Catastrophic Misinterpretation Research Articles

An Integrated Therapeutic Application Using Elements of Cognitive Behavioral Therapy and Mindfulness-based Cognitive Therapy in Treatment of Panic Disorder

The commonly used protocol for the treatment of panic disorder has been the application of cognitive behavioral therapy (CBT). With the advent of third-wave psychotherapies such as acceptance and commitment therapy, dialectical behavioral therapy, and mindfulness-based cognitive therapy (MBCT), which focuses on experiential acceptance, there have been variations in the treatment of panic disorder. However, no case report has adopted an integrated treatment protocol using elements of CBT and MBCT. Here, we have presented a practical psychotherapy report of a 31-year-old woman who was treated over 16 sessions using such an integrated treatment protocol based on her personality and clinical profile. During the first phase of treatment, components of CBT were introduced to help her obtain firsthand evidence of her catastrophic misinterpretation of bodily sensations and to change her underlying threat schemas related to physical sensations. Aspects of MBCT were implemented in the intermediate phase to allow awareness and observation of her anxiety sensitivity, discourage immediate reactivity, and reduce overall catastrophizing tendencies. Moreover, MBCT also served to prevent relapse by enriching her overall quality of life by cultivating present-moment awareness through encouraging full engagement in experiences rather than being consumed by future-oriented concerns.

Understanding and Managing Anxiety Sensitivity During Critical Illness and Long-Term Recovery.

Anxiety sensitivity is a fear of symptoms associated with anxiety (eg, rapid respiration and heart rate, perspiration), also known as "fear of fear." This fear is a misinterpretation of nonthreatening symptoms as threatening across 3 domains: physical ("When my heart rate increases, I'm afraid I may have a heart attack"), social ("If people see me perspire, I fear they will negatively evaluate me"), and cognitive ("When I feel these symptoms, I fear it means I'm going crazy or will lose control and do something dangerous like disconnect my IV"). These thoughts stimulate the sympathetic nervous system, resulting in stronger sensations and further catastrophic misinterpretations, which may spiral into a panic attack. Strategies to address anxiety sensitivity include pharmacologic and nonpharmacologic interventions. In intensive care unit settings, anxiety sensitivity may be related to common monitoring and interventional procedures (eg, oxygen therapy, repositioning, use of urine collection systems). Anxiety sensitivity can be a barrier to weaning from mechanical ventilation when patients are uncomfortable following instructions to perform awakening or breathing trials. Fortunately, anxiety sensitivity is a malleable trait with evidence-based intervention options. However, few health care providers are aware of this psychological construct and available treatment. This article describes the nature of anxiety sensitivity, its potential impact on intensive care, how to assess and interpret scores from validated instruments such as the Anxiety Sensitivity Index, and treatment approaches across the critical care trajectory, including long-term recovery. Implications for critical care practice and future directions are also addressed.

Using the ABC theory of emotion to examine the relationship between health anxiety and health information-seeking behavior among the rural population.

The aim of the current study was to explore the relationship between online and offline health information-seeking behaviors, as antecedents and consequences, and health anxiety and related belief factors in rural residents. Based on the ABC theory of emotions (ABC model), this study developed two theoretical models of the association between health anxiety and health information-seeking behavior: Placing health information-seeking behavior (both online and offline) as an outcome and antecedent, respectively, and setting three belief factors of the perceived health threat, intolerance of uncertainty, and catastrophic misinterpretations. We collected 730 self-reported data points from 20 June to 5 July 2022 for rural residents in China and empirically tested the research model and hypotheses using partial least squares-based structural equation modeling. The perceived health threat and intolerance of uncertainty are significant motivators of health anxiety, and health anxiety has a direct beneficial effect on both online and offline health information-seeking behaviors. Health anxiety is influenced either directly or indirectly by catastrophic misinterpretations resulting from online health information-seeking, while offline health information-seeking behavior does not contribute as strongly to health anxiety directly but mainly reinforces it through the mediating influence of catastrophic misinterpretations. Rural residents' health anxiety promotes their online and offline health information behaviors. And both their online and offline health information-seeking behaviors may promote health anxiety directly and through catastrophic misinterpretations. Comparing the two, online health information-seeking behaviors primarily exacerbate health anxiety through direct effects, whereas offline health information-seeking behaviors primarily affect health anxiety through catastrophic misinterpretations. We provide suggested guidelines for alleviating health anxiety and regulating health information behaviors among rural residents.

