Residual Anxiety in Patients with Bipolar Disorder in Full or Partial Remission: Metacognitive Beliefs and Neurocognitive Function

Abstract

Maladaptive metacognitive beliefs are frequent during depressive states of bipolar disorder (BD). Still, it is unclear whether they persist in remitted phases and play a role in patients’ residual anxiety. The study aimed to investigate whether remitted patients with BD display maladaptive metacognitive beliefs, and whether these beliefs are associated with more residual anxiety and lower attention control. Patients with BD in full remission (n = 28) and healthy control participants (HCs) (n = 31) were assessed with self-reported questionnaires measuring metacognitions, anxiety, attention, and a screening for cognitive impairment as well as two computerised attention tasks. Patients with BD exhibited higher levels of maladaptive metacognitive beliefs than HCs, also after adjustment for subsyndromal mood symptoms. Patients with BD also showed reduced attention control and cognitive impairments. Across the entire sample, more maladaptive metacognitive beliefs were associated with more anxiety symptoms, poorer cognition and lower attention control. Maladaptive metacognitive beliefs are associated with residual anxiety in remitted patients with BD. Treatments that specifically target maladaptive metacognitive beliefs may have potential to reduce anxiety in remitted phases of BD and enhance patients’ functional recovery and quality of life.