Bruce A. Fernie

Metacognitions in Problem Gambling

Problem gambling is heterogeneous in nature, ranging in severity from occasional but problematic gambling episodes, to extreme, impulsive and pervasive gambling behaviour. Problem gambling may be accompanied by a sense of impaired control and can give rise to financial, interpersonal, legal and vocational costs for the sufferer, their families and society. This study investigated the relationship among metacognitions, anxiety, depression and gambling in a sample of problem gamblers. A total of 91 individuals attending gambling treatment services completed a battery of self-report instruments that consisted of the Metacognitions Questionnaire 30 (MCQ-30), the Hospital Anxiety and Depression Scale (HADS) and the South Oaks Gambling Scale (SOGS). Correlation analyses showed that anxiety, depression and metacognitions were positively and significantly correlated with both gambling consequences and behaviour. Hierarchical regression analyses indicated that two metacognitive constructs (negative beliefs about thoughts concerning uncontrollability and danger and beliefs about the need to control thoughts) predicted gambling behaviour independently of anxiety and depression. These findings are consistent with the hypothesis that metacognitions play a role in problem gambling.

Metacognitions and negative emotions as predictors of symptom severity in chronic fatigue syndrome

OBJECTIVE Chronic fatigue syndrome (CFS) describes a condition that is primarily characterized by fatigue and flu-like symptoms that are not alleviated by rest. This study investigated the relationship among metacognitions, negative emotions, and symptom severity in CFS. METHODS A total of 96 patients who had received a diagnosis of CFS according to the Oxford Criteria completed a battery of self-report measures that consisted of the Depression Anxiety Stress Scales, the 30-Item Metacognitions Questionnaire, the Chalder Fatigue Questionnaire (CFQ), and the RAND 36-Item Short-Form Health Survey-Physical Functioning. RESULTS Correlation analyses showed that negative emotions and metacognitions were positively correlated with measures of symptom severity and that metacognitions were a better predictor of symptom severity than anxiety and depression. Hierarchical regression analyses indicated that (1) lack of cognitive confidence predicted both mental and physical factors of the CFQ and physical functioning independently of negative emotions and (2) beliefs about the need to control thoughts predicted the mental factor of the CFQ independently of negative emotions and lack of cognitive confidence. CONCLUSION The data support the potential application of the metacognitive model of psychological disorder to understanding CFS.

Metacognitions about Procrastination: A Preliminary Investigation

Procrastination can have deleterious effects on well-being. Despite this, little is known about cognitive-attentional processes involved in procrastination. In this study, 12 individuals self-reporting problematic procrastination were assessed using a semi-structured interview to investigate: (1) whether they held positive and/or negative metacognitive beliefs about procrastination; (2) what was their main goal in procrastinating, and how they knew if they had achieved their goal; (3) how they directed their focus of attention when procrastinating; and (4) what they perceived the advantages and disadvantages of these attentional strategies to be. Results indicated that participants endorsed both positive and negative metacognitive beliefs about procrastination, and that the goal of procrastination was to regulate cognition and negative affect. Participants reported that they either did not know how to determine if they had achieved their goal or that an improvement in mood would signal the goal was achieved. Participants also reported that the principal object of their attentional focus when procrastinating was their emotional state. All participants were able to identify disadvantages to their attentional strategies, whilst nine participants described perceived advantages. The implications of the findings are discussed.

Profiling metacognition in gambling disorder

BACKGROUND Preliminary research has indicated that general facets of metacognition are associated with problem gambling. In the present study we aimed to investigate whether specific facets of metacognition play a role in explaining gambling initiation and perseveration in individuals presenting with gambling disorder. AIM To investigate: (1) the presence of metacognitive beliefs about gambling; (2) the goal of gambling, and its start and stop signals; and (3) the perceived impact of gambling on self-consciousness. METHOD Ten individuals with a diagnosis of gambling disorder were assessed using metacognitive profiling, a semi-structured interview. RESULTS Findings indicated that all participants endorsed both positive and negative metacognitive beliefs about gambling. The primary goal of gambling was to relieve economic hardship and improve cognitive-emotional state. All participants reported that they did not know when this goal was achieved. Start signals for gambling included the ideas and feelings that gambling could solve problems and sensations that it might be the right time to win. The stop signal for gambling, for all participants, was running out of money. All participants also reported a perceived reduction in self-consciousness during a gambling episode. CONCLUSIONS These findings provide preliminary evidence that specific facets of metacognition play a role in gambling disorder.

