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Metacognition and experiences of psychosis: an investigation of metacognitive beliefs and coping strategies
[Thesis]. Manchester, UK: The University of Manchester; 2017.
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Abstract
This thesis investigated the application of the Self-Regulatory Executive Function (S-REF) model (Wells & Matthews, 1994, 1996) to distressing experiences of psychosis. A multi-method approach tested a series of hypotheses derived from the S-REF model. The methods included systematic review, meta-analysis, cross-sectional and experimental designs. Statistical methods examined relationships between metacognitive beliefs, coping strategies, positive symptoms and distress. Chapter 1 provides a general introduction to psychosis and metacognition, and outlines the aims and objectives of the thesis. Chapter 2 provides an overview of the methods used in subsequent studies and presents a detailed rationale for the choice of design and analysis. Chapters 3 and 4 (study 1 and 2) present the findings of two systematic reviews and meta-analyses. The reviews reflect two fundamental aspects of the S-REF model (metacognitive beliefs and unhelpful coping strategies) and summarise the current empirical position of research in each area respectively. Study 1 revealed a high level of similarity between metacognitive beliefs endorsed by people with psychosis and people with emotional disorder. Study 2 revealed several plausible links between unhelpful coping strategies, experiences of psychosis and negative affect. The reviews identified areas that require further investigation and guided the development of the subsequent studies. Chapter 5 (study 3) examines the relationships between metacognitive beliefs, positive symptoms and negative affect in a clinical sample. The results showed that metacognitive beliefs predict negative affect over and above the topological characteristics of positive symptoms. The findings highlight the influence of metacognitive beliefs in negative affective states when the contribution of psychotic symptoms is controlled. In a similar design, chapter 6 (study 4) examines the relationships between unhelpful coping strategies and positive and negative outcomes in a clinical sample. The results revealed that coping strategies did not predict positive symptoms, negative affect, quality of life or recovery. However, metacognitive beliefs emerged as consistent and unique predictors of these variables when the comorbidities were controlled. The findings further highlight the influence of metacognitive beliefs on subjective wellbeing. Chapters 7 and 8 examine the relationship between metacognitive beliefs, paranoia and negative affect. Chapter 7 (study 5) tested whether experimental manipulation of negative metacognitive beliefs could increase paranoid intrusions and negative affect. The study utilised a fake-EEG paradigm, whereby metacognitive beliefs were manipulated with the suggestion that detection of a paranoid thought by the EEG would result in a loud noise. The findings were not statistically significant, but demonstrated the manipulations worked and the experimental paradigm is feasible. Chapter 8 (study 6) explored the combined role of cognition (i.e. schemas) and metacognition in non-clinical paranoia. The findings suggest that schemas predict paranoia frequency whilst metacognitive beliefs moderate distress. This thesis has extended current research by demonstrating novel links between metacognition and negative affect in the context of experiences of psychosis. The findings have relevance for psychological approaches as they support the investigation of both cognitive and metacognitive factors. The findings also have relevance for psychological intervention as they support the consideration of metacognitive approaches.