Metacognition, Stress & Recovery

286 Pages·2017·4.25 MB·English

Metacognition, Stress & Recovery

A thesis submitted to The University of Manchester for the degree
of
Doctor of Philosophy in Clinical Psychology
in the Faculty of Biology, Medicine, and Health

2016

LORA CAPOBIANCO

SCHOOL OF HEALTH SCIENCES
DIVISION OF PSYCHOLOGY & MENTAL HEALTH

1
Table of Contents
Page
List of Tables 11
List of Figures 12
List of Appendices 13
List of Abbreviations. 15
Abstract of Thesis 19
Declaration 20
Copyright Statement 22
Acknowledgements 23
The Author 24
Chapter 1- Introduction 25
1.1. Models and Definitions of Stress 25
1.1.1. Models of Stress 26
1.2. Definitions of Recovery 29
1.2.1. Experimental Recovery From A Stressor 29
1.2.2. Clinical Recovery 30
1.2.2.1. Treatments for Emotional Disorders 31
1.2.3. Resilience 33
1.2.3.1. Overview of Models of Resilience 34
1.3. Definitions of Metacognition 36
1.3.1. Introduction to the S-REF Model 37
2
1.4. Aims and Objective of this Thesis 39
Chapter 2- Methodology Employed Throughout The Thesis 41
2.1. Overview of Methods 41
2.2. Study 1: The Role of Metacognition in Bouncing Back From Stress: A 41
Systematic Review
2.3. Experimental Paradigms 42
2.3.1. Physiological Measures of Stress 42
2.3.2. Psychological Measures of Stress 43
2.3.3. Stress Paradigms 44
2.3.4. Study 2: Worry and Rumination: Do They Prolong Physiological or 45
Affective Recovery From Stress?
2.3.5. Study 3: The Effect of Thought Importance on Stress Responses: A 46
Test of Metacognitive Theory
2.4. Studies 4 & 5: Psychometric Properties of the Detached Mindfulness 46
Questionnaire in a Non-Clinical Sample & A Prospective Cohort Study of
the Metacognitive Predictors of Bouncing Back From Stress
2.4.1. Questionnaires 47
2.5. Study 6: Modelling the Causal Relationship Between Change in 50
Metacognition and Symptom Improvement During Transdiagnostic Group
Metacognitive Therapy
2.6. Study 7: Group Metacognitive Therapy versus Mindfulness Meditation 51
Therapy in a Transdiagnostic Patient Sample: A Pilot Feasibility Study
2.7. Overview of Statistical Analyses Used Throughout The Thesis 52
2.7.1. Generalized Estimating Equations 52
3
2.7.2. Analysis of Covariance (ANCOVA) 53
2.7.3. Evaluating the Psychometric Properties of Questionnaires 53
2.7.4. Linear and Logistic Regression 55
2.7.5. Structural Equation Modelling 57
2.7.6. Analyses of Feasibility Studies 58
2.8. Summary of Methodologies 59
Chapter 3 - The Role of Metacognition in Bouncing Back From Stress: A 60
Systematic Review
3.1. Abstract 61
3.2. Introduction 62
3.2.1. Models of Resilience 62
3.2.2. A Metacognitive Approach to Resilience 64
3.3. Methods 65
3.3.1. Definition of Terms 65
3.3.2. Inclusion Criteria 66
3.3.3. Exclusion Criteria 66
3.3.4. Study Selection and Quality Ratings 67
3.4. Results 77
3.4.1. Overview of Studies 77
3.4.2. Factors Associated with Resilience 78
3.4.3. Metacognition: Strategies and Beliefs 81
3.4.4. Coping Strategies as Measured by the TCQ 81
4
3.4.5. Metacognitive Beliefs 83
3.5. Discussion 85
3.5.1. Common Factors Associated with Resilience 85
3.5.2. A Metacognitive Account for Resilience 87
3.5.3. Limitations 88
3.5.4. Future Considerations 89
3.6. Conclusions 89
Chapter 4 - Worry and Rumination: Do They Prolong Physiological or 90
Affective Recovery From Stress?
4.1. Abstract 91
4.2. Introduction 92
4.3. Methods 96
4.3.1. Participants 96
4.3.2. Measures 96
4.3.3. Materials 97
4.3.4. Procedure 98
4.4. Results 99
4.4.1. Participant Characteristics 99
4.4.2. Manipulation Check 100
4.4.3. Psychological and Physiological Outcomes 101
4.5. Discussion 105
Chapter 5 - The Effect of Thought Importance on Stress Responses: A Test 109
of Metacognitive Theory
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5.1. Abstract 110
5.2. Introduction 111
5.3. Methods 113
5.3.1. Participants 113
5.3.2. Measures 114
