Cognitive Attentional Syndrome Research Articles

Metacognitive strategies mediate the association between metacognitive beliefs and perceived quality of life.

Quality of life may be understood as a multidimensional evaluation of life circumstances in relation to values, expectations, and perceived well-being. Quality of life is thus dependent on the subjective perception of the current life situation, not only objective circumstances. According to metacognitive theory, metacognition guides the appraisal of inner experiences (i.e., thoughts and feelings) and influences how one relates to external stressors. Hence, dysfunctional metacognitive beliefs and the cognitive attentional syndrome (CAS), which includes perseverative thinking, threat monitoring and ineffective coping strategies, may negatively influence subjective quality of life. Therefore, we aimed to investigate if metacognitive beliefs and CAS strategies were associated with quality of life. A sample of 503 participants (77.1% women, mean age 41.0, SD = 11.5) completed the metacognitions questionnaire 30 (MCQ-30), the CAS-1 and the quality of life scale (QOLS). We used structural equation modelling (SEM) to estimate associations between the variables founded in metacognitive theory. The results of the SEM showed a significant direct relationship between metacognitive beliefs and quality of life. CAS strategies mediated the effect of metacognitive beliefs on quality of life. Higher level of metacognitive beliefs was associated with greater use of CAS strategies, which in turn was associated with lower quality of life. Further, more CAS strategies were associated with lower quality of life. The results support the generic metacognitive model and suggest that stronger endorsement of dysfunctional metacognitive beliefs and corresponding CAS strategies are associated with lower quality of life. This observation held even when controlling for relevant covariates and suggests that modifying metacognitive beliefs may impact on subjective quality of life.

'I felt like I'd lost control of everything': An exploration of metacognition and masculinity in men experiencing suicidality.

Seventy-five per cent of UK suicides are completed by men, and associated masculinity beliefs are well researched. The self-regulatory executive functioning (S-REF) model of distress is governed by metacognitive beliefs about mental processes, such as worry and rumination. Little is known about metacognition in male suicidality and how these processes interact with masculinity beliefs, suicidal ideation and behaviour. To identify which aspects of the S-REF model were present in a sample of men experiencing suicidality, and to consider how these processes interact with masculinity beliefs, suicidal ideation and behaviour. Fifteen men experiencing suicidal ideation or behaviour were recruited from a home-based treatment team. Semi-structured interviews and self-report measures were administered to identify metacognitive processes and masculinity beliefs. Interviews were analysed using the framework approach. The S-REF model was identified across three super-ordinate themes; 'the cognitive attentional syndrome (CAS) and maladaptive coping', 'metacognitive beliefs about worry, uncontrollability and danger' and 'consequences'. Thirteen sub-ordinate themes included processes such as 'worry' and 'rumination', metacognitive beliefs such as 'worrying helps me avoid problems' and 'worry is dangerous for me' and emotional consequences such as 'overwhelm', 'emasculation' and 'escape'. Perseverative thinking and erroneous metacognitive beliefs were associated with reduced functioning, which was incompatible with masculinity beliefs about leadership and strength, and suicide was considered as re-establishing control. Further research into metacognitive processes in male suicidality would enhance theoretical understanding.

Did Cognitive Attentional Syndrome Symptoms Predict Stress- and Trauma-Related Symptoms in the Initial Phase of the COVID-19 Pandemic? Results from a Two-Wave Study on a Sample of Polish Internet Users.

According to metacognitive theory, Cognitive Attentional Syndrome (CAS) is a transdiagnostic factor and a main mechanism of psychopathology maintenance. The main goal of this study is to examine whether CAS predicted stress- and trauma-related symptomatology in the first months of the COVID-19 pandemic and three months later. Initially, 1792 participants were recruited online via social media; the data were collected at two time points. The measures included the Cognitive Attentional Syndrome Questionnaire, the Adjustment Disorder-New Module 20, the International Trauma Questionnaire, and additional measures. Structural equation modeling was conducted in order to determine the relations between the reported stressors, CAS, and symptomatology. At both time points, CAS was a significant mediator between the stressors and symptoms of adjustment disorder. Despite the decrease in the intensity of adjustment disorder symptoms between waves, it was a significant predictor of other psychopathologies at both time points, except for traumatic stress. The findings confirm the assumption that CAS is a transdiagnostic factor of psychopathology and has a mediating role in the relationship between stressors and adjustment disorder and co-occurring symptomatology. The effect was particularly significant in the initial phase of the pandemic, which was highly stressful for many people.

