Psychiatry Research ∎ (∎∎∎∎) ∎∎∎–∎∎∎

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Psychiatry Research
journal homepage: www.elsevier.com/locate/psychres

Metacognitive capacity predicts severity of trauma-related

dysfunctional cognitions in adults with posttraumatic stress disorder
Louanne W. Davis a,b,n, Bethany L. Leonhardt b, Alysia Siegel c, Beth Brustuen c,
Brandi Luedtke d, Jennifer L. Vohs b, Alison V. James e, Paul H. Lysaker a,b
a
Psychiatry Department, Roudebush VA Medical Center, 1481 West 10th Street, Indianapolis, IN 46202, USA
b
Department of Psychiatry, Indiana University School of Medicine, Goodman Hall, 355 W. 16th St, Suite 4800, Indianapolis, IN 46202, USA
c
School of Psychological Sciences, University of Indianapolis, 1400 East Hanna Ave GH109, Indianapolis, IN 46227, USA
d
Department of Psychology, Carl T. Hayden VA Medical Center, 650 E Indian School Rd, Phoenix, AZ 85012, USA
e
Department of Psychology, Indiana State University, Root Hall B-202,Terre Haute, IN 47809, USA

art ic l e i nf o a b s t r a c t

Article history: Deficits in metacognition have been proposed as a barrier to adaptive responding to trauma. However,
Received 12 June 2015 little is known about how different aspects of metacognitive capacity relate to responses to trauma and
Received in revised form whether their potential link to such responses is independent of the overall level of psychopathology. To
17 October 2015
explore both issues, negative trauma-related cognitions about the self, the world, and self-blame, as
Accepted 21 January 2016
measured by the Posttraumatic Cognitions Inventory (PTCI), were correlated with concurrent measures
of depression, posttraumatic stress disorder symptoms, and two forms of metacognition; the Metacog-
Keywords: nitions questionnaire (MCQ-30), which focuses on specific thoughts, and the Metacognition Assessment
PTSD Scale Abbreviated (MAS-A) which focuses on the degree to which persons can form complex re-
Metacognition
presentations of self and other. Participants were 51 veterans of the wars in Iraq and Afghanistan who
Depression
had a PTSD diagnosis primarily involving a combat-related index trauma. Correlations revealed that
Cognition
Self-blame being younger and more depressed were linked with greater levels of negative cognitions about self and
the world. Lower levels of self-reflectivity on the MAS-A and higher levels of cognitive self-consciousness
on the MCQ-30 were uniquely related to greater levels of self-blame even after controlling for age, level
of depression, and PTSD. Implications for research and treatment are discussed.
Published by Elsevier Ireland Ltd.

1. Introduction as “the trauma ruined my life” or “I am to blame for what hap-

pened (the trauma),” may be linked to higher levels of depression
Given that the severity of posttraumatic stress disorder (PTSD) (Beevers et al., 2007; McEvoy et al., 2013) and overall severity of
symptoms are not fully explained by trauma severity (Brewin PTSD symptoms (Moser et al., 2007; Blain et al., 2012).
et al., 2000), interest has grown in identifying the factors that Evidence suggests that addressing dysfunctional posttraumatic
influence how persons respond to trauma. One element of parti- cognitions with treatment, such as Cognitive Processing Therapy,
cular relevance for understanding response to trauma, based on may lead to reductions in PTSD symptoms (Holliday et al., 2014).
the information processing theory of PTSD development (Hor- However, it is less clear what kinds of deeper cognitive processes
owitz, 1986; Foa et al., 1992), is how people make sense of trau- may affect the extent to which cognitions about the self, others,
matic experiences, which is reflected by their cognitions about and the world are adaptive following trauma. Understanding the
themselves, others, and the world in general. For example, trauma processes that lead to more severely maladaptive posttraumatic
can shatter beliefs that are at the core of one's conceptual system, cognitions seems essential. This understanding could point to
such as “I am a good person who lives in a benevolent, just, and meaningful targets for prevention and treatment, which if ad-
meaningful world” (Janoff-Bulman, 1992; Beck et al., 2014). Re- dressed, could potentially reduce the risk for developing PTSD or
search suggests that dysfunctional posttraumatic cognitions, such assist persons who have PTSD to recover more fully and perhaps
more quickly.
n The current study seeks to extend previous research by ex-
Corresponding author at: Psychiatry Department, Roudebush VA Medical
Center, 1481 West 10th Street, Indianapolis, IN 46202, USA. amining a related set of psychological processes that might influ-
E-mail address: lwdavis@iupui.edu (L.W. Davis). ence posttraumatic cognitions, namely metacognition. In this

