Coronavirus Anxiety, COVID Anxiety Syndrome and Mental Health: A Test Among Six Countries During March 2021

The negative impact of the COVID-19 pandemic on mental health outcomes is widely documented. Specifically, individuals experiencing greater degrees of severity in coronavirus anxiety have demonstrated higher levels of generalized anxiety, depression and psychological distress. Yet the pathways in which coronavirus anxiety confers vulnerability are not well known. The present investigation sought to address this gap in the scientific literature by testing the indirect effect of the COVID-19 anxiety syndrome, which centres on the function of detecting and managing the environmental threat of virus exposure and its sequalae. Data were collected during the height of the pandemic (March 2021) and included 5297 adults across six countries. Structural equation modelling techniques revealed that the COVID-19 anxiety syndrome evidenced a statistically significant indirect effect between coronavirus anxiety and generalized anxiety, depression and work/social adjustment. Overall, results suggest there could be public health merit to targeting anxiety related to virus exposure to improve behavioural health for those who are struggling with excessive fear and worry.

The Arab COVID-19 Anxiety Syndrome Scale (C-19ASS): COVID-19 anxiety syndrome and psychological symptoms in the Saudi Arabian population

INTRODUCTION

The COVID-19 Anxiety Syndrome Scale (C-19ASS) is a reliable scale assessing dysfunctional coping strategies activated in response to COVID-19 fear and threat. The present study aimed to provide a validation of the Arabic version of the C-19ASS and to explore the association between the C-19ASS and psychological symptoms syndrome.

METHOD

In Study 1, a community sample of 404 participants completed the Arabic version of the C-19ASS and results were subjected to an exploratory factor analysis. In Study 2, a community sample of 903 participants completed the Arabic version of the C-19ASS and a series of measures assessing depressed mood and anhedonia, generalized anxiety and health anxiety. Internal consistency, construct validity and incremental validity were assessed. Associations between C-19ASS and psychological symptoms were assessed.

RESULTS

Factor analysis identified a two-factor solution (i.e., C-19ASS-Perseveration and C-19ASS-Avoidance), and confirmatory factor analysis suggested a two-factor model best fits the data. The Arabic version of the C-19ASS showed good internal consistency, good construct and incremental validity. COVID-19 anxiety syndrome was associated with more severe anxiety symptoms, depressive symptoms and health anxiety. Females had higher levels of COVID-19 anxiety syndrome than males. Participants diagnosed with COVID-19, and those who had experienced loss as a consequence of COVID-19, had higher levels of COVID-19 anxiety syndrome (Perseveration).

CONCLUSIONS

The Arabic version of the C-19ASS appears to be a reliable and valid measure of the COVID-19 anxiety syndrome. The COVID-19 anxiety syndrome could be a suitable therapeutic target to improve psychological recovery during the COVID-19 pandemic among Arabs.

Psychometric properties and psychological correlates of the COVID-19 Anxiety Syndrome Scale: A comprehensive systematic review and meta-analysis

Coronavirus disease-19 (COVID-19) has led to the demise of millions of people worldwide; additionally, it has resulted in a significant economic and mental health burden. Since the onset of the COVID-19 pandemic, various measures have been constructed to evaluate pandemic-related fear and anxiety. The COVID-19 Anxiety Syndrome Scale (C-19ASS) is a promising measure that assesses coping strategies (e.g., avoidance, checking, worrying and threat monitoring), termed 'COVID-19 Anxiety Syndrome', in response to COVID-19 fear and anxiety. The measure has been broadly welcomed, leading to its use in Brazil (Portuguese), China, Greece, Indonesia, the Philippines, Iran (Farsi), Italy, Saudi Arabia (Arabic), Turkey, the United Kingdom and the United States. To gain a better understanding of the relevance of the COVID-19 Anxiety Syndrome, we conducted a systematic review and meta-analysis to explore the psychological correlates and psychometric properties of the C-19ASS. Through the analysis of a total of 17,789 individuals (age range 19-70; female = 33%-85%), the C-19ASS demonstrated a consistent factor structure, measurement invariance across gender and acceptable reliabilities. Furthermore, a significant association with COVID-19 anxiety, depressive symptoms, generalized anxiety, health anxiety, psychological distress and functional impairment (work and social adjustment) during the COVID-19 pandemic was observed. When considering the Big Five personality traits, the C-19ASS and its subscales were only significantly and negatively associated with extraversion; only the total score on the measure was associated with neuroticism. The observed effect sizes ranged from very small to medium. Given that all included studies (K = 24) were cross-sectional, and due to the nature of the COVID-19 Anxiety Syndrome, which may well persist after the pandemic ends, it is recommended to continue screening society for the persistence of this syndrome.

