Written by Danielle Fuller
March 2023
78/A+

Metacognition, which refers to the ability to reflect on one's own thoughts and cognitive processes, is a high-level cognitive process allowing us to reflect on how we think about thinking (Cartwright-Hatton & Wells, 1997). Development of metacognitive skills is critical in classroom settings and helping students gain self-regulation learning skills in planning, monitoring, and reflection (Cromley & Kunze, 2020; Říčan et al., 2022). A recent study also found that metacognition moderates the relationship between burnout risk factors and levels of emotional intelligence (Iacolino et al., 2023), suggesting that a greater ability to reflect upon our own thoughts can not only boost emotional intelligence but serve as a protective factor in stressful work environments. However, high levels of metacognitive processing are reliably found to be a significant predictor for anxiety (Aydin et al., 2022; Capobianco et al., 2020; Gkika et al., 2017; Hjemdal et al., 2013; Irak & Tosun, 2008; Spada et al., 2008). Research shows this predictive relationship with anxiety is particularly true in women (APA, 2013; Aydin et al., 2022; Gkika et al 2017; Hjemdal et al., 2013), those with particular physical and psychological clinical diagnoses such as cancer or Parkinson’s disease (Capobianco et al., 2020; Sun et al., 2017), and those with lower levels of education (Bjelland et al., 2008; Tambs et al., 2012). If metacognition is so beneficial to cognitive and emotional maturity, how are we meant to rationalize its seemingly detrimental effects on our mental health outcomes? If someone is already susceptible to anxiety, should they be discouraged from developing their metacognitive skills? 

This paper argues that it is inappropriate to classify metacognition as a solely harmful or solely beneficial process for mental health, noting that its complex relationship with anxiety is better considered in terms of (1) the type of metacognitive thinking in question, (2) the type of anxiety present, and (3) the individual differences of the person in question. Ultimately, this essay concludes that encouraging or discouraging metacognitive growth in those prone to or with anxiety should be considered on a case-by-case basis.

First, metacognition is an umbrella term that covers a variety of more specific metacognitive processes. Although metacognition can be dissected in multiple ways, this essay establishes the metacognitive framework based up on the facets defined by the Metacognitive Questionnaire (MCQ; Cartwright-Hatton & Wells, 1997; Wells & Cartwright-Hatton, 2004), a common tool used to analyze metacognitive tendencies in psychological disorders. Not only has the model been widely verified, validated, and utilized in metacognition research (Cho et al., 2012; Cook et al., 2014; Dai et al., 2018; Myers et al., 2019; Spada et al., 2008), but it was originally derived using participants with clinical anxiety diagnoses in particular (Cartwright-Hatton & Wells, 1997). According to the MCQ, the five facets of metacognition include: (1) positive belief about worry (PB), which refers to the idea that worrying is helpful and adaptive; (2) negative belief about the uncontrollability and danger of thought (NB), which is one’s idea that they cannot control or cope with potential threats; (3) cognitive confidence (CC), referring to the belief in and surety of one's own cognitive abilities; (4) cognitive self-consciousness (CSC), or awareness and process of monitoring one’s cognition; and (5) need to control one’s thoughts (NCT), or the desire to control one's environment and outcomes.

While the link between metacognition and anxiety has been consistently established, the relationship is not consistent across the different facets of the MCQ – specifically, only some aspects of metacognition, not all, reliably predict anxiety. The dysfunctional metacognitive factors (NB, NCT, and CSC), or those referring to unhelpful or harmful thoughts and beliefs about thinking, seeming drive the predictive relationship with anxiety, while metacognitive processes that commonly lead to helpful, adaptive thoughts and beliefs (PB and CC) have been shown to lower symptom severity for clinically diagnosed anxiety (Aydin et al., 2022) and serve as a protective factor against anxiety during stressful life events (Yilmaz et al., 2011). Due to this inconsistent relationship across facets, the generalized claim that metacognition as a whole leads to anxiety ignores the nuance inherent to the metacognitive facets. In order to address the effect one’s metacognitive processing might have on their anxiety, the scores of all five metacognitive facets should be considered individually.

Second, anxiety is similarly a more complex topic than one word can encompass. Defined by the American Psychological Association (APA) as the anticipation of future threats, anxiety is a natural response that helps motivate people to take action; it is considered a disorder when it becomes excessive, chronic, and/or debilitating (APA, 2013). International standards have most recently defined these as generalized anxiety disorder (GAD), social anxiety disorder, separation anxiety disorder, panic disorder, agoraphobia, specific phobia, and selective mutism (World Health Organization, 2019). Just as these disorders are not treated identically in the DSM or ICD, they should neither be assumed to have the same relationship with metacognitive processing.

