The Role of Metacognition, Intolerance of Uncertainty, and Cognitive‐Attentional Syndrome in Differentiating Fear of Cancer Recurrence

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OBJECTIVES: This study tested (1) whether intolerance of uncertainty (IU) and negative metacognitive beliefs independently differentiate fear of cancer recurrence (FCR) status, and (2) whether mediation by cognitive-attentional syndrome (CAS) elements modify the relationships of IU and metacognitive beliefs with FCR status. METHODS: Baseline data from 384 participants (collected ∼15.6 months post-diagnosis) pooled from a prospective longitudinal study and an FCR intervention trial were analyzed. Measures included FCRI-SF (FCR), MCQ-30 (metacognitive beliefs), IUS-12 (IU), and CAS-1 (CAS). FCR status was classified based on the FCRI-SF scores as non-clinical (< 13), subclinical (13-21), and clinically significant (≥ 22). Fully adjusted multinomial logistic regression examined direct effects of IU and metacognitive domains on FCR status and indirect effects via CAS. RESULTS: Compared to the non-clinical group (n = 116), subclinical (n = 190) and clinically-significant (n = 78) FCR groups showed greater negative beliefs about worry (OR range 1.297-1.500, p < 0.001), higher IU (OR 1.050-1.066, p = 0.037), increased use of CAS metacognitive strategies (OR 1.077-1.108, p = 0.021-< 0.001), and less perceived need to control thoughts (OR 0.847-0.857, p = 0.003-0.027). Clinically-significant FCR was additionally associated with poorer cognitive confidence (OR 1.122, p = 0.030). CAS partially mediated associations of FCR status with negative beliefs about worry, cognitive confidence, and IU, and fully mediated the association with need to control thoughts. CONCLUSIONS: IU and negative metacognitive beliefs can characterize individuals vulnerable to differentially-elevated FCR. CAS centrally mediates the relationships between FCR, IU, and metacognition. Cognitive-behavioral interventions for FCR explicitly targeting CAS should disrupt the impact of IU and metacognitive beliefs on FCR.

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