Development and Validation of the Cognitive Attentional Syndrome Scale 1 Revised–Japanese Version1

AbstractThe Cognitive Attentional Syndrome Scale 1 Revised (CAS‐1R) is a 10‐item self‐report measure designed to assess dysfunctional metacognition, a transdiagnostic predictor of psychological disorders (e.g., generalized anxiety disorder, major depression disorder). Dysfunctional metacognition is classified into “cognitive attentional syndrome” and “metacognitive beliefs,” and the latter in turn into negative and positive beliefs. We translated the CAS‐1R into Japanese (CAS‐1R‐J) and examined its reliability and validity in a Japanese community sample. We recruited 552 participants via the Internet and received responses from 552 individuals (Time 1) and 112 individuals (Time 2). Of these, the data of 87 individuals were used to examine test–retest reliability. Confirmatory factor analysis indicated that the factor structure (three‐factor model) of the CAS‐1R‐J was appropriate. Each subscale showed good internal consistency. Hierarchical logistic regression analysis showed discriminant and incremental validity for anxiety and depressive symptoms, meaning the CAS‐1R‐J is valid to assess state cognitive attentional syndrome and metacognitive beliefs among Japanese individuals.

Investigating the specific domains of the cognitive attentional syndrome that predict posttraumatic stress symptoms: The moderating effect of attentional control

The metacognitive model of posttraumatic stress disorder (PTSD) suggests that persistent use of the maladaptive self-regulation strategies that comprise the cognitive attentional syndrome (CAS) increases the likelihood of developing PTSD symptoms following trauma exposure. The metacognitive model also suggests that flexible regulation of attention might be protective against developing maladaptive outcomes that are associated with the CAS. The aims of this study were to (1) examine associations between all seven domains of the CAS and PTSD symptoms using a recently developed, multidimensional measure of the CAS, and (2) examine the moderating effect of self-reported attentional control on associations between the CAS and PTSD symptoms. Participants were trauma-exposed community adults (N = 237) who completed a battery of self-report measures. Results from linear regression analyses showed that worry, substance use, and internal threat monitoring accounted for unique variance in PTSD symptoms when all seven CAS domains were entered into the same model. Moderation analyses showed that attentional control dampened the effect of the CAS, specifically external threat monitoring, on PTSD symptoms. Study results support attentional control as a protective factor against the maladaptive effects of the CAS on PTSD symptoms.

Effect of CBT on Metacognitive Beliefs in Depressive Disorders.

Metacognitive beliefs operate through cognitive attentional syndrome, where attention concentrated on negative automatic thoughts results in rumination. This perseverative thinking style manifesting in the form of rumination and worry intensifies depression. This study aims to assess the effect of cognitive behaviour therapy (CBT) on metacognitive beliefs, symptom severity, quality of life, and functionality. A pre-post study design comparing CBT-alone and CBT-with-medication was employed using purposive sampling to recruit 40 participants diagnosed with depressive disorders. All the participants received 10 sessions of CBT. Pre and post assessment measures were Beck Depression Inventory-II, Metacognitive Questionnaire-30, World Health Organization Quality of Life- Brief, and Global Assessment of Functioning. Paired t-test analysis revealed significant difference on outcome measures in both groups. Between-subject analysis revealed that the CBT-alone group was not significantly different in terms of improvement than CBT-withmedication group even when confounding variables were statistically controlled by way of testing analysis of covariance and propensity score match (nearest neighbour match). Keywords: Cognitive behaviour therapy, metacognition, depressive disorders, metacognitive beliefs, depression, quality of life.

Study protocol of ConquerFear-HK: a randomised controlled trial of a metacognition-based, manualised intervention for fear of cancer recurrence among Chinese cancer survivors

IntroductionFear of cancer recurrence (FCR) is a prevalent and frequently debilitating response to a cancer diagnosis, affecting a substantial proportion of cancer survivors. Approximately 30% of local Hong Kong Chinese...

