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See Inside Scientific American Mind Volume 25, Issue 4

Rethink Your Thoughts about Thinking

Targeting metacognition—our beliefs about thoughts—might alleviate mood disorders and even schizophrenia



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Your beliefs about the way you think can shape your life in surprising ways. A spate of recent findings suggest that targeting such metacognition can help relieve mood and anxiety disorders, and it may even reduce symptoms of psychosis.

Metacognition often takes the form of a value judgment about one's thoughts, such as “It's bad that I overanalyze everything.” Research has shown that these metacognitive beliefs can play an important role in obsessive-compulsive disorder, depression and generalized anxiety disorder, among others. In particular, they may matter more than the way we frame situations in our mind, such as by focusing on the negative aspects of a life event. That framing, called cognitive appraisal, is typically addressed in psychotherapy, but metacognition is not, perhaps to the patient's detriment, explains psychologist Jennifer L. Hudson of Macquarie University in Australia. A study published last fall in the Journal of Clinical Child & Adolescent Psychology found that among 83 children, those with anxiety disorders held more negative beliefs (“Worrying might make me go crazy”) and positive beliefs (“Worrying helps me feel better”) about worry than the nonanxious children. “We think that these beliefs might play a causal, or at least a maintaining, role in the anxiety disorders,” says Hudson, a co-author of the study.

Metacognitive therapy can successfully treat mood and anxiety disorders, according to a growing body of research. Developed in 2008 by Adrian Wells, a clinical psychologist at the University of Manchester in England, the therapy teaches patients to recognize and reframe metacognitive thoughts that reinforce unhelpful coping mechanisms, such as “my fretting is uncontrollable,” much in the same way cognitive-behavior therapy (CBT) targets maladaptive beliefs along the lines of “the world is unsafe.” The technique also helps people become more flexible in the way they think about their thoughts, instead of defaulting to rumination, for example.

One small study published last year in the Japanese Journal of Personality examined whether metacognitive therapy could reduce depressive rumination by disproving positive beliefs about this style of thinking, such as “rumination increases insight into situations.” Twelve undergraduate students with high rumination scores were randomly assigned to an intervention group for two weeks, and 11 others were assigned to a no-treatment control group. The technique reduced the students' tendency to dwell on their negative thoughts.

More surprisingly, a small study from the June issue of the Journal of Behavior Therapy and Experimental Psychiatry found that metacognitive therapy reduced symptoms of psychosis. Citing the mixed results yielded by studies of CBT in treating psychotic disorders, researchers gave 10 patients with schizophrenia spectrum disorders up to 12 sessions of metacognitive therapy over a nine-month period. At the end of treatment, five of the participants had at least a 25 percent decrease in symptoms. Four of the five maintained this improvement at follow-up three months later.

Although larger studies are needed, many clinicians and researchers are now beginning to believe treatment should go beyond addressing a patient's specific thoughts to illuminate the underlying beliefs that might be reinforcing them. “Metacognitive factors are crucial in determining the unhelpful thinking styles in psychological disorders,” says Robin Bailey, a Ph.D. candidate at the University of Manchester and author of a recent paper showing that certain metacognitions are positively correlated with health anxiety. “How a person thinks may be more important than what a person thinks.”

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