Adrian Wells

Beliefs about worry and intrusions: the Meta-Cognitions Questionnaire and its correlates.

This report describes the development of the Meta-Cognitions Questionnaire to measure beliefs about worry and intrusive thoughts. Factor analyses of the scale demonstrated five empirically distinct and relatively stable dimensions of meta-cognition. Four of the factors representing beliefs were: Positive Beliefs About Worry: Negative Beliefs About the Controllability of Thoughts and Corresponding Danger; Cognitive Confidence; and Negative Beliefs about Thoughts in General, including Themes of Superstition, Punishment and Responsibility. The fifth factor represented Meta-Cognitive processes-Cognitive Self-Consciousness-a tendency to be aware of and monitor thinking. The measure showed good psychometric properties on a range of indices of reliability and validity. Scores on the questionnaire subscales predicted measures of worry proneness, proneness to obsessional symptoms, and anxiety. Regression analyses showed that the independent predictors of worry were: Positive Beliefs about Worry; Negative Beliefs About the Controllability of Thoughts and Corresponding Danger: and Cognitive Confidence. Significant differences in particular MCQ subscales were demonstrated between patients with intrusive thoughts, clinical controls and normals. The implications of these findings for models of worry and intrusive thoughts are discussed.

A short form of the metacognitions questionnaire: properties of the MCQ-30.

The metacognitions questionnaire (MCQ) measures individual differences in a selection of metacognitive beliefs, judgments and monitoring tendencies considered important in the metacognitive model of psychological disorders. The development and properties of a shortened 30-item version of the MCQ, the MCQ-30, are reported. Construct validity was evaluated by confirmatory and exploratory factor analysis. Overall, the fit indices suggested an acceptable fit to a five-factor model consistent with the original MCQ. Exploratory factor analysis supported a five-factor structure, which was almost identical to the original solution obtained in previous studies with the full MCQ. The five factors are cognitive confidence, positive beliefs about worry, cognitive self-consciousness, negative beliefs about uncontrollability of thoughts and danger, and beliefs about need to control thoughts. The MCQ-30 showed good internal consistency and convergent validity, and acceptable to good test-retest reliability. Positive relationships between metacognitions and measures of worry and obsessive-compulsive symptoms provided further support for the validity of the measure and the metacognitive theory of intrusive thoughts. The psychometric properties of MCQ-30 suggest that the instrument is a valuable addition to the assessment of metacognitions that has the advantage of being more economical to use compared with the original MCQ.

Meta-Cognition and Worry: A Cognitive Model of Generalized Anxiety Disorder

A meta-cognitive classification and analysis of factors contributing to the development of problematic worry is presented. Dimensions of meta-beliefs, meta-worry, cognitive consciousness, and strategies can be distinguished. A cognitive model of Generalized Anxiety Disorder is advanced based on this framework in which GAD results from an interaction between the motivated use of worry as a coping strategy, negative appraisal of worry, and worry control attempts. These factors result from combinations of dysfunctional meta-beliefs and contribute to subjectively diminished cognitive control. The model presents new implications for a cognitive therapy of GAD, and these are illustrated with a single case treatment study.

Modelling cognition in emotional disorder: the S-REF model.

Cognitive therapy techniques are applied to an ever-increasing range of psychological disorders. However, both basic methods and general theory of therapy have evolved more slowly. Although cognitive therapy is based on experimentally testable concepts derived from cognitive psychology, an integration of these areas capable of explaining cognitive-attentional phenomena and offering treatment Implications remains to be achieved. In this paper, we outline the Self-Regulatory Executive Function (S-REF) model of emotional disorder, which integrates information processing research with Becks schema theory. The model advances understanding of the roles of stimulus-driven and voluntary control of cognition, procedural knowledge (beliefs), and of the interactions between different levels of information-processing. It also accounts for cognitive bias effects demonstrated in the experimental psychopathology literature. The model presents implications concerning not only what should be done in cognitive therapy, but how cognitive change may be most effectively accomplished.

The thought control questionnaire: A measure of individual differences in the control of unwanted thoughts

Previous research has suggested that unpleasant and unwanted thoughts are a frequent experience in both normal and clinical populations. This paper describes the development and validation of a questionnaire that assesses strategies for controlling such thoughts. Analyses of the Thought Control Questionnaire (TCQ) demonstrated five replicable factors: Distraction; Social Control; Worry; Punishment and Reappraisal. Significant associations were found between the punishment and worry subscales of the TCQ and various measures of emotional vulnerability and perceptions of impaired control over cognition. The implications of these findings are discussed in relation to the literature on thought suppression, worry and mental self-regulation.

