Henrik Nordahl

Testing the Metacognitive model against the benchmark CBT model of Social anxiety disorder: Is it time to move beyond cognition?

The recommended treatment for Social Phobia is individual Cognitive-Behavioural Therapy (CBT). CBT-treatments emphasize social self-beliefs (schemas) as the core underlying factor for maladaptive self-processing and social anxiety symptoms. However, the need for such beliefs in models of psychopathology has recently been questioned. Specifically, the metacognitive model of psychological disorders asserts that particular beliefs about thinking (metacognitive beliefs) are involved in most disorders, including social anxiety, and are a more important factor underlying pathology. Comparing the relative importance of these disparate underlying belief systems has the potential to advance conceptualization and treatment for SAD. In the cognitive model, unhelpful self-regulatory processes (self-attention and safety behaviours) arise from (e.g. correlate with) cognitive beliefs (schemas) whilst the metacognitive model proposes that such processes arise from metacognitive beliefs. In the present study we therefore set out to evaluate the absolute and relative fit of the cognitive and metacognitive models in a longitudinal data-set, using structural equation modelling. Five-hundred and five (505) participants completed a battery of self-report questionnaires at two time points approximately 8 weeks apart. We found that both models fitted the data, but that the metacognitive model was a better fit to the data than the cognitive model. Further, a specified metacognitive model, emphasising negative metacognitive beliefs about the uncontrollability and danger of thoughts and cognitive confidence improved the model fit further and was significantly better than the cognitive model. It would seem that advances in understanding and treating social anxiety could benefit from moving to a full metacognitive theory that includes negative metacognitive beliefs about the uncontrollability and danger of thoughts, and judgements of cognitive confidence. These findings challenge a core assumption of the cognitive model and treatment of social phobia and offer further support to the metacognitive model.

Social anxiety and work status: the role of negative metacognitive beliefs, symptom severity and cognitive-behavioural factors

Abstract Background: Psychological health has a profound effect on personal and occupational functioning with Social Anxiety Symptoms in particular having a major effect on ability to work. Recent initiatives have focused on treating psychological illness with cognitive-behavioural models with a view to increasing return to work. However, the psychological correlates of work status amongst individuals with elevated mental health symptoms such as social anxiety are under-explored. Aims: This study reports a test of unique predictors of work status drawing on variables that have been given centre stage in cognitive-behavioural models and in the metacognitive model of psychological disorder. Methods: The sample consisted of high socially anxious individuals who reported to be working (n = 102) or receiving disability benefits (n = 102). Results: A comparison of these groups showed that those out of work and receiving benefits had greater symptom severity, higher avoidance and use of safety behaviours, greater self-consciousness, and elevated negative metacognitive beliefs and beliefs about the need to control thoughts. However, when the covariance’s between these variables were controlled, only negative metacognitive beliefs significantly predicted out-of-work status. Conclusions: Our finding might be important because CBT does not focus on metacognitive beliefs, but targets components that in our analysis had no unique predictive value for work status.

Metacognition and Perspective Taking Predict Negative Self-Evaluation of Social Performance in Patients with Social Anxiety Disorder:

This study set out to test metacognitive beliefs and perspective taking in self-imagery as predictors of negative self-evaluation of performance in social anxiety disorder. Forty-seven patients with a primary diagnosis of DSM-IV social anxiety disorder were asked to engage in a speech task. Metacognitive beliefs were assessed before the task, and perspective taking in self-imagery and negative self-evaluations of performance were measured after the task. Positive metacognitive beliefs about worrying and observer perspective imagery were positively correlated with negative self-evaluation. A hierarchical linear regression showed that age, and both positive metacognitive beliefs and the observer perspective, were unique predictors of negative self-evaluation. The results suggest that psychological models, especially those formulating the self-concept, should incorporate metacognitive beliefs.

Explaining depression symptoms in patients with social anxiety disorder: Do maladaptive metacognitive beliefs play a role?

Social anxiety disorder (SAD) is a major risk factor for developing symptoms of depression. Severity of social anxiety has previously been identified as a risk factor, and cognitive models emphasize dysfunctional schemas and self-processing as the key vulnerability factors underlying general distress in SAD. However, in the metacognitive model, depressive and other symptoms are related to metacognitive beliefs. The aim of this study was therefore to test the relative contribution of metacognitions when controlling for SAD severity and factors postulated in cognitive models. In a cross-sectional design, 102 patients diagnosed with primary SAD were included. We found that negative metacognitive beliefs concerning uncontrollability and danger and low confidence in memory emerged as the only factors explaining depressive symptoms in the regression model, suggesting that metacognitive beliefs are associated with increased depressive symptoms in SAD patients.

Metacognitive Therapy for Social Anxiety Disorder: An A–B Replication Series Across Social Anxiety Subtypes

Cognitive behavioural therapy (CBT) is the treatment of choice for Social anxiety disorder (SAD). However, factors additional to those emphasised in CBT are the primary cause of psychological disorder according to the metacognitive model. Metacognitive Therapy (MCT) aims to target a perseverative thinking style named the cognitive attentional syndrome and its underlying metacognitive beliefs (beliefs about cognition). The present study aimed to explore the effects of generic MCT for SAD. Treatment related effects were evaluated using direct replication single case (A–B) methodology across three patients with different subtypes of SAD; performance type, generalised and generalised plus avoidant personality disorder, representing increasing SAD severity/complexity. All patients responded during treatment and achieved substantial symptom reductions which were largely maintained at 6 months’ follow-up. Metacognitive therapy appears to be a suitable treatment and was associated with positive outcomes for patients with different presentations of SAD.

In or out of work: A preliminary investigation of mental health, trait anxiety and metacognitive beliefs as predictors of work status: Metacognitive beliefs and work status

trait anxiety and metacognitive beliefs as predictors of work status Henrik NORDAHL and Adrian WELLS Department of Psychology, Norwegian University of Science and Technology and St. Olavs Hospital, Division of Psychiatry, Nidaros DPS, Trondheim, Norway and Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester and Greater Manchester Mental Health NHS Foundation Trust, Prestwich, UK

Predictors of Biased Self-perception in Individuals with High Social Anxiety: The Effect of Self-consciousness in the Private and Public Self Domains

“Biased self-perception,” the tendency to perceive one’s social performance as more negative than observers do, is characteristic of socially anxious individuals. Self-attention processes are hypothesised to underlie biased self-perception, however, different models emphasise different aspects of self-attention, with attention to the public aspects of the self being prominent. The current study aimed to investigate the relative contribution of two types of dispositional self-attention; public- and private self-consciousness to biased self-perception in a high (n = 48) versus a low (n = 48) social anxiety group undergoing an interaction task. The main finding was that private self-consciousness explained substantial and unique variance in biased negative self-perception in individuals with high social anxiety, while public self-consciousness did not. This relationship was independent of increments in state anxiety. Private self-consciousness appeared to have a specific association with bias related to overestimation of negative social performance rather than underestimation of positive social performance. The implication of this finding is that current treatment models of Social anxiety disorder might include broader aspects of self-focused attention, especially in the context of formulating self-evaluation biases.