Changes in COPD-related anxiety symptoms during pulmonary rehabilitation: a prospective quantitative and qualitative study

Background

Fear-avoidance in COPD can have detrimental effects on pulmonary rehabilitation (PR) outcomes and is therefore important to address. This prospective study examined changes in and management of COPD-related anxiety symptoms over the course of a PR program.

Methods

Patients with COPD referred to 9-weeks of PR in the municipality of Vejle, Denmark from January to December 2022 completed a six-minute walk test (6MWT) and the following questionnaires, both before and after PR: COPD Anxiety Questionnaire 20-item version (CAF-R), measuring COPD-related anxiety; COPD Assessment Test (CAT), measuring COPD-related disability; 12-Item Short-Form Health Survey (SF-12), measuring health-related quality of life (HR-QoL); sociodemographic and disease-related information. After PR, a subsample of the patients took part in semi-structured interviews exploring their understanding of how they managed COPD-related anxiety during PR. Pre- and post-assessment of COPD-related anxiety and other PR outcomes were analysed with t-tests and correlation analyses. Qualitative interviews were analysed using a thematic analysis approach.

Results

A total of 72 patients with COPD (mean ± SD age 71 ± 8, 53% female) were included in the study, and 13 took part in qualitative interviews. A significant decrease in COPD-related anxiety was observed from before to after PR, corresponding to a small effect size (Cohen's d = 0.32; p = 0.018). Reductions in COPD-related anxiety were not associated with improvements in COPD-related disability, HR-QOL, or functional exercise capacity. The qualitative findings identified four anxiety management strategies, i.e., "planning", "problem-solving", "accepting", and "confronting", which were influenced by interactions with healthcare professionals and co-patients as well as patients' own perception.

Conclusions

COPD-related anxiety symptoms was reduced after PR, potentially through the use of various management strategies. The strategies appeared to be influenced by interactional factors during the PR program.

Trends in the dose-response relationship between adverse childhood experiences and maladaptive metacognitive beliefs: A cross-sectional study

BACKGROUND

Since the publication of the major research on adverse childhood experiences (ACE) at the turn of the millennium, our knowledge about the prevalence and physical and mental consequences of childhood adversities has increased substantially. In parallel, research on metacognition, which plays an important role in understanding our mental functioning, has also been on the rise. Although the adverse effects of ACEs on mental processes and the role of metacognitive deficits in the development of mental disorders are widely known, hardly any research into the interaction between these two areas has been conducted; this is what triggered our investigation.

METHODS

Our research was carried out as a cross-sectional study on a sample of 304 members of the general population. We measured ACEs with the 10-item Adverse Childhood Experiences Questionnaire and maladaptive metacognitions-positive and negative metacognitive beliefs, cognitive confidence, cognitive self-consciousness, and need to control thoughts- using the Meta-Cognitions Questionnaire. The closeness of the relationship between the ACE score and metacognitions was measured using Pearson's linear correlation coefficient, while the association of ACE accumulation with metacognitive beliefs was assessed using generalized linear models.

RESULTS

The most common ACE in our sample turned out to be emotional neglect (44.74%). All the examined maladaptive metacognitive beliefs correlate mildly to moderately with the number of suffered ACEs (r = 0.13-0.34), with an increase in the ACE score leading to a rise in the salience of maladaptive metacognitive beliefs. Moreover, a dose-response relationship was seen between increases in ACE scores and the overall values of metacognition, negative metacognitive beliefs, and the maladaptive metacognitive belief of the need to control thoughts.

CONCLUSIONS

Our results suggest that the more ACEs were experienced in childhood, the more pronounced the dysfunctional metacognitive beliefs are. Therefore, our findings emphasize the importance of further research into the topic.

Exploring age-related differences in metacognitive self-regulation: the influence of motivational factors in secondary school students

Introduction

Metacognitive self-regulation is a crucial factor that promotes students' learning and achievement. However, the evidence regarding age differences in metacognitive skills is rather mixed, with some evidence pointing toward further refinement and development and other evidence suggesting declining levels. Academic motivation, an important antecedent of metacognitive self-regulation, has also been reported to decline steeply in adolescence. Hence, this raises the question whether there are any age-related differences in academic motivation and metacognitive self-regulation of adolescents and whether age differences in academic motivation drive decreases in metacognitive self-regulation.