Social phobia: The role of in-situation safety behaviors in maintaining anxiety and negative beliefs

One of the puzzles surrounding social phobia is that patients with this problem are often exposed to phobic situations without showing a marked reduction in their fears. It is possible that individuals with social phobia engage in behaviors in the feared situation that are intended to avert feared catastrophes but that also prevent disconfirmation of their fears. This hypothesis was tested in a single case series of eight socially phobic patients. All patients received one session of exposure alone and one session of exposure plus decrease in “safety” behaviors in a counterbalanced within-subject design. Exposure plus decreased safety behaviors was significantly better than exposure alone in reducing within-situation anxiety and belief in the feared catastrophe. Other factors that may moderate exposure effects are also discussed.

An Empirical Test of a Clinical Metacognitive Model of Rumination and Depression

Rumination has attracted increasing theoretical and empirical interest in the past 15 years. Previous research has demonstrated significant relationships between rumination, depression, and metacognition. Two studies were conducted to further investigate these relationships and test the fit of a clinical metacognitive model of rumination and depression in samples of both depressed and nondepressed participants. In these studies, we collected cross-sectional data of rumination, depression, and metacognition. The relationships among variables were examined by testing the fit of structural equation models. In the study on depressed participants, a good model fit was obtained consistent with predictions. There were similarities and differences between the depressed and nondepressed samples in terms of relationships among metacognition, rumination, and depression. In each case, theoretically consistent paths between positive metacognitive beliefs, rumination, negative metacognitive beliefs, and depression were evident. The conceptual and clinical implications of these data are discussed.

Relationships between worry, obsessive-compulsive symptoms and meta-cognitive beliefs.

The present study had two principal aims. First, the overlap between the revised Padua Inventory (PI-WSUR) a measure of obsessive-compulsive symptoms (Burns et al., 1996) and worry was assessed. Second, the relationship between meta-cognitive beliefs, proneness to pathological worry and obsessive-compulsive symptoms was explored when controlling for the interdependency of worry and obsessive-compulsive measures. The results indicate that whilst the PI-WSUR shows reduced overlap with the Penn State Worry Questionnaire, there are still problematic levels of overlap with a more content-based measure of worry. Results of multiple regression analyses demonstrated that specific sets of meta-cognitive beliefs were associated with worry proneness and obsessive-compulsive symptoms. The present data are consistent with recent formulations of generalized anxiety disorder and obsessive-compulsive disorder.

Further tests of a cognitive model of generalized anxiety disorder: Metacognitions and worry in GAD, panic disorder, social phobia, depression, and nonpatients

Advances in treating generalized anxiety disorder (GAD) are likely to result from a better understanding of the dysfunctional cognitive mechanisms underlying persistent worrying. In a cognitive model of GAD, Wells (1995) proposed that pathological worry is maintained by maladaptive metacognitions (negative beliefs about worry concerning uncontrollability and danger, and negative appraisal of worrying [meta-worry]) and linked behaviors. Twenty-four patients with GAD were compared with sex-matched groups — social phobia, panic disorder, and nonpatients — on measures of negative metacognitions and worry. It was hypothesized that patients with GAD would obtain higher negative metacognitive belief scores and higher meta-worry scores than the other groups; differences in negative metacognitions would be independent of the general frequency of worry. A group of individuals with major depression was also examined as a subsidiary exploration of relative metacognitive and worry characteristics of this disorder. All of the hypotheses were upheld in the univariate ANOVAs. There was a loss of one hypothesized significant difference between the GAD and panic disorder groups in meta-worry when general worry frequency was controlled. However, the GAD group still had higher meta-worry scores than the panic group. This effect appears to be the result of patients with panic having intermediate meta-worry scores falling between the GAD and other groups. Differences between the GAD group and all other groups in negative metacognitive beliefs concerning uncontrollability and danger remained when general worry was controlled. The results add further support to the cognitive model, and treatment implications are briefly discussed.

Metacognitive beliefs about rumination in recurrent major depression

Wells and Matthews (1994, 1996) proposed that perseverative negative thinking, such as depressive rumination and anxious worry, is supported by metacognitive beliefs concerning the functions and consequences of these styles of thinking. However, to date no studies have investigated metacognitive beliefs about rumination. This study examined the presence and content of metacognitive beliefs about rumination in patients with recurrent major depression. To achieve this aim, a semistructured interview was conducted with each patient. The results showed that all patients held positive and negative beliefs about rumination. Positive beliefs appear to reflect themes concerning rumination as a coping strategy. Negative beliefs seem to reflect themes concerning uncontrollability and harm, and interpersonal and social consequences of rumination. The conceptual and clinical implications of the results are discussed.