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Dysfunctional metacognition across psychopathologies: A meta-analytic review

Published online by Cambridge University Press:  23 March 2020

X. Sun ,
C. Zhu  and
S.H.W. So
X. Sun
Affiliation:
Department of psychology, Wong Foo Yuan building, The Chinese university of Hong Kong, Shatin, New Territories, Room 321, 3/F Hong Kong, SAR999077, Taiwan
C. Zhu
Affiliation:
Department of psychology, Wong Foo Yuan building, The Chinese university of Hong Kong, Shatin, New Territories, Room 321, 3/F Hong Kong, SAR999077, Taiwan
S.H.W. So*
Affiliation:
Department of psychology, Wong Foo Yuan building, The Chinese university of Hong Kong, Shatin, New Territories, Room 321, 3/F Hong Kong, SAR999077, Taiwan
*
*Corresponding author. E-mail address:shwso@psy.cuhk.edu.hk (S.H.W. So).
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Abstract

Background:

Dysfunctions in metacognition have been reported in individuals with anxiety disorders. Although recent studies have examined metacognition in other disorders, how dysfunctional metacognition compares across disorders is not clear. This review aimed to ascertain the importance of dysfunctional metacognition in various psychopathologies, and to identify similarities and differences in metacognitive profiles across disorders.

Methods:

Forty-seven studies were selected from 586 articles published between 1990 and August 2015, including a total sample of 3772 patients and 3376 healthy individuals. Studies that measured metacognition using the Meta-Cognitions Questionnaire (MCQ) and its variants were included. We conducted five meta-analyses including 49 to 55 effect sizes, comparing psychiatric patients to healthy individuals on respective metacognitive dimensions of the MCQ.

Results:

We found elevated metacognitive dysfunctions in patients, as a group, on all MCQ dimensions. Group effects were large and robust for the two negative beliefs (i.e., beliefs about the uncontrollability and danger of thoughts, and beliefs about the need to control thoughts), and moderate and unstable for the positive beliefs. Patients showed decreased cognitive confidence and heightened cognitive self-consciousness on moderate to large levels. Moderator analyses revealed that negative beliefs about uncontrollability and danger of thoughts were most prevalent in generalized anxiety disorder, whereas heightened cognitive self-consciousness was more characteristic in obsessive-compulsive disorder. Generalized anxiety disorder, obsessive-compulsive disorder and eating disorders manifested more similar metacognitive profiles than other disorders.

Conclusions:

Our findings supported dysfunctional metacognition as common processes across psychopathologies, with certain dimensions being more prevalent in particular disorders.

Keywords

TransdiagnosticBelief about beliefCognitive attentional syndromeSelf-regulatory executive functionCognitive confidenceCognitive self-consciousness

Information

Type
Review
Information
European Psychiatry , Volume 45 , September 2017 , pp. 139 - 153
Copyright
Copyright © European Psychiatric Association 2017