An assessment of the psychometric properties and psychological correlates of the Greek COVID-19 Anxiety Syndrome Scale (C-19ASS)

In Greece, the COVID-19 pandemic was associated with social isolation, economic crisis, considerable unemployment, and an escalation of psychological distress. Given the potential of COVID-19 to engender a long-lasting impact on mental health, validating the COVID-19 Anxiety Syndrome Scale (C-19ASS) may be beneficial in determining if fear-based behaviors may persist post-pandemic. This is a psychometric study examining the C-19ASS features across a general sample of Greeks (n = 912; female = 78%; mean age = 32.35, ±9.25). The Greek C-19ASS demonstrated a two-factor structure consistent with the original scale's perseveration and avoidance subscales. This structure was supported by confirmatory factor analysis, which demonstrated a strong fit and robust reliability along with good divergent and convergent validity evidenced by correlational analyses. The incremental validity test revealed that the Greek C-19ASS predicted functional impairment and COVID-19 anxiety independently of health anxiety, generalized anxiety, and depressive symptoms, the Big Five personality traits, pandemic-related factors, and demographic variables. The findings were discussed using a self-regulatory executive function model as a theoretical background to discuss this pandemic-related phenomenon.

Twisted memories: Addiction-related engrams are strengthened by desire thinking

Associative learning plays a central role in addiction by reinforcing associations between environmental cues and addiction-related information. Unsupervised learning models posit that memories are adjusted based on how strongly these representations are coactivated during the retrieval process. From a different perspective, clinical models of addiction posit that the escalation and persistence of craving may depend on desire thinking, a thinking style orienting to prefigure information about positive addiction-related experiences. In the present work, we tested the main hypothesis that desire thinking is a key factor in the strengthening of addiction-related associations. A group of adult smoking volunteers (N = 26) engaged in a period of desire thinking before performing an associative learning task in which neutral words (cues) were shown along with images (smoking-related vs. neutral context) at different frequencies. Two retrieval tests were administered, one immediately after encoding and the other after 24 h, to test how the recall of associations changed as a function of retention interval. Two control groups, smokers (N = 21) and non-smokers (N = 22), performed a similar procedure, with a neutral imagination task replacing desire thinking. Participants who engaged in desire thinking increased their performance from the first to the second retrieval test only for the most frequent smoking-related associations. Crucially, this selective effect was not observed in the two control groups. These results provide behavioral evidence in support of the idea that desire thinking plays a role in strengthening addiction-related associations. Thus, this thinking process may be considered a target for reconsolidation-based conceptualizations of, and treatments for, addiction.

Impulsivity dimensions and their associations with disinhibited and actual eating behaviour

BACKGROUND

Previous research has suggested that there is an association between impulsivity, assessed via self-report measures and behaviourally, and disinhibited eating patterns, but it remains unclear which specific dimension of impulsivity is the most salient in this relationship. Furthermore, it remains uncertain whether any such associations would extend to actual eating behaviours and food consumption.

AIMS

The present study aimed to examine whether impulsivity, assessed both behaviourally and via self-report, is associated with self-reported disinhibited and actual eating behaviour in a controlled eating task.

METHOD

70 women from a community sample (aged 21-35) completed the Disinhibition subscale of the Three Factor Eating Questionnaire (TFEQ), the Barratt Impulsiveness Scale (BIS-11), the Matching Familiar Figures Task (MFFT-20), and a behavioural food consumption task.

RESULTS

Bivariate correlational analyses revealed significant associations between self-report measure of impulsivity, the scores on the MFFT-20 (assessing reflection impulsivity), and self-report measure of disinhibited eating. All these measures were associated with overall food consumption in a taste task, with reflection impulsivity, that is poor ability to reflect on information before making a decision, having the strongest association with the amount of food consumed. Self-reported impulsivity was most strongly associated with disinhibited eating. Partial correlations controlling for BMI and age did not diminish any significant correlations within these relationships.

CONCLUSIONS

Significant associations between both trait and behavioural (reflection) impulsivity, and self-reported disinhibited eating and actual eating behaviour were demonstrated. The implications of these findings on uncontrolled eating patterns in real life are discussed.

Psychological Impact and Women's Evaluation of the First-Trimester Pre-Eclampsia Screening and Prevention: ASPRE Trial

OBJECTIVE

This study aims to extend the understanding of the psychological impact of the first-trimester pre-eclampsia (PE) screening on women identified as high risk for preterm PE. We examined the differences between low- vs. high-risk women throughout pregnancy in: symptoms of distress (anxiety, depression, physical and mental health, and worry), health behaviour changes, the experience of pregnancy, and attitudes towards PE screening.

METHODS

This study was nested within the ASPRE trial. Pregnant women were screened for preterm-PE risk status in the first trimester; the assessments were carried out before the screening, in the second and in the third trimester (n = 155 low-risk women and N = 82 high-risk women in the second trimester).

RESULTS

The high-risk-for-PE women exhibited more depressive symptoms compared to the low-risk women in the second but not in the third trimester. No differences were observed between the two groups in other distress symptoms or in the women's evaluation of their experience of pregnancy. The high-risk group reported greater health behaviour changes compared to the low-risk group, but this was moderated by depression levels.

CONCLUSIONS

Overall, pregnant women reported positive attitudes towards first-trimester PE screening, despite transient depressive symptoms. This study offers supportive evidence concerning the appropriateness of PE screening in ethical terms.

The Italian COVID-19 Anxiety Syndrome Scale (C-19ASS): investigation of the COVID-19 Anxiety Syndrome and its association with psychological symptoms in an Italian population

Introduction

The COVID‐19 Anxiety Syndrome Scale (C‐19ASS) is a quick and reliable scale assessing dysfunctional coping strategies activated in response to COVID‐19 fear and threat. The present study aimed to provide a preliminary validation of the Italian version of the C‐19ASS and investigated whether the C‐19ASS would mediate the relationship between the Big Five personality traits and psychological outcomes.

