The Effectiveness of Meta-Cognitive Therapy on Cognitive-Attentional Syndrome, Catastrophizing and Pain Intensity in Women with Fibromyalgia

Document Type : Research Paper

Authors

1 Department of Clinical Psychology, Psychology and Educational Science Faculty, Semnan University, Semnan, Iran.

2 Associate Professor, Department of Psychology, Psychology and Educational Science Faculty, Semnan University, Semnan, Iran.

Abstract

The objective of this investigation was to evaluate the efficacy of metacognitive therapy in the treatment of cognitive-attentional syndrome, catastrophizing, and pain intensity in women with fibromyalgia. This investigation was a practical and semi-experimental study that included a pre-test-post-test design and a control group. 42 patients were selected from the statistical population of the study, which consisted of women with fibromyalgia who visited specialized rheumatology and orthopedic clinics in Tehran in April and May 2022. The selection was based on the definitive diagnosis of fibromyalgia, and used the available sampling method. Then, the participants were randomly assigned to the experimental and control groups. The Cognitive Attention Syndrome Scale (CAS-1), Pain Catastrophizing Scale (PCS), and Pain Intensity Scale Questionnaire (SCPQ) were employed to evaluate the participants. The information was analyzed and the research hypotheses were addressed using descriptive and inferential statistics in SPSS-26. The mean and standard deviation were employed at the descriptive level. The Shapiro-Wilk Test was implemented to evaluate the normality of the variable distribution at the inferential level, while the Levene’s Test was implemented to evaluate the homogeneity of variances. Additionally, Multivariate Analysis of Covariance (MANCOVA) and Univariate Analysis of Covariance (ANCOVA) tests were used to examine the research hypothesis. The analysis of the data from the pre-tests and post-tests obtained from the participants at a significant level (P<0.01) revealed that metacognitive therapy significantly reduced attentional cognitive syndrome (effect size of 0.85), pain catastrophizing (effect size of 0.89), and pain intensity (effect size of 0.86, 0.83, 0.69) in fibromyalgia patients. The findings indicate that metacognitive therapy alleviates cognitive-attentional symptoms, catastrophizing, and pain intensity in fibromyalgia patients.

Keywords

حاجی محمدکاظمی، ش.، منشئی، غ. و قمرانی، ا. (1398). اثربخشی درمان مبتنی برمدل ارتقاء کیفیت زندگی بر فاجعه‌انگاری درد زنان مبتلا به بیماری فیبرومیالژیا. نشریۀ بیهوشی و درد، 10(۲)، 54-42. http://jap.iums.ac.ir/article-1-5428-fa.html
درگاهیان، ر.، محمّدخانی، ش.، حسنی، ج. و شمس، ج. (1390). اثربخشی درمان فراشناختی بر بهبود باورهای فراشناختی، نشخوار فکری و علایم افسردگی: مطالعۀ تک آزمودنی. فصلنامه مطالعات روان‌شناسی بالینی، 2(3)، 103-82. https://jcps.atu.ac.ir/article_2102.html
رحیمیان بوگر، ا. و بشارت، م. ع. (1391). تأثیر برنامۀ کاهش استرس بهشیاری محور گروهی بر شدت فیبرومیالژی. مجلۀ روانشناسی معاصر، 7(2)، 28-15. https://bjcp.ir/article-1-63-fa.html
سلمانی، ب.، حسنی، ج.، کرمی، غ. و محمدخانی، ش. (1392). اثربخشی درمان فراشناختی در سندرم شناختی/ توجهی (CAS) و راهبردهای نظم‌جویی شناختی هیجان (CER) بیماران مبتلا به اختلال اضطراب فراگیر (GAD). مجله علوم رفتاری، 7(2)، 254-245. https://www.behavsci.ir/article_67836.html
محمدی، س.، دهقانی، م.، حیدری، م.، صداقت، م. و خطیبی، ع. (1392). بررسی شباهت‌های روان‌شناختی مرتبط با درد در بیماران مبتلا به دردهای مزمن عضلانی-اسکلتی و همسران آنها. مجلۀ علوم رفتاری، 7(1)، 66-57. https://www.behavsci.ir/article_67812.html
مرادی کلارده، پ.، صادقی فیروزآبادی، و.، دهقانی، م. و حیدری، م. (1399). مقایسۀ مهارت‌های فرزندپروری در مادران مبتلا به درد مزمن و فاقد درد مزمن. مجله دانش و پژوهش در روان شناسی کاربردی، 21(2)، 123-115. https://doi.org/10.30486/jsrp.2019.1863437.1726
مصطفائی، ع.، زارع، ح.، علی پور، ا. و فرزاد، و. (1396). مقایسۀ اثربخشی درمان شناختی مبتنی بر مدل فرانظری و فراشناخت درمانی بر کنترل فکر و کاهش درد در بیماران مبتلا به درد مزمن. مجلۀ روان‌شناسی بالینی، 9(2)، 96-83. https://doi.org/10.22075/jcp.2017.10308.
