Validation of the Serbian version of the Metacognitions Questionnaire‐30 in nonclinical and clinical samples

The Metacognitions Questionnaire (MCQ‐30) is a brief multidimensional measure used for assessment of metacognitive beliefs in psychopathology. The aim of this study was to assess the psychometric properties of MCQ‐30 in Serbian nonclinical (n = 246) and clinical (n = 171; anxiety and depressive disorders) samples. The reliability of the questionnaire and its subscales was satisfactory. An exploratory factor analysis yielded a five‐factor solution in both groups, whereas a confirmatory factor analysis showed a somewhat weaker fit of the model. The MCQ‐30 showed positive associations with measures of anxiety, pathological worry, depressive, and obsessive–compulsive symptoms in both samples, demonstrating adequate convergent validity. The instrument was sensitive to differences in metacognitive beliefs between nonclinical and clinical samples. MCQ‐30 subscales showed incremental contributions in predicting pathological worry after controlling for the variance in obsessive–compulsive symptoms and vice versa. Our results suggest that the MCQ‐30 is a reliable and valid instrument for assessing metacognitive beliefs in both nonclinical and clinical samples. Moreover, the findings support the use of the MCQ‐30 in Serbian population and extend support for the metacognitive model.     

Preliminary validation of an ultra‐brief version of the Penn State Worry Questionnaire

The Penn State Worry Questionnaire (PSWQ) is widely regarded as the gold standard self‐report questionnaire for pathological worry. However, the factorial structure of the scale remains contentious. We sought to determine whether a psychometrically sound brief version of the PSWQ, which avoids contentious items and yet incorporates the essential features of pathological worry, could be derived from the existing PSWQ item pool. After inspecting items of the PSWQ and the findings of previous factor analytic studies, three items were selected that capture the essence of pathological worry (i.e., high frequency, perceived uncontrollability and multiple domains of worry), according to the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition). We then compared the psychometric properties of the 3‐item PSWQ with the full PSWQ in a sample of 225 clients attending an anxiety disorders clinic. Despite its brevity, the 3‐item PSWQ had internal consistency comparable with that of the standard PSWQ, and performed equally well with regards to convergent and discriminant validity, in screening for a generalized anxiety disorder diagnosis and in detecting change with treatment. The 3‐item ultra‐brief version of the PSWQ is quick to administer, simple to score and possesses psychometric properties very similar to the 16‐item version. Further research should confirm the psychometric properties of the 3‐item version when administered independently of the other items and assess the scale's test–retest reliability. Copyright © 2010 John Wiley & Sons, Ltd. Key Practitioner Message: ? The 3‐item version of the Penn State Worry Questionnaire (PSWQ) captures the essence of pathological worry, as defined by the Diagnostic and Statistical Manual of Mental Health Disorders (Fourth Edition). ? The 3‐item version of the PSWQ appears to have similar psychometric properties to the full, 16‐item version, and is therefore a good measure of pathological worry. ? The 3‐item PSWQ is quick to administer in time‐pressured clinical settings. ? The 3‐item PSWQ is simple to score and does not include reverse‐keyed items.     

Metacognitive beliefs and strategies predict worry,obsessive–compulsive symptoms and coping styles: A preliminary prospective study on an Italian non‐clinical sample

Eighty undergraduate students completed the Italian versions of the Metacognition Questionnaire and Thought Control Questionnaire along with well‐established measures of worry, obsessive–compulsive symptoms and coping styles on two occasions four months apart. A series of hierarchical regression analyses revealed that, after controlling the initial level of both worry and obsessionality, negative beliefs about worry focused on uncontrollability and danger appeared consistently associated with worry and obsessive symptoms at a four‐month distance. In addition, positive beliefs about worry predicted maladaptive coping styles whereas cognitive self‐consciousness and thought strategies aimed at distraction appeared to foster or facilitate adaptive coping styles. Results, implications and limitations are discussed according to Well's metacognitive model of emotional disorders. Copyright © 2007 John Wiley & Sons, Ltd.     

Metacognitive beliefs in obsessive-compulsive patients: A comparison with healthy and schizophrenia participants

Introduction. Distorted metacognitive beliefs are increasingly considered in theoretical models of obsessive-compulsive disorder (OCD). However, so far no consensus has emerged regarding the specific metacognitive profile of OCD.

