The Metacognitions about Symptoms Control Scale: Development and Concurrent Validity

Experience sampling methodology study of anxiety and depression in adolescents with epilepsy: The role of metacognitive beliefs and perseverative thinking

Emotional distress is common in young people with epilepsy (YPwE). According to the Self-Regulatory Executive Function (S-REF) model, maladaptive metacognitive beliefs and perseverative thinking are fundamental in the development and maintenance of emotional distress. As emotional distress and perseverative thinking can highly fluctuate over short intervals in YPwE, it is important to account for this variability when testing the utility of psychological models. Experience sampling methodology (ESM) was therefore used to explore the momentary relationship between metacognitive beliefs, perseverative thinking, and emotional distress in YPwE. Eighteen participants diagnosed with epilepsy (aged 12-17 years) completed the 10-day ESM period. Participants were prompted to complete the ESM assessment five times daily. The ESM assessment assessed participant's momentary levels of metacognitive beliefs, perseverative thinking (i.e., worry and rumination), and emotional distress (i.e., anxiety and depression). A series of multilevel regression analyses indicated that metacognitive beliefs were significantly positively associated with worry, rumination, anxiety and depression. After controlling for worry and rumination, respectively, metacognitive beliefs did not account for additional variance in anxiety or depression. Findings provide preliminary support for the utility of the S-REF model for emotional distress in YPwE. Metacognitive therapy, which is underpinned by the S-REF model, may be an appropriate intervention for emotional distress in YPwE. Future studies should assess the mediational relationship between metacognitive beliefs, perseverative thinking, and emotional distress using time-lagged models.

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

PURPOSE

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

METHOD

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

RESULTS

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

CONCLUSIONS

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

Transdiagnostic Cognitive-Behavioral Therapy for Depression and Anxiety Disorders in Cardiovascular Disease Patients: Results From the CHAMPS Pilot-Feasibility Trial

OBJECTIVE

The aim of the Cardiovascular Health in Anxiety and Mood Problems Study (CHAMPS) is to pilot the Unified Protocol (UP) for the transdiagnostic treatment of depression and anxiety disorders in patients recently hospitalized for cardiovascular diseases (CVDs) and evaluate the feasibility.

METHODS

The present study is a controlled, block randomized pragmatic pilot-feasibility trial incorporating qualitative interview data, comparing UP (n = 9) with enhanced usual care (EUC, n = 10). Eligible trial participants had a recent CVD-cause admission and were above the severity threshold for depression or anxiety denoted by Patient Health Questionnaire (PHQ-9) total scores ≥10 and/or Generalized Anxiety Disorder (GAD-7) total scores ≥7 respectively on two occasions, and met criteria for one or more depression or anxiety disorders determined by structured clinical interview. Study outcomes were analyzed as intention-to-treat using linear mixed models and qualitative interview data were analyzed with content analysis.

RESULTS

Quantitative and qualitative measured indicated acceptability of the transdiagnostic CBT intervention for CVD patients with depression or anxiety disorders. Satisfaction with UP was comparable to antidepressant therapy and higher than general physician counseling. However, there were difficulties recruiting participants with current disorders and distress on two occasions. The UP was associated with a reduction in total number of disorders determined by blinded raters. Linear mixed models indicated that a significantly greater reduction in anxiety symptoms was evident in the UP group by comparison to the EUC group (GAD-7, p between groups = 0.011; Overall Anxiety Severity and Impairment Scale, p between groups = 0.013). Results favored the UP group by comparison to EUC for change over 6 months on measures of physical quality of life and harmful alcohol use. There was no difference between the two groups on changes in depression symptoms (PHQ-9), stress, metacognitive worry beliefs, physical activity, or adherence.

DISCUSSION

In conclusion, this feasibility trial indicates acceptability of transdiagnostic CBT intervention for CVD patients with depression or anxiety disorders that is tempered by difficulties with recruitment. Larger trials are required to clarify the efficacy of transdiagnostic depression and anxiety disorder CBT in populations with CVDs and depressive or anxiety disorders.

CLINICAL TRIAL REGISTRATION

https://www.australianclinicaltrials.gov.au/anzctr/trial/ACTRN12615000555550, identifier: ACTRN12615000555550.

Development of Metacognition in Adolescence: The Congruency-Based Metacognition Scale

Introduction

Previous studies on metacognitive ability were explored using self-report questionnaires that are difficult to adequately measure and evaluate when the capacity for self-reference is undeveloped. This study aimed to validate the Congruency-based Metacognition Scale (CMS) to measure metacognition and the feeling of confidence abilities and to investigate the development of metacognition during adolescence.

