Samuel G. Myers

Metacognitive therapy in treatment-resistant depression: A platform trial

Patients with treatment-resistant depression received up to 8 sessions of metacognitive therapy (MCT) targeting attentional control, rumination, worry, and metacognitive beliefs. A baseline period was followed by weekly sessions with follow-up assessments at 6 and 12 months post treatment. Large and statistically significant improvements occurred in all symptom measures at post treatment and were maintained over follow-up. Two out of 3 process measures significantly improved at post treatment and all of these measures were improved at follow-up. Treatment was associated with similar response rates on the BDI and Hamilton rating scale. Using liberal criteria 80% of completers were classified as recovered at post treatment and 70% at follow-up on the BDI. In the intention to treat sample 66.6% were recovered at post treatment and 58.3% at follow-up. More stringent criteria showed 60% recovery rates at post treatment and at 12 m. The results suggest that MCT could be a brief and effective treatment and they provide a precedent for more definitive randomized controlled trials.

An empirical test of the metacognitive model of obsessive-compulsive symptoms : Fusion beliefs, beliefs about rituals, and stop signals

The metacognitive model of obsessive-compulsive symptoms [Wells, A. (1997). Cognitive therapy of anxiety disorders: a practice manual and conceptual guide. Chichester, UK: Wiley] emphasizes three types of metacognitive knowledge in the etiology and maintenance of symptoms: thought fusion beliefs, beliefs about the need to perform rituals, and criteria that signal rituals can be stopped. We tested the model using a series of hierarchical regression analyses. Results showed that each metacognitive domain when entered in their hypothesized causal sequence explained incremental variance in two different measures of obsessive-compulsive symptoms, with worry controlled. These incremental relationships remained when non-metacognitive beliefs (e.g., responsibility and perfectionism) which have been linked to obsessive-compulsive symptoms in other theories were controlled. Results provide further support for the metacognitive model.

An experimental manipulation of metacognition: A test of the metacognitive model of obsessive-compulsive symptoms

The metacognitive model of obsessive-compulsive symptoms [Wells, A. (1997). Cognitive therapy of anxiety disorders: A practice manual and conceptual guide. Chichester, UK: Wiley] assigns a necessary causal role to metacognitive beliefs in the development of symptoms. The current study tested the model by evaluating the effects of experimentally manipulating such beliefs. A 2×2 factorial design was used. Thirty-two students with high and 32 students with low obsessional symptoms were subject to an experimental (metacognitive belief induction) or control (no metacognitive belief induction) condition. All participants underwent fake EEG recordings and were informed that the EEG could sense hypothalamus activity caused by having thoughts related to drinking. Participants in the experimental condition were told that if such thoughts were detected they may be exposed to an aversive noise. Controls were told that they may hear an aversive noise but this would be unrelated to the thoughts they had. Results showed a significant interaction effect between level of obsessional symptoms and belief induction. Analysis of this effect demonstrated that in the high obsession group, participants in the experimental condition had significantly more intrusions about drinking, time spent thinking about these intrusions and discomfort from them, than controls. There were also significant main effects on some measures, such as effort to control intrusions about drinking, with higher scores in the experimental condition irrespective of levels of obsessional symptoms. Results support the metacognitive model.

Early trauma, negative affect, and anxious attachment: the role of metacognition

Background and Objectives: Metacognition is linked to the etiology and maintenance of negative emotions and psychological disorder in the Self-Regulatory Executive Function Model. Although there is significant evidence supporting the model, little is currently known about the situational factors for developing dysfunctional metacognitions. The current study explored the hypothesis that early aversive experiences might be important and also tested if metacognitions could mediate the relationship between such experiences and psychological symptoms. Design and Methods: Three hundred and fifty non-clinical adults completed a retrospective early trauma measure, as well as measures of current metacognitive beliefs, negative affect, and anxious attachment. Results: Early emotional abuse positively and significantly correlated with several metacognitive belief dimensions but other forms of early trauma did not. Metacognition fully mediated the relationship between emotional abuse and negative affect. Anxious attachment was also positively and significantly associated with metacognitive beliefs and specific relationships remained after controlling for early emotional abuse and current negative affect. Conclusions: Findings are consistent with the ideas that: (i) early negative experiences, and emotional abuse in particular, could be a factor in the formation of problematic metacognitions and (ii) these metacognitions may be important in determining the effects of abuse on subsequent psychological symptoms.