Metacognitive model of mindfulness

Mindfulness training has proven to be an efficacious therapeutic tool for a variety of clinical and nonclinical health problems and a booster of well-being. In this paper we propose a multi-level metacognitive model of mindfulness. We postulate and discuss following hypothesis: (1) mindfulness is related to the highest level of metacognition; (2) mindfulness depends on dynamic cooperation of three main components of the metacognition (metacognitive knowledge, metacognitive experiences and metacognitive skills); (3) a mindful meta-level is always conscious while the other meta-cognitive processes can occur implicitly; (4) intentionally practiced mindfulness decreases dissociations between awareness and meta-awareness; (5) components of mindful meta-level develop and change during continuous practice. The current model is discussed in the light of empirical data and other theoretical approaches to mindfulness concept. We believe that presented model provides some helpful avenues for future research and theoretical investigations into mindfulness and the mechanisms of its actions.     

Mediationg Role of Mindfulness as a Trait Between Attachment Styles and Depressive Symptoms

Attachment styles and dysfunctional symptoms have been associated. This relationship could be affected by metacognitive capacity. The aim of this study is to clarify the relationship between depressive symptoms, attachment styles, and metacognitive capacity. In addition, the mediating role of metacognition between attachment and depressive symptoms has been studied. A total of 505 participants recruited from the general population of the province of Bizkaia (Spain) completed questionnaires regarding depression, anxiety, mindfulness, decentering, and attachment. Results showed positive and significant relations between (a) dysfunctional symptoms and insecure attachment styles and (b) metacognitive capacity and secure attachment style. Additionally, the mediating role of metacognition between attachment and depressive symptoms was confirmed. Intervention in metacognitive abilities such as mindfulness could be a useful therapeutic tool for depressive symptoms.     

Clinical Considerations in Using Mindfulness- and Acceptance-Based Approaches With Diverse Populations: Addressing Challenges in Service Delivery in Diverse Community Settings

Mindfulness- and acceptance-based strategies effectively alter clients' relationships with their internal experiences, which may have been previously restricted, avoided, or even beyond clients' awareness. Even though the scientific exploration of the psychological benefits of mindfulness in the treatment literature continues to be in its infancy, it is important to uphold best practices by exploring the applications of these therapeutic approaches in diverse community populations. In this article, we discuss recommendations for addressing challenges that have arisen while delivering mindfulness- and acceptance-based behavioral therapies to consumers of mental health services from underserved and underrepresented backgrounds (e.g., marginalized racial, religious, and socioeconomic groups). Specific case examples illustrate the challenges of promoting acceptance in the face of adversity, the acceptability of mindfulness, attending to differences in the therapist and client perspectives, and promoting the pursuit of values in the face of adversity. Clinical recommendations and suggestions for dissemination of these approaches to clinicians working with racially and ethnically diverse, underserved populations are discussed.     

Development,Acceptability, and Effectiveness of an Acceptance-Based Behavioral Stress/Anxiety Management Workshop for University Students

College is a critical time in which individuals experience transition and stress, and may experience subthreshold or clinical symptoms of anxiety and depression. In addition, educational contexts offer a unique opportunity to serve the needs of a diverse group of students who may experience additional stressors related to experiences with discrimination; acculturative stress; financial strain; and balancing family, work, and school demands. Therefore, college appears to be an ideal time for students to learn about evidence-based skills to use in response to anxiety and depression.However, there are multiple barriers that may make it less likely that evidence-based skills and services are available to or utilized by students, including lack of funding and services available on campus, as well as concerns about mental health stigma. This study examines the preliminary acceptability and effectiveness of an acceptance-based behavioral stress/anxiety management workshop for university students on a diverse urban campus. Results indicate that participants found the workshop to be acceptable and helpful. Mixed-effect regression models examining symptom and impairment measures at preworkshop, 1-week follow-up, and 4-week follow-up showed a significant effect for time on anxious arousal, general anxiety symptoms, and social anxiety, but no significant effect for time on impairment. Implications and future directions for mindfulness and acceptance-based approaches in educational contexts are discussed.     