Method

In Study 1, a community sample of 271 participants completed the Italian version of the C‐19ASS and results were subjected to a Principal Component Analysis. In study 2, a community sample of 484 participants completed the Italian version of the C‐19ASS and a series of measures assessing COVID‐19 anxiety, COVID‐19 fear, functional impairment, personality traits, depression, generalized anxiety and health anxiety. Internal consistency, concurrent and incremental validity were assessed. Path analyses were run.

Results

Factor analysis identified a two‐factor solution (i.e., C‐19ASS Perseveration and C‐19ASS Avoidance) and confirmatory factor analysis suggested a two‐factor model best fits the data. The Italian version of the C‐19ASS showed good internal consistency. There was also evidence of convergent validity and incremental validity. Path analyses showed that C‐19ASS Perseveration mediates the relationship between emotional stability and psychological symptoms (depression, generalized anxiety and health anxiety).

Conclusion

The Italian version of the C‐19ASS appears to be a reliable and valid measure of the COVID‐19 anxiety syndrome. The COVID‐19 anxiety syndrome could be a suitable therapeutic target to reduce psychological symptoms typically linked to pandemic events, such as depression generalized anxiety and health anxiety.

A discriminant analysis model of psychosocial predictors of problematic Internet use and cannabis use disorder in university students

Researchers have found similarities and differences between behavioral and drug addictions. The present study was designed to explore which of a series of psychosocial predictors of addictive behaviors could differentiate problematic Internet use (PIU) and Cannabis Use Disorder (CUD) in a sample of University students. A total of 144 participants (76 males, mean age = 23.03 years ± 2.83) were separated into three groups: those presenting with PIU (18 females, Mean age = 22.27 years), those presenting with CUD (22 female, Mean age = 22.73 years), and a control group (28 female, Mean age = 24.04 years). Participants completed the Internet Abusive Use Questionnaire (IAUQ), the Severity of Dependence Scale (SDS), the Multidimensional Scale of Perceived Social Support (MSPSS), the Barratt Impulsiveness Scale-11 (BIS-11), the Multidimensional Distress Tolerance Scale (MDTS), the Emotion Regulation Questionnaire (ERQ), the Metacognitions Questionnaire-30 (MCQ-30), and the Repetitive Thinking Questionnaire-10 (RTQ-10). The classification analysis results showed that 68.8% of the control group, 70.8% of the PIU group, and 81.3% of the CUD group were correctly classified in their respective groups. In addition, the results of the discriminant function analysis showed that there was a significant difference between members of the PIU and CUD groups in the degree of family support (0.45), significant other (0.33), tolerance of physical discomfort (0.30), reappraisal (0.42), and cognitive confidence (0.35). The findings provide evidence that specific psychosocial predictors can discriminate PIU from CUD.

The Persian COVID-19 Anxiety Syndrome Scale (C-19ASS): Psychometric properties in a general community sample of Iranians

There is a potential for a long-lasting psychological and social impact from the COVID-19 pandemic. Recently, the COVID-19 Anxiety Syndrome Scale (C19-ASS) has been developed, which measures individuals' coping mechanisms in relation to the fear or threat of COVID-19. The C19-ASS was developed and has been used so far only in Western samples. Further psychometric evaluation is needed in ethnically diverse samples. Therefore, the current study sought to test the psychometric properties in a large sample of Iranians (n = 1429; female = 52.1%; Mean age = 35.83, ±12.89) who completed a cross-sectional survey. Exploratory factor analysis revealed that the Persian C19-ASS has a two-factor structure corresponding to the perseveration and avoidance subscales of the original scale. Confirmatory factor analyses also supported a two-factor solution, which showed a firm model fit and high internal consistencies. Furthermore, it showed excellent divergent validity from generalized anxiety, indicating that it is concerned explicitly with COVID-19, supported by correlational analyses and exploratory factor analysis. Test of incremental validity indicated the Persian C19-ASS explained more variance in functional impairment and COVID-19 anxiety than the gender, marital and educational status, generalized anxiety, neuroticism, openness, consciousness and having lost someone close due to COVID-19. Also, based on a mediation test, it was found that C19-ASS mediates the relationship between the Big Five personality traits (except openness and consciousness) and health anxiety, generalized anxiety, depression and COVID-19 anxiety. Overall, the current findings provide further evidence for the construct of the COVID-19 anxiety syndrome. The COVID-19 anxiety syndrome is discussed in light of the S-REF model that provides an explanatory framework for this pandemic-related construct.

