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Br J Clin Psychol. 2013 Sep;52(3):235-48. doi: 10.1111/bjc.12011. Epub 2012 Dec 14.

Metacognitive beliefs, beliefs about voices and affective symptoms in patients with severe auditory verbal hallucinations.

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  • 1Reinier van Arkel Psychiatric Institute, 's-Hertogenbosch, The Netherlands.



This study explores associations between metacognitive beliefs and beliefs about voices in patients with severe auditory verbal hallucinations, and their hypothesized relationship with levels of depression and anxiety. Furthermore, it was hypothesized that metacognitive beliefs are better able to explain differences in levels of depression and anxiety, than beliefs about voices.


Cross-sectional data were obtained from baseline measurements of a randomized controlled trial. All patients (N = 77) met the criteria for a DSM-IV diagnosis within the schizophrenia spectrum. A correlation analysis was conducted to explore the associations between metacognitive beliefs and beliefs about voices. Regression analysis was performed to test the second hypothesis.


Metacognitive beliefs were measured using the MCQ-30. Beliefs about voices were measured using the BAVQ-R. Furthermore, the Beck Depression Inventory-II and the Beck Anxiety Inventory were applied to measure depression and anxiety. All analyses were a priori controlled for gender and level of education.


Significant associations were found between negative beliefs about voices and negative metacognitive beliefs. One of the metacognitive beliefs, that is, perceived uncontrollability and danger of thinking, proved to be a key variable in explaining differences in levels of depression and anxiety and seemed to have greater explanatory value than all of the beliefs about voices when analysed simultaneously.


The results offer modest support to models emphasizing the fact that metacognitive beliefs are a core feature in the development and maintenance of depression and anxiety in patients with severe auditory verbal hallucinations.


POSITIVE CLINICAL IMPLICATIONS: Further evidence for the importance of metacognitive beliefs. Specific emphasis on anxiety and depression in patients with severe hallucinations.


Small sample size. Cross-sectional data only.

© 2012 The British Psychological Society.

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