This article was downloaded by: [Biblioteca Universidad Complutense de Madrid]On: 27 April 2012, At: 01:38Publisher: Psychology PressInforma Ltd Registered in England and Wales Registered Number: 1072954 Registeredoffice: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

Cognitive NeuropsychiatryPublication details, including instructions for authors andsubscription information:http://www.tandfonline.com/loi/pcnp20

Metacognitive beliefs andpsychological well-being in paranoiaand depressionCarmen Valiente a , Jose M. Prados b , Diego Gómez a &Filiberto Fuentenebro ca Department of Clinical Psychology, Complutense University ofMadrid, Madrid, Spainb Department of Cognitive Processes, Complutense University ofMadrid, Madrid, Spainc Department of Psychiatry, Complutense University of Madrid,Madrid, Spain

Available online: 25 Apr 2012

To cite this article: Carmen Valiente, Jose M. Prados, Diego Gómez & Filiberto Fuentenebro(2012): Metacognitive beliefs and psychological well-being in paranoia and depression, CognitiveNeuropsychiatry, DOI:10.1080/13546805.2012.670504

To link to this article: http://dx.doi.org/10.1080/13546805.2012.670504

PLEASE SCROLL DOWN FOR ARTICLE

Full terms and conditions of use: http://www.tandfonline.com/page/terms-and-conditions

This article may be used for research, teaching, and private study purposes. Anysubstantial or systematic reproduction, redistribution, reselling, loan, sub-licensing,systematic supply, or distribution in any form to anyone is expressly forbidden.

The publisher does not give any warranty express or implied or make anyrepresentation that the contents will be complete or accurate or up to date. Theaccuracy of any instructions, formulae, and drug doses should be independentlyverified with primary sources. The publisher shall not be liable for any loss, actions,claims, proceedings, demand, or costs or damages whatsoever or howsoever caused

arising directly or indirectly in connection with or arising out of the use of thismaterial.

Dow

nloa

ded

by [

Bib

liote

ca U

nive

rsid

ad C

ompl

uten

se d

e M

adri

d] a

t 01:

38 2

7 A

pril

2012

Metacognitive beliefs and psychological well-being

in paranoia and depression

Carmen Valiente1, Jose M. Prados2, Diego Gomez1, andFiliberto Fuentenebro3

1Department of Clinical Psychology, Complutense University of

Madrid, Madrid, Spain2Department of Cognitive Processes, Complutense University of

Madrid, Madrid, Spain3Department of Psychiatry, Complutense University of Madrid,

Madrid, Spain

Introduction. Despite the growing interest in the effects of metacognitive beliefs andpsychological well-being on psychiatric conditions, little is known about how thesetwo variables interact in clinical samples. The central aim of this study was toinvestigate the role of some metacognitive beliefs in the relationship betweenpsychological well-being dimensions and psychopathology.Methods. Fifty-five participants with persecutory delusions diagnosed with schizo-phrenia or other psychotic disorders, 38 participants with a major depressiveepisode, and 44 healthy controls completed the 30-item short form of theMetacognitions Questionnaire (MCQ-30) and the 54-item form of the Ryff Scalesof Psychological Well-Being (PWB).Results. MANCOVA analyses revealed group differences on four subscales of PWB(self-acceptance, autonomy, personal growth, and environmental mastery), as wellas on three subscales of MCQ-30 (uncontrollability of worry, need to controlthoughts, and lack of memory confidence). Moderation analyses showed theinteraction between persecutory thinking and cognitive self-consciousness to be apredictor of psychological well-being.Conclusions. These findings suggest that psychological well-being is particularlycompromised in participants with a high level of persecutory thinking when theyhave low levels of cognitive self-consciousness.

Correspondence should be addressed to Carmen Valiente, Department of Clinical Psychology,

Complutense University of Madrid, 28223 Pozuelo de Alarcon, Madrid, Spain.

E-mail: mcvalien@pdi.ucm.es

This research was supported by grants from the Spanish Ministry of Science and Innovation

(PSI2009-13472). We thank Dolores Cantero for her assistance with data collection.

COGNITIVE NEUROPSYCHIATRY

2012, 1�17, iFirst

# 2012 Psychology Press, an imprint of the Taylor & Francis Group, an Informa business

http://www.psypress.com/cogneuropsychiatry http://dx.doi.org/10.1080/13546805.2012.670504

Dow

nloa

ded

by [

Bib

liote

ca U

nive

rsid

ad C

ompl

uten

se d

e M

adri

d] a

t 01:

38 2

7 A

pril

2012

Keywords: Depression; Metacognitive Beliefs; Paranoia; Psychological

well-being.

INTRODUCTION

Metacognition has recently become a research focus in the study and

treatment of most psychiatric conditions (Corcoran & Segal, 2008; Fisher &

Wells, 2009; Lysaker et al., 2011; Wells, 2000, 2009). Some authors have

claimed that psychotic symptoms are associated with deficits in metacogni-

tion that lead to unawareness of the agency of one’s own thoughts and

actions (e.g., Frith, 1992), and others have argued that metacognitive beliefs

can lead to interpretation biases that bring about psychotic experiences (e.g.,

Morrison, 2001; Morrison & Wells, 2003). Most of the research on

metacognition in patients with schizophrenia has been carried out with

individuals experiencing hallucinations (Baker & Morrison, 1998). Several

studies have also found an association between delusional ideation and

metacognition in subjects with a clinical profile similar to panic disorder,

halfway between people with hallucinations and healthy controls (Morrison

& Wells, 2003). More precisely, Freeman and Garety (1999) found that

people with persecutory delusions tend to experience ‘‘meta-worry’’, i.e.,

worry about their ability to control their delusive thinking.

Maladaptive metacognitive beliefs have been found to correlate positively

with psychopathology, not only in psychotic samples but also in nonclinical

psychotic-prone groups (Larøi & van der Linden, 2005; Morrison, French, &

Wells, 2007; Morrison & Petersen, 2003). It may be important to consider

carefully the type of metacognitive belief. For example, Reeder, Rexhepi-

Johansson, and Wykes (2010) have pointed out that only negative beliefs

about thoughts were significantly associated with psychotic-like experiences,

but not beliefs about one’s own cognitive skills.In contrast to numerous studies of metacognition in psychotic disorders,

its potential involvement in depression has received considerably less

attention. Nevertheless, evidence already suggests that it plays at least a

partial role in the disorder (Papageorgiou & Wells, 2009). Papageorgiou and

Wells (2001) have found that positive beliefs about rumination (e.g.,

‘‘Ruminating about my depression helps me to understand past mistakes

and failures’’) correlate with higher levels of depressive symptomatology. In

fact, the role of metacognitive awareness is seen as particularly relevant to

the treatment of depression. For instance, it has been argued that the ability

to shift to a decentred metacognitive perspective mediates the ability of

cognitive therapy to prevent depressive relapse (Teasdale et al., 2002).