Many studies in this arena use general scales for anxiety (Aydin et al., 2022; Hjemdal et al., 2013; Irak & Tosun 2008; Vishwanathan et al., 2022), but some research does differentiate between anxiety variants and find key differences in how metacognition impacts symptom manifestation and severity. For example, NB has been shown to associate more closely with GAD than either social phobia or panic disorder (Gkika et al., 2017; Wells & Carter, 2001) while CSC has a strong relationship with obsessive-compulsive disorder, previously considered an anxiety disorder by the APA (APA, 2013), but not with GAD (Irak & Tosun 2008; Janek et al., 2003). Because of these disparities amongst anxiety types, treatment plans relating to an anxious individual’s metacognitive thoughts will be more effective if tailored to address the specific types of metacognition known to predict or exacerbate that particular type of anxiety. However, even within a singular disorder there can still be relational nuance to consider. Social anxiety, for example, has a seemingly contradictory relationship with metacognition in the initiation and maintenance phases of anxiety management; in a study exploring social anxiety levels before and after giving a speech, higher metacognition reduced anxiety right before presenting and increased social anxiety after the speech was over (Gkika & Wells, 2016). This case in particular, where anxiety was both helped and hindered by high metacognition, highlights the dichotomous relationship; generalization of the high-level relationship overlooks critical context unique to specific types of anxiety and how they interact with various metacognitive processes.

By understanding the relationship is one of nuance on both the metacognitive and anxiety sides of the equation, individuals and clinicians are better able to manage symptoms more effectively by targeting the specific problematic metacognitive processes for the specific type of anxiety. For instance, anxious individuals with high NCT may benefit from Cognitive Behavioral Therapy (CBT; Coull & Morris, 2011) to learn how to modify how they think about their natural thoughts, whereas someone with social anxiety with extreme levels of CSC may respond well to mindfulness training (Sevinc et al., 2020) that focuses on becoming either more or less in-tune with their thoughts. Theoretically, it could even be useful to understand the metacognitive thought processes of someone exhibiting no anxiety; should someone without anxiety also have low levels of PB, indicating they hold negative beliefs about the act of worrying, this may indicate a dismissive relationship with negativity – presenting as an idealistic, “everything is fine in the world, why worry?” attitude – and potentially Acceptance and Commitment Therapy (Twohig, 2012) could be applied to challenge their avoidance of experiencing worry and accept that low-levels of worry and anxiety are important to the human experience. As with most everything in life, what’s perfect for one person may be catastrophic for another, so it’s important that decisions to treat dysfunctional (or encourage productive) metacognitive processes consider the patient’s individualized struggles and personal background.

Finally, individual differences must be considered before determining whether to encourage or treat metacognitive processing in someone with anxious tendencies. Beyond the nuance inherent in metacognition and anxiety as individual and interacting constructs lies demographic variables that further denigrate the generalization of their relationship. Age is one of the factors that is important to note. The studies cited up to this point were assessing metacognition and anxiety within adult populations; however, the same assumptions don’t appear to hold when the studied participants are children. Bacow et al. (2010) used the child-adapted MCQ to study kids aged 7 to 17 with diagnoses of either GAD, social phobia, or separation anxiety disorder, and found the adult metacognitive model didn’t hold. In fact, non-patient children in the study demonstrated more, not less, metacognitive processing than the children with an anxiety disorder. This indicates that high levels of metacognitive processing may not predict anxiety in children like they do in adults, hinting that the relationship between metacognition and anxiety is age-dependent and a generalized explanation of the relationship independent of age could lead to improper treatment plans for the younger population. On the other hand, a more recent study did find a correlation between changes in both NB and anxiety following intervention, indicating metacognition could indeed be a relevant consideration for anxious children after all (Köcher et al., 2022). Köcher et al. admitted that their study lacked power, however, so more research is needed to fully understand the moderating effect of age before addressing metacognitive processing or interventions in anxious children.

Similarly, level of education may play a noteworthy moderating role in the relationship. While the relationship between education level and metacognition has not been extensively studied, the development of metacognitive skills – particularly those of planning, monitoring, and reflection – play a crucial role in self-regulated learning and have been implemented in classrooms at all levels (Cromley & Kunze, 2020; Rican et al., 2022). It follows that increased levels of education would lead to increased levels of metacognition, and consequently increased levels of anxiety; however, the opposite seems to be true, as those with lower educational levels have been found to struggle with anxiety more than their well-educated counterparts (Bjelland et al., 2008; Tambs et al., 2012). This may be due to confounding factors that accompany low education, such as lower pay potential leading to increased anxiety about one’s ability to pay bills (Sareen et al., 2011). The limited amount of research on the topic warrants further study to better understand the moderating effect education has on the metacognition-anxiety relationship; however, this counterintuitive relationship could be important to note on an individual basis, particularly for the younger population, where encouraging further education might improve helpful metacognitive processes and possibly protecting against anxiety. And while this essay only looked into education level and age, it’s important to note that other aspects outside the scope of this discussion, such as gender identity, socio-economic status, physical health, and presence and/or severity of diagnosis, should similarly be reviewed as part of the whole-person approach. 

