A meta-analysis of metacognitive beliefs as implicated in the self-regulatory executive function model in clinical psychosis

Breaking the cycle: Exploring the relationship of metacognition beliefs, obsessive-compulsive symptoms, and psychosocial performance among individuals diagnosed with schizophrenia

THE RELEVANCE TO MENTAL HEALTH NURSING

This research paper explores the intricate relationship between metacognitive dysfunctional beliefs, obsessive-compulsive symptoms, and psychosocial performance in patients diagnosed with schizophrenia. Understanding these dynamics can help mental health nurses identify and address each patient's needs more effectively. It can guide them in devising personalized care plans that not only manage the symptoms but also improve the underlying mechanism that exacerbates the psychotic symptoms and social functioning and the overall quality of life. Moreover, the findings of this research can contribute to developing training programs for mental health nurses, equipping them with the necessary skills and knowledge to provide optimal care. What the paper adds to existing knowledge? • This study provides empirical evidence of the significant positive correlation between OCS and metacognitive dimensions in individuals with schizophrenia. • It highlights the role of certain demographic factors, such as younger age and single marital status, in increasing the likelihood of elevated OCS. • It underscores the inverse relationship between higher metacognitive dysfunctional beliefs and lower levels of psychosocial functioning. • It identifies age and metacognitive scores as crucial predictors of psychosocial functioning across various domains. What are the implications for practice? • The findings suggest that therapeutic nursing interventions for individuals diagnosed with schizophrenia should address metacognitive dysfunctional beliefs to improve overall functioning and well-being. • Clinicians, including psychiatrists and psychiatric nurses, should consider the patient's age, marital status, and metacognitive scores when assessing the risk of elevated OCS and devising treatment plans. • The study emphasizes the need for comprehensive psychiatric nursing assessment, including metacognitive dysfunction and OCS evaluation. What are the implications for future research? • Future research could explore the causal relationships between metacognitive dysfunctional beliefs, OCS, and psychosocial functioning in schizophrenia. • Longitudinal studies could provide insights into the progression of these relationships over time and the impact of therapeutic interventions. • Further research could also investigate the effectiveness of specific therapeutic strategies such as Metacognitive Therapy (MCT), Schema Therapy (ST), Cognitive Enhancement Therapy (CET), and Cognitive Behaviour Therapy (CBT) to address this population's metacognitive dysfunctional beliefs.

ABSTRACT

BACKGROUND: Schizophrenia is a chronic mental health disorder that significantly impacts an individual's cognitive, emotional and social functioning. Recent research has highlighted the role of metacognitive beliefs and obsessive-compulsive symptoms (OCS) in the psychosocial performance of individuals diagnosed with schizophrenia. Understanding these relationships could provide valuable insights for developing more effective nursing interventions. This study aimed to investigate the relationship between metacognitive beliefs, OCS and psychosocial performance among individuals diagnosed with schizophrenia.

DESIGN

A cross-sectional survey was conducted involving 174 purposively selected participants diagnosed with schizophrenia.

TOOLS

The Meta-Cognitions Questionnaire-30, Young Adult Self-Report Scale for OCS and Specific Level of Functioning Scale were used to gather the necessary data.

RESULTS

The study found a significant positive correlation between OCS and metacognitive dimensions. Age was a significant predictor with an Oddis Ratio of 2.471. The metacognitive dysfunction was a highly significant predictor in univariate and multivariate analyses, with Oddis Ratios of 1.087 and 1.106, respectively. The study also discovered that higher levels of metacognitive dysfunctional beliefs were associated with lower levels of psychosocial functioning. Age and the metacognitive dysfunction score were significant predictors of psychosocial functioning scores, accounting for 26.8% of the variance in these scores.

CONCLUSION

The study reveals a compelling inverse relationship between higher metacognitive dysfunctional beliefs and lower levels of psychosocial functioning in individuals diagnosed with schizophrenia. It also identifies certain demographic factors, such as younger age, as significant contributors to elevated OCS. Importantly, metacognitive dysfunction emerged as a critical predictor of psychosocial functioning across various domains. These findings underscore the potential of incorporating metacognitive-focused interventions in the treatment plans for schizophrenia patients. By addressing these cognitive patterns, healthcare professionals can enhance overall functioning and well-being in individuals diagnosed with schizophrenia.

The relationship between metacognitive processes and cognitive performances in older adults with no significant impairment: a cross-sectional study

BACKGROUND

Metacognitive dysfunctions have been implicated in several neuropsychiatric conditions, while cognitive performances have been evaluated by measuring cognitive domains in older adults. This study investigated a relationship between metacognitive processes and cognitive performances in older adults.

METHODS

A sociodemographic form, the Standardised Mini-Mental State Examination (SMMSE) and the Metacognitions Questionnaire-30 (MCQ-30) were applied to participants aged >65 years who had no significant cognitive decline defined as normal or with mild cognitive impairment.

RESULTS

'Negative beliefs about worry' and 'need to control thoughts' domains of MCQ-30 were related to cognitive performance measured with SMMSE. Increased negative beliefs about worry were a predicting factor for total cognitive performance as a means of contributing to cognitive impairment, whereas an increased need to control thoughts was related to having a less likely cognitive impairment.

CONCLUSIONS

Metacognitive dysfunctional processes, in particular about worry, might contribute to determining more decent outcomes for cognitive conditions in older adults with no significant cognitive dysfunction.

Meta-analysis of the relationship between metacognition and disorganized symptoms in psychosis

OBJECTIVE

Disorganized symptoms show associations with metacognitive deficits in psychosis. However, the magnitude of this relationship is unclear. This meta-analysis aimed to 1) quantify relationships between metacognition and both disorganized symptoms and disorganized speech; and 2) examine moderators of these relationships (e.g., metacognition type, neurocognition).