Mechanisms underlying interoceptive exposure: belief disconfirmation or extinction? A preliminary study

ABSTRACT Interoceptive exposure, or exposure to one’s feared physical sensations, has been shown to be an important technique in cognitive behavioral therapies for anxiety disorders and related constructs, such as anxiety sensitivity (AS). The current study sought to further clarify the underlying cognitive-behavioral mechanisms of interoceptive exposure in a lab-based, analog study with individuals high in AS. Participants (n = 59) were randomized into three groups: a cognitive-behavioral intervention emphasizing belief disconfirmation (CbI), a behavioral intervention emphasizing exposure (BI), and a control condition. Self-report measures assessing AS, catastrophizing of bodily sensations, and subjective units of distress (SUDS) were collected before, during and after the intervention. Participants also completed online questionnaires at a one-month follow-up. Following the CbI but not BI, a decrease was observed in both AS and catastrophizing interpretations. Furthermore, only the CbI group exhibited a decrease in SUDS ratings, whereas the BI group exhibited a significant increase. Notably, these effects were not maintained at a one-month follow-up. Findings suggest that cognitive interventions without repeated behavioral exposure may be sufficient in reducing self-reported anxiety-related symptoms and catastrophic misinterpretations, though not at maintaining them. This raises questions regarding the role of pure behavioral mechanisms in exposure.

Adolescents’ lived experience of panic disorder: an interpretative phenomenological analysis

BackgroundPanic disorder is a debilitating anxiety disorder that has a serious impact on adolescents’ social and academic functioning and general wellbeing. Panic disorder is experienced by around 1 to 3% of the adolescent population. The aim of this study was to examine adolescents’ experiences of having panic disorder.MethodsSemi-structured interviews were conducted with eight adolescents with a primary diagnosis of panic disorder. Interpretative Phenomenological Analysis was used to gain an understanding of adolescents’ lived experience of panic disorder.ResultsTwo superordinate themes were identified: (1) Drowning in sensations, and (2) An unacceptable self. The findings show that adolescents experience panic disorder as extremely overwhelming and unpleasant, with debilitating feelings of drowning in sensations. Adolescents’ experiences largely fit with the cognitive model of panic, in which catastrophic misinterpretation of bodily sensations is associated with anxiety, avoidance, and safety behaviours, creating a vicious cycle. Attempts to avoid or prevent the attacks appear to inadvertently make them worse. Social worries, feeling broadly misunderstood, and unhelpful responses from others, contributed to feelings of being different or abnormal and were connected to a negative self-concept. Negative social interactions with teachers and peers in the school environment were particularly damaging.ConclusionsThese findings offer new insight into these adolescents’ lived experience of panic disorder and highlight the need for adolescents to access timely, evidence-based treatment, as well as the need for increased awareness and understanding of panic disorder in schools.

Anxiety sensitivity, uncertainty and recursive thinking: A continuum on Cyberchondria conditions during the Covid Outbreak

Background. Cyberchondria is a term used to refer to excessive surfing the web looking for health care information, excessive checking behavior being related to health-related anxiety. This period of quarantine for the Covid-19 pandemic is increasing the pathological use of the internet, and the excessive surfing the web looking for health care information. Another dimension related to the Covid-19 outbreak refers to uncertainty intolerance, for this reason being necessary for the healthcare professionals to provide clear and linear information. Aim. The aim of this review is to identify the psychological correlations connected to cyberchondria in the quarantine period. Methods. Following the PRISMA guidelines, we carried out a systematic review of the literature on PubMed. The terms used for the search were “Cyberchondria” OR “Anxiety” AND “Quarantine”. Results. As resulting from the reviewed literature, there is a relationship between anxiety for one’s own state of health and cyberchondria, with negative psychological effects of quarantine, including post-traumatic stress symptoms, depression, anxiety, low mood, irritability, insomnia, uncertainty, emotional exhaustion, this condition being associated with hypervigilance, and catastrophic misinterpretation of bodily signs. Conclusion. In the light of this and according to the literature, it would be desirable that research can further explore the factors influencing the increase in cyberchondria in the future.