Methods. Participants with OCD (n=55), schizophrenia (n=39), and nonclinical controls (n=49) were assessed with the Metacognitions Questionnaire (MCQ-30).

Results. Except for positive beliefs about worry, both patient samples exceeded nonclinical controls on all MCQ subscales. The MCQ “need to control thoughts” and “negative beliefs about uncontrollability and danger” subscales showed strong correlations with obsessions, and scores in the former scale were elevated in hallucinators. In contrast to several prior studies, “cognitive confidence” was related neither to core OCD nor to schizophrenia symptomatology.

Conclusions. Notwithstanding large pathogenetic differences between OCD and schizophrenia, findings suggest that obsessions and hallucinations may share a common metacognitive pathway. Need to control thoughts and dysfunctional beliefs about the malleability of worries may represent critical prerequisites for the two phenomena to emerge.     

Dose meta‐cognition or responsibility predict obsessive–compulsive symptoms: a test of the metacognitive model

Cognitive models of Obsessive–Compulsive disorder (OCD) have emphasized inflated responsibility (Salkovskis, 1985), thought–action fusion (Rachman, 1993), and metacognitive beliefs (Wells, 1997; Wells & Matthews, 1994), as factors contributing to disorder. The metacognitive model views responsibility as a by‐product of metacognitions that make little additional contribution to OCD, and gives rise to the following hypotheses: (1) responsibility and meta‐cognitive beliefs are positively correlated with obsessive–compulsive symptoms, (2) the relationship between responsibility and obsessive–compulsive symptoms is statistically dependent on meta‐cognition, (3) meta‐cognitions positively correlate with obsessive–compulsive symptoms independently of responsibility. The results supported each of these hypotheses and exploratory analyses were conducted to find the best unique set of predictors among a range of metacognitive dimensions. Metacognitive beliefs concerning need to control thoughts, thought–action fusion, and negative beliefs about cognitive competence emerged as reliable predictors. An additional contribution was made by thought–event fusion in one equation. The results provide support for the meta‐cognitive model. Copyright © 2004 John Wiley & Sons, Ltd.     

Cognitive Predictors of Obsessive–Compulsive Symptoms in Adolescence: A Preliminary Investigation

This study examined relations among responsibility attitudes, metacognitive beliefs, and obsessive–compulsive (O–C) symptoms in youth. One hundred sixty-six nonclinical youth (ages 13 to 17 years) completed the following: Responsibility Attitude Scale (RAS; Salkovskis et al., 2000); Meta-Cognitions Questionnaire–Adolescent Version (MCQ–A; Cartwright-Hatton et al., 2004); Children's Depression Inventory–Short Form (CDI–S; Kovacs, 1985); Revised Children's Manifest Anxiety Scale (RCMAS; Reynolds & Richmond, 1978); the Leyton Obsessional Inventory–Child Version Survey Form (LOI–CVS; Berg, Whitaker, Davies, Flament, & Rapoport, 1988). Participants endorsed a range of responsibility and metacognitive beliefs, and both responsibility and metacognition were positively correlated with O–C symptoms. However, when age, sex, and depression were controlled, only metacognition was a predictor of O–C symptoms. The findings suggest metacognition and responsibility may be important correlates of O–C symptoms in youth.     

Characterizing the nature of worry in a sample of perinatal women with generalized anxiety disorder

Prevalence of perinatal anxiety disorders continues to grow, with estimates greater than those of postpartum depression. Generalized anxiety disorder (GAD) is the most commonly reported perinatal anxiety disorder, yet very little is known about the worry content experienced during the perinatal period in those with GAD. This study investigated worry content and frequency in a sample of perinatal women (n = 20) and age‐matched nonperinatal women (n = 20) diagnosed with GAD. Participants completed the Penn State Worry Questionnaire (PSWQ) to assess worry severity, in addition to providing their current top worries. Mean scores on the PSWQ in both samples exceeded a clinical cut‐off score of 65, and thematic analyses revealed that perinatal women experienced significantly greater parental‐themed worries compared with the nonperinatal GAD sample (p < .05). Capturing the unique content of worry for perinatal woman will assist clinicians in identifying treatment targets and may enhance treatment outcome.     

Explaining depression symptoms in patients with social anxiety disorder: Do maladaptive metacognitive beliefs play a role?

