Brett C M C, Johns L C, Peters E P, McGuire P K
Department of Psychological Medicine, Institute of Psychiatry, London, UK.
Psychol Med. 2009 Jun;39(6):939-50. doi: 10.1017/S0033291708004650. Epub 2008 Nov 12.
Current psychological models of psychotic symptoms suggest that metacognitive beliefs impact on an individual's appraisal of anomalous experiences, and thereby influence whether these lead to distress and become clinical symptoms. This study examined the relationship between maladaptive metacognitive beliefs, anomalous experiences, anomaly-related distress, anxiety and depression and diagnostic status.
The Metacognitions Questionnaire (MCQ), Symptom Checklist 90 - Revised, and Appraisals of Anomalous Experiences interview were administered to 27 people diagnosed with a psychotic disorder, 32 people meeting At Risk Mental State (ARMS) criteria, 24 people with psychotic-like experiences but no need for care, and 32 healthy volunteers.
The two clinical groups scored higher than non-patient controls and individuals experiencing psychotic-like anomalies with no need for care on most subscales of the MCQ, particularly the 'general negative beliefs about thoughts' (NEG) subscale. However, most group differences became non-significant when anxiety and depression were controlled for. Few relationships were found between the MCQ subscales and psychotic-like anomalies and anomaly-related distress. Cognitive/attentional difficulty was the only type of anomaly to be significantly associated with maladaptive metacognitive beliefs. Anomaly-related distress was associated with only the NEG subscale of the MCQ.
Maladaptive metacognitive beliefs, as measured by the MCQ, appear to be related more to elevated levels of general psychopathology in psychotic and at-risk groups than to the presence of, and distress associated with, psychotic experiences. Processes by which metacognitions may impact upon the need for care are discussed.
当前关于精神病症状的心理学模型表明，元认知信念会影响个体对异常体验的评估，从而影响这些体验是否会导致痛苦并成为临床症状。本研究考察了适应不良的元认知信念、异常体验、与异常相关的痛苦、焦虑和抑郁与诊断状态之间的关系。
对27名被诊断患有精神障碍的患者、32名符合高危精神状态（ARMS）标准的人、24名有类似精神病体验但无需护理的人以及32名健康志愿者进行了元认知问卷（MCQ）、症状自评量表90修订版和异常体验评估访谈。
在MCQ的大多数分量表上，这两个临床组的得分高于非患者对照组以及有类似精神病异常体验但无需护理的个体，尤其是在“对思维的一般消极信念”（NEG）分量表上。然而，在控制了焦虑和抑郁之后，大多数组间差异变得不显著。在MCQ分量表与类似精神病的异常体验和与异常相关的痛苦之间，几乎没有发现相关性。认知/注意力困难是唯一与适应不良的元认知信念显著相关的异常类型。与异常相关的痛苦仅与MCQ的NEG分量表相关。
通过MCQ测量的适应不良的元认知信念，似乎更多地与精神病组和高危组中一般精神病理学水平的升高有关，而不是与精神病体验的存在及其相关痛苦有关。文中讨论了元认知可能影响护理需求的过程。
