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What is Metacognitive Therapy? An Introduction

Back in the late 20th century, medics promoted the monoamine theory of depression in that imbalances in neurotransmitters such as serotonin, dopamine and norepinephrine were responsible for mental illness.

The theory was that if you were to increase or rebalance these biochemicals, you would fix the problem and the patient would get better. During this time, drugs like Prozac, Zoloft, Effexor and Paxil were hailed as a panacea for those who had the blues or any nervous disorder.

Along with psychiatry providing treatment using drugs like the above came a huge growth in talk therapy, whereby the patient would talk to a psychologist or a therapist about their problems in order to perhaps gain better perspectives.

But despite using antidepressants and therapy, there are many who stay stuck or who get worse rather than better. There is, however, a new body of evidence that is gaining a lot of momentum, which strongly suggests that anxiety and depression are caused and maintained by unhelpful thinking styles and an unhelpful way of relating to thoughts and feelings, which is also under the control of the individual.

Once we learn to relate to our thoughts and feelings in a more resourceful way, melancholy sadness, depression and anxiety can be reduced or eliminated entirely. Yes, pharmaceuticals and psychotherapy can help, but they are rarely fully or even partially effective at alleviating symptoms. They are often just band-aids over a gaping wound.

We need a new solution, one which really works and keeps working and which can be self-directed without long term engagement with therapists needed.

Those with mental illness tend to ruminate and worry a lot. If you do this, your ruminations and worries are likely maintaining and often worsening your already poor mental health. You might agree, at least to a certain extent, with this assertion.

Trying to figure a way out of your illness and your life’s problems can backfire and worsen the very problem it’s trying to solve. Rumination causes and maintains and worsens depression. Sadness and despair. Worrying causes, maintains and worsens anxiety, OCD and impulsiveness.

“But thinking happens by itself” you say. “I have no control over it,” you say. The first statement is true, but fortunately, the second statement is completely false.

Even for those who suffer for years, if you can focus on making a cup of tea for yourself or brushing your teeth or tying your shoelaces, you can successfully practice metacognitive therapy. This is the therapy that would help you to get well and stay well. Metacognitive therapy, or MCT for short, is extremely effective at reducing symptoms of depression and anxiety, and it’s also very easy to use, albeit potentially hard to get your head around at first, and it may be hard to believe how simple and effective it can be also.

This article is a brief introduction to metacognitive therapy, but it’s not a complete guide in itself on how to practice it. I am not a qualified therapist, and therefore I’m not in a position to give you a guide on how to practice metacognitive therapy. My account here is to record and convey the amazing recovery I’ve experienced from learning and using MCT and also to give you a decent overview of the therapy.

Metacognitive therapy and how it can help You.
I’ve personally become peaceful, happy and content, and I want to show you how that is also possible for you. Here I’m going to summarize the theory and practice of metacognitive therapy. But this section is only a short introduction to the therapy. It will help to inform you and give you a basis for the therapy, but as I said before, this is by no means a complete user guide on the subject.

You will need to read the books I mentioned in the recommended reading, given here, or engage with a qualified metacognitive therapist, given here, in order to learn how to use MCT.

I’m sure that many of you have heard of or even used cognitive behavioral therapy or CBT, where users learn to spot distorted thoughts and beliefs and challenge, reduce or replace them with more realistic and useful thoughts.

In the CBT model, a thought like “I’m worthless” would be evaluated and countered with evidence proving your worth using a conceptual process. But, in MCT, the response to this is “what’s the point of even evaluating my worth”, and simply to let the thought go using attention training or detached mindfulness. As Dr Adrian Wells, creator of Metacognitive Therapy, suggests, “Do everything you can to do nothing”.

So, in MCT, we identify the thought like above as a negative trigger thought, and we don’t bother wasting energy by doing anything with this trigger thought.

The process of ruminating over, for example, the thought that you are worthless and then fixating and then ruminating on it with additional thoughts like “nobody likes me, it’s no wonder I’m alone, my life is terrible!” is called the cognitive attentional syndrome, or CAS for short.

MCT provides a few different strategies for dealing with trigger thoughts like this. The main strategies are postponement of worry and ruminating, attention training or switching (to other thoughts, or to sensory stimuli such as your surrounding auditory environment/sound) and detached mindfulness.

