{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T14:37:33Z","timestamp":1772721453956,"version":"3.50.1"},"reference-count":42,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T00:00:00Z","timestamp":1772064000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100005322","name":"Recep Tayyip Erdogan University Development Foundation","doi-asserted-by":"publisher","award":["02025012001839"],"award-info":[{"award-number":["02025012001839"]}],"id":[{"id":"10.13039\/501100005322","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background\/Objectives: The prevalence of mental disorders has increased in fibromyalgia (FM). Therefore, individuals\u2019 pain perception, emotional schemas, and coping strategies are important. Our study aims to examine emotional schemas and metacognitive levels in FM. Methods: The study included 88 FM and 88 healthy controls who consecutively presented to the clinic. All participants completed the Leahy Emotional Schema Scale-II (LESS-II) and the Metacognition Questionnaire-30 (MCQ-30). Patients were also administered the Polysymptomatic Distress scale (PSD) and the Fibromyalgia Impact Questionnaire (FIQ). Results: The study included 88 FM patients and 88 controls. In the study, the LESS-II total score and MCQ-30 score were significantly higher in the patient group compared to the control group (p &lt; 0.05). When examining the factors affecting FIQ severity, LESS-II scores and gender variables were found to be variables predicting FIQ values (p = 0.002, p = 0.002, respectively). When looking at the factors affecting the PSD score, the LESS-II score is a significant variable predicting the PSD score (p = 0.029). Conclusions: This study demonstrated that FM patients have higher levels of negative emotional schemas compared to healthy controls, and that emotional schemas are associated with both FM symptom severity and the impact of the disease on daily life. In particular, that LESS-II scores predict PSD scores and that LESS-II and gender variables predict FIQ scores suggests that symptom burden and functional effects in FM may be closely related to cognitive-emotional processes. The findings support the importance of considering emotional schemas in FM assessment and treatment approaches.<\/jats:p>","DOI":"10.3390\/diagnostics16050696","type":"journal-article","created":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T16:57:13Z","timestamp":1772125033000},"page":"696","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Effect of Metacognitive and Emotional Schemas on the Severity of Symptoms in Patients with Fibromyalgia"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4525-3928","authenticated-orcid":false,"given":"Mehmet Serhat","family":"Topalo\u011flu","sequence":"first","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Recep Tayyip Erdo\u011fan University, Rize 53100, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meltem","family":"Pu\u015furo\u011flu","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Faculty of Medicine, Recep Tayyip Erdo\u011fan University, Rize 53100, T\u00fcrkiye"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,26]]},"reference":[{"key":"ref_1","first-page":"3","article-title":"One year in review 2020: Fibromyalgia","volume":"38","author":"Bazzichi","year":"2020","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"645","DOI":"10.1038\/s41584-020-00506-w","article-title":"Fibromyalgia: An update on clinical characteristics, aetiopathogenesis and treatment","volume":"16","author":"Giorgi","year":"2020","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e250268","DOI":"10.1001\/jamanetworkopen.2025.0268","article-title":"Prevalence of Depression and Anxiety Among Adults with Chronic Pain: A Systematic Review and Meta-Analysis","volume":"8","author":"Aaron","year":"2025","journal-title":"JAMA Netw. Open"},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Maffei, M.E. (2020). Fibromyalgia: Recent Advances in Diagnosis, Classification, Pharmacotherapy and Alternative Remedies. Int. J. Mol. Sci., 21.","DOI":"10.3390\/ijms21217877"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1007\/s00296-014-3208-7","article-title":"Fibrofog and fibromyalgia: A narrative review and implications for clinical practice","volume":"35","author":"Kravitz","year":"2015","journal-title":"Rheumatol. Int."