Method

A large sample size of 1,027 Greek adolescents (ages 12-16, M age = 13.95, SD = 0.78) was utilized in the present study. Multigroup measurement invariance analyses were deployed to compare the latent means of motivational factors (self-efficacy, task value, mastery, and performance goals) and metacognitive self-regulation across age groups. Cholesky decomposition was applied to test the independent contribution of motivational factors to and the indirect effects of age on metacognitive self-regulation.

Results

Invariance analyses revealed scalar invariance for metacognitive self-regulation, language self-efficacy, mastery and performance goal orientations and partially scalar invariance for task value. Older adolescents scored lower on metacognitive self-regulation, mastery and performance goals, and self-efficacy. Older students scored lower on metacognitive self-regulation via indirect effects through Cholesky decomposed motivational factors.

Discussion

Self-efficacy, mastery and performance goals, and task value are similarly understood across adolescents in different age groups. Decreased mastery and performance goals and task value can lead to reduced metacognitive self-regulation in adolescents. The implications of the findings underscore the key role of making students more engaged with lessons' content in order to promote greater academic motivation and prevent decreases in metacognitive self-regulation.

Hot metacognition: poorer metacognitive efficiency following acute but not traumatic stress

Aberrations to metacognition-the ability to reflect on and evaluate self-performance-are a feature of poor mental health. Theoretical models of post-traumatic stress disorder propose that following severe stress or trauma, maladaptive metacognitive evaluations and appraisals of the event drive the development of symptoms. Empirical research is required in order to reveal whether disruptions to metacognition cause or contribute to symptom development in line with theoretical accounts, or are simply a consequence of ongoing psychopathology. In two experiments, using hierarchical Bayesian modelling of metacognition measured in a memory recognition task, we assessed whether distortions to metacognition occur at a state-level after an acute stress induction, and/or at a trait-level in a sample of individuals experiencing intrusive memories following traumatic stress. Results from experiment 1, an in-person laboratory-based experiment, demonstrated that heightened psychological responses to the stress induction were associated with poorer metacognitive efficiency, despite there being no overall change in metacognitive efficiency from pre- to post-stress (N = 27). Conversely, in experiment 2, an online experiment using the same metamemory task, we did not find evidence of metacognitive alterations in a transdiagnostic sample of patients with intrusive memory symptomatology following traumatic stress (N = 36, compared to 44 matched controls). Our results indicate a relationship between state-level psychological responses to stress and metacognitive alterations. The lack of evidence for pre- to post-stress differences in metamemory illustrates the importance for future studies to reveal the direction of this relationship, and consequently the duration of stress-associated metacognitive impairments and their impact on mental health.

A Self-Regulation Intervention Conducted by Teachers in a Disadvantaged School Neighborhood: Implementers' and Observers' Perceptions of Its Impact on Elementary Students

Self-regulated learning contributes to students' academic success and their future as citizens. However, self-regulation skills are seldom or poorly promoted during instruction. To address this gap, the current article reports data on the implementation of an evidence-based intervention (i.e., a narrative-based intervention called "Yellow Trials and Tribulations") in a disadvantaged school neighborhood. Prior studies showed positive results of this intervention in promoting elementary students' self-regulation skills. Still, the data are mainly quantitative and limited to students' reports or classroom observations made by researchers. Hence, the current study aimed to explore the implementers' and observers' perceptions of the impact of the intervention. Four elementary teachers implemented the intervention in their fourth-grade classes (N = 96 students). For each session, the implementers and observers completed a session sheet collaboratively, as well as individual final reports at the end of the intervention. The records were analyzed through a direct content analysis. The data indicated a perceived increase in knowledge and the use of self-regulation skills in the educational context and in daily life routines. Moreover, the data allowed for the identification of other positive gains of the intervention. The findings extended prior research while helping researchers to further understand the impact of the narrative-based intervention. The implications for research and educational practice are provided.