In this way, the importance of metacognition in explanatory models has

become central in most prominent mental health disorders. Indeed, the

2 VALIENTE ET AL.

Dow

nloa

ded

by [

Bib

liote

ca U

nive

rsid

ad C

ompl

uten

se d

e M

adri

d] a

t 01:

38 2

7 A

pril

2012

Self-Regulatory Executive Function Model (S-REF; Wells & Mathews, 1994,

1996) holds that metacognition affects the development and persistence of

psychological disorders. More precisely, psychological disorders are main-

tained by maladaptive coping strategies (e.g., perseverative thinking) that

perpetuate dysfunctional self-beliefs and increase the accessibility of negativeinformation about self (Wells, 2000).

Increasing the attention paid to metacognition may make cognitive-

behavioural interventions more effective at improving psychological well-

being, which has evolved into the main outcome of psychotherapy. For

example, measuring the success of recovery from schizophrenia (Liberman &

Kopelowicz, 2005) involves assessing functional as well as subjective

dimensions, i.e., psychological well-being (Brekke, Levin, Wolkon, Sobel,

& Slade, 1993; Chino, Nemoto, Fujii, & Mizuno, 2009). In some approachesto treating psychosis, the main objective is to reduce not the symptoms but

the distress associated with them (Chadwick, Birchwood, & Trower, 1996).

Yanos and Moos (2007) have argued that a wide range of environmental and

personal factors influence well-being in schizophrenia. In particular,

cognitive appraisals are crucial to understanding well-being since they are

directly linked to patients’ efforts to manage their subjective experiences

(Brett, Johns, Peters, & McGuire, 2009). Furthermore, psychotherapeutic

strategies that enhance well-being, such as ‘‘well-being therapy’’, have provento be a valid approach for people suffering recurrent depression (Fava, 1999;

Fava et al., 2004).

Despite growing academic interest in both metacognition and psycholo-

gical well-being, little is known about the interaction between these two

variables (Harrington & Loffredo, 2001). Metacognitive beliefs may

moderate, at least in part, the relationship between well-being and paranoia

or depression. We believe that ascertaining the dynamic interaction between

well-being and metacognitive beliefs is crucial to improving our clinicalinterventions. Most cognitive-behavioural interventions aim to reduce

distress and increase well-being by increasing metacognitive introspection

and changing metacognitive evaluation (Chadwick, 2006; Sheppard &

Teasdale, 2004; Wells, 2007, 2009; Wells et al., 2009).

The regulatory role of metacognitive beliefs may depend upon the type of

psychopathology experienced. Nevertheless, evidence suggests that, as a

general rule, self-consciousness is related with the tendency to engage in

paranoid inferences (Fenigstein & Vanable, 1992). Bentall, Corcoran,Howard, Blackwood, and Kinderman (2001) have argued that assuming

that disappointments in life are caused by the intentional actions of others is

a characteristic paranoid strategy to avoid negative effects on self-esteem.

Accordingly, one could expect that individuals with paranoia use self-

consciousness (defined as the process of directing attention towards the self)

to monitor self-threats. Thus, self-consciousness could be linked to subjective

METACOGNITIVE BELIEFS AND WELL-BEING 3

Dow

nloa

ded

by [

Bib

liote

ca U

nive

rsid

ad C

ompl

uten

se d

e M

adri

d] a

t 01:

38 2

7 A

pril

2012

well-being when the level of paranoia is high. Recently, Valiente, Provencio,

Espinosa, Chaves, and Fuentenebro (2011) have suggested that a defensive-

self plays a role in persecutory delusions, but this self-pattern is absent in

depression. In fact, patients with major depression have been found to have

low scores on public self-consciousness (Ruiperez & Belloch, 2003).

AIMS AND PREDICTIONS OF THE CURRENT STUDY

The general goal of this study was to examine psychological well-being and

certain metacognitive beliefs in three groups: participants with persecution

delusions, participants with depression, and healthy participants. Seconda-

rily, we wanted to determine how the relationship between self-conscious-

ness, as a metacognitive dimension, and psychological well-being depends on

the level of paranoia and depressive symptomatology.Based on previous findings, we expected to find that (1) clinical patients,

in comparison with healthy controls, would exhibit higher levels of

dysfunctional metacognitive beliefs, in particular negative beliefs about

worry including uncontrollability and danger; and (2) clinical patients, in

comparison with healthy controls, would exhibit lower levels of psycholo-

gical well-being. In line with the self-serving model of paranoia (Bentall

et al., 2001), we expected to find (3) a moderating effect of cognitive self-

consciousness on the relationship between the level of persecutory thinkingand the level of psychological well-being. In other words, participants with

a high level of persecutory thinking would experience more subjective well-

being when cognitive self-consciousness was high, whereas participants with

a low level of persecutory thinking would experience more subjective well-

being when cognitive self-consciousness was low. However, we did not

expect to find a moderating effect of cognitive self-consciousness on the

relationship between severity of depressive symptoms and psychological

well-being.

METHODS

Participants and procedure

One hundred and thirty-seven individuals (58.4% women) aged between 16and 65 (M�37.80, SD�12.26) volunteered to collaborate in this study after

reading and signing a consent form. Three groups of participants were

formed: the current persecutory beliefs group, the depression group, and the

nonpsychiatric control group.

The current persecutory beliefs group (PG) included 55 participants

(28 men and 27 women) who were treated at a university hospital inpatient

4 VALIENTE ET AL.

Dow

nloa

ded

by [

Bib

liote

ca U

nive

rsid

ad C

ompl

uten

se d

e M

adri

d] a

t 01:

38 2

7 A

pril

2012

psychiatric unit. The mean age of the PG was 34.64 years (SD�11.14). All

participants were suffering persecutory beliefs at the time of the study, as

assessed by the Present State Examination (10th ed.; PSE-10) of the

Schedules for Clinical Assessment in Neuropsychiatry (World Health

Organisation, 1992). Participants with delusions of guilt were excluded, asthese contents are usually associated with major depressive disorders with

psychotic characteristics. Participants were selected through hospital records,

and diagnoses were confirmed using the MINI International Neuropsychia-

tric Interview (MINIPLUS; Sheehan & Lecrubier, 2002), a structured

clinical interview. Participants met criteria of the Diagnostic and Statistical

Manual of Mental Disorders (4th ed.; DSM-IV; American Psychiatric

Association [APA], 1994) for the following categories: schizophrenia

paranoid type (n�28), schizophreniform disorder (n�9), schizoaffectivedisorder (n�6), delusional disorder (n�8), brief psychotic disorder (n�2),

and psychotic disorder not otherwise specified (n�2). All participants were

receiving antipsychotic medication at the time of the study. The mean age of

illness onset for this group was 25.42 (SD�7.68), and the average mean

illness duration was 8.75 years (SD�9.90).

