/2020] [Accepted: 01/28/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Illness anxiety disorder (IAD) is a common, distressing, and debilitating condition with the key feature being a persistent conviction of the possibility of having one or more serious or progressive physical disorders. Because eye movements are guided by visual-spatial attention, eye-tracking technology is a comparatively direct, continuous measure of attention direction and speed when stimuli are oriented. Researchers have tried to identify selective visual attention biases by tracking eye movements within dot-probe paradigms because dot-probe paradigm can distinguish these attentional biases more clearly. AIM To examine the association between IAD and biased processing of illness-related information. METHODS A case-control study design was used to record eye movements of individuals with IAD and healthy controls while participants viewed a set of pictures from four categories (illness-related, socially threatening, positive, and neutral images). Biases in initial orienting were assessed from the location of the initial shift in gaze, and biases in the maintenance of attention were assessed from the duration of gaze that was initially fixated on the picture per image category. RESULTS The eye movement of the participants in the IAD group was characterized by an avoidance bias in initial orienting to illness-related pictures. There was no evidence of individuals with IAD spending significantly more time viewing illness-related images compared with other images. Patients with IAD had an attention bias at the early stage and overall attentional avoidance. In addition, this study found that patients with significant anxiety symptoms showed attention bias in the late stages of attention processing. CONCLUSION Illness-related information processing biases appear to be a robust feature of IAD and may have an important role in explaining the etiology and maintenance of the disorder.
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Affiliation(s)
- Yan-Bo Zhang
- The Department of Clinical Psychology and National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing An’Ding Hospital, Capital Medical University, and Center of Schizophrenia, Beijing Institute for Brain Disorders, Beijing 100089, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100089, China
- Psychology Department, Beijing Tongren Hospital, Capital Medical University, Beijing 100089, China
| | - Peng-Chong Wang
- The Department of Clinical Psychology and National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing An’Ding Hospital, Capital Medical University, and Center of Schizophrenia, Beijing Institute for Brain Disorders, Beijing 100089, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100089, China
| | - Yun Ma
- The Department of Clinical Psychology and National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing An’Ding Hospital, Capital Medical University, and Center of Schizophrenia, Beijing Institute for Brain Disorders, Beijing 100089, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100089, China
| | - Xiang-Yun Yang
- The Department of Clinical Psychology and National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing An’Ding Hospital, Capital Medical University, and Center of Schizophrenia, Beijing Institute for Brain Disorders, Beijing 100089, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100089, China
| | - Fan-Qiang Meng
- The Department of Clinical Psychology and National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing An’Ding Hospital, Capital Medical University, and Center of Schizophrenia, Beijing Institute for Brain Disorders, Beijing 100089, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100089, China
| | - Simon A Broadley
- Menzies Health Institute Queensland and School of Medicine, Griffith University, Gold Coast 4222, Queensland, Australia
| | - Jing Sun
- The Department of Clinical Psychology and National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing An’Ding Hospital, Capital Medical University, and Center of Schizophrenia, Beijing Institute for Brain Disorders, Beijing 100089, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100089, China
- Menzies Health Institute Queensland and School of Medicine, Griffith University, Gold Coast 4222, Queensland, Australia
| | - Zhan-Jiang Li
- The Department of Clinical Psychology and National Clinical Research Center for Mental Disorders and Beijing Key Laboratory of Mental Disorders, Beijing An’Ding Hospital, Capital Medical University, and Center of Schizophrenia, Beijing Institute for Brain Disorders, Beijing 100089, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing 100089, China
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18
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Guo Y, Yang H, Elhai J, McKay D. Anxiety Regarding COVID-19 Is Related to Attentional Control: The Mediating Role of Anxiety Sensitivity. Front Psychiatry 2021; 12:713279. [PMID: 34456768 PMCID: PMC8385276 DOI: 10.3389/fpsyt.2021.713279] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 07/16/2021] [Indexed: 12/25/2022] Open
Abstract
Background: As an emergent public health event, COVID-19 has had a significant impact on mental health, particularly causing anxiety. Some cognitive-affective related studies have demonstrated that attentional control is related to levels of anxiety. More specifically, recent research has shown that anxiety sensitivity is uniquely associated with mental health responses to COVID-19. The aim of the current study was to investigate the role of anxiety sensitivity during COVID-19 outbreak period, especially physical and cognitive concerns, in relation to attentional control and anxiety. Methods: It is a questionnaire study. A total of 464 participants were recruited through online sampling between February and March, 2020. They were surveyed by the Attentional Control Scale (ATTC), Anxiety Sensitivity Index-3 (ASI-3) and Depression Anxiety Stress Scale-21 (DASS-21). Data were analyzed using descriptive statistics and correlation analysis. We also tested the mediating effect. Results: The results showed that attentional control is negatively correlated with physical concern, cognitive concern and anxiety. And results support that physical and cognitive concerns play a mediating role between attentional control and anxiety. Conclusions: Anxiety sensitivity plays a mediating role between attentional control and anxiety. These findings can help effective prevention and intervention of anxiety.
