Measuring the Cognitive Attentional Syndrome Associated with Emotional Distress: Psychometric Properties of the CAS-1

  • Henrik NordahlEmail author
  • Adrian Wells


The self-regulatory executive function model is the basis of metacognitive therapy and proposes that psychological disorders are caused by maladaptive beliefs about thinking (metacognitive beliefs) and a perseverative negative thinking style associated with them, named the cognitive attentional syndrome (CAS). The CAS-1 was devised and has been used as a clinical tool for assessment and monitoring of the cognitive attentional syndrome and underlying positive and negative metacognitive beliefs during the course of treatment. The aim of this study is to assess the psychometric properties of the CAS-1. Seven hundred and seventy-three participants completed a battery of self-report questionnaires at the cross-sectional level, and 431 individuals also completed the same measures 6 and 12 weeks later. Confirmatory factor analysis supported the proposed three-factor solution of the measure, and the factors demonstrated good internal consistency (α ranging from .77 to .89), convergent validity, incremental validity, stability and discriminative validity were satisfactory. Our findings support the continued use of the CAS-1 in clinical and research settings.


Psychometric properties CAS-1 Metacognitive beliefs Cognitive attentional syndrome 


Compliance with Ethical Standards

Conflict of Interest

On behalf of both authors, the corresponding author states that there is no conflict of interest.