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References

Wells, AMetacognitive therapy for anxiety and depression New York: Guilford Press; 2009Google Scholar
Wells, AMatthews, GModelling cognition in emotional disorder: the S-REF model. Behav Res Ther 1996; 34: 881–888.CrossRefGoogle ScholarPubMed
Beck, ACognitive therapy and the emotional disorders London: Penguin; 1991Google Scholar
Wells, AAttention and the control of worry. In: Davey, G.C.L.Tallis, F editors. Worrying: perspectives on theory, assessment and treatment. Oxford, England: John Wiley & Sons; 1994. p. 91–114.Google Scholar
Cartwright-Hatton, SWells, ABeliefs about worry and intrusions: the meta-cognitions questionnaire and its correlates. J Anxiety Disord 1997; 11: 279–296.CrossRefGoogle ScholarPubMed
Wells, ACartwright-Hatton, SA short form of the metacognitions questionnaire: properties of the MCQ-30. Behav Res Ther 2004; 42: 385–396.CrossRefGoogle Scholar
Lobban, FHaddock, GKinderman, P, et al.The role of metacognitive beliefs in auditory hallucinations. Personal Individ Differ 2002; 32: 1351–1363.CrossRefGoogle Scholar
Janeck, ASCalamari, JERiemann, BC, et al.Too much thinking about thinking? Metacognitive differences in obsessive-compulsive disorder. J Anxiety Disord 2003; 17: 181–195.CrossRefGoogle ScholarPubMed
Cucchi, MBottelli, VCavadini, D, et al.An explorative study on metacognition in obsessive-compulsive disorder and panic disorder. Compr Psychiatry 2012; 53: 546–553.CrossRefGoogle Scholar
Halvorsen, MHagen, RHjemdal, O, et al.Metacognitions and thought control strategies in unipolar major depression: a comparison of currently depressed, previously depressed, and never-depressed individuals. Cogn Ther Res 2015; 39: 31–40.CrossRefGoogle Scholar
Jelinek, LWittekind, CEKellner, M, et al.(Meta)cognitive beliefs in posttraumatic stress disorder following forced displacement at the end of the Second World War in older adults and their offspring. Cognit Neuropsychiatry 2013; 18: 452–462.CrossRefGoogle ScholarPubMed
Sarisoy, GPazvantoğlu, OÖzturan, DD, et al.Metacognitive beliefs in unipolar and bipolar depression: a comparative study. Nord J Psychiatry 2014; 68: 275–281.CrossRefGoogle ScholarPubMed
Wells, AMeta-cognition and worry: a cognitive model of generalized anxiety disorder. Behav Cogn Psychother 1995; 23: 301–320.CrossRefGoogle Scholar
Wells, ACarter, KFurther tests of a cognitive model of generalized anxiety disorder: metacognitions and worry in GAD, panic disorder, social phobia, depression, and nonpatients. Behav Ther 2002; 32: 85–102.CrossRefGoogle Scholar
Austin, SFMors, ONordentoft, M, et al.Schizophrenia and metacognition: an investigation of course of illness and metacognitive beliefs within a first episode psychosis. Cogn Ther Res 2015; 39: 61–69.CrossRefGoogle Scholar
Brett, C.M.C.Johns, LCPeters, EP, et al.The role of metacognitive beliefs in determining the impact of anomalous experiences: a comparison of help-seeking and non-help-seeking groups of people experiencing psychotic-like anomalies. Psychol Med 2009; 39: 939–950.CrossRefGoogle ScholarPubMed
Morrison, APThe interpretation of intrusions in psychosis: an integrative cognitive approach to hallucinations and delusions. Behav Cogn Psychother Camb 2001; 29: 257–276.CrossRefGoogle Scholar
Morrison, APGumley, AIAshcroft, K, et al.Metacognition and persecutory delusions: tests of a metacognitive model in a clinical population and comparisons with non-patients. Br J Clin Psychol 2011; 50: 223–233.CrossRefGoogle Scholar
Barahmand, UMeta-cognitive profiles in anxiety disorders. Psychiatry Res 2009; 169: 240–243.CrossRefGoogle ScholarPubMed
