Ivan Lavinia, Foerster Petra, Bermpohl Frederic Maas Genannt, Gerlach Alexander L, Pohl Anna
Department of Clinical Psychology and Psychotherapy, University of Cologne, Cologne, Germany.
Department of Clinical Psychology and Psychotherapy, University of Wuppertal, Wuppertal, Germany.
PLoS One. 2025 Jul 16;20(7):e0325563. doi: 10.1371/journal.pone.0325563. eCollection 2025.
The purpose of this meta-analysis is to give an overview of the relationships between positive and negative metacognitions (PMC, NMC) with health anxiety and pathological safety seeking and avoidant behavior (SSB, AB).
The preregistered systematic literature screening included following data bases: MEDLINE, PsycINFO, PSYNDEX, PubMed, The Cochrane Library, Web of Science, ProQuest Dissertations & Theses, and The German National Library. The studies were evaluated based on predefined eligibility criteria (i.e., data for PMC/NMC and health anxiety and/ or SSB/AB from adult samples, assessed with validated inventories and presented in English or German language) and risk of bias categories. Correlation coefficients were aggregated with random effect models. Publication biases were estimated with contour enhanced funnel plots and outlier analyses.
23 studies (N = 9229) were included in the meta-analysis. Most studies assessed health anxiety in analogue samples. A significant medium effect was found for PMC and health anxiety (r = .36, p < 0.0001, 95% CI:.29 ≤ r ≤ .43), whereas for NMC the effect was large (r = .52, p < 0.0001, 95% CI:.46 ≤ r ≤ .58). For the relationship with SSB the results revealed a moderate effect for PMC (r = 0.31, p = .004; 95%-CI: 0.19 ≤ r ≤ 0.42) and a small effect for NMC (r = .25, p = .02, 95% CI:.05 ≤ r ≤ .43). No study assessed AB.
Metacognitions are a significant pathological factor in health anxiety, with particularly strong association with NMC. PMC might be of special interest for health anxiety and SSB compared to other psychopathologies. Heterogeneity, missing clinical samples and studies on AB limit generalizability. Future research should further explore the role of metacognitions in health anxiety and focus on the relation with pathological SSB and AB.
本荟萃分析旨在概述积极和消极元认知（PMC、NMC）与健康焦虑以及病理性安全寻求和回避行为（SSB、AB）之间的关系。
预先注册的系统文献筛选涵盖以下数据库：MEDLINE、PsycINFO、PSYNDEX、PubMed、Cochrane图书馆、科学网、ProQuest学位论文数据库以及德国国家图书馆。根据预先定义的纳入标准（即来自成人样本的PMC/NMC以及健康焦虑和/或SSB/AB的数据，通过经过验证的量表进行评估，并以英语或德语呈现）和偏倚风险类别对研究进行评估。相关系数采用随机效应模型进行汇总。通过等高线增强漏斗图和异常值分析估计发表偏倚。
荟萃分析纳入了23项研究（N = 9229）。大多数研究评估了模拟样本中的健康焦虑。发现PMC与健康焦虑之间存在显著的中等效应（r = 0.36，p < 0.0001，95%置信区间：0.29 ≤ r ≤ 0.43），而NMC的效应较大（r = 0.52，p < 0.0001，95%置信区间：0.46 ≤ r ≤ 0.58）。对于与SSB的关系，结果显示PMC有中等效应（r = 0.31，p = 0.004；95%置信区间：0.19 ≤ r ≤ 0.42），NMC有较小效应（r = 0.25，p = 0.02，95%置信区间：0.05 ≤ r ≤ 0.43）。没有研究评估AB。
元认知是健康焦虑中的一个重要病理因素，与NMC的关联尤为强烈。与其他精神病理学相比，PMC可能对健康焦虑和SSB具有特殊意义。异质性、缺乏临床样本以及关于AB的研究限制了普遍性。未来的研究应进一步探索元认知在健康焦虑中的作用，并关注与病理性SSB和AB的关系。