The depression group (DG) included 38 participants (nine men and 29

women) who were recruited from an outpatient mental health service. The

mean age of the DG was 42.84 (SD�11.51). Participants in the DG metDSM-IV criteria for a current depressive disorder and had never experienced

persecutory delusions. Diagnoses were confirmed using MINIPLUS

(Sheehan & Lecrubier, 2002). Participants met criteria of the DSM-IV

(APA, 1994) for the following categories: major depressive disorder, single

episode (n�11), major depressive disorder, recurrent episode (n�22), and

bipolar depression I (n�5). All but four participants were receiving

antidepressants at the time of the study. The mean age of onset of the

disorder for this group was 34.84 years (SD�9.74).The nonpsychiatric control group (CG) comprised 44 participants

(20 men and 24 women) who were recruited via informal contacts. The

mean age of the CG was 37.41 years (SD�13.06). They were screened for

the absence of any clinical syndrome, and they had never required

psychological assistance for any mental disorder or any concurrent medical

condition.

In the clinical groups, participants had a clinical interview that included

the MINIPLUS; participants with persecutory delusions also completed thePSE-10. For the control group, the interview was designed to screen for the

absence of mental illness. After the interview, all participants were given a set

of questionnaires to fill out. After receiving a brief explanation about the

purpose of the study and after having time to ask questions, the participants

were dismissed. Data collection took place between Spring 2009 and

Winter 2010.

METACOGNITIVE BELIEFS AND WELL-BEING 5

Dow

nloa

ded

by [

Bib

liote

ca U

nive

rsid

ad C

ompl

uten

se d

e M

adri

d] a

t 01:

38 2

7 A

pril

2012

Measures

Metacognitions Questionnaire (MCQ-30; Wells & Cartwright-Hatton,

2004). The MCQ-30 is a self-report scale that assesses different beliefs

about worry and cognition. This instrument has 30 items that are rated on a

4-point scale from 1 (‘‘do not agree’’) to 4 (‘‘agree very much’’) and that

cover five different domains: (1) positive beliefs about worry, Positive beliefs

(e.g., ‘‘Worrying helps me to avoid problems in the future’’); (2) negative

beliefs about worry concerning uncontrollability and danger, Uncontroll-

ability and danger (e.g., ‘‘My worrying is dangerous for me’’); (3) beliefsabout lack of confidence in memory, Cognitive confidence (e.g., ‘‘I have a

poor memory’’); (4) beliefs concerning the need to control one’s own

thoughts, Need to control thoughts (e.g., ‘‘If I could not control my

thoughts, I would not be able to function’’); and (5) beliefs about one’s own

tendency to monitor and focus on thoughts, Cognitive self-consciousness

(e.g., ‘‘I think a lot about my thoughts’’). The MCQ-30 has demonstrated

acceptable to good internal consistency and test�retest reliability across

different samples (Cronbach’s a from .72 to .93, and r from .74 to .87; Spada,Mohiyeddini, & Wells, 2008; Wells & Cartwright-Hatton, 2004; Yilmaz,

Gencoz, & Wells, 2008). In this study the Cronbach’s a ranged from .78

to .92.

Psychological Well-Being Scales (PWB; Ryff, 1989; Ryff & Singer,2002). The PWB is a construct-oriented self-report scale that integrates

mental health and life span developmental theories about positive psycho-

logical functioning in six different domains: autonomy, positive relations

with others, self-acceptance, environmental mastery, purpose in life, and

personal growth (Ryff & Keyes, 1995). Each item of this instrument scores

on a 6-point scale from 1 (‘‘disagree very much’’) to 6 (‘‘agree very much’’).

The PWB has demonstrated good internal consistency and test�retest

reliability across different samples (Cronbach’s a from .86 to .93, and r

from .81 to .88; Ryff & Singer, 2002, 2006; van Dierendonck, 2004). In this

study we used the 54-item version, and its Cronbach’s a was .91 in the overall

sample.

Persecution and Deservedness Scale (PaDS; Melo, Corcoran, Shryane, &

Bentall, 2009). This is a brief measure to assess both the severity ofpersecutory thinking and the perceived deservedness of persecution, and it is

suitable for both clinical and nonclinical populations. In this study we used

only the 10 statements of the persecution subscale (PaDS-P), which assume

that the individual is the object of others’ malevolence (e.g., ‘‘There are times

when I worry that others might be plotting against me’’). The PaDS-P items

cover a broad conceptualisation of persecution (e.g., ‘‘I believe that some

6 VALIENTE ET AL.

Dow

nloa

ded

by [

Bib

liote

ca U

nive

rsid

ad C

ompl

uten

se d

e M

adri

d] a

t 01:

38 2

7 A

pril

2012

people want to hurt me deliberately’’), including general mistrust (e.g., ‘‘You

should only trust yourself ’’). Participants were asked to rate each statement

on a 5-point scale ranging from 0 (‘‘certainly false’’) to 4 (‘‘certainly true’’).

Melo et al. (2009) have reported good internal reliability (Cronbach’s a�.84)

and a high correlation (r�.78) with the Paranoia Scale (Fenigstein &Vanable, 1992). In this study we found a Cronbach’s a of .91.

Beck Depression Inventory�2nd edition (BDI-II; Beck, Steer, & Brown,

1996). The BDI-II is a 21-item self-report questionnaire of depression

symptom severity over the two preceding weeks. As each item of this

instrument has a 3-point score, the total score ranges between 0 and 63. The

BDI-II has demonstrated good internal consistency and acceptable test�retest reliability across different samples (Cronbach’s a�.91, r�.71; see

Dozois & Covin, 2004; Dozois, Dobson, & Ahnberg, 1998). In this study wefound a Cronbach’s a of .94.

Statistical analyses

We used one-way analyses of variance (ANOVA) to compare the threegroups with respect to age and years of education, and chi-squared tests to

compare them with respect to gender, marital status, and employment.

Multivariate analyses of covariance (MANCOVA) were used to investigate

clinical, metacognitive beliefs, and psychological well-being differences

among the three groups; a Type IV sum of squares was applied when data

were missing. Pair-wise comparisons were made using Bonferroni and

Games-Howell post hoc comparisons. Finally, hierarchical multiple regres-

sions were used to predict PWB score.

RESULTS

Demographic and clinical status

Table 1 shows sociodemographic parameters of the sample. One-way

analysis of variance revealed significant group differences for age, h2�.07.

Post hoc Bonferroni comparisons indicated that participants with persecu-

tory delusions were younger than participants with depression, t(91)�3.27,p�.004. However, there were no differences between CG and DG,

t(80)�2.06, p�.123, or between CG and PG, t(97)�1.15, p�.753.

