Metacognition & Health Anxiety.

Abstract

The development, maintenance, and treatment of health anxiety remains an important area in psychological research. The cognitive behavioural therapy (CBT) model has gained popularity, as an evidence-based approach for explaining and treating health anxiety (Barsky & Ahern, 2004; Clark, et al., 1998; Warwick, et al., 1996). However, significant limitations exist, not least because treating illness-related cognitions appears not to confer much advantage over other treatment approaches. An emerging psychological approach, Metacognitive Therapy (Wells & Matthews, 1994), may offer an alternative approach for understanding and treating this disorder. In this thesis the predictions made by the metacognitive model and applied to health anxiety were tested using data from cross sectional, longitudinal and treatment designs. In Chapter 2 a cross sectional study investigated whether metacognition was associated with health anxiety when controlling for other factors (i.e., neuroticism, somatosensory amplification, and illness cognition). Results indicated a strong positive association between metacognition and health anxiety, and demonstrated the predictive potential of specific metacognitions over and above other established correlates of symptoms. In Chapter 3exploratory and confirmatory factor analysis was used to develop a specific metacognitive measure. This resulted in a 14 item, three factor measure, with further analysis suggesting good internal-consistency, incremental, convergent and discriminant validity. Preliminary findings from this study support the assessment of health-anxiety specific metacognitions with this new tool. Chapter 4 expanded the findings of chapter 2 and directly compared key aspects of the metacognitive model (metacognition) with the cognitive model (dysfunctional beliefs). Metacognitive beliefs were found to explain almost half of the variance in health anxiety when controlling for dysfunctional illness beliefs, and emerged as the strongest independent predictors. These data support a key component of the metacognitive model, that metacognition may be more important in health anxiety than symptom/illness-related beliefs. In Chapter 5 & 6 both cross-sectional and longitudinal designs explored the relationship between cognition (catastrophic misinterpretation), and metacognition. Consistent with the metacognitive model the effect of cognition on health anxiety was explained by an interaction with metacognition. The results of these findings add further weight to the idea that metacognition may be more important in both the development and maintenance of health anxiety than cognition. Finally, in Chapter 7 an A-B single case series treatment design (N=4) was used to investigate the effects associated with metacognitive therapy (MCT) applied to health anxiety. The results showed that all four patients treated with MCT demonstrated large and clinically meaningful improvements in health anxiety both at post treatment and follow up. These improvements also corresponded with substantial changes in patients metacognitive beliefs. Overall this case series provides preliminary evidence that MCT can be applied to health anxiety. Collectively the results of this thesis provide new insights into the role played by metacognition in health anxiety. It provides evidence for a role of metacognition in both the development and maintenance of health anxiety, and indicates that targeting metacognition can be applied in treatment of these patients and may bring about a reduction in health anxiety symptoms.

Date of Award	1 Aug 2017
Original language	English
Awarding Institution	The University of Manchester
Supervisor	Adrian Wells (Supervisor)