METHOD

A literature search was conducted using PsycINFO, Web of Science, PubMed, and EMBASE databases. English-language studies measuring disorganized symptoms and metacognition (i.e., introspective accuracy, metacognitive beliefs, or metacognitive capacity) in psychosis were included. Random effects meta-analyses were conducted using Pearson's r.

RESULTS

Meta-analysis of 20 studies (n = 1490) resulted in a significant negative medium correlation between disorganized symptoms and metacognition (r = -0.332, 95 % CI [-0.423, -0.235]). Magnitude was moderated by metacognition type. A significant negative small correlation between disorganized speech and metacognition (r = -0.173, 95 % CI [-0.254, -0.089], n = 1470) was observed, with no significant moderators.

CONCLUSIONS

Results clarify the magnitude of the relationships between metacognition and both disorganized symptoms and disorganized speech. Significant relationships may indicate conceptual links, yet the different magnitudes may reflect a distinction between disorganized symptoms and speech. The moderator finding highlights that metacognitive capacity has an especially strong link to disorganized symptoms and underscores the need for careful distinction between types of metacognition in future work.

A systematic review of the relationship between generic and specific metacognitive beliefs and emotion dysregulation: A metacognitive model of emotion dysregulation

Although a probable association between metacognitive beliefs (also termed 'metacognitions') and emotion dysregulation has been suggested in the literature, the evidence is still sparse and inconclusive. The current study aims to present a comprehensive evaluation of the literature examining the association between metacognitive beliefs and emotion dysregulation. In accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, a search was conducted on PubMed and Ebsco. A manual search of reference lists was also run. Search terms were 'metacognitions/metacognitive beliefs/positive metacognitive beliefs/negative metacognitive beliefs/cognitive self-consciousness/beliefs about the need to control thoughts/cognitive confidence/negative beliefs about thoughts concerning uncontrollability and danger/AND difficulties emotion regulation/emotion dysregulation'. A total of 19 studies met the inclusion criteria. In both non-clinical and clinical populations, a higher endorsement of dysfunctional metacognitive beliefs was found to be associated with emotion dysregulation and vice versa. A higher endorsement of metacognitive beliefs may be associated, either directly or via maladaptive forms of mental control (e.g., worry, rumination and suppression) to emotion dysregulation. Metacognitive beliefs could be the potential therapeutic target in clinical interventions aimed at reducing emotion regulation difficulties.

Understanding pathways from narcissistic grandiosity to psychotic-like experiences: Insights from the network analysis

It has been shown that narcissistic grandiosity and psychotic-like experiences (PLEs) may share the common psychological mechanisms, including impairments of metacognition, social cognition, cognitive biases, emotion regulation through fantasizing and dissociation. However, it remains unknown as to whether these mechanisms are associated with the occurrence of PLEs in people with narcissistic grandiosity. Therefore, in the present study, we approached a network analysis in order to investigate pathways from narcissistic grandiosity to PLEs taking into consideration the mediating effect of common psychological mechanisms. The study was based on a non-clinical sample of 1647 individuals, aged 18-35 years. Data were collected through self-reports administered in the online survey. There were no direct connections between narcissistic grandiosity and PLEs. However, four pathways connecting narcissistic grandiosity and PLEs through the effect of one mediating psychological mechanism were identified. These mechanisms covered external attribution biases, the need to control thoughts, social cognition, and emotion regulation through fantasizing. Among them, the shortest pathway led through the effects of external attribution biases. Age, gender, education and lifetime history of psychiatric treatment were included as covariates in a network analysis. Findings from this study indicate that higher levels of external attributions, the need to control thoughts, impairments of social cognition, and emotion regulation strategies based on fantasizing might be associated with the development of PLEs in people showing narcissistic grandiosity. These observations indicate potential targets for therapeutic approaches that aim to reduce the risk of developing comorbid psychopathology in people with grandiose narcissism traits.

The Metacognitions about Binge Eating Questionnaire: Investigation of the association between specific metacognitions and Binge Eating Disorder

Literature suggested that metacognitions are involved in eating problems and may be relevant to the understanding of Binge Eating Disorder (BED). The goal of the current studies was to develop the first self-report instrument on metacognitions about binge eating. In Study 1, a community sample completed the Metacognitions about Binge Eating Questionnaire (MBEQ); an Exploratory Factor Analysis (EFA) was performed. In study 2, a community sample completed the MBEQ and measures assessing severity of binge eating, irrational food beliefs, anxiety, depression, impulsiveness. A Confirmatory Factor Analysis (CFA) was performed. Concurrent and incremental validity were assessed. In study 3, a clinical sample of participants with a diagnosis of BED completed the MBEQ and other measures. Bivariate correlational analysis and hierarchical linear regression were performed. Participants from the general population and participants with a diagnosis of BED were compared. EFA and CFA supported a two-factor solution consisting of positive and negative metacognitions about binge eating. Concurrent and incremental validity were acceptable. The metacognitions factors correlated positively with anxiety, depression, irrational food beliefs, impulsiveness in the community sample, and anxiety, irrational food beliefs, impulsiveness in clinical sample. The metacognitions factors contributed to the prediction of BEDs symptoms, in community and clinical samples, over and above age, gender, impulsiveness, anxiety, depression, irrational food beliefs. The MBEQ possesses good psychometric properties and appears a reliable and valid measure of positive and negative metacognitions about binge eating. Metacognitions about binge eating could be a therapeutic target to reduce the severity of binge eating episodes.

The psychometric properties of positive and negative beliefs about the rumination scale in Chinese undergraduates

BACKGROUND

Rumination, a transdiagnostic factor in different psychopathological conditions, is believed to be activated and sustained by dysfunctional metacognition. The Positive Beliefs about Rumination Scale (PBRS) and the Negative Beliefs about Rumination Scale (NBRS) have been used to measure the metacognitive beliefs of rumination and have been investigated in many cultural contexts. However, it remains unclear whether these scales can work as well for the Chinese population. Therefore, this study aimed to explore the psychometric properties of the Chinese versions of these scales and to test the metacognitive model of rumination for students with different levels of depression.

