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

Published online by Cambridge University Press:  11 April 2017

T. Østefjells ,
J. U. Lystad ,
A. O. Berg ,
R. Hagen ,
R. Loewy ,
L. Sandvik ,
I. Melle  and
J. I. Røssberg
T. Østefjells*
Affiliation:
NORMENT, KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway Department for Specialised Inpatient Treatment, Division of Mental Health and Addiction, Akershus University Hospital, Lørenskog, Norway
J. U. Lystad
Affiliation:
NORMENT, KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
A. O. Berg
Affiliation:
NORMENT, KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
R. Hagen
Affiliation:
Department of Psychology, Norwegian University of Science and Technology, Trondheim, Norway
R. Loewy
Affiliation:
Department of Psychiatry, University of California San Francisco, San Francisco, CA, USA
L. Sandvik
Affiliation:
Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway
I. Melle
Affiliation:
NORMENT, KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
J. I. Røssberg
Affiliation:
NORMENT, KG Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
*
*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: [email protected])
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Abstract

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 (R2 = 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.

Keywords

Bipolar disordermediationmetacognitionpsychosis
Type
Original Articles
Information
Psychological Medicine , Volume 47 , Issue 13 , October 2017 , pp. 2323 - 2333
Copyright
Copyright © Cambridge University Press 2017 

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References

Aas, M, Andreassen, OA, Aminoff, SR, Færden, A, Romm, KL, Nesvåg, R, Berg, AO, Simonsen, C, Agartz, I, Melle, I (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, 1–8.Google Scholar
Aas, M, Henry, C, Andreassen, OA, Bellivier, F, Melle, I, Etain, B (2016 b). The role of childhood trauma in bipolar disorders. International Journal of Bipolar Disorders 4, 2.Google Scholar
Agnew-Blais, J, Danese, A (2016). Childhood maltreatment and unfavourable clinical outcomes in bipolar disorder: a systematic review and meta-analysis. The Lancet Psychiatry 3, 342–349.CrossRefGoogle ScholarPubMed
Alloy, LB, Abramson, LY, Walshaw, PD, Keyser, J, Gerstein, RK (2006). A cognitive vulnerability–stress perspective on bipolar spectrum disorders in a normative adolescent brain, cognitive, and emotional development context. Development and Psychopathology 18, 1055–1103.CrossRefGoogle Scholar
APA (1994). Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) . American Psychological Association: Washington, DC, USA.Google Scholar
Austin, SF, Mors, O, Nordentoft, M, Hjorthøj, CR, Secher, RG, Hesse, M, Hagen, R, Spada, M, Wells, A (2015). Schizophrenia and metacognition: an investigation of course of illness and metacognitive beliefs within a first episode psychosis. Cognitive Therapy and Research 39, 61–69.Google Scholar
Batmaz, S, Kaymak, SU, Kocbiyik, S, Turkcapar, MH (2014). Metacognitions and emotional schemas: a new cognitive perspective for the distinction between unipolar and bipolar depression. Comprehensive Psychiatry 55, 1546–1555.Google Scholar
Bernstein, DP, Stein, JA, Newcomb, MD, Walker, E, Pogge, D, Ahluvalia, T, Stokes, J, Handelsman, L, Medrano, M, Desmond, D, Zule, W (2003). Development and validation of a brief screening version of the Childhood Trauma Questionnaire. Child Abuse & Neglect 27, 169–190.CrossRefGoogle ScholarPubMed
