Metacognitive therapy: characteristics and psychological effects.

A summary of the characteristics, functioning and benefits of this type of psychotherapy.

Within the cognitive current, it is argued that most of the discomfort a person suffers is due more to the way he or she sees and interprets 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 or she perceives them, that is, it takes into account his or her metacognition.

Throughout this article we will go into more depth about metacognitive therapy, as well as explaining in more detail the idea behind the concept of metacognition and what disorders it is used for.

What is metacognitive therapy?

Traditionally, cognitive therapies have held that alterations or biases in thinking are the cause of the patient's psychological distress, rather than the situation itself. The distress is caused by the way 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 onset and maintenance of psychological disorders.. That is why it is among the therapies of this type.

However, a key point of metacognitive therapy is its focus. This type of therapy tries to understand why there are people who, faced with an adverse situation, are capable of being carefree while others, faced with the same situation, manifest depressive and anxious symptoms.

According to Wells' theory, what would be behind the maintenance of this discomfort are the person's metacognitions, i.e., the way he or she views his or her own thinking.that is, the way he or she sees his or her own thinking. 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 modes of thinking that incur dysfunctional beliefs. In other words, the aim is to change the inflexible way in which the person views stimuli that, within his or her mentality, are considered threatening. By changing this way of seeing and interpreting things, the person is no longer trapped by the situation and acquires a greater degree of well-being by being able to cope with the problems. by knowing how to cope with problems.

What is metacognition?

On many occasions, the discomfort experienced in a given 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, when faced with an adverse situation, know how to cope and do not worry too much while others suffer to such an extent that they are paralyzed.

Within the cognitive current, therapy aims to identify, question and change those automatic thoughts that, activated in a given situation, are the real source of the person's discomfort. By questioning the strength of these dysfunctional thoughts, the negative emotions associated with these harmful beliefs will diminish.

However, in order to be able to do this, it is necessary to make the person aware of his or her own thoughts.. That is, to think about what he or she is thinking and how he or she thinks 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 theory of mind.. This concept can be subdivided into several components, being mainly the knowledge, experiences and strategies that the person has to cope with the situations presented. Metacognition is composed 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.

1. Explicit beliefs

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

An example of this type of belief would be 'I have bad thoughts, so I am a bad person', 'worrying can cause me to have a Heart attack', 'what I have been thinking is a sign that something is wrong'.

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

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

Some examples of negative metacognitive beliefs would be "I have no control over my thoughts", "if I think in a violent way, I am going to do some aggression"...

2. Implicit beliefs

Implicit beliefs refer to those rules or programs that guide a person's thinking, such as paying attention to a certainsuch 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 been shown to be effective and efficient in terms of improving patients' well-being. This could be empirically observed in research, putting for example the case of Normann and Morina (2018) 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 setting it has been seen 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.

Therapy usually takes place between 8 and 12 sessions. The therapist discusses with the patient about the adjustment of his or her way of interpreting his or her own cognition.that is, thoughts, past experiences and applied strategies. Once it has been possible to see what is causing the discomfort, therapy focuses on promoting in the patient more adaptive and appropriate thinking styles to the situations that had previously been associated with problems.

Attentional cognitive syndrome

The metacognition of people suffering from psychological disorders, according to Wells, gives rise to a particular way of responding to internal experience, i.e., their thoughts and emotions. This causes these negative feelings to become chronic and the person continues to suffer.. This thought pattern has been called Attentional Cognitive Syndrome (ACS) which would be composed of the following three aspects:

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

This syndrome is of vital importance for understanding the metacognitive therapy model. This becomes especially understandable in those who suffer from an anxiety disorder: their attention becomes fixated on a threatThey try to get rid of this negative emotionality, and they carry out coping strategies which, in the long run, make them think even more about this problem. Thus, they end up having thoughts like "what if this happens?2, "I should worry about this not getting worse"....

Bibliographical 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 CognitiveBehavioral 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. Attentional cognitive syndrome and cognitive processes. Argentine Journal of Clinical Psychology. 25(2). 125-134.