Methods

The CMS was administered to 633 child–parent pairs in Japan (child, mean age = 16.0 years, 46.0% female; parent, mean age = 48.3 years, 94.9% mother). The CMS metacognition score was assessed based on congruency scores between the self-report of the child from a third-person perspective (3PP) and the parent’s report from the first-person perspective (1PP). The CMS self-judgment accuracy score was assessed by the congruency scores between the children’s self-report from the 1PP and 3PP. For both measures, the more distant the 3PP on the self-report was from the 1PP on the parent’s report and child self-report means low ability. An exploratory factor analysis (EFA) was conducted to examine construct validity and then a confirmatory factor analysis (CFA) was used. Criterion validity was examined by calculating Pearson’s correlation coefficients with scores on the Beck Cognitive Insight Scale (BCIS) and Autism Quotient (AQ). We used intraclass correlation and Cronbach’s alpha to examine the test–retest and internal consistency reliability.

Results

Based on the results of the EFA and CFA, we adopted one factor structure with five items. The CMS metacognition and CMS self-judgment accuracy showed evidence criterion validity, exhibiting significant correlations with the BCIS self-reflectiveness (r = 0.16) and self-certainty scores (r = 0.17), respectively. Regarding to the AQ, only the CMS metacognition score had significant correlations with the social skills (r = 0.22) and total scale score (r = 0.20). The test–retest reliability showed adequate (intraclass correlation coefficient 0.70–0.81 and the Cronbach’s alpha coefficient 0.63–0.59). Adolescents were found to have significantly lower metacognitive ability compared to young adults.

Conclusion

CMS could be a valid and reliable measure to examine metacognitive abilities for adolescents.

Metacognitions on Pain, Functionality and Intensity of Pain in Women with Fibromyalgia

To determine the explanatory capacity of pain metacognitions and beliefs over the functionality, coping and pain intensity, following the Model of Self-Regulatory Executive Functions (S-REF) in a sample of women with fibromyalgia from Medellín and its Metropolitan Area. Method: Metacognitions Scale on Symptom Control, Pain Self-efficacy Questionnaire, Chronic Pain Catastrophizing Scale, Chronic Pain Coping Questionnaire, WHODAS 2.0 Scale, and Pain Intensity Numerical Scale. The sample was represented by 108 women between 24 and 60 years old with a diagnosis of fibromyalgia. A modeling process was carried out through an analysis of structural equations. Results: The final model fails to fit. Despite this, the analysis suggests that negative metacognitions and pain self-efficacy have an effect over the tendency to catastrophizing. The latter and the pain self-efficacy are the main mediators in the effects of functionality. The intensity of pain is not determined by the metacognitions related to it.

Assessing Beliefs Underlying Rumination About Pain: Development and Validation of the Pain Metacognitions Questionnaire

Metacognitions, which are beliefs about our own thinking processes, can modulate worry and rumination and thereby influence emotional distress. This study aimed to develop a self-report measure of unhelpful pain-related metacognitions which might serve as a clinical and research tool to better understand pain catastrophizing, a significant risk factor for adverse pain outcomes. Two phases of validation are presented. Phase 1 reports on how the Pain Metacognitions Questionnaire (PMQ) was empirically developed through a qualitative study of 20 people with chronic back (n = 15) or knee (n = 5) pain in secondary or tertiary care and then validated in a large internet sample of people experiencing pain (N = 864). Rasch analysis yielded a 21-item scale with two dimensions (positive and negative metacognition) assessing how useful and problematic people believe rumination about pain to be, respectively. In Phase 2, further validation using a new sample (N = 510) replicated initial findings. Both PMQ subscales have good retest reliability (r = 0.76, r = 0.72) and internal consistency (0.86, 0.87). They correlate negatively with mindfulness and positively with pain intensity, disability, anxiety, depression, catastrophizing, rumination, and metacognition. The PMQ also predicts unique variance in catastrophizing when other variables are controlled and predicts 'patient' status for pain catastrophizing. Sensitivity analysis yielded preliminary suggestions for clinically meaningful cut-offs. Unhelpful pain metacognitions can be validly and reliably measured using a self-report instrument. Future studies using the PMQ might shed new light on pain-related thinking processes to develop better interventions for people prone to worry and rumination about their pain.

Transcultural, transdiagnostic, and concurrent validity of a revised metacognitions about symptoms control scale

Anxiety and depression add to the burden of chronic fatigue syndrome (CFS), fibromyalgia (FM), and type 1 diabetes mellitus (T1DM). Metacognitions play a role in this distress. The metacognitions about symptoms control scale (MaSCS) measure metacognitive beliefs regarding symptoms but have weaknesses. The current study created a revised MaSCS (MaSCS-R) in English, German, and Arabic versions using CFS, FM, and T1DM samples and examined the transcultural, transdiagnostic, and concurrent validity of metacognitions about symptom control. This study used data from 563 participants clinically diagnosed with CFS (n = 124; English), FM (n = 348; German), or T1DM (n = 91; Lebanese). CFS and FM data had been used in earlier published studies but were subjected to new analyses. CFS data were used to create the English version of the MaSCS-R and FM and T1DM data for German and Arabic versions. Metacognitions about worry, anxiety, depression, and symptom severity were measured. The three MaSCS-R versions, consisting of two factors (each with four items), had adequate psychometric properties, possessing configural and metric invariance. Metacognitive factors were associated with distress and symptom severity in all three samples. Metacognitions about symptom control have transcultural, transdiagnostic, and concurrent validity.