A systematic framework of creative metacognition

Creative cognition does not just involve cognitive processes in direct service of the main task objective (e.g., idea generation), but also metacognitive processes that monitor and regulate cognition adaptively (e.g., evaluation of ideas and task performance, or development and selection of task strategies). Although metacognition is vital for creative performance, relevant work is sparse, which may be partly due to persistent ambiguities in the theoretical conceptualization of creative metacognition. Therefore, this article proposes a systematic framework of creative metacognition (CMC), which builds on recent advancements in metacognition theory and extends them to meet the specifics of creative cognition. The CMC framework consists of two dynamic components-monitoring and control-and a more static component of metacognitive knowledge, each subsuming metacognitive processes applying to the level of task, performance, and responses. We describe the presumed function of these metacognitive components in the creative process, present evidence in support of each, and discuss their association with related constructs, such as creative self-beliefs. We further highlight the dynamic interplay of metacognitive processes across task performance and identify promising avenues for future research.

How we learn social norms: a three-stage model for social norm learning

As social animals, humans are unique to make the world function well by developing, maintaining, and enforcing social norms. As a prerequisite among these norm-related processes, learning social norms can act as a basis that helps us quickly coordinate with others, which is beneficial to social inclusion when people enter into a new environment or experience certain sociocultural changes. Given the positive effects of learning social norms on social order and sociocultural adaptability in daily life, there is an urgent need to understand the underlying mechanisms of social norm learning. In this article, we review a set of works regarding social norms and highlight the specificity of social norm learning. We then propose an integrated model of social norm learning containing three stages, i.e., pre-learning, reinforcement learning, and internalization, map a potential brain network in processing social norm learning, and further discuss the potential influencing factors that modulate social norm learning. Finally, we outline a couple of future directions along this line, including theoretical (i.e., societal and individual differences in social norm learning), methodological (i.e., longitudinal research, experimental methods, neuroimaging studies), and practical issues.

Illusion of knowledge in statistics among clinicians: evaluating the alignment between objective accuracy and subjective confidence, an online survey

Healthcare professionals' statistical illiteracy can impair medical decision quality and compromise patient safety. Previous studies have documented clinicians' insufficient proficiency in statistics and a tendency in overconfidence. However, an underexplored aspect is clinicians' awareness of their lack of statistical knowledge that precludes any corrective intervention attempt. Here, we investigated physicians', residents' and medical students' alignment between subjective confidence judgments and objective accuracy in basic medical statistics. We also examined how gender, profile of experience and practice of research activity affect this alignment, and the influence of problem framing (conditional probabilities, CP vs. natural frequencies, NF). Eight hundred ninety-eight clinicians completed an online survey assessing skill and confidence on three topics: vaccine efficacy, p value and diagnostic test results interpretation. Results evidenced an overall consistent poor proficiency in statistics often combined with high confidence, even in incorrect answers. We also demonstrate that despite overconfidence bias, clinicians show a degree of metacognitive sensitivity, as their confidence judgments discriminate between their correct and incorrect answers. Finally, we confirm the positive impact of the more intuitive NF framing on accuracy. Together, our results pave the way for the development of teaching recommendations and pedagogical interventions such as promoting metacognition on basic knowledge and statistical reasoning as well as the use of NF to tackle statistical illiteracy in the medical context.

Beyond emotional intelligence: The new construct of meta-emotional intelligence

Meta-emotional intelligence is a recently developed multidimensional construct that, starting from the original ability model of emotional intelligence, focuses on the cognitive aspects of emotional abilities and on the metacognitive and meta-emotional processes that influence our emotional life. Thus, meta-emotional intelligence is the combination of emotional abilities and meta-emotional dimensions, such as the beliefs about emotions, the self-concept about one's emotional abilities, and the self-evaluation of performance. This article aims to illustrate the theoretical and methodological background of this construct and to describe the IE-ACCME test, an original multi-method tool that has been developed to measure the different variables that compose meta-emotional intelligence. Applications of this construct will be discussed, as well as future directions.