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1669","DOI":"10.1002\/acr.24089","article-title":"Fibrofog in Daily Life: An Examination of Ambulatory Subjective and Objective Cognitive Function in Fibromyalgia","volume":"72","author":"Kratz","year":"2020","journal-title":"Arthritis Care Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"21501319221120738","DOI":"10.1177\/21501319221120738","article-title":"Depression: A Modifiable Risk Factor for Poor Outcomes in Fibromyalgia","volume":"13","author":"Munipalli","year":"2022","journal-title":"J. Prim. Care Community Health"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Capobianco, L., Faija, C., Husain, Z., and Wells, A. (2020). Metacognitive beliefs and their relationship with anxiety and depression in physical illnesses: A systematic review. PLoS ONE, 15.","DOI":"10.1371\/journal.pone.0238457"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Ko\u0142odziejczyk, A., Krawczyk, J., Tkaczyszyn-Mika, E., Gniewczy\u0144ska, J., Ziarko, M., Zozuli\u0144ska-Zi\u00f3\u0142kiewicz, D., and Paw\u0142owski, T. (2024). The Role of Metacognition in the Prediction of Depressive and Anxiety Symptoms in Chronically Ill Patients. J. Clin. Med., 13.","DOI":"10.3390\/jcm13051306"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1016\/j.brat.2004.09.002","article-title":"Experimental modification of beliefs in obsessive-compulsive disorder: A test of the metacognitive model","volume":"43","author":"Fisher","year":"2005","journal-title":"Behav. Res. Ther."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.paid.2015.08.053","article-title":"Post-traumatic stress symptom, metacognition, emotional schema and emotion regulation: A structural equation model","volume":"88","author":"Mazloom","year":"2016","journal-title":"Personal. Individ. Differ."},{"key":"ref_12","first-page":"284","article-title":"Emotional Schemas and Psychological Distress: Mediating Role of Resilience and Cognitive Flexibility","volume":"17","author":"Mohammadkhani","year":"2022","journal-title":"Iran. J. Psychiatry"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1016\/j.nicl.2016.01.021","article-title":"Characterizing \u201cfibrofog\u201d: Subjective appraisal, objective performance, and task-related brain activity during a working memory task","volume":"11","author":"Walitt","year":"2016","journal-title":"NeuroImage Clin."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1097\/00124743-200204000-00003","article-title":"Cognitive and dissociative manifestations in fibromyalgia","volume":"8","author":"Leavitt","year":"2002","journal-title":"J. Clin. Rheumatol."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Hjemdal, O., Solem, S., Hagen, R., Kennair, L.E.O., Nordahl, H.M., and Wells, A. (2019). A Randomized Controlled Trial of Metacognitive Therapy for Depression: Analysis of 1-Year Follow-Up. Front. Psychol., 10.","DOI":"10.3389\/fpsyg.2019.01842"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Paschali, M., Lazaridou, A., Vilsmark, E.S., Lee, J., Berry, M., Grahl, A., Anzolin, A., Loggia, M., Napadow, V., and Edwards, R.R. (2021). The \u201cself\u201d in pain: High levels of schema-enmeshment worsen fibromyalgia impact. BMC Musculoskelet. Disord., 22.","DOI":"10.1186\/s12891-021-04740-5"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1037\/tra0001441","article-title":"Early maladaptive schemas as a risk factor for fibromyalgia: A case-control study","volume":"16","author":"Pacho","year":"2024","journal-title":"Psychol. Trauma"},{"key":"ref_18","unstructured":"Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences, Lawrence Erlbaum Associates. [2nd ed.]."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.jad.2025.04.062","article-title":"Metacognition and pain in patients with fibromyalgia: The role of psychological distress","volume":"382","author":"Romeo","year":"2025","journal-title":"J. Affect. Disord."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1016\/S1077-7229(02)80048-7","article-title":"A model of emotional schemas","volume":"9","author":"Leahy","year":"2002","journal-title":"Cogn. Behav. Pract."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"23","DOI":"10.5455\/apd.170597","article-title":"Psychometric properties of the Turkish version of the Leahy Emotional Schema Scale-II","volume":"16","author":"Batmaz","year":"2015","journal-title":"Anatol. J. Psychiatry\/Anadolu Psikiyatr. Derg."},{"key":"ref_22","first-page":"67","article-title":"\u00dcstbili\u015f \u00d6l\u00e7e\u011fi-30\u2019un T\u00fcrk\u00e7e Uyarlamas\u0131, Ge\u00e7erli\u011fi, G\u00fcvenirli\u011fi, Kayg\u0131 ve Obsesif-Komp\u00fclsif Belirtilerle \u0130li\u015fkisi","volume":"19","author":"Tosun","year":"2008","journal-title":"Turk Psikiyatr. Derg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1016\/S0005-7967(03)00147-5","article-title":"A short form of the metacognitions questionnaire: Properties of the MCQ-30","volume":"42","author":"Wells","year":"2004","journal-title":"Behav. Res. Ther."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/j.semarthrit.2016.08.012","article-title":"2016 Revisions to the 2010\/2011 fibromyalgia diagnostic criteria","volume":"46","author":"Wolfe","year":"2016","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_25","first-page":"1225","article-title":"The measurement of fibromyalgia severity: Converting scores between the FIQR, the PSD and the FASmod","volume":"41","author":"Salaffi","year":"2023","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_26","first-page":"S154","article-title":"The Fibromyalgia Impact Questionnaire (FIQ): A review of its development, current version, operating characteristics and uses","volume":"23","author":"Bennett","year":"2005","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1002\/cpp.2630","article-title":"Early maladaptive schemas and depression in adulthood: A systematic review and meta-analysis","volume":"29","author":"Bishop","year":"2022","journal-title":"Clin. Psychol. Psychother."