Another one-way analysis of variance also revealed significant group

differences for years of education, h2�.16. Post hoc Bonferroni compar-

isons indicated that participants with persecutory delusions had fewer years

of education than participants with depression, t(91)�3.75, p�.001, or

METACOGNITIVE BELIEFS AND WELL-BEING 7

Dow

nloa

ded

by [

Bib

liote

ca U

nive

rsid

ad C

ompl

uten

se d

e M

adri

d] a

t 01:

38 2

7 A

pril

2012

nonpsychiatric control participants, t(97)�4.71, pB.001. However, no

differences were found between DG and CG, tB1.

Finally, chi-square tests showed the three groups differed significantly in

gender, with a smaller number of men in DG than in PG or CG. However,

the groups showed no differences in employment or marital status.

Gender, years of education, and gender differences between groups were

statistically controlled in the following analyses.

Table 2 shows means and standard deviations of scores on BDI-II and

PaDS-P scales for the three groups. In the MANCOVA, BDI-II, and PaDS-P

scores were introduced as dependent variables, and age, years of education,

and gender were introduced as covariates. The analysis revealed a significant

main effect for group, Wilks’s lambda�0.47, F(4, 216)�23.98, pB.001,

h2�.31. There were significant group differences for the BDI-II, h2�.44,

and for the PaDS-P, h2�.20. As Levene’s tests indicated heteroscedasticity

for BDI-II, F(2, 112)�5.37, p�.006, and PaDS-P, F(2, 112)�13.17,

pB.001, group differences for these variables were corroborated using the

Kruskall-Wallis test, x2(2, N�117)�51.33, pB.001; and x2(2, N�119)�24.69, pB.001.

As expected, post hoc Games-Howell comparisons showed that scores on

BDI-II were higher for the DG than for the PG, t(86)�7.61, pB.001, or

CG, t(63)�9.47, pB.001. Moreover, BDI-II scores were higher for the PG

than for CG, t(79)�3.09, p�.002. Compared to controls, PaDS-P scores

were higher for the PG, t(81)�5.55, pB.001, and for DG, t(64)�4.38,

pB.001. However, there were no significant differences between the two

clinical groups, t B1.

TABLE 1Participant characteristics

Nonclinical

(n�44)

Depression

(n�38)

Paranoia

(n�55) F x2 p

Mean age (SD) 37.41 (13.06) 42.84 (11.51) 34.64 (11.14) 5.39 .006

Years of education

(SD)

14.75 (3.69) 14.15 (4.07) 11.23 (3.38) 12.98 B.001

Gender

Men 20 9 28 7.25 .027

Women 24 29 27

Marital status 5.59 �.05

Never married 22 18 38

Ever married 22 20 17

Employment 5.56 �.05

Not employed 19 15 34

Employed 25 23 21

8 VALIENTE ET AL.

Dow

nloa

ded

by [

Bib

liote

ca U

nive

rsid

ad C

ompl

uten

se d

e M

adri

d] a

t 01:

38 2

7 A

pril

2012

Group differences on MCQ-30

Table 2 shows means and standard deviations of the MCQ-30 subscales for

the three groups. Another MANCOVA was used to assess group differences

in MCQ-30 subscales; here, again, the covariates were age, years of

education, and gender. After determining that Box’s test was nonsignificant

(M�37.02), F(30, 45008)�1.16, p�.247, we found a significant main effect

for group, Wilks’s lambda�0.58, F(10, 240)�7.38, pB.001, h2�.23, and

gender, Wilks’s lambda�0.85, F(5, 120)�4.12, p�.002, h2�.14. There

were significant differences in three MCQ-30 subscales: uncontrollability and

danger, h2�.32; need to control thoughts, h2�.18; and cognitive con-

fidence, h2�.10.

Post hoc Bonferroni analysis revealed that participants in the DG scored

higher on the uncontrollability and danger subscale than those in the PG,

t(86)�2.96, p�.011, or CG, t(77)�7.58, pB.001. In addition, the PG

scored higher than nonclinical participants, t(91)�4.48, pB.001. A

significant gender effect was found for the uncontrollability and danger

TABLE 2Means and standard deviations (in parenthesis) on BDI-II, PaDS-P, MCQ-30, and

PWQ scales

Scale

Nonclinical

(n�44)

Depression

(n�38)

Paranoia

(n�55) F p

BDI-II 6.31 (6.68) 31.05 (9.82) 13.96 (12.65) 43.98 B.001

PaDS-P 4.86 (5.01) 15.80 (10.20) 16.54 (10.90) 13.67 B.001

MCQ-30

Cognitive confidence 12.02 (4.35) 15.83 (4.37) 12.64 (4.59) 7.01 .001

Positive beliefs 12.50 (4.78) 12.16 (4.43) 14.45 (5.65) 1.07 .346

Cognitive self-

consciousness

15.92 (4.02) 16.51 (3.20) 16.84 (4.44) 0.99 .374

Uncontrollability and

danger

10.88 (3.57) 18.89 (4.64) 15.39 (4.69) 29.39 B.001

Need to control

thoughts

11.78 (3.41) 16.21 (3.65) 15.05 (4.32) 13.72 B.001

PWQ

Autonomy 33.55 (5.42) 30.22 (5.34) 33.32 (7.22) 4.47 .013

Relations with others 34.44 (5.77) 31.30 (6.43) 33.59 (7.85) 2.52 .084

Self-acceptance 33.83 (6.30) 27.33 (5.14) 32.46 (6.46) 10.36 B.001

Environmental mastery 33.02 (6.20) 29.02 (5.52) 31.19 (6.92) 4.83 .009

Purpose in life 30.00 (5.15) 27.55 (5.72) 30.90 (7.83) 2.60 .078

Personal growth 31.48 (5.60) 28.41 (6.12) 31.61 (7.57) 3.24 .042

BDI-II, Beck Depression Inventory (2nd edition); PaDS-P, Persecution and Deservedness

Scale�Persecutory thinking dimension; MCQ-30, Metacognitions Questionnaire; PWB, Scales of

Psychological Well-Being.

METACOGNITIVE BELIEFS AND WELL-BEING 9

Dow

nloa

ded

by [

Bib

liote

ca U

nive

rsid

ad C

ompl

uten

se d

e M

adri

d] a

t 01:

38 2

7 A

pril

2012

subscale, F(1, 124)�8.48, p�.004, h2�.06, reflecting higher scores for

women (M�16.22, SD�5.34) than men (M�12.77, SD�4.70). Follow-up

ANOVA using group and gender as factors and the uncontrollability and

danger subscale as the dependent variable corroborated the main group and

gender effects, but showed no interaction effect, FB1.Finally, post hoc comparisons showed that scores on the need to control

thoughts subscale were lower for the CG than for the DG, t(77)�5.10,

pB.001, or the PG, t(91)�3.39, p�.003. However, there were no differences

between participants in clinical groups, t(86)�1.64, p�.309.

