Abstract
The evaluation of effective psychological therapies for anxiety and depression in cardiac patients is a priority, and progress in this area depends on the suitability and validity of measures. Metacognitive Therapy is a treatment with established efficacy in mental health settings. It postulates that anxiety and depression are caused by dysfunctional metacognitions, such as those assessed with the Metacognitions Questionnaire 30 (MCQ-30), which impair effective regulation of repetitive negative thinking patterns. The aim of this study was to examine the psychometric properties of the MCQ-30 in a cardiac sample. A sample of 440 cardiac patients with co-morbid anxiety and/or depression symptoms completed the MCQ-30 and the Hospital Anxiety and Depression Scale. Confirmatory factor analysis (CFA) was used to test established factor structures of the MCQ-30: a correlated five-factor model and a bi-factor model. The five-factor model just failed to meet our minimum criteria for an acceptable fit on Comparative Fit Index (CFI) = 0.892 vs. criterion of ≥ 0.9; but was acceptable on the Root Mean Square Error of Approximation (RMSEA) = 0.061 vs. ≤ 0.08; whereas the bi-factor model just met those criteria (CFI = 0.913; RMSEA = 0.056). These findings suggest that the bi-factor solution may carry additional information beyond the five subscale scores alone. However, such a model needs to be evaluated further before widespread adoption could be recommended. Meantime we recommend cautious continued use of the five-factor model. Structural issues aside, all five subscales demonstrated good internal consistency (Cronbach alphas > 0.7) and similar relationships to HADS scores as in other patient populations. The MCQ-30 accounted for additional variance in anxiety and depression after controlling for age and gender.
Highlights
Anxiety and depression are common among patients with heart disease (Chaddha et al, 2016; Kosela et al, 2016; ChauvetGelinier and Bonin, 2017) and have been associated with adverse outcomes such as increased risk of mortality, poorer quality of life, and greater health care use (Palacios et al, 2018)
Metacognitive therapy (MCT) is based on an information processing model (SelfRegulatory Executive Function; S-REF) which postulates that metacognition plays a key role in the development and maintenance of anxiety and depression by causing perseverative negative thinking styles (Wells and Matthews, 1994, 1996)
We investigated the applicability of both factor models of the Metacognitions Questionnaire 30 (MCQ-30) in this population, but because this is the first study exploring the psychometric properties of the MCQ-30 in cardiac patients, we aimed to explore if an alternative factor structure might prove a better fit to the data
Summary
Anxiety and depression are common among patients with heart disease (Chaddha et al, 2016; Kosela et al, 2016; ChauvetGelinier and Bonin, 2017) and have been associated with adverse outcomes such as increased risk of mortality, poorer quality of life, and greater health care use (Palacios et al, 2018). Two broad categories of metacognitive beliefs are distinguished in MCT: positive metacognitive beliefs, concerned with the advantages of worry, rumination and paying attention to threat; and negative metacognitive beliefs, focused on the concept that worrying/rumination is uncontrollable and/or dangerous (Wells, 2009). These metacognitions are thought to lead to a persistence of negative thinking in response to stress because they bias mental control in a way that undermines effective self-regulation (Wells, 2009)
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