Detached Mindfulness In Cognitive Therapy: A Metacognitive Analysis And Ten Techniques

This paper describes the nature and information processing requirements of detached mindfulness. The construct emerged from the self-regulatory information processing theory of emotional disorder (Wells & Matthews, 1994), and is viewed as a metacognitive state that facilitates change in core underlying pathological processes. Detached mindfulness has multiple components, requiring the activation of metacognitive knowledge, metacognitive monitoring and control, suspension of conceptual processing, attentional flexibility, and a de-centered relationship with thoughts. A model of the cognitive structures and processes supporting the state is presented. Implications of the model for the scientific development and effective use of mindfulness techniques are discussed. Ten techniques for rapidly achieving detached mindfulness in the course of metacognitive therapy are described.Address correspondence to Professor Adrian Wells, Academic Division of Clinical Psychology, The University of Manchester, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, UK; e-mail: Adrian.Wells@manchester.ac.uk.     

Changes in Decentering and Reappraisal Temporally Precede Symptom Reduction During Emotion Regulation Therapy for Generalized Anxiety Disorder With and Without Co-Occurring Depression

Emotion Regulation Therapy (ERT) has demonstrated efficacy in both open and randomized trials for generalized anxiety disorder (GAD) with and without co-occurring depression. An important goal in ERT is to teach clients adaptive emotion regulation, including healthier metacognitive abilities such as decentering and cognitive reappraisal. A few studies thus far have demonstrated a mediating role for these metacognitive abilities in other cognitive behavioral therapies (CBTs) for GAD. However, a drawback to most of these has been the ability to demonstrate a causal role for improved metacognitive abilities in outcome. In the present study, we utilized multilevel time-lagged segment analyses to explore the temporal dynamics between session-by-session changes in metacognition and anxiety outcomes from ERT. Thirty-one young adults diagnosed with GAD with and without co-occurring depression received 16 sessions of ERT. Prior to each session, participants completed questionnaires pertaining to metacognition (i.e., decentering and cognitive reappraisal) and anxiety symptoms (i.e., worry, trait anxiousness, and generalized anxiety). Changes in decentering temporally preceded changes in worry and trait anxiousness of a medium to large magnitude, and changes in cognitive reappraisal temporally preceded changes in all three outcomes of a medium to large magnitude. The reverse direction, where mediators were predicted by outcomes, was nonsignificant. These findings support the notion that adaptive metacognitive emotion regulation is involved in reducing worry and anxiety in GAD. Having a clearer understanding of the temporal dynamics between metacognitive abilities and symptoms of anxiety can inform and improve not only ERT but other CBTs for GAD, as well.     

Domain-specific and domain-general processes underlying metacognitive judgments

Metacognition and self-awareness are commonly assumed to operate as global capacities. However, there have been few attempts to test this assumption across multiple cognitive domains and metacognitive evaluations. Here, we assessed the covariance between “online” metacognitive processes, as measured by decision confidence judgments in the domains of perception and memory, and error awareness in the domain of attention to action. Previous research investigating metacognition across task domains have not matched stimulus characteristics across tasks raising the possibility that any differences in metacognitive accuracy may be influenced by local task properties. The current experiment measured metacognition in perceptual, memorial and attention tasks that were closely matched for stimulus characteristics. We found that metacognitive accuracy across the three tasks was dissociated suggesting that domain specific networks support an individual’s capacity for accurate metacognition. This finding was independent of objective performance, which was controlled using a staircase procedure. However, response times for metacognitive judgments and error awareness were associated suggesting that shared mechanisms determining how these meta-level evaluations unfold in time may underlie these different types of decision. In addition, the relationship between these laboratory measures of metacognition and reports of everyday functioning from participants and their significant others (informants) was investigated. We found that informant reports, but not self reports, predicted metacognitive accuracy on the perceptual task and participants who underreported cognitive difficulties relative to their informants also showed poorer metacognitive accuracy on the perceptual task. These results are discussed in the context of models of metacognitive regulation and neuropsychological evidence for dissociable metacognitive systems. The potential for the refinement of metacognitive assessment in clinical populations is also discussed.     