Metacognitions, rumination, and worry in personality disorder

Research on metacognitions and repetitive negative thinking in patients with Personality Disorder (PD) is scarce. We aimed to determine if metacognitions and repetitive negative thinking differed between patients with PD and those without PD, and if metacognitions would predict repetitive negative thinking in patients with PD controlling for several variables. A sample of 558 clinical participants were assessed for the presence of a PD diagnosis and completed the following questionnaires: Penn-State Worry Questionnaire, Ruminative Response Scale, Metacognitions Questionnaire 30, Beck Anxiety Inventory and Beck Depression Inventory. Compared to patients without a diagnosis of PD, patients with a PD diagnosis reported higher scores on both rumination and worry (as well as depression and anxiety) and three out of five of the MCQ-30 subscales (positive beliefs about worry, negative beliefs about thoughts concerning uncontrollability and danger, and beliefs about the need to control thoughts). Furthermore, the results of two hierarchical regression analyses in patients with a diagnosis of PD indicated that positive beliefs about worry and negative beliefs about thoughts concerning uncontrollability and danger were independent predictors of worry, and that negative beliefs about thoughts concerning uncontrollability and danger and cognitive self-consciousness were independent predictors of rumination. Metacognitions and repetitive negative thinking may play a role in the severity of psychological distress experienced in PD presentations. The implications of these findings are discussed.

The relative contribution of health cognitions and metacognitions about health anxiety to cyberchondria: A prospective study

OBJECTIVES

Cyberchondria involves the excessive and compulsive use of the Internet to search for health information. The present study investigated the relative contribution of health cognitions and metacognitions about health anxiety to prospective cyberchondria scores, controlling for health anxiety and hours spent online per day.

METHODS

A convenience sample of 221 participants was recruited for the purpose of this study with a final sample totaling 125 participants (58.4% females, M_age  = 34.51 years) who completed the full survey at baseline (T₀ ) and a measure of cyberchondria after 30 days (T₁ ).

RESULTS

The results of the study showed that metacognition about health anxiety relating to beliefs about the uncontrollability of thoughts was the only significant predictor of prospective cyberchondria scores when controlling for health anxiety.

CONCLUSIONS

These results offer further support to the role of beliefs about the uncontrollability of thoughts in cyberchondria. The implications of the findings are discussed.

The COVID-19 anxiety syndrome and selective attentional bias towards COVID-19-related stimuli in UK residents during the 2020-2021 pandemic

The psychological and social effects of the COVID‐19 pandemic are pervasive, and there is potential for a long‐lasting impact on mental health. In the current study, we sought to provide, in a representative sample of UK residents during the third COVID‐19 lockdown in February 2021, further evidence for the validation of the COVID‐19 anxiety syndrome construct. We did this by evaluating the COVID‐19 anxiety syndrome against measures of personality, health anxiety and COVID‐19 anxiety in predicting levels of generalized anxiety and depression and by examining whether increased health anxiety and COVID‐19 psychological distress (COVID‐19 anxiety and COVID‐19 anxiety syndrome) scores were associated with increased attentional bias to COVID‐19‐related stimuli. A series of correlation analyses revealed that neuroticism, health anxiety, COVID‐19 anxiety and COVID‐19 anxiety syndrome scores were positively and significantly correlated with generalized anxiety and depression scores and that the perseveration component of the COVID‐19 anxiety syndrome predicted generalized anxiety and depression scores independently of age, gender, conscientiousness, openness, health anxiety and COVID‐19 anxiety. Furthermore, results indicated that only the total COVID‐19 anxiety syndrome score and the scores on the avoidance and perseveration components were positively and significantly correlated with attentional bias indices. More specifically, the general attentional bias index was only shown to be positively and significantly correlated with the total COVID‐19 anxiety syndrome score and its perseveration component, while slowed disengagement was only shown to be negatively and significantly correlated with the total COVID‐19 anxiety syndrome score and its avoidance component. The implications of these findings are discussed.

The relationship between fear of COVID-19 and health anxiety among families with COVID-19 infected: The mediating role of metacognitions, intolerance of uncertainty and emotion regulation

The current study aimed to investigate the mediating role of metacognitions, intolerance of uncertainty and emotion regulation in the relationship between fear of COVID-19 (FC-19) and health anxiety, among families with COVID-19 infected. Participants were 541 individuals from family members of patients with COVID-19 (F = 52.3%, mean age = 41.3 ± 13.2 years). Data were collected with a packet including sociodemographic and risk factors, the Fear of COVID-19 Scale, the Short Health Anxiety Inventory, the Metacognitions Questionnaire 30, the Intolerance of Uncertainty Scale-12 and the Emotion Regulation Questionnaire. Structural equation modelling analyses revealed a full mediation of metacognitions (i.e., positive beliefs about worry, negative beliefs about thoughts concerning uncontrollability and danger, cognitive confidence and beliefs about the need to control thoughts), intolerance of uncertainty and expressive suppression in the relation between FC-19 and health anxiety. Moreover, the strongest indirect links were found between FC-19 and health anxiety through negative beliefs about thoughts concerning uncontrollability and danger and intolerance of uncertainty. These associations were independent of gender and risk status. The final model accounted for 71% of the variance of health anxiety. These findings suggest that particularly metacognitions, intolerance of uncertainty and expressive suppression play a full mediational role in the relation between FC-19 and health anxiety.

