Metacognitive therapy: characteristics and psychological effects

Within the cognitive current, it is argued that most of the discomfort that a person suffers is due more to their way of seeing and interpreting reality than to the problem itself.

One of the therapies that takes this into account is metacognitive therapy., which not only focuses on the patient's dysfunctional thoughts, but also on how he perceives them, that is, it takes into account her metacognition.

Throughout this article we will delve deeper into metacognitive therapy, in addition to explaining in more detail the idea behind the concept of metacognition and for which disorders it is uses.

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What is metacognitive therapy?

Traditionally, cognitive therapies have maintained that alterations or biases in thought are the cause of the patient's psychological discomfort, rather than the situation itself. The discomfort is given in the way in which reality is interpreted, not by reality itself.

Metacognitive therapy, which was developed by Adrian Wells, agrees with the fundamental premise of cognitive therapies,

Giving importance to cognitive factors in the appearance and maintenance of psychological disorders. That is why this is within the therapies of this type.

However, a key point of metacognitive therapy is its focus of attention. This type of therapy tries to understand why there are people who, faced with an adverse situation, are capable of of not worrying while others, faced with the same situation, manifest depressive symptoms and anxious.

According to Wells's theory, what would be behind this discomfort being maintained are the metacognitions of the person, that is, the way he has of seeing her own thought. These metacognitions would be responsible for the individual having a healthy or pathological control of his mind.

Based on this, the objective of metacognitive therapy is to eliminate ways of thinking that incur dysfunctional beliefs. That is to say, it is intended to change the inflexible way that the person has of seeing the stimuli that, within their mentality, are considered as something threatening. By changing this way of seeing and interpreting things, the person stops being trapped by the situation and acquires a greater degree of well-being Knowing how to deal with problems.

What is meant by metacognition?

On many occasions, the discomfort that is experienced in a certain situation is not due to the situation itself, but to the way in which it is interpreted. This means that The same situation can be seen in very different ways depending on the person. In this way, it is understood that there are people who, faced with an adverse situation, know how to deal with it and do not worry too much, while others suffer to such an extent that they remain paralyzed.

Within the cognitive stream, therapy aims to identify, question and change those automatic thoughts that, activated before a certain situation, are the true source of discomfort of the person. By questioning the strength of these dysfunctional thoughts, the negative emotions associated with these harmful beliefs will diminish.

However, in order to do this, it is necessary to make the person aware of his own thoughts. That is, think about what you are thinking and how you think about it. According to Wells, the term 'metacognition' refers to a wide range of interrelated factors. composed of all cognitive processes that are involved in the interpretation, monitoring and control of one's own cognition.

Metacognition is an aspect that has been closely related to the theory of mind.. This concept can be subdivided into several components, being mainly knowledge, experiences and the strategies that the person has to face the situations that are present. Metacognition is made up of beliefs and theories about our own way of thinking.

Within the metacognitive therapy model, a distinction is made between explicit or declarative beliefs, and implicit or procedural beliefs.

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1. explicit beliefs

Explicit beliefs can be expressed verbally, and refer to specific thoughts of patients that cause them discomfort.

An example of this type of belief would be 'I have bad thoughts, which makes me a bad person', ‘worrying can give me a heart attack’, ‘what I have thought is a sign that something is not right.’

Explicit metacognitive knowledge can show up in the form of positive or negative beliefs. Positive explicit beliefs are those that the patient believes are advantageous to him, such as ‘if I worry, I will be prepared for when things are worse’, ‘focusing on the threat will help me to know what do'.

On the other hand, the negative allude to negative evaluations of sensations and thoughts related to the perceived danger. They are formulated in terms of uncontrollability, meaning, importance and dangerousness of thoughts.

Some examples of negative metacognitive beliefs would be "I don't have control over my thoughts", "if I think violently, I'm going to do some aggression"...

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2. implicit beliefs

Implicit beliefs refer to those rules or programs that guide a person's thinking, such as paying attention to a particular stimulus, ruminating on particular memories or the way in which other people are judged.

How and for what disorders is it used?

Metacognitive therapy has shown to be effective and efficient in terms of improving the well-being of patients. This has been empirically observed in research, taking the case of Normann and Morina (2018) for example, who saw how this type of therapy improved the mental health of patients. However, it should be noted that It is especially useful for anxiety disorders and depression..

In fact, in the clinical field it has been possible to see how effective it is with multiple anxiety problems. Some of them are social anxiety, generalized anxiety disorder, obsessive compulsive disorder, post traumatic stress disorder. However, when this model was formulated, the goal was for it to be used transdiagnostically, that is, for multiple psychological disorders of any kind.

Normally the therapy is carried out between 8 and 12 sessions. The therapist argues with the patient about the accuracy of his way of interpreting his own cognition, that is, thoughts, past experiences and applied strategies. Once it has been possible to see what causes the discomfort, the therapy focuses on promoting in the patient more adaptive and appropriate thinking styles to situations previously associated with issues.

Attentional cognitive syndrome

The metacognition of people who suffer from psychological disorders, according to Wells, gives give rise to a particular way of responding to inner experience, that is, your thoughts and emotions. This causes those negative feelings to become chronic and the person continues to suffer.. This thought pattern has been called Cognitive Attention Syndrome (ACS) which would be composed of the following three aspects:

• Rumination and worry.
• Fixed attention: attentional bias especially around threats.
• Negative self-regulation strategy.

This syndrome is of vital importance to understand the model of metacognitive therapy. This becomes especially understandable in those people who suffer from an anxiety disorder: your attention is fixed on a threat, which causes them great concern and, trying to get rid of this negative emotionality, carry out coping strategies that, in the long run, make them think even more about this problem. So, they end up having thoughts like "what if this happens? 2, "I should worry that this doesn't get worse"...

Bibliographic references:

• American Psychiatric Association. (1994). Diagnostic and statistical manual on mental disorders (4th ed.). Washington DC: Author.
• Ashouri, A., Atef-Vahid, M.K., Gharaee, B., Rasoulian, M. (2013). Effectiveness of Meta-Cognitive and Cognitive Behavioral Therapy in Patients with Major Depressive Disorder. Iranian Journal of Psychiatry and Behavioral Sciences, 7(2), 24-34.
• Normann, N., & Morina, N. (2018). The Efficacy of Metacognitive Therapy: A Systematic Review and Meta-Analysis. Frontiers in psychology, 9, 2211. doi: 10.3389/fpsyg.2018.02211
• Garay, C. J and Keegan, E. (2016). Metacognitive therapy. Cognitive attentional syndrome and cognitive processes. Argentine Journal of Clinical Psychology. 25(2). 125-134.