I have found that detached mindfulness is the optimal state for the user who is practicing metacognitive therapy. It’s achieved through the resolution of thought brought about by the modification of metacognitive beliefs related to your thinking. The main metacognitive beliefs relating to worry and rumination fall into positive – such as that “worry and rumination are necessary and helpful”, “worry helps me to find solutions” – or negative beliefs about rumination – such as “worry and rumination are uncontrollable” or that “worry and rumination are harmful.” In metacognitive therapy, these are the only beliefs and thoughts that we work on on a conceptual basis. Once these beliefs are changed, which is quite easy, the process of achieving detached mindfulness is much easier, because you have changed your mindset relating to worry and rumination.

You can go from the belief that some or all of the above beliefs are true to the actual fact and reality, which is that the above beliefs are false and erroneous.

This helps to remove the cognitive attentional syndrome (the CAS), simply because it is very hard to continue doing something that you know is harmful, once you realise it as so. I have found in my own experience that it is very hard to continue to worry or ruminate once I realize its uselessness, even if it’s something that I’ve been doing out of habit every day ad nauseum, for literally decades, which was exactly the case for me.

Mindful Detachment, Detachment and Transcendence

Mindful Detachment is a state that is easy to achieve once you have examined and changed and corrected one or all of the metacognitive beliefs relating to worry and rumination. It’s a state where ruminations on worries may still occur in the lower, automatic level of the mind, but they don’t affect you emotionally because you simply allow them to be, you don’t follow them, and you aren’t identified nor attached to them.

You can observe the thoughts come and go, but you aren’t identified with them, nor do you follow them with more ruminations or worries. For me, it’s almost like a transcendental state, which is generally accompanied by a better mood than if you were to become engaged with the thoughts. You may also, when practicing mindful detachment, notice that you have more resilience, energy and stamina than before. This is because engaging in the low level processing and negativity of rumination and worry is very energy depleting. I have personally been able to gain such detachment from worry and rumination that even the trigger thoughts rarely come anymore. If they do, I let them go and they vaporize and disappear with little nor any emotional disturbance.

Years of recursive endless thought about my illness, mental observation, whether verbal thoughts or imagery of my past or future deterioration, mishaps or demise has led me to the firm conviction that trying to solve any mental illness this way is counterproductive. Actually, it’s more than that. It actually is the illness. I speculate that the illness is nothing more than that for many. I call this the personal reflexive (PR) CAS. Yes, there may be external events which form the main focus of the CAS cognitions, but it’s the ones that are worries and ruminations on one’s own illness and its imagined grim implications for the future, which fuel anxiety, worries (future) and depression (ruminations, past.)

Letting go of rumination and worry.

Attention training and mindful detachment is the most effective way to deal with CAS. But there are other ways that are also very effective. Here we will talk about simply the technique of recognizing a trigger thought and letting it go. So we already mentioned that trigger thoughts once engaged with and followed usually lead to the looping process of fixation on negative thoughts which result in deteriorating mood. So anyone can learn to recognize these trigger thoughts and to let them go before your mind starts the fixation process, which constitutes the CAS.

Your cognitive attention in this way strengthens the ability to switch and focus awareness on other thoughts or sensory perceptions, such as sounds, and can greatly diminish the fuel that powers the CAS and therefore a poor mood.

Deliberate attention training using specialized audio tracks or even the ambient noise where you are sitting or standing is particularly effective for this purpose. In fact, daily short attention training sessions using audio that are custom built for this purpose or even using the surrounding sound where you are sitting, lying or standing, has been proven to significantly enhance the user’s ability to switch and maintain attention away from trigger thoughts and from the CAS, and to recover from depression and to stay well. This is especially true for people who suffer from severe depression. I will send you links to free online attention training tracks if you register for the free bonuses at this link.

Examples of trigger thoughts that I used to have are “I feel terrible. I’m still depressed. Why am I so anxious? I’m falling into a hole again. I always fail. It’s getting worse. Why am I such a failure?”

