Metacognitive therapy for depression: What you’ll want to know

You’ve heard it ad nauseam: “You know, if you’d stop thinking so much, or change what you think about, you wouldn’t be depressed.” Go ahead and admit it, you’re starting to believe it. That’s a good thing.

We began a two-part series on metacognitive therapy (wait, what?) a week ago.

In that piece the table was set for this therapy discussion, as we reviewed metacognition, cognitive attentional syndrome, and rumination.

Intro

The series was inspired by an article I bumped into that detailed the work of Professor Roger Hagen and colleagues from Norwegian University of Science and Technology.

Professor Hagen and team published a scientific paper several years ago on the treatment of depression using metacognitive therapy (MCT). It was fascinating and hopeful.

What is metacognition?

Let’s begin with a portion of the details shared in part one regarding metacognition. Can’t understand the therapy if we don’t know what it is, right? I turned to the Metacognitive Therapy Institute for reference.

Simply, metacognition is the aspect of cognition that controls mental processes and thinking.

For instance, think about the last time you couldn’t come up with someone’s name (the “tip-of-the-tongue phenomenon”), only to have it pop into your mind a few days later.

Metacognition informed you the name was in your memory, and later retrieved it and pushed it into your consciousness.

We can have positive and negative metacognitions. We’re aware of some of them; however, most of the ones that control our thinking and conscious experience operate beneath conscious awareness.

Metacognitive therapy for depression

Professor Hagen believes when patients become aware of when they start to ruminate, they learn to take control of their own thoughts.

He confidently says depressed individuals “don’t need to worry and ruminate.” He goes on to say, “Just realizing this is liberating for a lot of people.”

Pretty powerful observations, don’t you think?

And it seems he can back it up. The patients involved in the study were treated over a 10 week period. After six months, 80% of them had fully recovered.

How does metacognitive therapy work?

Cognitive behavioral therapy (CBT) is by far the most commonly used therapy for depression and anxiety.

As you may know, CBT focuses upon our thoughts and patterns of thinking as well as their impact upon our emotions and behavior. Through analysis, modification and cessation strategies for negative thoughts are formulated, practiced, and monitored. It’s kind of a reality check.

What about MCT?

Rumination rules

It’s real simple. MCT addresses all things rumination.

Professor Hagen…

Anxiety and depression give rise to difficult and painful negative thoughts. Many patients have thoughts of mistakes, past failures or other negative thoughts. Metacognitive therapy addresses thinking processes, rather than the thought content. Patients with depression think too much which MCT refers to as ‘depressive rumination.’ Rather than ruminating so much on negative thoughts, MCT helps patients to reduce negative thought processes and get them under control.

Bottom-line: MCT views depression as robustly maintained by rumination – more specifically, brooding.

Cognitive attentional syndrome

The team identifies a thinking style called the cognitive attentional syndrome (CAS). The CAS is a universal feature of emotional and mental illnesses, and responsible for prolonging and intensifying distressing emotions.

The CAS consists of inflexible self-focused attention, perseverative thinking in the form of worry and rumination, threat monitoring, and maladaptive coping behaviors

Thoughts are just thoughts

So according to the team, instead of reacting with endless ruminations and self-monitoring, we can try detached mindfulness, which can help us see our thoughts as just thoughts – not a reflection of reality.

I mean, thinking a thought doesn’t make it true.

Hagen…

The patients come in thinking they’re going to talk about all the problems they have and get to the bottom of it, but instead we try to find out how their mind and thinking processes work. You can’t control what you think, but you can control how you respond to what you think.

Makes sense to me. How ‘bout you?

Availability

MCT is gaining notoriety; however, finding a therapist to facilitate it is a challenge. For instance, MCT isn’t listed as a therapy option on Psychology Today’s Find a Therapist.

Along with that, I can’t imagine MCT being covered by health insurance providers, though I think that will change.

All that said, you don’t have to do without it. Sites such as Meta Cognitive Therapy Central offer resources and online therapy. Psychology Tools is another excellent resource.

Here’s another angle. Say you’re working with a therapist who’s using CBT. You could ask if they’d be willing to use portions of MCT that fit well for you. Not working with a therapist? Inquire about the same thing before scheduling an appointment.

Recovery rates

The recovery rates for MCT are fairly high, often around 80%, and often remain relatively unchanged over time. In some studies it can be as long as three years.

Those are substantially lower relapse rates compared with those reported for other treatments.

Learn and pursue

“You know, if you’d stop thinking so much, or change what you think about, you wouldn’t be depressed.” You’re starting to believe it.

Yes, that’s a good thing. So learn about and pursue the best possible interventions. I think metacognitive therapy is excellent.

If you haven’t already, be sure to read part one: Metacognitive therapy for depression: What you’ll want to know

Here’s a summary of the paper from Norwegian University of Science and Technology, written by Veronika Søum: Getting rid of depression by changing how you think

The paper in its entirety: Metacognitive therapy for depression

Head over to the Metacognitive Therapy Institute site and see what you can see and learn.

This is an excellent article: Metacognition: Definition, Strategies, & Skills

Those Chipur emotional and mental illness info and inspiration titles. Review them all or by category – just below on mobile, right sidebar on desktop.

After a decades-long battle with panic, generalized anxiety, fluctuating moods, and alcohol dependence; Bill finally found his life’s passion and work – lending a hand to those in the same boat. At age 49 he hit grad school and earned his counseling credentials. And he continues his service through Chipur and other projects.