Factors influencing health anxiety: the stimulus–organism–response model perspective

PurposeWith the popularity of the internet, access to health-related information has become more convenient. However, the easy acquisition of e-health information could lead to unfavorable consequences, such as health anxiety. The purpose of this paper is to explore a set of important influencing factors that lead to health anxiety.Design/methodology/approachBased on the stimulus–organism–response (S-O-R) framework, we propose a theoretical model of health anxiety, with metacognitive beliefs and catastrophic misinterpretation as the mediators between stimulus factors and health anxiety. Using 218 self-reported data points, the authors empirically examine the research model and hypotheses.FindingsThe study results show that anxiety sensitivity positively affects metacognitive beliefs. The severity of physical symptoms has a significant positive impact on catastrophic misinterpretation. Metacognitive beliefs and catastrophic misinterpretation have significant positive impacts on health anxiety.Originality/valueBased on the S-O-R model, this paper develops a comprehensive model to explain health anxiety and verifies the model using firsthand data.

Adventurous Play as a Mechanism for Reducing Risk for Childhood Anxiety: A Conceptual Model

In this conceptual article, we draw upon the literature regarding cognitive and behavioural factors that underpin childhood anxiety to outline how a range of these risk markers might be targeted through adventurous play. When children play in an adventurous way, climbing trees, riding their bikes fast downhill and jumping from rocks, they experience feelings of fear and excitement, thrill and adrenaline. We propose that the positive, thrilling and playful emotions associated with this type of child-led play facilitate exposure to fear-provoking situations and, in doing so, provide opportunities for children to learn about physiological arousal, uncertainty and coping. We hypothesise that these learning opportunities will, over time, reduce children’s risk for elevated anxiety by increasing children’s expectations and ability to cope with anxiety, decreasing intolerance of uncertainty and preventing catastrophic misinterpretations of physiological arousal. If our conceptual model is correct, then ensuring that children have the physical and psychological space required to play in an adventurous way may help to decrease their risk for elevated or clinical anxiety.

Are Catastrophic Misinterpretations of Bodily Sensations Typical for Patients with Panic Disorder? An Experimental Study of Patients with Panic Disorder or Other Anxiety Disorders and Healthy Controls

BackgroundResearch on catastrophic misinterpretations of bodily sensations in patients with a diagnosis of panic disorder has yielded inconsistent findings concerning the question of how typical these misinterpretations are and how this compares with other anxiety disorders. Limitations of assessment strategies concerning catastrophic misinterpretations have been discussed. We assessed catastrophic misinterpretations by activating participants’ fear memory, as has been suggested.MethodsParticipants in the experimental group (EG) were shown a suspenseful film clip to induce physiological arousal before completing a measure of catastrophic misinterpretation (BSIQ-FR). Skin conductance level (SCL) was used as marker for physiological arousal.ResultsAs expected, the film manipulation led to a significant increase in physiological arousal in the EG compared to the control group (CG) across all disorder groups. ANOVAs did not show significant interactions between factors Group (Panic Disorder, Other Anxiety Disorder, and Healthy Controls) and Condition (EG, CG). However, comparison of means indicated that participants with panic disorder showed more catastrophic misinterpretations of bodily sensations than patients with other anxiety disorders in the EG, but not in the CG.ConclusionsThe findings indicate that the activation of fear memory via induction of physiological arousal facilitated the measurement of catastrophic misinterpretations, and provide further evidence that catastrophic misinterpretations of bodily sensations are typical for panic disorder.

Does physiological arousal lead to increased catastrophic misinterpretation? An experiment based on the concept of a fear memory

BackgroundWhile there has been research on catastrophic misinterpretation of ambiguous situations and on the effects of the induction of physiological arousal, there has been no experimental research on the relationship between them. Based on the concept of a fear memory, we aimed to investigate if the induction of physiological arousal leads to catastrophic misinterpretations.MethodsParticipants were shown either a suspenseful film clip to induce physiological arousal (EG, n = 43) or a calm film clip with no specific effect on arousal levels (CG, n = 40) before completing a measure of catastrophic misinterpretation (BSIQ-FR). To assess the specific predictive value of physiological arousal, measurements of other known predictors were included (BSI, BDI-II, ACQ, BSQ, STAI-T, ASI-3).ResultsThe film manipulation led to a significant increase in physiological arousal in the EG but not in the CG. The EG did not report more catastrophic misinterpretations than the CG – however, more participants in the EG reported at least one catastrophic misinterpretation. The increase in physiological arousal due to the film manipulation predicted catastrophic misinterpretation in the open response format in the EG, but not in the CG, even when controlling for other known predictors.ConclusionsOur study provides evidence that experimentally induced physiological arousal can predict catastrophic misinterpretation. The findings support the concept of a fear memory. With the BSIQ-FR, a German questionnaire measuring catastrophic misinterpretation was introduced. Further research on the relationship between physiological arousal and catastrophic misinterpretation with clinical samples is recommended.

