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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)...
Background</title> <p>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.</p> </sec> <sec secType='methods' id='sec_a2'> <title>Method</title> <p>Patients (<span class='italic'>N</span> = 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.</p> </sec> <sec secType='results' id='sec_a3'> <title>Results</title> <p>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 (<span class='italic'>R</span> <span class='sup'>2</span> = 0.21–0.29).</p> </sec> <sec secType='conclusion' id='sec_a4'> <title>Conclusion
Background

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.

Method

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.

Results

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).

Conclusion

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.

Copyright
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: tiril.ostefjells@medisin.uio.no)
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M Aas , OA Andreassen , SR Aminoff , A Færden , KL Romm , R Nesvåg , AO Berg , C Simonsen , I Agartz , I Melle (2016 a). A history of childhood trauma is associated with slower improvement rates: findings from a one-year follow-up study of patients with a first-episode psychosis. BMC Psychiatry 16, 18.

M Aas , C Henry , OA Andreassen , F Bellivier , I Melle , B Etain (2016 b). The role of childhood trauma in bipolar disorders. International Journal of Bipolar Disorders 4, 2.

J Agnew-Blais , A Danese (2016). Childhood maltreatment and unfavourable clinical outcomes in bipolar disorder: a systematic review and meta-analysis. The Lancet Psychiatry 3, 342349.

LB Alloy , LY Abramson , PD Walshaw , J Keyser , RK Gerstein (2006). A cognitive vulnerability–stress perspective on bipolar spectrum disorders in a normative adolescent brain, cognitive, and emotional development context. Development and Psychopathology 18, 10551103.

SF Austin , O Mors , M Nordentoft , CR Hjorthøj , RG Secher , M Hesse , R Hagen , M Spada , A Wells (2015). Schizophrenia and metacognition: an investigation of course of illness and metacognitive beliefs within a first episode psychosis. Cognitive Therapy and Research 39, 6169.

S Batmaz , SU Kaymak , S Kocbiyik , MH Turkcapar (2014). Metacognitions and emotional schemas: a new cognitive perspective for the distinction between unipolar and bipolar depression. Comprehensive Psychiatry 55, 15461555.

DP Bernstein , JA Stein , MD Newcomb , E Walker , D Pogge , T Ahluvalia , J Stokes , L Handelsman , M Medrano , D Desmond , W Zule (2003). Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse & Neglect 27, 169190.

I Bonoldi , E Simeone , M Rocchetti , L Codjoe , G Rossi , F Gambi , U Balottin , E Caverzasi , P Politi , P Fusar-Poli (2013). Prevalence of self-reported childhood abuse in psychosis: a meta-analysis of retrospective studies. Psychiatry Research 210, 815.

C Bortolon , F Larøi , Y Stephan , D Capdevielle , H Yazbek , J-P Boulenger , M-C Gely-Nargeot , S Raffard (2014). Further insight into the role of metacognitive beliefs in schizophrenia and OCD patients: testing a mediation model. Psychiatry Research 220, 698701.

C Braehler , L Valiquette , D Holowka , AK Malla , R Joober , A Ciampi , N Pawliuk , S King (2013). Childhood trauma and dissociation in first-episode psychosis, chronic schizophrenia and community controls. Psychiatry Research 210, 3642.

L Daruy-Filho , E Brietzke , B Lafer , R Grassi-Oliveira (2011). Childhood maltreatment and clinical outcomes of bipolar disorder. Acta Psychiatrica Scandinavica 124, 427434.

J Endicott , RL Spitzer , JL Fleiss , J Cohen (1976). The global assessment scale: a procedure for measuring overall severity of psychiatric disturbance. Archives of General Psychiatry 33, 766771.

B Etain , M Aas , OA Andreassen , S Lorentzen , I Dieset , S Gard , JP Kahn , F Bellivier , M Leboyer , I Melle , C Henry (2013). Childhood trauma is associated with severe clinical characteristics of bipolar disorders. Journal of Clinical Psychiatry 74, 991998.

B Etain , M Lajnef , F Bellivier , C Henry , K M'Bailara , JP Kahn , M Leboyer , HL Fisher (2017). Revisiting the association between childhood trauma and psychosis in bipolar disorder: a quasi-dimensional path-analysis. Journal of Psychiatric Research. Advance online publication 84, 7379.

D Freeman , D Fowler (2009). Routes to psychotic symptoms: Trauma, anxiety and psychosis-like experiences. Psychiatry Research 169, 107112.

D Freeman , PA Garety (2003). Connecting neurosis and psychosis: the direct influence of emotion on delusions and hallucinations. Behaviour Research and Therapy 41, 923947.

JL Garno , JF Goldberg , PM Ramirez , BA Ritzler (2005). Impact of childhood abuse on the clinical course of bipolar disorder. The British Journal of Psychiatry 186, 121125.

LE Gibson , LB Alloy , LM Ellman (2016). Trauma and the psychosis spectrum: a review of symptom specificity and explanatory mechanisms. Clinical Psychology Review 49, 92105.

