Anxiety and depression in people with epilepsy_the contribution of metacognitive beliefs.doc

Contribution to both anxiety and depression was

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contribution to both anxiety and depression was reduced cognitive confidence, which assesses the belief that one’s memory is inefficient. Reduced cognitive confidence reflects a subjective 15
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evaluation that one’s executive control is compromised, which may result in increased use of compensatory strategies including worry and rumination to overcome perceived memory deficits. Reduced cognitive confidence is also likely to fuel the belief that worry and rumination is an uncontrollable process [14, 15]. However, as some PWE will experience objective reductions in executive control, future studies should examine the relative contribution of objective and subjective assessments of executive control. There is some evidence that subjective appraisals of memory dysfunction contribute more to distress than objective deficits in memory performance [40] The hypothesis that worry would fully mediate the relationship between positive metacognitive beliefs and anxiety and depression, when controlling for potentially confounding variables including negative metacognitive beliefs about the uncontrollability and danger of worry was not supported. It is possible that by controlling for a broad range of covariates in mediational analysis may have masked the indirect pathway from the Positive Beliefs About Worry subscale to emotional distress via worry. Furthermore, the S-REF model also predicts that positive metacognitive belief lead to activation of the CAS (worry/rumination, attentional control strategies and unhelpful coping response) and that if the CAS had been selected as the mediating variable a positive association may have been obtained- this remains to be tested in future research. However, S-REF theory would predict that, although positive metacognitive beliefs increase the likelihood that and individual will “select” worry in response to negative thoughts or feelings, it is the negative metacognitive beliefs that are fundamental to emotional disorder by exacerbating and maintaining worry. Accordingly, the relationship between negative beliefs about uncontrollability and harm and anxiety and depressive symptoms was partially mediated by worry thereby supporting the fundamental tenet of the S-REF model. There are several limitations to the present study, which warrant further investigation. First, because the study was cross-sectional, it cannot be inferred that there is causal relationship exist between metacognitive beliefs anxiety and depression. It is possible that the maladaptive metacognitions reported are a consequence of distress. Therefore, a prospective test of the model is necessary to establish a causal role of metacognitive beliefs in anxiety and depression in PWE. One research possibility would to examine if metacognitive beliefs would predict whether people with recently diagnosed epilepsy adjust or experience persistent emotional distress. Prospective studies have previously supported the temporal precedence of metacognitive beliefs in several 16
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  • Fall '19
  • The Road, Selective serotonin reuptake inhibitor, Major depressive disorder

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