title: Exploring the utility of the metacognitive model in predicting and preventing emotional distress after cancer
Creators: name: Cook, Sharon
Publisher: name: University of Liverpool Repository
Year: 2016

description: Why some people recover emotionally after diagnosis and treatment of cancer, while others experience persistent or recurrent symptoms of emotional distress is not well understood. The literature exploring predictors of persistent distress after cancer has not been able to explain this. In addition, predominant theoretical perspectives (based on the cognitive paradigm) have fallen short of being able to explain causal mechanisms that underlie the maintenance of distress. A more promising perspective is offered by the metacognitive model of emotional disorder. This model implicates beliefs about thinking (metacognitive beliefs) that drive a repetitive and problematic thinking style (the Cognitive Attentional Syndrome; CAS), as the key to understanding why such problems persist. The overarching aim of this thesis is to explore for the first time the utility of this model for understanding persistent emotional distress in cancer. In order to achieve this, a series of linked empirical studies were conducted using data from a prospective cohort study of recently diagnosed breast and prostate cancer patients (n=206). Data were obtained at a pre-treatment baseline (T1) and twelve month follow-up (T2) using self-report questionnaires to assess emotional distress (HADS), illness perceptions (IPQ-R) and metacognitive beliefs and CAS processes (MCQ-30 / CAS-1). The first study tested the validity of the MCQ-30 for use in cancer. Confirmatory and exploratory factor analyses provided evidence supporting the validity of the previously published 5-factor structure of the MCQ-30 in this population. In addition structural equation modelling (SEM) indicated that metacognitive beliefs were significantly associated with anxiety and depression as predicted, providing further evidence of concurrent validity. Following this, three studies used hierarchical regression and SEM techniques to test theoretical predictions from the metacognitive model by exploring cross-sectional and prospective associations between maladaptive metacognitions and emotional distress as well as testing whether metacognitive beliefs could explain more of the variance in emotional distress than could content of cognition (i.e. illness perceptions). The findings of these studies provided evidence supporting theoretical predictions that metacognitive beliefs cause and maintain distress by activating a style of inflexible responding to thoughts. The view that metacognitive beliefs may be more important in the development of emotional distress than the specific content of negative thoughts about cancer was also supported. Such findings suggest a potential to reduce anxiety by modifying metacognitive beliefs and processes as an alternative to more traditional cognitive approaches. Finally, a small pilot study tested the potential of a single component of metacognitive therapy (MCT), Attention Training Technique, for reducing emotional distress in cancer. The findings did not provide clear evidence of benefit, but did indicate that intervention was effective, when undertaken appropriately, and was well received. This suggests there is promise in pursuing further development of interventions based on MCT in this population.