An observational treatment study of metacognition in anxious-depression

Prior studies have found metacognitive biases are linked to a transdiagnostic dimension of anxious-depression, manifesting as reduced confidence in performance. However, previous work has been cross-sectional and so it is unclear if under-confidence is a trait-like marker of anxious-depression vulne...

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Main Authors: Celine Ann Fox, Chi Tak Lee, Anna Kathleen Hanlon, Tricia XF Seow, Kevin Lynch, Siobhán Harty, Derek Richards, Jorge Palacios, Veronica O'Keane, Klaas Enno Stephan, Claire M Gillan
Format: Article
Language:English
Published: eLife Sciences Publications Ltd 2023-10-01
Series:eLife
Subjects:
Online Access:https://elifesciences.org/articles/87193
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author Celine Ann Fox
Chi Tak Lee
Anna Kathleen Hanlon
Tricia XF Seow
Kevin Lynch
Siobhán Harty
Derek Richards
Jorge Palacios
Veronica O'Keane
Klaas Enno Stephan
Claire M Gillan
author_facet Celine Ann Fox
Chi Tak Lee
Anna Kathleen Hanlon
Tricia XF Seow
Kevin Lynch
Siobhán Harty
Derek Richards
Jorge Palacios
Veronica O'Keane
Klaas Enno Stephan
Claire M Gillan
author_sort Celine Ann Fox
collection DOAJ
description Prior studies have found metacognitive biases are linked to a transdiagnostic dimension of anxious-depression, manifesting as reduced confidence in performance. However, previous work has been cross-sectional and so it is unclear if under-confidence is a trait-like marker of anxious-depression vulnerability, or if it resolves when anxious-depression improves. Data were collected as part of a large-scale transdiagnostic, four-week observational study of individuals initiating internet-based cognitive behavioural therapy (iCBT) or antidepressant medication. Self-reported clinical questionnaires and perceptual task performance were gathered to assess anxious-depression and metacognitive bias at baseline and 4-week follow-up. Primary analyses were conducted for individuals who received iCBT (n=649), with comparisons between smaller samples that received antidepressant medication (n=82) and a control group receiving no intervention (n=88). Prior to receiving treatment, anxious-depression severity was associated with under-confidence in performance in the iCBT arm, replicating previous work. From baseline to follow-up, levels of anxious-depression were significantly reduced, and this was accompanied by a significant increase in metacognitive confidence in the iCBT arm (β=0.17, SE=0.02, p<0.001). These changes were correlated (r(647)=-0.12, p=0.002); those with the greatest reductions in anxious-depression levels had the largest increase in confidence. While the three-way interaction effect of group and time on confidence was not significant (F(2, 1632)=0.60, p=0.550), confidence increased in the antidepressant group (β=0.31, SE = 0.08, p<0.001), but not among controls (β=0.11, SE = 0.07, p=0.103). Metacognitive biases in anxious-depression are state-dependent; when symptoms improve with treatment, so does confidence in performance. Our results suggest this is not specific to the type of intervention.
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spelling doaj.art-bc1e941667f8405ab05ec1d458871c362023-10-11T11:26:12ZengeLife Sciences Publications LtdeLife2050-084X2023-10-011210.7554/eLife.87193An observational treatment study of metacognition in anxious-depressionCeline Ann Fox0https://orcid.org/0000-0003-1740-3765Chi Tak Lee1Anna Kathleen Hanlon2Tricia XF Seow3https://orcid.org/0000-0002-5930-8929Kevin Lynch4Siobhán Harty5Derek Richards6https://orcid.org/0000-0003-0871-4078Jorge Palacios7Veronica O'Keane8Klaas Enno Stephan9https://orcid.org/0000-0002-8594-9092Claire M Gillan10https://orcid.org/0000-0001-9065-403XSchool of Psychology, Trinity College Dublin, Dublin, Ireland; Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, IrelandSchool of Psychology, Trinity College Dublin, Dublin, Ireland; Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, IrelandSchool of Psychology, Trinity College Dublin, Dublin, Ireland; Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, IrelandWellcome Centre for Human Neuroimaging, University College London, London, United KingdomSchool of Psychology, Trinity College Dublin, Dublin, IrelandSilverCloud Science, SilverCloud Health Ltd, Dublin, IrelandSchool of Psychology, Trinity College Dublin, Dublin, Ireland; SilverCloud Science, SilverCloud Health Ltd, Dublin, IrelandSchool of Psychology, Trinity College Dublin, Dublin, Ireland; SilverCloud Science, SilverCloud Health Ltd, Dublin, IrelandDepartment of Psychiatry, Trinity College Dublin, Dublin, Ireland; Tallaght Hospital, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin, IrelandTranslational Neuroimaging Unit (TNU), Institute for Biomedical Engineering, University of Zurich, Zurich, Switzerland; Max Planck Institute for Metabolism Research, Cologne, GermanySchool of Psychology, Trinity College Dublin, Dublin, Ireland; Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland; Global Brain Health Institute, Trinity College Dublin, Dublin, IrelandPrior studies have found metacognitive biases are linked to a transdiagnostic dimension of anxious-depression, manifesting as reduced confidence in performance. However, previous work has been cross-sectional and so it is unclear if under-confidence is a trait-like marker of anxious-depression vulnerability, or if it resolves when anxious-depression improves. Data were collected as part of a large-scale transdiagnostic, four-week observational study of individuals initiating internet-based cognitive behavioural therapy (iCBT) or antidepressant medication. Self-reported clinical questionnaires and perceptual task performance were gathered to assess anxious-depression and metacognitive bias at baseline and 4-week follow-up. Primary analyses were conducted for individuals who received iCBT (n=649), with comparisons between smaller samples that received antidepressant medication (n=82) and a control group receiving no intervention (n=88). Prior to receiving treatment, anxious-depression severity was associated with under-confidence in performance in the iCBT arm, replicating previous work. From baseline to follow-up, levels of anxious-depression were significantly reduced, and this was accompanied by a significant increase in metacognitive confidence in the iCBT arm (β=0.17, SE=0.02, p<0.001). These changes were correlated (r(647)=-0.12, p=0.002); those with the greatest reductions in anxious-depression levels had the largest increase in confidence. While the three-way interaction effect of group and time on confidence was not significant (F(2, 1632)=0.60, p=0.550), confidence increased in the antidepressant group (β=0.31, SE = 0.08, p<0.001), but not among controls (β=0.11, SE = 0.07, p=0.103). Metacognitive biases in anxious-depression are state-dependent; when symptoms improve with treatment, so does confidence in performance. Our results suggest this is not specific to the type of intervention.https://elifesciences.org/articles/87193metacognitionconfidenceanxious-depressiontransdiagnosticiCBTantidepressant
spellingShingle Celine Ann Fox
Chi Tak Lee
Anna Kathleen Hanlon
Tricia XF Seow
Kevin Lynch
Siobhán Harty
Derek Richards
Jorge Palacios
Veronica O'Keane
Klaas Enno Stephan
Claire M Gillan
An observational treatment study of metacognition in anxious-depression
eLife
metacognition
confidence
anxious-depression
transdiagnostic
iCBT
antidepressant
title An observational treatment study of metacognition in anxious-depression
title_full An observational treatment study of metacognition in anxious-depression
title_fullStr An observational treatment study of metacognition in anxious-depression
title_full_unstemmed An observational treatment study of metacognition in anxious-depression
title_short An observational treatment study of metacognition in anxious-depression
title_sort observational treatment study of metacognition in anxious depression
topic metacognition
confidence
anxious-depression
transdiagnostic
iCBT
antidepressant
url https://elifesciences.org/articles/87193
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