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Affiliation(s)
- Yawen Guo
- Faculty of Psychology, Tianjin Normal University, Tianjin, China
| | - Haibo Yang
- Faculty of Psychology, Tianjin Normal University, Tianjin, China
| | - Jon Elhai
- Department of Psychology, University of Toledo, Toledo, OH, United States
| | - Dean McKay
- Department of Psychology, Fordham University, New York, NY, United States
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19
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Pan X, Ding W, Sun X, Ji C, Zhou Q, Yan C, Zhou Y, Luo Y. Gray Matter Density of the Dorsomedial Prefrontal Cortex Mediates the Relationship Between Catastrophizing and Anxiety in Somatic Symptom Disorder. Neuropsychiatr Dis Treat 2021; 17:757-764. [PMID: 33727819 PMCID: PMC7955750 DOI: 10.2147/ndt.s296462] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 02/18/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Catastrophizing is commonly co-occurrence with anxiety in somatic symptom disorder (SSD). However, the quantitative relationship between catastrophizing and anxiety in SSD and its underlying neuropsychopathology remains unclear. METHODS To address the issue, twenty-eight SSD patients and twenty-nine healthy controls (HCs) completed the Hamilton anxiety scale and the catastrophizing subscale of the cognitive emotion regulation questionnaire. Then they underwent structural magnetic resonance imaging and voxel-based morphometry analysis was performed to obtain gray matter density (GMD) of the dorsomedial prefrontal cortex (dmPFC). RESULTS Independent samples t-tests showed no significance between SSD patients and HCs in the scores on the catastrophizing subscale and GMD of the dmPFC. However, correlation analysis found that catastrophizing was significantly positively associated with anxiety in SSD. Further, mediation analyses revealed that GMD of the dmPFC (bilateral medial Brodmann area 8) mediated the relationship between catastrophizing and anxiety in SSD. CONCLUSION These findings support Kirmayer's disease model of SSD that catastrophic interpretations of somatic symptoms resulted in increased anxiety and demonstrate that the dmPFC may be a potential neural site linking catastrophizing and anxiety in SSD.
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Affiliation(s)
- Xiandi Pan
- Pudong New Area Mental Health Center, Tongji University School of Medicine, Shanghai, People's Republic of China
| | - Weina Ding
- Department of Radiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Xia Sun
- Department of Psychological Medicine, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Chenfeng Ji
- Department of Psychological Medicine, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Qian Zhou
- Department of Psychological Medicine, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Chao Yan
- Key Laboratory of Brain Functional Genomics (MOE&STCSM), Shanghai Changning-ECNU Mental Health Center, School of Psychology and Cognitive Science, East China Normal University, Shanghai, People's Republic of China
| | - Yan Zhou
- Department of Radiology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Yanli Luo
- Department of Psychological Medicine, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
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20
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Metacognitive beliefs mediate the relationship between anxiety sensitivity and traits of obsessive-compulsive symptoms. BMC Psychol 2020; 8:40. [PMID: 32336292 PMCID: PMC7184693 DOI: 10.1186/s40359-020-00412-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 04/16/2020] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Metacognition has been shown as a key contributor to Obsessive Compulsive Disorder as well as other anxiety-related disorders, yet its role in the development and maintenance of these disorders remains unclear. This study aims to investigate whether anxiety sensitivity traits are related to obsessive-compulsive symptoms in the general population and whether the relationship between anxiety sensitivity and obsessive-compulsive symptoms is mediated by metacognition. METHODS Non-clinical volunteers (N = 156, mean age: 23.97, 121 females) completed measures related to state/trait anxiety, anxiety sensitivity, obsessive compulsive symptoms and metacognition. RESULTS A direct relationship between anxiety sensitivity and obsessive-compulsive symptoms was established. Further analysis revealed that metacognition was the strongest mediator of this relationship, even when accounting for state and trait anxiety. CONCLUSIONS Results suggest that the relationships between traits of anxiety sensitivity and obsessive-compulsive symptoms are partially attributable to the role of metacognition.
