The Role of Metacognition in Suicidal Thinking and Rumination

  • Robert Hallard

Student thesis: Doctor of Clinical Psychology


The Self-Regulatory Executive Function (S-REF) model (Wells & Matthew, 2015) states that psychological disorder results from an unhelpful thinking style called the Cognitive Attentional Syndrome (CAS). The CAS incorporates worry/rumination, threat monitoring and unhelpful thought control strategies and is controlled by erroneous metacognitive beliefs. The contribution of the S-REF model to the understating of rumination (paper one) and suicidal ideation (paper two) is evaluated within this thesis. Rumination is one component of the CAS. According to the S-REF model, its execution is guided by metacognitive beliefs. Paper one describes a systematic review and meta-analysis that was undertaken to establish the nature and strength of the relationships between rumination and metacognitive beliefs. Robust relationships, of moderate strength, were observed between rumination and beliefs about its benefits and between rumination and beliefs about its negative consequences. Future research should aim to delineate causality in the observed relationships and consider confounder variables. In paper two it is argued that the S-REF conceptualisation represents a promising new approach to the understanding of suicidal ideation. The importance of considering CAS processes was supported by the study findings. Worry and punishment-related thought control strategies, alongside rumination, predicted suicidal ideation. Distraction, social control and reappraisal strategies negatively predicted suicidal ideation. Some evidence that CAS processes were controlled by erroneous metacognitive beliefs was also obtained. However, this was not conclusive and should be considered again in a larger sample. Paper three describes the development of papers one and two in more detail, highlighting and justifying the important decisions made. Further reflections on methodology are also provided to demonstrate the learning achieved.
Date of Award31 Dec 2017
Original languageEnglish
Awarding Institution
  • The University of Manchester
SupervisorAdrian Wells (Supervisor) & Daniel Pratt (Supervisor)


  • S-REF
  • thought control
  • meta-analysis
  • suicide
  • rumination
  • metacognition
  • ESM

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