Cognitive-Attentional Syndrome Moderates the Relationship Between Fear of Coronavirus and Symptoms of Coronavirus-Specific Health Anxiety

This study was aimed at exploring the possible roles of the cognitive attentional syndrome (CAS) and metacognitive beliefs in moderating the relationships between fear of coronavirus during the pandemic and health anxiety. Because some symptoms of health anxiety may overlap with symptoms of other anxiety disorders, we also tried to ascertain whether our hypothesized relations would be maintained when taking other anxiety disorder symptoms into account. We hypothesized that CAS strategies and meta-beliefs would play a role in the progression from fears of the coronavirus to coronavirus health anxiety. The method done was a cross-sectional study with n = 783 participants who completed questionnaires on fear of coronavirus, coronavirus-specific health anxiety, CAS, and symptoms of anxiety disorders. Fear of coronavirus and coronavirus health anxiety are correlated with medium effect size. CAS and metacognitive beliefs moderate the relationship between fear of coronavirus and symptoms of coronavirus-specific health anxiety. CAS predicts a unique part of health anxiety symptoms variance above symptoms of other anxiety disorders. The results of this cross-sectional study preclude causal inferences but tentatively suggest that CAS strategies may play a role in moderating the relationship between fear of coronavirus and coronavirus-related health anxiety. These relationships were obtained after controlling for variance shared with agoraphobia, social phobia, and general physical symptoms of anxiety.

Cultural adaptation and validation of the Arabic version of the multidimensional cognitive attentional syndrome scale (MCASS)

ABSTRACT The cognitive attentional syndrome (CAS) is a core concept within metacognitive theory. The premise of the CAS is related to metacognition, however its role in psychopathology is distinct. Due to the complex nature of the CAS, a theoretically driven and psychometrically sound self-report measure of the CAS for the Arabic population is yet to be developed. We translated the Multidimensional Cognitive Attentional Syndrome Scale (MCASS) into the Arabic language and tested its structural validity. The MCASS was translated according to the standard guidelines of forward-translation followed by backward-translation. In Study 1, the MCASS was administered to a larger sample (N = 1027), selected from 22 Arabic-speaking countries in the Arab League countries, and exploratory factor analysis (EFA) was used to examine the factor structure of the measure. Those who participated in Study 1 were excluded from participating in Study 2. Confirmatory factor analysis (CFA) was used in Study 2 (N = 567) to assess the latent factor structure of MCASS, which supported a six-factor model. Results support multidimensional assessment of the CAS using the MCASS, and demonstrate suitability for use in Arab speaking samples. Implications of this study and recommendations for use of the Arabic version of MCASS are discussed.

Metacognitions About Health in Relation to Coronavirus Anxiety: The Mediating Role of Cognitive Attentional Syndrome and Distress Tolerance.

The current study aimed to investigate the mediating role of cognitive attentional syndrome (CAS) and distress tolerance in the relationship between health-related metacognitions and coronavirus anxiety. The sample of this study consisted of 462 participants (381 female). Participants voluntarily completed self-report questionnaires on each of the variables mentioned above. The results of the structural modeling analysis showed that health-related metacognitions have a significant effect on the mediator variable of distress tolerance and CAS. Also, health-related metacognitions had a direct effect on coronavirus anxiety. Also, based on the results of the bootstrap test, it can be argued that health-related metacognitive beliefs, apart from their direct effect, play an important role in coronavirus anxiety, with CAS acting as a mediator. This study provides insights into the relationships among metacognitive beliefs, coronavirus anxiety, CAS, and distress tolerance. In particular, dysfunctional metacognitive beliefs, including an individual's beliefs about the uncontrollability of disease-related thoughts, are risk factors that could negatively affect mental health, leading to coronavirus anxiety. In addition, the association of dysfunctional beliefs with maladaptive behaviors resulting from the cognitive attentional syndrome is also involved in predicting and causing coronavirus anxiety. Given the insignificant role of emotional distress tolerance in the psychopathology of COVID-19 anxiety, the findings emphasize the importance of cognitive factors in this context.

‘Thinking about Them is only making me feel worse’. The mediating role of metacognitive factors in the relationship between paranoia-like beliefs and psychopathology symptoms in a community sample

IntroductionParanoia in community samples is associated with higher levels of depression, anxiety symptoms and suicidality. The metacognitive model assumes the role of metacognitive factors in these associations. Positive and negative metacognitive beliefs (PMB and NMB, respectively) and cognitive-attentional syndrome (CAS) are to mediate between paranoia-like beliefs and psychopathology symptoms. The current study is an attempt to test this prediction. MethodsA cross-sectional community study with n = 840 participants. We used R-GPTS's persecutory subscale to measure paranoia-like beliefs, CAS-1 for CAS and metacognitive beliefs and SCL-27-plus for psychopathology symptoms. ResultsIndirect effects of PMB, CAS and NMB accounted for 22% to 56% (CI 95%) of total effects of relationships between paranoia-like beliefs and vegetative symptoms, symptoms of social phobia, agoraphobia, depression and suicidality screening. ConclusionsWe demonstrated that PMB, CAS and NMB mediate between paranoia-like beliefs and various psychopathological symptoms, as predicted by the metacognitive model of psychopathology. We also uncovered other indirect effects, including negative mediation effect of PMB on the relationship between paranoia-like beliefs and depressive symptoms and suicidality.