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21
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Salguero JM, García‐Sancho E, Ramos‐Cejudo J, Kannis‐Dymand L. Individual differences in anger and displaced aggression: The role of metacognitive beliefs and anger rumination. Aggress Behav 2020; 46:162-169. [PMID: 31957050 DOI: 10.1002/ab.21878] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 11/13/2019] [Accepted: 11/15/2019] [Indexed: 12/25/2022]
Abstract
Metacognitive model is a theoretical approach aimed to explain emotion dysregulation and others emotion-related issues, such anger, and aggressive behavior. From this model, people having higher maladaptive metacognitive beliefs (e.g., "I can't control my thoughts") are more likely to activate and maintain anger rumination and, in turn, to experience higher levels of anger and to act aggressively. Preliminary evidence shows the role of metacognitive beliefs on anger rumination and anger levels, whereas no studies have examined its association with aggressive behavior. This study first examined the associations between metacognitive beliefs, anger rumination, anger levels, and the propensity to engage in displaced aggression, and second, the mediation role of anger rumination in the relations among metacognitive beliefs and anger and displaced aggression. Participants were 947 students and non-students from general population recruited in two different countries (Australia and Spain). Correlational analyses revealed a similar pattern of results in the Australian and Spanish sample, with participants having dysfunctional metacognitive beliefs also showing higher anger rumination, higher levels of anger and a higher tendency to act aggressively. Structural equation analyses revealed the associations of metacognitive beliefs with anger levels and displaced aggression was fully mediated by anger rumination in both samples. These results suggest that metacognitive beliefs should be considered in comprehensive models and in the therapy of anger problems and aggression.
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Affiliation(s)
- José M. Salguero
- Department of Personality, Evaluation and Psychological TreatmentUniversity of Malaga Malaga Spain
| | | | - Juan Ramos‐Cejudo
- Department of Social, Work and Differential PsychologyComplutense University of Madrid Madrid Spain
| | - Lee Kannis‐Dymand
- Sunshine Coast Mind and Neuroscience‐Thompson Institute, School of Social SciencesUniversity of the Sunshine Coast Queensland Australia
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22
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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: 68] [Impact Index Per Article: 11.3] [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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23
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Salguero JM, Ramos-Cejudo J, García-Sancho E. Metacognitive Beliefs and Emotional Dysregulation Have a Specific Contribution on Worry and the Emotional Symptoms of Generalized Anxiety Disorder. Int J Cogn Ther 2019. [DOI: 10.1007/s41811-019-00048-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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24
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Yavuz M, Aluç N, Tasa H, Hamamcıoğlu İ, Bolat N. The relationships between attachment quality, metacognition, and somatization in adolescents: The mediator role of metacognition. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2019; 32:33-39. [DOI: 10.1111/jcap.12224] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 01/17/2019] [Accepted: 01/18/2019] [Indexed: 12/25/2022]
Affiliation(s)
- Mesut Yavuz
- Department of PsychologyFrench Lape Hospital, Child and Adolescent Psychiatry, İstanbul Aydin Universityİstanbul Turkey
| | - Nurşah Aluç
- Department of Psychologyİstanbul Aydin Universityİstanbul Turkey
| | - Hande Tasa
- Department of Psychologyİstanbul Aydin Universityİstanbul Turkey
| | - İrem Hamamcıoğlu
- Department of Child and Adolescent PsychiatryYalova State HospitalYalova Turkey
| | - Nurullah Bolat
- Department of Child and Adolescent PsychiatryÇanakkale Onsekiz Mart University School of MedicineÇanakkale Turkey
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25
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Leonidou C, Panayiotou G. How do illness-anxious individuals process health-threatening information? A systematic review of evidence for the cognitive-behavioral model. J Psychosom Res 2018; 111:100-115. [PMID: 29935741 DOI: 10.1016/j.jpsychores.2018.06.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2018] [Revised: 05/29/2018] [Accepted: 06/01/2018] [Indexed: 01/17/2023]
Abstract
UNLABELLED According to the cognitive-behavioral model, illness anxiety is developed and maintained through biased processing of health-threatening information and maladaptive responses to such information. OBJECTIVE This study is a systematic review of research that attempted to validate central tenets of the cognitive-behavioral model regarding etiological and maintenance mechanisms in illness anxiety. METHODS Sixty-two studies, including correlational and experimental designs, were identified through a systematic search of databases and were evaluated for their quality. RESULTS Outcomes were synthesized following a qualitative thematic approach under categories of theoretically driven mechanisms derived from the cognitive-behavioral model: attention, memory and interpretation biases, perceived awareness and inaccuracy in perception of somatic sensations, negativity bias, emotion dysregulation, and behavioral avoidance. CONCLUSIONS Findings partly support the cognitive-behavioral model, but several of its hypothetical mechanisms only receive weak support due to the scarcity of relevant studies. Directions for future research are suggested based on identified gaps in the existing literature.