The Effect of State and Trait Self-Critical Rumination on Acute Distress: An Exploratory Experimental Investigation

Self-critical rumination is a process whereby individuals focus attention on past failures and inadequacies without consideration for improvement or problem-solving. Past research has demonstrated that self-critical rumination is a separate process from the experience of having intrusive self-critical thoughts and that engaging in self-critical rumination is strongly correlated with beliefs that it is uncontrollable or represents a weakness of character. What is less clear at this time, however, is the impact that self-critical rumination has on levels of distress when faced with failure. Thirty volunteers who were not experiencing significant levels of depression were randomly assigned across three groups: one rumination and two controls. Acute distress was measured prior to and immediately following a task, as well as upon debrief. Individuals expected to complete an impossible task, who experienced simulated self-critical rumination experienced greater levels of acute distress than controls immediately following the task. There was also a significant correlation between reported levels of trait self-critical rumination, negative metacognitive beliefs and self-esteem with levels of distress following debrief when controlling for initial levels of distress and group membership. The use of subjective self-reports and small sample size limits the findings of this exploratory study. Engaging in self-critical rumination, and associated negative metacognitive beliefs, may have a significant impact on levels of acute distress following a recent failure.

The COVID-19 anxiety syndrome scale: Development and psychometric properties

The central aim of our study was to widen the mental health response to the COVID-19 pandemic by developing and evaluating a measure that could be used to identify the presence of anxiety syndrome features associated with COVID-19. In Study 1, a community sample of 292 participants completed the newly developed COVID-19 Anxiety Syndrome Scale (C-19ASS) and results were subjected to a Principal Components Analysis. An 11-item two-factor structure was identified. In Study 2, a community sample of 426 participants completed a battery of questionnaires including the C-19ASS. A Confirmatory Factor Analysis was performed on the C-19ASS. A 9-item two-factor structure was confirmed. Results also indicated that the C-19ASS has acceptable levels of reliability and concurrent validity. The C-19ASS perseveration factor was found to explain an additional 9.3% variance in COVID-19 anxiety, and additional 2.2% variance in work and social adjustment (functional impairment), over and above all other variables. The C-19ASS appears to be a reliable and valid measure of the COVID-19 anxiety syndrome. The implications of these findings are discussed.

Reasons for accepting or declining participation in the ASPRE trial: A qualitative study with women at high risk of preterm pre-eclampsia

OBJECTIVE

To identify factors that affected the decision of pregnant women at high risk for pre-eclampsia (PE) in accepting or declining participation in a medicated clinical trial (ASPRE) for the prevention of preterm PE.

METHOD

This was a qualitative, cross-sectional study. A purposive sample of 14 participants and 13 decliners of the ASPRE trial were interviewed using semi-structured interviews. Data were analysed using template analysis.

RESULTS

For participants, their high-risk status seems to have motivated them to take part in the trial. This was enabled by their perception that the trial drug aspirin was commonly used, the safety of the procedure, and the belief that they will be in receipt of extra monitoring in pregnancy. Decliners expressed discomfort about taking medications in pregnancy, and about the presence of the placebo arm; they seemed to be motivated by desire to reduce harm. Satisfaction with the information provided by the medical professionals was also influential in women's decision making, and so were the views of their partners and other trusted individuals.

CONCLUSION

Pregnant women's motivation to take part or to decline participation in a medicated trail can be understood as an attempt to cope with the threat posed by their high-risk status.

A metacognitive model of self-esteem

BACKGROUND

In the current study, we aimed to test a metacognitive model of self-esteem grounded in the Self-Regulatory Executive Function model of psychopathology.

METHOD

A convenience sample of 346 community participants were recruited and completed a battery of online questionnaires that measured self-esteem, self-criticism, self-critical rumination, metacognitions about self-critical rumination, generic metacognitions and negative affect. Initially, we tested a series of hypotheses to establish the relationships between the study variables. We then conducted a path analysis to test a metacognitive model of self-esteem, where the process of self-critical rumination and its associated metacognitive beliefs was hypothesized to mediate the relationship between affect and self-esteem.

RESULTS

Self-critical rumination and its associated negative metacognitions, levels of depression and self-criticism independently predicted self-esteem. However, the multicollinearity between rumination and metacognitions suggests that one might not exist without the other. Additionally, a path analysis revealed that the study data was a very good fit to the proposed metacognitive model of self-esteem.

CONCLUSION

The metacognitive model of self-esteem presented in this paper may be used to generate novel interventions to improve self-esteem and decrease self-critical rumination.

An evaluation of the contribution of maladaptive attitudes specific to motherhood and metacognitions in perinatal depression

The cognitive model of depression suggests that dysfunctional attitudes represent vulnerability towards developing depression. The metacognitive model suggests that metacognitions may play a more important role in predicting depression, compared to cognitions. We tested the relative contribution of dysfunctional attitudes and metacognitions, and their interrelationship, in predicting perinatal depressive symptomatology. A cross-sectional perinatal sample (N = 344) completed questionnaires of dysfunctional attitudes (both general and specific to motherhood), metacognitions, and sociodemographic factors including age, ethnicity, education, marital status, parity and previous history of mental health problems. Correlational analyses indicated that dysfunctional attitudes (both general and specific to motherhood), as well as metacognitions were intercorrelated and all were associated with perinatal depressive symptomatology. Controlling for sociodemographic factors, hierarchical regression analysis showed that general dysfunctional attitudes were weakly associated with perinatal depression. Moreover, maladaptive attitudes specific to motherhood and negative beliefs about the uncontrollability and danger of worry were independently associated with perinatal depressive symptomatology, with the latter variable having the strongest association with the outcome variable. Path analyses demonstrated that negative beliefs about the uncontrollability and danger of worry partially mediated the relationship between maladaptive attitudes specific to motherhood and perinatal depressive symptomatology. The results support the metacognitive conceptualisation of psychopathology which places importance on metacognitions in the maintenance of depression.