This essay is not an exhaustive list of the considerations that should be made when deciding how metacognition should be developed or treated in those with anxiety; other factors such as cognitive ability, life experience, and cultural background might also play a role in the development and execution of metacognitive processes. Regardless, metacognition is inherently multifaceted and has been shown to be both a help and a hindrance in relation to anxiety, depending upon the specific facet and the particular anxious disorder, as well as the individual differences of the anxious person. This complex relationship demands a nuanced approach, applied on a case-by-case basis, to help clinicians and patients manage anxious symptoms more effectively by targeting individual metacognitive processes to develop more adaptive, effective ways of coping.

References:

American Psychiatric Association. (2013). Anxiety disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596.dsm05

Aydın, O., Obuća, F., Çakıroğlu, E., Ünal-Aydın, P., & Esen-Danacı, A. (2022). The effect of mindfulness and metacognition on anxiety symptoms: a case-control study. Middle East Current Psychiatry (Cairo), 29(1), 1–10. https://doi.org/10.1186/s43045-022-00260-7 

Bacow, T.L., May, J. E., Brody, L. R., & Pincus, D. B. (2010). Are there specific metacognitive processes associated with anxiety disorders in youth? Psychology Research and Behavior Management, 3, 81–90. https://doi.org/10.2147/PRBM.S11785 

Bjelland, I., Krokstad, S., Mykletun, A., Dahl, A. A., Tell, G. S., & Tambs, K. (2008). Does a higher educational level protect against anxiety and depression? The HUNT study. Social Science & Medicine, 66(6), 1334–1345. https://doi.org/10.1016/j.socscimed.2007.12.019 

Capobianco, L., Faija, C., Husain, Z., & Wells, A. (2020). Metacognitive beliefs and their relationship with anxiety and depression in physical illnesses: A systematic review. PloS One, 15(9), e0238457–e0238457. https://doi.org/10.1371/journal.pone.0238457 

Cartwright-Hatton, & Wells, A. (1997). Beliefs about Worry and Intrusions: The Meta-Cognitions Questionnaire and its Correlates. Journal of Anxiety Disorders, 11(3), 279–296. https://doi.org/10.1016/S0887-6185(97)00011-X 

Cho, Y., Jahng, S., & Chai, S. (2012). The Factor Structure and Concurrent Validity of the Korean Version of the Metacognitions Questionnaire 30 (K-MCQ-30). Journal of Clinical Psychology, 68(3), 349–391. https://doi.org/10.1002/jclp.20867 

Cook, S., Salmon, P., Dunn, G., & Fisher, P. (2014). Measuring metacognition in cancer: validation of the Metacognitions Questionnaire 30 (MCQ-30). PloS One, 9(9), e107302–e107302. https://doi.org/10.1371/journal.pone.0107302 

Coull, G., & Morris, P. (2011). The clinical effectiveness of CBT-based guided self-help interventions for anxiety and depressive disorders: A systematic review. Psychological Medicine, 41(11), 2239-2252. https://doi:10.1017/S0033291711000900 

Cromley, J., & Kunze, A. J. (2020). Metacognition in Education: Translational Research. Translational Issues in Psychological Science, 6(1), 15–20. https://doi.org/10.1037/tps0000218 

Dai, L., Bailey, R., & Deng, Y. (2018). The reliability and validity of the Chinese version of the Metacognitions about Health Questionnaire in college students. Quality of Life Research, 27(4), 1099–1108. https://doi.org/10.1007/s11136-017-1780-5 

Gkika, S., & Wells, A. (2016). The impact of metacognitive beliefs and anticipatory processing on state anxiety in high socially anxious individuals in a speech task. Journal of Experimental Psychopathology, 7(4), 588–600. https://doi.org/10.5127/jep.054916

Gkika, S., Wittkowski, A., & Wells, A. (2018). Social cognition and metacognition in social anxiety: A systematic review. Clinical Psychology and Psychotherapy, 25(1), 10–30. https://doi.org/10.1002/cpp.2127 

Hjemdal, O., Stiles, T., & Wells, A. (2013). Automatic thoughts and meta-cognition as predictors of depressive or anxious symptoms: A prospective study of two trajectories. Scandinavian Journal of Psychology, 54(2), 59–65. https://doi.org/10.1111/sjop.12010 

Iacolino, C., Cervellione, B., Isgrò, R., Lombardo, E. M. C., Ferracane, G., Barattucci, M., & Ramaci, T. (2023). The Role of Emotional Intelligence and Metacognition in Teachers’ Stress during Pandemic Remote Working: A Moderated Mediation Model. European Journal of Investigation in Health, Psychology and Education, 13(1), 81–95. https://doi.org/10.3390/ejihpe13010006 