METHODS

The PBRS and NBRS were forward-backward translated into Mandarin. In total 1,025 college students were recruited to complete a battery of web-based questionnaires. Exploratory factor analysis, confirmatory factor analysis, and correlation analysis were used to test the structure, validity, and reliability of the two scales, as well as their item correlations with rumination.

RESULTS

A new two-factor structure of the PBRS (rather than the original one-factor model) and a new three-factor structure of the NBRS (rather than the original two-factor model) were extracted. The goodness-of-fit indices of these two factor models showed they had a good to very good fit with the data. The internal consistency and construct validity of PBRS and NBRS were also affirmed.

CONCLUSION

The Chinese versions of the PBRS and the NBRS were generally shown to be reliable and valid, but their newly extracted structures fit the Chinese college students better than their original structures. These new models of PBRS and NBRS are of value to be further explored in Chinese population.

Repetitive Negative Thinking as a Central Node Between Psychopathological Domains: a Network Analysis

Repetitive negative thinking (RNT) may be defined as a reiterative, passive and uncontrollable thinking process. RNT has been recognized as a transdiagnostic phenomenon associated with the onset and maintenance of several clinical conditions including depression, generalised anxiety, psychosis and insomnia. We aimed to estimate a network model of mutual associations between RNT and the aforementioned indicators whilst controlling for other well-established transdiagnostic factors (i.e. perceived stress, loneliness). A total of 324 participants (Mage = 25.26 years, SD = 6.89; 69.3% females) completed a cross-sectional survey of self-report questionnaires. A Gaussian graphical model was estimated using the graphical LASSO in combination with the extended Bayesian information criterion. We found a dense network in which RNT exhibited substantial connections with the majority of the psychopathological domains. The centrality indices confirmed that RNT was one of the most important nodes in the network. Moreover, the estimated network showed satisfactory accuracy and stability. Findings emphasized RNT as a potentially good therapeutic target for psychopathology prevention and treatment protocols.

Metacognitive sensitivity and symptoms of mental disorder: A systematic review and meta-analysis

Introduction

Metacognition is a term used to refer to cognition about cognitive processes. In this systematic review and meta-analysis, we reviewed studies that investigated the relationship between experimentally measured objective metacognitive sensitivity and diverse symptoms of mental disorder. In these studies, metacognitive sensitivity is operationalized as the correspondence between the accuracy of task performance and reported confidence therein.

Methods

A literature search was conducted across four databases and studies were selected for review based on predefined eligibility criteria. Twenty studies were included in the review and separate meta-analyses were conducted for psychotic and non-psychotic categories of psychiatric symptoms.

Results

A significant reduction (medium effect size) in metacognitive sensitivity was found in individuals with psychosis-related symptoms of mental disorder compared to healthy control groups, but no significant difference was found for individuals with non-psychotic symptoms. It should be noted though, that fewer studies were available for the latter group. Sub-group analysis found no evidence that the effect of metacognitive impairment depended on whether perceptual or non-perceptual experimental tasks were employed.

Discussion

These findings are discussed in relation to other conceptualizations of metacognition and the role reduced metacognitive sensitivity may play in forms of mental disorder.

Personality traits and mental distress after COVID-19 testing. Prospective long-term analysis in a Viennese cohort

BACKGROUND

Symptoms of mental stress are a hallmark of the COVID-19 pandemic. We hypothesized that just testing for COVID-19 could act as an effective stressor for persisting symptoms of mental distress including posttraumatic stress disorder. Our study aimed to determine whether personal beliefs on individual control and competence (locus of control, LoC) correlate with symptoms of mental distress and positive screening for post-traumatic stress disorder during a 9-month observational period.

METHODS

Between March and December 2021, we applied online versions of the Questionnaire on Competence and Control Expectations (FKK), the Depression, Anxiety, and Stress Score (DASS), the Short Screening Scale for DSM-IV Posttraumatic Stress Disorder (PTSD), and a medical history questionnaire for COVID-19 symptoms (visit 1). 48 hours after negative COVID-19 testing, DASS was repeated to address relief effects on mental distress (visit 2). Following 90 days (visit 3), development of mental distress was addressed by a combination of DASS and PTSD, while the possible long-term manifestation of PTSD was evaluated 9 months later (visit 4).

RESULTS

At visit 1, 7.4 percent of the total sample (n = 867) demonstrated a positive screening for PTSD, while after nine months (at visit 4), 8.9 percent of the remaining sample (n = 204) had positive screening results. The mean age was 36.2 years; 60.8% were women, 39.2% men. In contrast to individuals with negative PTSD screening, these participants demonstrated a significantly different LoC personality profile. This was confirmed by the results of both DASS and the COVID-19 medical history questionnaire.

CONCLUSION

Following testing for COVID-19, individuals with positive long-term PTSD screening present with significantly different personality traits than those w/o suggesting that self-confidence and effective control over one's own actions serve as a protective function against mental distress.

Metacognition vulnerabilities in time of crisis: Who to protect from suicidal risk?

INTRODUCTION

During stressful events, we are all trying to cope. We may not be equal depending on our emotional, psychological, and mental states. During the COVID-19 pandemic, we could try to avoid negative information processing and anxiogenics content to prevent unhealthy thinking processes. One of the processes we can observe regarding our way of thinking and its impact on our psychological well-being is Metacognition.

METHODS

We recruited 104 outpatients in 2018. In 2020, during the pandemic, we recruited 216 outpatients and 176 healthy controls. We assessed their level of metacognition with the MCQ30 scale together with Suicidal risk and Hopelessness.

RESULTS

All three groups showed significant differences, with the nonclinical sample having higher scores in MCQ30. Regression revealed the different profiles where Hopelessness was the only predictor for the clinical sample, whereas metacognition was an adjunctive predictor of suicidal risk for the nonclinical sample.