Regarding the cognitive confidence subscale, participants in the DG had

higher scores than participants in the PG, t(86)�3.03, p�.009, and CG,

t(77)�3.45, p�.002. But no differences were found between participants in

the PG and CG, tB1.

Group differences on PWB

Table 2 shows means and standard deviations of the PWB subscales for thethree groups. MANCOVA was used to assess group differences in the six

PWB subscales while controlling age, years of education, and gender as

covariates. This analysis revealed only a significant group effect, Wilks’s

lambda�0.81, F(12, 240)�2.21, pB.012, h2�.10. In particular, there were

significant group differences on four PWB dimensions: self-acceptance,

h2�.14; environmental mastery, h2�.07; autonomy, h2�.06; and personal

growth, h2�.04.

Post hoc Bonferroni comparison revealed that participants in the DGscored lower than participants in the CG on the subscales for self-

acceptance, t(77)�4.45, pB.001, environmental mastery, t(77)�3.10,

p�.007, autonomy, t(77)�2.57, p�.033, and personal growth,

t(77)�2.42, p�.050. In addition, participants in the DG scored lower

than participants in the PG on the self-acceptance subscale, t(86)�3.21,

p�.005, and autonomy subscale, t(86)�2.67, p�.026. But no differences

were found between the PG and CG on any PWB subscale (p�.05).

Predicting PWB: A moderation analysis

After preliminary analyses conducted to ensure that assumptions ofregression were not violated, hierarchical multiple regression analyses were

used to examine whether cognitive self-consciousness (MCQ-30-CSC)

moderated the relationship between severity of persecutory thinking

(PaDS-P) and psychological well-being (PWB). Standardised scores for

PaDS-P and MCQ-30-CSC were introduced at Step 1 and their interaction

(PaDS-P�MCQ-CSC) was introduced at Step 2.

10 VALIENTE ET AL.

Dow

nloa

ded

by [

Bib

liote

ca U

nive

rsid

ad C

ompl

uten

se d

e M

adri

d] a

t 01:

38 2

7 A

pril

2012

Severity of persecutory thinking and cognitive self-consciousness at Step 1

explained no more than 0.1% of variance: DR2�.001, DF(2, 109)�0.057,

p�.94. However for PWB score at Step 2, the interaction of severity of

persecutory thinking with cognitive self-consciousness explained an addi-

tional 15% after controlling for each of the independent variables, DF(1,108)�19.05, p B.001, indicating that the interaction made a unique and

significant contribution to the final model (see Table 3).

As shown in Figure 1, participants with low scores for persecutory

thinking presented high levels of psychological well-being when cognitive

self-consciousness was low. However, participants with high scores for

persecutory thinking presented higher levels of psychological well-being

when self-consciousness was high.

The same moderation analyses were also used to examine whethercognitive self-consciousness moderated the relationship between severity of

depression and psychological well-being but no effect was found, DR2�.011,

DF(1, 108)�1.23, p�.26.

DISCUSSION

The examination of metacognitive beliefs between groups confirmed our first

hypothesis, i.e., that clinical participants would show significantly higher

scores than the control group for negative beliefs about worry, includinguncontrollability (e.g., ‘‘When I start worrying I cannot stop’’) and danger

(e.g., ‘‘My worrying is dangerous for me’’). This suggests that clinical

participants perceive a greater need to control their thoughts than do healthy

individuals. These results are consistent with theoretical accounts of

emotional disorders, in which negative beliefs about worry are considered

dysfunctional (Wells, 2009; Wells & Mathews, 1994, 1996), as well as with

TABLE 3Regression analysis to assess how well persecutory thinking (PaDS-P) and cognitiveself-consciousness (MCQ-30-SC) predict dimensions of psychological well-being

(PWB) (N �112)

R2 DR2 t b p

Step 1 .001 .001

Persecutory thinking 0.23 .02 .81

Cognitive self consciousness 0.13 .01 .89

Step 2 .150 .151

Persecutory thinking�Cognitive self consciousness 4.36 .39 .000*

PWB, Scales of Psychological Well-Being; PaDS-P, Persecution and Deservedness Scale�Persecutory thinking dimension; MCQ-30-SC, Metacognitions Questionnaire�Self

consciousness. *p B.001.

METACOGNITIVE BELIEFS AND WELL-BEING 11

Dow

nloa

ded

by [

Bib

liote

ca U

nive

rsid

ad C

ompl

uten

se d

e M

adri

d] a

t 01:

38 2

7 A

pril

2012

previous research that has reported a high level of these beliefs in paranoia

and depression (Foster, Startup, Potts, & Freeman, 2010; Moritz, Peters,

Larøi, & Lincoln, 2010; Morrison & Wells, 2007; Startup, Freeman, &

Garety, 2007). These findings support new clinical interventions to treat

psychosis that encourage acceptance of internal experience (e.g., Chadwick,

2006) and unavoidable private events (Bach & Hayes, 2002).

In line with prior studies that indicate memory deficits in depression (e.g.,

Hermens, Naismith, Redoblado-Hodge, Scott, & Hickie, 2010), our study

shows a significant lack of memory confidence in the depression group. This

may be linked to their high level of worry (Starcevic, 1995), because some

evidence suggests that worry restricts working memory capacity (Hayes,

Hirsch, & Mathews, 2008; Rapee, 1993). Interestingly, our participants with

persecutory delusions had similar memory confidence as healthy controls,

which is consistent with previous research (Moritz et al., 2010). The possible

link between worry and memory in deluded patients should be explored in

further research.

Similar to other clinical comparisons (Wells & Carter, 2001), our study

did not find differences among groups in positive beliefs about worry.

Although self-consciousness has been linked to paranoid thinking

(Fenigstein & Vanable, 1992), our groups did not show differences in

cognitive self-consciousness scores. Other research has also suggested that

cognitive self-consciousness, as assessed with the MCQ-30, is not linked to

depression severity (Yilmaz et al., 2008). Future research should address

these apparent discrepancies about the effect of self-consciousness.

155

160

165

170

175

180

185

190

195

200

Low Persecutory Thinking(PaDS)

High Persecutory Thinking(PaDS)

Psy

cho

log

ical

Wel

l-b

ein

g (

PW

B)

Low Self-Consciousness(MCQ-30)

High Self-Consciousness(MCQ-30)

Figure 1. Moderating effect of cognitive self-consciousness and persecution thinking on psycholo-

gical well-being. PWB, Scales of Psychological Well-Being; PaDS, Persecution and Deservedness

Scale; MCQ-30, Metacognitions Questionnaire.