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Affiliation(s)
| | - Georgia Panayiotou
- Department of Psychology, University of Cyprus, Cyprus; Center of Applied Neuroscience, University of Cyprus, Cyprus
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26
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Campbell B, Curran M, Inkpen R, Katsikitis M, Kannis-Dymand L. A preliminary evaluation of metacognitive beliefs in high functioning children with autism spectrum disorder. ADVANCES IN AUTISM 2018. [DOI: 10.1108/aia-08-2017-0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Purpose
Metacognitive beliefs and processes have been found to perpetuate anxiety and depression in youth and adults. However, the presence of metacognitive beliefs in children with autism spectrum disorder is somewhat unclear and has received limited research attention to date. The purpose of this paper is to explore metacognitive beliefs in children with autism and associations with anxiety and depression.
Design/methodology/approach
In total, 23 high functioning participants (17 male and 6 female) between the ages of 8 and 12 (M=10.38) diagnosed on the autism spectrum completed the study. Participants completed the Revised Children’s Scale of Anxiety and Depression and the Metacognitions Questionnaire for Children.
Findings
Correlation analyses revealed that positive and negative metacognitive beliefs were found, as hypothesised, to be prevalent in this sample.
Originality/value
Despite methodological limitations, this is one of the first research evaluations to provide evidence for metacognitive beliefs in high functioning children with autism and comorbid anxiety or low mood.
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27
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López-Solà C, Bui M, Hopper JL, Fontenelle LF, Davey CG, Pantelis C, Alonso P, van den Heuvel OA, Harrison BJ. Predictors and consequences of health anxiety symptoms: a novel twin modeling study. Acta Psychiatr Scand 2018; 137:241-251. [PMID: 29336012 DOI: 10.1111/acps.12850] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The question of how to best conceptualize health anxiety (HA) from a diagnostic and etiological perspective remains debated. The aim was to examine the relationship between HA and the symptoms of anxiety and obsessive-compulsive-related disorders in a normative twin population. METHOD Four hundred and ninety-six monozygotic adult twin pairs from the Australian Twin Registry participated in the study (age, 34.4 ± 7.72 years; 59% females). Validated scales were used to assess each domain. We applied a twin regression methodology-ICE FALCON-to determine whether there was evidence consistent with 'causal' relationships between HA and other symptoms by fitting and comparing model estimates. RESULTS Estimates were consistent with higher levels of obsessing ('unwanted thoughts') (P = 0.008), social anxiety (P = 0.03), and body dysmorphic symptoms (P = 0.008) causing higher levels of HA symptoms, and with higher levels of HA symptoms causing higher levels of physical/somatic anxiety symptoms (P = 0.001). CONCLUSION Obsessional thoughts, body dysmorphic concerns, and social anxiety symptoms may have a causal influence on HA. To report physical/somatic anxiety appears to be a consequence of the underlying presence of HA-related fears. Should our results be confirmed by longitudinal studies, the evaluation and treatment of HA may benefit from the consideration of these identified risk factors.
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Affiliation(s)
- C López-Solà
- Adult Mental Health Department, Parc Taulí University Hospital, Universitat Autònoma de Barcelona, Sabadell, Spain.,Carlos III Health Institute, CIBERSAM (Centro de Investigación en Red de Salud Mental), Barcelona, Spain
| | - M Bui
- Centre for Epidemiology and Biostatistics, Melbourne School of Population Health, The University of Melbourne, Melbourne, Vic, Australia
| | - J L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population Health, The University of Melbourne, Melbourne, Vic, Australia.,Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnamgu, Seoul, South Korea
| | - L F Fontenelle
- Department of Epidemiology, School of Public Health, Seoul National University, Seoul, South Korea.,Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brazil.,Brain & Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Vic, Australia
| | - C G Davey
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Vic, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Vic, Australia.,Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Melbourne, Vic, Australia
| | - C Pantelis
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Melbourne, Vic, Australia
| | - P Alonso
- Carlos III Health Institute, CIBERSAM (Centro de Investigación en Red de Salud Mental), Barcelona, Spain.,Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - O A van den Heuvel