Bonoldi, I, Simeone, E, Rocchetti, M, Codjoe, L, Rossi, G, Gambi, F, Balottin, U, Caverzasi, E, Politi, P, Fusar-Poli, P (2013). Prevalence of self-reported childhood abuse in psychosis: a meta-analysis of retrospective studies. Psychiatry Research 210, 8–15.CrossRefGoogle ScholarPubMed
Bortolon, C, Larøi, F, Stephan, Y, Capdevielle, D, Yazbek, H, Boulenger, J-P, Gely-Nargeot, M-C, Raffard, S (2014). Further insight into the role of metacognitive beliefs in schizophrenia and OCD patients: testing a mediation model. Psychiatry Research 220, 698–701.Google Scholar
Braehler, C, Valiquette, L, Holowka, D, Malla, AK, Joober, R, Ciampi, A, Pawliuk, N, King, S (2013). Childhood trauma and dissociation in first-episode psychosis, chronic schizophrenia and community controls. Psychiatry Research 210, 36–42.Google Scholar
Daruy-Filho, L, Brietzke, E, Lafer, B, Grassi-Oliveira, R (2011). Childhood maltreatment and clinical outcomes of bipolar disorder. Acta Psychiatrica Scandinavica 124, 427–434.CrossRefGoogle ScholarPubMed
Endicott, J, Spitzer, RL, Fleiss, JL, Cohen, J (1976). The global assessment scale: a procedure for measuring overall severity of psychiatric disturbance. Archives of General Psychiatry 33, 766–771.Google Scholar
Etain, B, Aas, M, Andreassen, OA, Lorentzen, S, Dieset, I, Gard, S, Kahn, JP, Bellivier, F, Leboyer, M, Melle, I, Henry, C (2013). Childhood trauma is associated with severe clinical characteristics of bipolar disorders. Journal of Clinical Psychiatry 74, 991–998.Google Scholar
Etain, B, Lajnef, M, Bellivier, F, Henry, C, M'Bailara, K, Kahn, JP, Leboyer, M, Fisher, HL (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, 73–79.Google Scholar
Etain, B, Mathieu, F, Henry, C, Raust, A, Roy, I, Germain, A, Leboyer, M, Bellivier, F (2010). Preferential association between childhood emotional abuse and bipolar disorder. Journal of Trauma Stress 23, 376–383.CrossRefGoogle ScholarPubMed
Freeman, D, Fowler, D (2009). Routes to psychotic symptoms: Trauma, anxiety and psychosis-like experiences. Psychiatry Research 169, 107–112.Google Scholar
Freeman, D, Garety, PA (2003). Connecting neurosis and psychosis: the direct influence of emotion on delusions and hallucinations. Behaviour Research and Therapy 41, 923–947.CrossRefGoogle ScholarPubMed
Garno, JL, Goldberg, JF, Ramirez, PM, Ritzler, BA (2005). Impact of childhood abuse on the clinical course of bipolar disorder. The British Journal of Psychiatry 186, 121–125.Google Scholar
Gibson, LE, Alloy, LB, Ellman, LM (2016). Trauma and the psychosis spectrum: a review of symptom specificity and explanatory mechanisms. Clinical Psychology Review 49, 92–105.CrossRefGoogle ScholarPubMed
Green, MJ, Girshkin, L, Teroganova, N, Quidé, Y (2014). Stress, Schizophrenia and Bipolar Disorder. In Behavioral Neurobiology of Stress-related Disorders (ed. Pariante, C. M. and Lapiz-Bluhm, M. D.), pp. 217–235. Springer: Berlin, Heidelberg.Google Scholar
Hammersley, P, Dias, A, Todd, G, Bowen-Jones, K, Reilly, BM, Bentall, R (2003). Childhood trauma and hallucinations in bipolar affective disorder. British Journal of Psychiatry 182, 543–547.Google Scholar
Hanssen, MM, Peeters, FF, Krabbendam, LL, Radstake, SS, Verdoux, HH, van Os, JJ (2003). How psychotic are individuals with non-psychotic disorders? Social Psychiatry and Psychiatric Epidemiology 38, 149–154.Google Scholar