http://dx.doi.org/10.1016/j.psychres.2016.01.045
0165-1781/Published by Elsevier Ireland Ltd.

Please cite this article as: Davis, L.W., et al., Metacognitive capacity predicts severity of trauma-related dysfunctional cognitions in
adults with posttraumatic stress disorder. Psychiatry Research (2016), http://dx.doi.org/10.1016/j.psychres.2016.01.045i
2 L.W. Davis et al. / Psychiatry Research ∎ (∎∎∎∎) ∎∎∎–∎∎∎

paper, we use a definition of metacognition that stresses a spec- psychotherapy session content; uncontrolled psychotic or bipolar
trum of abilities which range from the consideration of discrete disorder; active substance dependence; self-mutilation or self-in-
thoughts and feelings to the synthesis of discrete perceptions into jury in the previous 6 months; current suicidal/homicidal intent;
an integrated representation of the self and others (Semerari et al., and severe physical or sexual relationship aggression in the past
2003; Lysaker et al., 2013). Metacognition has been suggested as a year. The mean age was 39.33 (sd¼10.81) and the mean education
foundation for resiliency as it provides the means to: (1) under- was 14.81 (sd¼ 1.74). Forty-six of the participants were male and
stand the unique meaning of adversity; (2) make sense of one's five were female (N ¼ 51). Forty-four of the participants were
own psychological responses to adversity; and (3) find adaptive Caucasian, three were African American, one was Latino, and three
ways to respond to adversity (Lysaker et al., 2013). Similar to social were identified as “Other” (Native American, Asian N ¼51).
cognition, metacognition is concerned with how persons form
ideas about social exchanges (Pinkham et al., 2014). However, 2.2. Instruments
metacognition focuses more on variations in the complexity,
adaptiveness and flexibility of mental representations, not merely 2.2.1. Metacognitions Questionnaire-30 (MCQ-30; Wells and Cart-
on their accuracy. Metacognition is related to the construct of wright-Hatton, 2004)
mentalizing (Fonagy et al., 2002), although the latter con- The MCQ-30 is a shortened version of the original Metacogni-
ceptualizes disruptions of these processes as occurring within the tions Questionnaire (Cartwright-Hatton and Wells, 1997) designed
context of a disturbed attachment, an assumption that metacog- to assess multiple dimensions of metacognition considered im-
nitive research does not share. portant in conceptualizing psychopathological processes for a
Support for the potential relationship of metacognition with range of psychological disorders. This 30-item self-report measure
posttraumatic cognitions can be found in work that suggests yields a total scale score as well as scores for five subscales: po-
adults with PTSD experience a range of metacognitive deficits sitive beliefs about worry (POS), negative beliefs about thoughts
(Mazza et al., 2012; Farina and Liotti, 2013; Nazarov et al., 2014; related to uncontrollability and danger of worry (NEG), cognitive
Lysaker, et al., 2015). Others propose that trauma may disrupt at- confidence (CC), need for control (NC), and cognitive self-con-
tachment patterns causing deficits in source monitoring, emo- sciousness (CSC). The POS subscale assesses the belief that wor-
tional recognition, and ultimately the ability to form coherent rying is useful for avoiding problems in the future. In contrast,
representations of oneself and others (Fonagy et al., 2002; Siegel, negative beliefs about worry (i.e., worrying is uncontrollable or
2003; Verhaeghe and Vanheule, 2005; Liotti and Prunetti, 2010). dangerous) are evaluated by the NEG subscale. The CC subscale
More direct evidence can be found in the work of Wells and Col- measures thoughts and beliefs about the quality of one's attention
bear (2012), who propose that PTSD symptoms are sustained by and memory. The NC subscale evaluates beliefs regarding the ne-
metacognitive beliefs and have presented preliminary evidence cessity of thought control and consequences of lacking thought