5.3.3. Primary Dependent Variables 114
5.3.3. Secondary Measures 114
5.3.5. Procedure 116
5.4. Results 118
5.4.1. Participant Characteristics 118
5.4.2. Manipulation Check 119
5.4.3. Affect Ratings 120
5.4.4. Galvanic Skin Response 123
5.5. Discussion 124
Chapter 6 - Psychometric Properties of the Detached Mindfulness 127
Questionnaire in a Non-Clinical Sample
6.1. Abstract 128
6.2. Introduction 129
6.3. Methods 131
6.3.1. Design 131
6.3.2. Participants 131
6.3.3. Procedure 131
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6.3.4. Measures 132
6.3.5. Analysis Plan 133
6.4. Results 133
6.4.1. Gender Differences 135
6.4.2. Construct Validity 135
6.4.3. Internal Consistency 137
6.4.4. Stability of Subscales 139
6.4.5. Convergent Validity 139
6.5. Discussion 140
Chapter 7 - A Prospective Cohort Study of the Metacognitive Predictors of 143
Bouncing Back From Stress
7.1. Abstract 144
7.2. Introduction 145
7.3. Methods 149
7.3.1. Participants 149
7.3.2. Measures 150
7.3.3. Primary Dependent Variable 150
7.3.4. Secondary Outcome Measures 150
7.3.5. Procedure 152
7.3.6. Data Analysis Plan 153
7.4. Results 154
7.4.1. Data Descriptives 154
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7.4.2. Predictors of Resilience 159
7.4.3. Predictors of Psychological Distress 162
7.4.4. Reliable Change 163
7.4.5. Predictors of Reliable Change 163
7.4.6. Resilience as a Predictor of Metacognition and Psychological Distress 165
7.5. Discussion 166
Chapter 8 - Modelling the Causal Relationship Between Change in 169
Metacognition and Symptom Improvement During
Transdiagnostic Group Metacognitive Therapy
8.1. Abstract 170
8.2. Introduction 171
8.3. Methods 173
8.3.1. Participants 173
8.3.2. Procedure 173
8.3.3. Measures 174
8.3.4. Primary Outcome Measure 174
8.3.5. Secondary Outcome Measure 174
8.3.6. Sample Size 175
8.3.7. Analysis Plan and Model Hypotheses 175
8.3.8. Latent Variable Identification 176
8.4. Results 179
8.4.1. Descriptive Statistics 179
8.4.2. Structural Equation Modelling 179
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8.4.3. Tests of The Structural Model Assumptions 184
8.5. Discussion 185
Chapter 9 - Group Metacognitive Therapy versus Mindfulness Meditation 187
Therapy in a Transdiagnostic Patient Sample: A Feasibility
Study
9.1. Abstract 188
9.2. Introduction 189
9.3. Methods 191
9.3.1. Study Design 191
9.3.2. Deviations From Protocol 192
9.3.3. Participants 193
9.3.4. Randomization and Sample Size 195
9.3.5. Measures 195
9.3.6. Feasibility & Acceptability Outcomes 195
9.3.7. Primary Symptom Outcome Variable 196
9.3.8. Secondary Outcome Measures 196
9.3.9. Screening Measures 196
9.3.10. Interventions 197
9.3.11. Statistical Analysis Plan 198
9.4. Results 199
9.4.1. Participant Characteristics 199
9.4.2. Feasibility and Acceptability Assessment 200
9.4.3. Treatment Efficacy Analyses 202
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9.4.4. Metacognitive Beliefs 205
9.5. Discussion 207
Chapter 10 – Discussion 211
10.1. Outline of Chapter 211
10.2. Overview of Aims and Key Findings 211
10.3. General Discussion 216
10.3.1. Metacognition and Stress Recovery to Daily and Induced Stress 217
10.3.2. Clinically Reliable Recovery: Similarities Among Analogue and 218
Clinical Samples
10.4. Strengths and Limitations 219
10.4.1. Key Strengths 219
10.4.2. Limitations 221
10.5. Implications for Clinical Practice 224
10.5.1. Challenging Metacognitive Beliefs 224
10.5.2. Detached Mindfulness and Treatment 226
10.6. Future Research 228
10.6.1. A Definitive Trial: Group Metacognitive Therapy versus Mindfulness 228
Based Stress Reduction
10.6.2. Quantifying Recovery: How Long Does It Take To Recover From 229
Stress
10.6.3. A Further Manipulation of Metacognitive Beliefs 230
10.7. Conclusions 231
References 232
Word Count: 69, 854
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