تقدم زمانی فراشناخت در توسعه علائم اضطراب و افسردگی در زمینه استرس زندگی: یک مطالعه آینده نگر

According to the metacognitive theory of psychological disorder, metacognitions are vulnerability factors in predicting development of psychological symptoms. The present study investigated metacognitive factors and life stress in a prospective test of their proposed temporal precedence in the development of anxiety and depression symptoms. Participants were 172 students and adults recruited in Ankara and Bolu, Turkey. Two separate sets of hierarchical regression analyses were conducted. In these analyses, Time 2 anxiety or depression was regressed on the main and interaction effects of metacognition and stress after controlling for baseline symptom levels measured at Time 1, age, and gender. Results revealed that negative metacognitive beliefs about the uncontrollability and danger of worry significantly predicted residual change in both anxiety and depression after controlling for the negative effect of stressful life events. Furthermore, lack of cognitive confidence interacted with daily hassles to predict the change in anxiety, when the baseline level of anxiety and other individual differences were controlled. Our results support the metacognitive theory of psychopathology.

A central idea in the metacognitive theory of psychological disorders (Wells, 2000 and Wells and Matthews, 1994) is that dysfunctional beliefs about cognition, which constitute metacognition, are the basis for the development and maintenance of clinical problems. Specifically, beliefs about sustained thinking and the uncontrollability and danger of thoughts lead to a pattern of thinking dominated by worry, rumination, fixation on threat and counterproductive thought control processes. As a result, a sense of threat and sustained thinking prevails such that negative emotions persist. In the theory, metacognitions are generic causal factors in predicting the development of a broad range of psychological disorder (Wells, 1997, Wells, 2000 and Wells, 2009). Although different metacognitive models draw out specific components relevant to individual psychological disorders, a central theme cutting across all the metacognitive conceptualizations is an emphasis on beliefs and knowledge that individuals have about their own thinking patterns. In particular, metacognitions in the form of positive and negative beliefs about thinking (e.g., “I must worry in order to be prepared”; “I cannot control my thoughts”) and selective attention to internal cognitive events function as general purpose plans that guide information processing and maintain maladaptive processing routines leading to emotional disturbance (Wells, 1997, Wells, 2000 and Wells and Matthews, 1994). The theoretical framework suggested by the metacognitive model was initially elaborated to clarify development and maintenance mechanisms of generalized anxiety disorder (Wells, 1995 and Wells, 1999). In line with the theory, it has been shown that metacognitive beliefs were strongly associated with pathological worry (Davis and Valentiner, 2000, Wells and Carter, 1999 and Wells and Papageorgiou, 1998). In recent years, the metacognitive approach has been influential in problems such as obsessive-compulsive disorder (Cartwright-Hatton and Wells, 1997, Cohen and Calamari, 2004, Emmelkamp and Aardema, 1999, Fisher and Wells, 2005, Gwilliam et al., 2004, Myers and Wells, 2005, Purdon and Clark, 1999 and Wells and Papageorgiou, 1998). Here, metacognitive beliefs concern the power and importance of thoughts to cause or portend harm and this leads to worry about intrusions. In major depression (Papageorgiou and Wells, 1999 and Papageorgiou and Wells, 2003), individuals respond to negative thoughts with sustained rumination because they hold positive beliefs about the value of such a process and they come to believe that the process is beyond their control. In post traumatic stress disorder (Holeva et al., 2001 and Wells and Sembi, 2004), beliefs about intrusions and use of perseverative thought control strategies lead to a persistence of symptoms. Predisposition to auditory hallucinations (Lobban, Haddock, Kinderman, & Wells, 2002), hypochondriasis (Bouman & Meijer, 1999), and test-anxiety (Matthews, Hillyard, & Campbell, 1999) have also been shown to be associated with beliefs about thoughts as predicted by the theory. Despite growing evidence for the metacognitive theory, some important aspects remain to be empirically validated. In particular, much of the evidence for the theory comes from cross-sectional designs that prevent causal interpretations. This is because an association of a variable with symptoms may be a consequence rather than cause of symptom occurrence. For example, it may well be that metacognitive factors lead to emotional psychopathology, but it is also possible that these metacognitive constructs are just by-products of psychological distress. Thus, if metacognition is a vulnerability factor for development of many psychological disorders as asserted in the metacognitive model of psychopathology, then a prospective test of the theory is necessary. On the other hand, the mere existence of a vulnerability factor without existence of a precipitating factor is not a sufficient condition to lead to psychological disorder, although it is necessary. Instead, a pre-existing vulnerability factor later interacts with stress to lead to psychological disturbance. Thus, a prospective vulnerability-stress study should be designed in order to draw firmer conclusions regarding the role of metacognitive factors in the etiology of psychopathology. In this context, the present study attempted to investigate metacognitive factors and life stress in a two-time measurement design, to be able to test the temporal precedence of metacognitions as vulnerability factors in the development of anxiety and depression symptoms. Establishing a relationship of this kind is an initial step that would be consistent with the idea that metacognitions cause emotional symptoms, although the design cannot provide definitive evidence of causality. In line with this aim, the metacognitive model suggests several possible patterns of result. First, metacognitions may contribute to change in symptoms over and above exposure to stress. Second, metacognitions may interact with stress (i.e., be activated by stress) leading to more negative emotions, hence maintaining anxiety and depression. Third, the contribution of metacognitions may be tested in the context of different life events such as daily hassles and more traumatic experiences, as long as the stressor intensifies self-focused attention and threatens self-regulation. Thus, the specific hypotheses with respect to the aim of the study and the propositions of the metacognitive theory were as follows: (1) metacognitive beliefs and processes measured at Time 1 would prospectively predict anxiety and depression at Time 2, when stress occurrences (in the context of both major life events and daily hassles) between the two measurement times are controlled, along with the preexisting symptom level; (2) metacognitive beliefs and processes measured at Time 1 would interact with stress (both major life events and daily hassles) to predict change in the severity of symptomatology, when the level of preexisting symptom severity is controlled.