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What is metacognitive therapy?

13 June 2017

Metacognitive therapy (MCT) is a relatively new form of therapy that looks at thinking about thinking. It's super useful. But what exactly does it all mean? In this episode, Chris explains the basics of MCT and how it can be applicable to reducing your anxiety.

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Transcription

Hey, it's Chris, and welcome to the Worfolk Anxiety Podcast. Hope you're doing well, thanks for spending some time listening to the podcast. It's really good to have you here. Today, we are taking a look at metacognitive therapy, so [00:00:30] maybe a bit dry and academic, but I'm really gonna try and keep it focused on why metacognitive therapy is cool and the potentials it has and the practical applications, not necessarily the academic stuff about why it's good, the research studies and that kind of stuff.

If you've had anxiety, depression, OCD, other mental health issues for a while, you're probably [00:01:00] familiar with cognitive behavioural therapy, if you've gone for any kind of therapy. If you've spoken to your GP, it's probably been mentioned to you. If you haven't, then cognitive behavioural therapy, CBT, is the dominant way that we treat mental health difficulties these days, and there's a good reason for that. It's really evidence-based, it's been around a long time, and it's just the most effective thing we have for it. There are other [00:01:30] therapies out there, such as acceptance and commitment therapy and mindfulness-based cognitive therapy.

The new therapy on the block

Then there's a new one, I say new, it's called metacognitive therapy. It's new in terms of it's only been around a decade or two, and it takes a long time to build up these big evidence bases to show it works. The big driver behind it is a guy called Adrian Wells, who is a professor [00:02:00] of psychology, I want to say, I think his official title is psychopathy, which sounds even cooler. He's based over at the University of Manchester but did his masters degree at my university, the University of Leeds, so that's pretty cool. 

The idea behind metacognitive therapy is that it is thinking about thinking. It's quite deep, if [00:02:30] you like to get into the layers of thinking, then this is really good therapy for. It does make it complicated though. I know when I did some, just to find out what it was like, and it's difficult to get out of that CBT mindset and into a metacognitive mindset, where you're thinking about thinking.

So, practically, what does that mean, thinking about thinking? What does that mean in the real world? The idea [00:03:00] is that we have some beliefs about our beliefs. So it's not just we have a belief that says if I go to this party, I will die of embarrassment. That's belief, and it's an incorrect belief, and it's one of the beliefs that will cause us to have anxiety, and that we can reduce our anxiety by dispelling. So that's a belief. But what metacognitive says is that we actually have beliefs [00:03:30] about beliefs as well. These beliefs might be, for example, "Worrying keeps me safe," or "worrying is useful," and many of us will, if we're really honest with ourselves, will believe that. 

Positive and negative metacognitions

The idea that worrying keeps us safe is something that really resonates with me. I think I need to worry, because otherwise bad things will happen, and in fact, I went on a trip to the [00:04:00] beach on Saturday, and I took loads of stuff, and I kind of know that the reason I take so much stuff is 'cause I'm a worrier, but actually, also, I believe deep down that if I didn't take all this stuff, then something goes wrong, I cut myself and I didn't pack my first aid kit, so I end up bleeding to death on the beach, and everyone's sad 'cause I'm dead. The problem with this belief is that [00:04:30] when you believe that worrying keeps you safe, you're never really gonna engage that much with a therapy that's designed to reduce your worry, because on a subconscious level, you're thinking, "No, I have to worry, because I'm kept safe by this."

So, "worrying keeps me safe" is an example of a positive metacognitive belief, and there's also negative metacognitive [00:05:00] beliefs. For example, "I cannot change," or "I cannot control my thoughts," they're negative beliefs about our mind. Again, the idea that worrying keeps me safe can perpetuate our anxious thoughts because we think it's useful, when we think we can't change and we can't control the thoughts in our mind, again, that's gonna cause us not to engage in therapy, because we think, "What's the point? We're stuck like this, we can never [00:05:30] change our thoughts." 

So the idea of metacognitive therapy is to challenge these beliefs, both the positive and the negative ones, because it all contributes to maintaining our anxiety, and then once we've got rid of these beliefs, we can then attack the beliefs themselves, and be much more successful about, because now we believe that it's going to work, and it's going to be beneficial for us.

MCT compared with CBT

Let's compare CBT to [00:06:00] metacognitive therapy, and let's use a party example again. In CBT, cognitive behavioural therapy, we would look at why we were anxious about going to a party, and the belief would usually be something like, "I'm worried that I will make a fool out of myself, and humiliate myself, because that would really be embarrassing, and my friends will all laugh at me, and they'll never [00:06:30] invite me back to their party again, and I'll have no friends, and I'll die alone." That's a typical fear that we might have in going into a social situation. 

