The metacognitive beliefs account of hallucinatory experiences: A literature review and meta-analysis
Research highlights
► Metacognitive beliefs (MB) are related to hallucinations in nonclinical samples. ► Only small associations between MB and hallucinations are found in clinical samples. ► After controlling for confounds, associations between MB and hallucinations are weak. ► These results challenge the validity of the MB account of hallucinations.
Introduction
Hallucinations have been defined as percept-like experiences which occur in the absence of appropriate stimuli, have the full force of the corresponding actual (real) perceptions and which are usually unamenable to direct and voluntary control (Slade & Bentall, 1988). Even though they have often been regarded within mainstream psychiatry as pathognomonic for schizophrenia, hallucinations are reported by patients with different diagnoses, including bipolar disorder, unipolar depression, obsessive compulsive disorder, dissociative disorders and post-traumatic stress disorder (e.g. Allen and Coyne, 1995, Baethge et al., 2005, Fontenelle et al., 2008, Hammersley et al., 2003, Morrison et al., 2003; for a recent review of the prevalence of hallucinations in different psychiatric and neurological groups, see Aleman & Larøi, 2008). In addition, they are also reported by individuals without any psychiatric diagnoses (e.g. Andrew et al., 2008, Honig et al., 1998), and recent epidemiological studies have reported lifetime prevalence rates for hallucinations in the general population ranging between 6.9% and 13% (Ohayon, 2000, Tien, 1991, van Os et al., 2000).
Although the factors and processes which might ultimately account for the genesis of hallucinatory experiences are still debated, there has been an emerging consensus among researchers that they are the consequence of the misattribution of internally generated cognitive events to external sources (Bentall, 1990, Frith, 1992, Hoffman, 1986, Larøi and Woodward, 2007). Along these lines, Morrison, Haddock, and Tarrier (1995) have proposed a cognitive model that assumes that hallucinations are misattributed intrusive thoughts, and that their misattribution to an external source is influenced by metacognitive beliefs (i.e. beliefs about cognition that can influence the processes used by the individuals to monitor and control their own thoughts; Flavell, 1979). Intrusive thoughts are generally defined as thoughts that are unwanted or unintended, perceived as uncontrollable, egodystonic and capable of interrupting ongoing activity (Clark & Purdon, 1995; Clark & Rhyno, 2005; Rachman, 1981). Intrusive cognitions are commonly associated with negative affect (e.g. Clark & de Silva, 1985), and with a number of deliberate strategies to suppress or control them (e.g. Purdon and Clark, 2001, Wells and Davies, 1994). The model proposed by Morrison et al. postulates that hallucinations are generated by the attempts to reduce the negative arousal that results from the experience of thoughts of this kind. Specifically, it is argued that hallucination-prone individuals hold certain metacognitive beliefs about the importance of thought consistency and the need to control thoughts. When intrusive thoughts are experienced, the inconsistency between these metacognitive beliefs and the experience of uncontrollable mental events leads to cognitive dissonance (Festinger, 1957), a state of negative arousal that individuals are motivated to escape. From this perspective, hallucination-prone individuals are therefore motivated to attribute their intrusive thoughts to an external source in the attempt to prevent cognitive dissonance from occurring.
Although the proponents of this account have described a number of additional factors believed to be involved in the maintenance of hallucinatory experiences (Morrison, 1998, Morrison, 2001, Morrison et al., 1995), most of the empirical studies investigating testable predictions of the model have focused on the role played by metacognitive beliefs, and the relationship between cognitive intrusions and hallucination-proneness. The present systematic review will organize and synthesize the wealth of empirical findings on these topics. Firstly, the existing literature will be reviewed to establish the empirical support for an association between cognitive intrusions and hallucinations. Secondly, a narrative review will be presented to describe and synthesize the existing literature on the association between hallucinatory experiences and maladaptive metacognitive beliefs. Finally, we will use meta-analytic methods to synthesize the results of quantitative investigations of the association between hallucinations and metacognitive beliefs.
