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Temple J, Gemma Cherry M, Gray V, Jones A, Fisher P. Experience sampling methodology study of anxiety and depression in adolescents with epilepsy: The role of metacognitive beliefs and perseverative thinking. Epilepsy Behav 2024; 151:109599. [PMID: 38160577 DOI: 10.1016/j.yebeh.2023.109599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 12/10/2023] [Accepted: 12/21/2023] [Indexed: 01/03/2024]
Abstract
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.
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Affiliation(s)
- James Temple
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK; Mersey Care NHS Foundation Trust, Liverpool, UK
| | - Mary Gemma Cherry
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK; Clinical Health Psychology Service, Liverpool University NHS Foundation Trust, Liverpool, UK.
| | - Victoria Gray
- Psychological Services (Paediatrics), Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | - Andrew Jones
- Department of Psychology, Liverpool John Moores University, Liverpool, L3 3AF, UK
| | - Peter Fisher
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK; Clinical Health Psychology Service, Liverpool University NHS Foundation Trust, Liverpool, UK
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Orson J, Pearson L, Parker S. 'I felt like I'd lost control of everything': An exploration of metacognition and masculinity in men experiencing suicidality. Psychol Psychother 2024. [PMID: 38284500 DOI: 10.1111/papt.12519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 12/30/2023] [Accepted: 01/16/2024] [Indexed: 01/30/2024]
Abstract
BACKGROUND Seventy-five per cent of UK suicides are completed by men, and associated masculinity beliefs are well researched. The self-regulatory executive functioning (S-REF) model of distress is governed by metacognitive beliefs about mental processes, such as worry and rumination. Little is known about metacognition in male suicidality and how these processes interact with masculinity beliefs, suicidal ideation and behaviour. AIMS To identify which aspects of the S-REF model were present in a sample of men experiencing suicidality, and to consider how these processes interact with masculinity beliefs, suicidal ideation and behaviour. METHOD Fifteen men experiencing suicidal ideation or behaviour were recruited from a home-based treatment team. Semi-structured interviews and self-report measures were administered to identify metacognitive processes and masculinity beliefs. Interviews were analysed using the framework approach. RESULTS The S-REF model was identified across three super-ordinate themes; 'the cognitive attentional syndrome (CAS) and maladaptive coping', 'metacognitive beliefs about worry, uncontrollability and danger' and 'consequences'. Thirteen sub-ordinate themes included processes such as 'worry' and 'rumination', metacognitive beliefs such as 'worrying helps me avoid problems' and 'worry is dangerous for me' and emotional consequences such as 'overwhelm', 'emasculation' and 'escape'. CONCLUSION Perseverative thinking and erroneous metacognitive beliefs were associated with reduced functioning, which was incompatible with masculinity beliefs about leadership and strength, and suicide was considered as re-establishing control. Further research into metacognitive processes in male suicidality would enhance theoretical understanding.
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Affiliation(s)
- Jonothan Orson
- Mental Health Nursing Research Unit, Greater Manchester Mental Health NHS FT, Manchester, UK
| | - Lydia Pearson
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS FT, Manchester, UK
| | - Sophie Parker
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS FT, Manchester, UK
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
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Kowalski J, Gawęda Ł. 'Thinking about Them is only making me feel worse'. The mediating role of metacognitive factors in the relationship between paranoia-like beliefs and psychopathology symptoms in a community sample. Schizophr Res 2022; 244:84-90. [PMID: 35640356 DOI: 10.1016/j.schres.2022.05.014] [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] [Received: 11/10/2020] [Revised: 01/10/2022] [Accepted: 05/18/2022] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Paranoia in community samples is associated with higher levels of depression, anxiety symptoms and suicidality. The metacognitive model assumes the role of metacognitive factors in these associations. Positive and negative metacognitive beliefs (PMB and NMB, respectively) and cognitive-attentional syndrome (CAS) are to mediate between paranoia-like beliefs and psychopathology symptoms. The current study is an attempt to test this prediction. METHODS A cross-sectional community study with n = 840 participants. We used R-GPTS's persecutory subscale to measure paranoia-like beliefs, CAS-1 for CAS and metacognitive beliefs and SCL-27-plus for psychopathology symptoms. RESULTS Indirect effects of PMB, CAS and NMB accounted for 22% to 56% (CI 95%) of total effects of relationships between paranoia-like beliefs and vegetative symptoms, symptoms of social phobia, agoraphobia, depression and suicidality screening. CONCLUSIONS We demonstrated that PMB, CAS and NMB mediate between paranoia-like beliefs and various psychopathological symptoms, as predicted by the metacognitive model of psychopathology. We also uncovered other indirect effects, including negative mediation effect of PMB on the relationship between paranoia-like beliefs and depressive symptoms and suicidality.