that metacognitive therapy, which focuses on modifying meta- control. Finally, the tendency to focus attention on thought pro-
cognitive beliefs about rumination, worry, attention and symp- cesses or metacognitive monitoring is measured by the cognitive
toms, may reduce PTSD symptoms. self-consciousness (CSC) subscale. Scores for each subscale are
Accordingly, this study sought to test whether two different calculated by summing the value of the response indicated on a
forms of metacognitive capacities were linked with three different 4-point Likert scale ranging from 1 (“do not agree”) to 4 (“agree
kinds of posttraumatic beliefs: maladaptive beliefs about the self, very much”). A total score is calculated by summing scores for
the world, and self-blame. The two types of metacognition include each subscale.
one that is more synthetic and involves forming complex and in-
tegrated representations of the self and others (as measured by the 2.2.2. Posttraumatic Cognitions Inventory (PTCI; Foa et al., 1999)
MAS-A; Lysaker et al., 2005) and the other a more discrete form The PTCI is a 36-item self-report measure of thoughts and be-
which assesses metacognitive beliefs related to the types of things liefs typically associated with trauma. The three subscales of the
people tend to focus their thinking upon (as measured by the PTCI include: Negative Cognitions about the Self (negative beliefs
MCQ, Wells and Cartwright-Hatton, 2004). We predicted that regarding him/herself), Negative Cognitions about the World (ne-
deficits in both forms of metacognition would be associated with gative beliefs about others and the safety of the world), and self-
more maladaptive posttraumatic cognitions. Given that severity of blame (blame attributed to the self regarding the traumatic event).
PTSD symptoms and depression might be expected to be linked Each item is rated on a 7-point Likert scale with 1 representing
with more maladaptive posttraumatic cognitions, we also included “totally disagree” and 7 representing “totally agree”. A total score
measures of these for use as covariates. is obtained by summing the scores for each of the 36 items. Scores
for each of the subscales are obtained by dividing the sum for each
subscale by the number of items that comprise the subscale.
2. Methods
2.2.3. Indiana Psychiatric Illness Interview (IPII; Lysaker et al., 2002)
2.1. Participants The IPII is a semi-structured interview that assesses how in-
dividuals understand their experience of mental illness. Trained
Fifty-one veterans of the Iraq and Afghanistan wars with a di- research assistants conducted the interviews that typically lasted
agnosis of posttraumatic stress disorder (PTSD) were recruited between 30 and 60 minutes. Responses were audio taped and later
from outpatient psychiatry clinics at the Indianapolis Roudebush transcribed. The interview is divided into five sections. First, rap-
VA Medical Center for a study of a mindfulness-based adaptation port is established and participants are asked to tell the story of
of Cognitive-Behavioral Conjoint Therapy for PTSD. All participants their lives. Second, participants are asked if they think they have a
met diagnostic criteria as evaluated by an interview with trained/ mental illness, which is followed by questions about whether or
reliable assessors using the Clinician-Administered PTSD Scale for not this condition has affected different facets of their life. Third,
DSM-IV (CAPS; Blake et al., 1995). All participants reported ex- participants are asked if and how their condition controls their life
periencing a traumatic event while serving in the U.S. military. and how they control their condition. Fourth, they are asked how
Exclusion criteria were: not enrolled in outpatient treatment; their condition affects and is affected by others. Finally, partici-
major changes in psychiatric medication within the last month; pants are asked about what they expect to remain the same and
cognitive impairment precluding understanding and/or retaining what will be different for them in the future.

