The Role of Metacognition and Psychological Distress in Fibromyalgia Impact: a cross-sectional study in a Turkish clinical sample

The Role of Metacognition and Psychological Distress in Fibromyalgia Impact: a cross-sectional study in a Turkish clinical sample | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article The Role of Metacognition and Psychological Distress in Fibromyalgia Impact: a cross-sectional study in a Turkish clinical sample Yunus Bayram Koçyiğit, Belgin Karaoğlan, Aslı Kuruoğlu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7687377/v1 This work is licensed under a CC BY 4.0 License Status: Under Revision Version 1 posted 9 You are reading this latest preprint version Abstract Objective: We examined whether metacognitive processes are associated with fibromyalgia impact and compared metacognitions between patients with fibromyalgia syndrome (FMS) and matched healthy controls. We hypothesized that MCQ-30 scores would be higher in FMS and would predict FIQR total. Methods: In this cross-sectional study, 56 female FMS patients and 69 age-/education-matched women completed the Metacognitions Questionnaire-30 (MCQ-30), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Revised Fibromyalgia Impact Questionnaire (FIQR). Group differences used t -tests or Mann–Whitney U tests; correlations used Pearson/Spearman with Benjamini–Hochberg FDR adjustment; simple linear regression tested MCQ-30 total → FIQR total. Assumptions and robustness (Huber M-regression) were examined. Results: Compared with controls, the FMS group showed higher MCQ-30 Cognitive Confidence, Uncontrollability/Danger, Cognitive Self-Consciousness, Need to Control Thoughts, MCQ-30 total, and all FIQR indices (all p<.001; d=0.66–2.60). In patients, FIQR total correlated with MCQ-30 total (r=.40, q<.01) and with Cognitive Confidence and Cognitive Self-Consciousness (q<.01). MCQ-30 total predicted FIQR total (B=0.417, SE=0.173, β=.31, R²=.10, p=.020; 95% CI for B=0.078–0.756). In robustness checks, the association remained significant (Huber M-regression B≈0.40, p<.05). Exploratory subgroup analyses using established BDI/BAI cut-offs indicated lower MCQ-30 and lower FIQR scores in patients with moderate-to-severe depression/anxiety versus those below cut-offs (all q≤.01) a counterintuitive pattern discussed within a cultural somatization/measurement-domain framework. Conclusions: Metacognitive dysfunctions are elevated in FMS and show a modest yet independent association with disease impact, supporting metacognition-focused psychosomatic interventions. The paradoxical subgroup pattern warrants cross-cultural, prespecified moderator analyses in longitudinal designs. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Biological sciences/Psychology Social science/Psychology Fibromyalgia Metacognition Symptom severity Psychosomatic medicine Functional impairment Cross-cultural Turkey 1. INTRODUCTION Fibromyalgia syndrome (FMS) is a chronic and disabling condition with an etiology and pathogenesis that remain poorly understood, marked by widespread pain, sleep and energy disturbances, cognitive dysfunction, and affective symptoms, and increasingly recognized within a biopsychosocial framework [1]. In the etiology of FMS, the interplay of multiple biological, genetic, psychosocial, and sociocultural factors has been increasingly emphasized as a holistic framework [2]. In FMS, hyperalgesia has been explained in part by central nervous system plasticity and central sensitization [3]. Central sensitization can be conceptualized as central hyperexcitability; it refers to a generalized state of heightened reactivity in the central nervous system triggered by various factors. FMS is considered within the group of central sensitization syndromes [4]. However, this mechanism alone is insufficient to account for the variations in patients’ symptom perception. Studies have shown that personality traits such as high alexithymia, perfectionism, neuroticism, and low self-regulation are common in FMS [5]. These findings suggest that cognitive and emotional regulatory processes may play a role in the perception of disease symptoms. Therefore, FMS is considered not only a biological disorder but also one that involves cognitive-emotional processes [6]. FMS patients also tend to cope with pain through dysfunctional strategies, such as pain catastrophizing, which are closely associated with psychological distress [7]. Metacognition refers to an individual’s awareness of events and processes occurring in their own mind [8]. Impairments in metacognitive functions may contribute to the maintenance of pathological thought patterns and to the exaggerated perception of symptoms [9]. To date, although cognitions have been widely studied, research specifically addressing the role of metacognitions in FMS remains limited [6,10,11]. The aim of this study is to examine the impact of metacognitive functions on the perception of disease symptoms in patients with FMS, while simultaneously considering common comorbidities such as depression and anxiety, and to elucidate the relationships among these factors. 2. MATERIALS AND METHODS 2.1. Study Setting and Design: This study is a cross-sectional research conducted at Gazi University Faculty of Medicine Hospital. 2.2. Participants: The study included patients aged 18–65 years who were diagnosed with FMS at the Department of Physical Medicine and Rehabilitation, Gazi University Faculty of Medicine, along with a healthy control group for comparison. Psychiatric disorders were excluded through the Structured Clinical Interview for DSM-5 (SCID-5). Individuals with organic diseases that could affect cognitive functions were not included, and participants using psychotropic medication were also excluded.The healthy control group consisted of participants without any psychiatric complaints, not using psychotropic medication, and free of pain-related organic diseases. A total of 56 patients with FMS and 69 healthy controls were included in the study. All participants were female. To control for gender, only women were included in the control group as well. The mean age was 39.14 years in the patient group and 38.67 years in the control group, with no significant difference between the two. The educational levels of both groups were matched, consisting of high school and university graduates. Patients were informed about the study and written consent was obtained. Following the initial interview, all participants completed Metacognitions Questionnaire-30 (MCQ-30), originally developed by Wells and Cartwright-Hatton [8] and subsequently validated in Turkish populations by Tosun and Irak [12]. Disease impact was measured with the Turkish version of the Revised Fibromyalgia Impact Questionnaire (FIQR), which was originally developed by Bennett et al. [13] and validated in Turkish populations by Ediz et al. [14]. Depressive symptoms were evaluated using the Beck Depression Inventory (BDI; Beck et al., 1961), and anxiety symptoms were assessed with the Beck Anxiety Inventory (BAI; Beck et al., 1988) Efforts to address potential sources of bias included strict exclusion of psychiatric comorbidities through SCID-5, restriction to female participants to control for gender effects, and matching the control group on age and education. Measurement bias was minimized by using validated Turkish versions of all scales (MCQ-30, FIQR, BDI, BAI). Residual sources of selection bias cannot be fully excluded due to the single-center design. Sample size was determined by the available number of eligible patients diagnosed with fibromyalgia at Gazi University Hospital during the recruitment period (n=56). No a priori power calculation was conducted; however, the final sample provided sufficient power to detect medium-to-large effect sizes in group comparisons and correlations, consistent with prior Fibromyalgia studies 2.3. Measures Metacognitions Questionnaire-30 (MCQ-30) Revised Fibromyalgia Impact Questionnaire (FIQR) Beck Depression Inventory (BDI) Beck Anxiety Inventory (BAI) Depressive symptoms were assessed with the Beck Depression Inventory (BDI; Beck et al., 1961). We classified severity according to established cut-offs: 0–13 minimal, 14–19 mild, 20–28 moderate, and 29–63 severe (Beck et al., 1988). Anxiety symptoms were evaluated using the Beck Anxiety Inventory (BAI; Beck et al., 1988), with cut-offs of 0–7 minimal, 8–15 mild, 16–25 moderate, and 26–63 severe. For subgroup analyses, patients at moderate-to-severe levels (≥20 on BDI; ≥16 on BAI) were contrasted with those below these thresholds, in line with prior validation studies. All quantitative variables (MCQ-30, FIQR, BDI, BAI scores; age; disease duration) were analyzed as continuous variables when assumptions of normality were met. Group comparisons used independent samples t-tests; if distributions were non-normal or subgroup sizes <30, Mann–Whitney U tests were applied. For descriptive and subgroup purposes, depression and anxiety scores were additionally categorized according to established BDI and BAI severity cut-offs (minimal, mild, moderate, severe) to contrast patients with moderate-to-severe symptoms against those with lower severity. This grouping was chosen to ensure clinical interpretability and comparability with previous validation studies. 2.4. Statistical Analysis: Data were analyzed in SPSS 23.0. Normality was assessed with Shapiro–Wilk and Q–Q plots; homoscedasticity with Levene’s test; heteroskedasticity with Breusch–Pagan. Between-group differences used independent-samples t -tests (or Mann–Whitney U when assumptions were violated or subgroup n <30); categorical variables used χ² tests. Correlations used Pearson’s r (or Spearman’s ρ when non-normal). To control multiplicity, Benjamini–Hochberg false discovery rate (FDR) adjustment (q=0.05) was applied to families of tests (all scale comparisons and correlation matrices); adjusted q -values are reported where applicable. A simple linear regression modeled FIQR total from MCQ-30 total. Multicollinearity was acceptable (VIF<2). Influence diagnostics (Cook’s distance, leverage) showed no undue influence. Robustness checks (Huber M-estimator regression; Spearman’s ρ) yielded qualitatively unchanged inferences. 2.5. Assumption Checks and Robustness. Normality and homoscedasticity assumptions were examined via Q–Q plots and Levene’s test, and heteroskedasticity was probed using Breusch–Pagan tests. Influence diagnostics (Cook’s distance and leverage) were inspected to detect potential outliers. To assess robustness, we repeated key associations using Spearman’s rho and Huber M-estimator regressions; inferences remained qualitatively unchanged. Internal consistency in the present sample was satisfactory. 2.6. Ethical Approval: The study protocol was reviewed and approved by the Ethics Committee of Gazi University, Türkiye (approval no. 2019/130). All methods were performed in accordance with the relevant guidelines and regulations, including the Declaration of Helsinki and institutional policies. All participants were adults (≥18 years), and written informed consent was obtained from all participants prior to enrolment. This observational study followed the STROBE guidelines for reporting. 3. RESULTS The mean age was 39.14 years in the patient group and 38.67 years in the control group ( t = 0.300, p = .765), with no significant differences in age or education level (χ² = 2.248, p = .134) (Table 1). In terms of place of residence, 85.7% of the patients and 95.6% of the controls were living in urban areas. Findings related to the clinical characteristics of the patient group are presented in Table 2. No missing data were observed for primary variables (MCQ-30, FIQR, BDI, BAI). Analyses were conducted on a complete-case basis. 3.1. Comparison of Scale Scores Between Groups Significant differences were found between groups in the following measures: MCQ-30 Cognitive Confidence ( t = 4.392, p < .001), Uncontrollability/Danger ( t = 3.754, p < .001), Cognitive Self-Consciousness ( t = 3.878, p < .001), Need to Control Thoughts ( t = 3.610, p < .001), MCQ-30 Total ( t = 4.805, p < .001), FIQR Functional Impairment ( t = 9.296, p < .001), FIQR Overall Impact ( t = 9.756, p < .001), FIQR Symptom Severity ( t = 13.821, p < .001), and FIQR Total ( t = 13.116, p < .001). (Table 3) The distribution of participants according to the Beck Depression Inventory and Beck Anxiety Inventory is presented in Table 4. 3.2. Effect of Depression When patients classified as depressive with high symptom severity (moderate to severe levels according to BDI/BAI cutoff scores) were compared with those without, the depressive group showed significantly lower scores on MCQ-30 Cognitive Confidence ( U = 209.5, p < .01), MCQ-30 Cognitive Self-Consciousness ( U = 139, p < .001), MCQ-30 Need to Control Thoughts ( U = 217.5, p < .01), and MCQ-30 Total ( U = 188, p < .01). Similarly, lower scores were observed on FIQR Functional Impairment ( U = 206.5, p < .01), FIQR Overall Impact ( U = 191.5, p < .01), FIQR Symptom Severity ( U = 121, p < .001), and FIQR Total ( U = 138.5, p < .001). (Table 5) 3.3. Effect of Anxiety When patients classified as anxious with high symptom severity (moderate to severe levels according to BDI/BAI cutoff scores) were compared with those without, the anxious group demonstrated significantly lower scores on MCQ-30 Positive Beliefs ( U = 252.5, p < .05), MCQ-30 Cognitive Confidence ( U = 222.5, p < .01), MCQ-30 Cognitive Self-Consciousness ( U = 135, p < .001), MCQ-30 Need to Control Thoughts ( U = 228, p < .05), and MCQ-30 Total ( U = 172, p < .001). Similarly, lower scores were found on FIQR Functional Impairment ( U = 199.5, p < .01), FIQR Overall Impact ( U = 260, p < .05), FIQR Symptom Severity ( U = 166.5, p < .001), and FIQR Total ( U = 175, p < .01). (Table 6) 3.4. Correlations Between MCQ-30 and FIQR Significant positive correlations were found between MCQ-30 total scores and FIQR Functional Impairment ( r = .439, p < .01), Overall Impact ( r = .310, p < .05), Symptom Severity ( r = .271, p < .05), and FIQR Total ( r = .395, p < .01). (Table 7) 3.5. Regression Analysis A significant association was found between MCQ-30 total scores and FIQR total scores (β = 0.305, t = 2.405, p = .020). Model coefficients were: A significant association was observed between MCQ-30 total and FIQR total ( β=0.31 , t(54)=2.41 , p=.020 ). Model fit indices : R=0.31 , R²=0.10 , Adj. R²=0.08 , F(1,54)=5.79 , p=.020 . Examination of the t -test results for regression coefficients indicated that MCQ-30 total scores were a significant predictor of FIQR total scores. (Table 8) The unstandardized coefficient showed a precise effect (B=0.417, SE=0.173; 95% CI=0.078–0.756), and the association remained significant in Huber M-regression (B≈0.40, p<.05) and under Spearman rank correlation (ρ≈.39, q<.01). 