مصطفائی، ع.، زارع، ح.، علی پور، ا. و فرزاد، و. (1397). مقایسۀ اثربخشی مداخلۀ شناختی مبتنی بر مدل فرانظری و فراشناخت درمانی بر میزان درد و درآمیختگی افکار در بیماران مبتلا به درد مزمن. فصلنامۀ علمی پژوهشی روان‌شناسی سلامت. 7(1)، 55-35. https://dor.isc.ac/dor/20.1001.1.23221283.1397.7.25.3.0
مؤمنی، خ.، و رادمهر، ف. (1399). اثربخشی درمان فراشناختی بر سندرم شناختی-توجهی در دانشجویان دختر مبتلا به اختلال اضطراب اجتماعی. فصلنامۀ دانش و پژوهش در روان‌شناسی کاربردی، 21(2)، 42-32.  https://doi.org/10.30486/jsrp.2019.572759.1420
یادآوری، م.، نادری، ف.، مکوندی، ب. و حافظی، ف. (1399). اثربخشی فراشناخت درمانی بر فاجعه‌سازی درد و کیفیت زندگی بیماران مبتلا به درد مزمن. مجلۀ مطالعات ناتوانی. 10(1)، 134. http://jdisabilstud.org/article-1-1991-fa.html
References
Ablin, J. N., Sarzi-Puttini, P., & 12-13 March 2020, Berlin, Germany (2020). The Second International Congress on Controversies in Fibromyalgia. Clinical and Experimental Rheumatology, 38 Suppl 123(1), 105–130. https://pubmed.ncbi.nlm.nih.gov/32116217/
Branco, J. C., Bannwarth, B., Failde, I., Abello Carbonell, J., … & Matucci-Cerinic, M. (2010). Prevalence of fibromyalgia: a survey in five European countries. Seminars in Arthritis and Rheumatism, 39(6), 448-453. https://doi.org/10.1016/j.semarthrit.2008.12.003
Carta, M. G., Moro, M. F., Pinna, F. L., Testa, G., Cacace, E., … & Sancassiani, F. (2018). The impact of fibromyalgia syndrome and the role of comorbidity with mood and post-traumatic stress disorder in worsening the quality of life. The International Journal of Social Psychiatry, 64(7), 647–655. https://doi.org/10.1177/0020764018795211
Conversano, C., Laura, M., Rebecca, C., Mirabelli, V., & Angelo, G. (2018). Catastrophizing and fibromyalgia: A mini-review. Journal of Translational Neurosciences, 3, 7. https://doi.org/10.21767/2573-5349.100020
Craner, J. R., Sperry, J. A., Koball, A. M., Morrison, E. J., & Gilliam, W. P. (2017). Unique contributions of acceptance and catastrophizing on chronic pain adaptation. International Journal of Behavioral Medicine, 24(4), 542–551. https://doi.org/10.1007/s12529-017-9646-3
Dahlhamer, J., Lucas, J., Zelaya, C., Nahin, R., Mackey, S., DeBar, L., Kerns, R., Von Korff, M., Porter, L., & Helmick, C. (2018). Prevalence of chronic pain and high-impact chronic pain among adults- United States, 2016. Morbidity and Mortality Weekly Report, 67(36), 1001–1006. http://dx.doi.org/10.15585/mmwr.mm6736a2
Dargahian, R., Mohammadkhani, Sh., Hasani, J. & Shams, J. (2011). The effectiveness of metacognitive therapy on improving metacognitive beliefs, rumination and depressive symptoms: a single case study. Clinical Psychology Study, 2(3), 81-104. https://jcps.atu.ac.ir/article_2102.html?lang=en (In Persian)
Dong, H. J., Gerdle, B., Bernfort, L., Levin, L. Å., & Dragioti, E. (2020). Pain catastrophizing in older adults with chronic pain: The mediator effect of mood using a path analysis approach. Journal of Clinical Medicine, 9(7), 2073. https://doi.org/10.3390/jcm9072073
Dunn, L. K., Durieux, M. E., Fernández, L. G., Tsang, S., Smith-Straesser, E. E., … & Naik, B. I. (2018). Influence of catastrophizing, anxiety, and depression on in-hospital opioid consumption, pain, and quality of recovery after adult spine surgery. Journal of Neurosurgery: Spine SPI, 28(1), 119–126. https://doi.org/10.3171/2017.5.SPINE1734
Fergus, T. A., Bardeen, J. R., & Orcutt, H. K. (2012). Attentional control moderates the relationship between activation of the cognitive attentional syndrome and symptoms of psychopathology. Personality and Individual Differences. 53(3), 213–217. https://doi.org/10.1016/j.paid.2012.03.017
