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Metacognition and Health Anxiety: A prospective Study.4 of neuroticism (Watson, 2012). This view however, has been challenged with studies showing that although health anxiety is associated with neuroticism it has incremental validity over this construct (Fergus & Valentiner, 2011; Ferguson et al, 2013). Recent advances have applied the metacognitive model of psychological disorder (Wells, 2000; Wells and Matthews, 1994; 1996) to understanding health anxiety. Central to this model is the idea that disorders such as health anxiety result from repetitive and difficult to control negative thinking marked by worry and rumination and the use of paradoxical mental control strategies such as seeking reassurance and thought suppression. Such repetitive negative thinking is the result of unhelpful metacognitions, that is underlying beliefs about thoughts, (e.g. “Thinking the worst about symptoms will keep me safe;” and “I cannot control my health worries”). The metacognitive model presents an explanation of health anxiety that is different from cognitive models, since health anxiety is seen as resulting more from extended and repetitive negative thinking about illness rather than from the belief that one is ill. Thus, according to the metacognitive model, metacognitive beliefs about repetitive thinking should be more important than beliefs about illness. This translates into different types of clinical practice; for example in traditional CBT a patient with health anxiety who believes that the sore throat they are experiencing is throat cancer, would be asked to generate alternative benign explanations for this symptom as a means of challenging their catastrophic misinterpretation. In contrast, in metacognitive therapy (MCT) the therapist would explore with the patient new ways of relating to the misinterpretation that consist of reduced thinking that can modify beliefs concerning the uncontrollability of health- related worrying. This would consist of postponing any attempt to deal with the interpretation until later. In CBT, patients are taught to challenge disease conviction and generate alternative content, however in MCT patients learn how to reduce their over-thinking response to disease convictions when they occur.
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Metacognition and Health Anxiety: A prospective Study.5 Consistent with this model several cross sectional studies have demonstrated a strong association between metacognition and health anxiety. In one study Kaur, Butow, & Thewes, (2011) found that metacognitive beliefs were associated with an attentional bias towards positive and negative health related information (range of correlations .32 to .69). Bailey & Wells (2013) found that metacognitive beliefs explained variance in health anxiety symptoms over and above other established correlates namely, illness cognition, somatosensory amplification, and neuroticism (range of correlations .46 to .47). Furthermore, metacognitive beliefs moderated the relationship between catastrophic misinterpretation of bodily symptoms and health anxiety (Bailey & Wells, 2015a) calling into question the importance given to misinterpretations. In this study the moderator effect showed that
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