Nonpharmacological management of psychological distress in people with COPD

Psychological distress is prevalent in people with COPD and relates to a worse course of disease. It often remains unrecognised and untreated, intensifying the burden on patients, carers and healthcare systems. Nonpharmacological management strategies have been suggested as important elements to manage psychological distress in COPD. Therefore, this review presents instruments for detecting psychological distress in COPD and provides an overview of available nonpharmacological management strategies together with available scientific evidence for their presumed benefits in COPD. Several instruments are available for detecting psychological distress in COPD, including simple questions, questionnaires and clinical diagnostic interviews, but their implementation in clinical practice is limited and heterogeneous. Moreover, various nonpharmacological management options are available for COPD, ranging from specific cognitive behavioural therapy (CBT) to multi-component pulmonary rehabilitation (PR) programmes. These interventions vary substantially in their specific content, intensity and duration across studies. Similarly, available evidence regarding their efficacy varies significantly, with the strongest evidence currently for CBT or PR. Further randomised controlled trials are needed with larger, culturally diverse samples and long-term follow-ups. Moreover, effective nonpharmacological interventions should be implemented more in the clinical routine. Respective barriers for patients, caregivers, clinicians, healthcare systems and research need to be overcome.

Students With High Metacognition Are Favourable Towards Individualism When Anxious

Metacognitive ability has been described as an important predictor of several processes involved in learning, including problem-solving. Although this relationship is fairly documented, little is known about the mechanisms that could modulate it. Given its relationship with both constructs, we decided to evaluate the impact of self-knowledge on PS. In addition, we inspected whether emotional (self-reported anxiety) and interpersonal (attitudes towards social interdependence) variables could affect the relationship between metacognition and problem-solving. We tested a sample of 32 undergraduate students and used behavioural tasks and self-report questionnaires. Contrary to the literature, we found no significant relationship between metacognition and problem-solving performance, nor a significant moderating effect when including emotional and interpersonal variables in the model. In contrast, we observed a significant moderating model combining metacognition, self-reported anxiety and attitudes towards social interdependence. It was found that participants with high metacognition reported attitudes unfavourable towards interdependence when they felt high anxiety. These results suggest that already anxious individuals with high metacognition would prefer to work alone rather than with others, as a coping mechanism against further anxiety derived from cooperation. We hypothesise that in anxiogenic contexts, metacognition is used as a tool to compare possible threats with one's own skills and act accordingly, in order to maximise one's own performance. Further studies are needed to understand how metacognition works in contexts adverse to learning.

Age-related differences in visual confidence are driven by individual differences in cognitive control capacities

Visual perception is not only shaped by sensitivity but also by confidence, i.e., the ability to estimate the accuracy of a visual decision. Younger observers have been reported to have access to a reliable measure of their own uncertainty when making visual decisions. This metacognitive ability might be challenged during ageing due to increasing sensory noise and decreasing cognitive control resources. We investigated age effects on visual confidence using a visual contrast discrimination task and a confidence forced-choice paradigm. Younger adults (19-38 years) showed significantly lower discrimination thresholds than older adults (60-78 years). To focus on confidence sensitivity above and beyond differences in discrimination performance, we estimated confidence efficiency that reflects the ability to distinguish good from bad perceptual decisions. Confidence efficiency was estimated by comparing thresholds obtained from all trials and trials that were judged with relatively higher confidence, respectively. In both age groups, high confidence judgments were associated with better visual performance, but confidence efficiency was reduced in older adults. However, we observed substantial variability across all participants. Controlling for age group, confidence effciency was closely linked to individual differences in cognitive control capacities. Our findings provide evidence for age-related differences in confidence efficiency that present a specific challenge to perceptual performance in old age. We propose that these differences are driven by cognitive control capacities, supporting their crucial role for metacognitive efficiency.

Feeling and Thinking about It Are Two Different Things: How to Capture Momentary Emotions of Extreme Sports in the Field

To learn about extreme sports and what motivates such activities, we need to understand the emotions embedded in the experience itself. However, how we go about assessing these emotions might provide us with very different answers. An experience is a fleeting and ever-changing phenomenon, rich in detail and filled with nuances. What we remember and, therefore, what we are able to report from our experience might, however, be strikingly different to what we experienced. Our memories are grained by time, impaired by arousal, and affected by context. Despite these limitations, the most common way to measure an experience is by self reporting. The current paper reviews some of the relevant theory on emotions and how this might impact different assessments. I also describe a new way of measuring momentary emotions in the field by use of video cameras and automatic coding of facially expressed emotions. Extreme sports may leave us with positive memories but may be anything but pleasant while in the midst of them. In the end, this paper may give some hints to why.

