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Nordahl H, Anyan F, Hjemdal O. Prospective Relations Between Dysfunctional Metacognitive Beliefs, Metacognitive Strategies, and Anxiety: Results From a Four-Wave Longitudinal Mediation Model. Behav Ther 2023; 54:765-776. [PMID: 37597956 DOI: 10.1016/j.beth.2023.02.003] [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: 08/15/2022] [Revised: 01/27/2023] [Accepted: 02/09/2023] [Indexed: 02/19/2023]
Abstract
The metacognitive model of psychological disorders suggests that emotional disorders are related to maladaptive metacognitive strategies corresponding to underlying dysfunctional metacognitive beliefs. There is substantial empirical evidence supporting a role of metacognition in psychopathology, but fewer studies have evaluated the metacognitive model using longitudinal data and taken into consideration its differentiation between components and how they are hypothesized to be related to each other. Thus, more specific model evaluation is important as it relates to identifying mechanisms of disorder with a potential to provide clinical advances. In the present study, 868 participants took part in a 4-wave survey and reported on metacognitive beliefs and strategies and anxiety symptoms. Two longitudinal mediation models (forward and reversed causation) were run to test temporal precedence and bidirectional relations. The results indicated that metacognitive beliefs significantly predicted metacognitive strategies, which further predicted anxiety symptoms and mediated the indirect effect in the relationship between metacognitive beliefs and anxiety over time. The relationship between metacognitive beliefs and anxiety symptoms over time were bidirectional, but this relationship was not accounted for by metacognitive strategies. These findings largely support central predictions set forward by the metacognitive model and indicate that metacognitions play a preceding and maintaining role in anxiety.
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Quan H, Zettle RD. The Contribution of Psychological Inflexibility and Metacognitive Processes to Emotional Distress. J Cogn Psychother 2023; 37:63-81. [PMID: 36788002 DOI: 10.1891/jcpsy-d-21-00014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Process-based cognitive behavior therapy (PB-CBT) may be informed by identifying shared mechanisms of disorder linked to shared processes of therapeutic change. Repetitive negative thinking (RNT) is a molar pathogenic process common to both generalized anxiety disorder and depression. Acceptance and commitment therapy (ACT) and metacognitive therapy (MCT) offer separate models of the relationship between RNT and emotional distress. In a pair of related studies, the relative degree to which processes specific to the two models accounted for variability in levels of generalized anxiety and depression in college student samples was evaluated. Across both studies, processes of cognitive fusion and obstructed valued living within the ACT model and beliefs about the negative consequences of RNT within the MCT model were most predictive of variability in levels of emotional distress. Limitations of this project as well as implications for further research and practice of PB-CBT for disorders of emotional distress are discussed.
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Affiliation(s)
- Huan Quan
- Wichita State University, Wichita, Kansas, USA
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Wahlund T, Hesser H, Perrin S, Johansson S, Huhn V, Sörhus S, Lindskog S, Serlachius E, Hedman-Lagerlöf E, Ljótsson B, Andersson E. Therapist-guided online metacognitive intervention for excessive worry: a randomized controlled trial with mediation analysis. Cogn Behav Ther 2021; 51:21-41. [PMID: 34283004 DOI: 10.1080/16506073.2021.1937695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Previous studies have found an association between excessive worrying and negative beliefs about worry. It is unclear if change in these beliefs mediate worry reduction. This study aimed to examine (1) if a simplified online metacognitive intervention can reduce worry, (2) whether changes in negative beliefs about worry mediate changes in worry severity, and (3) moderated mediation, i.e., if the mediating effect is more pronounced in individuals with a high degree of negative beliefs about worry at baseline. Adult excessive worriers (N = 108) were randomized to 10-weeks of the online metacognitive intervention (MCI) aimed at reducing negative beliefs about worry, or to wait-list (WL). Outcomes, mediation, and moderated mediation were examined via growth curve modelling. Results indicated a significant reduction in the MCI group (d = 1.6). Reductions in negative beliefs about worry and depressive symptoms separately mediated changes in worry severity during the intervention, but in a multivariate test only the former remained significant. Sensitivity analysis indicated that the hypothesized mediation was robust to possible violations of mediator-outcome confounding. The moderated mediation hypothesis was not supported. The results from this randomized trial add to the growing literature suggesting that negative beliefs about worry play a key role in worry-related problems. ClinicalTrials.gov Identifier: NCT03393156.
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Affiliation(s)
- Tove Wahlund
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Hugo Hesser
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.,School of Law, Psychology and Social Work, Center for Health and Medical Psychology, Örebro University, Örebro, Sweden
| | - Sean Perrin
- Department of Psychology, Lund University, Lund, Sweden
| | - Sanna Johansson
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet
| | - Vilgot Huhn
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet
| | - Sara Sörhus
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet
| | - Severin Lindskog
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet
| | - Eva Serlachius
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet.,Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Erik Hedman-Lagerlöf
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet
| | - Erik Andersson
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet
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