Metacognitive beliefs and their relationship with anxiety and depression in physical illnesses: A systematic review

Abstract

Anxiety and depression are common among patients with chronic physical illnesses and have a significant impact on morbidity, quality of life, and health service utilisation. Psychological treatment of anxiety and depression has small to moderate efficacy in this group and is not commonly based on a model of causal mechanisms. A novel approach to understanding and improving mental health outcomes in physical illnesses is needed. One approach may be to explore the role of metacognitive beliefs which are reliably associated with anxiety and depression in individuals with mental health difficulties. The current systematic review aimed to evaluate the contribution of metacognitive beliefs to anxiety and depression across physical illnesses. Systematic searches were conducted on Web of Science, PsychINFO, MEDLINE, Embase, and CINAHL of studies published between 1997 and January 2019. 13 eligible studies were identified that in sum comprised 2851 participants. Metacognitive beliefs were found to have reliable, moderate, positive and significant associations with anxiety and depression symptoms across a range of physical illnesses. There appeared to be commonality and some specificity in the relationships. Negative metacognitive beliefs concerned with uncontrollability and danger of worry were associated with both anxiety and depression across all physical illnesses assessed, whilst more specific associations emerged for individual medical conditions where positive beliefs about worry, cognitive confidence and cognitive self-consciousness were unique correlates. Negative metacognitive beliefs of uncontrollability and danger significantly and positively predicted symptoms of anxiety and depression after controlling for factors including age, gender, disease factors and cognition (illness perceptions and intolerance of uncertainty). The results suggest that the metacognitive model of psychological disorder is applicable to psychological symptoms of anxiety and depression across a range of chronic medical conditions, implying that metacognitive therapy might be helpful in improving outcomes in multiple morbidities that involve poor mental and medical health.

The Association Between Maladaptive Metacognitive Beliefs and Emotional Distress in People Living With Amyotrophic Lateral Sclerosis

“…In summary, our findings indicate that maladaptive metacognitive beliefs and repetitive negative thinking are strongly associated with emotional distress in people with ALS and account for substantial variance in emotional distress and after controlling for demographic and clinical factors. This is in keeping with findings of other studies examining the fit of the S-REF model in physical health populations (Capobianco et al, 2020). If tailored to the needs of people with ALS, MCT could be an acceptable psychological intervention.…”

“…There is growing support for the clinical applicability of the S-REF model to emotional distress in physical health conditions (Capobianco et al, 2020)-specifically, for people with cancer (Butow et al, 2015;Cook et al, 2015a,b), diabetes (Purewal and Fisher, 2018), epilepsy (Fisher and Noble, 2017;Fisher et al, 2018), multiple sclerosis (Heffer-Rahn and Fisher, 2018), chronic fatigue syndrome (Maher-Edwards et al, 2011), fibromyalgia (Kollmann et al, 2016), cardiovascular disease (Anderson et al, 2019), and Parkinson's disease (Brown and Fernie, 2015). Preliminary evidence indicates that MCT may be an effective and tolerable intervention for adults with physical health difficulties (Cherry et al, 2019;Fisher et al, 2019b;McPhillips et al, 2019).…”

Tinnitus and Metacognitive Beliefs—Results of a Cross-Sectional Observational Study

“…Anxiety and depression are frequently reported by patients with tinnitus [ 9 , 10 , 11 , 12 ] but the psychological mechanisms that drive this association are still unclear. In patients with physical health conditions, the symptoms of anxiety and depression are common and recent reviews have highlighted the role of metacognition as a moderator for psychological distress in patients with chronic diseases [ 13 , 14 ].…”

Adults’ Adherence to Growth Hormone Replacement in Relation to Medication-Related Beliefs, Coping and Quality of Life - An Exploratory Analysis

“…In short, this model states that favorable behavioral intentions (i.e., the intent to adhere to GHRx) can only then be translated into actual behavior (i.e., good adherence), if the individual has control over his/her behavioral engagement. Since depression has consistently been related to negative illness beliefs, helplessness and lack of perceived illness control [for an overview see ( 33 )], it may be concluded that patients with severely impaired mental QoL are less able to realize their intent to adhere to GHRx and other medications because of a lack of behavioral control over their illness and adequate coping strategies. A similar relationship has already been shown in breast cancer survivors ( 34 ), strengthening our hypothesis.…”