The Role of Emotional Competence in Takotsubo Cardiomyopathy

OBJECTIVE

The current study examined the role of emotional competences and depression in takotsubo cardiomyopathy (TTC).

METHODS

We compared 37 TTC patients who experienced emotion triggers (TTC-t: M (SD) age = 66.4 (12.8) years, 33 women) with 37 TTC patients who did not experience emotion triggers (TTC-nt: M (SD) age = 65.8 (11.1) years, 33 women) and 37 patients with acute myocardial infarction who experienced an emotion trigger (AMI-t: M (SD) age = 66.1 (10.1) years, 33 women). Three aspects of emotional competence (emotional intelligence, metacognitive beliefs, and emotional processing deficits) were assessed using the Trait Meta-Mood Scale (TMMS), the Meta-Cognitions Questionnaire 30, and the Emotional Processing Scale. Differences between-group means were evaluated using multivariate analysis of covariance, adjusting for depressive symptom (Hamilton Rating Scale for Depression).

RESULTS

Compared with the TTC-nt and AMI-t comparison groups, TTC-t patients had low scores on emotional intelligence (TMMS Attention: F(2, 184) = 23.10, p < .001; TMMS Repair: F(2, 184) = 11.98, p < .001) and high scores in metacognitive beliefs and emotional processing deficits (e.g., Meta-Cognitions Questionnaire 30 Negative Beliefs about Thoughts: F(2, 184) = 56.93, p < .001), independent of the levels of depressive symptom. TTC-nt patients also had significantly lower scores on the Hamilton Rating Scale for Depression scale compared with AMI-t (p = .021) and TTC-t (p = .004) patients.

CONCLUSIONS

TTC-t patients showed a specific dysfunctional profile of emotional competence, even after adjusting for depressive symptom. These results provided a better understanding of the psychological factors that contribute to TTC.

The relationship between negative metacognitive thoughts, pain catastrophizing and adjustment to chronic pain

BACKGROUND

Cognitive appraisals, most notably pain catastrophizing, play an important role in chronic pain. The role of metacognition and its impact on the relationship between pain catastrophizing and health are understudied. The identification of metacognition as a moderator of psychological constructs may have clinical and empirical implications. We hypothesized that negative metacognitive beliefs would moderate the relationships between pain catastrophizing and emotional functioning and physical activity.

METHOD

Participants (N = 211) with mixed aetiology chronic pain were primarily Caucasian females with severe average pain intensity. Over the course of 2 weeks, participants completed online daily-diary measures of pain catastrophizing, pain intensity, mood, physical activity and metacognition.

RESULTS

Participants with higher average levels of daily pain intensity and negative metacognitive beliefs about worry reported higher levels of daily pain catastrophizing, as well as daily depression, and anxiety. Some aspects of metacognitive beliefs (i.e. dangerousness and uncontrollability of thoughts) were also negatively associated with average daily levels of positive affect. However, these effects were not interactive; metacognitive beliefs did not moderate the relationships of pain catastrophizing with other daily variables.

CONCLUSIONS

From a daily coping perspective, findings reveal that people with stronger negative metacognitive beliefs report greater emotional distress on a day-to-day basis. However, negative metacognitive beliefs did not appear to modify the effects of pain catastrophizing on psychological and physical functioning at the daily level, suggesting that metacognitive beliefs may be better conceptualized as a more parallel indicator of emotional maladjustment to chronic pain whose effects do not reliably manifest in daily measurement models.

SIGNIFICANCE

Findings highlight the need to better characterize the value of metacognitive beliefs as an important predictor and therapeutic target. Despite limited evidence of a dynamic relationship between metacognition and daily adjustment to chronic pain, results emphasize the potential importance of interventions that target cognitive appraisal process beyond catastrophizing, including uncontrollability and danger-laden thought patterns.

Same, Same But Different? Cognitive Behavioural Treatment Approaches for Paediatric CFS/ME and Depression

BACKGROUND

Approximately one in three children and young people with chronic fatigue syndrome (CFS/ME) also have probable depression. Cognitive behaviour therapy (CBT) has a growing evidence base as an effective treatment approach for CFS/ME and for depression in this population.