12 VALIENTE ET AL.

Dow

nloa

ded

by [

Bib

liote

ca U

nive

rsid

ad C

ompl

uten

se d

e M

adri

d] a

t 01:

38 2

7 A

pril

2012

The findings of our study partially support our second hypothesis.

Participants with depression rated their psychological well-being lower

than did participants with persecution delusions and healthy controls,

especially in the self-acceptance and autonomy domains. However, partici-

pants with persecutory delusions and healthy controls did not differ insubjective psychological well-being. An inflated sense of well-being could

reflect a motivational bias in paranoia that seeks to preserve a positive sense

of self (Bentall et al., 2001; McKay, Langdon, & Coltheart, 2007; Valiente

et al., 2011). It would be interesting to try to replicate this finding using

objective measures of well-being.

Our third hypothesis predicted that the level of cognitive self-

consciousness would moderate the effects of persecutory thinking on well-

being. Our results showed that neither the level of persecutory thinkingnor the level of cognitive self-consciousness on their own was able to explain

the observed variance in well-being. Nevertheless, we did find that the level

of cognitive self-consciousness moderated the relationship between well-

being and persecutory thinking, though not the relationship between well-

being and depression severity. Participants with higher persecutory thinking

reported better well-being when they had higher cognitive self-consciousness

than when they had lower cognitive self-consciousness. And participants

with lower persecutory thinking reported worse well-being when they hadhigher cognitive self-consciousness than when they had lower cognitive self-

consciousness. These results suggest that the participants with higher

persecution thinking use cognitive self-consciousness as a strategy to

maintain a sense of wellness. The cross-sectional nature of our study

prevents us from reaching any definitive conclusions about causality, but

we speculate that the use of cognitive self-consciousness, as a way to regulate

well-being, may have positive effects in the short term, while perpetuating a

defensive self in the long term.This last finding has important clinical implications. For instance,

psychotherapy should build on people’s personal resources and mechanisms

(Tarrier et al., 1993), while redirecting self-effort towards more coherence

and authenticity (Kernis, 2003). This suggestion is also in line with recent

metacognitively oriented therapy for schizophrenia (Aghotor, Pfueller,

Moritz, Weisbrod, & Roesch-Ely, 2010; Buck & Lysaker, 2009; Lysaker,

Buck, & Ringer, 2007).

As a first attempt to study the relationship between metacognitive beliefsand psychological well-being, this study has several limitations that must be

addressed in future research. For example, external validity could be

enhanced by the inclusion of multiple measures of main variables; these

measures could be subjective, objective, and implicit. Future studies

could also address whether experimental manipulation of cognitive self-

consciousness affects the level of psychological well-being in clinical and

METACOGNITIVE BELIEFS AND WELL-BEING 13

Dow

nloa

ded

by [

Bib

liote

ca U

nive

rsid

ad C

ompl

uten

se d

e M

adri

d] a

t 01:

38 2

7 A

pril

2012

control samples. Further studies could explore how changes in cognitive self-

consciousness in context*over time and with different daily stresses*are

associated with changes in clinical and psychological adjustment.

Manuscript received 13 April 2011

Revised manuscript received 9 February 2012

First published online 24 April 2012

REFERENCES

Aghotor, J., Pfueller, U., Moritz, S., Weisbrod, M., & Roesch-Ely, D. (2010). Metacognitive training

for patients with schizophrenia (MCT): Feasibility and preliminary evidence for its efficacy.

Journal of Behavior Therapy and Experimental Psychiatry, 41, 207�211. doi:10.1016/

j.jbtep.2010.01.004

American Psychiatric Association (APA). (1994). Diagnostic and statistical manual of mental

disorders (4th ed.). Washington, DC: Author.

Bach, P., & Hayes, S. C. (2002). The use of acceptance and commitment therapy to prevent the

rehospitalization of psychotic patients: A randomized controlled trial. Journal of Consulting

and Clinical Psychology, 70, 1129�1139. doi:10.1037//0022-006X.70.5.1129

Baker, C. A., & Morrison, A. P. (1998). Cognitive processes in auditory hallucinations:

Attributional biases and metacognition. Psychological Medicine, 28, 1199�1208. doi:10.1017/

S0033291798007314

Beck, A. T., Steer, R. A., & Brown, G. K. (1996). Beck Depression Inventory�second edition manual.

San Antonio, TX: Psychological Corporation.

Bentall, R. P., Corcoran, R., Howard, R., Blackwood, N., & Kinderman, P. (2001). Persecutory

delusions: A review and theoretical integration. Clinical Psychology Review, 21, 1143�1192.

doi:10.1016/S0272-7358(01)00106-4

Brekke, J. S., Levin, S., Wolkon, G. H., Sobel, E., & Slade, E. (1993). Psychosocial functioning and

subjective experience in schizophrenia. Schizophrenia Bulletin, 19, 559�608. doi:10.1093/schbul/

19.3.599

Brett, C. M. C., Johns, L. C., Peters, E. P., & McGuire, P. K. (2009). The role of metacognitive

beliefs in determining the impact of anomalous experiences: A comparison of help-seeking and

non-help-seeking groups of people experiencing psychotic-like anomalies. Psychological

Medicine, 39, 939�950. doi:10.1017/S0033291708004650

Buck, K. D., & Lysaker, P. H. (2009). Addressing metacognitive capacity in the psychotherapy for

schizophrenia: A case study. Clinical Case Studies, 8, 463�472. doi:10.1177/1534650109352005.

Chadwick, P. (2006). Person based cognitive therapy for distressing psychosis. Chichester, UK: Wiley.

Chadwick, P., Birchwood, M. J., & Trower, P. (1996). Cognitive therapy for delusions, voices and

paranoia. Chichester, UK: Wiley.

Chino, B., Nemoto, T., Fujii, C., & Mizuno, M. (2009). Subjective assessments of the quality of life,

well-being and self-efficacy in patients with schizophrenia. Psychiatry and Clinical Neuros-

ciences, 63, 521�528. doi:10.1111/j.1440-1819.2009.01995.x

Corcoran, K. M., & Segal, Z. V. (2008). Metacognition in depressive and anxiety disorders:

Current directions. International Journal of Cognitive Therapy, 1, 33�44. doi:10.1680/

ijct.2008.1.1.33

Dozois, D. J. A., & Covin, R. (2004). The Beck Depression Inventory�II, Beck Hopelessness Scale

(BHS), and Beck Scale for Suicide Ideation (BSS). In M. Hersen, M. J. Hilsenroth, & D. L.

Segal (Eds.), Comprehensive handbook of psychological assessment: Personality assessment

(pp. 50�69). New York, NY: Wiley.

