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Metacognitive beliefs mediate the effect of emotional abuse on depressive and psychotic symptoms in severe mental disorders

  • T. Østefjells (a1) (a2) (a3), J. U. Lystad (a1) (a2), A. O. Berg (a1) (a2), R. Hagen (a4), R. Loewy (a5), L. Sandvik (a6), I. Melle (a1) (a2) and J. I. Røssberg (a1) (a2)...

Early trauma is linked to higher symptom levels in bipolar and psychotic disorders, but the translating mechanisms are not well understood. This study examines whether the relationship between early emotional abuse and depressive symptoms is mediated by metacognitive beliefs about thoughts being uncontrollable/dangerous, and whether this pathway extends to influence positive symptoms.


Patients (N = 261) with psychotic or bipolar disorders were assessed for early trauma experiences, metacognitive beliefs, and current depression/anxiety and positive symptoms. Mediation path analyses using ordinary least-squares regressions tested if the effect of early emotional abuse on depression/anxiety was mediated by metacognitive beliefs, and if the effect of early emotional abuse on positive symptoms was mediated by metacognitive beliefs and depression/anxiety.


Metacognitive beliefs about thoughts being uncontrollable/dangerous significantly mediated the relationship between early emotional abuse and depression/anxiety. Metacognitive beliefs and depression/anxiety significantly mediated the relationship between early emotional abuse and positive symptoms. The models explained a moderate amount of the variance in symptoms (R 2 = 0.21–0.29).


Our results indicate that early emotional abuse is relevant to depression/anxiety and positive symptoms in bipolar and psychotic disorders, and suggest that metacognitive beliefs could play a role in an affective pathway to psychosis. Metacognitive beliefs could be relevant treatment targets with regards to depression/anxiety and positive symptoms in bipolar and psychotic disorders.

Corresponding author
*Address for correspondence: T. Østefjells, Division of Mental Health and Addiction, Psychosis Research Unit/TOP, Oslo University Hospital HF, Ullevål Hospital, Building 49, P.O. Box 4956 Nydalen, N-0424 Oslo, Norway. (Email:
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