[Thesis]. Manchester, UK: The University of Manchester; 2017.
The development, maintenance, and treatment of health anxiety remains an important
area in psychological research. The cognitive behavioural therapy (CBT) model has
gained popularity, as an evidence-based approach for explaining and treating health
anxiety (Barsky & Ahern, 2004; Clark, et al., 1998; Warwick, et al., 1996). However,
significant limitations exist, not least because treating illness-related cognitions
appears not to confer much advantage over other treatment approaches. An emerging
psychological approach, Metacognitive Therapy (Wells & Matthews, 1994), may offer
an alternative approach for understanding and treating this disorder. In this thesis
the predictions made by the metacognitive model and applied to health anxiety were
tested using data from cross sectional, longitudinal and treatment designs.
In Chapter 2 a cross sectional study investigated whether metacognition was associated
with health anxiety when controlling for other factors (i.e., neuroticism, somatosensory
amplification, and illness cognition). Results indicated a strong positive association
between metacognition and health anxiety, and demonstrated the predictive potential
of specific metacognitions over and above other established correlates of symptoms.
In Chapter 3exploratory and confirmatory factor analysis was used to develop a specific
metacognitive measure. This resulted in a 14 item, three factor measure, with further
analysis suggesting good internal-consistency, incremental, convergent and discriminant
validity. Preliminary findings from this study support the assessment of health-anxiety
specific metacognitions with this new tool.
Chapter 4 expanded the findings of chapter 2 and directly compared key aspects of
the metacognitive model (metacognition) with the cognitive model (dysfunctional beliefs).
Metacognitive beliefs were found to explain almost half of the variance in health
anxiety when controlling for dysfunctional illness beliefs, and emerged as the strongest
independent predictors. These data support a key component of the metacognitive model,
that metacognition may be more important in health anxiety than symptom/illness-related
In Chapter 5 & 6 both cross-sectional and longitudinal designs explored the relationship
between cognition (catastrophic misinterpretation), and metacognition. Consistent
with the metacognitive model the effect of cognition on health anxiety was explained
by an interaction with metacognition. The results of these findings add further weight
to the idea that metacognition may be more important in both the development and maintenance
of health anxiety than cognition.
Finally, in Chapter 7 an A-B single case series treatment design (N=4) was used to
investigate the effects associated with metacognitive therapy (MCT) applied to health
anxiety. The results showed that all four patients treated with MCT demonstrated large
and clinically meaningful improvements in health anxiety both at post treatment and
follow up. These improvements also corresponded with substantial changes in patients
metacognitive beliefs. Overall this case series provides preliminary evidence that
MCT can be applied to health anxiety.
Collectively the results of this thesis provide new insights into the role played
by metacognition in health anxiety. It provides evidence for a role of metacognition
in both the development and maintenance of health anxiety, and indicates that targeting
metacognition can be applied in treatment of these patients and may bring about a
reduction in health anxiety symptoms.