Desire thinking as a predictor of gambling

Desire thinking is a voluntary cognitive process involving verbal and imaginal elaboration of a desired target. A desired target can relate to an object, an internal state or an activity, such as gambling. This study investigated the role of desire thinking in gambling in a cohort of participants recruited from community and clinical settings. Ninety five individuals completed a battery of self-report measures consisting of the Hospital Anxiety and Depression Scale (HADS), the Gambling Craving Scale (GCS), the Desire Thinking Questionnaire (DTQ) and the South Oaks Gambling Screen (SOGS). Correlation analyses revealed that gender, educational level, recruitment source, anxiety and depression, craving and desire thinking were correlated with gambling. A hierarchical multiple regression analysis revealed that both recruitment source and desire thinking were the only independent predictors of gambling when controlling for all other study variables, including craving. These findings are discussed in the light of metacognitive therapy (MCT).

Cognitive behavioural interventions for depression in chronic neurological conditions: A systematic review

OBJECTIVE Chronic neurological conditions (CNCs) affect over one million people in the UK alone. Individuals with CNCs endure an increased prevalence of comorbid depression and anxiety. Poor mental health exacerbates the cost of the treatment and management of CNCs. CBT is recommended for the treatment of depression. However the application of CBT to individuals with CNCs may be limited by disease characteristics (e.g. mobility issues restricting therapy attendance and reducing engagement with behavioural activation, as well as difficulties challenging the veracity of disease-related negative thoughts that may reflect accurate appraisals). The objective of this review is to assess the clinical effectiveness of cognitive and behavioural interventions for depressive symptoms in individuals with non-acquired, medically explained CNCs. DATA SOURCES Searches of The Cochrane Controlled Trials Register, PubMed, and PsychINFO were conducted. RESULTS All studies suggested that CBT is an effective treatment for depression comorbid to CNCs, however when CBT was compared to an active therapy control condition, between group differences were unstable. CONCLUSION CBT has promise for the treatment for depression in such conditions; however treatment protocols and outcome measures should be adapted for this population. Future trials should control for non-specific effects of therapy and, as much as possible, introduce blinding into methodologies.

Metacognitive factors in chronic fatigue syndrome.

UNLABELLED Chronic fatigue syndrome (CFS), which is characterized by fatigue and flu-like symptoms that are not alleviated by rest, is a poorly understood condition and an often controversial diagnosis. Earlier research has indicated that general metacognitions are associated with the severity of symptoms in patients with CFS. In the current study, we aimed to determine whether specific metacognitive factors are implicated in CFS. Using the metacognitive profiling interview template we investigated the following: (1) whether patients held positive or negative metacognitions about conceptual processes; (2) what their goals with respect to engaging in these processes were; and (3) what indicated that it was appropriate to stop. We also examined attention focus when experiencing CFS symptoms, and its advantages and disadvantages. Results showed that patients endorsed positive and negative metacognitions pertaining to conceptual processes. The goals of engaging in these processes were to identify the cause of, and devise strategies to cope with, symptoms. Patients were either unable to identify a stop signal for conceptual processing or identified an improvement in fatigue-related symptoms as representing the stop signal. Finally, patients reported that their attention focus when experiencing symptoms included distraction and monitoring of symptoms. Advantages to these strategies included symptom management, whereas disadvantages included an escalation of negative affect. The present findings provide preliminary evidence that specific metacognitive factors may be involved in CFS. KEY PRACTITIONER MESSAGE Metacognitive profiling that may aid assessment and conceptualisation of psychological distress in CFS.