Learning to spot similar trigger thoughts that you may have is very helpful. You can learn to switch your attention to the ambient sounds around you when you notice a trigger thought. Or to simply let the trigger thought go even if you fail to spot a trigger and you go into CAS (cognitive attentional syndrome). You can diffuse it by switching attention at any point in the process. There’s no perfection here, only practice. Many of those with mental illness worry and ruminate all day for many hours of the day. The extent that you eliminate this is the extent to which your mood and recovery will progress.

Again, it’s progress, not perfection that we’re aiming for here. Don’t compare yourself to others, only to your past self, notice progress where you can.

Worrying that this won’t work for you.
Let’s acknowledge the elephant in the room. Many could worry or ruminate their way out of metacognitive therapy not working for them. That’s a very common occurrence. “Oh, it’ll work for them, but it won’t work for me. Nothing ever works for me. This won’t work for me. Nothing does. I’ll fuck this up. I always do.” You may be thinking like this. You may need to read this article, and leave metacognitive therapy alone for a while. Many don’t get it the first time around. This happens to a lot of people and is not uncommon at all. After all, fear, doubt and a feeling of pessimism is often a core feature of the darkness that constitutes any mental illness. I get it. I’ve been there. I’ve lived in that particular prison for years myself. So what I suggest if this is an issue for you is to use metacognitive therapy on that as well. Let it go. Postpone it. Detached from it.

Postponement of worry and rumination.

Many MCT therapists will instruct their clients to postpone their worrying and rumination until a set period later in the day. For example, between six and eight in the evening. Of course, many users will say that the things that they are worrying about are important issues for them, for example, problems that they want to solve.

Acknowledging that this may be true, I will say that negative cognitive processing on the problem is only going to make you feel bad, and it’s also very unlikely to yield any solution.

Simply leaving the problem alone without ruminating on it will almost always leave space for the solution to arise in the mind and usually a much better solution than worrying would have produced. People will also say that if they don’t worry about a problem, they may forget about it and it will be neglected.

Metacognitive therapy will advise that if it’s important, trust your memory to remember and deal with it at an appropriate time later on. So detached mindfulness, attention switching and postponement make up the three main strategies for dealing with worry and rumination that constitute the CAS and the personal, reflexive CAS.

I would also add to this attention training, using audio and using ambient surrounding sounds is a very effective way, to take your focus away and remove the CAS.

Mood Monitoring Behaviour

Many would agree that when you feel depressed and or anxious, you live in a state of constant hypervigilance monitoring for threats. Worry and rumination create a sense of danger, and those afflicted live in a mode of almost constant threat monitoring. This monitoring consists of a scanning of the mind, the body and the environment for anything that could represent danger in the here and now or in the future. And as part of the cognitive attentional syndrome, this scanning can result in a feeling of dread for what may potentially happen and an unwanted sensitivity to events, then when the problem arises, even a trivial one, the person already primed for danger may often have an amplified emotional reaction to it, which would otherwise not occur.

If the threat monitoring sense did not exist, it would, under normal circumstances, have been dealt with without any drama or emotional pain. Under this state of heightened threat monitoring, non-trivial problems which represent greater meaning can result in prolonged experiences of worsened depression or anxiety.

Mood monitoring, mood monitoring behaviour is a form of threat monitoring and is something unhelpful that many with depression constantly engage in. The problem occurs in that unpleasant moods which are bound to occur on occasion are a natural occurrence and a part of being human. If left alone, they will self regulate and therefore will pass given time all by themselves.

Over vigilance in monitoring feelings, emotions and moods is unnecessary and counterproductive in that it can produce cognitive reactions, spiraling into negative thought patterns of the CAS and personal reflexive (PR) CAS.

If detached mindfulness is used in relation to moods rather than close monitoring behavior, they’re allowed to ebb and flow without affecting thought patterns, actions and therefore behavior. Detached mindfulness does not mean that we ignore or are unaware of our mood, rather that we are not identified with it. And therefore, we do not derive our identity or our sense of self from it. This spiral into cognitive attentional syndrome worries and ruminations may cause what began as a slight mood dip to develop into something worse in both intensity and duration. So you can see how mood monitoring is in and of itself, both an aspect of the CAS and also that which causes CAS worry and rumination.

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