Validation and clinical application of the Metacognitions Questionnaire in a sample of Brazilian generalized anxiety disorder patients: the effects of different treatment interventions

Schwinn, Julia Karl; Giusti Alves, Sofia; Costa, Marianna de Abreu; Gonçalves, Francine; Dreher, Carolina Blaya; Manfro, Gisele Gus

doi:10.47626/2237-6089-2021-0444

Tabla de contenido Anterior Actual Siguiente

Tabla de contenido

Original Article • Trends Psychiatry Psychother. 45 • 2023 • https://doi.org/10.47626/2237-6089-2021-0444 linkcopy

Validation and clinical application of the Metacognitions Questionnaire in a sample of Brazilian generalized anxiety disorder patients: the effects of different treatment interventions

Authorship SCIMAGO INSTITUTIONS RANKINGS

Introduction Metacognitive beliefs about worry may trigger anxiety. However, the effect of generalized anxiety disorder (GAD) treatment on metacognition has not yet been investigated.

Objectives To validate the Metacognitions Questionnaire (MCQ-30) in a Brazilian GAD sample and verify whether different interventions reduce metacognitive beliefs.

Method We recruited 180 GAD individuals and randomized them to Body in Mind Training (BMT), Fluoxetine (FLX), or an active control group (Quality of Life [QoL]) for 8 weeks. The MCQ-30 was assessed for internal consistency, was evaluated with confirmatory and exploratory factor analyses, and was tested for convergent validity with the Penn State Worry Questionnaire (PSWQ). Generalized estimating equations (GEE) were employed to analyze differences after the interventions.

Results The MCQ-30 demonstrated good internal consistency and acceptability; the original five-factor model was supported. There was a positive moderate correlation between MCQ-30 scores and worry. GEE showed a significant group x time interaction (p < 0.001). Both BMT (mean difference [MD] = -6.04, standard error [SE] = -2.39, p = 0.034) and FLX (MD = -5.78, SE = 1.91, p = 0.007) reduced MCQ-30 scores. FLX was superior to QoL, but not BMT, at weeks 5 and 8. There were no differences between BMT and QoL.

Conclusion The Brazilian-Portuguese version of MCQ-30 showed good psychometric properties. Furthermore, the positive effect of FLX and BMT on metacognition suggests it may represent a potential therapeutic target.

generalized anxiety disorder; metacognition; MCQ-30; mindfulness-based interventions; Body in Mind Training; selective serotonin reuptake inhibitor

	BMT (n = 61)	FLX (n = 62)	QoL (n = 57)	p-value *
Age, years (mean [SD])	36.93 (13.61)	35.04 (11.38)	36.54 (12.72)	0.739
Female, %	73.3	83.9	81.0	0.332
Education, %				0.332
Incomplete high school	5.1	0.0	0.0	0.312
Complete high school	0.0	3.2	1.8
Complete higher education	59.3	61.3	56.1
Postgraduate courses	35.6	35.5	42.1
Economic class (%)				0.851
A	3.3	0.0	0.0
B	46.7	50.0	50.0
C	46.7	46.8	44.8
D	0.0	0.0	0.6
Unknown	3.3	3.2	3.4
Axis I diagnosis, %
Major depression	38.3	25.8	36.2	0.291
Panic disorder	33.3	25.0	41.7	0.476
Agoraphobia	11.7	6.5	20.7	0.062
Obsessive-compulsive disorder	10.0	0.0	3.4	0.025
Social anxiety disorder	10.0	6.5	15.5	0.210
Posttraumatic stress disorder	5.0	6.5	1.7	0.538
HAMA, (mean [SD])	28.15 (7.21)	30.18 (8.89)	27.98 (7.62)	F = 1.23; p = 0.281
HAMD, (mean [SD])	13.11 (4.14)	15.53 (5.54)	14.78 (4.48)	0.094
GAD-7, (mean [SD])	15.56 (3.27)	15;89 (2.88)	15.11 (3.17)	0.417
PSWQ, (mean [SD])	61;49 (7.08)	61.89 (7.95)	60.07 (8.67)	0.639
MCQ-30, (mean [SD])
Total score	76.65 (14.46)	76.75 (15.20)	77.43 (13.28)	F = 0.18; p = 0.835
Factor 1	15.55 (5.23)	16.16 (5.06)	15.89 (5.89)	0.886
Factor 2	12.20 (4.96)	12.56 (4.81)	12.30 (4.13)	0.986
Factor 3	15.49 (4.17)	14.96 (3.68)	15.96 (3.62)	0.280
Factor 4	18.38 (3.74)	18.02 (4.42)	18.24 (4.23)	0.975
Factor 5	15.04 (3.73)	15.05 (3.81)	15.04 (3.55)	0.707