Hardy, A, Emsley, R, Freeman, D, Bebbington, P, Garety, PA, Kuipers, EE, Dunn, G, Fowler, D (2016). Psychological mechanisms mediating effects between trauma and psychotic symptoms: the role of affect regulation, intrusive trauma memory, beliefs, and depression. Schizophrenia Bulletin 42, S34–S43.Google Scholar
Hayes, AF (2013). Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach. Guilford Press: New York.Google Scholar
IBM (2013). SPSS Statistics for Windows. IBM Corp.: Armonk, NY.Google Scholar
Isvoranu, A-M, van Borkulo, CD, Boyette, L-L, Wigman, JTW, Vinkers, CH, Borsboom, D, Investigators, G (2017). A network approach to psychosis: pathways between childhood trauma and psychotic symptoms. Schizophrenia Bulletin 43, 187–196.Google Scholar
Janssen, I, Krabbendam, L, Bak, M, Hanssen, M, Vollebergh, W, De, G, Van, O (2004). Childhood abuse as a risk factor for psychotic experiences. Acta Psychiatrica Scandinavica 109, 38–45.Google Scholar
Kay, SR, Fiszbein, A, Opler, LA (1987). The Positive and Negative Syndrome Scale (PANSS) for Schizophrenia. Schizophrenia Bulletin 13, 261–276.Google Scholar
Kennedy, B, Dhaliwal, N, Pedley, L, Sahner, C, Greenberg, R, Manshadi, M (2002). Post-Traumatic Stress Disorder in subjects with schizophrenia and bipolar disorder. The Journal of the Kentucky Medical Association 100, 395–399.Google Scholar
Kim, D, Bae, H, Han, C, Oh, HY, MacDonald, K (2013). Psychometric properties of the Childhood Trauma Questionnaire-Short Form (CTQ-SF) in Korean patients with schizophrenia. Schizophrenia Research 144, 93–98.Google Scholar
Kuhn, D (2000). Metacognitive development. Current Directions in Psychological Science 9, 178–181.CrossRefGoogle Scholar
Lardinois, M, Lataster, T, Mengelers, R, Van Os, J, Myin-Germeys, I (2011). Childhood trauma and increased stress sensitivity in psychosis. Acta Psychiatrica Scandinavica 123, 28–35.CrossRefGoogle ScholarPubMed
Longden, E, Read, J (2016). Social adversity in the etiology of psychosis: a review of the evidence. American Journal of Psychotherapy 70, 5–33.CrossRefGoogle ScholarPubMed
Matheson, SL, Shepherd, AM, Pinchbeck, RM, Laurens, KR, Carr, VJ (2012). Childhood adversity in schizophrenia: a systematic meta-analysis. Psychological Medicine 43, 225–238.Google Scholar
McAusland, L, Buchy, L, Cadenhead, KS, Cannon, TD, Cornblatt, BA, Heinssen, R, McGlashan, TH, Perkins, DO, Seidman, LJ, Tsuang, MT, Walker, EF, Woods, SW, Bearden, CE, Mathalon, DH, Addington, J (2015). Anxiety in youth at clinical high risk for psychosis. Early Intervention in Psychiatry doi:10.1111/eip.12274.Google Scholar
McCabe, KL, Maloney, EA, Stain, HJ, Loughland, CM, Carr, VJ (2012). Relationship between childhood adversity and clinical and cognitive features in schizophrenia. Journal of Psychiatric Research 46, 600–607.Google Scholar
Myers, SG, Wells, A (2015). Early trauma, negative affect, and anxious attachment: the role of metacognition. Anxiety, Stress & Coping 28, 634–649.Google Scholar
Myin-Germeys, I, van Os, J (2007). Stress-reactivity in psychosis: evidence for an affective pathway to psychosis. Clinical Psychology Review 27, 409–424.Google Scholar
Østefjells, T, Melle, I, Aminoff, SR, Hellvin, T, Hagen, R, Lagerberg, TV, Lystad, JU, Røssberg, JI (2017). An exploration of metacognitive beliefs and thought control strategies in bipolar disorder. Comprehensive Psychiatry 73, 84–92.Google Scholar
