Metacognitive beliefs about worry and rumination can lead to perseverance behaviors, which may be predictive of anxiety and depression, according to study results published in Behavioural and Cognitive Psychotherapy. Perseverance of worry and rumination have been linked to both anxiety and depression.

Lee Kannis-Dymand, PhD, of the University of the Sunshine Coast, Queensland, Australia, and colleagues recruited participants (N=1033; aged 18 to 31 years) via email and social media pages. The researchers used self-report questionnaires to assess anxiety, depression, and perfectionism. Several questionnaires were used to assess the different metacognitive beliefs: the Metacognitive Questionnaire-30, the Positive Metacognitive Beliefs about Rumination Scale-Adapted version, and the Negative Beliefs about Rumination Scale.

Positive metacognitions about worry positively influenced negative metacognitions (F, 0.21; P <.001) and perseverance (F, 0.15; P <.001). Negative metacognitions positively influenced perseverance (F, 0.32; P <.001) and anxiety (F, 0.65; P <.001). Finally, perseverance had a positive effect on anxiety (F, 0.16; P <.001).

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The data focused on rumination showed that positive metacognitions positively affected negative metacognitive beliefs (F, 0.26; P <.001) and perseverance (F, 0.18; P <.001). Furthermore, negative metacognitive beliefs directly influenced perseverance (F, 0.38; P <.001), and depression (F, 0.54; P <.001). Beliefs about worry demonstrated stronger associations with anxiety (r, 0.23-0.59) over beliefs about rumination (r, 0.21-0.28). However, negative beliefs about rumination showed stronger associations with depression (r, 0.31) over beliefs about worry (r, 0.12).

Study limitations included reliance on self-report questionnaires, resulting in patients possibly overestimating symptoms compared with observational assessments. Furthermore, because the study participants were recruited from the general population, few participants had notable anxiety or depression. The applicability of this data to a clinical population is therefore limited.

The findings could imply that positive metacognitions lead to negative metacognitions, which then cause perseveration. When perseveration is caused by metacognitions about worry, anxiety is more likely compared with metacognitions about rumination, where depression is more likely.

“Future research could evaluate if metacognitive therapy effectively reduces perseverance behaviours through targeting metacognitive beliefs concerning the function of repetitive negative thinking and their associated behavior,” the researchers concluded.


Kannis-Dymand L, Hughes E, Mulgrew K, Carter JD, Love S. Examining the roles of metacognitive beliefs and maladaptive aspects of perfectionism in depression and anxiety [published online March 16, 2020]. Behav Cogn Psychother.  doi:10.1017/S1352465820000144