Combining mindfulness meditation with cognitive-behavior therapy for insomnia: a treatment-development study

This treatment-development study is a Stage I evaluation of an intervention that combines mindfulness meditation with cognitive-behavior therapy for insomnia (CBT-I). Thirty adults who met research diagnostic criteria for Psychophysiological Insomnia (Edinger et al., 2004) participated in a 6-week, multi-component group intervention using mindfulness meditation, sleep restriction, stimulus control, sleep education, and sleep hygiene. Sleep diaries and self-reported pre-sleep arousal were assessed weekly while secondary measures of insomnia severity, arousal, mindfulness skills, and daytime functioning were assessed at pre-treatment and post-treatment. Data collected on recruitment, retention, compliance, and satisfaction indicate that the treatment protocol is feasible to deliver and is acceptable for individuals seeking treatment for insomnia. The overall patterns of change with treatment demonstrated statistically and clinically significant improvements in several nighttime symptoms of insomnia as well as statistically significant reductions in pre-sleep arousal, sleep effort, and dysfunctional sleep-related cognitions. In addition, a significant correlation was found between the number of meditation sessions and changes on a trait measure of arousal. Together, the findings indicate that mindfulness meditation can be combined with CBT-I and this integrated intervention is associated with reductions in both sleep and sleep-related arousal. Further testing of this intervention using randomized controlled trials is warranted to evaluate the efficacy of the intervention for this population and the specific effects of each component on sleep and both psychological and physiological arousal.     

New Directions in the Cognitive-Behavioral Treatment of OCD: Theory,Research, and Practice

The beneficial effects of cognitive-behavioral interventions (particularly exposure and response prevention) for OCD are among the most consistent research findings in the mental health literature. Nevertheless, even after an adequate trial, many individuals experience residual symptoms, and others never receive adequate treatment due to limited access. These and other issues have prompted clinicians and researchers to search for ways to improve the conceptual and practical aspects of existing treatment approaches, as well as look for augmentation strategies. In the present article, we review a number of recent developments and new directions in the psychological treatment of OCD, including (a) the application of inhibitory learning approaches to exposure therapy, (b) the development of acceptance-based approaches, (c) involvement of caregivers (partners and parents) in treatment, (d) pharmacological cognitive enhancement of exposure therapy, and (e) the use of technology to disseminate effective treatment. We focus on both the conceptual/scientific and practical aspects of these topics so that clinicians and researchers alike can assess their relative merits and disadvantages.     

Metacognition and metarepresentation: is a self-directed theory of mind a precondition for metacognition?

Metacognition is often defined as thinking about thinking. It is exemplified in all the activities through which one tries to predict and evaluate one’s own mental dispositions, states and properties for their cognitive adequacy. This article discusses the view that metacognition has metarepresentational structure. Properties such as causal contiguity, epistemic transparency and procedural reflexivity are present in metacognition but missing in metarepresentation, while open-ended recursivity and inferential promiscuity only occur in metarepresentation. It is concluded that, although metarepresentations can redescribe metacognitive contents, metacognition and metarepresentation are functionally distinct.     

Experimental modification of beliefs in obsessive-compulsive disorder: a test of the metacognitive model

Metacognitive beliefs about the threatening meaning and significance of intrusions are fundamental to the development and maintenance of obsessive-compulsive disorder (OCD) in the metacognitive model (Cognitive therapy of anxiety disorders: a practice manual and conceptual guide, Chichester, UK, Wiley, 1997; Emotional disorders and metacognition: innovative cognitive therapy, Chichester, UK, Wiley, 2000). This predicts that reductions in metacognitive beliefs about intrusions will result in decreased anxiety and compulsions. It was hypothesized that brief (5min) exposure and response prevention configured as a behavioural experiment to challenge metacognitive beliefs would lead to reductions in anxiety, thought fusion beliefs and the urge to neutralize. Furthermore, these reductions would be greater than the effects observed in the same exposure and response prevention task, accompanied by a habituation rationale. The results were consistent with the hypotheses. The clinical implications for the treatment of OCD are discussed.     

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.     

Mindfulness and Acceptance in the Treatment of Disordered Eating

Mindfulness and acceptance-based approaches to the treatment of clinical problems are accruing substantial empirical support. This article examines the application of these approaches to disordered eating. Theoretical bases for the importance of mindfulness and acceptance in the treatment of eating problems are reviewed, and interventions for eating problems that incorporate mindfulness and acceptance skills are briefly described. Empirical data are presented from a pilot study of mindfulness-based cognitive therapy adapted for treatment of binge eating.     