Social anxiety disorder (SAD) is a major risk factor for developing symptoms of depression. Severity of social anxiety has previously been identified as a risk factor, and cognitive models emphasize dysfunctional schemas and self‐processing as the key vulnerability factors underlying general distress in SAD. However, in the metacognitive model, depressive and other symptoms are related to metacognitive beliefs. The aim of this study was therefore to test the relative contribution of metacognitions when controlling for SAD severity and factors postulated in cognitive models. In a cross‐sectional design, 102 patients diagnosed with primary SAD were included. We found that negative metacognitive beliefs concerning uncontrollability and danger and low confidence in memory emerged as the only factors explaining depressive symptoms in the regression model, suggesting that metacognitive beliefs are associated with increased depressive symptoms in SAD patients.     

Metacognitive,cognitive and developmental predictors of generalised anxiety disorder symptoms

Generalised anxiety disorder (GAD) is the most significant and common of the anxiety disorders. Intolerance of uncertainty (IU) and negative metacognitive beliefs are two prominent cognitive factors in models of GAD, however only one study to date has examined the relative contribution of these factors. Therefore, this study aimed to investigate and compare these cognitive factors in their prediction of GAD symptoms, and also to examine possible developmental influences on GAD by examining the link between symptoms and the parentification style of childrearing. In this analogue study, 119 non‐clinical participants (M age 22.90 years; 95 females, 24 males) completed measures of these constructs. Results indicated that both IU and negative beliefs about worry significantly related to GAD symptoms, however, the degree to which they predicted GAD symptoms did not significantly differ. Although a weak but significant relationship was found between parentification and GAD, this relationship did not remain significant after controlling for depression. Implications and limitations are discussed.     

The Penn State Worry Questionnaire and the Worry Domains Questionnaire: structure,reliability and validity

In this study the psychometric properties of the PSWQ and the WDQ were investigated in a community sample. The PSWQ proved to be unidimensional although the results indicated that the negatively keyed items contributed less to the general factor. Internal reliability of the PSWQ was satisfactory. Confirmatory analysis of the WDQ indicated that some alternations with regard to the content of the different domains had to be made. Furthermore, an additional health worry domain was included in the scale. This resulted in a revised revision of the WDQ. Internal reliability of the WDQ‐R was satisfactory, as well as consistencies of the different domains, with the exception of the Work Incompetence domain. High to moderate correlations were found between the two worry scales and measures of trait anxiety, depression and obsessive compulsive behaviour. In studying the relative impact of these constructs on worry it was found that the predictors accounted for 62 and 61% of the variance in the PSWQ and the WDQ‐R respectively, providing further evidence for the separate construct of worry. Copyright © 1999 John Wiley & Sons, Ltd.     

Obsessive–compulsive disorder beliefs,metacognitive beliefs and obsessional symptoms: relations between parent beliefs and child symptoms

Investigations of obsessive–compulsive disorder (OCD) have increasingly emphasized the role of cognition in symptom development and maintenance. In the present study, relationships between parent and adolescent child OCD symptoms and OCD cognition measures were explored to elucidate how OCD related beliefs and OCD symptoms might develop. One hundred and twenty‐six non‐clinical parent–adolescent pairs completed measures of OCD symptoms, OCD related beliefs and metacognitive beliefs (cognitive self‐consciousness [CSC], the tendency to focus attention on thought processes). A significant indirect relationship was found between parent OCD symptoms and adolescent OCD symptoms through specific adolescent OCD related beliefs. Contrary to expectations, parent and adolescent CSC were not correlated. Although findings were limited by the correlational and cross‐sectional design, implications of the observed associations for theory and treatment are discussed. Copyright © 2006 John Wiley & Sons, Ltd.     

Cognitive predictors of worry in a non-clinical population

Although worry is considered to be the key feature of generalised anxiety disorder, it has its own unique properties. The study aimed to investigate the extent to which intolerance of uncertainty, poor problem-solving confidence, positive beliefs about worry and negative thinking style, predicted worry, both individually and in combination, once the effects of trait anxiety were removed. Ninety-six university students participated in the study by completing a battery of questionnaires. Results showed trait anxiety to be the strongest predictor. Further, negative thinking, intolerance of uncertainty and positive beliefs about worry contributed to the prediction of worry individually, beyond the effects of trait anxiety. However, when examined collectively, intolerance of uncertainty and a negative thinking were shown to be superior predictors of worry. The findings support the cognitive processing models of worry and generalised anxiety. The implications of these findings are discussed with reference to future research.     

