Quiet Ego and Metacognitive Beliefs in Euthymic Bipolar Disorder: A Preliminary Report
DOI:
https://doi.org/10.12974/2313-1047.2026.13.06Keywords:
Bipolar Disorder, Euthymia, Quiet Ego, Metacognition, MCQ-30, QES, Personality traits, Dysfunctional beliefs, Cognitive confidenceAbstract
Bipolar Disorder (BD) is associated with functional disability even during euthymia, when residual dysfunctional thinking patterns, distinct from mood symptoms and neurocognitive deficits, may persist largely untreated by standard pharmacotherapy, psychoeducation, or cognitive remediation. This preliminary study examined the association between Quiet Ego, as measured by the Quiet Ego Scale (QES), and metacognitive beliefs, as measured by the Metacognitions Questionnaire-30 (MCQ-30), in fifty euthymic patients with BD. The QES total score was entered as a continuous predictor of each MCQ-30 subscale in simple linear regression models. Higher Quiet Ego scores were associated with higher Cognitive Confidence (i.e., lower scores on the MCQ-30 Cognitive Confidence subscale; β = -.393, R² = .154, p = .005), the only association that survived Bonferroni correction (α = .01). The association with negative beliefs about uncontrollability and danger was significant only at the uncorrected level (p = .034), and all remaining associations were not significant (p > .05). These preliminary findings suggest that Quiet Ego may be related to how patients appraise the reliability of their own cognition. Given the small sample, the cross-sectional design, and the self-reported nature of cognitive confidence, the results should be interpreted cautiously and require replication. Longitudinal and intervention studies are needed to test whether quiet-ego-enhancing approaches could serve as an adjunct in the long-term self-management of BD.
References
American Psychiatric Association (2015). Diagnostic and Statistical Manual of Mental Disorders (5th Edition Text-Revised) (DSM-5-TR). Washington, DC: APA.
Bauer JJ and Wayment HA. The psychology of the quiet ego. In: Transcending Self-Interest: Psychological Explorations of the Quiet Ego, eds Wayment HA and Bauer JJ (Washington, DC: American Psychological Association), 2008: 7-19. https://doi.org/10.1037/11771-001
Bernabei L, Silvestrini Cristiana, Lucrezia Andrea Grimaldi, Valentina Piserchia, Francesco Riggio, Giovanni Marino, Donatella Valente, Enrico Pompili. Psychometric properties of the Quiet Ego Scale (iQES) within the Italian cultural context. Frontiers in Psychology, 2024 15: 1348965. https://doi.org/10.3389/fpsyg.2024.1348965
Bernabei L, Bersani FS, Pompili E, Delle Chiaie R, Valente D, Corrado A, Vergnani L, Ferracuti S, Biondi M, Coccanari de’Fornari A. Cognitive Remediation for the treatment of neuropsychological disturbances in subjects with euthymic bipolar disorder: findings from a controlled study. Journal of Affective Disorders 273: 576-585. https://doi.org/10.1016/j.jad.2020.05.073
Bonnín CM, Torrent C, Vieta E, Martínez-Arán A. Restoring functioning in bipolar disorder: functional remediation. Harv Rev Psychiatry. 2014; 22(6): 326-330. https://doi.org/10.1097/HRP.0000000000000062
Colom F, Lam D. Psychoeducation: improving outcomes in bipolar disorder. Eur Psychiatry 2005 Aug; 20(5-6): 359-53.https://doi.org/10.1016/j.eurpsy.2005.06.002
Favaretto E, Bedani F, Offredi A, Schroffenegger M, Sassaroli S, Ruggiero G, Fagiolini A, Caselli G. Metacognitions and repetitive negative thinking in bipolar disorder and healthy controls: a comparative study. Journal of Affective Disorders 2020 (276): 152-158. https://doi.org/10.1016/j.jad.2020.07.013
Kaufman SB, Yaden DB, Hyde E, Tsukayama E. The light vs. dark triad of personality: contrasting two very different profiles of human nature. Front Psychol, 2019; 10: 467. https://doi.org/10.3389/fpsyg.2019.00467
Johnson WM, Fields SA, Bluett E. Bipolar disorder: managing the peaks and valleys. Int J Psychiatry Med 2020 sep; 55(5): 349-356. https://doi.org/10.1177/0091217420952573
Liu G, Isbell L, Constantino MJ, and Leidner B. Quiet ego intervention enhances flourishing by increasing quiet ego characteristics and trait emotional intelligence: a randomized experiment. J Happiness Stud. 23, 3605-3623. https://doi.org/10.1007/s10902-022-00560-z
Lucattelli R, Pecorari M, Mentuccia V, Biello C, Riggio F, Sagliano T, Marino G, Nicolò G, Bernabei L. Emotional psychoeducational group for psychiatric inpatients. Findings from a clinical study. Journal of Psychology and Psychotherapy Research 2023 (10): 106-115. https://doi.org/10.12974/2313-1047.2023.10.10