Transcultural, transdiagnostic, and concurrent validity of a revised metacognitions about symptoms control scale

Anxiety and depression add to the burden of chronic fatigue syndrome (CFS), fibromyalgia (FM), and type 1 diabetes mellitus (T1DM). Metacognitions play a role in this distress. The metacognitions about symptoms control scale (MaSCS) measure metacognitive beliefs regarding symptoms but have weaknesses. The current study created a revised MaSCS (MaSCS-R) in English, German, and Arabic versions using CFS, FM, and T1DM samples and examined the transcultural, transdiagnostic, and concurrent validity of metacognitions about symptom control. This study used data from 563 participants clinically diagnosed with CFS (n = 124; English), FM (n = 348; German), or T1DM (n = 91; Lebanese). CFS and FM data had been used in earlier published studies but were subjected to new analyses. CFS data were used to create the English version of the MaSCS-R and FM and T1DM data for German and Arabic versions. Metacognitions about worry, anxiety, depression, and symptom severity were measured. The three MaSCS-R versions, consisting of two factors (each with four items), had adequate psychometric properties, possessing configural and metric invariance. Metacognitive factors were associated with distress and symptom severity in all three samples. Metacognitions about symptom control have transcultural, transdiagnostic, and concurrent validity.

Metacognitions in smoking: Evidence from a cross-cultural validation of the metacognitions about smoking questionnaire in a Turkish sample

Metacognitions about the positive and negative effects of smoking have been associated with cigarette use and nicotine dependence. The aim of the present study was to validate the Turkish version of the Metacognitions about Smoking Questionnaire (MSQ; Nikčević et al., 2015). The sample consisted of 859 self-declared smokers (452 female) aged between 18 and 68 years (mean = 28.3; SD = 7.9). Once the English to Turkish translation of the MDQ was completed, confirmatory factor analyses were conducted based on the four-factor structure of the original measure. Initially results suggested that this model was an inadequate fit of the data obtained. However, by allowing three pairs of items (within factor) to co-vary, a re-specified model was tested that was found to be a satisfactory fit of the data. Internal reliability and predictive validity of the translated scale were observed to be good. The Turkish version of the MSQ exhibited suitable psychometric properties. This study also showed that metacognitions about smoking predict nicotine dependence independently of demographic variables, length of cigarette use, negative affect, and smoking outcome expectancies.

The Pregnancy Related Beliefs Questionnaire (PRBQ): An examination of the psychometric properties in perinatal samples

BACKGROUND

Identifying vulnerability to perinatal depression is an important public health issue. Risk factors include general and maternal-specific dysfunctional attitudes. Scales of maternal attitudes have a number of shortcomings. Further, it is not known whether antenatal maternal attitudes predict post-natal depression, independently of general dysfunctional attitudes (GDA). The aim of the current study was to examine the psychometric properties of the Pregnancy Related Beliefs Questionnaire (PRBQ) and to establish, prospectively, the utility of the revised PRBQ in predicting the symptoms of post-natal depression.

METHOD

In Study 1, a cross-sectional sample of 344 participants, who were either pregnant or in the post-natal period, completed a battery of questionnaires assessing background factors, GDA, attitudes specific to motherhood (PRBQ), and depression. In Study 2, a sample of 210 women completed a battery of questionnaires, including a measure of GDA, the PRBQ-8, and depression, on two occasions: early in the second trimester of pregnancy and post-natally.

RESULTS

Exploratory and confirmatory factor analyses supported a one-factor, eight-item measure of maladaptive attitudes specific to motherhood (PRBQ-8). The PRBQ-8 was found to have good convergent, concurrent, and predictive validity and high internal and test-retest reliability. A hierarchical regression analysis revealed that antenatal PRBQ-8 scores predict the severity of post-natal depression symptoms, after controlling for background factors, antenatal depression, and GDA.

CONCLUSIONS

The PRBQ-8 is a psychometrically sound measure of maternal attitudes that can be used antenatally to identify women at risk of post-natal depression.

Modelling the contribution of negative affect, outcome expectancies and metacognitions to cigarette use and nicotine dependence

BACKGROUND

Both positive smoking outcome expectancies and metacognitions about smoking have been found to be positively associated with cigarette use and nicotine dependence. The goal of this study was to test a model including nicotine dependence and number of daily cigarettes as dependent variables, anxiety and depression as independent variables, and smoking outcome expectancies and metacognitions about smoking as mediators between the independents and dependents.

METHODS

The sample consisted of 524 self-declared smokers who scored 3 or above on the Fagerstrom Test for Nicotine Dependence (FTND: Uysal et al., 2004).

