Investigating the specific domains of the cognitive attentional syndrome that predict posttraumatic stress symptoms: The moderating effect of attentional control

The metacognitive model of posttraumatic stress disorder (PTSD) suggests that persistent use of the maladaptive self-regulation strategies that comprise the cognitive attentional syndrome (CAS) increases the likelihood of developing PTSD symptoms following trauma exposure. The metacognitive model also suggests that flexible regulation of attention might be protective against developing maladaptive outcomes that are associated with the CAS. The aims of this study were to (1) examine associations between all seven domains of the CAS and PTSD symptoms using a recently developed, multidimensional measure of the CAS, and (2) examine the moderating effect of self-reported attentional control on associations between the CAS and PTSD symptoms. Participants were trauma-exposed community adults (N = 237) who completed a battery of self-report measures. Results from linear regression analyses showed that worry, substance use, and internal threat monitoring accounted for unique variance in PTSD symptoms when all seven CAS domains were entered into the same model. Moderation analyses showed that attentional control dampened the effect of the CAS, specifically external threat monitoring, on PTSD symptoms. Study results support attentional control as a protective factor against the maladaptive effects of the CAS on PTSD symptoms.

Metacognitions About Health in Relation to Coronavirus Anxiety: The Mediating Role of Cognitive Attentional Syndrome and Distress Tolerance

The current study aimed to investigate the mediating role of cognitive attentional syndrome (CAS) and distress tolerance in the relationship between health-related metacognitions and coronavirus anxiety. The sample of this study consisted of 462 participants (381 female). Participants voluntarily completed self-report questionnaires on each of the variables mentioned above. The results of the structural modeling analysis showed that health-related metacognitions have a significant effect on the mediator variable of distress tolerance and CAS. Also, health-related metacognitions had a direct effect on coronavirus anxiety. Also, based on the results of the bootstrap test, it can be argued that health-related metacognitive beliefs, apart from their direct effect, play an important role in coronavirus anxiety, with CAS acting as a mediator. This study provides insights into the relationships among metacognitive beliefs, coronavirus anxiety, CAS, and distress tolerance. In particular, dysfunctional metacognitive beliefs, including an individual's beliefs about the uncontrollability of disease-related thoughts, are risk factors that could negatively affect mental health, leading to coronavirus anxiety. In addition, the association of dysfunctional beliefs with maladaptive behaviors resulting from the cognitive attentional syndrome is also involved in predicting and causing coronavirus anxiety. Given the insignificant role of emotional distress tolerance in the psychopathology of COVID-19 anxiety, the findings emphasize the importance of cognitive factors in this context.

Cultural adaptation and validation of the Arabic version of the multidimensional cognitive attentional syndrome scale (MCASS)

The cognitive attentional syndrome (CAS) is a core concept within metacognitive theory. The premise of the CAS is related to metacognition, however its role in psychopathology is distinct. Due to the complex nature of the CAS, a theoretically driven and psychometrically sound self-report measure of the CAS for the Arabic population is yet to be developed. We translated the Multidimensional Cognitive Attentional Syndrome Scale (MCASS) into the Arabic language and tested its structural validity. The MCASS was translated according to the standard guidelines of forward-translation followed by backward-translation. In Study 1, the MCASS was administered to a larger sample (N = 1027), selected from 22 Arabic-speaking countries in the Arab League countries, and exploratory factor analysis (EFA) was used to examine the factor structure of the measure. Those who participated in Study 1 were excluded from participating in Study 2. Confirmatory factor analysis (CFA) was used in Study 2 (N = 567) to assess the latent factor structure of MCASS, which supported a six-factor model. Results support multidimensional assessment of the CAS using the MCASS, and demonstrate suitability for use in Arab speaking samples. Implications of this study and recommendations for use of the Arabic version of MCASS are discussed.

