Mental wellness Instagram brims with gentle reminders for scrollers to keep in their back pocket like “your anxiety is lying to you” and “you are not your depression.” The assertion that your anxiety is lying to you helps reinforce that thoughts powered by mental illness are not necessarily rooted in reality, and don’t need to be listened to.
You are not your depression focuses on the idea that depression is a condition and a feeling, but it’s not all-engulfing. These mantras are useful, wholesome nuggets floating around the big, bad Internet that intend to offer users something to grasp. But mantras aren’t always enough against the tidal wave of negative thought that is rumination.
Rumination is characterized by persistent, typically negative thinking, usually about something that’s past. It may feel like your mind keeps plodding the same path of thought patterns leading nowhere. It’s a pernicious, sometimes debilitating symptom.
Enter metacognitive therapy (MCT), a recent, evidence-based approach to helping those with mental illness manage rumination and anxiety. “Meta” refers to the fact that it addresses the thing that thinks your thoughts — your brain — rather than the thoughts themselves. This therapy, developed by Adrian Wells, a psychology professor at the University of Manchester, serves to fill in some gaps that Wells believes fails to fill.
A study published last week in the journal PLOS Medicine looked at how MCT can aid patients in cardiac rehabilitation, but anyone dealing with depression and anxiety can stand to benefit.
Science in action — In a clinical trial conducted between April 2017 and April 2020, researchers from the United Kingdom compared two types of therapy in 240 patients undergoing cardiac rehabilitation. These are people with cardiovascular disease who have experienced a major cardiac event, such as a major heart attack.
Cardiac rehab makes patients vulnerable to anxiety and depression, which can lead to worse recovery outcomes. Accounting for mental wellness is, therefore, critical to full recovery. In this randomized trial, one group of patients received standard cardiac rehabilitation, which focuses largely on exercise and lifestyle changes, while the other group received cardiac rehab plus MCT in the form of a self-guided book.
In a four-month follow-up, 36 percent of participants that received cardiac rehab alone improved compared to the 59 percent from the cardiac rehab augmented with MCT.
Why it’s a hack — While this clinical trial involved patients with heart disease, MCT could stand to benefit anyone prone to repetitive thoughts and constant worrying. Rumination can look like coming back to a single social interaction, like a conversation at a party, over and over, and imagining what one could have done differently. Re-envisioning past events is natural, but all-consuming thoughts on something that can’t be changed are unhelpful and leaves a mind vulnerable.
“We discovered some time ago that a particular style of thinking appears to make people vulnerable to anxiety and depression and trauma and is also responsible for keeping anxiety and depression going,” Wells tells Inverse. This style of thinking has a name: cognitive attentional syndrome. This name speaks Wells’ belief that rumination arises from what we pay attention to and how that shapes our beliefs.
Cognitive behavioral therapy (CBT) is a common practice to cope with depressive or obsessive thoughts. This method challenges the contents of the thoughts, perhaps by taking an extreme scenario to a logical conclusion or by trying to base them on reality. Ideally, the thinker comes to understand that these thoughts are fundamentally unrealistic and nothing to be scared of.
MCT, on the other hand, “focuses not on content, but how people regulate their thinking,” Wells tells Inverse. Especially in those recovering from major surgery or dealing with a recent diagnosis, CBT can fall short because the premise that negative thoughts are not rooted in reality isn’t true. It’s not possible to challenge the negative thought that someone’s life has changed — because if you’ve had a major heart attack, then your life has changed, and that thought is valid. Wells says MCT asks how much you worry and shows you how to worry less.
But you don’t need to suffer a major cardiac event to employ this tactic. If you are dealing with any kind of upheaval that throws you into a cognitive tailspin, MCT can help you better understand where that torrent of thought is coming from.
The manual that the patients used in the trial focused on understanding what perpetuates their anxiety and low mood to help understand the process behind constant distress. Then, after identifying some of those processes, the workbook’s modules offer techniques to reduce worry and rumination by identifying unhelpful behaviors and finding substitutions. This piecemeal process helps bring a sense of control back to your mind.
“One of the barriers to this, and it's central to the metacognitive model, is the belief that people develop that they've lost control of their thinking, which actually is a distortion,” Wells says, “because anxiety and depression don't lead to loss of control of thinking. It may feel that way, but it’s not a reality.”
How it affects longevity — It’s well documented that depression and anxiety are associated with adverse health effects. Respective of cardiac patients, Wells says this is also true; these patients are 30 percent more likely to develop these conditions, which can lead to worse health outcomes. However, “we don't know what the mechanism is,” Wells tells Inverse. “So it may not be anxiety and depression, that's a problem. It may be the way you cope with anxiety and depression.”
Rumination as a coping mechanism also comes with adverse effects. Wells says that many cardiac patients will shut themselves up to dwell on their condition. They wonder how they’ll get their life back in order or why such a tragedy has befallen them. In the long term, they may stop socializing, exercising, and taking care of themselves in favor of what they may see as a way of solving a problem.
Floating somewhere out in the vast reaches of the Instagram algorithm, there’s likely at least one stylish infographic breaking down the tenets of MCT, urging social media users to take the reins of what’s driving their rumination.
Hack score out of 10 — 🧠🧠🧠🧠🧠🧠 (6/10 brains practicing metacognitive therapy)