4. DISCUSSION In our study, 56 patients with FMS and 69 healthy controls were compared in terms of Metacognitions Questionnaire-30 (MCQ-30) scores and Fibromyalgia Impact Questionnaire-Revised (FIQR) scores. All patients with FMS were female, and to control for gender, the control group was also composed exclusively of women. Similarly, the mean age was 39.14 years in the patient group and 38.67 years in the control group, with no significant differences in either age or gender. The educational levels of both groups were also matched, and only participants who were high school or university graduates were included. The reason for selecting participants with higher educational levels was to control for potential confounding, as lower education has been associated in the literature with more pathological metacognitive systems [15]. Metacognition plays a critical role in the functional and adaptive operation of an individual’s cognitive processes. It has been suggested that any deviation within the metacognitive system may constitute an important factor in the development and maintenance of various psychopathologies [8]. Accordingly, impairments in metacognitive functions lead to dysfunctional thought patterns and ineffective coping styles in individuals. Moreover, individuals hold both positive and negative beliefs (metacognitions) about their own cognitions, which are often maladaptive. Such metacognitive beliefs may give rise to responses that disrupt psychological adjustment [9]. When the subcomponents of metacognition were examined, it was found that the FMS group had significantly higher scores than the healthy controls on the subscales of Cognitive Confidence, Uncontrollability and Danger, Cognitive Self-Consciousness, and Need to Control Thoughts. The “Uncontrollability and Danger” subscale assesses individuals’ beliefs that, in order to function effectively and feel safe, they must control their worries, while at the same time believing that worry is uncontrollable. This subscale encompasses situations in which individuals perceive their uncontrollable thoughts as a weakness, believe they may be punished for them, consider such thoughts as potentially impairing their functioning, or blame themselves for having these thoughts [8]. In patients, elevated scores on this subscale may be explained by tendencies toward pessimism about the future, negative thoughts about themselves and others, disregarding contradictory evidence, and experiencing bodily symptoms in an exaggerated manner. Similarly, the significantly higher scores on the Need to Control Thoughts subscale in the patient group suggest that these individuals are more preoccupied with their thoughts. When the total metacognition score was evaluated, positive correlations were also observed with all FIQR subscales and the total score. In the comparison between the two groups, significant differences were found in the total metacognition score and in the subscales of Uncontrollability and Danger, Cognitive Confidence, Need to Control Thoughts, and Cognitive Self-Consciousness. The positive correlations between total metacognition scores and all FIQR subscales, as well as the total score, support the view that metacognitive processes play a central role in the perception of symptoms in FMS. It can be suggested that characteristics such as anxiety, pessimism, maladjustment to the environment, passivity, excessive focus on flaws, and heightened bodily sensitivity may be more prominent in the FMS group, which in turn may negatively affect symptom perception. In this context, considering the positive correlation between disease symptoms and cognitive self-consciousness, increased illness awareness appears to heighten the focus on symptoms. This finding is also consistent with the literature suggesting that patients with FMS tend to employ pathological metacognitive thinking more frequently [6,16]. Similar to the findings of our study, a previous investigation of metacognition in FMS reported that positive metacognitions about symptoms predicted impairments in physical functioning, whereas negative metacognitions about symptoms were associated with stress, anxiety, depression, and overall metacognitions, and significantly predicted the impact of FMS [10]. Similarly, a study conducted on chronic fatigue syndrome examined metacognitive structures and found that negative emotions and metacognitions were positively correlated with symptom severity [17]. In this context, it has been suggested that positive metacognitive beliefs may be beneficial in symptom management by activating conceptual processes and enhancing insight, whereas negative metacognitions may constitute a risk factor by increasing fatigue and symptom severity. Furthermore, the literature has shown that catastrophic cognitions related to chronic pain are closely associated with pain intensity and functional impairment [18]. A study on pain catastrophizing demonstrated that awareness predicted this process and significantly moderated the relationship between pain intensity and catastrophizing. These findings support the strong association between awareness and pain catastrophizing [6,19]. However, pain catastrophizing is not a fixed trait; rather, it varies across individuals and over time depending on pain experience, contextual factors, ruminative thoughts, and metacognitive beliefs about coping strategies. In our study, 39.4% of patients reported a relapsing course of the illness, which suggests that this fluctuation may be associated with ruminative thoughts and variable metacognitive coping processes [20]. In our study, depression and anxiety scores were higher in the patient group compared to the control group, and this result was consistent with the literature [21]. However, the finding that FMS patients with depression and anxiety, as defined by BDI/BAI cutoff scores, had lower metacognition scores was unexpected and contradicts some reports in the literature [10,11,22,23]. This situation may be explained by patients’ tendency to catastrophize symptoms, their use of depressive and anxious language, or the possibility that depression and anxiety symptoms are expressed differently within a cultural context [25,26]. When compared with German and Italian samples (Kollmann, Romeo), the paradoxical association observed in the Turkish sample may be explained by cultural tendencies toward somatization. This finding supports the hypothesis that emotional symptoms may be masked and redirected into bodily complaints.On the other hand, it should also be considered that depression and anxiety may, in some individuals, increase symptom awareness and lead to a paradoxical rise in metacognitive functions (a consistent inconsistency), or that measurement biases may have played a role. This finding suggests that the relationships between metacognition and depression, and between metacognition and anxiety, are not homogeneous and may vary according to cultural context [27]. In this respect, our result may raise new questions for future cross-cultural and longitudinal studies. In our study, a negative association was identified between depression and anxiety scores and FIQR scores among patients with FMS. This finding suggests that some individuals may express intrapsychic conflicts related to depression and anxiety through somatization within a cultural context, thereby masking emotional symptoms and contributing to an increase in somatic complaints [28,29,30]. Previous literature has reported that higher levels of self-efficacy are associated with better symptom management and greater functionality [24]. Accordingly, the negative relationship between depression and anxiety and FIQR scores may be linked to coping strategies and tendencies toward somatization commonly employed in FMS. Nevertheless, these results point to masked depression or somatization merely as a hypothesis, which requires further validation through future research. At the same time, this observation underscores the importance of a psychosomatic perspective in evaluating conditions such as FMS, where bodily symptoms are prominent, in order to uncover patients’ underlying psychological needs. From a clinical standpoint, systematically assessing depressive and anxiety symptoms, rather than focusing solely on pain or physical complaints, and incorporating cognitive-behavioral interventions may provide a more comprehensive approach to the management of the illness. Our study has several limitations. The relatively small sample size, the use of cutoff scores for the BDI and BAI, the reliance on self-report measures, and the single-center design may limit the generalizability of the findings. In addition, the cross-sectional design prevents the establishment of causal relationships. The paradoxical association identified in depression and anxiety subgroups should be examined in greater detail in future studies using moderator analyses and longitudinal designs. Despite these limitations, the regression analysis showing that metacognitive processes modestly but independently predicted FIQR outcomes represents a key finding of our study and is consistent with the literature. The MCQ-30 total score accounted for only R²≈.10, Adj. R²≈.08 of the variance in FIQR total scores, representing a limited yet clinically meaningful contribution within the multifactorial nature of FMS. This finding indicates that metacognitive functions exert an independent influence on daily functioning. Taken together, these findings suggests that pathological metacognitive processes may increase the overall impact of the illness, as well as symptom severity and intensity, thereby negatively affecting patients’ functioning. This study is among the first to investigate the association between metacognitive functions and disease impact in FMS within a Turkish sample. The findings indicate that FMS is not merely a somatic pain disorder but rather a complex condition accompanied by impairments in cognitive, emotional, and social-cognitive processes. The observation that metacognitive dysfunction significantly predicted the impact of FMS on daily life suggests that metacognitive functions may play a fundamental role in the course of the illness. Therefore, the study proposes that metacognition-focused interventions targeting awareness in a psychosomatic context may be beneficial for symptom management in FMS. Declarations Acknowledgments The authors sincerely thank all participants for their valuable contribution to this study. Authors and affiliations: Yunus Bayram Koçyiğit Psychiatry Department of Fethiye State Hospital, Muğla, Türkiye Email: [email protected] | Phone: +90 506 572 8469 Belgin Karaoğlan Physical Medicine and Rehabilitation Department of Gazi University Hospital, Ankara, Türkiye Email: [email protected] Aslı Kuruoğlu Psychiatry Department of Gazi University Hospital, Ankara, Türkiye Email: [email protected] Corresponding author: Yunus Bayram Koçyiğit Psychiatry Department of Fethiye State Hospital, Muğla, Türkiye Email: [email protected] | Phone: +90 506 572 8469 CRediT authorship statement: Conceptualization: YBK, BK, AK Methodology: YBK, AK Investigation: BK, AK Formal analysis: YBK Writing – original draft: YBK Writing – review & editing:YBK, BK, AK Supervision: AK Data availability: Data are available from the corresponding author upon reasonable request. Declaration of competing interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Funding: The authors declare that they received no financial support for the conduct of the research and/or preparation of the article. This manuscript is derived from a psychiatry residency thesis completed at the Gazi University Faculty of Medicine in 2019; the data and interpretations have been updated and the work was prepared as a manuscript in 2025. References Häuser W, Zimmer C, Felde E, Köllner V. What are the key symptoms of fibromyalgia? Results of a survey of the German Fibromyalgia Association. Schmerz. 2008;22(2):176-183. DOI: 10.1007/s00482-007-0602-z Di Tella M, Castelli L, Colonna F, Fusaro E, Torta R, Ardito RB, Adenzato M. 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Cogn Emot. 1992;6(1):1-22. https://doi.org/10.1080/02699939208411055 Hana Karpin, Cognitive Self-Efficacy Levels Distinguish Among Disease Severity, Pain-Related Function, and Perceived Health of Individuals With Fibromyalgia, 2025; https://doi.org/10.5014/ajot.2025.050931 Xuexin Yu, Cross-national statistical harmonization of the Center for Epidemiologic Studies Depression (CES-D) scale among older adults in China, England, India, Mexico, South Africa, and the United States, 2025;DOI:10.1016/j.jclinepi.2024.111623 Yu (Carrie) CHENG, Cognitive impairment, physical frailty and depression in older adults from culturally and linguistically diverse community: A cross-sectional study, 2025; https://doi.org/10.1016/j.gerinurse.2025.103569 Corey Jackson, Mechanics of Mindfulness: Investigating Metacognitive Beliefs as a Pathway of Effect on Anxiety and Depression, tig Health Psychol Educ, 2025 Jun 12;15(6):109. DOI:10.3390/ejihpe15060109 Felix Angst, Somatization differentiates fibromyalgia from low back pain: a comparative, cross-sectional cohort studyRheumatology (Oxford)2025 Apr 1;64(4):1741-1749. DOI: 10.1093/rheumatology/keae462 Prisco V, Donnarumma B, Prisco L. Evolution of Psychosomatic Diagnosis: From Masked Depression to Somatic Symptoms and Related Disorders. OBM Geriatrics 2023 ; 7(1): 228; doi:10.21926/obm.geriatr.2301228 Can Nakkas, Somatization and Coping in Ethnic Minority Recruits, Mil Med, 2019 Dec 1;184(11-12):e680-e685. DOI:10.1093/milmed/usz014 Tables Table 1. Sociodemographic Characteristics (n and row percentages) Variable Patient n (%) Control n (%) Total n Marital Status – Single 16 (47.1) 18 (52.9) 34 Marital Status – Married 31 (39.7) 47 (60.3) 78 Marital Status – Divorced/Widowed 9 (69.2) 4 (30.8) 13 Education – University 39 (41.1) 56 (58.9) 95 Education – High School 17 (56.7) 13 (43.3) 30 Occupation – Civil Servant/Worker 22 (25.2) 65 (74.8) 87 Occupation – Retired 6 (100) 0 (0) 6 Occupation – Other 28 (87.5) 4 (12.5) 32 Currently Working 31 (31.0) 69 (69.0) 100 Not Working 25 (100) 0 (0) 25 Table 2. Clinical Characteristics of the Patient Group Variable n (%) Mean ± SD Course – Relapsing 22 (39.3) Course – Chronic 34 (60.7) Treatment – None 23 (41.1) Treatment – Present 33 (58.9) Comorbidity – None 45 (80.4) Comorbidity – Present 11 (19.6) Disease Duration (months) 53.48 ± 57.79 Longest