Metacognitive therapy

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The Metacognitive therapy is an evolution of cognitive therapy. After the first wave, behaviorism , and the second wave, the cognitive turn , metacognitive therapy, along with other forms of therapy, is included in the third wave, according to which the concept of mindfulness is given greater weight in therapy. It was developed by Adrian Wells (for a distinction between metacognitive therapy and metacognitive training and cognitive behavioral therapy, see).

Differentiation from cognitive therapy

While in cognitive therapy, developed by Aaron T. Beck , it is believed that dysfunctional schemata are responsible as the cause of mental disorders, in metacognitive therapy it is assumed that beliefs about how to think perpetuate the disorder. Thus, for example, the thought: “I am worthless” would not be responsible for the development of a depression, as is assumed in Beck's theory, but that one attaches importance to the thought and the positive metacognitive conviction that one is brooding or thinking about it - Concerns would have to be faced to change something. In cognitive therapy one would try to question the content of the thought, for example by collecting situations in which one has achieved something or through a Socratic dialogue about what determines a person's worth in the first place. In metacognitive therapy, however, one would assume that these techniques are already giving the thought an unrealistic amount of meaning and spending a lot of time thinking about the thought. The thought would then be more of a trigger for brooding and worrying. Instead, metacognitive therapy tries to treat the thought like other thoughts in everyday life that are not paid much attention to.

techniques

Postponing worrying and brooding

Those affected are given the task of postponing worrying and brooding by consciously saying "stop" in their minds (thought stopping technique) and agreeing on a fixed time at which they can think about it for 15 minutes, but by no means have to. In contrast to the “brooding time” that is otherwise used in cognitive behavioral therapy, the person affected is not asked to use problem-solving strategies during this agreed time, but is allowed to brood over them as before. It is up to him whether he actually uses the 15 minutes. Should he decide to do so, he should write down the reason why he chose it. The purpose of this technique is, on the one hand, to reduce the time for dysfunctional thought processes and to show that the thought processes can be controlled, i.e. to question the negative metacognitive conviction of uncontrollability. It is also important to make it clear that the unwanted thoughts should not be suppressed, because this would lead to an increased occurrence of the unwanted thoughts (rebound effect). Instead, only the subsequent increased preoccupation with the undesired thoughts should be postponed.

Attention Training Technique (ATT)

The goal of the Attention Training Technique is to direct attention away from dysfunctional thought processes and outwards. Metacognitive theory differs in this from other mindfulness techniques, which are also about directing attention to internal processes, such as MBSR or ACT .

There are three exercises that last a total of 15 minutes and should be repeated as homework:

  • Selective attention: The person concerned should only pay attention to at least 3 noises specified in the room at the same time (five minutes).
  • Change of attention: The person concerned should focus their attention on three other noises inside or outside the room. Then he should only focus his attention on one of the 6 to 8 noises and shift it quickly to another (five to six minutes).
  • Divided attention: In the end, attention should be focused on all the sounds at the same time. This task should be quite difficult (two to three minutes).

Detached mindfulness

Behavioral experiments show the possibility of letting go of thoughts without paying any further attention by naming different words that have little meaning for the person concerned. Another exercise is to imagine a tiger without actively changing the image, so that changes in the image are only passively observed.

literature

Peter Fischer and Adrian Wells: Metacognitive Therapy

Individual evidence

  1. ↑ Mervyn Schmucker, Rolf Köster: Practical Guide IRRT: Imagery Rescripting & Reprocessing Therapy for post-traumatic disorders, anxiety, depression and grief . Klett-Cotta, 2014, ISBN 978-3-608-20233-5 , pp. 13 .
  2. ↑ Steffen Moritz, Jan Philipp Klein, Paul H. Lysaker, Stephanie Mehl ,: Metacognitive and cognitive-behavioral interventions for psychosis: new developments . In: Dialogues in Clinical Neuroscience . tape 21 , no. 3 , September 30, 2019, p. 309-317 , doi : 10.31887 / DCNS.2019.21.3 / smoritz , PMID 31749655 ( dialogues-cns.org [accessed January 4, 2020]).
  3. ^ A b Peter Fisher, Adrian Wells: Metacognitive Therapy . Routledge / Taylor & Francis, 2015, ISBN 978-3-95571-002-6 , pp. 52-55 .