The Relationship Between Metacognition, Meta-worry, Rumination, and Cognitive-Attentional Syndrome in Iranian Combat Veterans with Post-traumatic Stress Disorder

Background: Post-traumatic stress disorder (PTSD) metacognitive model is considered a model with good power. There are not enough data that this model is appropriate to combat veterans with chronic PTSD. Objectives: This study aimed to investigate the association between metacognition components, including metacognitive beliefs and attitudes, meta-worry, rumination, and cognitive-attentional syndrome (CAS), in Iranian combat veterans with PTSD. Methods: The population of this study included all combat veterans referred to the rehabilitating center of Sari, Mazandaran province in 2016. After a clinical interview by a clinical psychologist, the veterans were divided into three groups (PTSD, non-PTSD, and non-traumatized). These three groups matched in age, gender, and socio-economic status. Exclusion criteria for three groups were as follows: Those who had a significant psychiatric disorder that has been active during the research plan. Moreover, data gathering instrument used in the current research was Metacognition Questionnaire [including Metacognitive Questionnaire (MCQ), Ruminative Responses Scale (RRS), Cognitive-Attentional Syndrome Scale (CAS-1), Impact of Event Scale-Revised (IES-R), and Meta-worry Questionnaire (MWQ)]. One-way variance analysis was used to compare groups in terms of metacognition, meta-worry, rumination, and CAS. Conclusions: Consistent with the metacognitive model of PTSD, metacognition components, ruminative responses, cognitive-attentional syndrome, and meta-worry have significant differences with non-PTSD and non-traumatized. It appears that meta-cognitive components are more disruptive in PTSD patients than other control groups. This finding could be integrated into the metacognition theory.

Effectiveness of Acceptance and Commitment Therapy on Stress, Cognitive-Attentional Syndrome, and Blood Sugar Indices in Patients with Type II Diabetes

Background: Psychological problems are mainly overlooked in patients with chronic diseases. Objectives: The present study aimed to investigate the effectiveness of acceptance and commitment therapy on stress, cognitive-attentional syndrome, and blood sugar indices in patients with type II diabetes. Methods: In this quasi-experimental study, 40 patients with type II diabetes, referred to Birjand Diabetes Clinic in 2019 were selected via convenience sampling method. Later, subjects meeting inclusion criteria were randomly assigned into experimental and control groups. The former received treatment based on acceptance and commitment therapy (ACT) in eight 90-minute weekly sessions. Controls received no intervention. Fasting Blood Sugar (FBS) and glycosylated hemoglobin indices were measured for all participants before and after the intervention. The data were collected, followed by administering DASS scale developed by Lovibond and Lovibond (1995) and Wells cognitive attentional syndrome or CAS (2009) questionnaires and analyzed using SPSS 22. Univariate and multivariate analyses of covariance were also performed at a significance level of 0.05. Results: The participants’ mean educational level and age were (1.53 ± 2.70) and (6.03 ± 45.58), respectively. Also, the mean values of the variables CAS, stress, HBA1C, and FBS were (22.51 ± 94.09), (09.09 ± 36.30), (0.90 ± 7.34) and (29.09 ± 151.82), respectively. Also, the mean scores of stress (P = 0.002), CAS (P = 0.001), FBS (P = 0.001), and glycosylated hemoglobin (P = 0.001) indices were significantly lower in experimental compared to controls after the intervention. Conclusions: In general, ACT effectively reduced stress, cognitive attention syndrome, and blood sugar indices among patients with type II diabetes. Experts should consider formality of this training in diabetes care treatment programs.

Brain structural correlates of cognitive-attentional syndrome - a Voxel-Based Morphometry Study.

Cognitive-attentional syndrome (CAS) is in the self-regulatory executive function model a set of cognitive and behavioural strategies aimed at regulating cognition and emotion originating from maladaptive metacognitive beliefs. Investigating the brain structure of people with high levels of CAS enables a better understanding of the syndrome and bridging between the metacognitive model of psychopathology and previous results on structural abnormalities in various psychological disorders. Participants with high (n=40) and low levels of CAS (n=44) underwent structural Magnetic Resonance Imaging session. Voxel-Based Morphometry analytical approach was used to compute grey matter volume (GMV) differences between the groups. The group with a high level of CAS had lower GMV in the dorsal part of the anterior cingulate cortex. Our results are in line with the self-regulatory executive function model of psychopathology, showing a link between CAS and lowered GMV in the brain region associated with the regulation of cognition and emotion. They are also in agreement with meta-analytical results on structural correlates of various psychological disorders.