RESULTS

Anxiety was not associated with either cigarette use or nicotine dependence but was positively associated with all mediators with the exception of stimulation state enhancement and social facilitation. Depression, on the other hand, was found to be positively associated with nicotine dependence (and very weakly to cigarette use) but was not associated with either smoking outcome expectancies or metacognitions about smoking. Only one smoking outcome expectancy (negative affect reduction) was found to be positively associated with nicotine dependence but not cigarette use. Furthermore one smoking outcome expectancy (negative social impression) was found to be positively associated with cigarette use (but not to nicotine dependence). All metacognitions about smoking were found to be positively associated with nicotine dependence. Moreover, negative metacognitions about uncontrollability were found to be positively associated with cigarette use.

CONCLUSIONS

Metacognitions about smoking appear to be a stronger mediator than smoking outcome expectancies in the relationship between negative affect and cigarette use/nicotine dependence. The implications of these findings are discussed.

The metacognitions about self-critical rumination questionnaire

BACKGROUND

Self-criticism refers to a series of persistent and negative self-judgements, often involuntary, that an individual makes about themselves. Recent research has explored the possibility that self-criticism can lead to a more perseverative style of thinking called self-critical rumination. There is evidence that self-critical rumination may be a separate construct from other forms of rumination, such as depressive rumination and post-event processing. Research has indicated that metacognitions, beliefs that individuals have about their internal experiences and how to control them, may play a role in self-critical rumination. The aim of our work was to develop a measure to assess metacognitions related to self-critical rumination.

METHOD

In Study 1, a community sample of 178 participants completed the newly developed Metacognitions about Self-Critical Rumination Questionnaire (MSCRQ) and results were subjected to a Principal Components Analysis. In Study 2, a community sample of 247 participants completed a battery of questionnaires including the MSCRQ. A Confirmatory Factors Analysis was performed on the MSCRQ and validity was ascertained by correlating with other measures.

RESULTS

In Study 1, a 15-item two-factor structure was identified. A 10-item two-factor structure was confirmed in Study 2. Results also indicated that the MSCRQ has acceptable levels of reliability, and good concurrent and incremental validity.

CONCLUSIONS

The MSCRQ appears to be a reliable and valid measure of metacognitions about self-critical rumination whilst the MCQ-30 is a better predictor of general emotional distress.

The importance of thinking styles in predicting binge eating

Impulsivity, Body Mass Index, negative emotions and irrational food beliefs are often reported as predictors of binge eating. In the current study we explored the role played by two thinking styles, namely food thought suppression and desire thinking, in predicting binge eating among young adults controlling for established predictors of this condition. A total of 338 university students (268 females) participated in this study by completing a battery of questionnaires measuring the study variables. Path analysis revealed that impulsivity was not associated with binge eating, that Body Mass Index and negative emotions predicted binge eating, and that irrational food beliefs only influenced binge eating via food thought suppression and desire thinking. In conclusion, thinking styles appear an important predictor of binge eating and they should be taken into consideration when developing clinical interventions for binge eating.

A Metacognitive model of procrastination

BACKGROUND

procrastination refers to the delay or postponement of task or decision-making initiation or completion and is often conceptualised as a failure of self-regulation. Recent research has suggested that metacognitions play a role in procrastination and that unintentional procrastination (UP), as opposed to intentional procrastination (IP), may be the most problematic form of this behaviour. We aimed to test a metacognitive model of procrastination that was grounded in the Self-Regulatory Executive Function model.

METHODS

a convenience sample of 400 participants were recruited and completed (at least partially) a battery of online questionnaires that measured IP and UP, metacognitions about procrastination, depression, and Cognitive Attentional Syndrome (CAS) configurations. Initially, we tested series of hypotheses to establish the relationships between the experimental variables and to test whether CAS configurations would independently predict UP when controlling for age, depression, IP, metacognitions about procrastination, and whether an individual reported that they had been diagnosed with a psychiatric disorder.

RESULTS

CAS configurations, depression, and metacognitions independently predicted UP. Additionally, path analysis revealed that the study data was an excellent fit to the proposed metacognitive model of procrastination.

LIMITATIONS

the study is cross-sectional.

CONCLUSIONS

the metacognitive model of procrastination presented in this paper can be used to generate novel interventions to treat this problematic behaviour.

Different coping strategies amongst individuals with grandiose and vulnerable narcissistic traits

OBJECTIVE

This study explored the relationships between coping with stress responses and grandiose and vulnerable narcissist traits.

METHOD

A community sample of 170 adults (113 female) participated in this study. A cross-sectional design was employed that utilized self-report measures of trait anxiety, social desirability, coping with stress responses, and pathological narcissism.

RESULTS

Regression models indicated that both grandiose and vulnerable narcissism traits are significantly associated with, in opposing directions, behavioural disengagement responses to stress when controlling for trait anxiety and social desirability. Vulnerable narcissism traits were significantly associated with the use of denial as coping with stress response when controlling for the same factors.

CONCLUSION

These findings provide further evidence of the discriminant validity of the Pathological Narcissism Inventory and inform our understanding of the differences that grandiose and vulnerable narcissistic traits have on coping.

Metacognitions as Mediators of Gender Identity-related Anxiety

OBJECTIVE

Research has found that the prevalence of psychological distress is substantially higher in transgender compared to cisgender populations. This study explored the role of metacognitions as mediators of anxiety in a sample comprising of cisgender and transgender individuals.