Remission (months) 6.05 ± 15.99 Longest Relapse (months) 6.36 ± 7.73 Untreated Duration (months) 14.07 ± 24.45 Table 3. Comparison of Patient and Control Groups on Scale Scores Measure Patient Mean±SD Control Mean±SD t p Cohen's d 95% CI (low) 95% CI (high) Effect size MCQ-30 Positive Beliefs 11.34 ± 4.24 10.22 ± 3.86 1.530 0.129 0.278 -0.077 0.632 Small MCQ-30 Cognitive Confidence 13.45 ± 3.92 10.45 ± 3.64 4.392 <0.001 0.796 0.430 1.163 Medium MCQ-30 Uncontrollability/Danger 15.00 ± 4.80 11.88 ± 4.37 3.754 <0.001 0.683 0.320 1.046 Medium MCQ-30 Cognitive Self-Consciousness 14.12 ± 4.77 11.13 ± 3.63 3.878 <0.001 0.716 0.352 1.079 Medium MCQ-30 Need to Control Thoughts 16.07 ± 3.94 13.67 ± 3.39 3.610 <0.001 0.658 0.296 1.020 Medium MCQ-30 Total 69.75 ± 15.81 57.09 ± 13.09 4.805 <0.001 0.881 0.512 1.250 Large FIQR Functional Impairment 12.31 ± 8.11 1.58 ± 3.30 9.296 <0.001 1.803 1.384 2.221 Large FIQR Overall Impact 8.52 ± 6.53 5.54 ± 7.42 9.756 <0.001 1.769 1.523 2.380 Large FIQR Symptom Severity 26.49 ± 10.07 4.96 ± 6.52 13.821 <0.001 2.595 2.116 3.074 Large FIQR Total 47.08 ± 21.62 6.55 ± 9.12 13.116 <0.001 2.538 2.064 3.012 Large Notes. Values are presented as Mean ± SD. Independent-samples t -tests were used unless indicated. †Mann–Whitney U test applied due to zero variance in controls. Effect sizes are interpreted as: small (d≈0.20/r≈0.10), medium (d≈0.50/r≈0.30), large, group comparison used Mann–Whitney U ; effect size r is reported. (d≥0.80/r≥0.50). FIQR: Fibromyalgia Impact Questionnaire-Revised; MCQ-30: Metacognitions Questionnaire-30. Table 4. Distribution of Beck Depression and Anxiety Levels Scale/Level Patient n (%) Control n (%) Total n Depression – None/Minimal 15 (26.3) 42 (73.7) 57 Depression – Mild 16 (45.7) 19 (54.3) 35 Depression – Moderate 21 (75.0) 7 (25.0) 28 Depression – Severe 4 (80.0) 1 (20.0) 5 Anxiety – None 11 (19.6) 45 (80.4) 56 Anxiety – Mild 13 (41.9) 18 (58.1) 31 Anxiety – Moderate 14 (70.0) 6 (30.0) 20 Anxiety – Severe 18 (100) 0 (0) 18 Notes: Values are n (%) . Group differences assessed with χ² tests .” Table 5. Comparison of Patients With and Without Depression Measure n_low / n_high U z p r Effect size MCQ-30 Positive Beliefs 35 / 21 313.5 -1.22 .220 -0.16 Small MCQ-30 Cognitive Confidence 35 / 21 209.5 -2.93 .003 -0.39 Medium MCQ-30 Uncontrollability/Danger 35 / 21 288.5 -1.63 .102 -0.22 Small MCQ-30 Cognitive Self-Consciousness 35 / 21 139.0 -4.10 <.001 -0.55 Large MCQ-30 Need to Control Thoughts 35 / 21 217.5 -2.80 .005 -0.37 Medium MCQ-30 Total 35 / 21 188.0 -3.29 <.001 -0.44 Medium FIQR Functional Impairment 35 / 21 206.5 -2.98 .003 -0.40 Medium FIQR Overall Impact 35 / 21 191.5 -3.23 <.001 -0.43 Medium FIQR Symptom Severity 35 / 21 121.0 -4.39 <.001 -0.59 Large FIQR Total 35 / 21 138.5 -4.10 <.001 -0.55 Large Note. Values are median [IQR]. Mann–Whitney U test used due to non-normal distributions. Effect sizes (r) calculated as z/√N, with N_total = 56. Severity levels for BDI (0–13 minimal, 14–19 mild, 20–28 moderate, 29–63 severe) and BAI (0–7 minimal, 8–15 mild, 16–25 moderate, 26–63 severe) were used. Subgroup comparisons contrasted patients with moderate-to-severe symptoms (BDI ≥20; BAI ≥16) against those below these thresholds. Cut-offs based on Beck et al., 1961/1988 validation studies. Table 6. Comparison of Patients With and Without Anxiety Measure n_low / n_high U z p r Effect size MCQ-30 Positive Beliefs 38 / 18 252.5 -2.18 .029 -0.29 Small MCQ-30 Cognitive Confidence 38 / 18 222.5 -2.67 .007 -0.36 Medium MCQ-30 Uncontrollability/Danger 38 / 18 329.5 -0.90 .365 -0.12 Small MCQ-30 Cognitive Self-Consciousness 38 / 18 135.0 -4.12 <.001 -0.55 Large MCQ-30 Need to Control Thoughts 38 / 18 228.0 -2.58 <.010 -0.35 Medium MCQ-30 Total 38 / 18 172.0 -3.51 <.001 -0.47 Medium FIQR Functional Impairment 38 / 18 199.5 -3.06 .002 -0.41 Medium FIQR Overall Impact 38 / 18 260.0 -2.05 .039 -0.27 Small FIQR Symptom Severity 38 / 18 166.5 -3.60 <.001 -0.48 Medium FIQR Total 38 / 18 175.0 -3.46 <.001 -0.46 Medium Note. Values are median [IQR]. Mann–Whitney U test used due to non-normal distributions. Effect sizes (r) calculated as z/√N, with N_total = 56. Severity levels for BDI (0–13 minimal, 14–19 mild, 20–28 moderate, 29–63 severe) and BAI (0–7 minimal, 8–15 mild, 16–25 moderate, 26–63 severe) were used. Subgroup comparisons contrasted patients with moderate-to-severe symptoms (BDI ≥20; BAI ≥16) against those below these thresholds. Cut-offs based on Beck et al., 1961/1988 Table 7. Correlations Between MCQ-30 and FIQR in Patient Group Measure MCQ-30 Subscale r p 95% CI (low) 95% CI (high) Strength Significance FIQR Functional Impairment Positive Beliefs 0.189 - -0.078 0.431 Small ns FIQR Functional Impairment Cognitive Confidence 0.474 <.01 0.241 0.655 Medium Significant FIQR Functional Impairment Uncontrollability /Danger 0.329 <.05 0.072 0.545 Medium Significant FIQR Functional Impairment Cognitive Self-Consciousness 0.387 <.01 0.138 0.590 Medium Significant FIQR Functional Impairment Need to Control Thoughts 0.229 - -0.036 0.464 Small ns FIQR Functional Impairment Total 0.439 <.01 0.199 0.629 Medium Significant FIQR Overall Impact Positive Beliefs 0.145 - -0.123 0.393 Small ns FIQR Overall Impact Cognitive Confidence 0.383 <.01 0.134 0.587 Medium Significant FIQR Overall Impact Uncontrollability /Danger 0.161 - -0.106 0.407 Small ns FIQR Overall Impact Cognitive Self-Consciousness 0.284 <.05 0.023 0.509 Small Significant FIQR Overall Impact Need to Control Thoughts 0.124 - -0.144 0.375 Small ns FIQR Overall Impact Total 0.310 <.05 0.051 0.530 Medium Significant FIQR Symptom Severity Positive Beliefs 0.029 - -0.236 0.290 Negligible ns FIQR Symptom Severity Cognitive Confidence 0.327 <.05 0.070 0.543 Medium Significant FIQR Symptom Severity Uncontrollability /Danger 0.253 - -0.011 0.484 Small ns FIQR Symptom Severity Cognitive Self-Consciousness 0.375 <.01 0.124 0.581 Medium Significant FIQR Symptom Severity Need to Control Thoughts 0.114 - -0.154 0.366 Small ns FIQR Symptom Severity Total 0.271 <.05 0.009 0.498 Small Significant FIQR Total Positive Beliefs 0.138 - -0.130 0.387 Small ns FIQR Total Cognitive Confidence 0.459 <.01 0.223 0.644 Medium Significant FIQR Total Uncontrollability /Danger 0.291 <.05 0.030 0.515 Small Significant FIQR Total Cognitive Self-Consciousness 0.409 <.01 0.164 0.607 Medium Significant FIQR Total Need to Control Thoughts 0.189 - -0.078 0.431 Small ns FIQR Total Total 0.395 <.01 0.147 0.596 Medium Significant Notes. Pearson’s correlations reported when assumptions were met; otherwise Spearman’s rho. Effect size interpretation: |r|≈0.10 small, |r|≈0.30 medium, |r|≥0.50 large. p values are two-tailed and FDR-adjusted. Table 8. Regression Analysis Predicting FIQR Total Scores (Single Predictor Model) Variable B SE β t p MCQ-30 Total 0.417 0.173 0.311 2.405 .020 Model Summary: R = 0.311, R² = 0.097, Adj. R² = 0.080, F(1,54) = 5.79, p = .020 Notes. Simple linear regression with FIQR total as dependent variable. Multicollinearity diagnostics acceptable (VIF < 2). β = standardized regression coefficient. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Revision Version 1 posted Editorial decision: Revision requested 25 Feb, 2026 Reviews received at journal 21 Feb, 2026 Reviews received at journal 20 Feb, 2026 Reviewers agreed at journal 09 Feb, 2026 Reviewers agreed at journal 06 Feb, 2026 Reviewers invited by journal 27 Jan, 2026 Editor assigned by journal 30 Sep, 2025 Submission checks completed at journal 26 Sep, 2025 First submitted to journal 26 Sep, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7687377","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":581340904,"identity":"37aadf22-15d9-495c-9f45-a1c156f1591d","order_by":0,"name":"Yunus Bayram Koçyiğit","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+UlEQVRIiWNgGAWjYLACxgYwxQzENiBu4wFStKSBuSRpOQxm4dVicCP3mOTPHXaJ29tPJxt8qDlvt7b9MNCWGpto3Fry0qR5zyQnzjmTuzlxxrHbydvOJAK1HEvLbcCpJcdMmrGNOXEGQ+7mw7wNt5PNDgC1MDYcxqtF8mdbfeIM/rcgLeeSzc4/JKxFgrftcOIMidzNybwNB+zMbhCwRfLMG2Nr3jPHjWdIvN1sOONYcoLZDaAtCXj8wnc8x/Dmzx3VsjP4czdLfKixszc7n/7wwYcaG5xaFA5AaEeYgkQwIwGHchCQhyq1hwnY41A4CkbBKBgFIxgAAGSjaRwASMkEAAAAAElFTkSuQmCC","orcid":"","institution":"Muğla Fethiye State Hospital","correspondingAuthor":true,"prefix":"","firstName":"Yunus","middleName":"Bayram","lastName":"Koçyiğit","suffix":""},{"id":581340905,"identity":"8dd782c8-9a27-453f-8239-a424efd52baf","order_by":1,"name":"Belgin Karaoğlan","email":"","orcid":"","institution":"Gazi University","correspondingAuthor":false,"prefix":"","firstName":"Belgin","middleName":"","lastName":"Karaoğlan","suffix":""},{"id":581340906,"identity":"c7dfa578-32f4-42a8-8190-d606a9d5f00e","order_by":2,"name":"Aslı Kuruoğlu","email":"","orcid":"","institution":"Gazi University","correspondingAuthor":false,"prefix":"","firstName":"Aslı","middleName":"","lastName":"Kuruoğlu","suffix":""}],"badges":[],"createdAt":"2025-09-23 01:53:34","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7687377/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7687377/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":101345320,"identity":"ea6ce19b-af4b-47fe-a3e2-321426b4551d","added_by":"auto","created_at":"2026-01-28 17:00:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2426166,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7687377/v1/85812d4c-9593-49c6-9946-e797eb051063.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Role of Metacognition and Psychological Distress in Fibromyalgia Impact: a cross-sectional study in a Turkish clinical sample","fulltext":[{"header":"1. INTRODUCTION","content":"\u003cp\u003eFibromyalgia syndrome (FMS) is a chronic and disabling condition with an etiology and pathogenesis that remain poorly understood, marked by widespread pain, sleep and energy disturbances, cognitive dysfunction, and affective symptoms, and increasingly recognized within a biopsychosocial framework \u003cstrong\u003e[1].\u003c/strong\u003e In the etiology of FMS, the interplay of multiple biological, genetic, psychosocial, and sociocultural factors has been increasingly emphasized as a holistic framework \u003cstrong\u003e[2].\u003c/strong\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn FMS, hyperalgesia has been explained in part by central nervous system plasticity and central sensitization \u003cstrong\u003e[3].\u003c/strong\u003e Central sensitization can be conceptualized as central hyperexcitability; it refers to a generalized state of heightened reactivity in the central nervous system triggered by various factors. FMS is considered within the group of central sensitization syndromes \u003cstrong\u003e[4].\u0026nbsp;\u003c/strong\u003eHowever, this mechanism alone is insufficient to account for the variations in patients\u0026rsquo; symptom perception. Studies have shown that personality traits such as high alexithymia, perfectionism, neuroticism, and low self-regulation are common in FMS \u003cstrong\u003e[5].\u003c/strong\u003e These findings suggest that cognitive and emotional regulatory processes may play a role in the perception of disease symptoms.\u003cstrong\u003eTherefore, FMS is considered not only a biological disorder but also one that involves cognitive-emotional processes [6].\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFMS patients also tend to cope with pain through dysfunctional strategies, such as pain catastrophizing, which are closely associated with psychological distress \u003cstrong\u003e[7].\u0026nbsp;\u003c/strong\u003eMetacognition refers to an individual\u0026rsquo;s awareness of events and processes occurring in their own mind \u003cstrong\u003e[8].\u003c/strong\u003e Impairments in metacognitive functions may contribute to the maintenance of pathological thought patterns and to the exaggerated perception of symptoms \u003cstrong\u003e[9].\u003c/strong\u003e To date, although cognitions have been widely studied, research specifically addressing the role of metacognitions in FMS remains limited \u003cstrong\u003e[6,10,11].\u003c/strong\u003e \u003cstrong\u003eThe aim of this study is to examine the impact of metacognitive functions on the perception of disease symptoms in patients with FMS, while simultaneously considering common comorbidities such as depression and anxiety, and to elucidate the relationships among these factors.\u003c/strong\u003e\u003c/p\u003e"},{"header":"2. MATERIALS AND METHODS","content":"\u003cp\u003e\u003cstrong\u003e\u0026nbsp;2.1. Study Setting and Design:\u003c/strong\u003e This study is a cross-sectional research conducted at Gazi University Faculty of Medicine Hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;2.2. Participants:\u003c/strong\u003e The study included patients aged 18\u0026ndash;65 years who were diagnosed with FMS at the Department of Physical Medicine and Rehabilitation, Gazi University Faculty of Medicine, along with a healthy control group for comparison. Psychiatric disorders were excluded through the Structured Clinical Interview for DSM-5 (SCID-5). Individuals with organic diseases that could affect cognitive functions were not included, and participants using psychotropic medication were also excluded.The healthy control group consisted of participants without any psychiatric complaints, not using psychotropic medication, and free of pain-related organic diseases. A total of 56 patients with FMS and 69 healthy controls were included in the study. All participants were female. To control for gender, only women were included in the control group as well. The mean age was 39.14 years in the patient group and 38.67 years in the control group, with no significant difference between the two. The educational levels of both groups were matched, consisting of high school and university graduates. Patients were informed about the study and written consent was obtained. Following the initial interview, all participants completed Metacognitions Questionnaire-30 (MCQ-30), originally developed by Wells and Cartwright-Hatton \u003cstrong\u003e[8]\u003c/strong\u003e and subsequently validated in Turkish populations by Tosun and Irak \u003cstrong\u003e[12].\u003c/strong\u003e Disease impact was measured with the Turkish version of the Revised Fibromyalgia Impact Questionnaire (FIQR), which was originally developed by Bennett et al. \u003cstrong\u003e[13]\u003c/strong\u003e and validated in Turkish populations by Ediz et al. \u003cstrong\u003e[14].