CONCLUSION

Our results showed that the COVID-19 crisis influenced metacognitive levels for the nonclinical sample but not for the clinical population. Moreover, Hopelessness predicted suicide risk for both populations, but Metacognition was also a predictive factor for the nonclinical sample. We conclude with the possible impact of preventive measures based on Metacognitive work that can be created out of these results.

Mediating role for metacognitive processes in the relationship between schizotypy and anxiety and depression symptoms

Introduction: Depression and anxiety symptoms are highly prevalent in schizophrenia-spectrum disorders and are commonly associated with schizotypy in non-clinical samples. However, it remains unclear what factors could be contributing to the relationships between schizotypy and anxiety and depression symptoms. Using path analysis, we explored the complex interplay between schizotypy, metacognitive beliefs, cognitive insight, and symptoms of emotional distress.Methods: Self-report data of schizotypy, metacognitive beliefs, cognitive insight, depression, and anxiety symptoms were collected from 344 participants from a predominantly student sample.Results: Path analysis confirmed unique associations between schizotypy dimensions, metacognitive beliefs, and cognitive insight. Furthermore, negative beliefs about worry mediated the link between the schizotypy dimensions, unusual experiences, cognitive disorganisation, and introvertive anhedonia and both depression and anxiety symptoms. Lack of cognitive confidence also mediated the relationship between cognitive disorganisation and depression symptoms. Finally, the cognitive insight subcomponent self-reflectiveness mediated the relationship between unusual experiences and cognitive disorganisation and anxiety.Conclusions: This study significantly furthers our understanding of the complex relationship between schizotypy, metacognitive processes, and emotional distress. Our findings also provide support for interventions which modify metacognitive beliefs and self-reflectiveness, which may prove beneficial for treatment in clinical settings.

Validation of the metacognitions about online gaming scale (MOGS) among Chinese gamers

With the largest online gamer population worldwide and a heightened rate of Internet Gaming Disorder (IGD), China has a long-lasting need to identify salient correlates of IGD and provide corresponding assessment tools to support cost-effective IGD screening and interventions. To respond to such a need, the present study aimed to validate the Metacognitions about Online Gaming Scale (MOGS) among Chinese gamers to provide an additional tool for promoting studies investigating metacognition, a promising and newly emerged correlate of IGD, in China. To evaluate the psychometric properties of MOGS, we collected data from 1340 Chinese university students with gaming experiences (59.3% female, M_age = 19.84 years), in which 262 of them also participated in the one-month retest. Our results indicated that the Chinese version of MOGS has a two-factor structure and satisfactory reliabilities (α = 0.90 and 0.92, ICC = 0.60 and 0.64, AVE = 0.56 and 0.70, ρ_c = 0.88 and 0.92). Moreover, MOGS's convergent validity was evidenced by the expected, positive associations with generic metacognitions, stress, and IGD tendency (r (1338) = 0.29-0.55, p < 0.001) as well as significant MOGS differences between probable IGD and non-IGD gamers (p < 0.001). A 6-item, short-form MOGS, which displayed equivalent psychometric soundness as its full-scale counterpart, was also developed. As the first study to validate MOGS among Chinese gamers, the present study attested to the readiness of this measure in facilitating further studies of gaming-specific metacognitions for early identification of and tailored interventions for high-risk gamers in China.

'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

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.

MetaCogs: Mitigating Executive Dysfunction via Agent-Based Modeling for Metacognitive Strategy Development

Executive functions (EF) are a collection of cognitive domains governing task initiation, motor planning, attention, and goal-oriented action. Difficulties with EF have marked impacts on adaptive living skills, learning outcomes, and quality of life for people with cognitive and psychosocial disabilities, as well as the broader population. While there is considerable research interest in EF training intervention for disabled populations, very few studies explore metacognitive intervention for people with cognitive disabilities. Metacognition comprises conscious beliefs and strategies around task management and goal setting. Metacognitive awareness has been shown to mediate the effects of executive function on self-regulated learning. Metacognitive interventions have also shown promise in general education, military training, and medical practice. We present a virtual reality experience deploying agent-based modeling to support explicit metacognitive strategy instruction for undergraduate students of all neurotypes. Our results support that explicit instructional material explaining executive function and metacognition in relation to problem-solving experiences influenced participant self-concept and awareness of personal traits and cognitive processes.

Metacognitive Abilities as a Protective Factor for the Occurrence of Psychotic-Like Experiences in a Non-clinical Population

Psychotic-like experiences (PLEs) are a phenomenon that occurs in the general population experiencing delusional thoughts and hallucinations without being in a clinical condition. PLEs involve erroneous attributions of inner cognitive events to the external environment and the presence of intrusive thoughts influenced by dysfunctional beliefs; for these reasons, the role played by metacognition has been largely studied. This study investigates PLEs in a non-clinical population and discriminating factors involved in this kind of experience, among which metacognition, as well as psychopathological features, seems to have a crucial role. The aim of this study was to extend the knowledge about the relationship between metacognition, psychopathology, and PLEs, orienting the focus on metacognitive functioning. The sample consisted of 207 Italian participants (men = 32% and women = 68%) voluntarily recruited online, who gave consent to participate in the study. The average age of the sample was 32.69 years (SD: 9.63; range: 18-71). Subjects affected by psychosis, neurological disease, and drug addiction were excluded from the analyses. The following scales were used to investigate PLEs: Peters et al. Delusions Inventory (PDI), Launay-Slade Hallucinations Scale-Extended Revised (LSHSE), Prodromal Questionnaire-Brief (PQ-B), and Revised Hallucination Scale (RHS). To assess general psychopathological features, the Behavior and Symptom Identification Scale (BASIS-32) was administrated. The Metacognition Self-Assessment Scale (MSAS) was chosen to evaluate metacognitive functioning. From hierarchical regression analyses, it emerged that the presence of anxiety, depression, and impulsive/addictive symptoms constitute a remarkable vulnerability factor for PLEs, in line with previous evidence regarding the relationship between general psychopathology and PLEs. Metacognition negatively predicts PLEs, and its presence does not affect the significance of psychopathological variables, suggesting that metacognitive abilities seem to play a protective role for the occurrence of PLEs among non-clinical individuals, and such ability operates as an independent predictor along with other variables. These results are explained by the role of metacognitive functions, which allow individuals to operate many mental processes such as interpreting sensorial events as real or illusory, understanding behaviors, thoughts, and drives of others, and questioning the subjective interpretation of facts.

