The Role of Metacognition and Psychological Distress in Fibromyalgia Impact: a cross-sectional study in a Turkish clinical sample

Objective: We examined whether metacognitive processes are associated with fibromyalgia impact and compared metacognitions between patients with fibromyalgia syndrome (FMS) and matched healthy controls. We hypothesized that MCQ-30 scores would be higher in FMS and would predict FIQR total. Methods: In this cross-sectional study, 56 female FMS patients and 69 age-/education-matched women completed the Metacognitions Questionnaire-30 (MCQ-30), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), and Revised Fibromyalgia Impact Questionnaire (FIQR). Group differences used t -tests or Mann–Whitney U tests; correlations used Pearson/Spearman with Benjamini–Hochberg FDR adjustment; simple linear regression tested MCQ-30 total → FIQR total. Assumptions and robustness (Huber M-regression) were examined. Results: Compared with controls, the FMS group showed higher MCQ-30 Cognitive Confidence, Uncontrollability/Danger, Cognitive Self-Consciousness, Need to Control Thoughts, MCQ-30 total, and all FIQR indices (all p<.001; d=0.66–2.60). In patients, FIQR total correlated with MCQ-30 total (r=.40, q<.01) and with Cognitive Confidence and Cognitive Self-Consciousness (q<.01). MCQ-30 total predicted FIQR total (B=0.417, SE=0.173, β=.31, R²=.10, p=.020; 95% CI for B=0.078–0.756). In robustness checks, the association remained significant (Huber M-regression B≈0.40, p<.05). Exploratory subgroup analyses using established BDI/BAI cut-offs indicated lower MCQ-30 and lower FIQR scores in patients with moderate-to-severe depression/anxiety versus those below cut-offs (all q≤.01) a counterintuitive pattern discussed within a cultural somatization/measurement-domain framework. Conclusions: Metacognitive dysfunctions are elevated in FMS and show a modest yet independent association with disease impact, supporting metacognition-focused psychosomatic interventions. The paradoxical subgroup pattern warrants cross-cultural, prespecified moderator analyses in longitudinal designs.