If we look at this from a CBT lens, then what we would do, we would challenge this idea, "Will we humiliate ourselves?" Well, it's possible, but it's very unlikely. We've been to a lot of parties, and maybe we humiliated ourselves once, but [00:07:00] it really doesn't happen that often, so we can say, "Well, the idea that it will happen is, that's a false belief because it's unlikely to happen," and the other way we could challenge that would be to look at the social consequences, to say, "Well, even if we did humiliate ourselves, everyone would have a laugh, we'd remember it forever, but actually our friends would have forgotten about it two weeks later when someone else did something funny, and they move on to that. Actually, the social consequences of doing something embarrassing are not that bad." 

[00:07:30] So that would be the cognitive side of the CBT, and then we'd go to the party, and we'd notice that we weren't humiliating ourselves, and then when we did do something embarrassing, people just overlooked it, and they didn't say anything, and they just forgot about it really quickly, and that would be how we would tackle that. 

Now if we switch that to a metacognitive lens, then we would challenge not the [00:08:00] beliefs themselves, but the beliefs we have about the beliefs, so we wouldn't even give the idea credit that we'd humiliate ourselves. We'd just say, "Well, why, why would we even give this thought some, some air time in our brain?" So we'd say things like, "Well, is it that useful to worry? Maybe all this worrying does help us stop us humiliate ourselves, but actually, it's not that bad. We've [00:08:30] dispelled the social consequences, so this worrying isn't really keeping us safe because there's no danger here."

Secondly, we could challenge the idea that we needed to keep worrying, because a lot of these times, we'll worry, and then we'll tell ourselves, "No, it's fine," and then we'll come back and do some more worrying later. We can challenge the idea that that worrying is useful, because we don't have any new information, the party's on Saturday, you've done some [00:09:00] worrying on Tuesday, and you've reminded yourself that this worrying isn't keeping you safe, and then on Wednesday, the worry comes back, it just pops into our mind, that happens a lot, it's annoying. At that point, one of the metacognitive techniques we could use was to say, "I have no new information from yesterday, so I wouldn't give this worrying any more time, because it's not productive, I can't make a better decision [00:09:30] based on new information, because there isn't new information, so based on that, I'm just gonna stick to the decision I made yesterday, and not give this worrying any air time."

It's tough to do this because it's a whole level of abstraction. You've got the first layer, I guess the real, really happening to me, and then CBT takes it one layer up, and say, "Let's examine the beliefs that are making [00:10:00] us feel this way, that is giving us the tight chest and the nauseated feeling and all of that." And then metacognitive therapy takes it a layer up, and says, "Why am I having these beliefs, and what can we do about them? Are they legitimate? Should we be giving them attention?" So it was definitely a struggle for me to get up to that level, but once I did, it was really useful to understand why I was maintaining [00:10:30] a lot of these thoughts, and why I was reluctant to give them up, and why my subconscious was still giving them value.

Homework and exercises

In CBT, you have exercises to do, like building your exposure hierarchy and then going out and doing some of those things, and in metacognitive therapy, there are exercises as well, and just to give you one example, for example, a negative metacognitive [00:11:00] belief you might have is that you cannot control your thoughts. Well, that's quite easy to prove or disprove in an exercise, because all we need to do is do a mindfulness-based exercise, where we are directing our thoughts at specific things, and just learning to focus on them, and doing things like this shows us that actually we can control our thoughts, because we can move it from item to item in [00:11:30] a room, and we can just focus on that, and whenever thoughts come in, we can learn to bat them away, and really stay focused, and for each of the beliefs, there are different exercises to challenge the ideas.

Summary

Just to summarise, metacognitive therapy, it's about challenging beliefs about beliefs, which is quite a high level of abstraction. I really like it, I don't think that it will directly replace cognitive behavioural [00:12:00] therapy but what I think it will do is provide us with another tool in the tool belt, so we'll probably do some CBT, that'll give us techniques to challenge our beliefs directly. Maybe we'll do some metacognitive and that'll give us some tools to challenge the beliefs about the beliefs, and then we can get rid of them, and then go back to CBT and CBT will be more effective again. Where exactly it will fit into the lineup of therapy I think is still to [00:12:30] be determined, but it's really interesting, it's a really eye-opening topic for me, and I look forward to seeing where metacognitive will go in the future. 

If you have any more questions, just drop me an email, we're on all the social media channels as well, and yeah, loads of ways to get in touch. Hope you've enjoyed the podcast. If you're on iTunes, it would be great if you could go rate and review the show, if you're not following us already, then you can subscribe [00:13:00] on iTunes, subscribe on Stitcher, there's a subscribe on Android, if you go to the website, there are loads of ways to subscribe to make sure you don't miss out on future podcasts. Thanks for listening, I will speak to [00:13:30] you [00:14:00] soon.