\u003c/strong\u003e Depressive symptoms were evaluated using the Beck Depression Inventory (BDI; Beck et al., 1961), and anxiety symptoms were assessed with the Beck Anxiety Inventory (BAI; Beck et al., 1988)\u003c/p\u003e\n\u003cp\u003eEfforts to address potential sources of bias included strict exclusion of psychiatric comorbidities through SCID-5, restriction to female participants to control for gender effects, and matching the control group on age and education. Measurement bias was minimized by using validated Turkish versions of all scales (MCQ-30, FIQR, BDI, BAI). Residual sources of selection bias cannot be fully excluded due to the single-center design.\u003c/p\u003e\n\u003cp\u003eSample size was determined by the available number of eligible patients diagnosed with fibromyalgia at Gazi University Hospital during the recruitment period (n=56). No a priori power calculation was conducted; however, the final sample provided sufficient power to detect medium-to-large effect sizes in group comparisons and correlations, consistent with prior Fibromyalgia studies\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e2.3. Measures\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\u003cstrong\u003eMetacognitions Questionnaire-30 (MCQ-30)\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eRevised Fibromyalgia Impact Questionnaire (FIQR)\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eBeck Depression Inventory (BDI)\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eBeck Anxiety Inventory (BAI)\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eDepressive symptoms were assessed with the Beck Depression Inventory (BDI; Beck et al., 1961). We classified severity according to established cut-offs: 0\u0026ndash;13 minimal, 14\u0026ndash;19 mild, 20\u0026ndash;28 moderate, and 29\u0026ndash;63 severe (Beck et al., 1988). Anxiety symptoms were evaluated using the Beck Anxiety Inventory (BAI; Beck et al., 1988), with cut-offs of 0\u0026ndash;7 minimal, 8\u0026ndash;15 mild, 16\u0026ndash;25 moderate, and 26\u0026ndash;63 severe. For subgroup analyses, patients at moderate-to-severe levels (\u0026ge;20 on BDI; \u0026ge;16 on BAI) were contrasted with those below these thresholds, in line with prior validation studies.\u003c/p\u003e\n\u003cp\u003eAll quantitative variables (MCQ-30, FIQR, BDI, BAI scores; age; disease duration) were analyzed as continuous variables when assumptions of normality were met. Group comparisons used independent samples t-tests; if distributions were non-normal or subgroup sizes \u0026lt;30, Mann\u0026ndash;Whitney U tests were applied. For descriptive and subgroup purposes, depression and anxiety scores were additionally categorized according to established BDI and BAI severity cut-offs (minimal, mild, moderate, severe) to contrast patients with moderate-to-severe symptoms against those with lower severity. This grouping was chosen to ensure clinical interpretability and comparability with previous validation studies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;2.4. Statistical Analysis:\u003c/strong\u003e Data were analyzed in SPSS 23.0. Normality was assessed with Shapiro\u0026ndash;Wilk and Q\u0026ndash;Q plots; homoscedasticity with Levene\u0026rsquo;s test; heteroskedasticity with Breusch\u0026ndash;Pagan. Between-group differences used independent-samples \u003cem\u003et\u003c/em\u003e-tests (or Mann\u0026ndash;Whitney U when assumptions were violated or subgroup \u003cem\u003en\u003c/em\u003e\u0026lt;30); categorical variables used \u0026chi;\u0026sup2; tests. Correlations used Pearson\u0026rsquo;s \u003cem\u003er\u003c/em\u003e (or Spearman\u0026rsquo;s \u0026rho; when non-normal). To control multiplicity, Benjamini\u0026ndash;Hochberg false discovery rate (FDR) adjustment (q=0.05) was applied to families of tests (all scale comparisons and correlation matrices); adjusted \u003cem\u003eq\u003c/em\u003e-values are reported where applicable. A simple linear regression modeled FIQR total from MCQ-30 total. Multicollinearity was acceptable (VIF\u0026lt;2). Influence diagnostics (Cook\u0026rsquo;s distance, leverage) showed no undue influence. Robustness checks (Huber M-estimator regression; Spearman\u0026rsquo;s \u0026rho;) yielded qualitatively unchanged inferences.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;2.5. Assumption Checks and Robustness.\u003c/strong\u003e Normality and homoscedasticity assumptions were examined via Q\u0026ndash;Q plots and Levene\u0026rsquo;s test, and heteroskedasticity was probed using Breusch\u0026ndash;Pagan tests. Influence diagnostics (Cook\u0026rsquo;s distance and leverage) were inspected to detect potential outliers. To assess robustness, we repeated key associations using Spearman\u0026rsquo;s rho and Huber M-estimator regressions; inferences remained qualitatively unchanged. Internal consistency in the present sample was satisfactory.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;2.6. Ethical Approval:\u003c/strong\u003e The study protocol was reviewed and approved by the Ethics Committee of Gazi University, T\u0026uuml;rkiye (approval no. 2019/130). \u003cstrong\u003eAll methods were performed in accordance with the relevant guidelines and regulations, including the\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eDeclaration of\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eHelsinki and institutional policies.\u003c/strong\u003e All participants were adults (\u0026ge;18 years), and \u003cstrong\u003ewritten informed consent\u003c/strong\u003e was obtained from all participants prior to enrolment.\u003c/p\u003e\n\u003cp\u003eThis observational study \u003cstrong\u003efollowed the STROBE guidelines\u003c/strong\u003efor reporting.\u003c/p\u003e"},{"header":"3. RESULTS","content":"\u003cp\u003eThe mean age was 39.14 years in the patient group and 38.67 years in the control group (\u003cem\u003et\u003c/em\u003e = 0.300, \u003cem\u003ep\u003c/em\u003e = .765), with no significant differences in age or education level (\u0026chi;\u0026sup2; = 2.248, \u003cem\u003ep\u003c/em\u003e = .134) \u003cstrong\u003e(Table 1).\u003c/strong\u003e In terms of place of residence, 85.7% of the patients and 95.6% of the controls were living in urban areas.\u003c/p\u003e\n\u003cp\u003eFindings related to the clinical characteristics of the patient group are presented in \u003cstrong\u003eTable 2.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo missing data were observed for primary variables (MCQ-30, FIQR, BDI, BAI). Analyses were conducted on a complete-case basis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.1. Comparison of Scale Scores Between Groups\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSignificant differences were found between groups in the following measures: MCQ-30 Cognitive Confidence (\u003cem\u003et\u003c/em\u003e = 4.392, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001), Uncontrollability/Danger (\u003cem\u003et\u003c/em\u003e = 3.754, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001), Cognitive Self-Consciousness (\u003cem\u003et\u003c/em\u003e = 3.878, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001), Need to Control Thoughts (\u003cem\u003et\u003c/em\u003e = 3.610, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001), MCQ-30 Total (\u003cem\u003et\u003c/em\u003e = 4.805, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001), FIQR Functional Impairment (\u003cem\u003et\u003c/em\u003e = 9.296, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001), FIQR Overall Impact (\u003cem\u003et\u003c/em\u003e = 9.756, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001), FIQR Symptom Severity (\u003cem\u003et\u003c/em\u003e = 13.821, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001), and FIQR Total (\u003cem\u003et\u003c/em\u003e = 13.116, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001). \u003cstrong\u003e(Table 3)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe distribution of participants according to the Beck Depression Inventory and Beck Anxiety Inventory is presented in \u003cstrong\u003eTable 4.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.2. Effect of Depression\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhen patients classified as \u003cem\u003edepressive\u003c/em\u003e with \u003cstrong\u003ehigh symptom severity\u003c/strong\u003e (moderate to severe levels according to BDI/BAI cutoff scores) were compared with those without, the depressive group showed significantly lower scores on MCQ-30 Cognitive Confidence (\u003cem\u003eU\u003c/em\u003e = 209.5, \u003cem\u003ep\u003c/em\u003e \u0026lt; .01), MCQ-30 Cognitive Self-Consciousness (\u003cem\u003eU\u003c/em\u003e = 139, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001), MCQ-30 Need to Control Thoughts (\u003cem\u003eU\u003c/em\u003e = 217.5, \u003cem\u003ep\u003c/em\u003e \u0026lt; .01), and MCQ-30 Total (\u003cem\u003eU\u003c/em\u003e = 188, \u003cem\u003ep\u003c/em\u003e \u0026lt; .01). Similarly, lower scores were observed on FIQR Functional Impairment (\u003cem\u003eU\u003c/em\u003e = 206.5, \u003cem\u003ep\u003c/em\u003e \u0026lt; .01), FIQR Overall Impact (\u003cem\u003eU\u003c/em\u003e = 191.5, \u003cem\u003ep\u003c/em\u003e \u0026lt; .01), FIQR Symptom Severity (\u003cem\u003eU\u003c/em\u003e = 121, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001), and FIQR Total (\u003cem\u003eU\u003c/em\u003e = 138.5, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001). \u003cstrong\u003e(Table 5)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.3. Effect of Anxiety\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhen patients classified as \u003cem\u003eanxious\u003c/em\u003e with \u003cstrong\u003ehigh symptom severity\u003c/strong\u003e (moderate to severe levels according to BDI/BAI cutoff scores) were compared with those without, the anxious group demonstrated significantly lower scores on MCQ-30 Positive Beliefs (\u003cem\u003eU\u003c/em\u003e = 252.5, \u003cem\u003ep\u003c/em\u003e \u0026lt; .05), MCQ-30 Cognitive Confidence (\u003cem\u003eU\u003c/em\u003e = 222.5, \u003cem\u003ep\u003c/em\u003e \u0026lt; .01), MCQ-30 Cognitive Self-Consciousness (\u003cem\u003eU\u003c/em\u003e = 135, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001), MCQ-30 Need to Control Thoughts (\u003cem\u003eU\u003c/em\u003e = 228, \u003cem\u003ep\u003c/em\u003e \u0026lt; .05), and MCQ-30 Total (\u003cem\u003eU\u003c/em\u003e = 172, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001). Similarly, lower scores were found on FIQR Functional Impairment (\u003cem\u003eU\u003c/em\u003e = 199.5, \u003cem\u003ep\u003c/em\u003e \u0026lt; .01), FIQR Overall Impact (\u003cem\u003eU\u003c/em\u003e = 260, \u003cem\u003ep\u003c/em\u003e \u0026lt; .05), FIQR Symptom Severity (\u003cem\u003eU\u003c/em\u003e = 166.5, \u003cem\u003ep\u003c/em\u003e \u0026lt; .001), and FIQR Total (\u003cem\u003eU\u003c/em\u003e = 175, \u003cem\u003ep\u003c/em\u003e \u0026lt; .01). \u003cstrong\u003e(Table 6)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;3.4. Correlations Between MCQ-30 and FIQR\u003c/strong\u003e\u003cbr\u003eSignificant positive correlations were found between MCQ-30 total scores and FIQR Functional Impairment (\u003cem\u003er\u003c/em\u003e = .439, \u003cem\u003ep\u003c/em\u003e\u0026lt; .01), Overall Impact (\u003cem\u003er\u003c/em\u003e = .310, \u003cem\u003ep\u003c/em\u003e \u0026lt; .05), Symptom Severity (\u003cem\u003er\u003c/em\u003e = .271, \u003cem\u003ep\u003c/em\u003e \u0026lt; .05), and FIQR Total (\u003cem\u003er\u003c/em\u003e = .395, \u003cem\u003ep\u003c/em\u003e \u0026lt; .01). \u003cstrong\u003e(Table 7)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e3.5. Regression Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA significant association was found between MCQ-30 total scores and FIQR total scores (\u0026beta; = 0.305, \u003cem\u003et\u003c/em\u003e = 2.405, \u003cem\u003ep\u003c/em\u003e = .020). Model coefficients were: A significant association was observed between MCQ-30 total and FIQR total \u003cstrong\u003e(\u003c/strong\u003e\u003cstrong\u003e\u0026beta;=0.31\u003c/strong\u003e\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003et(54)=2.41\u003c/strong\u003e\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ep=.020\u003c/strong\u003e\u003cstrong\u003e).\u003c/strong\u003e Model fit indices\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eR=0.31\u003c/strong\u003e\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eR\u0026sup2;=0.10\u003c/strong\u003e\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAdj. R\u0026sup2;=0.08\u003c/strong\u003e\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eF(1,54)=5.79\u003c/strong\u003e\u003cstrong\u003e,\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003ep=.020\u003c/strong\u003e\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eExamination of the \u003cem\u003et\u003c/em\u003e-test results for regression coefficients indicated that MCQ-30 total scores were a significant predictor of FIQR total scores. \u003cstrong\u003e(Table 8)\u0026nbsp;\u003c/strong\u003eThe unstandardized coefficient showed a precise effect (B=0.417, SE=0.173; 95% CI=0.078\u0026ndash;0.756), and the association remained significant in Huber M-regression (B\u0026asymp;0.40, p\u0026lt;.05) and under Spearman rank correlation (\u0026rho;\u0026asymp;.39, q\u0026lt;.01).\u003c/p\u003e"},{"header":"4. DISCUSSION","content":"\u003cp\u003eIn our study, 56 patients with FMS and 69 healthy controls were compared in terms of Metacognitions Questionnaire-30 (MCQ-30) scores and Fibromyalgia Impact Questionnaire-Revised (FIQR) scores. All patients with FMS were female, and to control for gender, the control group was also composed exclusively of women.\u003c/p\u003e\n\u003cp\u003eSimilarly, the mean age was 39.14 years in the patient group and 38.67 years in the control group, with no significant differences in either age or gender. The educational levels of both groups were also matched, and only participants who were high school or university graduates were included. The reason for selecting participants with higher educational levels was to control for potential confounding, as lower education has been associated in the literature with more pathological metacognitive systems \u003cstrong\u003e[15].\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eMetacognition plays a critical role in the functional and adaptive operation of an individual’s cognitive processes. It has been suggested that any deviation within the metacognitive system may constitute an important factor in the development and maintenance of various psychopathologies \u003cstrong\u003e[8].\u003c/strong\u003e Accordingly, impairments in metacognitive functions lead to dysfunctional thought patterns and ineffective coping styles in individuals. Moreover, individuals hold both positive and negative beliefs (metacognitions) about their own cognitions, which are often maladaptive. Such metacognitive beliefs may give rise to responses that disrupt psychological adjustment \u003cstrong\u003e[9].