The role of metacognition in fibromyalgia impact and psychological distress: a cross-sectional study in Turkish women with fibromyalgia

 We examined whether metacognitive beliefs were associated with fibromyalgia impact and compared metacognitive beliefs between patients with Fibromyalgia Syndrome (FMS) and matched healthy controls. We hypothesized that Metacognitions Questionnaire-30 (MCQ-30) scores would be higher in FMS and would show a significant association with Revised Fibromyalgia Impact Questionnaire (FIQR) total scores. This cross-sectional study included 56 women with FMS and 69 healthy women controls who were comparable in age and education level. Participants completed MCQ-30, the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), and FIQR. Group differences were evaluated using independent-samples t-tests or Mann–Whitney U tests, depending on distributional characteristics. Associations between variables were examined using Pearson’s correlations or Spearman’s rank correlations. The association between MCQ-30 total scores and FIQR total scores was tested using simple linear regression. Analytical assumptions were evaluated, and the robustness of the findings was examined using Huber M-regression. Compared with controls, the FMS group had higher scores on MCQ-30 Cognitive Confidence, Uncontrollability/Danger, Cognitive Self-Consciousness, Need to Control Thoughts, and MCQ-30 total scores (t = 3.610–4.805, all p < .001; d = 0.66–0.88). The FMS group also had higher scores across all FIQR indices (p values ranging from .020 to < .001; d = 0.42–2.60). In the patient group, FIQR total scores were positively associated with MCQ-30 total scores (r = .395, p < .01). MCQ-30 total scores were significantly associated with FIQR total scores (B = 0.417, SE = 0.173, β = .31, R² = .10, p = .020; 95% CI = 0.078–0.756), and this association was retained in Huber M-regression (B ≈ 0.40, p < .05). In exploratory subgroup analyses, significant differences in MCQ-30 and FIQR scores were observed between patients with moderate-to-severe depressive/anxiety symptoms, as defined by BDI/BAI cutoffs, and those below these thresholds. MCQ-30 scores were higher in FMS than in healthy controls and were associated with disease impact. These findings suggest that metacognitive beliefs may represent a hypothesis-generating process marker related to symptom perception and functioning in FMS; however, causal inferences cannot be drawn because of the cross-sectional design. The unexpected subgroup pattern should be interpreted cautiously and examined in longitudinal studies using pre-specified moderator analyses.