Is metacognitive therapy the new black in treatment of anxiety and depression?

By Dr. Monika Walczak

Metacognitive therapy (MCT) is a relatively new form of cognitive intervention that has received growing attention within the field of clinical psychology. One might say it has taken the Scandinavian countries by storm. MCT was developed in the 1990s by Professor Adrian Wells, a renowned clinical psychologist, author and researcher at the University of Manchester.

Metacognitive therapy is based on the simple premise that all people have negative thoughts and feelings, but it is not these thoughts and feelings that are maintaining the problem, but how one relates to them. The aim of metacognitive therapy is to help people relate to their thoughts differently. MCT differs from the traditional CBT in that it does not aim to change the content of the client’s thoughts, but instead focuses on the thought processes. Metacognitive therapy was originally developed for treatment of generalized anxiety disorder (GAD), but it has since been applied in treatment of a variety of psychological problems including depression, stress, OCD, and PTSD.

Metacognitive therapy is grounded in theory, which emphasizes the similarities in maladaptive cognitive processing across psychological disorders. It proposes that all disorders are linked to the activation of a dysfunctional psychological processes that occur in response to negative thoughts: the repetitive negative thinking in a form of worry or rumination, attentional threat monitoring and unhelpful coping behaviors such as avoidance, thought suppression or reassurance seeking. These unhelpful cognitive processes result from an individual’s erroneous metacognitive beliefs.

Simply put, metacognitions are thoughts about thoughts. The two main domains of metacognition that maintain worry and rumination  are positive metacognitive beliefs and negative metacognitive beliefs about one’s repetitive thinking. Positive metacognitive beliefs concern the usefulness of worry and rumination (i.e., “if I worry, I’ll be prepared”, “The more I ruminate , the closer I get to figure out why I feel this bad”). If people believe that worrying or rumination is useful, they are more likely to continue to worry/ ruminate. Negative metacognitive beliefs concern the uncontrollability and danger of worry and/or rumination (i.e., “I cannot control my worry,” “I cannot stop ruminating”).  Metacognitive therapy aims to modify positive and negative metacognitive beliefs and reduce worrying and rumination.

Unhelpful behavioral strategies such as avoidance of situations that trigger worry or rumination, thought control strategies including either lack of attempts to interrupt ongoing worry or rumination sequences, or attempts to suppress thoughts that trigger worrying and maintain maladaptive metacognitions and anxiety or depression. Often times people spend endless amounts of time scrolling through social media, or watching TV, so they can distract themselves from the thinking that makes them feel anxious or sad. This form of distraction may work in temporary alleviation of negative feelings, however such coping strategy backfires in the long run, and maintains psychological problems.

Metacognitive therapists help to equipe their clients with techniques aimed at changing how they relate to thoughts and that bring extended thinking under control. Main components of metacognitive therapy include challenging negative and positive metacognitive beliefs, detached mindfulness techniques to reduce worrying/ rumination, and attention training techniques designed to increase attentional flexibility and control so that inflexible and excessive self-focused attention and repetitive thinking can be interrupted.

Detached mindfulness (DM) is a way of relating to one’s thoughts. It is a technique designed to help coping with worry and rumination and gaining control over these unhelpful repetitive thinking styles. DM involves a way of relating to and experiencing thoughts in a different and more appropriate way. It is about being mindful about the fact that one has a triggering thought, and at the same time being detached from this trigger without engaging in or answering to the thought. Detached mindfulness is not about controlling, analyzing or reacting to one’s trigger but instead acknowledging the presence of the trigger and not giving it more attention.

A growing body of research suggests that metacognitive therapy is an effective treatment for a variety of psychological problems. A substantial number of studies investigated the effects of MCT in adults with generalized anxiety disorder, depression, as well as social anxiety, OCD and PTSD and found that it is an effective treatment. Some suggest that metacognitive therapy may be more effective than traditional cognitive behavioral therapy, however more research is needed to sustain these claims. Nonetheless, MCT appears promising and might offer a necessary advance in the treatment of a variety of psychological complaints.

If you struggle with anxiety disorders or depression and are curious about metacognitive therapy, you are welcome to contact Monika Walczak, who is a certified metacognitive therapist, clinical psychologist and researcher in the area of anxiety disorders and metacognitive therapy.