Metacognitive evaluation in patients with fibromyalgia syndrome

Objective: Metacognition is defined as the way of controlling our knowledge and thoughts on “thinking about thinking” and “whether we know something or not”. In this study, we tested the assumption that patients with Fibromyalgia Syndrome (FMS) experience more metacognitive thoughts compared to healthy individuals.

Methods: In this study, 202 patients diagnosed as primary FMS and 143 healthy volunteers (all females between 18 and 64 years old) were included. All participants completed the Metacognition-30, Cope, Fibromyalgia Impact Questionnaire (FIQ), Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI).

Results: The mean age of the patient and the control group were 43.28±11.29 and 41.13±11.97 years, respectively. The FIQ, BDI, BAI, the Metacognition-30 total, and Cope total scores were significantly higher in the patient group. The Metacognition-30 sub-scales including positive beliefs, negative beliefs, cognitive insecurity, need to control thoughts and cognitive awareness scores were also higher in the patient group.

Conclusion: It has been reported that etiological explanations of FMS include psychological variables such as depression, anxiety, despair, wrong coping strategies, and certain personal features. In the present study, both BDS and BAS scores were significantly higher in the patient group. Recent studies have identified depression, somatoform, obsessive compulsive disorder, and panic disorders as the most common psychiatric disorders in FMS. FMS could cause lifelong depression, reaching up to 71% occurrence. On the other hand, some studies have reported that FMS is accompanied by anxiety disorders more frequently than by depression. In addition, contrary to the view that there is an association of tender points with incidence and severity of depression in FMS patients, there are studies pointing out that pain severity and number of tender points are positively associated with anxiety level in FMS. In the present study, coping behaviors of the patient and healthy control groups were studied. Denial, behavioral avoidance, substance abuse, need for emotional support, suppression of other activities and total scores were significantly higher in FMS patient group compared to healthy controls. According to the correlation analyses, FIQ had positive correlations with denial, behavioral avoidance and substance abuse, and negative correlation with need for emotional support. The higher use of non-functional coping strategies by patients with FMS could be explained by the assumption that women have more difficulties with physical and psychogenic stresses and tend to deny them. It could hypothesized that the disease may become chronic by frequent use of denial as a coping strategy by FMS patients. Within this context, considering the positive correlation between disease symptoms and cognitive awareness, an increase in awareness of patients could aggravate the focusing on the disease symptoms. FMS patients’ dominant usage of suppressing other activities could also lead them to focus on disease symptoms. The results of our study showed that FMS patients use metacognitive thoughts more frequently. Our findings suggest possible contributions of evaluating metacognitive functioning in patients with FMS, by forging a common language among clinicians.