Theory and Nature of Metacognitive Therapy by Adrian Wells

[SWM]

Theory and Nature of Metacognitive Therapy

by
Adrian Wells

available on amazon Adrian Wells Metacognitive Therapy

Thoughts don’t matter but your response to them does.

Everyone has negative thoughts and everyone believes their negative thoughts sometimes. But not everyone develops sustained anxiety, depression, or emotional suffering. An important question is: What is it that controls thoughts and determines whether one can dismiss them or whether one sinks into prolonged and deeper distress?

This book proposes that metacognitions are responsible for healthy and unhealthy control of the mind. It is based on the principle that it is not merely what a person thinks but how he or she thinks that determines emotions and the control one has over them.

Metacognition is cognition applied to cognition. It monitors, controls, and appraises the products and process of awareness. For most of us, emotional discomfort is transitory because we learn ways of flexibly dealing with the negative ideas (i.e., thoughts and beliefs) that our minds construct. The metacognitive approach is based on the idea that people become trapped in emotional disturbance because their metacognitions cause a particular pattern of responding to inner experiences that maintains emotion and strengthens negative ideas.

The pattern in question is called the cognitive attentional syndrome (CAS) which consists of worry, rumination, fixated attention, and unhelpful self-regulatory strategies or coping behaviors. A hint of this toxic pattern can be seen in the response of a recent patient.

I asked this person, “What is the main thing you have learned during metacognitive therapy for your depression?” She replied, “The problem isn’t really that I have negative thoughts about myself, it’s how I’ve been reacting to them. I’ve discovered that I’ve been pouring coal on the fire. I just didn’t see that process before.” This patient discovered that her responses to negative thoughts had inadvertently developed into an unhelpful thinking style that reinforced her negative self-view.

Metacognitive therapy (MCT) is based on the principle that metacognition is vitally important in understanding how cognition operates and how it generates the conscious experiences that we have of ourselves and the world around us. Metacognition shapes what we pay attention to and the factors that enter consciousness. It also shapes appraisals and influences the types of strategies that we use to regulate thoughts and feelings. The argument developed and illustrated throughout this book proposes metacognition as a crucial influence on what we believe and think and as the basis of normal and abnormal emotional and conscious experiences.

A basic premise of traditional cognitive-behavioral therapy (CBT), such as Beck’s schema theory (e.g., Beck, 1967, 1976) and Ellis’s rational-emotive behavior therapy (REBT; Ellis, 1962; Ellis & Harper, 1961) is that disturbances or biases in thinking cause psychological disorder. Both of  these approaches give a central role to dysfunctional beliefs. MCT is in agreement with this view as a general principle, making it a type of cognitive therapy. Where it differs from previous approaches is in identifying a particular style of thinking and types of beliefs not emphasized by these other theories as the cause of disorder. The style of thinking emphasized is not about cognitive distortions such as absolutistic standards or black-andwhite thinking.

The style of interest in MCT is the CAS, which is marked by engaging in excessive amounts of sustained verbal thinking and dwelling in the form of worry and rumination. This is accompanied by a specific attentional bias in which attention is locked onto threat. The beliefs of importance in MCT are not the ordinary cognitions of CBT and REBT concerning the world and the social and physical self, but are beliefs about thinking (metacognitive beliefs).

The traditional CBT approach to psychological disorder asserts that it is not events themselves that cause psychological problems but the way those events are interpreted. CBT deals with the meanings that people give to their experiences. It assumes that the problem rests with erroneous and distorted views of the self and the world. It deals with changing this thought content and the person’s belief in the validity of that content.

In contrast, MCT deals with the way that people think and it assumes the problem rests with inflexible and recurrent styles of thinking in response to negative thoughts, feelings, and beliefs. It focuses on removing unhelpful processing styles. It proposes that any challenges to cognitive themes (content) occur exclusively at the metacognitive level. For instance, if we consider the case of a depressed patient who believes “I’m worthless,” the CBT therapist tackles the problem by asking, “What is your evidence?” In contrast, the MCT therapist asks, “What is the point in evaluating your worth?” In both the CBT and the MCT approaches, the content of beliefs and thoughts determines the type of disorder experienced. Thoughts about danger give rise to anxiety; thoughts about loss and self-devaluation
give rise to sadness. MCT posits that this content does not cause disorder because most people have these thoughts and for most the emotion is transitory.

Emotional disorder is a problem of being trapped in a state of distress. It is chronic or recurrent. Emotional disorder is caused by the metacognitions that give rise to thinking styles that lock the individual into prolonged and recurrent states of negative self-relevant processing. In essence, MCT is about the factors that lead to sustained thinking and misdirected coping.

In CBT erroneous interpretations of events that cause psychological disorder are assumed to emanate from beliefs, but the beliefs emphasized are in the ordinary cognitive domain. These are beliefs such as “The world is dangerous” and “I’m inadequate.” In MCT these beliefs can be seen as the products of metacognitions that give rise to patterns of attention and thinking that repeatedly generate or lock onto these ideas. The implication is that metacognition and patterns of thinking should be modified in treatment because these are the cause of stable negative beliefs or “ordinary cognitions.” The beliefs or schemas of CBT are not seen by the MCT practitioner as stable entities that should be erased but instead are seen as the products of thinking processes. It is clear from the foregoing introduction that MCT introduces an important distinction between cognition and metacognition, with therapeutic work focused primarily on the latter domain. There is no clear differentiation between cognition and metacognition in earlier cognitive therapies.

This is exemplified in an extract taken from Beck’s influential writing: “Through interviewing this depressed mother, I discovered that her thinking was controlled by erroneous ideas about herself and her world. Despite contrary evidence, she believed she had been a failure as a mother” (Beck, 1976, p. 16).

Here, it is apparent that depressive thinking is attributed to the presence of negative beliefs about being a “failure.” Beck assumes that the patient’s thinking is controlled by her erroneous ideas about being a failure. However, it does not invariably follow that believing that one is a failure will control one’s thinking. If we take all of the individuals who believe this, will they all become depressed? According to cognitive theory they should, but this is unlikely to be true. MCT views this situation differently. It assumes that most people will have thoughts or beliefs about being a failure, but that individuals will respond to these thoughts in different ways depending on their metacognitions. So it is metacognitive knowledge or beliefs that control subsequent thinking, not the ordinary cognitions that do so.

Let’s look at this in more detail. Most people will believe that they are a “failure” at some time in their lives, but for some this belief is followed by renewed efforts to succeed, while for others it is followed by chains of negative thoughts consisting of brooding on personal failings and weaknesses. What is needed is a mechanism that accounts for the existence of these different cognitive and emotional response patterns.

I have proposed that the mechanism is metacognition, that aspect of cognition that controls the way a person thinks and behaves in response to a thought, belief, or feeling. In the case of the depressed mother Beck describes, we might assume that her thinking is controlled by metacognitive beliefs, perhaps something resembling the following: “If I think about my failings and analyze why they occurred, I will be a better mother.” Unfortunately, the thinking process of rumination that results from this metacognitive belief is unlikely to lead to satisfactory answers, and the patient will persist in thinking about being a failure.

In the remainder of this chapter, I describe in greater depth the basic principles of MCT theory and treatment.

Taken from

Theory and Nature of Metacognitive Therapy

by
Adrian Wells

available on amazon Adrian Wells Metacognitive Therapy