Metacognitions in Patients With Frequent Mental Disorders After Diagnosis of Pulmonary Arterial Hypertension

BACKGROUND

The prevalence of mental disorders, particularly adjustment disorder (AD), major depressive disorder (MDD) and panic disorder (PD) is increased in patients with pulmonary arterial hypertension (PAH). However, it is unclear which pathogenic mechanisms determine their development and could therefore be targeted in prevention or therapeutic interventions. Here, we assessed metacognitions in a sample of PAH patients with and without MDD and PD. Moreover, we reconstructed the course of mental illnesses following the PAH diagnosis.

METHODS

Two hundred seventeen PAH patients were included in this cross-sectional study. The prevalence of AD was assessed retrospectively using DSM-V criteria. Current mental disorders were assessed using the structured clinical interview for DSM-V. Additionally, metacognitive beliefs and processes were assessed using established questionnaires (MCQ-30, AnTI).

RESULTS

Patients with an AD consecutive to the PAH diagnosis more frequently developed MDD (37.5 vs. 13.9%, p < 0.001) and PD (26.3 vs. 8.8%, p = 0.001) later on compared to PAH patients without a former AD. Moreover, patients with current MDD/PD displayed more dysfunctional metacognitions than those without current MDD/PD (p < 0.001). Patients with current MDD/PD in the context of former AD had more dysfunctional metacognitive worries and beliefs compared to patients with current MDD/PD without former AD (p = 0.009).

CONCLUSION

Our results suggest that in the context of PAH, dysfunctional metacognitions are associated with MDD and PD. Therefore, a metacognitive approach to treat and prevent those mental illnesses seems promising and should be investigated in future studies.

Metacognitive Beliefs and Suicidal Ideation: An Experience Sampling Study

The current study aimed to examine the relationship between metacognitive beliefs about suicidal ideation and the content and process of suicidal ideation. This was to examine the potential contribution of the Self-Regulatory Executive Function (S-REF) model (Wells and Matthew, 2015) to suicidal ideation. Twenty-seven participants completed both trait and state-level measures of suicidal ideation, negative affect, defeat, hopelessness, entrapment and metacognitive beliefs. Experience Sampling Methodology (ESM) was adopted to measure state-level measurements with participants invited to complete an online diary up to seven times a day for six days. Multi-level modelling enabled a detailed examination of the relationships between metacognitive beliefs and suicidal ideation. Positive (β = 0.241, p < 0.001) and negative (β = 0.167, p < 0.001) metacognitive beliefs about suicidal ideation were positively associated with concurrent suicidal ideation even when known cognitive correlates of suicide were controlled for. The results have important clinical implications for the assessment, formulation and treatment of suicidal ideation. Novel meta-cognitive treatments targeting beliefs about suicidal ideation are now indicated. A limited range of characteristics reported by participants affects the generalizability of findings. Future research is recommended to advance understanding of metacognition and suicide but results demonstrate an important contribution of the S-REF model.

Metacognitive Rating Scale: A Study Applying a Korean Translation to Individuals with Schizophrenia

Metacognition is a higher-level cognition of identifying one’s own mental status, beliefs, and intentions. This research comprised a survey of 184 people with schizophrenia to verify the reliability of the metacognitive rating scale (MCRS) with the revised and supplemented metacognitions questionnaire (MCQ) to measure the dysfunctional metacognitive beliefs of people with schizophrenia by adding the concepts of anger and anxiety. This study analyzed the data using principal component analysis and the varimax method for exploratory factor analysis. To examine the reliability of the extracted factors, Cronbach’s α was used. According to the results, reliability was ensured for five factors: positive beliefs about worry, negative beliefs about uncontrollability and danger of worry, cognitive confidence, need for control, and cognitive self-consciousness. The negative beliefs about uncontrollability and danger of worry and the need for control on anger expression, which were both added in this research, exhibited the highest correlation (r = 0.727). The results suggest that the MCRS is a reliable tool to measure the metacognition of people with schizophrenia.

Pivotal mental states

This paper introduces a new construct, the 'pivotal mental state', which is defined as a hyper-plastic state aiding rapid and deep learning that can mediate psychological transformation. We believe this new construct bears relevance to a broad range of psychological and psychiatric phenomena. We argue that pivotal mental states serve an important evolutionary function, that is, to aid psychological transformation when actual or perceived environmental pressures demand this. We cite evidence that chronic stress and neurotic traits are primers for a pivotal mental state, whereas acute stress can be a trigger. Inspired by research with serotonin 2A receptor agonist psychedelics, we highlight how activity at this particular receptor can robustly and reliably induce pivotal mental states, but we argue that the capacity for pivotal mental states is an inherent property of the human brain itself. Moreover, we hypothesize that serotonergic psychedelics hijack a system that has evolved to mediate rapid and deep learning when its need is sensed. We cite a breadth of evidences linking stress via a variety of inducers, with an upregulated serotonin 2A receptor system (e.g. upregulated availability of and/or binding to the receptor) and acute stress with 5-HT release, which we argue can activate this primed system to induce a pivotal mental state. The pivotal mental state model is multi-level, linking a specific molecular gateway (increased serotonin 2A receptor signaling) with the inception of a hyper-plastic brain and mind state, enhanced rate of associative learning and the potential mediation of a psychological transformation.

