What Lies Beneath Trait-Anxiety? Testing the Self-Regulatory Executive Function Model of Vulnerability

Vulnerability to psychological disorder can be assessed with constructs such as trait anxiety and neuroticism which among others are transdiagnostic risk factors. However, trait-anxiety and related concepts have been criticised because they don’t illuminate the etiological mechanisms of psychopathology. In contrast, the metacognitive (S-REF) model offers a framework in which metacognitive knowledge conceptualised in trait terms is part of a core mechanism underlying trait-anxiety and related constructs. The present study therefore set out to explore metacognitions as potential underlying factors in trait-anxiety (the propensity to depression and anxiety). Nine hundred and eighty two participants completed self-report measures of metacognitions and trait-anxiety at time 1, and 425 individuals completed the same measures 8 weeks later. At the cross-sectional level, metacognitions accounted for 83% of the variance in anxiety- and 64% of depression propensity. Furthermore, despite both domains of trait-anxiety showing high stability over time, negative- and positive metacognitive beliefs were significant prospective predictors of both domains of vulnerability. These findings suggests that metacognitive beliefs may be an underlying mechanism of vulnerability attributed to trait-anxiety with the implication that the metacognitive (S-REF) model informs conceptualization of psychological vulnerability, and that metacognitive therapy applications might be employed to enhance psychological resilience

Metacognitive Therapy for Depression in Adults: A Waiting List Randomized Controlled Trial with Six Months Follow-Up

This randomized controlled trial examines the efficacy of metacognitive therapy (MCT) for depression. Thirty-nine patients with depression were randomly assigned to immediate MCT (10 sessions) or a 10-week wait list period (WL). The WL-group received 10 sessions of MCT after the waiting period. Two participants dropped out from WL and none dropped out of immediate MCT treatment. Participants receiving MCT improved significantly more than the WL group. Large controlled effect sizes were observed for both depressive (d = 2.51) and anxious symptoms (d = 1.92). Approximately 70–80% could be classified as recovered at post-treatment and 6 months follow-up following immediate MCT, whilst 5% of the WL patients recovered during the waiting period. The results suggest that MCT is a promising treatment for depression. Future controlled studies should compare MCT with other active treatments

Personality styles in patients with fibromyalgia, major depression and healthy controls

BACKGROUND: The fibromyalgia syndrome (FMS) is suggested to be a manifestation of depression or affective spectrum disorder. We measured the cognitive style of patients with FMS to assess personality styles in 44 patients with fibromyalgia syndrome (FMS) by comparing them with 43 patients with major depressive disorder (MDD) and 41 healthy controls (HC). METHODS: Personality styles were measured by the Sociotropy and Autonomy Scale (SAS) and the Dysfunctional Attitude Scale (DAS). The Structured Clinical interview for DSM Axis I was applied to Axis I disorders, while the Beck Depression Inventory was used to measure depression severity. RESULTS: Patients with FMS in general have a sociotropic personality style similar to patients with MDD, and different from HC, but FMS patients without a lifetime history of MDD had a cognitive personality style different from patients with MDD and similar to HC. CONCLUSION: These findings suggest that a depressotypic personality style is related to depressive disorder, but not to FMS

Cognitive and metacognitive predictors of symptom improvement following treatment for social anxiety disorder:A secondary analysis from a randomized controlled trial

Cognitive therapy for social anxiety disorder (SAD) based on the Clark and Wells model emphasizes negative beliefs about the social self and self‐consciousness as central causal factors. However, Wells’ metacognitive model proposes that metacognitive beliefs are central to pathology universally. The relative importance of cognitive and metacognitive beliefs in the treatment of SAD is therefore an important research question. This study examined change in negative cognitive and negative metacognitive beliefs as independent correlates of symptom improvement in 46 SAD patients undergoing evidence‐based treatments. Both types of beliefs decreased during treatment. However, change in metacognitive belief was the only consistent independent predictor across all outcomes and change in cognitive beliefs did not significantly predict outcomes when change in self‐consciousness was controlled. The implication of this finding is that metacognitive change might be more important than cognitive belief change in symptom outcome and recovery in SAD

Metacognitive therapy of early traumatized patients with borderline personality disorder:A phase-II baseline-controlled trial

Metacognitive therapy (MCT) is proving to be an effective and brief treatment for anxiety disorders and depression, but there are no investigations of its feasibility and effect on primary personality disorders. We conducted a baseline controlled phase II trial of MCT on a group of patients with Borderline personality disorder all reporting early trauma history with sexual or physical abuse. All had been referred to our study after hospitalization and subsequently treated at the university outpatient clinic at NTNU. Twelve patients referred for severe long-term trauma and emotional instability were offered participation in the program. All gave their consent and were included in the trial. We aimed to examine retention over treatment and follow-up, if the treatment can be delivered in a standardized way across complex and heterogeneous patients and any evidence associated with treatment effects on a range of measures to inform subsequent trials. We measured change in mood, borderline-related symptoms, interpersonal problems, trauma symptoms, suicidal thoughts and self-harming behaviors across pre- post-treatment and by 1- and 2-year follow-up. Treatment appeared feasible with all patients completing the course and 11 out of 12 completing all follow-up assessments. All outcome measures showed a high retention rate and no drop-outs from the treatment. Large improvements over time and treatment gains were maintained at 2 years. There was significant reduction of borderline symptom severity, interpersonal problems and trauma symptoms from pre to 2-year follow-up. The results indicate that MCT may be applied to Borderline personality disorder and that future more definitive trials are warranted

What lies beneath trait-anxiety? Testing the self-regulatory executive function model of vulnerability

Vulnerability to psychological disorder can be assessed with constructs such as trait anxiety and neuroticism which among others are transdiagnostic risk factors. However, trait-anxiety and related concepts have been criticised because they don’t illuminate the etiological mechanisms of psychopathology. In contrast, the metacognitive (S-REF) model offers a framework in which metacognitive knowledge conceptualised in trait terms is part of a core mechanism underlying trait-anxiety and related constructs. The present study therefore set out to explore metacognitions as potential underlying factors in trait-anxiety (the propensity to depression and anxiety). Nine hundred and eighty two participants completed self-report measures of metacognitions and trait-anxiety at time 1, and 425 individuals completed the same measures 8 weeks later. At the cross-sectional level, metacognitions accounted for 83% of the variance in anxiety- and 64% of depression propensity. Furthermore, despite both domains of trait-anxiety showing high stability over time, negative- and positive metacognitive beliefs were significant prospective predictors of both domains of vulnerability. These findings suggests that metacognitive beliefs may be an underlying mechanism of vulnerability attributed to trait-anxiety with the implication that the metacognitive (S-REF) model informs conceptualization of psychological vulnerability, and that metacognitive therapy applications might be employed to enhance psychological resilience.publishedVersionCopyright © 2019 Nordahl, Hjemdal, Hagen, Nordahl and Wells. This is an openaccess article distributed under the terms of the Creative Commons Attribution License (CC BY