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1080\/13546805.2019.1651708","article-title":"Metacognition in functional cognitive disorder\u2014A potential mechanism and treatment target","volume":"24","author":"Bhome","year":"2019","journal-title":"Cogn. Neuropsychiatry"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1177\/09567976211043428","article-title":"The Cognition\/Metacognition Trade-Off","volume":"33","author":"Rosenbaum","year":"2022","journal-title":"Psychol. Sci."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"120340","DOI":"10.1016\/j.jad.2025.120340","article-title":"The global prevalence of depression and anxiety among fibromyalgia patients: A systematic review and meta-analysis","volume":"393","author":"Jafari","year":"2026","journal-title":"J. Affect. Disord."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"R120","DOI":"10.1186\/ar2783","article-title":"The revised fibromyalgia impact questionnaire (FIQR): Validation and psychometric properties","volume":"11","author":"Bennett","year":"2009","journal-title":"Arthritis Res. Ther."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"174","DOI":"10.55563\/clinexprheumatol\/73g6np","article-title":"Gender differences on psychological factors in fibromyalgia: A systematic review on the male experience","volume":"39","author":"Conversano","year":"2021","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1111\/1467-8721.00142","article-title":"Gender differences in depression","volume":"10","year":"2001","journal-title":"Curr. Dir. Psychol. Sci."},{"key":"ref_34","first-page":"128","article-title":"Fibromiyalji sendromu tan\u0131s\u0131 alan ve almayan hastalar\u0131n erken d\u00f6nem uyumsuz \u015femalar a\u00e7\u0131s\u0131ndan kar\u015f\u0131la\u015ft\u0131r\u0131lmas\u0131","volume":"5","author":"Karaca","year":"2021","journal-title":"Klin. Psikol. Derg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"1594","DOI":"10.1016\/j.jpain.2023.04.007","article-title":"Emotional Dynamics in Fibromyalgia: Pain, Fatigue, and Stress Moderate Momentary Associations Between Positive and Negative Emotions","volume":"24","author":"Kim","year":"2023","journal-title":"J. Pain"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"11","DOI":"10.4103\/abr.abr_85_22","article-title":"Effectiveness of Group Emotional Schema Therapy on Psychological Distress, Severity and Frequency of Symptoms in Women with Irritable Bowel Syndrome","volume":"13","author":"Erfan","year":"2024","journal-title":"Adv. Biomed. Res."},{"key":"ref_37","first-page":"442","article-title":"Relationships between Emotional Schemas, Mindfulness, Self-Compassion and Unconditional Self-Acceptance on the Regulation of Psychological Needs","volume":"23","author":"Faustino","year":"2020","journal-title":"Res. Psychother."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Hohendorf, M., and Bauer, M. (2023). Metacognitive sensitivity and symptoms of mental disorder: A systematic review and meta-analysis. Front. Psychol., 14.","DOI":"10.3389\/fpsyg.2023.991339"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1398","DOI":"10.1111\/bjhp.12609","article-title":"A systematic review evaluating metacognitive beliefs in health anxiety and somatic distress","volume":"27","author":"Keen","year":"2022","journal-title":"Br. J. Health Psychol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1080\/13548506.2023.2235741","article-title":"The relationship between metacognition, anger, and pain intensity among fibromyalgia patients: A serial mediation model","volume":"29","author":"Tenti","year":"2024","journal-title":"Psychol. Health Med."},{"key":"ref_41","doi-asserted-by":"crossref","unstructured":"Tenti, M., Varallo, G., Cilenti, F., Raffaeli, W., Scorza, M., Rubichi, S., Pietrabissa, G., Castelnuovo, G., Gremigni, P., and Casu, G. (2025). Pain, Anger, and Rumination in Fibromyalgia: A Vicious Cycle?. J. Clin. Med., 14.","DOI":"10.3390\/jcm14113662"},{"key":"ref_42","first-page":"78","article-title":"Metacognitions on Pain, Functionality and Intensity of Pain in Women with Fibromyalgia","volume":"14","year":"2021","journal-title":"Int. J. Psychol. Res."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/5\/696\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,5]],"date-time":"2026-03-05T13:27:55Z","timestamp":1772717275000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/16\/5\/696"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,26]]},"references-count":42,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["diagnostics16050696"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics16050696","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,26]]}}}