A bibliometric analysis of Community of Inquiry in online learning contexts over twenty-five years

Since the outbreak of COVID-19, online learning has gained popularity among educators and learners, where Community of Inquiry (CoI) has caught researchers' attention. To bibliometrically analyze the framework of CoI over twenty-five years, we adopted both qualitative and quantitative research methods to examine the framework of CoI in online learning contexts. We concluded that teaching presence, social presence, cognitive presence, metacognition, and self-efficacy played important roles in the framework of CoI. This study also explored the top ten authors, sources, organizations, and countries using VOSviewer and established citation networks through the clustering techniques in CitNetExplorer. Future research could focus on how to motivate the educational institutes and educators to change their traditional educational methods and whether to include both metacognition and self-efficacy in the CoI framework.

Is information literacy ability, and metacognition of that ability, related to interest, gender, or education level? A cross-sectional study of higher education students

How information literate are students in higher education, and how accurate is their metacognition related to that ability? Are students’ perceived needs to learn more and their level of interest in becoming information literate related to their pursuit of information literacy (IL) skill development? First-year undergraduates, master’s, and PhD students ( N = 760) took an objective IL test and estimated their scores both before and after the test. IL ability, as well as students’ estimation of their IL ability, increased with higher education experience and IL test experience, though also varied notably within groups. Low-performers tended to overestimate their abilities, while high-performers tended to underestimate them—both evidence of the Dunning-Kruger effect. Furthermore, gender comparisons revealed that men tended to estimate higher, and more accurate, scores than women. Finally, PhD students reported greater interest in becoming information literate than undergraduates. Although undergraduates felt a greater need to learn more, PhD students were more inclined to pursue IL growth. For both groups, interest in becoming information literate correlated far more with their likelihood to invest effort into developing IL competencies than their perceived need to know more. What implications might these findings have for how we conceptualize the teaching of IL?

Drinking-Related Metacognitive Guidance Contributes to Students’ Expression of Healthy Drinking Principles as Part of Biology Teaching

Biology education has adopted the goal of educating future generations about sustainable, healthy habits. The current paper focuses on drinking-related nutritional literacy—the characteristic of health education that refers to aspects of healthy drinking: drinking enough water and fewer sugar-sweetened beverages (SSBs). The study aims to foster school students’ critical thinking about the quality and the quantity of what they drink in everyday life. Facilitating students’ metacognitive awareness was achieved, as they were engaged in a biology learning activity centered on the importance of healthy drinking in everyday life. The study focused on two research questions: 1. What is the contribution of drinking-related metacognitive guidance to the development of metacognitive awareness concerning healthy drinking among students? 2. What is the contribution of drinking-related metacognitive guidance to the way students express the principles and importance of healthy drinking as part of their metacognitive awareness thinking process? The findings indicate a quantitative and qualitative improvement in drinking-related metacognitive awareness among those students who received metacognitive guidance as part of biology teaching. This paper suggests that metacognitive guidance has a significant pedagogical potential to improve sustainable healthy habits among children.

Overestimation of volatility in schizophrenia and autism? A comparative study using a probabilistic reasoning task

BACKGROUND AND OBJECTIVES

A plethora of studies has investigated and compared social cognition in autism and schizophrenia ever since both conditions were first described in conjunction more than a century ago. Recent computational theories have proposed similar mechanistic explanations for various symptoms beyond social cognition. They are grounded in the idea of a general misestimation of uncertainty but so far, almost no studies have directly compared both conditions regarding uncertainty processing. The current study aimed to do so with a particular focus on estimation of volatility, i.e. the probability for the environment to change.