Cognitive attentional syndrome in Hong Kong people with depression

Objective: The aim of this study was to examine the occurrence of Cognitive Attentional Syndrome (CAS) in the Hong Kong Chinese population with depression and to assess the psychometric properties of the translated Traditional Chinese version of the CAS-1 questionnaire. Method: The English version of the CAS-1 questionnaire was translated into Traditional Chinese for this study. Study participants with (N=64) and without (N=64) depression completed the Chinese version of the CAS-1 and the psychometric properties assessed. Results: The internal consistency of the total CAS-1 scores (α=0.704), metacognitive strategies (α=0.789) and metacognitive belief subscales (α=0.716) of the translated Chinese CAS-1 were found to be statistically acceptable. ANCOVA indicated a statistically significant difference between participants with depression and those without depression in CAS-1 total scores (F=4.574, p<0.035) and CAS-1 metacognitive strategies subscale (F=46.615, p<0.0001), treating education level and sex as covariates. Conclusion: The results support the use of the Traditional Chinese version of the CAS-1 questionnaire in clinical settings. In addition, the findings provide the first empirical evidence of the existence of CAS in Hong Kong people with depression.

Worry and rumination predict insomnia in patients with coronary heart disease: a cross-sectional study with long-term follow-up.

Insomnia is highly prevalent and associated with anxiety and depression in patients with coronary heart disease patients. The development of effective psychological interventions is needed. Worry and rumination are potential risk factors for the maintenance of insomnia, anxiety, and depression that may be modified by psychological treatment grounded in the Self-Regulatory Executive Function model. However, the relationships between worry, rumination, anxiety and depression, and insomnia are not known. Therefore, we investigated these relationships both cross-sectionally and longitudinally among patients with coronary heart disease. A cross-sectional study consecutively included 1,082 patients in 2014-2015, and 686 were followed up after mean of 4.7 years. Data were gathered from hospital records and self-report questionnaires comprising assessment of worry (Penn State Worry Questionnaire), rumination (Ruminative Responses Scale), anxiety and depression (Hospital Anxiety and Depression Scale), and insomnia (Bergen Insomnia Scale). Insomnia correlated moderately with all other psychological variables (R 0.18-0.50, all P values < .001). After adjustments for anxiety and depression, odds ratios for insomnia at baseline were 1.27 (95% confidence interval 1.08-1.50) and 1.60 (95% confidence interval 1.31-1.94) per 10 points increase of worry and rumination, respectively. Corresponding odds ratios for insomnia at follow-up were 1.28 (95% confidence interval 1.05-1.55) and 1.38 (95% confidence interval 1.09-1.75). Depression was no longer significantly associated with insomnia after adjustments for worry and rumination, but anxiety remained significant. Worry and rumination predicted insomnia both cross-sectionally and prospectively, even after controlling for anxiety and depression, although anxiety remained significant. Future studies may test psychological interventions targeting these factors in patients with coronary heart disease and insomnia. Frøjd LA, Papageorgiou C, Munkhaugen J, etal. Worry and rumination predict insomnia in patients with coronary heart disease: a cross-sectional study with long-term follow-up. J Clin Sleep Med. 2022;18(3):779-787.

Examining Changes in the Cognitive Attentional Syndrome and Attentional Control Following Metacognitive Therapy for Children with Generalized Anxiety Disorder

Examining Changes in the Cognitive Attentional Syndrome and Attentional Control Following Metacognitive Therapy for Children with Generalized Anxiety Disorder

Cognitive attentional syndrome and metacognitive beliefs as potential treatment targets for metacognitive therapy in bipolar disorder.