Do intuitive ideas of the qualities that should characterize involuntary and voluntary memories affect their classification?

It is assumed that the difference between voluntary and involuntary autobiographical memories lies in the intentionality to retrieve a memory assigned by the experimenter. Memories that are retrieved when people are instructed to do so in response to cues are considered voluntary (VAMs), those that pop up spontaneously are considered involuntary (IAMs). VAMs and IAMs so classified are also found to differ in terms of phenomenological characteristics, such as perceived accessibility, vividness etc. These differences are assumed to be due to differences in intentionality and the different retrieval processes at play. It is possible, however, that these differences (which are subjective attributions of phenomenological characteristics) are the result of metacognitive beliefs of what IAMs and VAMs should be. In two experiments, we investigated the possible role of these metacognitive beliefs. Participants rated IAMs and VAMs on a number of phenomenological characteristics in two conditions, when these memories were presented in blocks that specified whether they were retrieved in a voluntary or involuntary task, or when presented in a mixed list with no information provided. If metacognitive beliefs influence the reporting of memory properties, then the block presentation would increase the differences between the characteristics of the two types of memories. The results showed that, besides replicating the characteristics of IAMs and VAMs already observed in the literature, there were almost no differences between the blocked and the mixed lists. We discuss the results as supporting the idea that the difference in characteristics attributed to IAMs and VAMs reflect a genuine difference in the nature of the retrieval and is not the result of pre-existing metacognitive belief on what a voluntary and an involuntary memory should be.

Metacognitive Therapy for Work-Related Stress: A Feasibility Study

About 25% of EU workers experience work-related stress for all or most of their working time, showing that work-related stress is a major cause of health problems for the EU population. This situation has been worsened even more by the COVID-19 restrictions embraced by employers worldwide. However, a timely and sustainable intervention protocol for treating such issues has not been developed yet. Thus, the present research shows a first effective attempt based on Metacognitive therapy (MCT) to solve this issue. MCT was practiced on four individuals suffering from chronic work-related stress. Primary outcome variables were general mental health, perceived stress, and blood pressure. Participants were assessed at multiple baselines before the start of therapy and then attended a 3- and 6-months follow-up after treatment termination. Results showed significant improvements in general mental health, perceived stress, and blood pressure in each client. Secondary outcome variables improved too-maladaptive coping strategies, avoidance behaviors, and depression symptoms-corroborating the main findings. At 3- and 6-month follow-up, results were maintained. The findings suggest that MCT might be a promising and sustainable intervention for work-related stress, although a metacognitive model for stress and large-scale RCTs need to be developed and carried out to further explore the effect of MCT on stress. Our results represent one of the first attempts to treat work-related stress via Metacognitive Therapy and support the feasibility of the treatment, both in terms of its efficacy and sustainability, in a historical moment in which work-related stress is increased worldwide because of the COVID-19 pandemic. Within such a realm, our feasibility study should be followed by larger and controlled studies that, if successful, would provide various stakeholders-including organizational and institutional decision-makers-with a solid, timely and cost-effective method to help the workforce coping with work-related stress.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

A Systematic Review of Metacognitive Beliefs in Chronic Medical Conditions

Background: Psychological functioning plays an important role in medical conditions and impacts patients' quality of life. Previously, many studies have highlighted the association of metacognition to both the development and maintenance of emotional disorders. Recently, several researchers pointed out the relevant role of dysfunctional metacognitive beliefs in the context of chronic diseases. Hence, dysfunctional metacognitive beliefs could be directly related to anxiety and depression, regardless of the medical condition's expression. The aim of this systematic review was to summarize the available evidence regarding the association of metacognition with anxiety, depression, and perceived quality of life, in the context of medical conditions, according to Wells' theory.

Methods: A systematic review based on electronic bibliographic databases (PsycINFO, PubMed, Scopus, Web of Science, and Web of Knowledge) of scientific literature was carried out. Studies involving patients evaluated in clinical settings were included in the analysis.

Results: Our findings indicated that metacognition appears to be related to anxiety, depression, and quality of life in patients with medical chronic conditions. Therefore, dysfunctional metacognitive beliefs might be a relevant factor associated with the process of adapting to illness.

Conclusions: The additional evaluation of metacognitive factors in the context of several medical chronic conditions appears valuable. Due to the rising interest in the study of metacognition, suggestions for future research have also been provided.

Breaking the Cybernetic Code: Understanding and Treating the Human Metacognitive Control System to Enhance Mental Health

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.

Nonsocial and social cognition in schizophrenia: current evidence and future directions

Cognitive impairment in schizophrenia involves a broad array of nonsocial and social cognitive domains. It is a core feature of the illness, and one with substantial implications for treatment and prognosis. Our understanding of the causes, consequences and interventions for cognitive impairment in schizophrenia has grown substantially in recent years. Here we review a range of topics, including: a) the types of nonsocial cognitive, social cognitive, and perceptual deficits in schizophrenia; b) how deficits in schizophrenia are similar or different from those in other disorders; c) cognitive impairments in the prodromal period and over the lifespan in schizophrenia; d) neuroimaging of the neural substrates of nonsocial and social cognition, and e) relationships of nonsocial and social cognition to functional outcome. The paper also reviews the considerable efforts that have been directed to improve cognitive impairments in schizophrenia through novel psychopharmacology, cognitive remediation, social cognitive training, and alternative approaches. In the final section, we consider areas that are emerging and have the potential to provide future insights, including the interface of motivation and cognition, the influence of childhood adversity, metacognition, the role of neuroinflammation, computational modelling, the application of remote digital technology, and novel methods to evaluate brain network organization. The study of cognitive impairment has provided a way to approach, examine and comprehend a wide range of features of schizophrenia, and it may ultimately affect how we define and diagnose this complex disorder.