Østefjells, T, Melle, I, Hagen, R, Romm, KL, Sönmez, N, Andreassen, OA, Røssberg, JI (2015). Unhelpful metacognitive beliefs in early psychosis are associated with affective symptoms and childhood social adjustment. Schizophrenia Research 169, 280–285.Google Scholar
Palmier-Claus, JE, Berry, K, Bucci, S, Mansell, W, Varese, F (2016). Relationship between childhood adversity and bipolar affective disorder: systematic review and meta-analysis. The British Journal of Psychiatry 209, 454–459.Google Scholar
Pedersen, G, Hagtvet, KA, Karterud, S (2007). Generalizability studies of the Global Assessment of Functioning-Split version. Comprehensive Psychiatry 48, 88–94.Google Scholar
Raes, F, Hermans, D (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.Google Scholar
Read, J, Gumley, A (2008). Can attachment theory help explain the relationship between childhood adversity and psychosis? Attachment 2, 1–35.Google Scholar
Sarisoy, G, Pazvantoğlu, O, Özturan, DD, Ay, ND, Yilman, T, Mor, S, Korkmaz, IZ, Kaçar, ÖF, Gümüş, K (2013). Metacognitive beliefs in unipolar and bipolar depression: a comparative study. Nordic Journal of Psychiatry 68, 275–281.Google Scholar
Scherer-Dickson, N (2010). Effects of early trauma on metacognitive functioning in psychosis. In Psychology. University of Edinburgh, Edinburgh. http://hdl.handle.net/1842/5611.Google Scholar
Sellers, R, Varese, F, Wells, A, Morrison, AP (2016). A meta-analysis of metacognitive beliefs as implicated in the self-regulatory executive function model in clinical psychosis. Schizophrenia Research 179, 75–84.Google Scholar
Shannon, C, Hanna, D, Tumelty, L, Waldron, D, Maguire, C, Mowlds, W, Meenagh, C, Mulholland, C (2016). Reliability of reports of childhood trauma in bipolar disorder: a test-retest study over eighteen months. Journal of Trauma & Dissociation 17, 511–519.CrossRefGoogle Scholar
Spasojevic, J, Alloy, LB (2002). Who becomes a depressive ruminator? Developmental antecedents of ruminative response style. Journal of Cognitive Psychotherapy 16, 405.CrossRefGoogle Scholar
Trauelsen, AM, Bendall, S, Jansen, JE, Nielsen, H-GL, Pedersen, MB, Trier, CH, Haahr, UH, Simonsen, E (2015). Childhood adversity specificity and dose-response effect in non-affective first-episode psychosis. Schizophrenia Research 165, 52–59.Google Scholar
Upthegrove, R, Chard, C, Jones, L, Gordon-Smith, K, Forty, L, Jones, I, Craddock, N (2015). Adverse childhood events and psychosis in bipolar affective disorder. The British Journal of Psychiatry 206, 191–197.Google Scholar
Upthegrove, R, Marwaha, S, Birchwood, M (2017). Depression and schizophrenia: cause, consequence or trans-diagnostic issue? Schizophrenia Bulletin 43, 240–244.Google Scholar
van Dam, DS, van Nierop, M, Viechtbauer, W, Velthorst, E, van Winkel, R, Bruggeman, R, Cahn, W, de Haan, L, Kahn, RS, Meijer, CJ, Myin-Germeys, I, van Os, J, Wiersma, D (2015). Childhood abuse and neglect in relation to the presence and persistence of psychotic and depressive symptomatology. Psychological Medicine 45, 1363–1377.CrossRefGoogle Scholar
van Nierop, M, van Os, J, Gunther, N, van Zelst, C, de Graaf, R, ten Have, M, van Dorsselaer, S, Bak, M, Myin-Germeys, I, van Winkel, R (2014 a). Does social defeat mediate the association between childhood trauma and psychosis? Evidence from the NEMESIS-2 Study. Acta Psychiatrica Scandinavica 129, 467–476.Google Scholar