The metacognitive account of hallucinatory experiences has received apparent support from studies investigating the association between intrusive thoughts and hallucination-proneness in both clinical and non-clinical samples. In the first study that systematically examined the prevalence of intrusive cognitions in hallucinating and non-hallucinating psychotic patients, Morrison and Baker (2000) reported that hallucinating patients scored higher than controls on frequency of intrusive thoughts as measured by the Distressing Thoughts Questionnaire (DTQ; Clark & de Silva, 1985). Similarly, Lobban, Haddock, Kinderman, and Wells (2002) found that hallucinating psychiatric patients scored significantly higher than patients with no history of auditory hallucinations on self-report measures of unwanted thoughts (although this difference was no longer significant after that the effect of depression and anxiety had been taken into account). Although these two studies suggest the existence of a robust association between intrusive thoughts and hallucinatory experiences, in another clinical investigation Linney and Peters (2007) found no difference between hallucinating and non-hallucinating psychotic patients in terms of cognitive intrusions as assessed by the Obsessive Compulsive Thoughts Checklist (Bouvard, Mollard, Cottraux, & Guerin, 1989) and the revised Padua Inventory (Burns, Keortge, Formea, & Sternberger, 1996). Conversely, in the same psychiatric sample cognitive intrusions were found to be significantly associated with symptoms of thought interference, suggesting that intrusive cognitions might be related to psychotic symptoms other than hallucinations.
In a recent non-clinical sample of undergraduate students, a robust positive association was found between hallucination-proneness and a subset of items of the White Bear Suppression Inventory (Wegner & Zanakos, 1994) that assessed intrusiveness of unwanted thoughts (Jones & Fernyhough, 2006). This finding has recently been replicated using the DTQ in a non-clinical study conducted by Varese, Barkus, and Bentall (2010), which nonetheless found that the association between intrusions and hallucinatory experiences was relatively small (τp (315) = 0.11, p < 0.001) when compared to the magnitude of the association between paranoia and intrusions (τp (315) = 0.31, p < 0.001) once the covariation between paranoid ideation and hallucination-proneness had been taken into account. In this study, Varese et al. were also able to identify a small number of hallucination-prone individuals who very infrequently experienced intrusions, a finding interpreted as suggesting that hallucinatory predisposition is to a certain extent independent from the proneness to experience intrusive thoughts.
The cognitive model proposed by Morrison et al. (1995) has received further support from a number of studies which have investigated the association between maladaptive metacognitive beliefs and hallucination proneness. In the majority of these studies the Metacognitions Questionnaire (MCQ; Cartwright-Hatton & Wells, 1997) was used to assess metacognitive beliefs. The MCQ is a self-report questionnaire comprising five subscales: (i) positive beliefs about worry (beliefs that worry helps to solve problems and avoid unpleasant events); (ii) negative beliefs about the uncontrollability of thoughts and corresponding danger (beliefs that one's own thoughts is uncontrollable and beliefs about the importance of controlling thought process in order to function effectively as a person); (iii) cognitive confidence (beliefs about one's own cognitive skills, in particular memory and attentional functioning); (iv) negative beliefs about thought in general (beliefs about potential negative consequences of having certain thoughts); and (v) cognitive self-consciousness (a subscale assessing the predisposition to monitor or focus upon one's own thought processes). The majority of the studies investing the association between metacognitive beliefs and hallucination-proneness used the original 65-item version of the MCQ (in this review we will refer to this version as MCQ-65), whereas a smaller number of studies used a shorter version of the questionnaire with a comparable factor structure (the MCQ-30; Wells & Cartwright-Hatton, 2004) or other modified versions of the instrument (Lobban et al., 2002, Stirling et al., 2007).
The studies which specifically investigated the association between metacognitive beliefs and hallucinatory experiences in clinical samples are listed in Table 1. Although these studies frequently compared hallucinating patients to both clinical and non-clinical controls, only the results from the comparison between hallucinating and non-hallucinating patients with comparable diagnoses will be considered, in order to evaluate the empirical support given by these studies to the alleged specific association between metacognitive beliefs and hallucinatory experiences.