Please cite this article as: Davis, L.W., et al., Metacognitive capacity predicts severity of trauma-related dysfunctional cognitions in
adults with posttraumatic stress disorder. Psychiatry Research (2016), http://dx.doi.org/10.1016/j.psychres.2016.01.045i
 L.W. Davis et al. / Psychiatry Research ∎ (∎∎∎∎) ∎∎∎–∎∎∎ 3

2.2.4. The Metacognition Assessment Scale Abbreviated (MAS-A; assessments and prior to any form of intervention.
Lysaker et al., 2005)
The MAS-A is a rating scale that assesses metacognitive abilities 2.4. Data analysis
as they pertain to the formation of complex and integrated re-
presentations of the self and others. It is a modification of the All analyses were performed using SPSS 19 and were planned
Metacognition Assessment Scale (Semerari et al., 2003), which in four stages. In the first stage, we examined whether PTCI scores
was originally designed to detect growth within psychotherapy were linked to demographic variables to determine whether there
transcripts. The MAS-A was developed in consultation with the was a need to account for these as covariates in the third stage of
original authors of the Metacognition Assessment Scale and the analyses. In the second stage, we examined whether the PTCI
adapted for the study of IPII transcripts (Lysaker et al., 2005). The subscales (Negative Cognitions about the Self, Negative Cognitions
MAS-A contains four scores: Self-reflectivity, which refers to the about the World, and Self-Blame) were related to levels of psy-
ability to think about oneself with scores ranging from 0 to 9; chopathology and metacognitive capacity by calculating Pearson
Understanding of Others’ Minds (Awareness of Others), which correlations between the three PTCI sub-scales and the BDI-II and
refers to the ability to think about the thoughts and feelings of CAPS total scores as well as MAS-A and MCQ-30 scores. Of note,
others with scores ranging from 0 to 7; Decentration, which ran- we did not control for the number of comparisons but did use two
ges from 0 to 3 and refers to the ability to see the world from tailed tests in spite of having made unidirectional hypotheses. In
different perspectives; and Mastery, which refers to the ability to the third stage, we performed three stepwise multiple regressions
use knowledge of one's mental states in order to solve psycholo- predicting each of the PTCI subscales, entering any demographics
gical problems with scores ranging from 0 to 9. For all scales, and psychopathology measures (CAPS and BDI-II) as covariates in
higher scores indicate the capacity to engage in increasingly the first step and then metacognitive measures (MAS-A and MCQ-
complex acts of metacognition. Trained raters have produced ac- 30) in the second step. In these regressions we included only those
ceptable to excellent levels of inter-rater reliability, and evidence metacognitive and demographic variables found to be correlated
of validity includes findings linking MAS-A scores with in- with the cognition variables in the second step. In the fourth and
dependent assessments of awareness of illness, cognitive insight, final stage, we performed exploratory correlations, correlating the
complexity of social schema, self-reported coping, and memory MAS-A scores with MCQ-30 scores to examine whether a sig-
accuracy in schizophrenia patients (Lysaker and Dimaggio, 2014). nificant overlap existed between these two measures. These cor-
relations were considered exploratory, as we are unaware of any
2.2.5. Clinician-Administered PTSD Scale (CAPS; Blake et al., 1995) previous research examining how these measures are related to
The CAPS is a structured clinical interview that assesses Diag- one another.
nostic and Statistical Manual of Mental Disorders, 4th edition,
PTSD symptomatology and PTSD diagnostic status based on a total
CAPS severity score of 45 or higher. The CAPS assesses for the 3. Results
presence of the 17 core PTSD symptoms within the past month
(American Psychiatric Association, 1994). Items are scored on a Mean scores for all instruments are reported in Table 1. All core
0 to 4 frequency scale and a 0 to 4 intensity scale and are then measures were normally distributed. T-tests revealed that the PTCI
added together to provide a total symptom severity score ranging scores of males were not significantly different than those of fe-
from 0 to 136. CAPS assessors had the equivalent of a masters or males. PTCI scores were not significantly correlated with educa-
doctorate in psychology. For the purposes of this study, the con- tion. However, age was significantly correlated with the PTCI Ne-
cern was with the overall symptom severity, and therefore, the gative Cognitions about the Self scale (r¼ 0.32, p ¼0.01) and Ne-
total score was used. The CAPS has consistently demonstrated
gative Cognitions about the World (r ¼  0.38, p ¼0.01) scores,
excellent psychometric properties and is considered the gold
though not self-blame (r ¼  0.11, p¼ 0.46). The PTCI Negative
standard in PTSD assessment (Weathers et al., 2001).
Cognitions about the Self scale was significantly correlated with
Negative Cognitions about the World scale (r ¼ 0.47, p ¼0.001) and
2.2.6. Beck Depression Inventory, 2nd Edition (BDI-II; Beck et al.,
1996)
Table 1
The BDI-II is a 21-item self-report measure of depressive Mean Scores of posttraumatic cognitions, metacognition assessments, depression
symptoms experienced over the past two weeks. Each item is and severity of PTSD (N¼ 51).
rated on a 4-point scale ranging from 0 to 3, and the total score can
Mean Standard deviation
range from 0 to 63. The BDI-II possesses adequate reliability and
validity for clinical purposes with high test-retest reliability Posttraumatic Cognitions about Self 3.52 1.10
(r ¼ 0.93, po 0.00) reported by Beck and colleagues (1996). The Posttraumatic Cognitions about World 5.43 0.97
total BDI-II score was utilized for the purposes of this study. Posttraumatic Cognitions about Self-Blame 2.51 1.10
BDI Total 26.08 9.02
CAPS Total 71.84 12.17
2.3. Procedures