Anxiety in youth at clinical high risk for psychosis: A case study and conceptual model

Some individuals identified as being at clinical high risk (CHR) for developing psychosis may suffer substantial anxiety due to a fear of transitioning to psychosis. This can be associated with catastrophic misinterpretation of normal mental experiences, such as a momentary lapse in attention, as markers for psychosis, fueled by hypervigilance for mental experiences that may be perceived as signs of impending psychosis. This anxiety may only worsen due to the self-stigma triggered by admission to a psychiatric CHR clinic, independent of whether or not the individual transitions to psychosis. Based on a clinical case study, we propose a cognitive model for this anxiety, an extension of Clark's model of panic. Our model accounts for causal factors of this distress, such as self-stigma and maladaptive core beliefs. It also includes maintaining factors such as hypervigilance for mental experiences and catastrophic misinterpretation of normal mental experiences as anomalous and portending eventual psychosis. We outline assessment and treatment guidelines and offer suggestions for how this model could be empirically validated. We suggest that treatment with this model, under the neural diathesis-stress framework, may have the potential to lower the risk of transition to psychosis and that assessment for such anxiety should be part of standard CHR care.

Validation of the Serbian version of the Metacognitions Questionnaire-30 in nonclinical and clinical samples

The Metacognitions Questionnaire (MCQ-30) is a brief multidimensional measure used for assessment of metacognitive beliefs in psychopathology. The aim of this study was to assess the psychometric properties of MCQ-30 in Serbian nonclinical (n = 246) and clinical (n = 171; anxiety and depressive disorders) samples. The reliability of the questionnaire and its subscales was satisfactory. An exploratory factor analysis yielded a five-factor solution in both groups, whereas a confirmatory factor analysis showed a somewhat weaker fit of the model. The MCQ-30 showed positive associations with measures of anxiety, pathological worry, depressive, and obsessive-compulsive symptoms in both samples, demonstrating adequate convergent validity. The instrument was sensitive to differences in metacognitive beliefs between nonclinical and clinical samples. MCQ-30 subscales showed incremental contributions in predicting pathological worry after controlling for the variance in obsessive-compulsive symptoms and vice versa. Our results suggest that the MCQ-30 is a reliable and valid instrument for assessing metacognitive beliefs in both nonclinical and clinical samples. Moreover, the findings support the use of the MCQ-30 in Serbian population and extend support for the metacognitive model.

Suicidal Ideation in People With Psychosis Not Taking Antipsychotic Medication: Do Negative Appraisals and Negative Metacognitive Beliefs Mediate the Effect of Symptoms?

Between 5% and 10% of people with psychosis will die by suicide, a rate which is 20-75 times higher than the general population. This risk is even greater in those not taking antipsychotic medication. We examined whether negative appraisals of psychotic experiences and negative metacognitive beliefs about losing mental control mediated a relationship between psychotic symptoms and suicidal ideation in this group. Participants were diagnosed with schizophrenia spectrum disorders, antipsychotic-free for 6 months at baseline, and were participating in an 18-month randomized controlled trial of cognitive therapy vs treatment as usual. We conducted a series of mediation analyses with bootstrapping on baseline (N = 68), follow-up data (9-18 mo; n = 49), and longitudinal data (n = 47). Concurrent general symptoms were directly associated with suicidal ideation at baseline, and concurrent negative symptoms were directly associated with suicidal ideation at 9-18 months. Concurrent positive, negative, general, and overall symptoms were each indirectly associated with suicidal ideation via negative appraisals and/or negative metacognitive beliefs, at baseline and 9-18 months, except for negative symptoms at baseline. Controlling for baseline suicidal ideation and treatment allocation, baseline general symptoms were indirectly associated with later suicidal ideation, via baseline negative appraisals and negative metacognitive beliefs. Baseline negative metacognitive beliefs also had a direct association with later suicidal ideation. These findings suggest the clinical assessment of suicidal ideation in psychosis may be enhanced by considering metacognitive beliefs about the probability and consequences of losing mental control.

Metacognitive approaches to the treatment of psychosis: a comparison of four approaches

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.

The role of cognitive and metacognitive factors in non-clinical paranoia and negative affect

OBJECTIVES

It is increasingly accepted that paranoia lies on a continuum of severity that can be observed in the general population. Several psychological factors have been implicated in the development of more distressing persecutory ideas including negative affect (i.e., anxiety and depression), beliefs about oneself and other people (i.e., schemas), and metacognitive beliefs. This study aimed to explore the combined role of cognition and metacognition in paranoia. Specifically, unhelpful metacognitive beliefs and schematic beliefs were tested as potential moderators of the relationship between non-clinical paranoid ideation and negative affect.

METHODS

Measures from 227 people who took part in a cross-sectional online survey were analysed using structural equation modelling. A series of models grounded in cognitive and metacognitive theory were tested sequentially.

RESULTS

The results demonstrated that unhelpful metacognitive beliefs had a positive moderating effect on the relationship between paranoia and negative affect. Negative beliefs about oneself and other people did not moderate negative affect but positive beliefs about other people had a negative moderating effect. In a final model, negative schematic beliefs predicted paranoid ideation whilst metacognitive beliefs predicted and moderated affect.

CONCLUSIONS

The findings suggest that consideration of metacognitive beliefs, as well as schemas, may be important in understanding non-clinical paranoia.

PRACTITIONER POINTS

Metacognitive beliefs may be an important determinant of negative affect in the context of non-clinical paranoia. The consideration of both cognitive and metacognitive factors may be helpful when working with people with distressing paranoid ideas.