METHOD

One-hundred and twenty-five individuals (19 trans-male; 24 male; 25 trans-female; 57 female) completed a series of measures that assessed metacognitions, worry and anxiety.

RESULTS

Correlation analyses were used to identify potential mediators of the relationship between gender identity and anxiety. A mediation model indicated that beliefs about thoughts concerning uncontrollability and danger entirely mediated the relationship between gender identity and anxiety (b = 2.00, bias corrected and accelerated confidence interval [0.68, 3.49]).

CONCLUSIONS

Metacognitions play an important role in anxiety in transgender individuals.

HIGHLIGHTS

-Metacognitions were found to mediate anxiety in transgender and cisgender individuals. -The exploration of metacognitions in transgender individuals experiencing psychological distress may have clinical utility. Copyright © 2015 John Wiley & Sons, Ltd.

The Metacognitions about Smoking Questionnaire: development and psychometric properties

OBJECTIVES

Recent research has suggested that metacognitions may play a role in smoking. The goal of the current set of studies was to develop the first self-report instrument of metacognitions about smoking.

METHOD

We conducted three studies with samples of smokers (n = 222, n = 143, n = 25) to test the structure and psychometric properties of the Metacognitions about Smoking Questionnaire and examined its capacity to predict smoking behaviour.

RESULTS

Exploratory and confirmatory factor analyses supported a four-factor solution: positive metacognitions about cognitive regulation, positive metacognitions about emotional regulation, negative metacognitions about uncontrollability, and negative metacognitions about cognitive interference. Internal consistency, predictive and divergent validity, and temporal stability were acceptable. The metacognition factors correlated positively with daily cigarette use and levels of nicotine dependence, and contributed to the prediction of these outcomes over and above smoking outcome expectancies.

CONCLUSIONS

The Metacognitions about Smoking Questionnaire was shown to possess good psychometric properties, as well as predictive and divergent validity within the populations that were tested. The metacognition factors explained incremental variance in smoking behaviour above smoking outcome expectancies.

Metacognition in addictive behaviors

BACKGROUND

Over the last twenty years metacognitive theory has provided a novel framework, in the form of the Self-Regulatory Executive Function (S-REF) model, for conceptualizing psychological distress (Wells & Matthews, 1994, 1996). The S-REF model proposes that psychological distress persists because of unhelpful coping styles (e.g. extended thinking and thought suppression) which are activated and maintained as a result of metacognitive beliefs.

OBJECTIVE

This paper describes the S-REF model and its application to addictive behaviors using a triphasic metacognitive formulation.

DISCUSSION

Evidence on the components of the triphasic metacognitive formulation is reviewed and the clinical implications for applying metacognitive therapy to addictive behaviors outlined.

A systematic review of treatments for Impulse Control Disorders and related behaviours in Parkinson's disease

Impulse Control Disorders (ICDs) are a set of behaviours characterised by impulsivity despite known harm. Related to ICDs is the dopamine dysregulation syndrome (DDS), which is characterised by an addiction-like consumption of dopaminergic medication and punding. These behaviours all have an increased prevalence in Parkinson׳s disease (PD). The aim of this review is to identify treatments available for patients suffering from ICDs, DDS and punding in PD. Searches of The Cochrane Controlled Trials Register, Embase, Medline and PsychInfo were conducted, using the entire timescale available. Seven out of the 688 papers retrieved met the inclusion criteria and were considered in this systematic review. One class I study, one class II study, and five class IV studies were identified. All studies demonstrated a positive effect on ICDs in PD. Research in this field is still in its early stages. At present, there is insufficient evidence to recommend any treatment over another. There is a need for more methodologically robust research, using larger, more generalisable samples, randomisation and meaningful follow-up periods. In addition, the use of a validated outcome measures should be implemented in future research efforts.

The Metacognitions about Symptoms Control Scale: Development and Concurrent Validity

OBJECTIVE

This paper presents the development and preliminary validation of a self-report instrument designed to measure metacognitions pertaining to symptoms control in the form of the following: (1) symptoms focusing and (2) symptoms conceptual thinking.

METHODS

A total of 124 patients (95 female and 29 male) presenting with chronic fatigue syndrome (CFS) contributed data to the study to test the structure and psychometric properties of the Metacognitions about Symptoms Control Scale (MaSCS).

RESULTS

A principal components factor analysis indicated that a two-factor solution best fitted the data. The factors were labelled positive and negative metacognitions about symptoms control. Further analyses revealed that both factors had good internal consistency. Correlation analyses established preliminary concurrent validity, indicating that both positive and negative metacognitions about symptoms control were significantly associated with levels of fatigue in CFS. Regression analysis revealed that positive and negative metacognitions about symptoms control significantly predicted fatigue severity when controlling for anxiety and depression.

CONCLUSIONS

The newly developed instrument may help future research that examines the role of metacognitions in CFS, as well as aiding clinical assessment and case formulation.

KEY PRACTITIONER MESSAGE

The MaSCS is a useful first instrument to assess metacognitions in CFS. The MaSCS may help to deepen our understanding of symptoms control (symptoms focusing and conceptual thinking about symptoms) in the experience of CFS symptoms. Assessing and conceptualizing symptoms control through the MaSCS may aid treatment of CFS.