Moderators and predictors of outcome in metacognitive and cognitive behavioural therapy for co‐morbid anxiety disorders

This study aimed to investigate whether two theoretically derived moderators of treatment, degree of worry and avoidance at pretreatment, moderated anxiety from pretreatment to post‐treatment in a randomized controlled trial comparing metacognitive therapy and cognitive behavioural therapy. Personality problems, degree of co‐morbidity, and demographic characteristics (work status and education) were also investigated. Seventy‐four patients with a primary diagnosis of post‐traumatic stress disorder, social phobia, or panic disorder with and without agoraphobia were analysed using multilevel modelling. There were no significant predictors of treatment outcome, indicating that the slope was not dependent on worry, avoidance, personality problems, degree of co‐morbidity, and demographic characteristics. Furthermore, no interaction with treatment condition was found. Due to the sample size, the results of the moderator analysis should be interpreted with caution and replicated. Worry, avoidance, personality problems, degree of co‐morbidity, and demographic variables did not moderate the effect of metacognitive therapy and cognitive behavioural therapy or predict treatment outcome for co‐morbid anxiety disorders. Clinical implications are discussed.     

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.     

A comparison of the 27‐item and 12‐item intolerance of uncertainty scales

The 27‐item Intolerance of Uncertainty Scale (IUS) has become one of the most frequently used measure of Intolerance of Uncertainty. More recently, an abridged, 12‐item version of the IUS has been developed. The current research used clinical (n = 50) and non‐clinical (n = 56) samples to examine and compare the psychometric properties of both versions of the IUS. The two scales showed good internal consistency at both the total and subscale level and had satisfactory test‐retest reliability. Both versions were correlated with worry and trait anxiety and had satisfactory concurrent validity. Significant differences between the scores of the clinical and non‐clinical sample supported discriminant validity. Predictive validity was also supported for the two scales. Total scores, in the case of the clinical sample, and a subscale, in the case of the non‐clinical sample, significantly predicted pathological worry and trait anxiety. Overall, the clinicians and researchers can use either version of the IUS with confidence, due to their sound psychometric properties.     

Empirical evidence of the validity of the Spanish version of the pain vigilance awareness questionnaire

Background

The Spanish version of the Pain Vigilance and Awareness Questionnaire has not been validated.

Purpose

The aims of this study were to examine the factor structure of the Spanish version of the Pain Vigilance and Awareness Questionnaire and present empirical evidence regarding its validity.

Method

A sample of 468 chronic back pain patients completed a battery of instruments to assess fear-avoidance beliefs, pain anxiety, pain catastrophizing, pain vigilance and awareness, pain acceptance, depression, anxiety, disability, and pain intensity.

Results

Confirmatory factor analysis supported the validity of a nine-item version with two subscales: Active Vigilance and Passive Awareness. Both subscales and the total score were positively and significantly correlated with other fear-related constructs: fear-avoidance beliefs, pain anxiety, and pain catastrophizing. Regression analyses showed that Active Vigilance and the two subscales of the Fear-Avoidance Beliefs Questionnaire were significantly associated with higher anxiety and that the Acceptance Activity Engagement subscale was significantly associated with lower anxiety. The Fear-Avoidance Beliefs Questionnaire–Physical subscale was associated with higher disability and the Acceptance Pain Willingness subscale was associated with lower disability. The Fear-Avoidance Beliefs Questionnaire–Work subscale was significantly associated with higher pain intensity and depression; the Acceptance Activity Engagement and Pain Willingness subscales were significantly associated with lower pain intensity and depression.

Conclusion

The Spanish version of the Pain Vigilance and Awareness Questionnaire is a reliable and valid instrument. Pain Acceptance and Fear Avoidance beliefs are better predictors of adjustment to pain than pain hypervigilance.     