All procedures received appropriate institutional review board Metacognition Assessment Scale-A total 17.07 3.91
Self-reflectivity 6.40 1.66
approval. Following written informed consent, inclusion and ex-
Awareness of others 4.48 1.03
clusion criteria were evaluated and a PTSD diagnosis was con- Decentration 1.46 0.62
firmed with the CAPS. Next, participants completed the PTCI, Mastery 4.73 1.40
MCQ-30, BDI-II, and IPII. The IPII interviews were conducted by
research assistants with at least a Bachelor's degree in psychology. Metacognition Questionnaire Total 72.11 12.34
The IPIIs were transcribed and then evaluated with the MAS-A by Uncontrollability and danger 13.96 4.30
raters who were blind to all other test scores, did not transcribe Lack of cognitive confidence 17.41 4.80
the interview, were not present while the interview took place, Positive beliefs 11.27 4.45
Self-consciousness 15.29 3.59
nor were involved in conducting the study interventions. Proce- Need to Control 14.18 3.52
dures for all participants were completed as part of baseline

Please cite this article as: Davis, L.W., et al., Metacognitive capacity predicts severity of trauma-related dysfunctional cognitions in
adults with posttraumatic stress disorder. Psychiatry Research (2016), http://dx.doi.org/10.1016/j.psychres.2016.01.045i
4 L.W. Davis et al. / Psychiatry Research ∎ (∎∎∎∎) ∎∎∎–∎∎∎