Personality as Mediator Between Catastrophic Misinterpretation and Metacognitive Beliefs

Personality as Mediator Between Catastrophic Misinterpretation and Metacognitive Beliefs

Importance of knowledge in the behavioural treatment of panic disorder.

Cognitive behavioural therapy (CBT) for panic disorder encourages patients to learn about and make changes to thoughts and behaviour patterns that maintain symptoms of the disorder. Instruments to assess whether or not patients understand therapy content do not currently exist. The aim of this study was to examine if increases within specific knowledge domains of panic disorder were related to improvement in panic symptoms following an intensive 2-day panic treatment. Thirty-nine Veterans enrolled in an intensive weekend panic disorder treatment completed knowledge measures immediately before the first session of therapy and at the end of the last day of therapy. Four panic disorder experts evaluated items and reached consensus on subscales. Subscales were reduced further to create psychometrically sound subscales of catastrophic misinterpretation (CM), behaviours (BE), and self-efficacy (SE). A simple regression analysis was conducted to determine whether increased knowledge predicted symptom change at a 3-month follow-up assessment. The overall knowledge scale was reduced to three subscales BE (n = 7), CM (n = 13) and SE (n = 8) with good internal consistency. Veterans' knowledge of panic disorder improved from pre- to post-treatment. Greater increase in scores on the knowledge assessment predicted lower panic severity scores at a 3-month follow-up. A follow-up analysis using the three subscales as predictors showed that only changes in CM significantly contributed to the prediction. In an intensive therapy format, reduction in panic severity was related to improved knowledge overall, but particularly as a result of fewer catastrophic misinterpretations.

Can Brief, Daily Training Using a Mobile App Help Change Maladaptive Beliefs? Crossover Randomized Controlled Trial.

BackgroundObsessive-compulsive disorder (OCD) is a disabling condition with a wide variety of clinical presentations including contamination fears, fear of harm, and relationship-related obsessions. Cognitive behavioral models of OCD suggest that OC symptoms result from catastrophic misinterpretations of commonly occurring intrusive experiences and associated dysfunctional strategies used to manage them. OCD-related maladaptive beliefs including inflated responsibility, importance and control of thoughts, perfectionism, and intolerance for uncertainty increase the likelihood of such misinterpretations.ObjectiveConsidering accumulating evidence suggesting that mobile health (mHealth) apps based on cognitive-behavioral principles may lead to significant reductions in psychopathological symptoms, we assessed the effectiveness of a novel cognitive training app (GGRO) designed to challenge OCD-related beliefs.MethodsA total of 97 students were randomized to groups undertaking immediate-use (iApp) or delayed use (dApp) of GGRO. All participants were requested to complete Web-based assessments, with questionnaires relating to maladaptive beliefs, mood, and OC symptoms at baseline (T1), 15 days from baseline (T2), and 30 days from baseline (T3). Participants in iApp group started using the app at baseline and continued using the app for 15 consecutive days. They were then requested to stop using the app until T3. Participants in the dApp group were requested to wait for 15 days and only then start using the app (crossover) for 15 consecutive days.ResultsAll participants used the app for a mean of 14.07 (SD 1.41) days with 2.94 levels per day. Consistent with previous findings, app use was associated with medium-large effect size reductions in both iApp (n=51) and dApp (n=46) groups. In the iApp group, all effects remained significant during the 15 days of follow-up. Analyses focusing on the first two assessment occasions revealed significant treatment × repeated measures interactions on maladaptive beliefs, several OC symptom measures, and self-esteem.ConclusionsThis study provides further evidence for the efficacy of GGRO as a mobile-delivered training exercise that is useful for reducing OCD-related beliefs and symptoms.Trial RegistrationClinicalTrials.gov NCT03571464; https://clinicaltrials.gov/ct2/show/NCT03571464 (Archived by WebCite at http://www.webcitation.org/7675sYPsH)

Catastrophic misinterpretation of bodily sensations and external events in panic disorder, other anxiety disorders, and healthy subjects: A systematic review and meta-analysis.

The catastrophic misinterpretation model of panic disorder (PD) predicts that the catastrophic misinterpretation of bodily sensations is a distinctive characteristic of PD. Existing research on this prediction has produced mixed findings. This paper presents a systematic review and meta-analysis of studies comparing the strength of catastrophic misinterpretation of bodily sensations and external events in patients with PD, patients with other anxiety disorders, and healthy controls. Following a systematic screening, seven studies were included in the meta-analysis. For the catastrophic misinterpretation of bodily sensations, analyses showed medium to large effects between patients with PD and healthy controls and between patients with PD and patients with other anxiety disorders. For the catastrophic misinterpretation of external events, analyses showed medium to large effects between patients with PD and healthy controls and a small negative effect between patients with PD and patients with other anxiety disorders. The findings support the assumption that the catastrophic misinterpretation of bodily sensations is a distinctive characteristic of panic disorder and thus lend support to the catastrophic misinterpretation model of PD.