The first clinical study to examine group differences in metacognitive beliefs between hallucinating and non-hallucinating psychotic patients was carried out by Baker and Morrison (1998). This study revealed that hallucinating patients scored significantly higher than non-hallucinating patients on two subscales of the MCQ-65 (positive beliefs about worry and negative beliefs about the uncontrollability and danger of thoughts). Lobban et al. (2002) tried to replicate these results using a modified and shortened version of the MCQ which also included an additional subscale assessing beliefs about the importance of consistency of thoughts. In this study, hallucinating psychotic patients scored significantly higher than non-hallucinating patients only on beliefs about the importance of thought consistency. However, after controlling for the effect of anxiety and depression, there were no significant differences between hallucinating and non-hallucinating groups on MCQ scores, with the exception of lack of cognitive confidence, which was significantly greater in the non-hallucinating rather than the hallucinating patients. In a subsequent study, hallucinating patients scored significantly higher than non-hallucinating patients with persecutory delusions on negative beliefs about uncontrollability and danger, lack of cognitive confidence and negative beliefs about thoughts in general (Morrison & Wells, 2003). Finally, García-Montes, Pérez-Álvarez, Balbuena, Garcelán, and Cangas (2006) found no significant differences between hallucinating psychotic patients and psychotic patients with no history of auditory hallucinations on the metacognitive factors of the MCQ-65.
More recently, following several studies suggesting elevated rates of dysfunctional metacognitive beliefs in individuals at ultra high risk of developing a psychotic disorder (Morrison, Bentall, et al., 2002, Morrison et al., 2006, Morrison et al., 2007), Brett, Johns, Peters, and McGuire (2009) investigated the association between the metacognitive factors of the MCQ-65 and different psychotic-like anomalous experiences reported by psychotic patients, individuals experiencing at risk mental states (ARMS) and non-clinical participants experiencing psychotic-like anomalies who had never sought or received psychiatric care. This study revealed no association between the metacognitive factors of the MCQ-65 and a subscale of the Appraisals of Anomalous Experiences Interview (AANEX; Brett et al., 2007) assessing lifetime occurrence of Shneiderian first rank symptoms (including auditory hallucinations, thought broadcast and passivity phenomena), therefore suggesting that metacognitive beliefs are not specifically implicated in the genesis of these experiences.
Further empirical evidence about the hypothesized association between hallucinatory experiences and dysfunctional metacognitive beliefs is provided by a small number of clinical studies which have used self-report measures other than the MCQ, although assessing comparable constructs. Morrison and Haddock (1997) found that hallucinating patients with a diagnosis of schizophrenia scored significantly higher than non-hallucinating patients on the Private Self-Consciousness Scale (PSCS; Fenigstein, Scheier, & Buss, 1975), a self-report measure assessing self-focused attention. However, these results were not replicated by a subsequent study which found no difference in terms of self-focused attention between currently hallucinating psychotic patients and psychotic patients with no history of auditory hallucinations (Perona-Garcelán et al., 2008). In addition, in a recent study of psychotic patients carried out by Linney and Peters (2007), metacognitive beliefs about the importance of controlling intrusive cognitions (as assessed by the Obsessive Beliefs Questionnaire-44; Obsessive Compulsive Cognitions Working Group, 2001) were associated with symptoms of thought interference, but not auditory hallucinations.
A number of analogue studies (i.e. studies carried out on non-clinical samples presenting characteristics which resemble specific features of clinical populations) investigating the association between metacognitive beliefs and hallucination-proneness have been reported in recent years. In the first study of this kind, Morrison, Wells, and Nothard (2000) showed that hallucination-prone students identified using a modified version of the Launay–Slade Hallucination Scale (LSHS; Launay & Slade, 1981) scored significantly higher than non-prone students on a number of subscales of the MCQ-65, including cognitive self-consciousness and negative beliefs about the uncontrollability and danger of thoughts, whereas the difference for the general negative beliefs subscale only approached statistical significance. Using a modified version of the LSHS which allows the independent assessment of the predisposition to auditory and visual hallucinations, the same research group found that, after controlling for the effect of trait anxiety, the positive beliefs about worry subscale of the MCQ-65 was the only significant predictor of auditory hallucination-proneness whereas uncontrollability and danger and positive beliefs about worry were the only significant predictors of the predisposition to experience visual hallucinations (Morrison, Wells, & Nothard, 2002). Divergent results were obtained in a subsequent study by Morrison and Petersen (2003) which found that the negative beliefs about the uncontrollability of thoughts and lack of cognitive confidence subscales of the MCQ-65 were significantly related to both visual and auditory hallucination-proneness in a small sample of undergraduate students, whereas cognitive self-consciousness was associated only with the predisposition to experience visual hallucinations.