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Affiliation(s)
- Joachim Kowalski
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland.
| | - Łukasz Gawęda
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
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Sharma V, Sagar R, Kaloiya G, Mehta M. The Scope of Metacognitive Therapy in the Treatment of Psychiatric Disorders. Cureus 2022; 14:e23424. [PMID: 35475111 PMCID: PMC9030663 DOI: 10.7759/cureus.23424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 03/23/2022] [Indexed: 12/17/2022] Open
Abstract
Metacognitive therapy (MCT) is a novel and promising transdiagnostic psychotherapy intervention based on the Self-Regulatory Executive Function model of conceptualizing emotional disorders. It was developed by Adrian Wells in 2009. Its therapeutic response occurs by reducing dysfunctional metacognitive beliefs regarding worry and rumination, often seen in patients with psychiatric disorders. Since its inception, it has been increasingly applied to a wide spectrum of psychiatric illnesses, but mainly focusing on mood and anxiety disorders. To our knowledge, no study has detailed its existing therapeutic scope in psychiatry. In this comprehensive narrative review, we describe the various psychiatric illnesses in which MCT has been used, the advantages of MCT, and the limitations of the MCT research. In addition, we propose some solutions to systematically examine its place in psychiatry. We encountered its potential role in treating trauma and stress-related disorders, obsessive-compulsive spectrum disorders, personality disorders, psychotic disorders, substance use disorders, and sexual disorders.
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Affiliation(s)
- Vandita Sharma
- Psychiatry, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | - Rajesh Sagar
- Psychiatry, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
| | | | - Manju Mehta
- Psychiatry, All India Institute of Medical Sciences, New Delhi, New Delhi, IND
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Lam KCK, Tsang HWH. Cognitive attentional syndrome in Hong Kong people with depression. ENVIRONMENTAL AND OCCUPATIONAL HEALTH PRACTICE 2022. [DOI: 10.1539/eohp.2022-0013-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Kino Chiu-Kim Lam
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University
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Liu J, Chan TCT, Chong SA, Subramaniam M, Mahendran R. Impact of emotion dysregulation and cognitive insight on psychotic and depressive symptoms during the early course of schizophrenia spectrum disorders. Early Interv Psychiatry 2020; 14:691-697. [PMID: 31692276 DOI: 10.1111/eip.12895] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 09/24/2019] [Accepted: 10/19/2019] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Emotion dysregulation is relevant to the aetiology of schizophrenia spectrum disorders (SSD). While most studies have focused on the chronic phase of SSD, little is known about the effects of emotion dysregulation and associated cognitive risk factors during the early phase of the illness, with negative implications for early intervention. The purpose of this study is to examine the impact of maladaptive cognitive emotion regulation strategies, global emotion dysregulation, and cognitive insight on psychotic and comorbid depressive symptoms in patients with early SSD. METHOD Participants included 150 newly diagnosed outpatients with SSD who were seeking treatment at the Early Psychosis Intervention Program. All participants completed the Cognitive Emotion Regulation Questionnaire, Difficulties with Emotion Regulation Scale, and Beck Cognitive Insight Scale. Severity of psychotic and depressive symptoms were rated on the Brief Psychiatric Rating Scale. RESULTS Multivariate regression adjusting for gender and psychiatric comorbidity revealed that global emotion dysregulation was associated with more severe positive and depressive symptoms. Further moderation analyses revealed a significant interaction between global emotion dysregulation and cognitive insight (self-certainty) on depression such that for patients with high self-certainty, greater global emotion dysregulation was associated with increased severity of depressive symptoms. There was no interaction between global emotion dysregulation and cognitive insight on positive symptoms. CONCLUSIONS Our findings provide preliminary support for the associations between emotion dysregulation and psychopathology in early SSD. Further research is needed to examine the transdiagnostic role of emotion dysregulation in the aetiology and treatment of a wider range of psychotic disorders.