Association Between Stress-Related Sleep Reactivity and Metacognitive Beliefs About Sleep in Insomnia Disorder: Preliminary Results

To evaluate the relation between stress-related sleep reactivity and metacognitive beliefs about sleep in subjects with insomnia disorder (93) and in a group of healthy controls (30) a set of variables, including Ford Insomnia Response to Stress Test (FIRST) and Metacognition Questionnaire–Insomnia (MCQ-I), have been used. Internal consistency of the Italian version of FIRST was studied. Univariate correlation, regression analysis, and principal component analysis were also performed. The Italian version of FIRST showed good internal consistency and discriminant validity. Sleep reactivity was higher in women (p < .05) and correlates positively in both genders with metacognitive beliefs about sleep (p < .01) in insomnia. In insomnia, metacognitive beliefs may play a key role in modulating sleep reactivity. Therapeutic strategies acting selectively on metacognition to reduce stress-related sleep reactivity in insomnia may be useful.     

Testing the Italian version of the Cyberchondria Severity Scale and a metacognitive model of cyberchondria

Cyberchondria refers to the tendency to excessively and compulsively search for online medical information despite the distress experienced, with consequent impairment of daily‐life activities. The current two studies sought to explore (i) the factor structure of the Italian version of the Cyberchondria Severity Scale (CSS) and (ii) a metacognitive model of cyberchondria. Participants were Italian community adults who reported using the Internet to search for health‐related information (Study 1: N = 374, Study 2: N = 717). Results from Study 1 supported the Italian version of the CSS exhibiting a five‐factor structure, with the resulting scales demonstrating good internal consistency, 5‐week test–retest reliability, and generally strong correlations with indices of health anxiety. In Study 2, results of a path analysis showed that the negative metacognitive belief domain (“thoughts are uncontrollable”) shared the strongest direct association with each of the five dimensions of cyberchondria, followed by beliefs about rituals. Consistently, the strongest indirect associations were found between “thoughts are uncontrollable” and all the five cyberchondria dimensions via beliefs about rituals. These results provide support for an Italian version of the CSS and the metacognitive conceptualization of cyberchondria.     

Social cognition and metacognition in social anxiety: A systematic review

Cognitive–behavioural and metacognitive approaches to emotional disorder implicate beliefs in social anxiety, but the types of beliefs differ across these perspectives. Cognitive models suggest that social beliefs about the self (i.e., high standards and conditional and unconditional beliefs) are central. In contrast, the metacognitive model gives centre stage to metacognitive beliefs (i.e., positive and negative beliefs about thinking) as main contributors to the maintenance of the disorder. Despite an expanding research interest in this area, the evidence for such contributions has not yet been reviewed. This study set out to systematically review relevant cross‐sectional, longitudinal, and experimental investigations of the direct and indirect (through cognitive processes, such as anticipatory processing, self‐focused attention, the post‐mortem, and avoidance) relationships of social and metacognitive beliefs with social anxiety. Clinical and nonclinical samples were included, and correlation and regression coefficients as well as results from group comparisons (e.g., t tests and analyses of variance) were extracted. Overall, 23 papers were located, through PsycINFO, PubMed, and Web of Science, and reviewed using narrative synthesis. The results showed a robust positive relationship between social beliefs and social anxiety that appeared to be mediated by cognitive processes. Specific metacognitive beliefs were found to positively contribute to social anxiety both directly and indirectly, through cognitive processes. The study's findings are limited to 2 models of social anxiety and other minor limitations (e.g., grey literature was excluded). With these accounted for, the results are discussed in terms of the conceptualization and treatment of social anxiety and suggestions for future research are made.     

Negative metacognitive beliefs predict sexual distress over and above pain in women with endometriosis

The aim of the study was to assess the predictive value of dyspareunia, general chronic pain, and metacognitive beliefs to sexual distress in a sample of women with endometriosis. Ninety-six women (mean age = 34.60 ± 6.44 years) with a diagnosis of endometriosis took part to this cross-sectional study. Sociodemographic and clinical data were collected by means of a structured ad hoc questionnaire. Metacognitive beliefs and sexual distress were assessed by means of the Metacognitions Questionnaire (MCQ30) and the Female Sexual Distress Scale-R (FSDS-r). General chronic pain intensity was collected by means of a Numeric Rating Scale. Data were subjected to Hierarchical logistic regression. We found high percentages of dyspareunia and sexual distress (i.e., 66% and 76%). Findings suggested that dyspareunia and chronic pain did not predict sexual distress, while negative beliefs about worries predicted sexual distress over and above them (p = .040, odd ratio 1.159). In the target population, metacognitive beliefs may have more influence on sexual distress than pain symptomatology.