Morrison, APWells, AA comparison of metacognitions in patients with hallucinations, delusions, panic disorder, and non-patient controls. Behav Res Ther 2003; 41: 251–256.CrossRefGoogle ScholarPubMed
Insel, TCuthbert, BGarvey, M, et al.Research domain criteria (RDoC): toward a new classification framework for research on mental disorders. Am J Psychiatry 2010; 167: 748–751.CrossRefGoogle Scholar
Liberati, AAltman, DGTetzlaff, J, et al.The Prisma statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Plos Med 2009;6:e1000100.CrossRefGoogle ScholarPubMed
Moher, DLiberati, ATetzlaff, J, et al.Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Plos Med 2009;6:e1000097.CrossRefGoogle ScholarPubMed
American psychiatric association. Diagnostic and statistical manual of mental disorders (DSM-5®). American Psychiatric Pub; 2013.Google Scholar
World Health Organization. The ICD-10 classification of mental and behavioural disorders: clinical descriptions and diagnostic guidelines. Geneva: World Health Organization. 1992. http://www.who.int/iris/handle/10665/37958 (accessed 15 March 2017).Google Scholar
Morrison, APGumley, AISchwannauer, M, et al.The beliefs about paranoia scale: preliminary validation of a metacognitive approach to conceptualizing paranoia. Behav Cogn Psychother Camb 2005; 33: 153–164.CrossRefGoogle Scholar
Chadwick, PBirchwood, MThe omnipotence of voices. II: The beliefs about voices questionnaire (BAVQ). Br J Psychiatry 1995; 166: 773–776.CrossRefGoogle Scholar
Rees, CSAnderson, RAA review of metacognition in psychological models of obsessive-compulsive disorder. Clin Psychol 2013; 17: 1–8.CrossRefGoogle Scholar
Varese, FBentall, RPThe metacognitive beliefs account of hallucinatory experiences: a literature review and meta-analysis. Clin Psychol Rev 2011; 31: 850–864.CrossRefGoogle ScholarPubMed
Wells, AMetacognitive theory and therapy for worry and generalized anxiety disorder: review and status. J Exp Psychopathol 2010; 1: 133–145.CrossRefGoogle Scholar
Van Noorden, RScientists and the social network. Nat Lond 2014; 512: 126–129.CrossRefGoogle ScholarPubMed
Cooper, HHedges, LVValentine, JCThe handbook of research synthesis and meta-analysis. Russell Sage Foundation; 2009.Google Scholar
Higgins, J.P.T.Green, SCochrane handbook for systematic reviews of interventions. John Wiley & Sons; 2011.Google Scholar
Bouman, TKMeijer, KJA preliminary study of worry and metacognitions in hypochondriasis. Clin Psychol Psychother 1999; 6: 96–101.3.0.CO;2-G>CrossRefGoogle Scholar
Goldstone, EFarhall, JOng, BModelling the emergence of hallucinations: early acquired vulnerabilities, proximal life stressors and maladaptive psychological processes. Soc Psychiatry Psychiatr Epidemiol 2012; 47: 1367–1380.CrossRefGoogle ScholarPubMed
Kikul, JVetter, JLincoln, TM, et al.Effects of cognitive self-consciousness on visual memory in obsessive-compulsive disorder. J Anxiety Disord 2011; 25: 490–497.CrossRefGoogle ScholarPubMed
Koch, JExner, CSelective attention deficits in obsessive-compulsive disorder: the role of metacognitive processes. Psychiatry Res 2015; 225: 550–555.CrossRefGoogle ScholarPubMed
Methods guide for effectiveness and comparative effectiveness reviews. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008. http://www.ncbi.nlm.nih.gov/books/NBK47095/ (accessed 15 March 2017).Google Scholar
Higgins, J.P.T.Thompson, SGDeeks, JJ, et al.Measuring inconsistency in meta-analyses. BMJ 2003; 327: 557–560.CrossRefGoogle ScholarPubMed
Sterne, J.A.C.Higgins, J.P.T.Reeves, BCOn behalf of the development group for ACROBAT-NRSI. A Cochrane risk of bias assessment tool: for non-randomized studies of interventions (ACROBAT-NRSI), version 1.0.0; 2014. Sites Google Comsiteriskofbiastoolaccessed, 2015.Google Scholar