\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWhen the subcomponents of metacognition were examined, it was found that the FMS group had significantly higher scores than the healthy controls on the subscales of Cognitive Confidence, Uncontrollability and Danger, Cognitive Self-Consciousness, and Need to Control Thoughts. The “Uncontrollability and Danger” subscale assesses individuals’ beliefs that, in order to function effectively and feel safe, they must control their worries, while at the same time believing that worry is uncontrollable. This subscale encompasses situations in which individuals perceive their uncontrollable thoughts as a weakness, believe they may be punished for them, consider such thoughts as potentially impairing their functioning, or blame themselves for having these thoughts \u003cstrong\u003e[8].\u003c/strong\u003e In patients, elevated scores on this subscale may be explained by tendencies toward pessimism about the future, negative thoughts about themselves and others, disregarding contradictory evidence, and experiencing bodily symptoms in an exaggerated manner. Similarly, the significantly higher scores on the Need to Control Thoughts subscale in the patient group suggest that these individuals are more preoccupied with their thoughts.\u003c/p\u003e\n\u003cp\u003eWhen the total metacognition score was evaluated, positive correlations were also observed with all FIQR subscales and the total score. In the comparison between the two groups, significant differences were found in the total metacognition score and in the subscales of Uncontrollability and Danger, Cognitive Confidence, Need to Control Thoughts, and Cognitive Self-Consciousness. The positive correlations between total metacognition scores and all FIQR subscales, as well as the total score, support the view that metacognitive processes play a central role in the perception of symptoms in FMS. It can be suggested that characteristics such as anxiety, pessimism, maladjustment to the environment, passivity, excessive focus on flaws, and heightened bodily sensitivity may be more prominent in the FMS group, which in turn may negatively affect symptom perception. In this context, considering the positive correlation between disease symptoms and cognitive self-consciousness, increased illness awareness appears to heighten the focus on symptoms. This finding is also consistent with the literature suggesting that patients with FMS tend to employ pathological metacognitive thinking more frequently \u003cstrong\u003e[6,16].\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSimilar to the findings of our study, a previous investigation of metacognition in FMS reported that positive metacognitions about symptoms predicted impairments in physical functioning, whereas negative metacognitions about symptoms were associated with stress, anxiety, depression, and overall metacognitions, and significantly predicted the impact of FMS \u003cstrong\u003e[10].\u003c/strong\u003e Similarly, a study conducted on chronic fatigue syndrome examined metacognitive structures and found that negative emotions and metacognitions were positively correlated with symptom severity \u003cstrong\u003e[17].\u003c/strong\u003e In this context, it has been suggested that positive metacognitive beliefs may be beneficial in symptom management by activating conceptual processes and enhancing insight, whereas negative metacognitions may constitute a risk factor by increasing fatigue and symptom severity. Furthermore, the literature has shown that catastrophic cognitions related to chronic pain are closely associated with pain intensity and functional impairment \u003cstrong\u003e[18].\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA study on pain catastrophizing demonstrated that awareness predicted this process and significantly moderated the relationship between pain intensity and catastrophizing. These findings support the strong association between awareness and pain catastrophizing \u003cstrong\u003e[6,19].\u003c/strong\u003e However, pain catastrophizing is not a fixed trait; rather, it varies across individuals and over time depending on pain experience, contextual factors, ruminative thoughts, and metacognitive beliefs about coping strategies. In our study, 39.4% of patients reported a relapsing course of the illness, which suggests that this fluctuation may be associated with ruminative thoughts and variable metacognitive coping processes \u003cstrong\u003e[20].\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIn our study, depression and anxiety scores were higher in the patient group compared to the control group, and this result was consistent with the literature \u003cstrong\u003e[21].\u003c/strong\u003e However, the finding that FMS patients with depression and anxiety, as defined by BDI/BAI cutoff scores, had lower metacognition scores was unexpected and contradicts some reports in the literature \u003cstrong\u003e[10,11,22,23].\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis situation may be explained by patients’ tendency to catastrophize symptoms, their use of depressive and anxious language, or the possibility that depression and anxiety symptoms are expressed differently within a cultural context \u003cstrong\u003e[25,26].\u003c/strong\u003e When compared with German and Italian samples (Kollmann, Romeo), the paradoxical association observed in the Turkish sample may be explained by cultural tendencies toward somatization. This finding supports the hypothesis that emotional symptoms may be masked and redirected into bodily complaints.On the other hand, it should also be considered that depression and anxiety may, in some individuals, increase symptom awareness and lead to a paradoxical rise in metacognitive functions (a consistent inconsistency), or that measurement biases may have played a role. This finding suggests that the relationships between metacognition and depression, and between metacognition and anxiety, are not homogeneous and may vary according to cultural context \u003cstrong\u003e[27].\u003c/strong\u003e In this respect, our result may raise new questions for future cross-cultural and longitudinal studies.\u003c/p\u003e\n\u003cp\u003eIn our study, a negative association was identified between depression and anxiety scores and FIQR scores among patients with FMS. This finding suggests that some individuals may express intrapsychic conflicts related to depression and anxiety through somatization within a cultural context, thereby masking emotional symptoms and contributing to an increase in somatic complaints \u003cstrong\u003e[28,29,30].\u003c/strong\u003e Previous literature has reported that higher levels of self-efficacy are associated with better symptom management and greater functionality\u0026nbsp;\u003cstrong\u003e[24].\u003c/strong\u003e Accordingly, the negative relationship between depression and anxiety and FIQR scores may be linked to coping strategies and tendencies toward somatization commonly employed in FMS. Nevertheless, these results point to masked depression or somatization merely as a hypothesis, which requires further validation through future research. At the same time, this observation underscores the importance of a psychosomatic perspective in evaluating conditions such as FMS, where bodily symptoms are prominent, in order to uncover patients’ underlying psychological needs. From a clinical standpoint, systematically assessing depressive and anxiety symptoms, rather than focusing solely on pain or physical complaints, and incorporating cognitive-behavioral interventions may provide a more comprehensive approach to the management of the illness.\u003cbr\u003e\u0026nbsp;\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOur study has several limitations. The relatively small sample size, the use of cutoff scores for the BDI and BAI, the reliance on self-report measures, and the single-center design may limit the generalizability of the findings. In addition, the cross-sectional design prevents the establishment of causal relationships. The paradoxical association identified in depression and anxiety subgroups should be examined in greater detail in future studies using moderator analyses and longitudinal designs.\u0026nbsp;Despite these limitations, the regression analysis showing that metacognitive processes modestly but independently predicted FIQR outcomes represents a key finding of our study and is consistent with the literature.\u0026nbsp;The MCQ-30 total score accounted for only\u0026nbsp;\u003cstrong\u003eR²≈.10, Adj. R²≈.08\u0026nbsp;\u003c/strong\u003eof the variance in FIQR total scores, representing a limited yet clinically meaningful contribution within the multifactorial nature of FMS. This finding indicates that metacognitive functions exert an independent influence on daily functioning. Taken together, these findings suggests that pathological metacognitive processes may increase the overall impact of the illness, as well as symptom severity and intensity, thereby negatively affecting patients’ functioning.\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThis study is among the first to investigate the association between metacognitive functions and disease impact in FMS within a Turkish sample. The findings indicate that FMS is not merely a somatic pain disorder but rather a complex condition accompanied by impairments in cognitive, emotional, and social-cognitive processes. The observation that metacognitive dysfunction significantly predicted the impact of FMS on daily life suggests that metacognitive functions may play a fundamental role in the course of the illness. Therefore, the study proposes that metacognition-focused interventions targeting awareness in a psychosomatic context may be beneficial for symptom management in FMS.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;The authors sincerely thank all participants for their valuable contribution to this study.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors and affiliations:\u003c/strong\u003e\u003c/p\u003e\n\u003col\u003e\n \u003cli\u003e\u003cstrong\u003eYunus Bayram Koçyiğit\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Psychiatry Department of Fethiye State Hospital, Muğla, Türkiye\u003cbr\u003eEmail: [email protected] | Phone: +90 506 572 8469\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eBelgin Karaoğlan\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Physical Medicine and Rehabilitation Department of Gazi University Hospital, Ankara, Türkiye\u003cbr\u003eEmail: [email protected]\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAslı Kuruoğlu\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Psychiatry Department of Gazi University Hospital, Ankara, Türkiye\u003cbr\u003eEmail: [email protected]\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e\u003cstrong\u003eCorresponding author:\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Yunus Bayram Koçyiğit\u003cbr\u003e\u0026nbsp;Psychiatry Department of Fethiye State Hospital, Muğla, Türkiye\u003cbr\u003eEmail: [email protected] | Phone: +90 506 572 8469\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCRediT authorship statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eConceptualization: YBK, BK, AK\u003c/li\u003e\n \u003cli\u003eMethodology: YBK, AK\u003c/li\u003e\n \u003cli\u003eInvestigation: BK, AK\u003c/li\u003e\n \u003cli\u003eFormal analysis: YBK\u003c/li\u003e\n \u003cli\u003eWriting – original draft: YBK\u003c/li\u003e\n \u003cli\u003eWriting – review \u0026amp; editing:YBK, BK, AK\u003c/li\u003e\n \u003cli\u003eSupervision: AK\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e\u003cstrong\u003eData availability:\u003c/strong\u003e Data are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDeclaration of competing interests:\u003c/strong\u003e The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u003c/strong\u003e The authors declare that they received no financial support for the conduct of the research and/or preparation of the article.\u003c/p\u003e\n\u003cp\u003eThis manuscript is derived from a psychiatry residency thesis completed at the Gazi University Faculty of Medicine in 2019; the data and interpretations have been updated and the work was prepared as a manuscript in 2025.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eH\u0026auml;user W, Zimmer C, Felde E, K\u0026ouml;llner V. 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DOI:\u0026nbsp;10.1371/journal.pone.0116542\u003c/li\u003e\n\u003cli\u003eJulius H.\u0026nbsp;Bourke, Central sensitisation in chronic fatigue syndrome and fibromyalgia; a case control study, J Psychosom Res.\u0026nbsp;2021; doi: https://doi.org/10.1016/j.jpsychores.2021.110624\u003c/li\u003e\n\u003cli\u003eMin LiuGender differences in clinical presentations and sensory profiles in patients with fibromyalgia: implications of peripheral and central mechanisms, 2025; doi:10.1097/PR9.0000000000001229\u003c/li\u003e\n\u003cli\u003eMolnar DS, Flett GL, Sadava SW, Colautti J. Perfectionism and health functioning in women with fibromyalgia.\u0026nbsp;\u003cem\u003eJ Psychosom Res.\u003c/em\u003e\u0026nbsp;2012;73(4):295-300. DOI:\u0026nbsp;10.1016/j.jpsychores.2012.08.001\u003c/li\u003e\n\u003cli\u003eAnnunziata\u0026nbsp;Romeo, Metacognition and pain in patients with fibromyalgia: the role of psychological distress, 2025; https://doi.org/10.1016/j.jad.2025.04.062\u003c/li\u003e\n\u003cli\u003eGalvez-Sa ́nchez, C.M., Montoro, C.I., Duschek, S., Reyes Del Paso, G.A., 2020. Depression and trait-anxiety mediate the influence of clinical pain on health-related quality of life in fibromyalgia. J. Affect. Disord. 15, 486\u0026ndash;495.2020; https://doi.org/10.1016/j.jad.2020.01.129\u003c/li\u003e\n\u003cli\u003eWells A, Cartwright-Hatton S. A short form of the metacognitions questionnaire: properties of the MCQ-30.\u0026nbsp;\u003cem\u003eBehav Res Ther.\u003c/em\u003e\u0026nbsp;2004;42(4):385-396. https://doi.org/10.1016/S0005-7967(03)00147-5\u003c/li\u003e\n\u003cli\u003eCartwright-Hatton S, Wells A. Beliefs about worry and intrusions: the Meta-Cognitions Questionnaire and its correlates.\u0026nbsp;\u003cem\u003eJ Anxiety Disord.\u003c/em\u003e\u0026nbsp;1997;11(3):279-296. https://doi.org/10.1016/S0887-6185(97)00011-X\u003c/li\u003e\n\u003cli\u003eKollmann J, Gollwitzer M, Spada MM, Fernie BA. The association between metacognitions and the impact of fibromyalgia in a German sample.\u0026nbsp;\u003cem\u003eJ Psychosom Res.