Metacognitive beliefs about procrastination: development and concurrent validity of a self-report questionnaire

This article describes the development of a questionnaire on metacognitive beliefs about procrastination. In Study 1 we performed a principal axis factor analysis that suggested a two-factor solution for the data obtained from the preliminary questionnaire. The factors identified were named positive and negative metacognitive beliefs about procrastination. The factor analysis reduced the questionnaire from 22 to 16 items, with each factor consisting of 8 items. In Study 2 we performed a confirmatory factor analysis that provided support for the two-factor solution suggested by the exploratory factor analysis. Both factors had adequate internal consistency. Concurrent validity was partially established through correlation analyses. These showed that positive metacognitive beliefs about procrastination were positively correlated with decisional procrastination, and that negative metacognitive beliefs about procrastination were positively correlated with both decisional and behavioral procrastination. The Metacognitive Beliefs About Procrastination Questionnaire may aid future research into procrastination and facilitate clinical assessment and case formulation.

Metacognitions, anxiety, and distress related to motor fluctuations in Parkinson's disease

OBJECTIVE This study tested the relationship between metacognitive factors, intolerance of uncertainty, anxiety, and the predictability of, and distress associated with, acute fluctuations in symptoms in idiopathic Parkinsons disease (PD), when controlling for disease parameters. METHOD 106 adults with idiopathic PD (30 females; Mage=65.3; 90% white) participated in this study, with 93 of them reported experiencing off-periods. A cross-sectional design was employed that utilised: the Hospital Depression and Anxiety Scale, Movement Disorder Society revision of the Unified Parkinsons Disease Rating Scale, the Addenbrookes Cognitive Examination - Revised, the Intolerance of Uncertainty Scale, and the Metacognitions Questionnaire 30. Correlation analyses, hierarchical regression analysis, and ordinal regression analysis were used to test the experimental hypotheses. RESULTS Anxiety was not significantly associated with motor symptom severity or cognitive functioning, while metacognitive factors were significantly related to anxiety when controlling for motor experiences of daily living and intolerance of uncertainty, R(2)=0.56, F(1,82)=15.04, p<0.001 (adjusted R(2)=0.53). For participants with motor fluctuations, no association was found between predictability of, and distress associated with, off-periods. Metacognitions concerning uncontrollability and danger were significantly related to off-period distress when controlling for motor experiences of daily living, intolerance of uncertainty, and other metacognitive factors, χ(2)(1)=20.52, p=0.001. CONCLUSION Metacognitive factors play a role in anxiety and off-period distress in PD and this is discussed in terms of the Self-Regulatory Executive Function model. Interventions from metacognitive therapy are potential means to ameliorate off-period distress and anxiety in PD.

The Metacognitions about Symptoms Control Scale: Development and Concurrent Validity

OBJECTIVE This paper presents the development and preliminary validation of a self-report instrument designed to measure metacognitions pertaining to symptoms control in the form of the following: (1) symptoms focusing and (2) symptoms conceptual thinking. METHODS A total of 124 patients (95 female and 29 male) presenting with chronic fatigue syndrome (CFS) contributed data to the study to test the structure and psychometric properties of the Metacognitions about Symptoms Control Scale (MaSCS). RESULTS A principal components factor analysis indicated that a two-factor solution best fitted the data. The factors were labelled positive and negative metacognitions about symptoms control. Further analyses revealed that both factors had good internal consistency. Correlation analyses established preliminary concurrent validity, indicating that both positive and negative metacognitions about symptoms control were significantly associated with levels of fatigue in CFS. Regression analysis revealed that positive and negative metacognitions about symptoms control significantly predicted fatigue severity when controlling for anxiety and depression. CONCLUSIONS The newly developed instrument may help future research that examines the role of metacognitions in CFS, as well as aiding clinical assessment and case formulation. KEY PRACTITIONER MESSAGE The MaSCS is a useful first instrument to assess metacognitions in CFS. The MaSCS may help to deepen our understanding of symptoms control (symptoms focusing and conceptual thinking about symptoms) in the experience of CFS symptoms. Assessing and conceptualizing symptoms control through the MaSCS may aid treatment of CFS.