Borenstein, MHedges, LHiggins, JRothstein, HComprehensive meta-analysis version 3 [computer software] Englewood, NJ: Biostat, Inc; 2014 http://meta-analysis.com.Google Scholar
Borenstein, MHedges, LVHiggins, JPT, et al.Identifying and quantifying heterogeneity. Introduction to meta-analysis. John Wiley & Sons, Ltd. p. 107–25.Google Scholar
Light, RJPillemer, DBSumming up. Harvard University Press; 1984.Google Scholar
Rosenthal, RMeta-analytic procedures for social research. SAGE; 1991.CrossRefGoogle Scholar
Borenstein, MHedges, LVHiggins, JPT, et al. Subgroup analyses. In: Introduction to meta-analysis. John Wiley & Sons, Ltd. p. 149–86.Google Scholar
Diefenbach, GJStanley, MABeck, JGWorry content reported by older adults with and without generalized anxiety disorder. Aging Ment Health 2001; 5: 269–274.CrossRefGoogle ScholarPubMed
Valiente, CPrados, JMGómez, D, et al.Metacognitive beliefs and psychological well-being in paranoia and depression. Cognit Neuropsychiatry 2012; 17: 527–543.CrossRefGoogle ScholarPubMed
Fraser, JMorrison, AWells, ACognitive processes, reasoning biases and persecutory delusions: a comparative study. Behav Cogn Psychother 2006; 34: 421–435.CrossRefGoogle Scholar
Andor, TGerlach, ALRist, FSuperior perception of phasic physiological arousal and the detrimental consequences of the conviction to be aroused on worrying and metacognitions in GAD. J Abnorm Psychol 2008; 117: 193–205.CrossRefGoogle ScholarPubMed
Hansmeier, JGlombiewski, JARief, W, et al.Differential memory effects for encoding and retrieving disorder-relevant contents in relation to checking. J Behav Ther Exp Psychiatry 2015; 46: 99–106.CrossRefGoogle ScholarPubMed
Marker, CDCalamari, JEWoodard, JL, et al.Cognitive self-consciousness, implicit learning and obsessive-compulsive disorder. J Anxiety Disord 2006; 20: 389–407.CrossRefGoogle ScholarPubMed
Walker, EHernandez, AVKattan, MWMeta-analysis: its strengths and limitations. Cleve Clin J Med 2008; 75: 431–439.CrossRefGoogle ScholarPubMed
Turner, HCooper, MCognitions and their origins in women with anorexia nervosa, normal dieters and female controls. Clin Psychol Psychother 2002; 9: 242–252.CrossRefGoogle Scholar
Wells, AWorry, Metacognition, and GAD: nature, consequences, and treatment. J Cogn Psychother 2002; 16: 179–192.CrossRefGoogle Scholar
Tas, CBrown, ECAydemir, O, et al.Metacognition in psychosis: comparison of schizophrenia with bipolar disorder. Psychiatry Res 2014; 219: 464–469.CrossRefGoogle ScholarPubMed
Vohs, JLLysaker, PHFrancis, MM, et al.Metacognition, social cognition, and symptoms in patients with first episode and prolonged psychoses. Schizophr Res 2014; 153: 54–59.CrossRefGoogle ScholarPubMed
Bora, EPantelis, CMeta-analysis of cognitive impairment in first-episode bipolar disorder: comparison with first-episode schizophrenia and healthy controls. Schizophr Bull 2015; 41: 1095–1104.CrossRefGoogle Scholar
Lee, R.S.C.Hermens, DFPorter, MA, et al.A meta-analysis of cognitive deficits in first-episode Major depressive disorder. J Affect Disord 2012; 140: 113–124.CrossRefGoogle ScholarPubMed
Shin, NYLee, TYKim, E, et al.Cognitive functioning in obsessive-compulsive disorder: a meta-analysis. Psychol Med 2014; 44: 1121–1130.CrossRefGoogle ScholarPubMed
Hermans, DEngelen, UGrouwels, L, et al.Cognitive confidence in obsessive-compulsive disorder: distrusting perception, attention and memory. Behav Res Ther 2008; 46: 98–113.CrossRefGoogle Scholar
Bora, EYücel, MPantelis, CCognitive impairment in schizophrenia and affective psychoses: implications for DSM-V criteria and beyond. Schizophr Bull 2010; 36: 36–42.CrossRefGoogle ScholarPubMed
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