AIMS

Given the high degree of co-morbidity, this discussion paper aims to compare and contrast CBT for CFS/ME and CBT for depression in children and young people.

METHOD

The existing literature on CBT for depression and CBT for CFS/ME, in relation to children and young people was reviewed.

RESULTS

Whilst there are commonalities to both treatments, the cognitive behavioural model of CFS/ME maintenance includes different factors and has a different emphasis to the cognitive behavioural model of depression, resulting in different intervention targets and strategies in a different sequence.

CONCLUSIONS

A collaborative, formulation-driven approach to intervention should inform the intervention targets and treatment strategies.

The Unintentional Procrastination Scale

Procrastination refers to the delay or postponement of a task or decision and is often conceptualised as a failure of self-regulation. Recent research has suggested that procrastination could be delineated into two domains: intentional and unintentional. In this two-study paper, we aimed to develop a measure of unintentional procrastination (named the Unintentional Procrastination Scale or the 'UPS') and test whether this would be a stronger marker of psychopathology than intentional and general procrastination. In Study 1, a community sample of 139 participants completed a questionnaire that consisted of several items pertaining to unintentional procrastination that had been derived from theory, previous research, and clinical experience. Responses were subjected to a principle components analysis and assessment of internal consistency. In Study 2, a community sample of 155 participants completed the newly developed scale, along with measures of general and intentional procrastination, metacognitions about procrastination, and negative affect. Data from the UPS were subjected to confirmatory factor analysis and revised accordingly. The UPS was then validated using correlation and regression analyses. The six-item UPS possesses construct and divergent validity and good internal consistency. The UPS appears to be a stronger marker of psychopathology than the pre-existing measures of procrastination used in this study. Results from the regression models suggest that both negative affect and metacognitions about procrastination differentiate between general, intentional, and unintentional procrastination. The UPS is brief, has good psychometric properties, and has strong associations with negative affect, suggesting it has value as a research and clinical tool.

Human behavioral assessments in current research of Parkinson's disease

Parkinson's disease (PD) is traditionally classified as a movement disorder because patients mainly complain about motor symptoms. Recently, non-motor symptoms of PD have been recognized by clinicians and scientists as early signs of PD, and they are detrimental factors in the quality of life in advanced PD patients. It is crucial to comprehensively understand the essence of behavioral assessments, from the simplest measurement of certain symptoms to complex neuropsychological tasks. We have recently reviewed behavioral assessments in PD research with animal models (Asakawa et al., 2016). As a companion volume, this article will systematically review the behavioral assessments of motor and non-motor PD symptoms of human patients in current research. The major aims of this article are: (1) promoting a comparative understanding of various behavioral assessments in terms of the principle and measuring indexes; (2) addressing the major strengths and weaknesses of these behavioral assessments for a better selection of tasks/tests in order to avoid biased conclusions due to inappropriate assessments; and (3) presenting new concepts regarding the development of wearable devices and mobile internet in future assessments. In conclusion we emphasize the importance of improving the assessments for non-motor symptoms because of their complex and unique mechanisms in human PD brains.

Metacognitions, anxiety, and distress related to motor fluctuations in Parkinson's disease

OBJECTIVE

This study tested the relationship between metacognitive factors, intolerance of uncertainty, anxiety, and the predictability of, and distress associated with, acute fluctuations in symptoms in idiopathic Parkinson's disease (PD), when controlling for disease parameters.

METHOD

106 adults with idiopathic PD (30 females; Mage=65.3; 90% white) participated in this study, with 93 of them reported experiencing off-periods. A cross-sectional design was employed that utilised: the Hospital Depression and Anxiety Scale, Movement Disorder Society revision of the Unified Parkinson's Disease Rating Scale, the Addenbrooke's Cognitive Examination - Revised, the Intolerance of Uncertainty Scale, and the Metacognitions Questionnaire 30. Correlation analyses, hierarchical regression analysis, and ordinal regression analysis were used to test the experimental hypotheses.

RESULTS

Anxiety was not significantly associated with motor symptom severity or cognitive functioning, while metacognitive factors were significantly related to anxiety when controlling for motor experiences of daily living and intolerance of uncertainty, R(2)=0.56, F(1,82)=15.04, p<0.001 (adjusted R(2)=0.53). For participants with motor fluctuations, no association was found between predictability of, and distress associated with, off-periods. Metacognitions concerning uncontrollability and danger were significantly related to off-period distress when controlling for motor experiences of daily living, intolerance of uncertainty, and other metacognitive factors, χ(2)(1)=20.52, p=0.001.

CONCLUSION

Metacognitive factors play a role in anxiety and off-period distress in PD and this is discussed in terms of the Self-Regulatory Executive Function model. Interventions from metacognitive therapy are potential means to ameliorate off-period distress and anxiety in PD.