教学活动条件下大学生英语写作元认知的特点

根据Flavell的元认知理论框架,拟订了写作元认知教学的原则,并以此对两个班62名一年级大学生进行了一系列针对大学生英语写作元认知的教学活动。通过采用开放式问卷和周记调查,探究了在教学活动条件下大学生写作元认知的特点。周记调查表明:教学活动条件下,大学生的英语写作元认知特点反映出教学原则的构想,即英语写作元认知体现为元认知知识和元认知体验两大要素。元认知知识由任务知识、主体知识和策略知识构成,元认知体验分为积极与消极体验。开放式问卷结果表明:英语写作元认知有一定的发展性。这些结果验证并丰富了Flavell的元认知理论,对我国大学英语写作教学实践有着重要的启示。     

元认知的本质与要素

该文就元认知的本质和要素进行了探讨。文章首先对已有的相关观点进行了分析,在此基础上,将元认知的内涵界定为“个体对当前认知活动的认知调节”,并确定了元认知活动的三要素,即元认知技能、元认知知识、元认知体验,论述了每一要素在元认知活动中的作用,并以元认知三要素关系示意图描述了三者之间的关系。     

Surviving and Thriving During Stress: A Randomized Clinical Trial Comparing a Brief Web-Based Therapist-Assisted Acceptance-Based Behavioral Intervention Versus Waitlist Control for College Students

The high rates of anxiety in college students and the many barriers to accessing evidence-based care in communities and on campuses indicate a clear need to explore ways to increase access to evidence-based treatments. Web-based interventions and preventions are one way to bridge this gap; they hold the potential to decrease mental health disparities and enhance student functioning. The current RCT examined the acceptability and efficacy of a 3-session web-based therapist-assisted acceptance-based behavioral intervention targeting anxiety (Surviving and Thriving During Stress) for college students versus a waitlist (WL) control condition, in a sample of racially and ethnically diverse college students. Overall, participants rated the program as helpful and acceptable. Mixed-effects regression models (MRMs) were run in SPSS to examine the effects of time, condition, and Condition × Time on outcomes and hypothesized mechanisms. Significant Condition × Time interactions for general anxiety, depression, and quality of life (QOL) emerged, suggesting that SATDS participants reported significantly greater changes on these outcomes from pre- to posttreatment versus WL. However, interaction effects were nonsignificant for anxious arousal and social anxiety. MRMs examining hypothesized mechanisms revealed significant Condition × Time interactions for experiential avoidance, decentering, and values-based living. However, interaction effects were nonsignificant for mindfulness. All significant gains were maintained at 1-month follow-up, with the exception of QOL. Results contribute to the growing literature on the acceptability and efficacy of web-based approaches, and suggest these approaches can be effective for diverse college students, and may provide a unique platform to increase access to evidence-based care.     

Psychological mechanisms of medically unexplained symptoms: an integrative conceptual model

Theories of medically unexplained illness based on the concepts of dissociation, conversion, and somatization are summarized. Evidence cited in support of these theories is described and the conceptual strengths and shortcomings of each approach are considered. It is argued that each of these approaches adds to the understanding of unexplained illness but that none is able to provide a comprehensive explanation of the phenomenon. An integrative conceptual model of unexplained illness based on cognitive psychological principles is then presented. This model attempts to combine existing theoretical approaches within a single explanatory framework, extending previous theory by explaining how compelling symptoms can exist in the absence of organic pathology. The clinical and empirical implications of the model are then considered.     

A cognitive perspective on mindfulness

Mindfulness, the core teaching of the Buddhist tradition, has been receiving serious attention from the West in recent decades as evidence of the efficacy of mindfulness‐based interventions for emotional distress have become available. Although traditional Buddhist texts have described the mechanisms of mindfulness and the way to cultivate it in great detail, much is still not known from the perspective of Western science. In particular, there is no general agreement on the conceptualization and operationalization of mindfulness. Several conceptual models of mindfulness (referred to as “state” or “trait”) have been put forward to elucidate different aspects of this phenomenon, but none has gained sufficient empirical validation. This article proposes a new cognitive model of mindfulness. It has been our goal to describe and interrelate a relatively comprehensive group of determinants of a state of mindfulness, the consequences of its regular practicing, the mechanisms responsible for its beneficial effects, and the feedback mechanisms operating between the various constituents of the model. Within this model, the primary emphasis has been placed on understanding the cognitive processes shaping a state of mindfulness (i.e., the links between consciousness, meta‐awareness and the unconscious), and on their determinants (i.e., the executive functions of attention and the components of working memory). A metacognitive system promoting mindfulness, as well as the general capability of the central executive system, is suggested as a factor explaining individual differences in mindfulness, whereas decentering, self‐compassion, and reduction of self‐focused attention are proposed as mechanisms mediating beneficial changes. We hope that the model presented will encourage further discussion and orient future studies in the area of mindfulness.     

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.