Nordahl Henrik, Wells Adrian
Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway.
St. Olavs Hospital, Division of Psychiatry, Trondheim, Norway.
PLoS One. 2017 May 4;12(5):e0177109. doi: 10.1371/journal.pone.0177109. eCollection 2017.
The recommended treatment for Social Phobia is individual Cognitive-Behavioural Therapy (CBT). CBT-treatments emphasize social self-beliefs (schemas) as the core underlying factor for maladaptive self-processing and social anxiety symptoms. However, the need for such beliefs in models of psychopathology has recently been questioned. Specifically, the metacognitive model of psychological disorders asserts that particular beliefs about thinking (metacognitive beliefs) are involved in most disorders, including social anxiety, and are a more important factor underlying pathology. Comparing the relative importance of these disparate underlying belief systems has the potential to advance conceptualization and treatment for SAD. In the cognitive model, unhelpful self-regulatory processes (self-attention and safety behaviours) arise from (e.g. correlate with) cognitive beliefs (schemas) whilst the metacognitive model proposes that such processes arise from metacognitive beliefs. In the present study we therefore set out to evaluate the absolute and relative fit of the cognitive and metacognitive models in a longitudinal data-set, using structural equation modelling. Five-hundred and five (505) participants completed a battery of self-report questionnaires at two time points approximately 8 weeks apart. We found that both models fitted the data, but that the metacognitive model was a better fit to the data than the cognitive model. Further, a specified metacognitive model, emphasising negative metacognitive beliefs about the uncontrollability and danger of thoughts and cognitive confidence improved the model fit further and was significantly better than the cognitive model. It would seem that advances in understanding and treating social anxiety could benefit from moving to a full metacognitive theory that includes negative metacognitive beliefs about the uncontrollability and danger of thoughts, and judgements of cognitive confidence. These findings challenge a core assumption of the cognitive model and treatment of social phobia and offer further support to the metacognitive model.
社交恐惧症的推荐治疗方法是个体认知行为疗法（CBT）。CBT治疗强调社交自我信念（图式）是适应不良的自我加工和社交焦虑症状的核心潜在因素。然而，最近人们对心理病理学模型中此类信念的必要性提出了质疑。具体而言，心理障碍的元认知模型断言，关于思维的特定信念（元认知信念）涉及包括社交焦虑在内的大多数障碍，并且是病理学背后更重要的因素。比较这些不同的潜在信念系统的相对重要性有可能推进社交焦虑障碍（SAD）的概念化和治疗。在认知模型中，无益的自我调节过程（自我关注和安全行为）源于（例如与……相关）认知信念（图式），而元认知模型则提出此类过程源于元认知信念。因此，在本研究中，我们着手使用结构方程模型评估纵向数据集中认知模型和元认知模型的绝对拟合度和相对拟合度。505名参与者在两个时间点完成了一系列自我报告问卷，这两个时间点相隔约8周。我们发现两个模型都与数据拟合，但元认知模型比认知模型更适合数据。此外，一个特定的元认知模型，强调对思维的不可控性和危险性以及认知信心的消极元认知信念，进一步改善了模型拟合度，并且明显优于认知模型。似乎在理解和治疗社交焦虑方面的进展可能受益于转向一个完整的元认知理论，该理论包括对思维的不可控性和危险性的消极元认知信念以及认知信心的判断。这些发现挑战了社交恐惧症认知模型和治疗的一个核心假设，并为元认知模型提供了进一步的支持。