Three successive studies used the French version of the MCQ-65 (Larøi, Van der Linden, & d'Acremont, 2009) to compare hallucination-prone university students (identified using a French version of the LSHS; Larøi, Marczewski, & Van der Linden, 2004) with students not prone to hallucinations. The results from these studies revealed that hallucination-prone students scored significantly higher than non-prone controls on all the subscales of the MCQ-65 (Larøi, van der Linden and Marczewski, 2004, Larøi et al., 2005, Larøi and Van der Linden, 2005). Similar results were obtained in a subsequent study which examined the association between metacognitive beliefs (as assessed by the Meta-Cognitions Questionnaire—Adolescent version; Cartwright-Hatton et al., 2004) and positive schizotypy (i.e. the expression in non-clinical populations of experiences similar to the positive symptoms of schizophrenia, including hallucinations and delusions) in a sample of Swiss adolescents (Debbané, Van der Linden, Gex-Fabry, & Eliez, 2009). The results of this study revealed that all the subscales of the MCQ significantly predicted the positive schizotypy scores of the French version of the Schizotypal Personality Questionnaire (SPQ; Dumas et al., 2000). Convergent results were obtained when the same analysis was carried out on a subsample of adolescents endorsing at least one of the three hallucination-related items of the SPQ.
Two additional published studies used the MCQ-65 to investigate the association between hallucination-proneness and metacognitive beliefs in samples of Spanish undergraduate students. Using a Spanish version of the Revised Hallucination Scale (Fidalgo, Gutierrez, García-Montes, & Cangas, 2003), Cangas, Errasti, García-Montes, Álvarez, and Ruiz (2006) found that negative beliefs about the uncontrollability and danger of thoughts were the only significant predictors of auditory hallucination-proneness, whereas both beliefs about uncontrollability and danger of thoughts and cognitive confidence significantly predicted visual hallucination-proneness scores. These results were at variance with the findings of a subsequent study conducted by the same research group, which reported that, after statistically controlling for the effect of trait anxiety, auditory hallucination-proneness was significantly associated only with lack of cognitive confidence. Conversely, both lack of cognitive confidence and positive beliefs about worry were positively associated with the predisposition to visual hallucinations (García-Montes, Cangas, Pérez-Álvarez, Fidalgo, & Gutiérrez, 2006).
Four recent studies have also investigated the relationship between hallucination-proneness and the metacognitive factors measured by the MCQ in large samples of British undergraduate students. Jones and Fernyhough (2006) found that hallucinatory predisposition was significantly associated with all the subscales of the MCQ-30. After statistically controlling for the effect of intrusiveness of thoughts, cognitive self-consciousness, negative beliefs about uncontrollability and danger and lack of cognitive confidence survived as significant predictors of hallucination-proneness. In a subsequent study, Stirling et al. (2007) compared three groups of participants with different levels of hallucination-proneness (high, medium and low hallucination-prone participants) selected using the LSHS and the unusual experiences subscale of the Oxford-Liverpool Inventory of Feelings and Experiences (Mason, Claridge, & Jackson, 1995). This study found that hallucination-proneness was associated with higher scores on four of the five subscales of the MCQ-65: negative beliefs about uncontrollability and danger, general negative beliefs, lack of cognitive confidence and cognitive self-consciousness. Stirling et al. also explored between-group differences on a modified version of the MCQ-65 named MCQ-thinking (MCQ-th) in which all the worry-related items were reworded to avoid overt reference to worry and anxiety, instead focusing on thought processes and cognition. Hallucination-proneness was associated with higher scores on three of the MCQ-th metacognitive factors: negative beliefs about uncontrollability and danger of thoughts, negative beliefs about thinking and awareness and usefulness of controlling thoughts (a factor including items corresponding to the cognitive self-consciousness and positive beliefs subscales of the MCQ-65). In another study, Varese et al. (2010) investigated whether the metacognitive factors of the MCQ-30 are specifically related to hallucination-proneness while controlling for comorbid symptoms. The results of this study revealed that, after controlling for the effect of intrusive cognitions and paranoid ideation, cognitive self-consciousness was the only significant predictor of hallucination-proneness in a large student sample. In this study, metacognitive beliefs assessed by the MCQ-30 were more robustly associated with paranoia and intrusive thoughts rather hallucination-proneness. Finally, Allen et al. (2005) found that hallucination-proneness was related to self-focused attention as assessed by the PSCS in another large sample of British undergraduate students.