A novel approach to challenging OCD related beliefs using a mobile-app: An exploratory study

Background and objectivesAccording to cognitive models, obsessive compulsive symptoms result from catastrophic misinterpretations of commonly occurring intrusive experiences and the use of counterproductive strategies to manage them. Obsessive Compulsive Disorder (OCD) related beliefs such as inflated responsibility, importance of thoughts and perfectionism increases the likelihood of such misinterpretations. Consistent with a growing body of literature supporting the usefulness of mobile delivered technologies in fostering cognitive behavior change, the present study assessed the effectiveness of a novel cognitive training exercise designed to challenge OCD-related beliefs. This mobile app training exercise consists of users having to pull statements challenging OCD beliefs towards themselves (downwards) and to throw away (push upwards) contra-productive self-statements. Methods36 third-year BA students started the trial. Twenty completed pre and post measures of OCD-beliefs, mood and OCD symptoms including relationship-obsessions. Participants were instructed to complete 3 min of daily training for a period of 15 days. ResultsNo significant differences were found between completers and non-completers on demographic and most symptom related measures at Time 1. Repeated-measures MANOVA of the 20 completers showed a significant reduction on all OCD symptoms measures and on OCD-beliefs. No significant reduction was found in depression symptoms. Regression analysis showed change in levels of OCD-beliefs was associated with reduction in OCD symptoms at Time 2 over and above OCD symptoms at Time 1. LimitationsThe study is an open trial with non-clinical participants. ConclusionsThis mobile delivered training exercise may be useful for the reduction and relapse prevention of OCD-related beliefs and symptoms.

'You've got your own demons that you've got to fight every day': A qualitative exploration of how people respond to the experience of psychosis.

Cognitive models of psychosis implicate how people respond to their distressing experiences in the maintenance of such experiences. Safety-seeking behaviours, which are employed in response to a catastrophic misinterpretation of threat, are viewed as unhelpful maintenance factors. However, the concept of safety seeking was developed in relation to anxiety disorders, and there may be additional complexities that apply in relation to the experience of psychosis. The ways in which people respond to their distressing experiences of psychosis are complex, multifaceted, and changeable, and qualitative research is needed to further the understanding of this process. A qualitative study was conducted using grounded theory methodology. In-depth interviews were conducted with fifteen participants who had experience of psychosis. A core category of fighting a daily battle to maintain functioning was identified. Related to this, three main themes also emerged. These were the perceived importance of responses, appraisal of threat, and perceived ability to control experiences. These categories are interrelated in that an increase in one is likely to result in increases in the others. Although these results provide partial support for the traditional view of safety-seeking behaviours, they also demonstrate further complexities in the way that distressing psychotic experiences are responded to. This has implications for cognitive behavioural therapy where emphasis is often placed on dropping safety-seeking behaviours. The traditional emphasis in cognitive behavioural therapy on dropping safety-seeking behaviours may not always be appropriate. This approach could have an impact on engagement in therapy and have the effect of reducing the client's feelings of choice and control. A detailed assessment of strategies used historically and how these may have been helpful previously, for example, suspiciousness, and withdrawal as a survival strategy should be conducted. The therapist should support the client to evaluate the importance of their responses alongside the accuracy of both threat appraisals and perceptions of ability to control experiences.

The effect of Korean-group cognitive behavioural therapy among patients with panic disorder in clinic settings.

Introduction In panic disorder, sensitivity to bodily sensations increases due to the patient's cognitive vulnerability. Cognitive behavioural therapy (CBT) can help to decrease sensitivity to bodily sensations by correcting these cognitive distortions by controlling negative thoughts and panic attacks. Aims This study verified whether group CBT is more effective than treatment as usual (TAU) in South Korean patients with panic disorder. Methods The study participants consisted of 76 panic disorder patients. Patients in the therapy condition attended sessions once a week for a total of 12 sessions in addition to drug treatment. Results In the therapy condition, there were significant decreases in panic-related bodily sensations and ranking and belief scores for catastrophic misinterpretation of external events. Discussion Group CBT, in comparison to TAU, decreases panic and agoraphobia symptom severity in South Korean patients with panic disorder. Our study provides evidence for the effectiveness of a panic disorder management programme that integrates group CBT and traditional pharmacotherapeutic treatment for patients with panic disorder. Implications for Practice The cognitive behavioural approach is needed to reduce panic and agoraphobia symptoms for hospitalized patients with panic disorder more than activity therapies, medications and supportive counselling by doctors and nurses.