Development and testing of a self-regulation model for recurrent depression

Self-regulation is a strategy for self-management of depression. Study aims were to (1) describe development of an intervention based on metacognition and self-regulation, (2) test intervention feasibility and utility, and (3) determine its effectiveness in reducing depressive symptoms. The Self-Regulated Illness Management of Depression intervention was developed and taught to 22 participants with recurrent depression. There was no attrition 6 months post intervention. At 6 months, there was a significant decrease in depressive symptoms (M = 10.21, standard deviation = 8.0), t(18) = 5.60, p < .001, and 73 percent of participants used Self-Regulated Illness Management of Depression frequently. Results indicated that Self-Regulated Illness Management of Depression was feasible and useful.

Metacognitive beliefs as psychological predictors of social functioning: An investigation with young people at risk of psychosis

Poor social functioning has been found to be present in those at risk for psychosis. This study aimed to examine metacognitive beliefs as potential predictors of structured activity (measure of social functioning) in those with an At Risk Mental State (ARMS). Regression and correlation analyses were conducted. The sample included 109 young people. Age was found to be positively correlated to structured activity. Metacognitive beliefs concerning uncontrollability and danger of worry were found to negatively predict structured activity. This was after controlling for age, gender, treatment allocation, cognitive schemas, positive symptom severity, social anxiety, and depression. Metacognitive danger items were most important. Age was the only control variable found to be an independent predictor of structured activity in the regression model, despite negative bi-variate relationships with structured activity found across three cognitive schema subscales and social anxiety. This is the first study to find that higher negative metacognitive beliefs about uncontrollability and danger predict lower social functioning in an ARMS sample, and that the perception of thoughts being dangerous was of particular importance. Psychological interventions should consider targeting this metacognitive dimension to increase social functioning. Future longitudinal research is required to strengthen findings in this area.

Attentional avoidance increases voice hearing in an analogue task in people with psychosis: An experimental study

Cognitive models of psychosis suggest that unhelpful ways of responding to experiences can maintain such experiences and the associated distress. The response styles of attentional avoidance and attentional focusing were manipulated in an analogue voice-hearing task. Predictions were that both would increase detection of words in response to an ambiguous audio-recording but that attentional avoidance would lead to a greater increase than focusing. We also predicted that there would be a greater increase in anxiety and distress in the avoidance group. Predictions were tested in a sample of 44 participants with a diagnosis of schizophrenia. Participants were randomly assigned to either attentional avoidance or focusing while listening to an ambiguous auditory task. Number of words identified and anxiety and distress were recorded. As predicted, there was an increase in the number of words identified in both groups; however, this increase was greater in the avoidance group. The prediction that there would also be an increase in distress that would be greater in the avoidance group was not supported. It is possible that emotional reactions relate more closely to appraisals of the voice. The results suggest that avoidance of experiences is particularly counterproductive and can result in greater detection of experiences.

Metacognitive beliefs mediate the effect of emotional abuse on depressive and psychotic symptoms in severe mental disorders

BACKGROUND

Early trauma is linked to higher symptom levels in bipolar and psychotic disorders, but the translating mechanisms are not well understood. This study examines whether the relationship between early emotional abuse and depressive symptoms is mediated by metacognitive beliefs about thoughts being uncontrollable/dangerous, and whether this pathway extends to influence positive symptoms.

METHOD

Patients (N = 261) with psychotic or bipolar disorders were assessed for early trauma experiences, metacognitive beliefs, and current depression/anxiety and positive symptoms. Mediation path analyses using ordinary least-squares regressions tested if the effect of early emotional abuse on depression/anxiety was mediated by metacognitive beliefs, and if the effect of early emotional abuse on positive symptoms was mediated by metacognitive beliefs and depression/anxiety.

RESULTS

Metacognitive beliefs about thoughts being uncontrollable/dangerous significantly mediated the relationship between early emotional abuse and depression/anxiety. Metacognitive beliefs and depression/anxiety significantly mediated the relationship between early emotional abuse and positive symptoms. The models explained a moderate amount of the variance in symptoms (R 2 = 0.21-0.29).

CONCLUSION

Our results indicate that early emotional abuse is relevant to depression/anxiety and positive symptoms in bipolar and psychotic disorders, and suggest that metacognitive beliefs could play a role in an affective pathway to psychosis. Metacognitive beliefs could be relevant treatment targets with regards to depression/anxiety and positive symptoms in bipolar and psychotic disorders.

The role of metacognition and obsessive-compulsive symptoms in psychosis: an analogue study

BACKGROUND

Several studies have indicated that obsessive-compulsive disorder (OCD) is a common comorbidity in patients with psychotic disorders, but there is sparse knowledge about the relationship between symptoms of OCD and psychotic symptoms. Metacognitions which guides thinking and coping is theorized to be a transdiagnostic component central for development and maintenance of psychological disorders, OCD and psychosis included. The aim of the study was therefore to explore how symptoms of OCD and metacognitions relate to symptoms of psychosis. Our main hypotheses were that metacognitions would be significantly related to all symptoms of psychological distress, and that there is considerable overlap between symptoms of psychosis and OCD.

METHODS

Community controls (N = 194) completed an internet survey measuring levels of paranoid ideation, predisposition to hallucinations, symptoms of OCD, depression, anxiety, and metacognitions. Correlations and hierarchical multiple linear regression analyses were used to unveil the relationship between symptoms and beliefs.

RESULTS

Symptoms of OCD showed a strong positive correlation with symptoms of psychosis, and the relationships were still significant after controlling for symptoms of anxiety and depression. Metacognitions also showed strong positive correlations with all symptom measures. Metacognition and OCD-symptoms accounted for 53.8% of the variance in paranoid ideation and 43.8% of predisposition to hallucinations. There was a large overlap between symptoms of psychosis, OCD-symptoms, and metacognitions (30.2-37.3%).

CONCLUSIONS

In general, the results suggest considerable overlap between paranoid ideation, predisposition to hallucinations, and OCD and metacognitive beliefs in a non-clinical sample. Further experimental- and clinical studies are needed in order to explore metacognitive models of OCD and psychosis.