Most treatment guidelines emphasize the use of psychotropic drugs for both the acute and maintenance treatment of bipolar disorder (BD). However, relying only on psychotropics without adjunctive psychosocial interventions may be insufficient in treating patients with BD. Given its unique view in the explanation of psychopathological states, metacognitive therapy (MCT) might be helpful for BD. Metacognitive theory posits that psychopathology is a result of the cognitive attentional syndrome (CAS) and that it is influenced and maintained by dysfunctional metacognitive beliefs, perseverative thinking, attentional biases, and dysfunctional coping strategies. In this review, literature data regarding these areas in BD are examined. Studies suggest that perseverative thinking might be among the emotion regulation strategies endorsed in individuals with BD. Regarding attentional biases, literature data show that state-dependent, mood-changing attentional biases and a ruminative self-focused attention are present. Studies also suggest that cognitive self-consciousness is higher in BD compared to controls. It is seen that maladaptive coping strategies are frequently reported in BD, and that these strategies are associated with depression severity, negative affect and relapse risk. Studies focusing on dysfunctional metacognitive beliefs in BD reported that individuals with BD had higher scores for negative metacognitive beliefs, self-consciousness, need to control thoughts, and a lack of cognitive confidence. Also, dysfunctional metacognitive beliefs were associated with depressive symptomatology. These findings suggest that the components of CAS and dysfunctional metacognitive beliefs are evident in BD. For a subgroup of patients with BD who fail to respond to evidence-based psychopharmacological and adjunctive psychotherapeutic interventions, MCT might be an alternative way to consider as a treatment option. In conclusion, taken the available data together, we propose a sequential treatment protocol for BD, mainly based on the MCT treatment plan of depressive disorders.

Development and validation of the Multidimensional Cognitive Attentional Syndrome Scale (MCASS).

The cognitive attentional syndrome (CAS), a multidimensional construct that consists of maladaptive forms of self-regulation, is central to the metacognitive model. Despite the CAS's central importance to the metacognitive model, as well as evidence that components of the CAS are risk factors for the development of emotional disorders, a psychometrically sound self-report measure that accounts for the multidimensional nature of the CAS has yet to be developed. The present set of studies details the development and initial validation of the Multidimensional Cognitive Attentional Syndrome Scale (MCASS). In study 1, a pool of 69 items, assessing the seven self-regulation strategies of the CAS, was administered to U.S. adults recruited through a crowd-sourcing website (N = 323). Structural analyses supported the proposed 7-factor solution and three items with the highest loadings on each factor, without salient cross-loadings, were retained. In Study 2, adult participants (N = 389) completed a battery of self-report measures, including the retained 21 MCASS items. The reduced item pool was examined using both first- and second-order measurement models. The 7-factor first-order measurement model and the second-order measurement model, with each of the first-order factors loading on a higher-order construct (i.e., CAS), provided adequate model fit. Each of the seven, first-order factors exhibited significant loadings on the second-order construct. Convergent, discriminant, and concurrent validity analyses further supported the construct validity of the MCASS scale scores. The MCASS may be particularly useful for examining the theoretical underpinnings of the metacognitive model, as well as for more comprehensive clinical monitoring of the CAS. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Comparing the Effectiveness of Behavioral Activation and Acceptance and Commitment Therapy in Cognitive-Attentional Syndrome in Patients with Depression

Background: Cognitive-attentional syndrome (CAS) is one of the primary constructs of depression, the treatment of which is highly challenging because of its high prevalence and the emergence of symptoms such as feelings of sadness, emptiness, and hopelessness. Objectives: The present study aimed to investigate the effectiveness of behavioral activation (BA) and acceptance and commitment therapy (ACT) in CAS in patients with depression. Methods: This quasi-experimental research utilized a pretest, posttest, and two-month follow-up design with a control group. The study population comprised 260 patients with a diagnosis of depression who referred to the psychological centers of Ahvaz in 2019. The sample consisted of 45 patients with depression selected by convenience sampling. We randomly divided the participants into two experimental groups (BA and ACT) and a control group (n = 15 per group). The research instrument included the cognitive-attentional syndrome (CAS-1) questionnaire. Data were analyzed using SPSS version 24.0 with descriptive and inferential statistics, such as mean, standard deviation, and multivariate analysis of covariance (MANCOVA). Results: In terms of CAS and its components, there was a significant difference between the experimental and control groups in the posttest and follow-up phases (P = 0.0001). Besides, ACT and BA significantly reduced CAS and its components in the posttest phase (P = 0.0001). However, the effectiveness of BA in decreasing CAS and its components remained during the follow-up phase. Furthermore, the results showed that ACT was more effective in reducing attention to threat and metacognitive beliefs during the posttest phase. Conclusions: According to research findings, both BA and ACT are efficient therapies in reducing CAS in patients with depression. Thus, both approaches can be used to strengthen treatment interventions to reduce CAS in patients with depression.