Table 2 higher levels of Cognitive Self-Consciousness, which all together

Pearson correlations of posttraumatic cognitions with metacognition, PTSD severity accounted for 43% of the variance. Finally, we correlated the two
and depression (N ¼51).
measures of metacognition for exploratory purposes. This pro-
Correlate Posttraumatic cognitions duced only one significant correlation, with the MAS-A Decen-
tration scores being negatively associated with the MCQ-30 Un-
Self World Self blame controllability and Danger subscale (r ¼0.28, p ¼0.046).
** *
BDI total 0.52 0.33 0.30*
CAPS total 0.31* 0.28* 0.18
MAS-A total  0.29*  0.27  0.36* 4. Discussion
Self reflectivity  0.21  0.24  0.35*
Awareness of others  0.18  0.17  0.31* In this study, we examined whether two different forms of
Decentration  0.22  0.12  0.19
metacognitive capacities were linked with three different kinds of
Mastery  0.34*  0.30*  0.26
MCQ total 0.17 0.14  0.16 posttraumatic beliefs: maladaptive beliefs about the self, the
Uncontrollability and danger 0.32* 0.18 0.14 world, and self-blame. We predicted that deficits in both forms of
Lack of cognitive confidence 0.20 0.17  0.14 metacognition would be associated with more maladaptive post-
Positive beliefs  0.18  0.08  0.31* traumatic cognitions. Consistent with our expectations, we found
Self consciousness  0.20 0.05  0.29*
Need to control 0.37** 0.09 0.15
lower levels of Self-Reflectivity on the MAS-A and higher levels of
cognitive self-consciousness on the MCQ-30 were uniquely related
*
p o 0.05. to higher levels of self-blaming posttraumatic beliefs even after
**
po 0.001. controlling for age, level of depression, and PTSD symptoms. Par-
tially consistent with our expectations, greater levels of Negative
the Self-Blame scale (r ¼0.51, p ¼ 0.001). The Negative Cognitions Cognitions about the Self and greater levels of Negative Cognitions
about the World scale and the Self-Blame scale were not sig- about the World were related to lesser levels of Mastery, as
nificantly correlated (r ¼0.15, p¼ 0.30). measured by the MAS-A. In addition, greater levels of cognitions
To determine whether the three PTCI domains were linked about Uncontrollability and Danger and a Need to Control were
with psychopathology and metacognition, Pearson correlations related to lower levels of Self-Reflectivity, Awareness of Others,
were calculated between the three PTCI subscales and the MAS-A, and Cognitive Self-Consciousness, as measured by the MCQ-30.
MCQ-30, CAPS and BDI-II. As shown in Table 2, greater levels of Correlations also revealed that being younger and more depressed
Negative Cognitions about the Self were related to higher levels of was linked with greater levels of negative cognitions about self
depression and PTSD symptoms. Greater levels of Negative Cog- and the world.
nitions about the Self were also related to lower levels of Mastery, While the cross-sectional design and exploratory nature of this
greater levels of cognitions about Uncontrollability and Danger, study does not allow us to directly address the question of caus-
and a Need to Control as measured by the MCQ-30. Greater levels ality, results could suggest several hypotheses. It is possible greater
of Negative Cognitions about the World were similarly related to levels of metacognitive deficits negatively affect how people make
greater levels of depression and PTSD symptoms and lesser levels meaning after trauma, above and beyond any concurrent levels of
of Mastery. Greater levels of self-blame, by contrast, was linked depression or PTSD symptoms. In particular, perhaps with lesser
with greater levels of depression and lower levels of Self-Re- complex or integrated ideas about the self, persons are less able to
flectivity, Awareness of Others, and Cognitive Self-consciousness. make deeper sense of profoundly disturbing experiences and are
To determine whether the metacognitive variables were un- ultimately more prone to blame themselves for traumatic events
iquely linked with all three PTCI subscales, we conducted three or the consequences of traumatic events. Additionally, those with
stepwise multiple regressions. In each regression, there were two lesser ability to think complexly about themselves and others may
steps. In the first step, age (the only demographic variable linked be more likely to form extreme and rigid negative beliefs about
with PTCI scores), and the BDI-II and PTSD total scores were al- their environment (i.e., perceiving it as always dangerous) because
lowed to enter. In the second step, the relevant MAS-A and MCQ- they do not have the metacognitive capacity to consider more
30 variables were allowed to enter. As summarized in Table 3, nuanced interpretations of their environment. For instance, those
these analyses revealed that being younger and more depressed with a more limited sense of themselves and knowledge of how to
was linked with greater levels of negative cognitions about the self respond to psychological problems may find it more difficult to see
and the world. Greater levels of Self-Blame were linked with their own pain and despair in the face of trauma as being some-
greater levels of depression, lesser levels of Self-Reflectivity, and thing beyond their own control. Similarly, a tendency to exert
control in an attempt to cope with posttraumatic beliefs, such as
Table 3 seeing the world as unpredictable and dangerous, may also lead to
Stepwise multiple regressions predicting posttraumatic cognitions (N ¼ 51). more maladaptive beliefs about trauma independent of the degree
of integration of self-representation.
Cognition Contributing F (df) Beta Partial R2 Model R2 As noted, these interpretations should be treated as speculative
component factors weight
and thus rival hypotheses cannot be ruled out. It is possible that
Self BDI total 12.18 (2,48)*** 0.49 0.27*** 0.27 the trauma itself, or related posttraumatic beliefs, affect meta-
Age  0.26 0.07*,1 0.34 cognitive capacity. For example, post-traumatic negative apprai-
World Age 6.92 (2,48)**  0.34 0.15** 0.15 sals of the self and world (including others) may impede Mastery
BDI 0.28 0.07**,1 0.22
by contributing to avoidance strategies in the face of psychological
Self blame BDI total 35.02 (3,47)** 0.21 0.09* 0.09
Self-reflectivity  0.33 0.10*,1 0.19 problems versus using the relational context as a support for
Cognitive self-  0.27 0.07*,1 0.26 psychological problems. Furthermore, it could be that the asso-
consciousness ciations noted here may have resulted from factors not assessed in
*
this study. Longitudinal studies including multiple assessments of
p o 0.05.
**
po 0.01.
these variables are required before we will be able to tease out
***
p o 0.0001. causal influences.
1
Significance in change in R2. In terms of our one exploratory analysis, we found that the two

