OBJECTIVE: Metacognitive theory suggests that maladaptive beliefs about thinking are associated with the cognitive attentional syndrome (CAS), which is characterized by repetitive negative thinking and heightened threat monitoring. This study examined a dual-mediation model in which rumination and anxiety sensitivity were tested simultaneously as mediators of the relationship between metacognitive beliefs and sleep quality in a nonclinical sample. METHODS: A total of 346 Iranian adults (18-60 years) completed validated self-report measures of metacognitive beliefs, rumination, anxiety sensitivity, and sleep quality. Structural equation modeling (SEM) with bias-corrected bootstrapping (2,000 resamples) was used to test the hypothesized model. RESULTS: The model demonstrated acceptable fit to the data (CFI = 0.96, RMSEA = 0.074). Metacognitive beliefs were not significantly associated with sleep quality after including the mediators. However, significant indirect effects were observed through rumination (β = 0.32, 95% CI 0.20, 0.40) and anxiety sensitivity (β = 0.28, 95% CI 0.17, 0.37). The model explained 50% of the variance in sleep quality. CONCLUSIONS: The findings indicate that metacognitive beliefs are statistically associated with poorer sleep quality indirectly through rumination and anxiety sensitivity in a community sample. These results support the value of examining transdiagnostic cognitive-emotional processes in sleep research. Due to the cross-sectional design and reliance on self-report measures, causal inferences cannot be drawn. Future longitudinal and experimental studies are needed to clarify the temporal relationships and clinical utility of these pathways.
Mohammadkhani et al. (Sat,) studied this question.