On the relationship between temperament, metacognition, and anxiety: independent and mediated effects

Abstract The present study examined the relations between temperamental traits distinguished in regulative theory of temperament, state anxiety, and metacognition as postulated in self-regulatory executive function (S-REF) theory of emotional disorder. Data analysis (n=315) consisted of independent and mediated effect analyses. Of the six traits, briskness, emotional reactivity and perseveration correlated significantly with both state anxiety and metacognitions (emotional reactivity and perseveration correlated positively, and briskness - negatively). These traits were predictors of state anxiety. Metacognition predicted state anxiety and relationships were independent of temperament. A mediating effect of metacognition was confirmed for the general index as well as negative and positive belief subscales. The findings support the metacognitive model of psychopathology and suggest that temperament is associated with metacognitions implicated in psychopathology and may have both direct and metacognitively mediated effects on anxiety.     

Temperament and Anxiety: The Mediating Role of Metacognition

The present study examines a simple model for the relationship between temperament, anxiety and maladaptive metacognition. A clinical sample of patients diagnosed with anxiety disorders (n?=?216) completed a set of self-reported questionnaires measuring temperament dimensions, state anxiety and metacognitions. Three temperament traits were included in the hypothesized model: emotional reactivity, perseveration and briskness. A structural equation modeling analysis supported a model in which the relationship between the three temperament traits and anxiety were fully mediated by metacognition. Dissimilar models were identified for the male and female subgroups, and also with reference to individual categories of maladaptive metacognition. The findings support the significance of metacognition as a factor influencing the temperament-anxiety relationship. Moreover, they confirm the roles both of emotional reactivity and of perseveration, being major traits related to anxiety which also turned out to be strongly associated with metacognition. In case of the models for the categories of metacognition, emotional reactivity was associated with negative beliefs, perseveration with negative and positive beliefs, while briskness predicted anxiety independently of metacognition. These results suggest the existence of more specific associations between temperament traits, anxiety, and various types of metacognition.     

Change in metacognitions predicts outcome in obsessive–compulsive disorder patients undergoing treatment with exposure and response prevention

Wells' (Wells, A. (1997). Cognitive therapy of anxiety disorders: a practice manual and conceptual guide. Chichester, UK: Wiley) metacognitive model of obsessive–compulsive disorder (OCD) predicts that metacognitions must change in order for psychological treatment to be effective. The aim of this study was to explore: (1) if metacognitions change in patients undergoing exposure treatment for OCD; (2) to determine the extent to which cognitive and metacognitive change predicts symptom improvement and recovery. The sample consisted of 83 outpatients with a diagnosis of OCD who completed exposure and response prevention treatment. The Yale–Brown Obsessive–Compulsive Scale (Y-BOCS), the Metacognitions Questionnaire (MCQ-30) and the Obsessive Beliefs Questionnaire (OBQ-44) were administered before treatment, after treatment, and at 12-month follow-up. Treatment resulted in significant changes in symptoms, metacognition score, responsibility and perfectionism. Regression analysis using post-treatment Y-BOCS as the dependent variable indicated that when the overlap between predictors was controlled for, only changes in metacognition were significant. Changes in metacognitions explained 22% of the variance in symptoms at post-treatment when controlling for pre-treatment symptoms and changes in mood. A further regression revealed that two MCQ-30 subscales made individual contributions. The patients had significantly higher scores compared to community controls on the MCQ-30. Patients who achieved clinical significant change had lower scores on the MCQ-30 compared to patients who did not change. The results did not change significantly from post-treatment to follow-up assessment. These findings provide further support for the importance of metacognitions in treating OCD.     