A New CBT Model of Panic Attack Treatment in Comorbid Heart Diseases (PATCHD): How to Calm an Anxious Heart and Mind

Treating anxiety comorbid with heart disease is challenging due to (a) diagnostic overlap between anxiety and heart disease, (b) the high risk associated with ignoring chest pain symptoms and delaying seeking medical attention, (c) that cognitive-behavioral therapy based on catastrophic misinterpretation of bodily symptoms requires adaption to incorporate the element of risk, and (d) that certain interoceptive symptom induction experiments may be harmful and are therefore fraught with liability. We describe Panic Attack Treatment in Comorbid Heart Diseases (PATCHD) that is based on enhancing coping skills, performing safe interoceptive exposures and supervised exercise, and countering avoidance to reduce panic attack frequency. Pre- and posttreatment data from 18 patients shows a significant reduction in cardiovascular hospital admissions and length of stay, panic attacks, general anxiety, and depression (all p<.05). Because of the complex nature of panic disorder comorbid with heart disease, health professionals should familiarize themselves with several necessary CBT adaptions.

Grief cognitions and cognitive-emotional regulation associated with romantic breakup distress among college students

IntroductionIndividuals manage differently the experience of a romantic breakup [RB]. These differences may in part be related to the use of different cognitive-emotional regulation strategies [CERS]. Also, global negative beliefs and catastrophic misinterpretations regarding the RB may contribute to the emotional distress (Boelen and Reijntjes, 2009).ObjectivesTo explore the associations between CERS, grief cognitions related to RBs, and depression and suicidal ideation/behaviors in a sample of college students.AimsTo conduct regression analyses to predict depression, anxiety, hostility, and suicide behaviors from CERS and grief cognitions (as independent variables).MethodsCross-sectional, self-report data was collected from 359 college students who experienced a RB. The assessments used were: Cognitive-Emotional Regulation Questionnaire- Short Form (Garnefski et al., 2002); the Grief Cognitions Questionnaire adjusted to grief after RBs (Boelen et al., 2003); the subscales of Depression, Anxiety, and Hostility of the Counseling Center Assessment of Psychological Symptoms-62; and the Suicide Behaviors Questionnaire-Revised, Osman et al., 2001).ResultsPast suicide thoughts or attempts were predicted by Other-Blame; self-reported likelihood of future suicide attempt was predicted by Self-Blame, Other-Blame, and Positive Reappraisal, Grief Cognitions-Future, and Grief Cognitions-Appropriateness. Depression was predicted by all cognitive-emotional regulation subscales except Acceptance and Perspective, and by RB grief cognitions (self, future, self-blame, others, and perceived appropriateness of own grief reaction).ConclusionsClinical assessment to evaluate at-risk young adults after RBs could incorporate evaluations of cognitions regarding the RB and self-blaming, appropriateness of one's own grief reaction, and thoughts about the future.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

Is metacognition a causal moderator of the relationship between catastrophic misinterpretation and health anxiety? A prospective study

Psychological theories have identified a range of variables contributing to health anxiety, including, dysfunctional illness beliefs, catastrophic misinterpretation, somatosensory amplification and neuroticism. More recently, metacognitive beliefs have been proposed as important in health anxiety. This study aimed to test the potential causal role of metacognitive beliefs in health anxiety. A prospective design was employed and participants (n = 105) completed a battery of questionnaire at two time points (6 months apart). Results demonstrated that cognitive, personality and metacognitive variables were bi-variate prospective correlates of health anxiety. Hierarchical regression analysis revealed that only metacognitive beliefs emerged as independent and significant prospective predictors of health anxiety. Moderation analysis demonstrated that metacognitive beliefs prospectively moderated the relationship between catastrophic misinterpretation and health anxiety. Follow-up regression analysis incorporating the interaction term (metacognition × misinterpretation) showed that the term explained additional variance in health anxiety. The results confirm that metacognition is a predictor of health anxiety and it is more substantive than misinterpretations of symptoms, somatosensory amplification, neuroticism, and illness beliefs. These results may have major implications for current cognitive models and for the treatment of health anxiety.