The role of meta-cognitive and emotional beliefs, and negative repetitive thinking in the relationship between emotional abuse and psychological distress in psychiatric outpatients: A serial multiple mediation model

Abstract

Background Although meta-cognitive and emotional beliefs are linked to higher psychological distress, little is known about the potential antecedents of these beliefs. On the other hand, the emotional schema model and metacognitive therapy posit that negative meta-cognitive and emotional beliefs generate negative repetitive thinking (NRTs) that lead to the development of psychological distress. In a meta-cognitive integrative model, we examined: (a) whether the link between emotional abuse and psychological distress was mediated serially by meta-cognitive beliefs (MCBs) and NRTs; (b) whether the relationship between emotional abuse and psychological distress was mediated serially by negative beliefs about emotional (NBEs) and NRTs. Methods Between 2021 and 2024, 514 outpatients (M age = 29.29; SD = 10.88) completed the Emotional Abuse Questionnaire (EAQ), Metacognitions Questionnaire (MCQ-30), Leahy Emotional Schema Scale (LESS), Perseverative Thinking Questionnaire (PTQ), and Kessler Psychological Distress Scale (K10). The PROCESS SPSS macro was used to conduct serial multiple mediation analysis. Results The multilevel mediation model demonstrated that the positive relationship between emotional abuse and psychological distress was partially mediated by MCBs, NBEs, and NRTs, and serially mediated by MCBs and then NRTs. The results also showed that the link between emotional abuse and psychological distress was mediated serially by NBEs and NRTs after controlling for age and gender. The model explained much of the variance in psychological distress (R2 = 0.52). Conclusion The current study contributes to the literature by validating a conceptual model to confirm the association between emotional abuse and psychological distress. The hypothesized model in the present study also suggested the salience of the emotional schema model and metacognitive model in predicting psychological distress. Our results also support that NRTs are strategies utilized to cope with MCBs and NBEs.