Miklowitz DJ, Efthimiou O, Furukawa TA, Scott J, McLaren R, Geddes JR, Cipriani A. Adjunctive psychotherapy for Bipolar Disorder. A systematic review and component network meta-analysis. JAMA Psychiatry 2021; 78(2): 141-150. https://doi.org/10.1001/jamapsychiatry.2020.2993
Østefjells T, Melle I, Aminoff SR, Hellvin T, hagen R, Lagerberg TV, Ullevoldsæter Lystad J, Røssberg JI. An exploration of metacognitive beliefs and thought control strategies in bipolar disorder. Comprehensive Psychiatry 2017, 73: 84-92. https://doi.org/10.1016/j.comppsych.2016.11.008
Samalin L, de Chazeron I, Vieta E, Bellivier F, Llorca PM. Residual symptoms and specific functional impairments in euthymic patients with bipolar disorder. Bipolar Disord. 2016; 18(2): 164-173. https://doi.org/10.1111/bdi.12376
Sandham C, Deacon E. The role of self-compassion in diabetes management: a rapid review. Front Psychol 2023, March 14. https://doi.org/10.3389/fpsyg.2023.1123157
Sarisoy G, Pazvantoǧlu O, Özturan DD, Ay ND, Yilman T, Mor S, Korkmaz IZ, Kaçar ÖF, Gümüş K. Metacognitive beliefs in unipolar and bipolar depression: A comparative study. Nord. J. Psychiatry 2014, 68, 275-281. https://doi.org/10.3109/08039488.2013.814710
Singh B, Swartz HA, Cuellar-Barboza AB, Schaffer A, Kato T, Dols A, Sperry SH, Vassilev AB, Burdick KE, Frye MA. Bipolar Disorder. Lancet, 2025 August 30; 406(10506): 963-978. https://doi.org/10.1016/S0140-6736(25)01140-7
Solè B, Jimenez E, Torrent C, Reinares M, Bonnin CDM, Torres I, Varo C, Grande I, Valls E, Salagre E, Sanchez-Moreno J, Martinez-Aran A, Carvalho AF, Vieta E. Cognitive impairment in bipolar disorder: Treatment and prevention strategies. Int J Neuropsychopharmacol 2017 Aug 1; 20(8): 670-680. https://doi.org/10.1093/ijnp/pyx032
Strand ER, Hjemdal O, Nordahl HM, Nordahl H. The relationships between metacognitive beliefs and personality dysfunction: a test controlling for personality traits, emotional distress symptoms and general functioning. Int J Cogn Ther 2024, 17: 743-61. https://doi.org/10.1007/s41811-024-00222-3
Sun X, Zhu C, Ho-wai So S. Dysfunctional metacognition across psychopathologies: a meta-analytic review. European Psychiatry 2017, 45: 139-153. https://doi.org/10.1016/j.eurpsy.2017.05.029
The Jamovi Project (2025). Jamovi (version 2.7) [Computer Software]. https: //www.jamovi.org
Thompson JM, Gallagher P, Hughes JH, Watson S, Gray JM, Ferrier IN, Young AH. Neurocognitive impairment in euthymic patients with bipolar affective disorder. British Journal of Psychiatry 2005(186): 32-40. https://doi.org/10.1192/bjp.186.1.32
Torrent C, Del Mar Bonnin C, Martinez-Aran A, et al. Efficacy of functional remediation in bipolar disorder: a multicenter randomized controlled study. Am J Psychiatry 2013 Aug; 170(8): 852-9.
Van Camp L, Sabbe BG, Oldenburg JFE. Metacognitive functioning in bipolar disorder versus controls and its correlations with neurocognitive functioning in a cross-sectional design. Compr Psychiatry 2019, Jul 92, 7-12. https://doi.org/10.1016/j.comppsych.2019.06.001
Wayment HA, Bauer JJ, Sylaska K. The Quiet Ego Scale: measuring the compassionate self-identity. J Happiness Stud. 2015a: 16, 999-1033. https://doi.org/10.1007/s10902-014-9546-z
Wayment HA, Huffmann AH, Eiler BA. A brief “quiet ego” workplace intervention to reduce compassion fatigue and improve health in hospital healthcare workers. Appl Nurs Res. 2019a: 49, 80-85. https://doi.org/10.1016/j.apnr.2019.05.002
Wayment HA, Cavolo K. Quiet ego, self-regulatory skills, and perceived stress in college students. J Am Coll Health 2019b Feb-Mar; 67(2): 92-96. https://doi.org/10.1080/07448481.2018.1462826
Wayment HA, Collier AF, Birkett M, Traustadòttir T, Till RE. Brief quiet ego contemplation reduces oxidative stress and mind-wandering. Front Psychol 2015b Sep 30; 6: 1481. https://doi.org/10.3389/fpsyg.2015.01481
Wayment HA. Academic identity and self-regulation strategies during the transition to college: the roles of quiet ego and self-esteem. Behav Sci 2026 Mar 26; 16(4): 489. https://doi.org/10.3390/bs16040489
Wells A, Matthews G. Modelling cognition in emotional disorder: the S-REF model. Behav Res Ther. 1996; Nov-Dec; 34(11-12): 881-888. https://doi.org/10.1016/S0005-7967(96)00050-2
Wells A. Breaking the cybernetic code: understanding and treating the human metacognitive control system to enhance mental health. Frontiers in Psychology 2019, 10: 2621. https://doi.org/10.3389/fpsyg.2019.02621
Wells A. Theory and nature of metacognitive therapy. Guilford Press, 2009.
Wells A, Cartwright-Hatton S. A short form of the metacognitions questionnaire: properties of the MCQ-30. Behav Res Ther. (2004), 42: 385-396. https://doi.org/10.1016/S0005-7967(03)00147-5
