Do metacognitive beliefs satisfy criteria as mechanisms of change in treatment? A systematic review and evidence synthesis
Abstract
The Self-Regulatory Executive Function (S-REF) model emphasizes biases in metacognition, and particularly negative metacognitive beliefs, as the central mechanism of persistent emotional distress and disorders. Hence, interventions which effectively modify dysfunctional metacognitions are predicted to create improvement regardless of whether metacognitions are directly targeted or not. With an aim to evaluate the empirical support for metacognitions as a mechanism of change in psychopathology, we conducted a systematic review of the literature focusing on metacognitive change and its relationship to change in outcomes across emotional disorders and therapeutic interventions. Systematic searches were conducted and following PRISMA 2020 guidelines, 27 articles were identified. Results were synthesized and evaluated against established criteria for accurately classifying theoretical predictors as mechanisms of change. Our review shows a consistent association between change in metacognitions, particularly negative metacognitive beliefs, and outcome changes across different mental disorders, outcomes, and interventions. This relationship held even when controlling competing mechanisms such as cognitive beliefs and support the criterion of specificity. However, most of the identified studies lacked the methodological rigor needed (e.g., multiple assessment points during the treatment phase) to draw firm conclusions about metacognitions as a causal mechanism of change. Based on…
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