- Department of Anatomy and Neurosciences, VU university medical center (VUmc), Amsterdam, The Netherlands.,Department of Psychiatry, VUmc, Amsterdam, The Netherlands.,Neuroscience Campus Amsterdam, VU/VUmc, Amsterdam, The Netherlands.,The OCD team, Haukeland University Hospital, Bergen, Norway
| | - B J Harrison
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Melbourne, Vic, Australia
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28
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Dai L, Bailey R, Deng Y. The reliability and validity of the Chinese version of the Metacognitions about Health Questionnaire in college students. Qual Life Res 2018; 27:1099-1108. [PMID: 29302850 DOI: 10.1007/s11136-017-1780-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2017] [Indexed: 01/24/2023]
Abstract
PURPOSE In order to explain the potential mechanism that might motivate and maintain health anxiety (HA), researchers have developed several measures to assess the level of HA and to identify related cognitions and personality features. However, such instruments typically measure general metacognitions [e.g., the Metacognition Questionnaire-30 (MCQ-30)], thereby compromising the degree of sensitivity and specificity of measurement as applied to HA-related metacognitions. To address that issue, the Metacognitions about Health Questionnaire (MCQ-HA) was designed especially for measuring metacognitive beliefs specific to HA. Because a Chinese version of MCQ-HA may be helpful in improving our understanding of HA in a Chinese population, in the current study we sought to develop a Chinese version of the MCQ-HA (CMCQ-HA). METHODS We translated the MCQ-HA into Chinese with consideration of cultural diversity. For evaluation of its validity and stability, a sample of 1290 Chinese college students answered the CMCQ-HA, the Short Health Anxiety Inventory, the MCQ-30, and the Neuroticism scale of the Eysenck Personality Questionnaire. 292 students of them answered the CMCQ-HA twice. RESULTS Good internal consistency (α = 0.81) and test-retest reliability (ICC = 0.70) of the CMCQ-HA was presented. Exploratory and confirmatory factor analyses indicated a three-factor structure: beliefs about biased thinking, beliefs that thoughts can cause illness, and beliefs that thoughts are uncontrollable. Convergent validity, divergent validity, and incremental validity all were acceptable. Measurement invariance across gender was established. CONCLUSIONS The CMCQ-HA shows promise for the measurement of specific HA-related metacognitions in Chinese populations.
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Affiliation(s)
- Lisha Dai
- Department of Psychiatry, The Third Xiangya Hospital, Central South University, Changsha, 410013, China
| | - Robin Bailey
- School of Health, BB235, University of Central Lancashire, Preston, Lancashire, PR1 2HE, UK
| | - Yunlong Deng
- Department of Psychiatry, The Third Xiangya Hospital, Central South University, Changsha, 410013, China.
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29
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Melli G, Bailey R, Carraresi C, Poli A. Metacognitive beliefs as a predictor of health anxiety in a self-reporting Italian clinical sample. Clin Psychol Psychother 2017; 25:263-271. [PMID: 29226504 DOI: 10.1002/cpp.2159] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 10/30/2017] [Accepted: 10/31/2017] [Indexed: 01/25/2023]
Abstract
Research has supported the specific role that anxiety sensitivity, health-related dysfunctional beliefs, and metacognitive beliefs may play in the development and maintenance of health anxiety symptoms. However, the role of metacognitive beliefs in health anxiety has only been explored in analogue samples. The aim of this study was to explore for the first time the association between metacognitive beliefs and health anxiety symptoms in a sample of participants who reported having received a diagnosis of severe health anxiety (hypochondriasis) or illness anxiety disorder and test whether these beliefs are significant predictors of health anxiety after controlling for anxiety, depression, anxiety sensitivity, and dysfunctional beliefs. A series of dimensional self-report measures were administered to a large Italian sample (N = 458). At a bivariate level, Beliefs that Thoughts are Uncontrollable had a stronger association with health anxiety than any of the dysfunctional beliefs and anxiety sensitivity subscales. Results from hierarchical multiple regression analysis indicated that Beliefs that Thoughts are Uncontrollable predicted health anxiety symptoms over-and-above depression, general anxiety, anxiety sensitivity, and health-related dysfunctional beliefs. Despite many important limitations, this study supported the hypothesis that metacognition may have an important role in health anxiety in clinical samples.