Although several studies reviewed in 1.3 Metacognitive beliefs and hallucinatory experiences: clinical studies, 1.4 Metacognitive beliefs and hallucination-proneness in non-clinical studies suggest a relationship between metacognitive beliefs and hallucinatory experiences, some also indicate that metacognitive beliefs may be associated with proneness to psychotic symptoms other than auditory and visual hallucinations. Consistent with the findings from several studies suggesting that metacognitive beliefs are implicated in both clinical and non-clinical paranoia (Fraser et al., 2006, García-Montes et al., 2005), two of the reviewed studies revealed that metacognitive beliefs are associated with both delusion-proneness (Larøi & Van der Linden, 2005) and paranoid ideation (Varese et al., 2010) in non-clinical samples. Metacognitive beliefs were also found to be associated with symptoms of thought interference but not with auditory hallucinations in a psychiatric sample (Linney & Peters, 2007). A growing body of literature also indicates that the metacognitive factors of the MCQ are associated with non-psychotic symptoms such as anxiety (e.g. Cartwright-Hatton and Wells, 1997, Davies and Valentiner, 2000), depression (e.g. Wells & Carter, 2001) and obsessive-compulsive symptoms (e.g. Gwilliam et al., 2004, Irak and Tosun, 2008, Myers and Wells, 2005). These findings are consistent with the results from many of the clinical studies reviewed in Section 1.3. For example, García-Montes, Pérez-Álvarez, et al. (2006) showed that, even though both hallucinating psychotic patients and patients with diagnosis of obsessive compulsive disorder (OCD) scored significantly higher than healthy controls on several subscales of the MCQ-65, there were no significant differences on metacognitive belief measures between these two clinical groups. Similarly, Lobban et al. (2002) found no significant differences between hallucinating psychotic patients and patients with anxiety disorders. Furthermore, Morrison and Wells (2003) showed that hallucinating psychotic patients, paranoid patients with no history of auditory hallucinations and patients with diagnosis of panic disorder all showed elevated MCQ-65 scores when compared to non-clinical controls. Overall, these findings raise doubts about the specific contribution of metacognitive beliefs to hallucinations and hallucination-proneness. In addition, these results suggest that the effect of comorbid symptoms which have been linked to dysfunctional metacognitive beliefs in previous research might represent an important confound in the relationship between hallucination-proneness and metacognitive beliefs.
Although the metacognitive beliefs account of hallucinatory experiences proposed by Morrison et al. (1995) has been widely accepted by researchers and clinicians in recent years, the findings of the studies reviewed in 1.2 Intrusive thoughts and hallucinatory experiences, 1.3 Metacognitive beliefs and hallucinatory experiences: clinical studies, 1.4 Metacognitive beliefs and hallucination-proneness in non-clinical studies offer at best mixed support to the model. To complicate matters, the relationship between intrusive thoughts and hallucination-proneness that might be predicted from the metacognitive belief model is not entirely obvious; a number of researchers have argued that, if hallucination-prone individuals are specifically motivated to misattribute intrusive thoughts to an external source when compared to non-prone individuals, fewer rather than more reported intrusive thoughts would be expected (e.g. Linney & Peters, 2007) whereas others have made the opposite prediction (e.g. Morrison & Baker, 2000). The investigations conducted to test whether hallucinatory experiences are specifically related to dysfunctional metacognitive beliefs have not consistently supported the more straightforward empirical predictions pertaining to this aspect of the model. While several studies suggest that hallucinatory experiences might be associated with elevated scores on the metacognitive factors assessed by the MCQ (e.g. Baker and Morrison, 1998, Morrison and Wells, 2003), other studies have failed to find evidence supporting this association (e.g. Brett et al., 2009, García-Montes, Pérez-Álvarez, et al., 2006, Linney and Peters, 2007). In addition, those studies which have reported associations between hallucinations or hallucination-proneness and MCQ scores have often pointed to the importance of different MCQ subscales. Hence, there is the need for an empirical summary of the existing findings generated in the substantial number of studies that have so far been conducted to address this issue.