METHODS

A probabilistic decision-making task and a visual working (meta-)memory task were administered to a sample of 86 participants (19 with a diagnosis of high-functioning autism, 21 with a diagnosis of schizophrenia, and 46 neurotypically developing individuals).

RESULTS

While persons with schizophrenia showed lower visual working memory accuracy than neurotypical individuals, no significant group differences were found for metamemory or any of the probabilistic decision-making task variables. Nevertheless, exploratory analyses suggest that there may be an overestimation of volatility in subgroups of participants with autism and schizophrenia. Correlations revealed relationships between different variables reflecting (mis)estimation of uncertainty, visual working memory accuracy and metamemory.

LIMITATIONS

Limitations include the comparably small sample sizes of the autism and the schizophrenia group as well as the lack of cognitive ability and clinical symptom measures.

CONCLUSIONS

The results of the current study provide partial support for the notion of a general uncertainty misestimation account of autism and schizophrenia.

Psychosis and Psychotic-Like Symptoms Affect Cognitive Abilities but Not Motivation in a Foraging Task

Background and Objective

Goal-directed behavior is a central feature of human functioning. It requires goal appraisal and implicit cost-benefit analyses, i.e., how much effort to invest in the pursuit of a certain goal, against its value and a confidence judgment regarding the chance of attainment. Persons with severe mental illness such as psychosis often struggle with reaching goals. Cognitive deficits, positive symptoms restricting balanced judgment, and negative symptoms such as anhedonia and avolition may compromise goal attainment. The objective of this study was to investigate to what degree symptom severity is related to cognitive abilities, metacognition, and effort-based decision-making in a visual search task.

Methods

Two studies were conducted: study 1: N = 52 (healthy controls), and study 2: N = 46 (23 patients with psychosis/23 matched healthy controls). Symptoms were measured by the CAPE-42 (study 1) and the PANSS (study 2). By using a visual search task, we concomitantly measured (a) accuracy in short-term memory, (b) perceived accuracy by participants making a capture area or confidence interval, and (c) effort by measuring how long one searched for the target. Perseverance was assessed in trials in which the target was omitted and search had to be abandoned.

Results

Higher levels of positive symptoms, and having a diagnosis of psychosis, were associated with larger errors in memory. Participants adjusted both their capture area and their search investment to the error of their memory. Perseverance was associated with negative symptoms in study 1 but not in study 2.

Conclusion

By simultaneously assessing error and confidence in one's memory, as well as effort in search, we found that memory was affected by positive, not negative, symptoms in healthy controls, and was reduced in patients with psychosis. However, impaired memory did not concur with overconfidence or less effort in search, i.e., goal directed behavior was unrelated to symptoms or diagnosis. Metacognition and motivation were neither affected by cognitive abilities nor by negative symptoms. Clinically, this could indicate that struggles with goal directed behavior in psychosis may not solely be dependent on primary illness factors.

Why Metacognition Is Not Always Helpful

In many situations, actively engaging in metacognition may improve cognitive achievement and subjective well-being. However, the potential disadvantages of metacognitive engagement are only rarely communicated in metacognition research. In this paper, I outline three ways in which metacognition may reduce cognitive achievement and psychological well-being. First, metacognition may sometimes actively interfere with task performance. Second, the costs of engaging in metacognitive strategies may under certain circumstances outweigh its benefits. Third, metacognitive judgments or feelings involving a negative self-evaluation may detract from psychological well-being. The main contribution of this paper is to integrate findings from different research traditions in order to illustrate the three suggested ways in which metacognition may be unhelpful. An implication of this overview is that although metacognition is most often beneficial to cognitive achievement and subjective well-being, one should bear in mind that it may also have the opposite effect. It is important for researchers and practitioners to take this potential downside of metacognition into account. Practitioners might find it useful to consider the following three questions that relate to my aforementioned claims: Is the nature of the task such that metacognition could interfere with performance? Is the cognitive demand required by the metacognitive strategy disproportionally large compared to its potential usefulness to cognitive achievement? Does metacognition lead to an unhelpful comparison of oneself to others? The same considerations should be kept in mind when researchers and practitioners communicate the potential implications of research findings in metacognition research to audiences within and beyond the research community.