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Affiliation(s)
- Gabriele Melli
- Department of Surgery, Medical, Molecular, and Critical Area Pathology, University of Pisa, Pisa, Italy.,Institute for Behavioral and Cognitive Psychology and Psychotherapy of Florence (IPSICO), Florence, Italy
| | | | - Claudia Carraresi
- Institute for Behavioral and Cognitive Psychology and Psychotherapy of Florence (IPSICO), Florence, Italy
| | - Andrea Poli
- Institute for Behavioral and Cognitive Psychology and Psychotherapy of Florence (IPSICO), Florence, Italy
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30
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Gkika S, Wittkowski A, Wells A. Social cognition and metacognition in social anxiety: A systematic review. Clin Psychol Psychother 2017; 25:10-30. [PMID: 28836318 DOI: 10.1002/cpp.2127] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 07/17/2017] [Accepted: 07/19/2017] [Indexed: 01/12/2023]
Abstract
Cognitive-behavioural and metacognitive approaches to emotional disorder implicate beliefs in social anxiety, but the types of beliefs differ across these perspectives. Cognitive models suggest that social beliefs about the self (i.e., high standards and conditional and unconditional beliefs) are central. In contrast, the metacognitive model gives centre stage to metacognitive beliefs (i.e., positive and negative beliefs about thinking) as main contributors to the maintenance of the disorder. Despite an expanding research interest in this area, the evidence for such contributions has not yet been reviewed. This study set out to systematically review relevant cross-sectional, longitudinal, and experimental investigations of the direct and indirect (through cognitive processes, such as anticipatory processing, self-focused attention, the post-mortem, and avoidance) relationships of social and metacognitive beliefs with social anxiety. Clinical and nonclinical samples were included, and correlation and regression coefficients as well as results from group comparisons (e.g., t tests and analyses of variance) were extracted. Overall, 23 papers were located, through PsycINFO, PubMed, and Web of Science, and reviewed using narrative synthesis. The results showed a robust positive relationship between social beliefs and social anxiety that appeared to be mediated by cognitive processes. Specific metacognitive beliefs were found to positively contribute to social anxiety both directly and indirectly, through cognitive processes. The study's findings are limited to 2 models of social anxiety and other minor limitations (e.g., grey literature was excluded). With these accounted for, the results are discussed in terms of the conceptualization and treatment of social anxiety and suggestions for future research are made.
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Affiliation(s)
- Styliani Gkika
- The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Anja Wittkowski
- The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Adrian Wells
- The University of Manchester, Manchester, UK.,Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
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31
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Ryum T, Kennair LEO, Hjemdal O, Hagen R, Halvorsen JØ, Solem S. Worry and Metacognitions as Predictors of Anxiety Symptoms: A Prospective Study. Front Psychol 2017; 8:924. [PMID: 28620338 PMCID: PMC5450809 DOI: 10.3389/fpsyg.2017.00924] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 05/19/2017] [Indexed: 01/23/2023] Open
Abstract
Both worry and metacognitive beliefs have been found to be related to the development of anxiety, but metacognitive theory (Wells and Matthews, 1994; Wells, 2009) suggest that metacognitive beliefs may play a more prominent role. The aim of the present prospective study was to examine whether worry, metacognitive beliefs or the interaction between worry and metacognitive beliefs, were the best predictor of anxiety over time, utilizing a longitudinal, prospective study design. An undergraduate student sample (N = 190) was assessed on measures of worry (PSWQ), metacognitive beliefs (MCQ-30) and anxiety (BAI) at three points in time over a 7-month period. A mixed-model analysis revealed that both worry and metacognitive beliefs predicted development of anxiety, independently of each other, with no indication of an interaction-effect (PSWQ * MCQ-30). Further, analyses of the MCQ-30 subscales indicated that negative metacognitive beliefs may be particularly important in the development of anxiety. While gender was correlated with worry, gender predicted anxiety beyond the effect of worry. Taken together, the results imply that both worry and metacognitive beliefs play a prominent role for the development of anxiety.
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Affiliation(s)
- Truls Ryum
- Department of Psychology, Norwegian University of Science and TechnologyTrondheim, Norway
| | | | - Odin Hjemdal
- Department of Psychology, Norwegian University of Science and TechnologyTrondheim, Norway
| | - Roger Hagen
- Department of Psychology, Norwegian University of Science and TechnologyTrondheim, Norway
| | | | - Stian Solem
- Department of Psychology, Norwegian University of Science and TechnologyTrondheim, Norway
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32
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Ramos-Cejudo J, Salguero JM. Negative metacognitive beliefs moderate the influence of perceived stress and anxiety in long-term anxiety. Psychiatry Res 2017; 250:25-29. [PMID: 28135644 DOI: 10.1016/j.psychres.2017.01.056] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 01/17/2017] [Accepted: 01/21/2017] [Indexed: 01/20/2023]
Abstract
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.
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Affiliation(s)
- Juan Ramos-Cejudo
- Dept. Personality, Evaluation, and Psychological Treatment II (Differential Psychology). School of Psychology, Complutense University of Madrid, Madrid, Spain.
| | - J Martín Salguero
- Personality, Evaluation, and Psychological Treatment. School of Psychology, University of Malaga, Malaga, Spain
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33
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Leonidou C, Panayiotou G, Bati A, Karekla M. Coping with psychosomatic symptoms: The buffering role of psychological flexibility and impact on quality of life. J Health Psychol 2016; 24:175-187. [DOI: 10.1177/1359105316666657] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Individual differences in avoidant coping were hypothesized to exacerbate quality of life impairment associated with somatization and illness anxiety symptoms; psychological flexibility was expected to moderate this impairment. Individuals from a random community sample ( N = 298; 182 females), who met screening criteria for somatization and illness anxiety, reported lower quality of life and psychological flexibility and greater avoidant coping compared to controls. Psychological flexibility significantly moderated the impact of somatization and illness anxiety on quality of life domains. Findings suggest that decreasing avoidant coping through therapy may be promising in mitigating the negative impact of these symptom categories.