Metadehumanization and Self-dehumanization are Linked to Reduced Drinking Refusal Self-Efficacy and Increased Anxiety and Depression Symptoms in Patients with Severe Alcohol Use Disorder

Metadehumanization, the perception of being treated as less than a human by others, is a pervasive phenomenon in intergroup relations. It is dissociated from stigmatization or stereotypes, and it has been recently identified as a critical process in severe alcohol use disorders (SAUD). Metadehumanization is associated with a wide array of negative consequences for the victim, including negative emotions, aversive self-awareness, cognitive deconstruction, and psychosomatic strains, which are related to anxiety and depression. This study aims to investigate if metadehumanization occurring among patients with SAUD is associated with clinical factors involved in the maintenance of the disease, namely symptoms of depression or anxiety and drinking refusal self-efficacy. A cross-sectional study was conducted among 120 patients with SAUD. Self-reported questionnaires measured metadehumanization, self-dehumanization (i.e., the feeling of being less than a human), anxiety, depression, drinking refusal self-efficacy, and demographics. Metadehumanization was significantly associated with self-dehumanization, anxiety, depression, and drinking refusal self-efficacy. Additionally, path analyses showed that self-dehumanization mediated the links between metadehumanization and clinical variables. These results indicate that metadehumanization and self-dehumanization could be essential factors to consider during SAUD treatment, as they are associated with increased psychiatric symptoms and reduced drinking refusal self-efficacy.     

Social anxiety and problematic alcohol consumption: the mediating role of drinking motives and situations

Social anxiety is inconsistently associated with alcohol use variables. To elucidate factors that contribute to the relationship between social anxiety and problematic alcohol use, the present study investigated drinking motives and drinking situations in an undergraduate sample (N = 293). Social anxiety was significantly correlated with endorsement of enhancement drinking motives (i.e., drinking to enhance positive experiences or emotions) but not social or coping motives. Social anxiety was also correlated with endorsement of drinking in the following high-risk situations: unpleasant emotions, conflict with others, social pressure, and testing personal control. Importantly, enhancement motives and each of these drinking situations mediated the relationship between social anxiety and alcohol-related problems. Findings suggest that alcohol use to enhance positive affect or in response to these specific situations may account for the risk for alcohol-related problems among those with social anxiety.     

Proneness to hallucinations and delusions in a non‐clinical sample: Exploring associations with metacognition and negative affect

Commonly, individuals prone to hallucinations and delusions hold dysfunctional metacognitive beliefs and report higher levels of negative affect, yet, these associations have not been clearly investigated in non‐clinical samples due to the failure to control for high intercorrelations between variables. The aim of the current study was to investigate how hallucination and delusion proneness are associated with dysfunctional metacognitions and negative affect. A cross‐sectional sample of 715 students free from psychiatric diagnoses (M_age = 28.1 years, SD = 10.9, range 18–65) completed the Launay‐Slade Hallucination Scale (LSHS‐R); Peters et al. Delusion Inventory (PDI‐21); Depression, Anxiety, and Stress Scale (DASS‐21); and the Metacognition Questionnaire (MCQ‐30). Findings that participants who were prone to both hallucinations and delusions reported elevated levels of negative affect support the need for targeted mental health treatment for individuals who experience psychological distress related to their hallucinatory and delusional experiences. While metacognition beliefs of need to control thoughts and cognitive self‐consciousness, along with the anxiety and stress DASS‐21 subscales appeared as significant cross‐sectional predictors of proneness to hallucinations and delusions, only metacognitions demonstrated any notable predictive value for delusion proneness. This finding questions the role of metacognitions in determining hallucination and delusion proneness in non‐clinical samples.     

Exploring the relationships between maternal and child metacognitions and child anxiety

Research has shown that anxiety may be transmitted through verbal information pathways, for example, when parents share their anxious cognitions with their child. Less is known about the influence of parental metacognitions, that is, beliefs regarding thoughts, on child anxiety. We explored the relations between metacognitions in mothers and their children and anxiety in the children. Our study included 111 non‐clinical children aged 8 to 12 years and their mothers. Children rated their metacognitions, worry and anxiety, and mothers rated their metacognitions. Results indicated agreement between maternal and child metacognitions. Maternal metacognitions were positively associated with children's anxiety symptoms and worry, and this relation was mediated by the children's metacognitions. Our results warrant further examination of the role of parental metacognitions in child anxiety.     

Cognition About Cognition: Metacognitive Therapy and Change in Generalized Anxiety Disorder and Social Phobia

Metacognitive theory and therapy views the persistence of negative beliefs and thoughts as a result of metacognitions controlling cognition. This paper describes, with reference to the treatment of generalized anxiety disorder (GAD) and social phobia, how metacognition contributes to cognitive stability and to change. Metacognitive therapy offers a level of formulation and intervention that does not focus predominantly on challenging the content of negative thoughts and beliefs that are emphasized in traditional cognitive therapy. The focus of treatment in GAD is on erroneous beliefs about worry and unhelpful mental regulation strategies. In treating social phobia, a greater emphasis is placed on modifying attention and worry processes and on configuring processing during and after behavioral experiments.     