P Hammersley , A Dias , G Todd , K Bowen-Jones , BM Reilly , R Bentall (2003). Childhood trauma and hallucinations in bipolar affective disorder. British Journal of Psychiatry 182, 543547.

MM Hanssen , FF Peeters , LL Krabbendam , SS Radstake , HH Verdoux , JJ van Os (2003). How psychotic are individuals with non-psychotic disorders? Social Psychiatry and Psychiatric Epidemiology 38, 149154.

A Hardy , R Emsley , D Freeman , P Bebbington , PA Garety , EE Kuipers , G Dunn , D Fowler (2016). Psychological mechanisms mediating effects between trauma and psychotic symptoms: the role of affect regulation, intrusive trauma memory, beliefs, and depression. Schizophrenia Bulletin 42, S34S43.

A-M Isvoranu , CD van Borkulo , L-L Boyette , JTW Wigman , CH Vinkers , D Borsboom , G Investigators (2017). A network approach to psychosis: pathways between childhood trauma and psychotic symptoms. Schizophrenia Bulletin 43, 187196.

I Janssen , L Krabbendam , M Bak , M Hanssen , W Vollebergh , G De , O Van (2004). Childhood abuse as a risk factor for psychotic experiences. Acta Psychiatrica Scandinavica 109, 3845.

SR Kay , A Fiszbein , LA Opler (1987). The Positive and Negative Syndrome Scale (PANSS) for Schizophrenia. Schizophrenia Bulletin 13, 261276.

D Kim , H Bae , C Han , HY Oh , K MacDonald (2013). Psychometric properties of the Childhood Trauma Questionnaire-Short Form (CTQ-SF) in Korean patients with schizophrenia. Schizophrenia Research 144, 9398.

D Kuhn (2000). Metacognitive development. Current Directions in Psychological Science 9, 178181.

M Lardinois , T Lataster , R Mengelers , J Van Os , I Myin-Germeys (2011). Childhood trauma and increased stress sensitivity in psychosis. Acta Psychiatrica Scandinavica 123, 2835.

SL Matheson , AM Shepherd , RM Pinchbeck , KR Laurens , VJ Carr (2012). Childhood adversity in schizophrenia: a systematic meta-analysis. Psychological Medicine 43, 225238.

L McAusland , L Buchy , KS Cadenhead , TD Cannon , BA Cornblatt , R Heinssen , TH McGlashan , DO Perkins , LJ Seidman , MT Tsuang , EF Walker , SW Woods , CE Bearden , DH Mathalon , J Addington (2015). Anxiety in youth at clinical high risk for psychosis. Early Intervention in Psychiatry doi:10.1111/eip.12274.

KL McCabe , EA Maloney , HJ Stain , CM Loughland , VJ Carr (2012). Relationship between childhood adversity and clinical and cognitive features in schizophrenia. Journal of Psychiatric Research 46, 600607.

SG Myers , A Wells (2015). Early trauma, negative affect, and anxious attachment: the role of metacognition. Anxiety, Stress & Coping 28, 634649.

I Myin-Germeys , J van Os (2007). Stress-reactivity in psychosis: evidence for an affective pathway to psychosis. Clinical Psychology Review 27, 409424.

T Østefjells , I Melle , SR Aminoff , T Hellvin , R Hagen , TV Lagerberg , JU Lystad , JI Røssberg (2017). An exploration of metacognitive beliefs and thought control strategies in bipolar disorder. Comprehensive Psychiatry 73, 8492.

T Østefjells , I Melle , R Hagen , KL Romm , N Sönmez , OA Andreassen , JI Røssberg (2015). Unhelpful metacognitive beliefs in early psychosis are associated with affective symptoms and childhood social adjustment. Schizophrenia Research 169, 280285.

JE Palmier-Claus , K Berry , S Bucci , W Mansell , F Varese (2016). Relationship between childhood adversity and bipolar affective disorder: systematic review and meta-analysis. The British Journal of Psychiatry 209, 454459.

G Pedersen , KA Hagtvet , S Karterud (2007). Generalizability studies of the Global Assessment of Functioning-Split version. Comprehensive Psychiatry 48, 8894.

F Raes , D Hermans (2008). On the mediating role of subtypes of rumination in the relationship between childhood emotional abuse and depressed mood: brooding versus reflection. Depression and Anxiety 25, 1067.

G Sarisoy , O Pazvantoğlu , DD Özturan , ND Ay , T Yilman , S Mor , IZ Korkmaz , ÖF Kaçar , K Gümüş (2013). Metacognitive beliefs in unipolar and bipolar depression: a comparative study. Nordic Journal of Psychiatry 68, 275281.

R Sellers , F Varese , A Wells , AP Morrison (2016). A meta-analysis of metacognitive beliefs as implicated in the self-regulatory executive function model in clinical psychosis. Schizophrenia Research 179, 7584.

C Shannon , D Hanna , L Tumelty , D Waldron , C Maguire , W Mowlds , C Meenagh , C Mulholland (2016). Reliability of reports of childhood trauma in bipolar disorder: a test-retest study over eighteen months. Journal of Trauma & Dissociation 17, 511519.