	Factors

	1	2	3	4	5
Cognitive confidence
8. I have little confidence in my memory for words and names.	0.79	0.20	0.04	0.05	0.17
14. My memory can mislead me at times.	0.77	0.21	0.06	0.17	0.14
17. I have a poor memory.	0.89	0.19	-0.02	0.17	0.24
24. I have little confidence in my memory for places.	0.60	0.17	-0.01	0.15	0.21
26. I do not trust my memory.	0.92	0.21	-0.01	0.10	0.25
29. I have little confidence in my memory for actions.	0.75	0.21	-0.07	0.09	0.24
Positive beliefs about worry
1. Worrying helps me to avoid problems in the future.	0.15	0.54	0.12	0.06	0.13
7. I need to worry in order to remain organized.	0.28	0.65	0.24	0.13	0.35
10. Worrying helps me to get things sorted out in my mind.	0.22	0.86	0.16	0.15	0.23
19. Worrying helps me cope.	0.15	0.84	0.29	0.08	0.33
23. Worrying helps me to solve problems.	0.21	0.82	0.28	0.12	0.24
28. I need to worry in order to work well.	0.12	0.54	0.27	0.17	0.35
Cognitive self-consciousness
3. I think a lot about my thoughts.	0.07	0.13	0.38	0.56	0.45
5. I am aware of the way my mind works when I am thinking through a problem.	-0.09	0.02	0.47	0.13	0.27
12. I monitor my thoughts.	0.11	0.39	0.63	0.12	0.30
16. I am constantly aware of my thinking.	0.04	0.31	0.69	0.16	0.29
18. I pay close attention to the way my mind works.	-0.08	0.11	0.83	0.22	0.05
30. I constantly examine my thoughts.	0.03	0.17	0.72	0.39	0.39
Negative beliefs about uncontrollability and danger
2. My worrying is dangerous for me.	0.06	0.08	0.19	0.52	0.46
4. I could make myself sick with worrying.*	0.08	0.11	0.26	0.44	0.37
9. My worrying thoughts persist, no matter how I try to stop them.	0.10	0.03	0.20	0.85	0.28
11. I cannot ignore my worrying thoughts.	0.08	0.09	0.21	0.85	0.43
15. My worrying could make me go mad.	0.23	0.07	0.12	0.57	0.54
21. When I start worrying I cannot stop.	0.16	0.14	0.18	0.80	0.41
Beliefs about the need to control thoughts
6. If I did not control a worrying thought and then it happened, it would be my fault.	0.08	0.19	0.26	0.38	0.61
13. I should be in control of my thoughts all of the time.^†	0.15	0.29	0.48	0.39	0.43
20. Not being able to control my thoughts is a sign of weakness.	0.23	0.25	0.27	0.41	0.74
22. I will be punished for not controlling certain thoughts.	0.19	0.19	0.19	0.31	0.63
25. It is bad to think certain thoughts.	0.15	0.12	0.27	0.51	0.40
27. If I could not control my thoughts, I would not be able to function.	0.13	0.23	0.39	0.21	0.23

	Estimated means* MD (SE)			Significance test* Wald χ² (p-value)			Adjusted MD at week 8 MD, (95%CI), p-value*