  1. Capobianco, L., Reeves, D., Morrison, A. P., & Wells, A. (2018). Group metacognitive therapy vs. mindfulness meditation therapy in a transdiagnostic patient sample: a randomised feasibility trial. Psychiatry Res, 259, 554–561 Scholar
  2. Cartwright-Hatton, S., & Wells, A. (1997). Beliefs about worry and intrusions: the meta-cognitions questionnaire and its correlates. Journal of Anxiety Disorders, 11, 279–296. Scholar
  3. Clark, D. M., & Wells, A. (1995). A cognitive model of social phobia. In R. G. Heimberg, M. R. Liebowitz, D. A. Hope, F. Schneier, & R. (Eds.), Social phobia: Diagnosis, assessment, and treatment (pp. 69–93). New York: The Guilford Press.Google Scholar
  4. Fergus, T. A., Bardeen, J. R., & Orcutt, H. K. (2012). Attentional control moderates the relationship between activation of the cognitive attentional syndrome and symptoms of psychopathology. Personal Individ Differ, 53, 213–217 Scholar
  5. Fergus, T. A., & Scullin, M. K. (2017). The cognitive attentional syndrome is associated with sleep difficulties in a community sample. Behav Sleep Med, 15, 410–420 Scholar
  6. Fergus, T. A., Valentiner, D. P., McGrath, P. B., Gier-Lonsway, S., & Jencius, S. (2013). The cognitive attentional syndrome: Examining relations with mood and anxiety symptoms and distinctiveness from psychological inflexibility in a clinical sample. Psychiatry Res, 210, 215–219 Scholar
  7. Fresco, D. M., Coles, M. E., Heimberg, R. G., Liebowitz, M. R., Hami, S., Stein, M. B., & Goetz, D. (2001). The Liebowitz Social Anxiety Scale: a comparison of the psychometric properties of self-report and clinician-administered formats. Psychol Med, 31, 1025–1035 Scholar
  8. Garver, M. S., & Mentzer, J. T. (1999). Logistics research methods: employing structural equation modeling to test for construct validity. J Bus Logist, 20, 33–57.Google Scholar
  9. Gkika, S., Wittkowski, A., & Wells, A. (2017). Social cognition and metacognition in social anxiety: a systematic review. Clinical Psychology & Psychotherapy, 25, 10–30. Scholar
  10. Hair, J. F., Black, W. C., Babin, B. J., & Anderson, R. E. (2014). In J. F. Hair, Jr., W. C. Black, B. J. Babin, & R. E. Anderson (Eds.), Multivariate data analysis (Pearson new international seventh ed.). Harlow, Essex: Pearson.Google Scholar
  11. Hoffart, A., Johnson, S. U., Nordahl, H. M., & Wells, A. (2018). Mechanisms of change in metacognitive and cognitive behavioral therapy for treatment-resistant anxiety: the role of metacognitive beliefs and coping strategies. Journal of Experimental Psychopathology, 9, 1–10 Scholar
  12. Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equ Model Multidiscip J, 6, 1–55 Scholar
  13. Hutton, P., Morrison, A. P., Wardle, M., & Wells, A. (2014). Metacognitive therapy in treatment-resistant psychosis: a multiple-baseline study. Behav Cogn Psychother, 42, 166–185 Scholar
  14. Kocalevent, R. D., Hinz, A., & Brähler, E. (2013). Standardization of the depression screener patient health questionnaire (PHQ-9) in the general population. Gen Hosp Psychiatry, 35, 551–555 Scholar
  15. Kowalski, J., & Dragan, M. (2019). Cognitive-attentional syndrome – the psychometric properties of the CAS-1 and multi-measure CAS-based clinical diagnosis. Compr Psychiatry, 91, 13–21 Scholar
  16. Kroenke, K., Spitzer, R. L., & Williams, J. B. (2001). The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med, 16, 606–613 Scholar
  17. Kroenke, K., Spitzer, R. L., Williams, J. B., & Löwe, B. (2010). The patient health questionnaire somatic, anxiety, and depressive symptom scales: a systematic review. Gen Hosp Psychiatry, 32, 345–359 Scholar
  18. Liebowitz, M. R. (1987). Social Phobia. In D. F. Klein (Ed.), Anxiety. New York, NY: Karger.Google Scholar
  19. Manea, L., Gilbody, S., & McMillan, D. (2015). A diagnostic meta-analysis of the Patient Health Questionnaire-9 (PHQ-9) algorithm scoring method as a screen for depression. Gen Hosp Psychiatry, 37, 67–75 Scholar
  20. Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and validation of the penn state worry questionnaire. Behav Res Ther, 28, 487–495 (90)90135-6.
  21. Nolen-Hoeksema, S., & Morrow, J. (1991). A prospective study of depression and posttraumatic stress symptoms after a natural disaster: the 1989 Loma Prieta Earthquake. J Pers Soc Psychol, 61, 115–121 Scholar
  22. Nordahl, H., Hjemdal, O., Hagen, R., Nordahl, H. M., & Wells, A. (2019). What lies beneath trait-anxiety? testing the self-regulatory executive function model of vulnerability. Front Psychol, 10, 122. Scholar
  23. Nordahl, H., & Wells, A. (2018). Metacognitive therapy for social anxiety disorder: an A-B replication series across social anxiety subtypes. Front Psychol, 9, 540 Scholar
  24. Normann, N., & Morina, N. (2018). The efficacy of metacognitive therapy: a systematic review and meta-analysis. Front Psychol, 9, 2211. Scholar
  25. Rochat, L., Manolov, R., & Billieux, J. (2018). Efficacy of metacognitive therapy in improving mental health: a meta-analysis of single-case studies. J Clin Psychol, 74, 896–915 Scholar
  26. Rytwinski, N. K., Fresco, D. M., Heimberg, R. G., Coles, M. E., Liebowitz, M. R., Cissell, S., et al. (2009). Screening for social anxiety disorder with the self-report version of the Liebowitz Social Anxiety Scale. Depression and Anxiety, 26, 34–38. Scholar
  27. Spada, M. M., Mohiyeddini, C., & Wells, A. (2008). Measuring metacognitions associated with emotional distress: Factor structure and predictive validity of the metacognitions questionnaire 30. Personal Individ Differ, 45, 238–242 Scholar
  28. Spitzer, R. L., Kroenke, K., Williams, J. B., & Löwe, B. (2006). A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med, 166, 1092–1097. Scholar
  29. Sellers, R., Varese, F., Wells, A., & Morrison, A. P. (2017). A meta-analysis of metacognitive beliefs as implicated in the self-regulatory executive function model in clinical psychosis. Schizophr Res, 179, 75–84 Scholar
  30. Sellers, R., Wells, A., Parker, S., & Morrison, A. P. (2018). Do people with psychosis engage in unhelpful metacognitive coping strategies? A test of the validity of the Cognitive Attentional Syndrome (CAS) in a clinical sample. Psychiatry Res, 259, 243–250 Scholar
  31. Sun, X., Zhu, C., & So, S. H. W. (2017). Dysfunctional metacognition across psychopathologies: a meta-analytic review. European Psychiatry, 45, 139–153 Scholar
  32. Wells, A. (2009). Metacognitive therapy for anxiety and depression. New York: Guilford press.Google Scholar
  33. Wells, A., & Cartwright-Hatton, S. (2004). A short form of the metacognitions questionnaire: properties of the MCQ-30. Behav Res Ther, 42, 385–396. Scholar
  34. Wells, A., & Matthews, G. (1994). Attention and emotion: A clinical perspective. Hove UK: Erlbaum.Google Scholar
  35. Wells, A., & Matthews, G. (1996). Modelling cognition in emotional disorder: the S-REF model. Behav Res Ther, 34, 881–888. Scholar
  36. Wong, Q. J., & Moulds, M. L. (2011). A new measure of the maladaptive self-beliefs in social anxiety: Psychometric properties in a non-clinical sample. J Psychopathol Behav Assess, 33, 273–284 Scholar
  37. Wong, Q. J., Moulds, M. L., & Rapee, R. M. (2014). Validation of the self-beliefs related to social anxiety scale: A replication and extension. Assessment, 21, 300–311 Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of PsychologyNorwegian University of Science and TechnologyTrondheimNorway
  2. 2.St. Olavs Hospital, Division of PsychiatryTrondheim University HospitalTrondheimNorway
  3. 3.The University of Manchester, Division of Psychology and Mental Health, School of Health Sciences, Faculty of Biology, Medicine and HealthManchesterUK
  4. 4.Greater Manchester Mental Health NHS Foundation TrustPrestwichUK

Personalised recommendations