Changing Metacognitive Appraisal Bias in High-Worriers Through Reappraisal Training

Cognitive Therapy and Research https://doi.org/10.1007/s10608-022-10297-x ORIGINAL ARTICLE Changing Metacognitive Appraisal Bias in High‑Worriers Through Reappraisal Training Nessa Ikani1 · Anne K. Radix1,2 · Mike Rinck1 · Eni S. Becker1 Accepted: 20 January 2022 © The Author(s) 2022 Abstract Background and Objectives Worry-related negative metacognitive beliefs about worrying maintain and predict pathological worry. For the current proof-of-principle study, we developed a computerized cognitive bias modification based—reappraisal training (RT), to modify the appraisal of negative metacognitive beliefs in a high-worrying sample. A functional and dysfunctional RT were pitted against each other to investigate whether appraisals of one’s thinking and coping changed following training. Moreover, training effects on the number of negative thoughts and interpretations of the worry content were examined. Methods Participants (N = 81) were trained to adopt a functional (disconfirmation of negative metacognitive beliefs) or dysfunctional (confirmation of negative metacognitive beliefs) appraisal style using a series of vignettes that had to be completed in line with the intended training direction. Changes in negative thoughts from pre- to post-RT were assessed with a behavioral state worry task, and transfer to interpretations with an open-ended stem sentence task. Results Findings support the use of the RT to alter a metacognitive appraisal bias, as participants receiving the functional RT reported fewer negative appraisals of one’s thinking and coping than participants in the dysfunctional RT group. Number of negative thoughts and interpretations were not directly affected by training. Limitations This study employed an analog sample and future research should replicate findings in a clinical sample for which negative metacognitions are more relevant. Conclusions These findings highlight the potential of metacognitive RT for future translational studies with (clinical) samples characterized by repetitive negative thinking and/or negative metacognitive beliefs. Keywords Metacognitive beliefs · Pathological worry · Reappraisal training · Cognitive bias modification Introduction Excessive worry about uncertain future events with possible negative outcome(s) increases mental distress (Borkovec et al., 1983) and plays an important role in anxiety (Borkovec & Inz, 1990; Tallis et al., 1991). The persistence and experienced uncontrollability of worry serves as an important risk and maintenance factor for Generalized Anxiety Disorder (GAD), in which worries about a wide variety of * Nessa Ikani 1 Experimental Psychopathology and Treatment, Behavioural Science Institute, Radboud University, PO Box 9104, 6500 HE Nijmegen, The Netherlands 2 LWL‑University Hospital Hamm for Child and Adolescent Psychiatry, Ruhr-University Bochum, Hamm, Germany topics are prominent, but also for affective disorders in general (Davey & Wells, 2006; Hirsch & Mathews, 2012). Worry evokes thoughts related to potential negativity, which gives rise to further worrying (Wells & Papageorgiou, 1995). That is, a vicious cycle develops, in which repeated negative thoughts are triggered and reinforced by biased informational processing, and deficits in exerting cognitive control concurrently hinder effective down-regulation of these thoughts/biases (Hirsch & Mathews, 2012). One possible factor feeding into this vicious cycle is metacognitive beliefs about worry—stable beliefs people have about their own cognitive systems and cognitive coping strategies (e.g., worry; Wells, 2019; Wells & Capobianco, 2020). They include an individual’s positive and negative beliefs about their own thinking that subsequently influence their appraisal and regulation of thoughts. In the context of worry, positive metacognitive beliefs about the use of worrying to anticipate 13 Vol.:(0123456789) Cognitive Therapy and Research or cope with potential threats (e.g., ‘Worrying prepares me’) contrast negative beliefs about the consequences, danger and uncontrollability of worry (e.g., ‘If I keep worrying like this, I will go crazy’). Relatedly, metacognitions refer to ‘psychological structures, knowledge, events and processes that are involved in the control, modification, and interpretation of thinking itself’ (Wells & Cartwright-Hatton, 2004, p. 385). The Metacognitive model of GAD (Wells, 1995) addresses the specific role of metacognitive beliefs in maladaptive emotion regulation and the development and persistence of psychopathology. It posits that positive beliefs about worrying being helpful, prompt the worry process. However, once this worrying is initiated, negative beliefs about the danger and uncontrollability of worry instigate unproductive cognitive processes (e.g., suppression and avoidance). The latter contribute to the escalation of worry, interfere with effective control over worry and reinforce existing negative beliefs about the uncontrollability and danger of worry, leading to even more pervasive distress (Wells, 2019). Consequently, negative metacognitive beliefs predict and worsen the development of GAD symptoms (Nassif, 1999; Penney et al., 2013), underlining their significant role in the etiology and maintenance of excessive worrying. Metacognitive Therapy (MCT) originated from the Metacognitive model of GAD and aims to target positive and negative metacognitive thoughts (Wells, 2008). Despite both being effective in reducing worry and GAD symptoms, MCT was found to generate better long-term recovery rates compared to Cognitive Behavioral Therapy (CBT; Nordahl et al., 2018). In addition, a recent meta-analysis reported considerable evidence for the effectiveness of individual MCT compared to CBT in a range of psychopathological complaints (Normann & Morina, 2018). However, these conclusions were drawn from a small number of studies that mostly focused on anxiety and depression and that consisted of rather small samples. Further refinement and augmentation of treatment is needed to improve response rates of MCT, as well as CBT, which both leave considerable room for improvement. Cognitive Bias Modification (CBM) has been proposed as an augmentation strategy to existing forms of CBT that tend to have a rather explicit nature. CBM techniques have been developed to test the causal role of information processing bias in psychological phenomena (in this case worry), to understand underlying mechanisms of these biases, and to evaluate the therapeutic effects of modifying them. CBMinterpretation interventions targeting interpretation bias (i.e., the tendency to interpret ambiguous information in a negative manner), for example, have been shown to successfully facilitate more benign interpretations about potential future negativity in anxiety, and to ameliorate worry related to anxiety, as well as general repetitive negative thinking across different psychological disorders (Fodor, et al., 2020; 13 Hayes et al. (...truncated)