	BMT	FLX	QoL	Group	Time	Group x Time	BMT vs. QoL	FLX vs. BMT	FLX vs. QoL
MCQ-30
Baseline	79.46 (2.71)	78.00 (3.09)	78.94 (2.76)	5.91	10.16	17.92	-6.19 (-12.98-0.60) 0.087	-1.20 (-8.29-5.91) 1.00	-7.39 (-14.24--0.53) 0.03
Week 5	77.10 (2.72)	72.03 (3.10)	81.51 (3.59)	(0.052)	(0.006)	(0.001)
Week 8	73.42 (2.95)	72.22 (3.33)	79.61 (3.00)
Factor 1							-1.75 (-4.00-0.50) 0.189	0.26 (-1.86-2.39) 1.000	-1.49 (-0.50-4.01) 0.335
Baseline	15.83 (0.88)	15.95 (0.96)	15;61 (0.96)	2.35	4.35	12.89
Week 5	14.56 (0.88)	14.90 (0.99)	16.65 (1.13)	(0.309)	(0.114)	(0.012)
Week 8	14.50 (0.84)	14.76 (1.03)	16.25 (1.02)
Factor 2							-2.43 (-4.62--0.25) 0.023	1.98 (-0.13-4.08) 0.074	-0.46 (-2.50-1.58) 1.000
Baseline	12.39 (0.96)	12.67 (0.91)	12.55 (0.85)	2.27	4.98	15.54
Week 5	13.18 (0.90)	12.58 (0.89)	13.95 (1.09)	(0.321)	(0.093)	(0.004)
Week 8	11.78 (0.94)	13.76 (0.93)	14.22 (0.94)
Factor 3							-0.33 (-2.24-1.57) 1.000	-1.42 (-3.28-0.43) 0.198	-1.75 (-3.54-0.03) 0.056
Baseline	15.79 (0.73)	15.02 (0.77)	16.12 (0.81)	6.63	1.97	2.49
Week 5	16.83 (0.82)	15.07 (0.82)	16.33 (0.89)	(0.036)	(0.374)	(0.647)
Week 8	16.36 (0.80)	14.94 (0.82)	16.70 (0.85)
Factor 4							-0.79 (-3.09-1.50) 1.000	-1.44 (-3.61-0.72) 0.330	-2.24 (-4.33--0.14) 0.032
Baseline	19.29 (0.58)	19.11 (0.67)	19.28 (0.67)	6.60	48.92	14.25
Week 5	18.37 (0.75)	15.89 (0.72)	18.51 (0.78)	(0.037)	(< 0.001)	(0.007)
Week 8	16.97 (0.79)	15.53 (0.73)	17.76 (0.79)
Factor 5							-0.43 (-2.36-1.49) 1.000	-0.23 (-2.04-1.57) 1.000	-0.67 (-.256-1.22) 1.000
Baseline	15.60 (0.55)	15.07 (0.60)	15.20 (0.60)	2.37	21.58	5.41
Week 5	13.57 (0.62)	13.66 (0.70)	16.68 (1.90)	(0.305)	(< 0.001)	(0.248)
Week 8	13.76 (0.63)	13.53 (0.70)	14.19 (0.73)

Scales	Mean difference Δ (SE)*	p-value	Effect size of differences d (95%CI)
MCQ-30 total
BMT	-6.04 (2.39)	0.034	-0.42 (-0.78--0.05)
FLX	-5.78 (1.91)	0.007	-0.46 (-0.83--0.10)
QoL	0.67 (1.70)	1.000	-
Factor 1
BMT	-1.33 (0.62)	0.094	-0.42 (-0.79--0.06)
FLX	-1.18 (0.48)	0.041	-0.44 (-0.81--0.08)
QoL	0.64 (0.49)	0.569	-
Factor 2
BMT	-0.61 (0.67)	1.000	-0.26 (-0.62- 0.10)
FLX	1.09 (0.55)	0.146	0.10 (-0.26- 0.46)
QoL	1.66 (0.59)	0.008	-
Factor 3
BMT	0.57 (0.56)	0.919	-0.002 (-0.36-0.36)
FLX	-0.08 (0.50)	1.000	-0.174 (-0.53- 0.19)
QoL	0.58 (0.49)	0.693	-
Factor 4
BMT	-2.32 (0.71)	0.003	-0.16 (-0.52- 0.20)
FLX	-3.59 (0.54)	< 0.001	-0.48 (-0.85--0.12)
QoL	-1.52 (0.58)	0.026	-
Factor 5
BMT	-1.84 (0.64)	0.012	-0.19 (-0.55- 0.17)
FLX	-1.54 (0.50)	0.007	-0.14 (-0.50- 0.22)
QoL	-1.00 (0.49)	0.121	-

location_on

Associação de Psiquiatria do Rio Grande do Sul Av. Ipiranga, 5311/202, 90610-001 Porto Alegre RS/ Brasil, Tel./Fax: (55 51) 3024 4846 - Porto Alegre - RS - Brazil
E-mail: trends@aprs.org.br

rss_feed Acompañe los números de esta revista en su lector de RSS

[TFN1] BMT = Body in Mind Training group; Factor 1 = cognitive confidence; Factor 2 = positive beliefs about worry; Factor 3 = cognitive self-consciousness; Factor 4 = negative beliefs about uncontrollability of thoughts and danger; Factor 5 = beliefs about the need to control thoughts; FLX = Fluoxetine group; GAD-7 = Generalized Anxiety Disorder 7-item scale; HAMA = Hamilton Anxiety Rating Scale; HAMD = Hamilton Rating Scale for Depression; MCQ-30 = Metacognitions Questionnaire; PSWQ = Penn State Worry Questionnaire; QoL = Quality of Life group; SD = standard deviation.

[TFN2] Values in bold indicate statistical significance.

[TFN3] * Estimated through chi-square test or Fisher’s exact test for categorical variables, analysis of variance (ANOVA) for continuous variables with normal distribution, and a nonparametric test for continuous variables with non-normal distribution.