With this purpose in mind, we conducted a series of meta-analyses to summarize the relevant quantitative findings. In addition to estimating the magnitude of the association observed between metacognitive beliefs and hallucinations we interrogated the existing data to establish the importance of methodological factors that were considered likely to influence the results observed in the individual studies. Finally, we carried out separate analyses of those studies which controlled for comorbid symptoms in order to establish the specificity of the association between metacognitive beliefs and hallucinatory experiences.
Section snippets
Literature search and eligibility criteria
A comprehensive search of relevant papers published between January 1995 and October 2009 was conducted using several computerized databases (PsychINFO, Web of Knowledge, and PubMed) and different combinations of the following keywords: “metacognit*”, “self-focus*”, “hallucinat*” “psychosis” and “schizo*”. In addition, a careful inspection of the studies' reference lists was carried out to identify any reports not previously retrieved through the databases search. In an attempt to reduce the
Literature search results
Twenty-six studies were retrieved through the search of the computerized databases and examination of cross-references. In addition, four additional studies were made available by the research groups contacted (Barkus et al., 2010, Johns, 2009, Varese et al., 2010, Varese and Bentall, 2008). Two studies (Ensum and Morrison, 2003, Startup et al., 2008) reported statistical analyses from methodological manipulations which prevented the computation of effect-sizes comparable to other reported
The association between metacognitive beliefs and hallucination proneness in clinical and non-clinical samples
The present meta-analysis aimed to evaluate and summarize the existing empirical evidence pertaining to the cognitive model of hallucinations proposed by Morrison et al. (1995). The results from the both the aggregated and analogue subgroup analyses indicated that, overall, the constructs assessed by the MCQ are robustly associated with hallucinations-proneness, with summary effect sizes presenting moderate-to-large magnitudes according to the conventional criteria proposed by Cohen (1988).
Acknowledgements
The authors would like to acknowledge the contribution of the researchers who kindly provided information regarding their relevant published and unpublished studies included in this review: Paul Allen, Emma Barkus, Caroline Brett, Martin Debbane, Daniel Freeman, Louise Johns, Simon Jones, Frank Larøi, José García-Montes, Anthony P. Morrison and Salvador Perona-Garcelán.
References (121)
- et al.
Persecutory delusions: A review and theoretical integration
Clinical Psychology Review
(2001) - et al.
Reliability of a scale measuring disposition towards hallucination: a brief report
Personality and Individual Differences
(1985) - et al.
Metacognitive factors and alterations of attention related to predisposition to hallucinations
Personality and Individual Differences
(2006) - et al.
Development and preliminary validation of the Meta-cognitions Questionnaire—Adolescent Version
Journal of Anxiety Disorders
(2004) - et al.
Beliefs about worry and intrusions: The meta-cognitions questionnaire and its correlates
Journal of Anxiety Disorders
(1997) - et al.
The nature of depressive and anxious intrusive thoughts: Distinct or uniform phenomena?
Behaviour Research and Therapy
(1985) - et al.
The assessment of unwanted intrusive thoughts: A review and critique of the literature
Behaviour Research and Therapy
(1995) - et al.
The effects of focus of attention on attributional bias in patients experiencing auditory hallucinations
Behaviour Research and Therapy
(2003) - et al.
Metacognitions in patients with hallucinations and obsessive-compulsive disorder: The superstition factor
Behaviour Research and Therapy
(2006) - et al.
