Metacognition and eating disorders

Abstract

Cognitive theories of emotional disorder maintain that psychological dysfunction is associated with a disturbance in thoughts and beliefs. In contrast, the self-regulatory executive function theory of emotional disorder (Wells & Matthews, 1994), posits that psychological disturbance is associated with metacognitive beliefs that promote the use of dysfunctional metacognitive control strategies. The aim of the thesis was to investigate whether metacognitive beliefs and metacognitive control strategies are associated with symptoms and features of eating disorders. In pursuit of this aim, two studies were undertaken examining: features of cognition between diagnostic groups, and compared to a non-clinical group; the inter-relatedness of cognitive and metacognitive constructs and their associations with symptoms; strategy-use during body exposure and cognitive predictors of state- and physical appearance anxiety; cognitive and metacognitive predictors of early treatment response in patients undergoing cognitive behaviour therapy (CBT) for an eating disorder. In Study 1, 90 clinical- and 108 non-clinical participants engaged in a guided 3-minute body exposure task, and then completed questionnaires measuring affective state, and engagement in- and efficacy of thought control strategies. In Study 2, 103 clinical participants engaged in either day-hospital or outpatient CBT. After 12-weeks of treatment, symptom measures were re-administered. The overall results indicated that, firstly, eating disorder subgroups have a similar cognitive profile, but differ substantially from a non-clinical group. Secondly, the pattern of inter-relationships between cognitive and metacognitive variables was found to be multidimensional. Thirdly, the clinical group displayed a greater tendency to use maladaptive thinking strategies in general, but not under body exposure conditions. Fourthly, metacognitive variables were only found to be associated with features of the disorder that are not specific to eating disorders. However, they were found to predict degree of treatment change in dietary restraint, bulimia, body dissatisfaction and stress, which suggests that targeting metacognitive processes may be important for facilitating change in these symptoms.