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34
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Donnellan C, Al Banna M, Redha N, Al Sharoqi I, Al-Jishi A, Bakhiet M, Taha S, Abdulla F. Association Between Metacognition and Mood Symptoms Poststroke. J Geriatr Psychiatry Neurol 2016; 29:212-20. [PMID: 27056067 DOI: 10.1177/0891988716640374] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 02/10/2016] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The link between metacognition and mood has been well established, particularly in other conditions with psychological comorbidity, however, there is no evidence regarding this association in the area of stroke. AIM The aim of this study was to examine the association between metacognition, based on the Self-Regulatory Executive Function model, and mood symptoms in the acute phase after stroke. METHODS One hundred thirty patients were recruited to a prospective stroke study in Bahrain, and n = 64 were assessed for mood and cognition. A neuropsychological battery of cognitive assessments included the following measures: the Mini-Mental State Examination, the Trail Making Test (A+B), and the Metacognition Questionnaire 30 (MCQ-30) for metacognition. The Hospital Anxiety and Depression Scale assessed mood symptoms, and stroke severity was measured using the National Institute of Health Stroke Severity Scale. RESULTS Total MCQ-30 scores were significantly associated with both anxiety (r = .47, P = .001) and depression (r = .54, P <. 0001). The MCQ-30 subscales' cognitive confidence, cognitive self-consciousness, and uncontrollability/danger were the specific factors to be associated with mood symptoms (P < .01). Global cognition (r =.32, P < .01), but not executive function, was significantly associated with depression only. Metacognition remained a statistically significant correlate with depression (β = .42, P < .0001) and anxiety (β = .51, P < .0001) after adjusting for education and global cognition. DISCUSSION Metacognition is a better determinant of mood symptoms after stroke, especially in regions where illiteracy levels are high in older populations, in comparison to executive function and global cognition.
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Affiliation(s)
- Claire Donnellan
- School of Medicine, Royal College of Surgeons in Ireland-Medical University of Bahrain, Busaiteen, Kingdom of Bahrain School of Postgraduate Studies, Royal College of Surgeons in Ireland-Medical University of Bahrain, Busaiteen, Kingdom of Bahrain School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - M Al Banna
- School of Postgraduate Studies, Royal College of Surgeons in Ireland-Medical University of Bahrain, Busaiteen, Kingdom of Bahrain
| | - N Redha
- School of Postgraduate Studies, Royal College of Surgeons in Ireland-Medical University of Bahrain, Busaiteen, Kingdom of Bahrain
| | - I Al Sharoqi
- Department of Clinical Neurosciences, Salmaniya Medical Complex, Salmaniya, Kingdom of Bahrain
| | - A Al-Jishi
- Department of Clinical Neurosciences, Salmaniya Medical Complex, Salmaniya, Kingdom of Bahrain
| | - M Bakhiet
- Department of Molecular Medicine, Princess Al-Jawhara Center for Genetics and Inherited Diseases, Salmaniya Kingdom of Bahrain
| | - S Taha
- Department of Molecular Medicine, Princess Al-Jawhara Center for Genetics and Inherited Diseases, Salmaniya Kingdom of Bahrain
| | - F Abdulla
- Department of Clinical Neurosciences, Salmaniya Medical Complex, Salmaniya, Kingdom of Bahrain
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35
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Fergus TA, Kelley LP, Griggs JO. The combination of health anxiety and somatic symptoms: Specificity to anxiety sensitivity cognitive concerns among patients in primary care. Psychiatry Res 2016; 239:117-21. [PMID: 27137971 DOI: 10.1016/j.psychres.2016.02.067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 02/17/2016] [Accepted: 02/27/2016] [Indexed: 12/20/2022]
Abstract
Prior research has found that health anxiety is related to poor patient outcomes in primary care settings. Health anxiety is characterized by at least two presentations: with either severe or no/mild somatic symptoms. Preliminary data indicate that anxiety sensitivity may be important for understanding the presentation of health anxiety with severe somatic symptoms. We further examined whether the combination of health anxiety and somatic symptoms was related to anxiety sensitivity. Participants were adults presenting for treatment at a community health center (N=538). As predicted, the interactive effect between health anxiety and somatic symptoms was associated with anxiety sensitivity cognitive concerns. Health anxiety shared a stronger association with anxiety sensitivity cognitive concerns when coupled with severe, relative to mild, somatic symptoms. Contrary to predictions, the interactive effect was not associated with the other dimensions of anxiety sensitivity. We discuss the potential relevancy of anxiety sensitivity cognitive concerns to the combined presentation of health anxiety and severe somatic symptoms, as well as how this dimension of anxiety sensitivity could be treated in primary care settings.
