A thought experiment:

Imagine you had to write down the following sentence:

“My mother will win a million euros in the lottery tomorrow.”

So far so simple. Now imagine you have to write down another sentence:

“My mother will die tomorrow.”

You probably found the second idea much more difficult. Because you shouldn’t write something like that. It’s best not to think something like that in the first place. Because thoughts are powerful, aren’t they?

But more and more studies suggest that the conviction (metacognition) that thoughts are powerful and uncontrollable contributes to the development and maintenance of mental disorders such as depression, generalized anxiety disorder, obsessive-compulsive disorder, etc. For example, anyone who is convinced that a thought such as “My mother/father could die soon.” is not just a thought, but a dark premonition that will materialize because we had this thought, with most likely feelings of anxiety, guilt and depression. If, on the other hand, we realize that thoughts are often nothing more than insignificant “brain farts”, of which we produce thousands every day, we remain relaxed and unimpressed. modern psychotherapy – especially metacognitive therapy – also makes use of these insights and achieves sometimes unprecedented therapeutic success…

People with OCD tend to evaluate their thoughts as overly significant and influential. The belief that certain thoughts could have catastrophic consequences leads to compulsive behaviors. Metacognitive therapy starts here and recognizes the need to break through this excessive evaluation. It is about teaching those affected to look at their thoughts more realistically and to understand that not every thought has the same power.

While behavioral therapy aims to directly influence mental disorders by changing behaviors, metacognitive therapy focuses on the meta-level of cognitive processes. For example, behavioral therapy can aim to interrupt compulsive behavior, while metacognitive therapy directly addresses the underlying thought patterns and beliefs.

The video provides insights into metacognitive therapy and presents a new study (Melchior et al., 2023) in which the effectiveness of metacognitive therapy was compared with the effectiveness of behavioral therapy.

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Studies (just a small selection):

Andouz, Z., Dolatshahi, B., Moshtagh, N., & Dadkhah, A. (2012). The efficacy of metacognitive therapy on patients suffering from pure obsession. Iranian journal of psychiatry, 7(1), 11.

Ferrando, C., & Selai, C. (2021). A systematic review and meta-analysis on the effectiveness of exposure and response prevention therapy in the treatment of Obsessive-Compulsive Disorder. Journal of Obsessive-Compulsive and Related Disorders, 31, 100684.

Glombiewski, J. A., Hansmeier, J., Haberkamp, A., Rief, W., & Exner, C. (2021). Metacognitive therapy versus exposure and response prevention for obsessive-compulsive disorder–A pilot randomized trial. Journal of Obsessive-Compulsive and Related Disorders, 30, 100650.

Hansmeier, J., Haberkamp, A., Glombiewski, J. A., & Exner, C. (2021). Metacognitive change during exposure and metacognitive therapy in obsessive-compulsive disorder. Frontiers in Psychiatry, 12, 722782.

Melchior, K., van der Heiden, C., Deen, M., Mayer, B., & Franken, I. H. (2023). The effectiveness of metacognitive therapy in comparison to exposure and response prevention for obsessive-compulsive disorder: A randomized controlled trial. Journal of Obsessive-Compulsive and Related Disorders, 36, 100780.

Melchior, K., Franken, I. H., & van der Heiden, C. (2018). Metacognitive therapy for obsessive-compulsive disorder: A case report. Bulletin of the Menninger Clinic, 82(4), 375-389.

Reid, J. E., Laws, K. R., Drummond, L., Vismara, M., Grancini, B., Mpavaenda, D., & Fineberg, N. A. (2021). Cognitive behavioural therapy with exposure and response prevention in the treatment of obsessive-compulsive disorder: A systematic review and meta-analysis of randomised controlled trials. Comprehensive psychiatry, 106, 152223.

Yan, J., Cui, L., Wang, M., Cui, Y., & Li, Y. (2022). The Efficacy and Neural Correlates of ERP-based Therapy for OCD & TS: A Systematic Review and Meta-Analysis. Journal of Integrative Neuroscience, 21(3), 97.

For decades scientists have tried to improve the effectiveness of depression therapy. Until recently only with limited access.

New evidence suggests that things could change due to Metacognitive Therapy which was developed by the clinical psychologist Adrian Wells (2011).

The treatment approach in Metacognitive Therapy is fundamentally different from other treatments. Whereas in cognitive behavioral therapy (CBT) a lot of effort goes into reframing negative thoughts in Metacognitive Therapy you don’t have to change the content of your thoughts. Instead you have to change what you belief about your thoughts (metacognitive = beliefs concerning your thoughts). This will help you to detach your attention from negative thoughts and will finally stop your rumination.

Studies & Books:

Callesen, P., Reeves, D., Heal, C., & Wells, A. (2020). Metacognitive therapy versus cognitive behaviour therapy in adults with major depression: a parallel single-blind randomised trial. Scientific reports, 10(1), 1-10.

Fisher, P., & Wells, A. (2014). Metakognitive Therapie (Vol. 8). Junfermann Verlag GmbH.

Wells, A., Fisher, P., Myers, S., Wheatley, J., Patel, T., & Brewin, C. R. (2009). Metacognitive therapy in recurrent and persistent depression: A multiple-baseline study of a new treatment. Cognitive therapy and research, 33(3), 291-300.

Wells, A., Fisher, P., Myers, S., Wheatley, J., Patel, T., & Brewin, C. R. (2012). Metacognitive therapy in treatment-resistant depression: A platform trial. Behaviour research and therapy, 50(6), 367-373.

Wells, A., & Papageorgiou, C. (2004). 13 Metacognitive Therapy for Depressive Rumination. Depressive rumination, 259.

Wells, A. (2011). Metacognitive therapy for anxiety and depression. Guilford press.

Wells, A. (2013). Advances in metacognitive therapy. International Journal of Cognitive Therapy, 6(2), 186-201.