Positive and negative metacognitions about illness worries

Metacognitions have been shown to be relevant in the emergence and maintenance of worry processes, particularly for generalized anxiety disorder (GAD). In contrast, metacognitions have been neglected in hypochondriasis and health anxiety, perhaps due to the traditional assignment of hypochondriasis to the somatoform disorders. Is worrying about illness associated with metacognitions and are these associated with other features of health anxiety? In this study 1,246 people took part in an online survey. Items capturing positive (PM) and negative metacognitions (NM) were presented together with instruments for the assessment of health anxiety and depressive symptoms. The dimensional structure of PM and NM over illness worries was examined with nonlinear confirmatory factor analyses. Associations with depressivity and the number of consultations by different physicians were examined in structural equation models (SEM), separately for subgroups with and without a diagnosed somatic disease. The PMs and NMs about illness worries varied relatively independently from one another along two dimensions. The PMs were specifically associated with health anxiety and the number of different physician consultations and NMs were related to all dimensions of the Whiteley index and particularly strongly to depressivity. Illness-related anxiety provokes metacognitions, similar to other worries as known from GAD. Considering the strong associations of PMs and NMs with several facets of health anxiety found, it appears promising to take them into account for the formulation of cognitive-behavioral models of health anxiety and its treatment.