Please cite this article as: Davis, L.W., et al., Metacognitive capacity predicts severity of trauma-related dysfunctional cognitions in
adults with posttraumatic stress disorder. Psychiatry Research (2016), http://dx.doi.org/10.1016/j.psychres.2016.01.045i
 L.W. Davis et al. / Psychiatry Research ∎ (∎∎∎∎) ∎∎∎–∎∎∎ 5

measures of metacognition were largely unrelated. This is con- possible. Views expressed in this article are those of the authors
sistent with assertions that these represent relatively independent and do not necessarily represent the views of the Department of
forms of metacognition, which may uniquely influence outcomes Veterans Affairs or the U.S. government. We have no competing
independent of one another. It is also consistent with models that interests to support. This work was supported by a Veterans
view metacognition as a continuum that involves interaction Health Administration Rehabilitation Research and Development
among different levels of reflection about the self and others Service grant DB7571N (PI: Davis) and Dr. Davis was also sup-
(Lysaker et al., 2013). ported in part by a VA Rehabilitation Research and Development
Of note, there are limitations that must be considered. We did Career Development Transition Award B7331R.
not fully assess trauma history in order to get a more complete
picture that would include frequency and severity of all types of
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Please cite this article as: Davis, L.W., et al., Metacognitive capacity predicts severity of trauma-related dysfunctional cognitions in
adults with posttraumatic stress disorder. Psychiatry Research (2016), http://dx.doi.org/10.1016/j.psychres.2016.01.045i
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Please cite this article as: Davis, L.W., et al., Metacognitive capacity predicts severity of trauma-related dysfunctional cognitions in
adults with posttraumatic stress disorder. Psychiatry Research (2016), http://dx.doi.org/10.1016/j.psychres.2016.01.045i