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. 2015 Mar;34(3):207-15.
doi: 10.1037/hea0000096. Epub 2014 Aug 18.

The association of metacognitive beliefs with emotional distress after diagnosis of cancer

Sharon A Cook  1 , Peter Salmon  1 , Graham Dunn  2 , Chris Holcombe  3 , Philip Cornford  3 , Peter Fisher  1
Affiliations
Free PMC article

The association of metacognitive beliefs with emotional distress after diagnosis of cancer

Sharon A Cook et al. Health Psychol. 2015 Mar.
Free PMC article

Abstract

Objective: Emotional distress after a diagnosis of cancer is normal and, for most people, will diminish over time. However, a significant minority of patients with cancer experience persistent or recurrent symptoms of emotional distress for which they need help. A model developed in mental health, the self-regulatory executive function model (S-REF), specifies that maladaptive metacognitive beliefs and processes, including persistent worry, are key to understanding why such emotional problems persist. This cross-sectional study explored, for the first, time whether metacognitive beliefs were associated with emotional distress in a cancer population, and whether this relationship was mediated by worry, as predicted by the S-REF model.

Method: Two hundred twenty-nine participants within 3 months of diagnosis of, and before treatment for, primary breast or prostate cancer completed self-report questionnaires measuring anxiety, depression, posttraumatic stress disorder (PTSD) symptoms, metacognitive beliefs, worry, and illness perceptions.

Results: Regression analysis showed that metacognitive beliefs were associated with symptoms of anxiety, depression, and PTSD, and explained additional variance in these outcomes after controlling for age, gender, and illness perceptions. Structural equation modeling was consistent with cross-sectional hypotheses derived from the theory that metacognitive beliefs cause and maintain distress both directly and indirectly by driving worry.

Conclusions: The findings provide promising first evidence that the S-REF model may be usefully applied in cancer. Further study is required to establish the predictive and clinical utility of these findings.

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Figures

Figure 1
Figure 1
Hypothesized path model of the relationship between metacognitive beliefs and emotional distress. Solid lines are predicted to be significant; dotted lines are not significant; “+” indicates positive direction of effect.
Figure 2
Figure 2
Final path model of relationship of positive and negative metacognitive beliefs with anxiety, depression, and posttraumatic stress disorder symptoms, including mediation by worry (Penn State Worry Questionnaire [PSWQ]). Solid lines, p < .05, with standardized coefficients; dotted lines are not significant. Measurement model component of full structural equation model and pathways for covariates (age and gender) is not shown but is available on request from corresponding author. Metacognitions Questionnaire 30 subscales: Positive Beliefs About Worry (POS); Negative Beliefs About Worry (NEG). PSWQ subscales: positively phrased items (PSWQ +ve); negatively phrased (PSWQ −ve).
Figure 3
Figure 3
Final path model of relationship between positive and negative metacognitive beliefs and anxiety, depression, and trauma mediated by the CAS-I. Solid lines, p < .05, with standardized coefficients; dotted lines are not significant. Measurement model component of full structural equation model and pathways for covariates (age and gender) is not shown but is available on request from corresponding author. Metacognitions Questionnaire 30 subscales: Positive Beliefs About Worry (POS); Negative Beliefs About Worry (NEG).
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