Flaskerud, J. H. (2015). Pain and culture: The catastrophizing construct and measurement. Issues in Mental Health Nursing, 36(2), 152–155. https://doi.org/10.3109/01612840.2014.941078
Fong, A., & Schug, S. A. (2014). Pathophysiology of pain: a practical primer. Plastic and Reconstructive Surgery, 134(2), 8S–14S. https://doi.org/10.1097/PRS.0000000000000682
Gómez-de-Regil, L., & Estrella-Castillo, D. (2020). Psychotherapy for physical pain in patients with fibromyalgia: A systematic review. Pain Research and Management, 2020, 3408052. https://doi.org/10.1155/2020/3408052
Haji Mohammad Kazemi, S., a Manshaee, G. R., & Ghamarani, A. (2019). The effectiveness of therapy based on quality of life promotion model on pain catastrophizing in female patients with fibromyalgia. Journal of Anesthesiology & Pain, 10(2), 42-54. http://jap.iums.ac.ir/article-1-5428-en.html (In Persian)
Hoffart, A., Johnson, S., Nordahl, H., & Wells, A. (2018). Mechanisms of change in metacognitive and cognitive behavioral therapy for treatment-resistant anxiety: The role of metacognitive beliefs and coping strategies. Journal of Experimental Psychopathology. 9(3). https://doi.org/10.1177/2043808718787414
Khera, T., & Rangasamy, V. (2021). Cognition and pain: A review. Frontiers in Psychology, 12, 673962. https://doi.org/10.3389/fpsyg.2021.673962
Klasen, B. W., Hallner, D., Schaub, C., Willburger, R., & Hasenbring, M. (2004). Validation and reliability of the German version of the Chronic Pain Grade questionnaire in primary care back pain patients. Psycho-Social Medicine. 1, Doc07. https://pubmed.ncbi.nlm.nih.gov/19742049/
Kollmann, J., Gollwitzer, M., Spada, M. M., & Fernie, B. A. (2016). The association between metacognitions and the impact of fibromyalgia in a German sample. Journal of Psychosomatic Research, 83, 1–9. https://doi.org/10.1016/j.jpsychores.2016.02.002
Kowalski, J., & Dragan, M. (2019). Cognitive-attentional syndrome - The psychometric properties of the CAS-1 and multi-measure CAS-based clinical diagnosis. Comprehensive Psychiatry, 91, 13–21. https://doi.org/10.1016/j.comppsych.2019.02.007
Marques, A. P., Santo, A., Berssaneti, A. A., Matsutani, L. A., & Yuan, S. (2017). Prevalence of fibromyalgia: Literature review update. Revista Brasileira de Reumatologia, 57(4), 356–363. https://doi.org/10.1016/j.rbre.2017.01.005
Mascarenhas, R. O., Souza, M. B., Oliveira, M. X., Lacerda, A. C., Mendonça, V. A., Henschke, N., & Oliveira, V. C. (2021). Association of therapies with reduced pain and improved quality of life in patients with fibromyalgia: A systematic review and meta-analysis. JAMA Internal Medicine, 181(1), 104–112. https://doi.org/10.1001/jamainternmed.2020.5651
Mohamadi, M., Dehghani M., Heidari, M., Sedaghat, M., & Khatibi, A., (2013). The evaluation of pain-related psychological similarities among patients with musculoskeletal chronic pain and their spouses. International Journal of Behavioral Sciences. 7(1), 57-66. https://www.behavsci.ir/article_67812.html (In Persian)
Momeni, Kh. & Radmehr, F. (2020). The effectiveness of meta-cognitive therapy on cognitive attention syndrome in female students with social anxiety disorder. Knowledge & Research in Applied Psychology. 21(2), 32-42. https://doi.org/10.30486/jsrp.2019.572759.1420 (In Persian)
Moradi Kelardeh, P., Sadeghi Firoozabadi, V., Heidari, M., & Dehghani, M. (2020). Comparison of parenting skills in mothers with and without chronic pain. Knowledge & Research in Applied Psychology, 21(2), 115-123. https://doi.org/10.30486/jsrp.2019.1863437.1726 (In Persian).
