Emotional burden and coping strategies in amyotrophic lateral sclerosis caregivers: the role of metacognitions

BACKGROUND: The present study examines the relationships between metacognitions and emotional burden and coping strategies in amyotrophic lateral sclerosis (ALS) caregivers. Metacognition is defined as "the aspect of information processing that monitors and evaluates the contents and processes of its organization". Maladaptive metacognitive beliefs can contribute the development of anxiety and depression and to the activation of an unhelpful style of information processing in health-related stressful situations. METHODS: A prospective multicenter cross-sectional study was performed by consecutively enrolling primary caregivers and related ALS patients (N.=70). They completed a set of self-reported questionnaires measuring metacognitions, state and trait anxiety, depressive symptoms and caregivers' burden. RESULTS: Metacognitions were significantly related to state and trait anxiety, cognitive and somatic aspects of depression and caregiver burden. Among the different subscales, "negative beliefs about worry concerning uncontrollability and danger" showed the strongest correlations with all the above mentioned aspects. Moreover, negative beliefs showed the strongest correlations with maladaptive coping strategies as denial and venting. This study provides evidence that metacognitive beliefs might be predictive factors of higher ALS caregivers anxiety, cognitive and somatic components of depression, burden and an increased use of maladaptive coping strategies. CONCLUSIONS: These results suggest the importance of evaluating psychological functioning for both ALS patients and their caregivers to individuate vulnerability factors of emotional distress. The presence of dysfunctional metacognitive beliefs may have some important implications for clinical practice. Hence, psychological interventions based on the metacognitive approach could have positive effects on ALS patients and their caregivers.