van Nierop, M, Viechtbauer, W, Gunther, N, van Zelst, C, de Graaf, R, ten Have, M, van Dorsselaer, S, Bak, M, van Winkel, R (2014 b). Childhood trauma is associated with a specific admixture of affective, anxiety, and psychosis symptoms cutting across traditional diagnostic boundaries. Psychological Medicine 45, 1277–1288.Google Scholar
van Oosterhout, B, Krabbendam, L, Smeets, G, van der Gaag, M (2013). Metacognitive beliefs, beliefs about voices and affective symptoms in patients with severe auditory verbal hallucinations. British Journal of Clinical Psychology 52, 235–248.CrossRefGoogle ScholarPubMed
Varese, F, Bentall, RP (2011). The metacognitive beliefs account of hallucinatory experiences: a literature review and meta-analysis. Clinical Psychology Review 31, 850–864.Google Scholar
Varese, F, Smeets, F, Drukker, M, Lieverse, R, Lataster, T, Viechtbauer, W, Read, J, van Os, J, Bentall, RP (2012). Childhood adversities increase the risk of psychosis: a meta-analysis of patient-control, prospective- and cross-sectional cohort studies. Schizophrenia Bulletin 38, 661–671.Google Scholar
Velthorst, E, Nieman, DH, Becker, HE, van de Fliert, R, Dingemans, PM, Klaassen, R, de Haan, L, van Amelsvoort, T, Linszen, DH (2009). Baseline differences in clinical symptomatology between ultra high risk subjects with and without a transition to psychosis. Schizophrenia Research 109, 60–65.Google Scholar
Ventura, J, Liberman, R, Green, M, Shaner, A, Mintz, J (1998). Training and quality assurance with the Structured Clinical Interview for DSM-IV (SCID-I/P). Psychiatry Research 79, 163–173.CrossRefGoogle ScholarPubMed
Walker, E, Tessner, K (2008). Schizophrenia. Perspectives on Psychological Science 3, 30–37.Google Scholar
Wallwork, RS, Fortgang, R, Hashimoto, R, Weinberger, DR, Dickinson, D (2012). Searching for a consensus five-factor model of the Positive and Negative Syndrome Scale for schizophrenia. Schizophrenia Research 137, 246–250.Google Scholar
Wells, A (2012). Metacognition and psychological therapy. In Social Metacognition (ed. Briñol, P and DeMarree, KG), pp. 323–342. Psychology Press: New York.Google Scholar
Wells, A, Cartwright-Hatton, S (2004). A short form of the metacognitions questionnaire: properties of the MCQ-30. Behaviour Research and Therapy 42, 385–396.Google Scholar
Wells, A, Matthews, G (1996). Modelling cognition in emotional disorder: the S-REF model. Behaviour Research and Therapy 34, 881–888.Google Scholar
Wigman, JTW, van Nierop, M, Vollebergh, WAM, Lieb, R, Beesdo-Baum, K, Wittchen, H-U, van Os, J (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, 247–257.Google Scholar
Yılmaz, AE, Gençöz, T, Wells, A (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, 389–396.CrossRefGoogle ScholarPubMed
Yung, AR, Buckby, JA, Cosgrave, EM, Killackey, EJ, Baker, K, Cotton, SM, McGorry, PD (2007). Association between psychotic experiences and depression in a clinical sample over 6 months. Schizophrenia Research 91, 246–253.Google Scholar
Yung, AR, Stanford, C, Cosgrave, E, Killackey, E, Phillips, L, Nelson, B, McGorry, PD (2006). Testing the ultra high risk (prodromal) criteria for the prediction of psychosis in a clinical sample of young people. Schizophrenia Research 84, 57–66.Google Scholar
Zubin, J, Spring, B (1977). Vulnerability: a new view of schizophrenia. Journal of Abnormal Psychology 86, 103–126.Google Scholar