\u003c/em\u003e\u0026nbsp;2016; 83:1-9. DOI:\u0026nbsp;10.1016/j.jpsychores.2016.02.002\u003c/li\u003e\n\u003cli\u003eAnne\u0026nbsp;Thingbak, Relationships between metacognitive beliefs and anxiety and depression in children and adolescents: A meta-analysis, Journal of Affective Disorders, 2024, https://doi.org/10.1016/j.jad.2024.05.123\u003c/li\u003e\n\u003cli\u003e\u003cem\u003eTosun, A. ve Irak, M. \u003c/em\u003eAdaptation, validity, and reliability of the Metacognition Questionnaire-30 for the Turkish population, and its relationship to anxiety and obsessive-compulsive symptoms, Turk Psikiyatri Derg. 2008 Spring;19(1):67-80.\u003c/li\u003e\n\u003cli\u003eRobert M Bennett, The Revised Fibromyalgia Impact Questionnaire (FIQR): validation and psychometric properties, 10 August 2009, \u003cem\u003eArthritis Research \u0026amp; Therapy\u003c/em\u003e\u003cstrong\u003e, \u003c/strong\u003eDOI:10.1186/ar2783\u003c/li\u003e\n\u003cli\u003eEdiz, L., Hiz, O., Toprak, M.\u0026nbsp;\u003cem\u003eet al.\u003c/em\u003e\u0026nbsp;The validity and reliability of the Turkish version of the Revised Fibromyalgia Impact Questionnaire.\u0026nbsp;\u003cem\u003eClin Rheumatol\u003c/em\u003e\u0026nbsp;\u003cstrong\u003e30\u003c/strong\u003e, 339\u0026ndash;346 (2011). https://doi.org/10.1007/s10067-010-1546-8\u003c/li\u003e\n\u003cli\u003eDelia Fentazi, Why is low educational attainment linked to worse pain and function in fibromyalgia? JPain. 2025 Feb: 27: 104764., DOI:10.1016/j.jpain.2024.104764\u003c/li\u003e\n\u003cli\u003eİnanır S, Taycan SE, İnanır A, \u0026Ccedil;elikel FC, Etikan İ. Metacognitive evaluation in patients with fibromyalgia syndrome.\u0026nbsp;Klinik Psikofarmakoloji Bulteni, 2015, Vol 25, pS175 ;25(1):18-26. doi:10.5455/bcp.20150118020941\u003c/li\u003e\n\u003cli\u003eMaher-Edwards L, Fernie BA, Murphy G, Nikcevic AV, Spada MM. Metacognitive factors in chronic fatigue syndrome.\u0026nbsp;\u003cem\u003eClin Psychol Psychother.2011;\u003c/em\u003e https://doi.org/10.1002/cpp.757\u003c/li\u003e\n\u003cli\u003eRaichle KA, Hanley M, Jensen MP, Cardenas DD. Cognitions, coping, and social environment predict adjustment to pain in spinal cord injury.\u0026nbsp;\u003cem\u003eJ Pain.\u003c/em\u003e\u0026nbsp;2007;8(9):718-729. DOI:\u0026nbsp;10.1016/j.jpain.2007.05.006\u003c/li\u003e\n\u003cli\u003eSch\u0026uuml;tze R, Rees C, Preece M, Sch\u0026uuml;tze M. Low mindfulness predicts pain catastrophizing in a fear-avoidance model of chronic pain. \u003cem\u003ePain.\u003c/em\u003e\u0026nbsp;2010;148(1):120-127. https://doi.org/10.1016/j.pain.2009.10.030\u003c/li\u003e\n\u003cli\u003eSch\u0026uuml;tze R, Rees C, Slater H, Smith A, O\u0026rsquo;Sullivan P. \u0026lsquo;I call it stinkin\u0026rsquo; thinkin\u0026rsquo;\u0026rsquo;: A qualitative analysis of metacognition in people with chronic low back pain and elevated catastrophizing.\u0026nbsp;\u003cem\u003eBr J Health Psychol.\u003c/em\u003e2017;22(3):463-480. https://doi.org/10.1111/bjhp.12240\u003c/li\u003e\n\u003cli\u003eA. Demirkan, The mediating role of anxiety and depression in the relationship between alexithymia, somatosensory amplification, and functional impairment in fibromyalgia, 2025; doi:10.3389/fpsyt.2025.1598901\u003c/li\u003e\n\u003cli\u003eHacker DJ, Dunlosky J, Graesser AC, editors.\u0026nbsp;\u003cem\u003eHandbook of metacognition in education\u003c/em\u003e. New York: Routledge; 1st Edition, 2009. eBook ISBN\u0026nbsp;9780203876428\u003c/li\u003e\n\u003cli\u003eSlife BD, Weaver CA. Depression, cognitive skill, and metacognitive skill in problem solving.\u0026nbsp;\u003cem\u003eCogn Emot.\u003c/em\u003e1992;6(1):1-22. https://doi.org/10.1080/02699939208411055\u003c/li\u003e\n\u003cli\u003eHana Karpin, Cognitive Self-Efficacy Levels Distinguish Among Disease Severity, Pain-Related Function, and Perceived Health of Individuals With Fibromyalgia, 2025; https://doi.org/10.5014/ajot.2025.050931\u003c/li\u003e\n\u003cli\u003eXuexin Yu, Cross-national statistical harmonization of the Center for Epidemiologic Studies Depression (CES-D) scale among older adults in China, England, India, Mexico, South Africa, and the United States, 2025;DOI:10.1016/j.jclinepi.2024.111623\u003c/li\u003e\n\u003cli\u003eYu (Carrie)\u0026nbsp;CHENG, Cognitive impairment, physical frailty and depression in older adults from culturally and linguistically diverse community: A cross-sectional study, 2025; https://doi.org/10.1016/j.gerinurse.2025.103569\u003c/li\u003e\n\u003cli\u003eCorey Jackson, Mechanics of Mindfulness: Investigating Metacognitive Beliefs as a Pathway of Effect on Anxiety and Depression, tig Health Psychol Educ, 2025 Jun 12;15(6):109. DOI:10.3390/ejihpe15060109\u003c/li\u003e\n\u003cli\u003eFelix Angst, Somatization differentiates fibromyalgia from low back pain: a comparative, cross-sectional cohort studyRheumatology (Oxford)2025 Apr 1;64(4):1741-1749. DOI:\u0026nbsp;10.1093/rheumatology/keae462\u003c/li\u003e\n\u003cli\u003ePrisco V, Donnarumma B, Prisco L. Evolution of Psychosomatic Diagnosis: From Masked Depression to Somatic Symptoms and Related Disorders.\u0026nbsp;\u003cem\u003eOBM Geriatrics\u003c/em\u003e\u0026nbsp;\u003cstrong\u003e2023\u003c/strong\u003e; 7(1): 228; doi:10.21926/obm.geriatr.2301228\u003c/li\u003e\n\u003cli\u003eCan Nakkas, Somatization and Coping in Ethnic Minority Recruits, Mil Med, 2019 Dec 1;184(11-12):e680-e685. DOI:10.1093/milmed/usz014\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e\u003cstrong\u003eTable 1. Sociodemographic Characteristics\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003e(n and row percentages)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatient n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal n\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status \u0026ndash; Single\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e16 (47.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e18 (52.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status \u0026ndash; Married\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e31 (39.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e47 (60.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e78\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status \u0026ndash; Divorced/Widowed\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e9 (69.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e4 (30.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e13\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation \u0026ndash; University\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e39 (41.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e56 (58.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e95\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEducation \u0026ndash; High School\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e17 (56.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e13 (43.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e30\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation \u0026ndash; Civil Servant/Worker\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e22 (25.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e65 (74.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation \u0026ndash; Retired\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e6 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eOccupation \u0026ndash; Other\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e28 (87.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e4 (12.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e32\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCurrently Working\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e31 (31.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e69 (69.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eNot Working\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e25 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Clinical Characteristics of the Patient Group\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCourse \u0026ndash; Relapsing\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e22 (39.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCourse \u0026ndash; Chronic\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e34 (60.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment \u0026ndash; None\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e23 (41.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTreatment \u0026ndash; Present\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e33 (58.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidity \u0026ndash; None\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e45 (80.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eComorbidity \u0026ndash; Present\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e11 (19.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDisease Duration (months)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e53.48 \u0026plusmn; 57.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLongest Remission (months)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e6.05 \u0026plusmn; 15.99\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eLongest Relapse (months)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e6.36 \u0026plusmn; 7.73\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eUntreated Duration (months)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 192px;\"\u003e\n \u003cp\u003e14.07 \u0026plusmn; 24.45\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Comparison of Patient and Control Groups on Scale Scores\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMeasure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatient Mean\u0026plusmn;SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl Mean\u0026plusmn;SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u003cstrong\u003et\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eCohen\u0026apos;s d\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI (low)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI (high)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEffect size\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMCQ-30 Positive Beliefs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e11.34 \u0026plusmn; 4.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e10.22 \u0026plusmn; 3.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e1.530\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e0.129\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.278\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e-0.077\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e0.632\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eSmall\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMCQ-30 Cognitive Confidence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e13.45 \u0026plusmn; 3.92\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e10.45 \u0026plusmn; 3.64\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e4.392\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.796\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e0.430\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1.163\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMCQ-30 Uncontrollability/Danger\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e15.00 \u0026plusmn; 4.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e11.88 \u0026plusmn; 4.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e3.754\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.683\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e0.320\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1.046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMCQ-30 Cognitive Self-Consciousness\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e14.12 \u0026plusmn; 4.77\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e11.13 \u0026plusmn; 3.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e3.878\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.716\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e0.352\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1.079\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMCQ-30 Need to Control Thoughts\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e16.07 \u0026plusmn; 3.94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e13.67 \u0026plusmn; 3.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e3.610\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.658\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e0.296\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1.020\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMCQ-30 Total\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e69.75 \u0026plusmn; 15.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e57.09 \u0026plusmn; 13.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e4.805\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e0.881\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e0.512\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e1.250\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eLarge\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIQR Functional Impairment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e12.31 \u0026plusmn; 8.11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e1.58 \u0026plusmn; 3.30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e9.296\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e1.803\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1.384\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e2.221\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eLarge\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIQR Overall Impact\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e8.52 \u0026plusmn; 6.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e5.54 \u0026plusmn;\u0026nbsp;\u003c/p\u003e\n \u003cp\u003e7.42\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e9.756\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e1.769\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e1.523\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e2.380\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eLarge\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIQR Symptom Severity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e26.49 \u0026plusmn; 10.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e4.96 \u0026plusmn; 6.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e13.821\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e2.595\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2.116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e3.074\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eLarge\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 155px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIQR Total\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e47.08 \u0026plusmn; 21.