Irak, M., & Tosun, A. (2008). Exploring the role of metacognition in obsessive–compulsive and anxiety symptoms. Journal of Anxiety Disorders, 22(8), 1316–1325. https://doi.org/10.1016/j.janxdis.2008.01.012 

Janeck, A.E., Calamari, J. E., Riemann, B. C., & Heffelfinger, S. K. (2003). Too much thinking about thinking?: metacognitive differences in obsessive–compulsive disorder. Journal of Anxiety Disorders, 17(2), 181–195. https://doi.org/10.1016/S0887-6185(02)00198-6 

Köcher, L.M., Pflug, V., Schneider, S., & Christiansen, H. (2022). Do Metacognitions of Children and Adolescents with Anxiety Disorders Change after Intensified Exposure Therapy? Children (Basel), 9(2), 168–. https://doi.org/10.3390/children9020168 

Myers, S., Solem, S., & Wells, A. (2019). The Metacognitions Questionnaire and Its Derivatives in Children and Adolescents: A Systematic Review of Psychometric Properties. Frontiers in Psychology, 10, 1871–1871. https://doi.org/10.3389/fpsyg.2019.01871 

Říčan, J., Chytrý, V., & Medová, J. (2022). Aspects of self-regulated learning and their influence on the mathematics achievement of fifth graders in the context of four different proclaimed curricula. Frontiers in Psychology, 13, 963151–963151. https://doi.org/10.3389/fpsyg.2022.963151 

Sareen, J., Afifi, T. O., McMillan, K. A., & Asmundson, G. J. (2011). Relationship between household income and mental disorders: findings from a population-based longitudinal study. Archives of General Psychiatry, 68(4), 419–427. https://doi.org/10.1001/archgenpsychiatry.2011.15

Sevinc, G., Greenberg, J., Hölzel, B. K., Gard, T., Calahan, T., Brunsch, V., Hashmi, J. A., Vangel, M., Orr, S. P., Milad, M. R., & Lazar, S. W. (2020). Hippocampal circuits underlie improvements in self‐reported anxiety following mindfulness training. Brain and Behavior, 10(9), e01766–n/a. https://doi.org/10.1002/brb3.1766

Spada, M., Mohiyeddini, C., & Wells, A. (2008). Measuring metacognitions associated with emotional distress: Factor structure and predictive validity of the metacognitions questionnaire 30. Personality and Individual Differences, 45(3), 238–242. https://doi.org/10.1016/j.paid.2008.04.005

Sun, X., Zhu, C., & So, S. H. W. (2017). Dysfunctional metacognition across psychopathologies: A meta-analytic review. European Psychiatry, 45, 139–153. https://doi.org/10.1016/j.eurpsy.2017.05.029

Tambs, K., Kendler, K. S., Reichborn-Kjennerud, T., Aggen, S. H., Harris, J. R., Neale, M. C., Hettema, J. M., Sundet, J. M., Battaglia, M., & Røysamb, E. (2012). Genetic and environmental contributions to the relationship between education and anxiety disorders - a twin study. Acta Psychiatrica Scandinavica, 125(3), 203–212. https://doi.org/10.1111/j.1600-0447.2011.01799.x 

Twohig, M. (2012) Acceptance and Commitment Therapy: Introduction. Cognitive and Behavioral Practice, 19(4), 499–507. https://doi.org/10.1016/j.cbpra.2012.04.003

Vishwanathan, A., Kashyap, H., Reddy, R. P., Philip, M., Thippeswamy, H., & Desai, G. (2022). Neurocognition and Metacognition in Anxiety Disorders. Indian Journal of Psychological Medicine, 44(6), 558–566. https://doi.org/10.1177/02537176211072408

Wells, A., & Carter, K. (2001). Further tests of a cognitive model of generalized anxiety disorder: Metacognitions and worry in GAD, panic disorder, social phobia, depression, and nonpatients. Behavior Therapy, 32(1), 85–102. https://doi.org/10.1016/S0005-7894(01)80045-9 

Wells, A., & Cartwright-Hatton, S. (2004). A short form of the metacognitions questionnaire: properties of the MCQ-30. Behaviour Research and Therapy, 42(4), 385–396. https://doi.org/10.1016/S0005-7967(03)00147-5 

Wilson, A.C., Mackintosh, K., Power, K. et al. (2019). Effectiveness of Self-Compassion Related Therapies: a Systematic Review and Meta-analysis. Mindfulness, 10, 979–995. https://doi.org/10.1007/s12671-018-1037-6 

World Health Organization. (2019). International statistical classification of diseases and related health problems (11th ed.). https://icd.who.int/ 

Yılmaz, A.E., 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(3), 389–396. https://doi.org/10.1016/j.janxdis.2010.11.001