An effective new approach to Generalized Anxiety Disorder, using Metacognitive Therapy
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Generalized Anxiety Disorder (GAD) is one of the most common yet misunderstood mental health conditions. It’s often described as free-floating anxiety, meaning it’s not necessarily tied to specific situations or objects.
People with GAD experience persistent worry in many areas of their lives that interferes with their day-to-day activities, accompanied by physical symptoms like restlessness, fatigue, difficulty concentrating, and sleep disturbances. The anxiety can feel overwhelming, leading them to constantly try to control or avoid their worries.
You might have heard that GAD is a result of traumatic experiences, genetics, and negative thinking patterns. But unlike traditional therapies, Metacognitive Therapy (MCT) offers a completely different perspective on the cause and solution: it focuses on your beliefs about worry, rather than the content of the specific worry itself.
The cycle of worry in Generalized Anxiety Disorder
People with GAD often feel trapped in a cycle:
- A trigger thought appears (for example: 'What if I lose my job?”).
- The person engages in worry to either eliminate that thought or to prepare for the worst (if they believe that worrying helps them stay prepared).
- If a solution isn’t found, more worries arise.
- If the person believes worry is uncontrollable or dangerous, they start worrying about the worry itself, scared that they’ll lose control or “go crazy”.
- Their attempt to suppress or counteract worry (through mindfulness techniques, reassurance-seeking, positive thinking) fail, reinforcing the belief that worry is uncontrollable.
- The cycle repeats.
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Why traditional therapies are less effective
Traditional treatments such as Cognitive Behavioral Therapy (CBT) and Mindfulness-Based Stress Reduction (MBSR) focus on altering negative thoughts, relaxation techniques, and developing coping strategies. These methods can be beneficial in the short-term, but they can also backfire and stunt recovery because they don’t address the core issue—beliefs about worry itself. Ultimately, they fail to break the cycle of excessive worry and its escalation into anxiety about worry itself.
CBT primarily focuses on changing negative thoughts into more realistic or positive ones, while mindfulness encourages relaxation and acceptance. But these approaches can actually be counterproductive for GAD, because they reinforce the idea that worry must be controlled or eliminated.
Adrian Wells, the psychologist and creator of Metacognitive Therapy, explains: 'Your thoughts don't matter, but your response to them does.'
In CBT, for example, strategies might involve planning for different scenarios to reduce worry, but this mirrors the very process that people with GAD already engage in—constant problem-solving and reassurance-seeking. Therapy becomes a never-ending exercise if you need to discuss and solve every new worry, rather than tackling the worry process at the source. In MCT, the solution is the same for every worry thought.
The Metacognitive Therapy approach
MCT was specifically developed to treat Generalized Anxiety Disorder, and studies show it’s currently the most effective method. Research shows that while CBT has a success rate of about 50%, MCT has a significantly higher recovery rate of 80-90%, with fewer relapses. It’s effective because it zooms out to target the way people relate to their thoughts and worries.
According to MCT, the root of GAD lies in three key beliefs, known as metacognitive beliefs:
- The belief that worrying is helpful. Many people with GAD use worry as a tool to stay prepared for any negative outcomes. They use worst-case scenario thinking in an attempt to reassure themselves or find solutions.
- The belief that worrying is uncontrollable. This idea makes people feel powerless over their own thoughts. When a worry arises, they feel the need to either push it away or resolve it completely. And when they can’t, they begin to worry about their worry.
- The belief that worrying is harmful: Because the worry can feel uncontrollable and overwhelming, this leads some people to become scared that their worry can harm them, reinforcing the anxiety.
Breaking the anxiety cycle
MCT helps people recognize that worry is neither uncontrollable nor dangerous. The therapy itself involves three key steps:
- Demonstrating that worry is controllable: People can engage in exercises where they postpone worry — if worry can be delayed, it proves that it is not entirely automatic or uncontrollable.
- Challenging the belief that worry is dangerous: Individuals are guided to test their fears of going crazy or losing control due to excessive worry. They come to realize that worry itself does not cause harm.
- Recognizing that worry is not helpful. Through exercises and discussion, people start to see that worrying does not actually prevent negative outcomes or make them more prepared.
A game-changing shift in anxiety treatment
These days, it’s common for people to believe that the way to stop anxiety is to push worries away or replace them with positive thoughts. But MCT research is creating a paradigm shift in how anxiety is approached, demonstrating that it’s the fear of worry itself that maintains the disorder. By changing our beliefs about worry and altering how we respond to it, MCT offers an effective, lasting solution to GAD, empowering people to break free from the cycle of worry. For a deeper dive into the causes of anxiety, you can read about the five key causes here.
If you’re interested in learning whether MCT can help you on your journey to better mental health, take this quiz to find out more.
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