The network structure of dysfunctional metacognition: Analysis of the MCQ-30

The Metacognitive Control System (MCS) model gives central importance to maladaptive metacognition in psychological vulnerability and disorder. The metacognitions questionnaire 30 (MCQ-30) is widely used to assess such metacognitions and to establish their effects. Previous studies consistently demonstrate that the MCQ-30 consists of five latent factors, with some factors showing wide-ranging positive associations with symptoms and some demonstrating more specific symptom links. Questions remain concerning relationships between MCQ-items (or domains) and the most central of these outside of the latent-factor model. In the present study we set out to explore the internal structure of the MCQ-30 using network analysis and estimated two graphical Gaussian models, one with items- and one with domains, in an unselected sample (N = 1080). The robustness and stability of the networks, as well as the node predictability were assessed. Among our observations was that the items of the MCQ-30 appeared to cluster in meaningful substructures, corresponding to metacognitive theory. Furthermore, "need for control" was the most centrally placed domain, suggesting it plays an important role in the network and that its activation has a strong influence on other nodes. The theoretical and clinical implications of the current findings are discussed in light of the metacognitive model of psychological disorder.

Validity and Reliability of Cognitive Attentional Syndrome-1 Questionnaire

OBJECTIVE

This study aimed to evaluate the reliability and validity of the Turkish version of Cognitive Attentional Syndrome-1 (CAS-1) questionnaire.

METHODS

221 participants were included in the study who do not meet any psychiatric diagnosis. Participants were applied SCID I and II and filled CAS-1 scale, Meta-Cognitions Questionnaire-30 (MCQ-30), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Generalized Anxiety Disorder-7 (GAD-7) Scale, and Penn State Worry Questionnaire (PSWQ). Testing the reliability Cronbach's alpha, item analysis and Item and total score correlation coefficients were applied. For testing structural validity, Confirmatory Factor Analysis was used, and for testing the content validity, the relationship between each item of CAS-1 and MCQ-30, BDI, BAI, GAD-7, PSWQ was examined.

RESULTS

The correlation reliability coefficients were statistically significant except for using alcohol/drugs as a coping mechanism. Cronbach Alpha reliability coefficient of 16 items was 0.771 whereas, this ratio was 0.772 for the first eight items (CAS) and 0.685 for the last eight items (Metacognitive Beliefs) which showed that the internal consistency of CAS-1 was high. Structural and Content Validity of the scale was significant.

CONCLUSION

The Turkish version of the CAS-1 was a reliable and valid measure to evaluate CAS in a Turkish population.

Dysfunctional metacognition across psychopathologies: A meta-analytic review

BACKGROUND

Dysfunctions in metacognition have been reported in individuals with anxiety disorders. Although recent studies have examined metacognition in other disorders, how dysfunctional metacognition compares across disorders is not clear. This review aimed to ascertain the importance of dysfunctional metacognition in various psychopathologies, and to identify similarities and differences in metacognitive profiles across disorders.

METHODS

Forty-seven studies were selected from 586 articles published between 1990 and August 2015, including a total sample of 3772 patients and 3376 healthy individuals. Studies that measured metacognition using the Meta-Cognitions Questionnaire (MCQ) and its variants were included. We conducted five meta-analyses including 49 to 55 effect sizes, comparing psychiatric patients to healthy individuals on respective metacognitive dimensions of the MCQ.

RESULTS

We found elevated metacognitive dysfunctions in patients, as a group, on all MCQ dimensions. Group effects were large and robust for the two negative beliefs (i.e., beliefs about the uncontrollability and danger of thoughts, and beliefs about the need to control thoughts), and moderate and unstable for the positive beliefs. Patients showed decreased cognitive confidence and heightened cognitive self-consciousness on moderate to large levels. Moderator analyses revealed that negative beliefs about uncontrollability and danger of thoughts were most prevalent in generalized anxiety disorder, whereas heightened cognitive self-consciousness was more characteristic in obsessive-compulsive disorder. Generalized anxiety disorder, obsessive-compulsive disorder and eating disorders manifested more similar metacognitive profiles than other disorders.

CONCLUSIONS

Our findings supported dysfunctional metacognition as common processes across psychopathologies, with certain dimensions being more prevalent in particular disorders.