Mostafaie, A., Zare, H., Alipour, A., & Farzad, V. (2017a). Appraisal of effectiveness and comparison of cognitive therapy based on meta-theoretical models and meta-cognitive therapy on thought control and reducing the pain in patients suffering from chronic pain. Journal of Clinical Psychology, 9(2), 83-96. https://doi.org/10.22075/jcp.2017.10308 (In Persian)
Mostafaie, A., Zare, H., Alipour, A., & Farzad, V. (2017b) compare the effectiveness of cognitive therapy based on meta-theoretical models and meta-cognitive therapy on amount pain and thoughts fusion in patients suffering from chronic pain. Health Psychology, 7(1), 35-55. https://hpj.journals.pnu.ac.ir/article_4758.html?lang=en (In Persian)
Normann, N., & Morina, N. (2018). The efficacy of metacognitive therapy: A Systematic review and meta-analysis. Frontiers in Psychology, 9, 2211. https://doi.org/10.3389/fpsyg.2018.02211.
Petrini, L., & Arendt-Nielsen, L. (2020). Understanding pain catastrophizing: Putting pieces together. Frontiers in Psychology, 11, 603420. https://doi.org/10.3389/fpsyg.2020.603420
Quartana, P. J., Campbell, C. M., & Edwards, R. R. (2009). Pain catastrophizing: A critical review. Expert Review of Neurotherapeutics, 9(5), 745–758. https://doi.org/10.1586/ern.09.34
Rachor, G. S., & Penney, A. M. (2020). Exploring metacognitions in health anxiety and chronic pain: A cross-sectional survey. BMC Psychology, 8, 81. https://doi.org/10.1186/s40359-020-00455-9
Rahimian Boogar, I. & Besharat, M. A. (2012). The effect of group mindfulness-based stress reduction program on the severity of fibromyalgia. Contemporary Psychology, 7(2), 15-28. https://bjcp.ir/article-1-63-en.html (In Persian)
Reiter, S., Eli, I., Mahameed, M., Emodi-Perlman, A., Friedman-Rubin, P., Reiter, M. A., & Winocur, E. (2018). Pain catastrophizing and pain persistence in temporomandibular disorder patients. Journal of Oral & Facial Pain and Headache, 32(3), 309–320. https://doi.org/10.11607/ofph.1968
Salmani, B., Hasani, J., Karami, G. R., & Mohammad Khani, Sh. (2013). Effectiveness of meta-cognitive therapy on cognitive attention syndrome and cognitive emotion regulation strategies of patients suffering from generalized anxiety disorder (GAD). Journal of Behavioral Sciences, 7(3), 245-254. https://www.behavsci.ir/article_67836.html (In Persian)
Schütze, R., Rees, C., Smith, A., Slater, H., & O'Sullivan, P. (2020). Metacognition, perseverative thinking, and pain catastrophizing: A moderated-mediation analysis. European Journal of Pain, 24(1), 223-233. https://doi.org/10.1002/ejp.1479
Schweiger, J. I., Kahl, K. G., Klein, J. P., Sipos, V., & Schweiger, U. (2019). Innovation in psychotherapy, challenges, and opportunities: An opinion paper. Frontiers in Psychology, 10, 495. https://doi.org/10.3389/fpsyg.2019.00495
Siracusa, R., Paola, R. D., Cuzzocrea, S., & Impellizzeri, D. (2021). Fibromyalgia: Pathogenesis, mechanisms, diagnosis and treatment options update. International Journal of Molecular Sciences, 22(8), 3891. https://doi.org/10.3390/ijms22083891
Smith, B. H., Penny, K. I., Purves, A. M., Munro, C., Wilson, B., Grimshaw, J., Chambers, W. A., & Smith, W. C. (1997). The chronic pain grade questionnaire: validation and reliability in postal research. Pain, 71(2), 141–147. https://doi.org/10.1016/s0304-3959(97)03347-2