14 VALIENTE ET AL.

Dow

nloa

ded

by [

Bib

liote

ca U

nive

rsid

ad C

ompl

uten

se d

e M

adri

d] a

t 01:

38 2

7 A

pril

2012

Dozois, D. J. A., Dobson, K. S., & Ahnberg, J. L. (1998). A psychometric evaluation of the Beck

Depression Inventory�II. Psychological Assessment, 10, 83�89.

Fava, G. A. (1999). Well-being therapy: Conceptual and technical issues. Psychotherapy and

Psychosomatics, 68, 171�179. doi:10.1159/000012329

Fava, G. A., Ruini, C., Rafanelli, C., Finos, L., Conti, S., & Grandi, S. (2004). Six-year outcome of

cognitive behavior therapy for prevention of recurrent depression. American Journal of

Psychiatry, 161, 1872�1876. doi:10.1176/appi.ajp.161.10.1872

Fenigstein, A., & Vanable, P. A. (1992). Paranoia and self-consciousness. Journal of Personality and

Social Psychology, 62, 129�134. doi:10.1037/0022-3514.62.1.129

Fisher, P., & Wells, A. (2009). Metacognitive therapy. Hove, UK: Routledge.

Foster, C., Startup, H., Potts, L., & Freeman, D. (2010). A randomised controlled trial of a worry

intervention for individuals with persistent persecutory delusions. Journal of Behavior Therapy

and Experimental Psychiatry, 41, 45�51. doi:10.1016/j.jbtep.2009.09.001

Freeman, D., & Garety, P. A. (1999). Worry, worry processes and dimensions of delusions: An

exploratory investigation of a role for anxiety processes in the maintenance of delusional

distress. Behavioural and Cognitive Psychotherapy, 27, 47�62.

Frith, C. D. (1992). The cognitive neuropsychology of schizophrenia. Hove, UK: Lawrence Erlbaum

Associates Ltd.

Harrington, R., & Loffredo, D. A. (2001). The relationship between life satisfaction, self-

consciousness and the Myers-Briggs Type Inventory dimensions. Journal of Psychology, 135,

439�450. doi:10.1080/00223980109603710

Hayes, S., Hirsch, C. R., & Mathews, A. (2008). Restriction of working memory capacity during

worry. Journal of Abnormal Psychology, 117, 712�717. doi:10.1037/a0012908

Hermens, D. F., Naismith, S. L., Redoblado-Hodge, M. A., Scott, E. M., & Hickie, I. B. (2010).

Impaired verbal memory in young adults with unipolar and bipolar depression. Early

Intervention in Psychiatry, 4, 227�233. doi:10.1111/j.1751-7893.2010.00194.x

Kernis, M. H. (2003). Toward a conceptualization of optimal self-esteem. Psychological Inquiry, 14,

1�26. doi:10.1207/S15327965PLI1401_01

Larøi, F., & van der Linden, M. (2005). Metacognition in proneness towards hallucinations and

delusions. Behaviour Research and Therapy, 43, 1425�1441. doi:10.1016/j.brat.2004.10.008

Liberman, R. P., & Kopelowicz, A. (2005). Recovery from schizophrenia: A concept in search of

research. Psychiatric Services, 56, 735�742. doi:10.1176/appi.ps.56.6.735

Lysaker, P. H., Buck, K. D., & Ringer, J. (2007). The recovery of metacognitive capacity in

schizophrenia across 32 months of individual psychotherapy: A case study. Psychotherapy

Research, 17, 713�720. doi:10.1080/10503300701255932]

Lysaker, P. H., Dimaggio, G., Buck, K. D., Callaway, S. S., Salvatore, G., Carcione, A., et al.

(2011). Poor insight in schizophrenia: Links between different forms of metacognition with

awareness of symptoms, treatment need, and consequences of illness. Comprehensive Psychiatry,

52, 253�260. doi:10.1016/j.comppsych.2010.07.007

McKay, R., Langdon, R., & Coltheart, M. (2007). The defensive function of persecutory delusions:

An investigation using the implicit association test. Cognitive Neuropsychiatry, 12, 1�24.

doi:10.1080/13546800500363996

Melo, S., Corcoran, R., Shryane, N., & Bentall, R. P. (2009). The persecution and deservedness

scale. Psychology and Psychotherapy: Theory, Research and Practice, 82, 247�260. doi:10.1348/

147608308X398337

Moritz, S., Peters, M. J. V., Larøi, F., & Lincoln, T. M. (2010). Metacognitive beliefs in obsessive-

compulsive patients: A comparison with healthy and schizophrenia participants. Cognitive

Neuropsychiatry, 15, 531�548. doi:10.1080/13546801003783508

Morrison, A. P. (2001). The interpretation of intrusions in psychosis: An integrative cognitive

approach to hallucinations and delusions. Behavioural and Cognitive Psychotherapy, 29,

257�276. doi:10.1017/S1352465801003010

METACOGNITIVE BELIEFS AND WELL-BEING 15

Dow

nloa

ded

by [

Bib

liote

ca U

nive

rsid

ad C

ompl

uten

se d

e M

adri

d] a

t 01:

38 2

7 A

pril

2012

Morrison, A. P., French, P., & Wells, A. (2007). Metacognitive beliefs across the continuum of

psychosis: Comparisons between patients with psychotic disorders, patients at ultra risk and

non-patients. Behaviour Research and Therapy, 45, 2241�2246. doi:10.1016/j.brat.2007.01.002

Morrison, A. P., & Petersen, T. (2003). Trauma, metacognition and predisposition to hallucinations

in non-patients. Behavioural and Cognitive Psychotherapy, 31, 235�246. doi:10.1017/

S1352465803003011

Morrison, A. P., & Wells, A. (2003). A comparison of metacognitions in patients with

hallucinations, delusions, panic disorder, and non-patient controls. Behaviour Research and

Therapy, 41, 251�256. doi:10.1016/S0005-7967(02)00095-5

Morrison, A. P., & Wells, A. (2007). Relationships between worry, psychotic experiences and

emotional distress in patients with schizophrenia spectrum diagnoses and comparisons with

anxious and non-patient groups. Behaviour Research and Therapy, 45, 1593�1600. doi:10.1016/

j.brat.2006.11.010

Papageorgiou, C., & Wells, A. (2001). Positive beliefs about depressive rumination: Development

and preliminary validation of a self-report scale. Behavior Therapy, 32, 13�26. doi:10.1016/

S0005-7894(01)80041-1

Papageorgiou, C., & Wells, A. (2009). A prospective test of the clinical metacognitive model of

rumination and depression. International Journal of Cognitive Therapy, 2, 123�131. doi:10.1521/

ijct.2009.2.2.123

Rapee, R. M. (1993). The utilisation of working memory by worry. Behaviour Research and

