Metacognition and Social Anxiety

Abstract

Social anxiety disorder is a common, debilitating condition involving fear of scrutiny and/or negative evaluation in social situations. Two prominent models, namely Clark and Wells' (1995) cognitive model of social anxiety and Wells and Matthews' (1994, 1996) transdiagnostic metacognitive model, offer competing explanations regarding the processes hypothesised to underlie this condition. While the former prioritises maladaptive cognitive beliefs about the social self (e.g. "I'm boring"), the latter suggests metacognitive beliefs (e.g. "I cannot control my worrying") are the key factor. Subsequently, both models have different implications regarding the conceptualisation and treatment of social anxiety disorder. This body of work aimed to investigate the cognitive and metacognitive beliefs relevant to this condition, in addition to providing preliminary exploration of the use of Metacognitive Therapy (MCT) for adolescents presenting with social anxiety. Paper One aimed to quantify the associations between social anxiety and both cognitive beliefs (high standards, conditional and unconditional beliefs) and metacognitive beliefs (including positive and negative beliefs about thinking). Findings from nine random effects meta-analyses suggest that metacognitive beliefs, particularly negative beliefs about uncontrollability and danger of thoughts and need to control thoughts, may be as relevant as cognitive beliefs in social anxiety. However, results should be interpreted with caution given the considerable statistical heterogeneity apparent and the small number studies identified investigating metacognitive beliefs. Recommendations for future research and clinical implications are discussed. Paper Two aimed to investigate the feasibility and acceptability of MCT for socially anxious adolescents and explore the effects associated with this treatment using an A-B case replication design with follow-up. Six adolescents were offered eight weekly sessions of MCT. Preliminary findings support the use of MCT as a feasible and acceptable intervention with this client group. Furthermore, MCT was associated with reliable improvements in social anxiety symptoms in four out of five patients at follow-up. A reduction in the mechanisms implicated in the maintenance of social anxiety was also seen in most cases. Results support more rigorous exploration via appropriately powered controlled trials. Paper Three provides a critical appraisal of both papers, as well as providing further information and justification regarding the planning and implementation of both the empirical and meta-analytic studies. Reflections on the overall research process are also discussed.

Date of Award	31 Dec 2019
Original language	English
Awarding Institution	The University of Manchester