Exploring the role of metacognition in obsessive-compulsive and anxiety symptoms
Journal of Anxiety Disorders
(2008)
The role of thought suppression and metacognitive beliefs in proneness to auditory verbal hallucinations in a non-clinical sample
Personality and Individual Differences
Reliability and validity of the positive and negative syndrome scale for schizophrenics
Psychiatry Research
The multi-dimensionality of hallucinatory predisposition: Factor structure of a modified version of the Launay–Slade Hallucinations Scale in a normal sample
European Psychiatry
Metacognitions and proneness towards hallucinations and delusions
Behaviour Research and Therapy
The measurement of hallucinatory predisposition in male and female prisoners
Personality and Individual Differences
The psychological processes underlying symptoms of thought interference in psychosis
Behaviour Research and Therapy
The role of metacognitive beliefs in auditory hallucinations
Personality and Individual Differences
The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories
Behaviour Research and Therapy
New scales for the assessment of schizotypy
Personality and Individual Differences
Intrusive thoughts and auditory hallucinations: A comparative study of intrusions in psychosis
Behaviour Research and Therapy
Metacognitive beliefs across the continuum of psychosis: Comparisons between patients with psychotic disorders, patients at ultra-high risk and non-patients
Behaviour Research and Therapy
Self-focused attention in schizophrenic patients with and without auditory hallucinations and normal subjects: A comparative study
Personality and Individual Differences
A comparison of metacognition in patients with hallucinations, delusions, panic disorder, and non-patients controls
Behaviour Research and Therapy
Obsessive-compulsive symptoms: The contributions of metacognition and responsibility
Journal of Anxiety Disorders
Prevalence of hallucinations and their pathological associations in the general population
Psychiatry Research
The Peters et al. Delusions Inventory (PDI): New forms for the 21-item version
Schizophrenia Research
Suppression of obsession-like thoughts in nonclinical individuals: Impact on thought frequency, appraisal and mood state
Journal
Unwanted intrusive cognitions
Advances in Behaviour Research and Therapy
Hallucinations: The science of idiosyncratic perception
Dissociation and vulnerability to psychotic experience
The Journal of Nervous and Mental Disease
Slow habituation of arousal associated with psychosis proneness
Psychological Medicine
The prediction of hallucinatory predisposition in non-clinical individuals: Examining the contribution of emotion and reasoning
The British Journal of Clinical Psychology
The scale for the assessment of positive symptoms (SAPS)
The relationship between trauma and beliefs about hearing voices: A study of psychiatric and non-psychiatric voice hearers
Psychological Medicine
Hallucinations in bipolar disorder: Characteristics and comparison to unipolar depression and schizophrenia
Bipolar Disorders
Cognitive processes in auditory hallucinations: Attributional bias and metacognition
Psychological Medicine
Distress and metacognition in psychosis prone individuals: Comparing high Schizotypy to the at-risk mental state
The Journal of Nervous and Mental Disease
An inventory for measuring clinical anxiety: Psychometric properties
Journal of Consulting and Clinical Psychology
An inventory for measuring depression
Archives of General Psychiatry
The illusion of reality: A review and integration of psychological research on hallucinations
Psychological Bulletin
Madness explained: Psychosis and the human nature
Introduction to meta-analysis
Etude de validation et analyse factorielle de la version francaise de l'echelle d'obsession compulsion de Yale Brown
Journal de Therapie Comportementale et Cognitive
The role of metacognitive beliefs in determining the impact of anomalous experiences: A comparison of help-seeking and non-help-seeking groups of people experiencing psychotic-like anomalies
Psychological Medicine
Appraisal of Anomalous Experiences Interview (AANEX): A multidimensional measure of psychological responses to anomalies associated with psychosis
The British Journal of Psychiatry
Revision of the Padua inventory of obsessive compulsive disorder symptoms: Distinctions between worry, obsessions, and compulsions
Behaviour Research and Therapy
Unwanted intrusive thoughts in nonclinical individuals: Implications for clinical disorders
Statistical power analysis for the behavioural sciences
Does meta-cognitive theory enhance our understanding of pathological worry and anxiety?
Personality and Individual Differences
Cognitive and emotional associations to positive schizotypy during adolescence
Journal of Child Psychology and Psychiatry
Cited by (56)
Experiencing hallucinations in daily life: The role of metacognition
2024, Schizophrenia ResearchMeta-analysis of the relationship between metacognition and disorganized symptoms in psychosis
2024, Schizophrenia ResearchMetacognition and psychosis-spectrum experiences: A study of objective and subjective measures
2023, Schizophrenia ResearchCognitive correlates of auditory hallucinations in schizophrenia spectrum disorders
2023, Psychiatry ResearchChildhood interpersonal trauma and paranoia in psychosis: The role of disorganised attachment and negative schema
2022, Schizophrenia ResearchCitation Excerpt :Internal consistency in the current study was good for the persecution subscale (α = 0.87). It has been suggested that controlling for the comorbidity between experiences of paranoia and hallucinations is necessary for identifying the underpinnings of specific psychotic experiences (Bentall et al., 2012; Varese and Bentall, 2011). Depression has also been identified as an important confounding variable in paranoia (Humphrey et al., in preparation).
Rumination and Related Constructs: Causes, Consequences, and Treatment of Thinking Too Much
2020, Rumination and Related Constructs: Causes, Consequences, and Treatment of Thinking Too Much