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Affiliation(s)
- Jianlin Liu
- Department of Psychological Medicine, National University of Singapore, Singapore, Singapore.,Research Division, Institute of Mental Health, Singapore, Singapore
| | - Tommy C T Chan
- Department of Early Psychosis Intervention, Institute of Mental Health, Singapore, Singapore
| | - Siow Ann Chong
- Research Division, Institute of Mental Health, Singapore, Singapore
| | | | - Rathi Mahendran
- Department of Psychological Medicine, National University of Singapore, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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Parker SK, Mulligan LD, Milner P, Bowe S, Palmier-Claus JE. Metacognitive Therapy for Individuals at High Risk of Developing Psychosis: A Pilot Study. Front Psychol 2020; 10:2741. [PMID: 32010004 PMCID: PMC6978773 DOI: 10.3389/fpsyg.2019.02741] [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] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 11/20/2019] [Indexed: 11/13/2022] Open
Abstract
Developing effective interventions for preventing first episode psychosis have been an important research focus in the last decade. Cognitive behavioral therapy is a currently indicated treatment for people at ultra-high risk of psychosis, however, access and resource issues limit its delivery within the NHS. Treatments which partial out potential active ingredients and are aimed at a range of psychological difficulties seen within this population have the potential to be more efficacious and efficient. We conducted a single-arm exploratory pilot trial, designed to investigate the feasibility and acceptability of Metacognitive therapy for individuals at ultra-high risk (UHR) of developing psychosis. Trial uptake was good, with 11 out of 12 referred individuals meeting for an eligibility assessment (one individual was excluded prior to the assessment). Of these, 10 individuals were eligible and included in the trial. Retention to treatment was high with 80% treatment adherence gained and an overall average of 8 sessions completed. All participants were offered follow-up assessments immediately post-treatment and at 6 months, which comprised measures of psychotic like experiences, anxiety and depression, and metacognitive processes implicated in the model. Retention to the post-treatment (12-week) follow-up was good, with 80% completion; however retention to the 6-month follow-up was lower at 60%. Clinically significant results were observed in psychotic like experiences, anxiety, depression and functioning with medium to large effect sizes. Measures related to beliefs and processes targeted within MCT showed clinically significant change with medium to large effect sizes. Our results suggest that MCT based upon a specific metacognitive model for individuals meeting ARMS criteria may be an important treatment target and warrants further attention. Limitations and possible focuses for future research are discussed. Registration: ISRCTN53190465 http://www.isrctn.com/ISRCTN53190465.
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Affiliation(s)
- Sophie Kate Parker
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
- Youth Mental Health Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
- Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom
| | - Lee D. Mulligan
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Philip Milner
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Samantha Bowe
- Psychosis Research Unit, Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom
| | - Jasper E. Palmier-Claus
- Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, United Kingdom
- Lancashire & South Cumbria NHS Foundation Trust, Lancashire, United Kingdom
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Nordahl H, Wells A. Measuring the Cognitive Attentional Syndrome Associated with Emotional Distress: Psychometric Properties of the CAS-1. Int J Cogn Ther 2019. [DOI: 10.1007/s41811-019-00056-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Lysaker PH, Gagen E, Moritz S, Schweitzer RD. Metacognitive approaches to the treatment of psychosis: a comparison of four approaches. Psychol Res Behav Manag 2018; 11:341-351. [PMID: 30233262 PMCID: PMC6130286 DOI: 10.2147/prbm.s146446] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
In light of increasing interest in metacognition and its role in recovery from psychosis, a range of new treatments focused on addressing metacognitive deficits have emerged. These include Metacognitive Therapy, Metacognitive Training, metacognitive insight and reflection therapy, and metacognitive interpersonal therapy for psychosis. While each of these treatments uses the term metacognitive, each differs in terms of their epistemological underpinnings, their structure, format, presumed mechanisms of action, and primary outcomes. To clarify how these treatments converge and diverge, we first offer a brief history of metacognition as well as its potential role in an individual's response to and recovery from complicated mental health conditions including psychosis. We then review the background, practices, and supporting evidence for each treatment. Finally, we will offer a framework for thinking about how each of these approaches may ultimately complement rather than contradict one another and highlight areas for development. We suggest first that each is concerned with something beyond what people with psychosis think about themselves and their lives. Each of these four approaches is interested in how patients with severe mental illness think about themselves. Each looks at immediate reactions and ideas that frame the meaning of thoughts. Second, each of these approaches is more concerned with why people make dysfunctional decisions and take maladaptive actions rather than what comprised those decisions and actions. Third, despite their differences, each of these treatments is true to the larger construct of metacognition and is focused on person's relationships to their mental experiences, promoting various forms of self-understanding which allow for better self-management. Each can be distinguished from other cognitive and skills-based approaches to the treatment of psychosis in their emphasis on sense-making rather than learning a new specific thing to say, think, or do in a given situation.
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Affiliation(s)
- Paul H Lysaker
- Department of Psychiatry, Richard L Roudebush VA Medical Center, Indianapolis, IN, USA,
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA,
| | - Emily Gagen
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Robert D Schweitzer
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia
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