Spada, M. M., Nikcevic, A. V., Fernie, B. A., & Caselli, G. (2016). Meta-cognitive beliefs about worry and pain catastrophizing as mediators between neuroticism and pain behavior. Clinical Psychologist, 20(3), 138-146. https://doi.org/10.1111/cp.12081
Steingrímsdóttir, Ó. A., Landmark, T., Macfarlane, G. J., & Nielsen, C. S. (2017). Defining chronic pain in epidemiological studies: A systematic review and meta-analysis. Pain, 158(11), 2092–2107. https://doi.org/10.1097/j.pain.0000000000001009
Sullivan, M. J. L., Bishop, S. R., & Pivik, J. (1995). The pain catastrophizing scale: Development and validation. Psychological Assessment, 7(4), 524–532. https://doi.org/10.1037/1040-3590.7.4.524
Suso-Ribera, C., García-Palacios, A., Botella, C., & Ribera-Canudas, M. V. (2017). Pain catastrophizing and its relationship with health outcomes: Does pain intensity matter?. Pain Research & Management, 2017, 9762864. https://doi.org/10.1155/2017/9762864
Theadom, A., Cropley, M., Smith, H. E., Feigin, V. L., & McPherson, K. (2015). Mind and body therapy for fibromyalgia. Cochrane Database of Systematic Reviews, 2015(4), CD001980. https://doi.org/10.1002/14651858.CD001980.pub3
Varallo, G., Scarpina, F., Giusti, E. M., Suso-Ribera, C., Cattivelli, R., Guerrini Usubini, A., Capodaglio, P., & Castelnuovo, G. (2021). The role of pain catastrophizing and pain acceptance in performance-based and self-reported physical functioning in individuals with fibromyalgia and obesity. Journal of Personalized Medicine, 11(8), 810. https://doi.org/10.3390/jpm11080810
Von Korff, M., Ormel, J., Keefe, F. J., & Dworkin, S. F. (1992). Grading the severity of chronic pain, Pain, 50(2), 133–149. https://doi.org/10.1016/0304-3959(92)90154-4
Weir, P. T., Harlan, G. A., Nkoy, F. L., Jones, S. S., Hegmann, K. T., Gren, L. H., & Lyon, J. L. (2006). The incidence of fibromyalgia and its associated comorbidities: A population-based retrospective cohort study based on international classification of diseases, 9th revision codes. Journal of Clinical Rheumatology, 12(3), 124–128. https://doi.org/10.1097/01.rhu.0000221817.46231.18
Wells A. (1997). Cognitive therapy of anxiety disorders: A practice manual and conceptual guide (1st ed). Chichester: Wiley.
Wells, A. (2009). Metacognitive Therapy for Anxiety and Depression (Reprint ed). The New York: Guilford Publications. Google Scholar
Wells A. (2019). Breaking the cybernetic code: understanding and treating the human metacognitive control system to enhance mental health. Frontiers in Psychology, 10, 2621. https://doi.org/10.3389/fpsyg.2019.02621
Yadavari, M., Naderi, F., Makbvandi, B. & Hafezi, F. (2020). The effects of metacognitive therapy on pain catastrophizing and quality of life in patients with chronic pain. Journal of Disability Studies, 10(1), 134. http://jdisabilstud.org/article-1-1991-en.html (In Persian)
Yoshida, T., Molton, I. R., Jensen, M. P., Nakamura, T., Arimura, T., Kubo, C., & Hosoi, M. (2012). Cognitions, metacognitions, and chronic pain. Rehabilitation Psychology, 57(3), 207–213. https://doi.org/10.1037/a0028903
Ziadni, M. S., Sturgeon, J. A., & Darnall, B. D. (2018). The relationship between negative metacognitive thoughts, pain catastrophizing and adjustment to chronic pain. European Journal of Pain, 22(4), 756–762. https://doi.org/10.1002/ejp.1160
Volume 16, Issue 3
October 2025
Pages 197-212
  • Receive Date: 01 February 2023
  • Revise Date: 12 June 2023
  • Accept Date: 02 July 2023
  • First Publish Date: 03 June 2025
  • Publish Date: 23 September 2025