The Relationship among Metacognitions,Attentional Control,and State Anxiety

Abstract

The present study explored the relationship among metacognitions, attentional control, and state anxiety. A convenience sample of 142 undergraduate students completed the Meta-Cognitions Questionnaire-30, the Attentional Control Scale, and the State subscale of the State–Trait Anxiety Inventory 3 weeks before end-of-year examinations. A cross-sectional design was adopted, and data analysis consisted of correlation and hierarchical regression analyses. Correlation analyses showed that three dimensions of metacognition (negative beliefs about thoughts concerning uncontrollability and danger, cognitive confidence, and beliefs about the need to control thoughts) were positively correlated with state anxiety. These same metacognitions were also found to be negatively correlated with attention shifting and, with the exception of cognitive confidence, attention focusing. Both attention focusing and attention shifting were found to be negatively correlated with state anxiety. A hierarchical regression analysis showed that negative beliefs about thoughts concerning uncontrollability and danger and attention focusing independently predicted state anxiety. Overall, these findings support the hypotheses and are consistent with the metacognitive theory of psychological dysfunction in that they show that metacognitions (in the form of negative beliefs about thoughts concerning uncontrollability and danger) and executive control (in the form of attention-focusing) individually contribute to state anxiety. The implications of these findings are discussed.     

Social anxiety, reasons for drinking, and college students

Recent research suggests that social anxiety may be associated with higher rates of alcohol problems in women, yet may be associated with lower levels of drinking in men. The current study investigated putative mechanisms that may underlie potential gender differences in the social anxiety-alcohol relationship. One hundred and eighteen college students (61.0% women) completed an interview assessing drinking behaviors and questionnaires measuring social anxiety, drinking motives, and drinking situations. Although college men and women both reported similar frequencies of drinking in positive situations and to enhance positive emotions, women reported drinking more often in negative situations and to cope with aversive emotions than men. Mediated moderation analyses suggested that women with social anxiety may be at greater risk of encountering adverse consequences because of their likelihood to drink to conform or to cope with the aversive affect they experience in negative situations. Conversely, when men experience high rates of adverse consequences, it may be due to drinking greater quantities of alcohol in positive situations. Highly socially anxious college men may drink less alcohol and experience fewer adverse consequences than their nonanxious or mildly anxious counterparts because they may find themselves in positive situations and drinking to enhance positive feelings less often, potentially due to avoidant behavior. These findings may help to explain why social anxiety serves as a potential risk factor for alcohol-related problems for college women, but a protective factor for college men.     

The Citizenship Project Part II: Impact of a Citizenship Intervention on Clinical and Community Outcomes for Persons with Mental Illness and Criminal Justice Involvement

This study assessed the effectiveness of an intervention based on a theoretical framework of citizenship on reducing psychiatric symptoms, alcohol use, and drug use, and increasing quality of life for persons with serious mental illness (SMI) and criminal justice involvement. One-hundred fourteen adults with SMI and a history of criminal justice involvement participated in a 2 × 3 longitudinal randomized controlled trial of a four-month citizenship intervention versus usual services. Linear mixed model analyses were used to assess the intervention’s impact on quality of life, symptoms, and substance use. After controlling for baseline covariates, participants in the experimental condition reported significantly increased quality of life, greater satisfaction with and amount of activity, higher satisfaction with work, and reduced alcohol and drug use over time. However, individuals in the experimental condition also reported increased anxiety/depression and agitation at 6 months (but not 12 months) and significantly increased negative symptoms at 12 months. Findings suggest that community-oriented, citizenship interventions for persons with SMI and criminal justice histories may facilitate improved clinical and community outcomes in some domains, but some negative clinical findings suggest the need for post-intervention support for intervention participants. Implications for practice and future research are discussed.     

