Vulnerability to psychological disorder can be assessed with constructs such as trait anxiety and neuroticism which among others are transdiagnostic risk factors. However, trait-anxiety and related concepts have been criticised because they don’t illuminate the etiological mechanisms of psychopathology. In contrast, the metacognitive (S-REF) model offers a framework in which metacognitive knowledge conceptualised in trait terms is part of a core mechanism underlying trait-anxiety and related constructs. The present study therefore set out to explore metacognitions as potential underlying factors in trait-anxiety (the propensity to depression and anxiety). Nine hundred and eighty two participants completed self-report measures of metacognitions and trait-anxiety at time 1, and 425 individuals completed the same measures 8 weeks later. At the cross-sectional level, metacognitions accounted for 83% of the variance in anxiety- and 64% of depression propensity. Furthermore, despite both domains of trait-anxiety showing high stability over time, negative- and positive metacognitive beliefs were significant prospective predictors of both domains of vulnerability. These findings suggests that metacognitive beliefs may be an underlying mechanism of vulnerability attributed to trait-anxiety with the implication that the metacognitive (S-REF) model informs conceptualization of psychological vulnerability, and that metacognitive therapy applications might be employed to enhance psychological resilience.

The Self-Regulatory Executive Function model is the basis of metacognitive therapy and proposes that psychological disorders are caused by maladaptive beliefs about thinking (metacognitive beliefs) and a perseverative negative thinking style associated with them, named the cognitive attentional syndrome (CAS). The CAS-1 was devised and has been used as a clinical tool for assessment and monitoring of the cognitive attentional syndrome and underlying positive-and negative metacognitive beliefs during the course of treatment. The aim of this study is to assess the psychometric properties of the CAS-1. Seven-hundred and seventy-three participants completed a battery of self-report questionnaires at the crosssectional level, and 431 individuals also completed the same measures 6-and 12 weeks later.Confirmatory factor analysis supported the proposed three-factor solution of the measure, and the factors demonstrated good internal consistency (α ranging from .77 to .89), convergent validity, incremental validity, stability and discriminative validity were satisfactory. Our findings support the continued use of the CAS-1 in clinical and research settings.

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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.

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.

This study set out to test metacognitive beliefs and perspective taking in self-imagery as predictors of negative selfevaluation 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.

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.

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.