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e6.55 \u0026plusmn; 9.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e13.116\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 44px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 58px;\"\u003e\n \u003cp\u003e2.538\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 45px;\"\u003e\n \u003cp\u003e2.064\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 49px;\"\u003e\n \u003cp\u003e3.012\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 57px;\"\u003e\n \u003cp\u003eLarge\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNotes.\u003c/strong\u003e\u003cbr\u003eValues are presented as Mean \u0026plusmn; SD. Independent-samples \u003cem\u003et\u003c/em\u003e-tests were used unless indicated. \u0026dagger;Mann\u0026ndash;Whitney U test applied due to zero variance in controls. Effect sizes are interpreted as: small (d\u0026asymp;0.20/r\u0026asymp;0.10), medium (d\u0026asymp;0.50/r\u0026asymp;0.30), large, group comparison used \u003cstrong\u003eMann\u0026ndash;Whitney U\u003c/strong\u003e; effect size r is reported. (d\u0026ge;0.80/r\u0026ge;0.50). FIQR: Fibromyalgia Impact Questionnaire-Revised; MCQ-30: Metacognitions Questionnaire-30.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4. Distribution of Beck Depression and Anxiety Levels\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eScale/Level\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ePatient n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eControl n (%)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eTotal n\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepression \u0026ndash; None/Minimal\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e15 (26.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e42 (73.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepression \u0026ndash; Mild\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e16 (45.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e19 (54.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e35\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepression \u0026ndash; Moderate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e21 (75.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e7 (25.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eDepression \u0026ndash; Severe\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e4 (80.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e1 (20.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnxiety \u0026ndash; None\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e11 (19.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e45 (80.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e56\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnxiety \u0026ndash; Mild\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e13 (41.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e18 (58.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnxiety \u0026ndash; Moderate\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e14 (70.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e6 (30.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAnxiety \u0026ndash; Severe\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e18 (100)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e0 (0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 144px;\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNotes: Values are \u003cstrong\u003en (%)\u003c/strong\u003e. Group differences assessed with \u003cstrong\u003e\u0026chi;\u0026sup2; tests\u003c/strong\u003e.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eTable 5. Comparison of Patients With and Without Depression\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMeasure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en_low / n_high\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eU\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ez\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026nbsp; p\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEffect size\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMCQ-30 Positive Beliefs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e35 / 21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e313.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-1.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;.220\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-0.16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eSmall\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMCQ-30 Cognitive Confidence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e35 / 21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e209.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-2.93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-0.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMCQ-30 Uncontrollability/Danger\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e35 / 21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e288.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-1.63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;.102\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-0.22\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eSmall\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMCQ-30 Cognitive Self-Consciousness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e35 / 21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e139.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-4.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eLarge\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMCQ-30 Need to Control Thoughts\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e35 / 21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e217.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-2.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;.005\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-0.37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMCQ-30 Total\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e35 / 21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e188.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-3.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-0.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIQR Functional Impairment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e35 / 21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e206.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-2.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-0.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIQR Overall Impact\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e35 / 21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e191.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-3.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-0.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIQR Symptom Severity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e35 / 21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e121.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-4.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-0.59\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eLarge\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIQR Total\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e35 / 21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e138.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-4.10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eLarge\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote. Values are median [IQR]. Mann\u0026ndash;Whitney U test used due to non-normal distributions. Effect sizes (r) calculated as z/\u0026radic;N, with N_total = 56. Severity levels for BDI (0\u0026ndash;13 minimal, 14\u0026ndash;19 mild, 20\u0026ndash;28 moderate, 29\u0026ndash;63 severe) and BAI (0\u0026ndash;7 minimal, 8\u0026ndash;15 mild, 16\u0026ndash;25 moderate, 26\u0026ndash;63 severe) were used. Subgroup comparisons contrasted patients with moderate-to-severe symptoms (BDI \u0026ge;20; BAI \u0026ge;16) against those below these thresholds. Cut-offs based on Beck et al., 1961/1988 validation studies.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6. Comparison of Patients With and Without Anxiety\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMeasure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003en_low / n_high\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eU\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ez\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eEffect size\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMCQ-30 Positive Beliefs\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e38 / 18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e252.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-2.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-0.29\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eSmall\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMCQ-30 Cognitive Confidence\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e38 / 18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e222.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-2.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e.007\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-0.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMCQ-30 Uncontrollability/Danger\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e38 / 18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e329.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-0.90\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e.365\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-0.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eSmall\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMCQ-30 Cognitive Self-Consciousness\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e38 / 18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e135.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-4.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-0.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eLarge\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMCQ-30 Need to Control Thoughts\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e38 / 18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e228.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-2.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026lt;.010\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-0.35\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMCQ-30 Total\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e38 / 18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e172.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-3.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-0.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIQR Functional Impairment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e38 / 18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e199.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-3.06\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026nbsp;.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-0.41\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIQR Overall Impact\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e38 / 18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e260.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-2.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e.039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eSmall\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIQR Symptom Severity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e38 / 18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e166.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-3.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-0.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIQR Total\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e38 / 18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e175.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-3.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e\u0026lt;.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003e-0.46\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 82px;\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eNote. Values are median [IQR]. Mann\u0026ndash;Whitney U test used due to non-normal distributions. Effect sizes (r) calculated as z/\u0026radic;N, with N_total = 56. Severity levels for BDI (0\u0026ndash;13 minimal, 14\u0026ndash;19 mild, 20\u0026ndash;28 moderate, 29\u0026ndash;63 severe) and BAI (0\u0026ndash;7 minimal, 8\u0026ndash;15 mild, 16\u0026ndash;25 moderate, 26\u0026ndash;63 severe) were used. Subgroup comparisons contrasted patients with moderate-to-severe symptoms (BDI \u0026ge;20; BAI \u0026ge;16) against those below these thresholds. Cut-offs based on Beck et al., 1961/1988\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7. Correlations Between MCQ-30 and FIQR in Patient Group\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMeasure\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMCQ-30 Subscale\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e\u003cstrong\u003er\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI (low)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI (high)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eStrength\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSignificance\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIQR Functional Impairment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003ePositive Beliefs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.189\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e-0.078\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.431\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eSmall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003ens\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIQR Functional Impairment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eCognitive Confidence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.474\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.241\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.655\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eSignificant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIQR Functional Impairment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eUncontrollability /Danger\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.329\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.072\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.545\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eSignificant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIQR Functional Impairment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eCognitive Self-Consciousness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.387\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.590\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eSignificant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIQR Functional Impairment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eNeed to Control Thoughts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.229\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e-0.036\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.464\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eSmall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003ens\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIQR Functional Impairment\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.439\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.199\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.629\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eSignificant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIQR Overall Impact\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003ePositive Beliefs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.145\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e-0.123\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.393\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eSmall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003ens\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIQR Overall Impact\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eCognitive Confidence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.383\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.134\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.587\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eSignificant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIQR Overall Impact\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eUncontrollability /Danger\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.161\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e-0.106\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.407\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eSmall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003ens\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIQR Overall Impact\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eCognitive Self-Consciousness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.284\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.023\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.509\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eSmall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eSignificant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIQR Overall Impact\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eNeed to Control Thoughts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e-0.144\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.375\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eSmall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003ens\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIQR Overall Impact\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.310\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.051\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.530\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eSignificant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIQR Symptom Severity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003ePositive Beliefs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.029\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e-0.236\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.290\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eNegligible\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003ens\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIQR Symptom Severity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eCognitive Confidence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.327\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.070\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.543\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eSignificant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIQR Symptom Severity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eUncontrollability /Danger\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.253\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e-0.011\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.484\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eSmall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003ens\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIQR Symptom Severity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eCognitive Self-Consciousness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.375\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.124\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.581\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eSignificant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIQR Symptom Severity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eNeed to Control Thoughts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.114\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e-0.154\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.366\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eSmall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003ens\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIQR Symptom Severity\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.271\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.498\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eSmall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eSignificant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIQR Total\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003ePositive Beliefs\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e-0.130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.387\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eSmall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003ens\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIQR Total\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eCognitive Confidence\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.459\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.223\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.644\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eSignificant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIQR Total\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eUncontrollability /Danger\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.291\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;.05\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.030\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.515\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eSmall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eSignificant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIQR Total\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eCognitive Self-Consciousness\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.409\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.164\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.607\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eSignificant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIQR Total\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eNeed to Control Thoughts\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.189\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e-0.078\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.431\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eSmall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003ens\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eFIQR Total\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 64px;\"\u003e\n \u003cp\u003e0.395\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 63px;\"\u003e\n \u003cp\u003e\u0026lt;.01\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 65px;\"\u003e\n \u003cp\u003e0.147\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 66px;\"\u003e\n \u003cp\u003e0.596\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 70px;\"\u003e\n \u003cp\u003eMedium\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003eSignificant\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNotes.\u003c/strong\u003e\u003cbr\u003e\u0026nbsp;Pearson\u0026rsquo;s correlations reported when assumptions were met; otherwise Spearman\u0026rsquo;s rho. Effect size interpretation: |r|\u0026asymp;0.10 small, |r|\u0026asymp;0.30 medium, |r|\u0026ge;0.50 large. p values are two-tailed and FDR-adjusted.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 8. Regression Analysis Predicting FIQR Total Scores (Single Predictor Model)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eB\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eSE\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u0026beta;\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003et\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMCQ-30 Total\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0.417\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0.173\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e0.311\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e2.405\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 96px;\"\u003e\n \u003cp\u003e.020\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eModel Summary: R = 0.311, R\u0026sup2; = 0.097, Adj. R\u0026sup2; = 0.080, F(1,54) = 5.79, p = .020\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNotes.\u003c/strong\u003e Simple linear regression with FIQR total as dependent variable. Multicollinearity diagnostics acceptable (VIF \u0026lt; 2). \u0026beta; = standardized regression coefficient.\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Fibromyalgia, Metacognition, Symptom severity, Psychosomatic medicine, Functional impairment, Cross-cultural, Turkey","lastPublishedDoi":"10.21203/rs.3.rs-7687377/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7687377/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e We examined whether metacognitive processes are associated with fibromyalgia impact and compared metacognitions between patients with fibromyalgia syndrome (FMS) and matched healthy controls. We hypothesized that MCQ-30 scores would be higher in FMS and would predict FIQR total.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e In this cross-sectional study, 56 female FMS patients and 69 age-/education-matched women completed the Metacognitions Questionnaire-30 (MCQ-30), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Revised Fibromyalgia Impact Questionnaire (FIQR). Group differences used \u003cem\u003et\u003c/em\u003e-tests or Mann–Whitney U tests; correlations used Pearson/Spearman with Benjamini–Hochberg FDR adjustment; simple linear regression tested MCQ-30 total → FIQR total. Assumptions and robustness (Huber M-regression) were examined.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e Compared with controls, the FMS group showed higher MCQ-30 Cognitive Confidence, Uncontrollability/Danger, Cognitive Self-Consciousness, Need to Control Thoughts, MCQ-30 total, and all FIQR indices (all p\u0026lt;.001; d=0.66–2.60). In patients, FIQR total correlated with MCQ-30 total (r=.40, q\u0026lt;.01) and with Cognitive Confidence and Cognitive Self-Consciousness (q\u0026lt;.01). MCQ-30 total predicted FIQR total (B=0.417, SE=0.173, β=.31, R²=.10, p=.020; 95% CI for B=0.078–0.756). In robustness checks, the association remained significant (Huber M-regression B≈0.40, p\u0026lt;.05). Exploratory subgroup analyses using established BDI/BAI cut-offs indicated \u003cstrong\u003elower\u003c/strong\u003e MCQ-30 and \u003cstrong\u003elower\u003c/strong\u003e FIQR scores in patients with moderate-to-severe depression/anxiety versus those below cut-offs (all q≤.01) a counterintuitive pattern discussed within a cultural somatization/measurement-domain framework.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e Metacognitive dysfunctions are elevated in FMS and show a modest yet independent association with disease impact, supporting metacognition-focused psychosomatic interventions. The paradoxical subgroup pattern warrants cross-cultural, prespecified moderator analyses in longitudinal designs.\u003c/p\u003e","manuscriptTitle":"The Role of Metacognition and Psychological Distress in Fibromyalgia Impact: a cross-sectional study in a Turkish clinical sample","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-01-28 16:55:53","doi":"10.21203/rs.3.rs-7687377/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2026-02-25T06:07:39+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-21T11:42:57+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-20T12:36:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"241122143688419433221037921795570728359","date":"2026-02-09T17:16:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"85698573539581548522983996089456803957","date":"2026-02-06T11:42:54+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-01-27T05:46:14+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-09-30T16:04:16+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-09-26T14:31:42+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-09-26T14:28:18+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"e49f7975-516c-4f77-b5b3-e4002cd9a572","owner":[],"postedDate":"January 28th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"in-revision","subjectAreas":[{"id":61847614,"name":"Health sciences/Diseases"},{"id":61847615,"name":"Health sciences/Health care"},{"id":61847616,"name":"Health sciences/Medical research"},{"id":61847617,"name":"Biological sciences/Psychology"},{"id":61847618,"name":"Social science/Psychology"}],"tags":[],"updatedAt":"2026-05-19T07:25:18+00:00","versionOfRecord":[],"versionCreatedAt":"2026-01-28 16:55:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7687377","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7687377","identity":"rs-7687377","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}