Abstract
Metacognitive Therapy (MCT) is a recent treatment with established efficacy in mental health settings. MCT is grounded in the Self-Regulatory Executive Function (S-REF) model of emotional disorders and treats a negative perseverative style of thinking called the cognitive attentional syndrome (CAS), thought to maintain psychological disorders, such as anxiety and depression. The evaluation of effective psychological therapies for anxiety and depression in chronic physical illness is a priority and research in this area depends on the suitability and validity of measures assessing key psychological constructs. The present study examined the psychometric performance of a ten-item scale measuring the CAS, the CAS-1R, in a sample of cardiac rehabilitation patients experiencing mild to severe symptoms of anxiety and/or depression (N = 440). Participants completed the CAS scale, the Hospital Anxiety and Depression Scale and the Metacognitions Questionnaire 30 (MCQ-30). The latent structure of the CAS-1R was assessed using confirmatory factor analyses (CFA). In addition, the validity of the measure in explaining anxiety and depression was assessed using hierarchical regression. CFA supported a three-factor solution (i.e., coping strategies, negative metacognitive beliefs and positive metacognitive beliefs). CFA demonstrated a good fit, with a CFI = 0.988 and an RMSEA = 0.041 (90% CI = 0.017–0.063). Internal consistency was acceptable for the first two factors but low for the third, though all three demonstrated construct validity and the measure accounted for additional variance in anxiety and depression beyond age and gender. Results support the multi-factorial assessment of the CAS using this instrument, and demonstrate suitability for use in cardiac patients who are psychologically distressed.
Highlights
Coronary heart disease is the leading cause of death for adult men and women worldwide in developed countries (World Health Organization, 2017)
We report the Chi-square statistic, but goodness-of-fit decisions were not based on this as it is known to be sensitive to sample size and to large correlations between factors within the model, making it an unreliable criterion for detecting well-fitting models (Tanaka, 1987)
Results of the confirmatory factor analyses (CFA) showed that the best fit for the CAS1R data in cardiac patients experiencing emotional distress corresponded to a three-factor model distinguishing between unhelpful coping strategies, negative and positive metacognitive beliefs, supporting the value in separating these constructs
Summary
Coronary heart disease is the leading cause of death for adult men and women worldwide in developed countries (World Health Organization, 2017). Anxiety and depression have been associated with adverse outcomes, such as increased risk of mortality and increased risk of future cardiac problems, poorer quality of life, poorer treatment adherence, and greater health care use (Thombs et al, 2008; Frasure-Smith and Lesperance, 2010; Palacios et al, 2018). Following a cardiac event or procedure, patients are offered cardiac rehabilitation (CR) to improve health outcomes and prevent future cardiac problems (Lesperance and Frasure-Smith, 2000). 18% experienced borderline or clinical levels of depression before starting CR and 12% continued to report depression afterwards (British Heart Foundation, 2018). The variation of improvement across CR programmes ranged from −13 to 43.6% for anxiety and from −12.5 to 36.4% for depression, suggesting that some patients got worse and a substantial number of them did not achieve the national average change in levels of anxiety and/or depression after CR (British Heart Foundation, 2018)
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