Therapy, 31, 617�620. doi:10.1016/0005-7967(93)90114-A

Reeder, C., Rexhepi-Johansson, T., & Wykes, T. (2010). Different components of metacognition

and their relationship to psychotic-like experiences. Behavioural and Cognitive Psychotherapy,

38, 49�57. doi:10.1017/S1352465809990403

Ruiperez, M. A., & Belloch, A. (2003). Dimensions of the self-consciousness scale and their

relationship with psychopathological indicators. Personality and Individual Differences, 35,

829�841. doi:10.1016/S0191-8869(02)00286-6

Ryff, C. D. (1989). Happiness is everything, or is it? Explorations on the meaning of psychological

well-being. Journal of Personality and Social Psychology, 57, 1069�1081. doi:10.1037/0022-

3514.57.6.1069

Ryff, C. D., & Keyes, C. L. (1995). The structure of psychological well-being revisited. Journal of

Personality and Social Psychology, 69, 719�727. doi:10.1037/0022-3514.69.4.719

Ryff, C., & Singer, B. (2002). From social structure to biology. In C. Zinder & A. Lopez (Eds.),

Handbook of positive psychology (pp. 63�73). London, UK: Oxford University Press.

Ryff, C. D., & Singer, B. H. (2006). Best news yet on the six-factor model of well-being. Social

Science Research, 35, 1103�1119. doi:10.1016/j.ssresearch.2006.01.002

Sheehan, D. V., & Lecrubier, Y. (2002). MINI International Neuropsychiatric Interview for DSM-IV

(English version 5.0.0). Tampa, FL: University of South Florida.

Sheppard, L., & Teasdale, J. D. (2004). How does dysfunctional thinking decrease during recovery

from major depression? Journal of Abnormal Psychology, 113, 64�71. doi:10.1037/0021-

843X.113.1.64

Spada, M. M., Mohiyeddini, C., & Wells, A. (2008). Measuring metacognitions associated with

emotional distress: Factor structure and predictive validity of the Metacognitions Question-

naire 30. Personality and Individual Differences, 45, 238�242. doi:10.1016/j.paid.2008.04.005

Starcevic, V. (1995). Pathological worry in major depression: Preliminary report. Behaviour

Research and Therapy, 33, 55�57. doi:10.1016/0005-7967(93)E0028-4

Startup, H., Freeman, D., & Garety, P. A. (2007). Persecutory delusions and catastrophic worry in

psychosis: Developing the understanding of delusion distress and persistence. Behaviour

Research and Therapy, 45, 523�537. doi:10.1016/j.brat.2006.04.006

Tarrier, N., Sharpe, L., Beckett, R., Harwood, S., Baker, A., & Yusopoff, L. (1993). A trial of two

cognitive behavioural methods of treating drug-resistant residual psychotic symptoms in

16 VALIENTE ET AL.

Dow

nloa

ded

by [

Bib

liote

ca U

nive

rsid

ad C

ompl

uten

se d

e M

adri

d] a

t 01:

38 2

7 A

pril

2012

schizophrenic patients: II. Treatment-specific changes in coping and problem-solving skills.

Social Psychiatry and Psychiatric Epidemiology, 28, 5�10. doi:10.1007/BF00797826

Teasdale, J. D., Moore, R. G., Hayhurst, H., Pope, M., Williams, S., & Segal, Z. V. (2002).

Metacognitive awareness and prevention of relapse in depression: Empirical evidence. Journal

of Consulting and Clinical Psychology, 70, 275�287. doi:10.1037//0022-006X.70.2.275

Valiente, C., Provencio, M., Espinosa, R., Chaves, C., & Fuentenebro, F. (2011). Predictors of

subjective well-being in patients with paranoid symptoms: Is insight necessarily advantageous?

Psychiatry Research, 189, 190�194. doi:10.1016/j.psychres.2011.02.018

van Dierendonck, D. (2004). The construct validity of Ryff ’s scales of psychological well-being and

its extension with spiritual well-being. Personality and Individual Differences, 36, 629�643.

doi:10.1016/S0191-8869(03)00122-3

Wells, A. (2000). Emotional disorders and metacognition: Innovative cognitive therapy. Chichester,

UK: Wiley.

Wells, A. (2007). The attention training technique: Theory, effects, and a metacognitive hypothesis

on auditory hallucinations. Cognitive and Behavioral Practice, 14(2), 134�138. doi:10.1016/

j.cbpra.2006.01.010

Wells, A. (2009). Metacognitive therapy for anxiety and depression. New York, NY: Guilford Press.

Wells, A., & Carter, K. (2001). Further tests of a cognitive model of generalized anxiety disorder:

Metacognitions and worry in GAD, panic disorder, social phobia, depression and nonpatients.

Behavior Therapy, 32, 85�102. doi:10.1016/S0005-7894(01)80045-9

Wells, A., & Cartwright-Hatton, S. (2004). A short form of the metacognitions questionnaire:

Properties of the MCQ-30. Behaviour Research and Therapy, 42, 385�396. doi:10.1016/S0005-

7967(03)00147-5

Wells, A., Fisher, P., Myers, S., Wheatley, J., Patel, T., & Brewin, C. R. (2009). Metacognitive

therapy in recurrent and persistent depression: A multiple-baseline study of a new treatment.

Cognitive Therapy and Research, 33, 291�300. doi:10.1007/s10608-007-9178-2

Wells, A., & Mathews, G. (1994). Attention and emotion: A clinical perspective. Hove, UK:

Lawrence Erlbaum Associates Ltd.

Wells, A., & Mathews, G. (1996). Modelling cognition in emotional disorder: The S-REF Model.

Behaviour Research and Therapy, 34, 881�888. doi:10.1016/S0005-7967(96)00050-2

World Health Organisation. (1992). The ICD-10 classification of mental and behavioural disorders:

Clinical descriptions and diagnostic guidelines. Geneva, Switzerland: Author.

Yanos, P. T., & Moos, R. H. (2007). Determinants of functioning and well-being among individuals

with schizophrenia: An integrated model. Clinical Psychology Review, 27, 58�77. doi:10.1016/

j.cpr.2005.12.008

Yilmaz, A. E., Gencoz, T., & Wells, A. (2008). Psychometric characteristics of the Penn State

Worry Questionnaire and Metacognitions Questionnaire-30 and metacognitive predictors of

worry and obsessive-compulsive symptoms in a Turkish sample. Clinical Psychology and

Psychotherapy, 15, 424�439. doi:10.1002/cpp.589

METACOGNITIVE BELIEFS AND WELL-BEING 17

Dow

nloa

ded

by [

Bib

liote

ca U

nive

rsid

ad C

ompl

uten

se d

e M

adri

d] a

t 01:

38 2

7 A

pril

2012