Comorbid interpretation and expectancy bias in social anxiety and alcohol use

Background: In two studies, the present research examined whether being high in both social anxiety and alcohol use disorder symptoms is associated with a comorbid interpretation and expectancy bias that reflects their bidirectional relationship.

Design: Cross-sectional, quantitative surveys.

Methods: Measures of social anxiety and alcohol use disorder symptoms, as well as an interpretation and expectancy bias task assessing biases for social anxiety, drinking, and comorbid social anxiety and drinking.

Results: In Study 1 (N?=?447), individuals high (vs. low) in social anxiety had stronger social threat bias and individuals high (vs. low) in alcohol use disorder symptoms had stronger drinking bias. Those high in both social anxiety and alcohol use disorder symptoms endorsed interpretations and expectancies linking social interaction with alcohol use. Comorbid bias predicted membership into the high social anxiety/drinking group, even after taking into account single-disorder biases. In Study 2 (N?=?325), alcohol use disorder symptoms predicted drinking bias and social anxiety symptoms predicted social anxiety bias. Alcohol use disorder symptoms, social anxiety symptoms, and their interaction predicted comorbid interpretation and expectancy bias.

Conclusion: Results indicate unique cognitive vulnerability markers for persons with comorbid social anxiety and alcohol use disorder symptoms, which may improve detection and treatment of this serious comorbidity.     

Positive Metacognitions and Meta-Emotions as Predictors of Posttraumatic Stress Disorder and Posttraumatic Growth in Survivors of a Natural Disaster

ABSTRACT

Exposure to natural disasters can lead to both negative and positive mental health consequences (i.e., posttraumatic stress disorder [PTSD] and posttraumatic growth [PTG]). While there is evidence linking metacognition to these outcomes, the focus is mostly on maladaptive metacognitions. The present study investigated the role of positive metacognitions and meta-emotions (i.e., confidence in extinguishing perseveration [Extinguishing], confidence in interpreting emotions as cues [Interpreting], and confidence in setting flexible and attainable hierarchies of goals [Setting]) on PTSD and PTG among Filipino typhoon survivors. Findings supported a model wherein Extinguishing and Setting, but not Interpreting, predicted PTSD and PTG through posttraumatic cognitions.     

Emotional health predictors of substance use initiation during middle school

This study aimed to evaluate whether emotional health factors, including anxiety and depression, stress, and social support, are associated with earlier youth initiation of alcohol and illicit substances during middle school (from the sixth to the eighth grade). Data for this study were from the Developmental Pathways Project, a longitudinal study of 521 youth sampled from the Seattle Public Schools. Discrete time survival analyses were used to assess the effects of depression, anxiety, stress, and support on initiation of substance use, measured every 6 months at five time points between sixth and eighth grade. Youth who had initiated prior to sixth grade had significantly higher levels of depressive symptoms. In multivariate survival analyses controlling for child race/ethnicity, gender, and socioeconomic status, and accounting for conduct problems, youth who reported higher levels of separation anxiety/panic symptoms were at decreased risk for early alcohol initiation. Children with higher levels of perceived teacher support had a significantly lower risk of alcohol initiation during early follow-up periods. Recent stressful life events in Grade 6 were associated with significantly greater risk of initiating an illicit substance by Grade 8. The current findings highlight the role of stress in the initiation of illicit substance use and suggest that teacher support is associated with lower risk for very early alcohol use. Future research examining anxiety as a predictor of substance use should distinguish between subtypes of anxiety.     

Urgency and negative emotions: Evidence for moderation on negative alcohol consequences

Prior research had shown that impulsivity may enhance the impact of negative emotions on alcohol related problems. However, these studies used broad measures of both negative emotions and impulsivity that may have obscured the effects of more specific constructs of impulsivity or negative emotions. One such construct is urgency, which is defined as the tendency to act impulsively in the face of strong positive emotions (positive urgency) or negative emotions (negative urgency). The present study tested whether urgency moderated the association between separate negative emotions (anger, depression and anxiety) and alcohol related problems. Data were obtained from a large online sample of currently drinking college students attending a large Northwestern university (n = 442). Findings indicated that alcohol related problems were directly associated with anger and both urgency facets. Additionally, positive urgency, but not negative urgency, enhanced the effects of depression, while the buffering effects of positive urgency on the anxiety-consequences association approached significance. These results suggest the importance of emotional context in understanding how dispositions towards rash action may lead to problematic alcohol use.     

