The Role of Metacognition, Intolerance of Uncertainty, and Cognitive‐Attentional Syndrome in Differentiating Fear of Cancer Recurrence

ABSTRACT Objectives This study tested (1) whether intolerance of uncertainty (IU) and negative metacognitive beliefs independently differentiate fear of cancer recurrence (FCR) status, and (2) whether mediation by cognitive‐attentional syndrome (CAS) elements modify the relationships of IU and metacognitive beliefs with FCR status. Methods Baseline data from 384 participants (collected ∼15.6 months post‐diagnosis) pooled from a prospective longitudinal study and an FCR intervention trial were analyzed. Measures included FCRI‐SF (FCR), MCQ‐30 (metacognitive beliefs), IUS‐12 (IU), and CAS‐1 (CAS). FCR status was classified based on the FCRI‐SF scores as non‐clinical (< 13), subclinical (13–21), and clinically significant (≥ 22). Fully adjusted multinomial logistic regression examined direct effects of IU and metacognitive domains on FCR status and indirect effects via CAS. Results Compared to the non‐clinical group ( n  = 116), subclinical ( n  = 190) and clinically‐significant ( n  = 78) FCR groups showed greater negative beliefs about worry (OR range 1.297–1.500, p  < 0.001), higher IU (OR 1.050–1.066, p  = 0.037), increased use of CAS metacognitive strategies (OR 1.077–1.108, p  = 0.021‐< 0.001), and less perceived need to control thoughts (OR 0.847–0.857, p  = 0.003–0.027). Clinically‐significant FCR was additionally associated with poorer cognitive confidence (OR 1.122, p  = 0.030). CAS partially mediated associations of FCR status with negative beliefs about worry, cognitive confidence, and IU, and fully mediated the association with need to control thoughts. Conclusions IU and negative metacognitive beliefs can characterize individuals vulnerable to differentially‐elevated FCR. CAS centrally mediates the relationships between FCR, IU, and metacognition. Cognitive‐behavioral interventions for FCR explicitly targeting CAS should disrupt the impact of IU and metacognitive beliefs on FCR.