Meta-cognitive beliefs in Major Depressive Disorder: A Comparison of Individuals with Major Depressive Disorder and Healthy Control

Major Depressive Disorder (MDD) is a prevalent mental illness affecting over 320 million people, equivalent to 4.4% of the global population (World Health Organization, 2017). MDD is primarily characterized by feelings of sadness, indifference, hopelessness, and persistent thoughts (Kanter et al., 2008; Otte et al., 2016). In recent years, there has been growing interest in identifying the cognitive aspects linked to MDD. There’s mounting evidence suggesting that impaired metacognition, the ability to assess and evaluate one’s own thought processes and actions, plays a significant role (Hoven et al., 2019; Rouault, Seow, et al., 2018; Trauelsen et al., 2016). Several theories, including the Self-Regulatory Executive Function (S-REF, Wells & Matthews, 1994), propose that dysfunctional metacognitive processes contribute to the onset and persistence of mental disorders. According to the S-REF theory, certain forms of metacognitive beliefs may predispose individuals with depression to adopt counterproductive responses to their thoughts and inner experiences, resulting in ineffective coping strategies (Wells, 2011). One particular response pattern, known as the Cognitive-Attention Syndrome (CAS), involves excessive engagement in worry, rumination, heightened focus on threats and negative information, and excessive self-focus. CAS also includes ineffective regulation strategies such as avoidance and thought suppression (Sun et al., 2017). This syndrome gradually emerges due to metacognitive beliefs, such as the idea that worrying and ruminating serve a purpose, or that thoughts and emotions are inherently negative and uncontrollable and should be avoided and suppressed (Sun et al., 2017). Over time, CAS ensnares individuals with depression in prolonged emotional turmoil, leading to persistent thinking patterns and contributing to the onset and perpetuation of the clinical disorder.