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Affiliation(s)
- Thomas A Fergus
- Department of Psychology and Neuroscience, Baylor University, Waco, TX, USA.
| | - Lance P Kelley
- Waco Family Medicine Residency Program, Heart of Texas Community Health Center, Waco, TX, USA
| | - Jackson O Griggs
- Waco Family Medicine Residency Program, Heart of Texas Community Health Center, Waco, TX, USA
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36
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Bailey R, Wells A. Is metacognition a causal moderator of the relationship between catastrophic misinterpretation and health anxiety? A prospective study. Behav Res Ther 2016; 78:43-50. [PMID: 26851713 DOI: 10.1016/j.brat.2016.01.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 12/30/2015] [Accepted: 01/23/2016] [Indexed: 01/20/2023]
Abstract
Psychological theories have identified a range of variables contributing to health anxiety, including, dysfunctional illness beliefs, catastrophic misinterpretation, somatosensory amplification and neuroticism. More recently, metacognitive beliefs have been proposed as important in health anxiety. This study aimed to test the potential causal role of metacognitive beliefs in health anxiety. A prospective design was employed and participants (n = 105) completed a battery of questionnaire at two time points (6 months apart). Results demonstrated that cognitive, personality and metacognitive variables were bi-variate prospective correlates of health anxiety. Hierarchical regression analysis revealed that only metacognitive beliefs emerged as independent and significant prospective predictors of health anxiety. Moderation analysis demonstrated that metacognitive beliefs prospectively moderated the relationship between catastrophic misinterpretation and health anxiety. Follow-up regression analysis incorporating the interaction term (metacognition × misinterpretation) showed that the term explained additional variance in health anxiety. The results confirm that metacognition is a predictor of health anxiety and it is more substantive than misinterpretations of symptoms, somatosensory amplification, neuroticism, and illness beliefs. These results may have major implications for current cognitive models and for the treatment of health anxiety.
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Affiliation(s)
- Robin Bailey
- Division of Clinical Psychology, University of Manchester, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK; School of Health, BB235, University of Central Lancashire, Preston, Lancashire, PR1 2HE, UK.
| | - Adrian Wells
- Division of Clinical Psychology, University of Manchester, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
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37
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Melli G, Carraresi C, Poli A, Bailey R. The role of metacognitive beliefs in health anxiety. PERSONALITY AND INDIVIDUAL DIFFERENCES 2016. [DOI: 10.1016/j.paid.2015.10.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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38
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Bailey R, Wells A. Development and initial validation of a measure of metacognitive beliefs in health anxiety: The MCQ-HA. Psychiatry Res 2015; 230:871-7. [PMID: 26626951 DOI: 10.1016/j.psychres.2015.11.035] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 10/29/2015] [Accepted: 11/13/2015] [Indexed: 12/19/2022]
Abstract
Metacognitive beliefs have been shown to correlate with emotional disorders and more recently have been implicated in health anxiety. Research exploring these beliefs have tended to use the Metacognition Questionnaire (MCQ), which is a general measure. To facilitate research on the metacognitive model applied to health anxiety the present study reports on the development and initial evaluation of a new specific metacognitive measure of health anxiety, the Metacognitions Questionnaire-Health Anxiety (MCQ-HA). Principal components analysis identified 14 suitable items to be explored. Subsequent exploratory factor analysis of the MCQ-HA identified three factors: "Beliefs that Thoughts can cause Illness", "Beliefs about Biased thinking", and "Beliefs that Thoughts are Uncontrollable". Confirmatory factor analysis supported the three factor model with all selected goodness-of-fit statistics equivalent to or better than recommended values. Preliminary evidence suggests good internal-consistency, incremental, convergent and discriminant validity in relation to associated measures. The MCQ-HA appears to be a potentially useful predictor of health anxiety.
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Affiliation(s)
- Robin Bailey
- Division of Clinical Psychology, University of Manchester, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; School of Health, BB235, University of Central Lancashire, Preston, Lancashire PR1 2HE, UK.
| | - Adrian Wells
- Division of Clinical Psychology, University of Manchester, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK
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