J Spasojevic , LB Alloy (2002). Who becomes a depressive ruminator? Developmental antecedents of ruminative response style. Journal of Cognitive Psychotherapy 16, 405.

AM Trauelsen , S Bendall , JE Jansen , H-GL Nielsen , MB Pedersen , CH Trier , UH Haahr , E Simonsen (2015). Childhood adversity specificity and dose-response effect in non-affective first-episode psychosis. Schizophrenia Research 165, 5259.

R Upthegrove , C Chard , L Jones , K Gordon-Smith , L Forty , I Jones , N Craddock (2015). Adverse childhood events and psychosis in bipolar affective disorder. The British Journal of Psychiatry 206, 191197.

DS van Dam , M van Nierop , W Viechtbauer , E Velthorst , R van Winkel , R Bruggeman , W Cahn , L de Haan , RS Kahn , CJ Meijer , I Myin-Germeys , J van Os , D Wiersma (2015). Childhood abuse and neglect in relation to the presence and persistence of psychotic and depressive symptomatology. Psychological Medicine 45, 13631377.

M van Nierop , J van Os , N Gunther , C van Zelst , R de Graaf , M ten Have , S van Dorsselaer , M Bak , I Myin-Germeys , R van Winkel (2014 a). Does social defeat mediate the association between childhood trauma and psychosis? Evidence from the NEMESIS-2 Study. Acta Psychiatrica Scandinavica 129, 467476.

M van Nierop , W Viechtbauer , N Gunther , C van Zelst , R de Graaf , M ten Have , S van Dorsselaer , M Bak , R van Winkel (2014 b). Childhood trauma is associated with a specific admixture of affective, anxiety, and psychosis symptoms cutting across traditional diagnostic boundaries. Psychological Medicine 45, 12771288.

B van Oosterhout , L Krabbendam , G Smeets , M van der Gaag (2013). Metacognitive beliefs, beliefs about voices and affective symptoms in patients with severe auditory verbal hallucinations. British Journal of Clinical Psychology 52, 235248.

F Varese , RP Bentall (2011). The metacognitive beliefs account of hallucinatory experiences: a literature review and meta-analysis. Clinical Psychology Review 31, 850864.

F Varese , F Smeets , M Drukker , R Lieverse , T Lataster , W Viechtbauer , J Read , J van Os , RP Bentall (2012). Childhood adversities increase the risk of psychosis: a meta-analysis of patient-control, prospective- and cross-sectional cohort studies. Schizophrenia Bulletin 38, 661671.

E Velthorst , DH Nieman , HE Becker , R van de Fliert , PM Dingemans , R Klaassen , L de Haan , T van Amelsvoort , DH Linszen (2009). Baseline differences in clinical symptomatology between ultra high risk subjects with and without a transition to psychosis. Schizophrenia Research 109, 6065.

J Ventura , R Liberman , M Green , A Shaner , J Mintz (1998). Training and quality assurance with the Structured Clinical Interview for DSM-IV (SCID-I/P). Psychiatry Research 79, 163173.

E Walker , K Tessner (2008). Schizophrenia. Perspectives on Psychological Science 3, 3037.

RS Wallwork , R Fortgang , R Hashimoto , DR Weinberger , D Dickinson (2012). Searching for a consensus five-factor model of the Positive and Negative Syndrome Scale for schizophrenia. Schizophrenia Research 137, 246250.

A Wells , S Cartwright-Hatton (2004). A short form of the metacognitions questionnaire: properties of the MCQ-30. Behaviour Research and Therapy 42, 385396.

A Wells , G Matthews (1996). Modelling cognition in emotional disorder: the S-REF model. Behaviour Research and Therapy 34, 881888.

JTW Wigman , M van Nierop , WAM Vollebergh , R Lieb , K Beesdo-Baum , H-U Wittchen , J van Os (2012). Evidence that psychotic symptoms are prevalent in disorders of anxiety and depression, impacting on illness onset, risk, and severity—implications for diagnosis and ultra-high risk research. Schizophrenia Bulletin 38, 247257.

AE Yılmaz , T Gençöz , A Wells (2011). The temporal precedence of metacognition in the development of anxiety and depression symptoms in the context of life-stress: a prospective study. Journal of Anxiety Disorders 25, 389396.

AR Yung , JA Buckby , EM Cosgrave , EJ Killackey , K Baker , SM Cotton , PD McGorry (2007). Association between psychotic experiences and depression in a clinical sample over 6 months. Schizophrenia Research 91, 246253.

AR Yung , C Stanford , E Cosgrave , E Killackey , L Phillips , B Nelson , PD McGorry (2006). Testing the ultra high risk (prodromal) criteria for the prediction of psychosis in a clinical sample of young people. Schizophrenia Research 84, 5766.

J Zubin , B Spring (1977). Vulnerability: a new view of schizophrenia. Journal of Abnormal Psychology 86, 103126.

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Psychological Medicine
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