The Role of Metacognitions in the Association between Children’s Perceptions of Maternal Control and Anxiety

We aimed to bring a developmental perspective to metacognitive theory. The metacognitive model (MCM) was originally developed for adults. However, an increasing number of studies demonstrate the MCM is relevant to child anxiety. Therefore, it is important to understand the origins of anxiety-specific metacognitions. Given the role experiences of controlling parenting play in maintaining and perhaps forming anxious cognitions or a cognitive vulnerability we focused on maternal behavioral and psychological control. Using a cross-sectional design, Danish school children (9–17 years old; N?=?1062) rated their levels of anxiety and anxiety-specific metacognitions, and their mothers' controlling behavior. Child-perceived maternal psychological control was positively correlated with each anxiety specific metacognition (positive and negative worry beliefs, cognitive confidence, need to control, and cognitive self-consciousness). Child-perceived autonomy-granting was negatively correlated with all metacognitions except cognitive self-consciousness. Child perceived maternal psychological control was indirectly associated with anxiety via total metacognitions. Child-perceived autonomy-granting, but not psychological control, was directly related to anxiety. Given the differential findings for psychological control and autonomy-granting, we suggest that specific types of parenting behavior may be related to specific elements of (meta-) cognitive vulnerability. Our findings are theoretically important because they propose maternal psychological control is an environmental factor that may play a role in the development of a metacognitive vulnerability related to anxiety. A potential clinical implication of our findings is that metacognitive therapy for children should include a parental component.     

Generalisierte Angststörung

The core features of generalized anxiety disorder (GAD) are excessive worry about various topics which are perceived as uncontrollable and mostly last for at least 6 months. Worrying is accompanied by a number of symptoms (e.g. muscle tension and irritability). Various etiological models suggest that avoidance of internal processes (e.g. cognitive, emotional, and physical) by worrying is central to the development and maintenance of GAD. Empirically well supported cognitive-behavioral interventions are worry exposure, applied relaxation, treating metacognitions, intolerance of uncertainty and negative problem orientation. Initial studies indicate the efficacy of mindfulness and acceptance-based approaches as well as psychodynamic approaches to treat GAD. The present article reports central diagnostic procedures, important differential diagnoses and illustrates actual (psycho) therapeutic treatment options.     

Emotional Dynamics in the Development of Early Adolescent Psychopathology: A One-Year Longitudinal Study

This study examined the role of the level and variability of happiness, anger, anxiety, and sadness in the development of adolescent-reported anxiety disorder symptoms, depressive symptoms, and aggressive behavior in 452 adolescents (250 male) followed from age 13 to 14. Level and between-day variability of emotions were assessed through adolescent report at 3-month intervals across a 1 year period. Level and variability of the four emotions contributed to changes in anxiety disorder and depressive symptoms more consistently than to changes in aggressive behavior. All four emotions were predictive of changes in internalizing problems, while anger played the most prominent role in the development of aggressive behavior. Variability of emotions contributed to changes in anxiety disorder symptoms, while heightened levels of negative emotions and diminished happiness contributed to changes in depression. Results suggested somewhat stronger effects of negative affect on aggressive behavior for females than for males. Results underscore the role of emotion dysregulation in the development of psychopathology.     

Metacognitive Therapy in Major Depression: An Open Trial of Comorbid Cases

This open trial investigated the transdiagnostic effects of metacognitive therapy (MCT) in patients with severe major depressive disorder and comorbid psychiatric disorder. Ten patients were treated with MCT over 10 sessions and were assessed with measures of depression, anxiety, rumination, and metacognitions at pre- and posttreatment and at 6 months follow-up. None of the patients were diagnosed as depressed at posttreatment, and of the initial 21 total diagnoses at pretreatment only 3 diagnoses remained at postintervention. The effect sizes were large for symptoms of depression, rumination, and worry. At 6 months follow-up standardized recovery criteria on the BDI showed that 70% were recovered, 20% improved, and 10% unchanged. The results indicate that MCT was associated with high rates of transdiagnostic improvement.