Why MCT can help more people with its transdiagnostic approach
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Metacognitive Therapy (MCT) is revolutionizing mental health treatment by targeting the thought processes underlying a wide range of psychological disorders. Unlike traditional methods that focus on talking through specific thoughts or problems, dealing with them one at a time, MCT offers a unified approach to recovery. This transdiagnostic perspective shows more efficient and effective outcomes across multiple conditions.
Did you know that it's common for people to struggle with more than one psychological disorder at once? For instance, it's not uncommon for someone who struggles with generalized anxiety disorder (GAD) to also experience symptoms that are commonly linked to OCD. Or for someone who struggles with Social Anxiety to also have symptoms of Depression and Performance Anxiety.
Traditionally, we have explained this through genetics, trauma, and life experiences. But is that the full story?
The common mechanisms underlying mental illness
Clinical psychologist Dr. Adrian Wells discovered that there is a type of coping style that is found across the spectrum of psychological disorders, whether its anxiety, depression, OCD, or PTSD. This coping style is responsible for escalating and maintaining mental distress.
He called it the Cognitive Attentional Syndrome (CAS), and it's characterized by:
- Repetitive negative thinking (worry, rumination, dwelling, doubting).
- Repetitive or prolonged focus on threats (paying extra attention to symptoms, negative feelings, or scary thoughts).
- Unhelpful coping strategies that backfire (thought suppression, avoidance, or trying to control feelings and symptoms).
The CAS is central to understanding and addressing mental disorders in Metacognitive Therapy (MCT). Research has repeatedly found that the CAS leads to prolonged mental distress, and that reducing or removing the CAS improves mental health and wellbeing.
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The CAS-strategies are under your control
Although you may feel like you have no control over your worrying or threat monitoring, research consistently shows that these strategies are under our control, and are used because they are believed to be helpful, necessary, or unavoidable.
For example, many people believe that worry is helpful, but also that it's uncontrollable. Or that monitoring symptoms will help you find illness or symptoms early. Or that certain thoughts are important and must always be dealt with. These beliefs can lead to excessive worry, symptom monitoring, and thought control strategies, which again can lead to escalating mental distress.
By challenging your unhelpful beliefs about your thoughts and strategies (metacognitive beliefs), MCT helps you reduce or remove the CAS and find more helpful ways to deal with negative thoughts, feelings, and symptoms.
Many birds, one stone
MCT research sees mental problems as being more similar than they are different [1]. By attacking their common underlying causes, there can be improvement across multiple diagnoses.
If you struggle with your mental health, it's likely that you engage with CAS strategies frequently, like worrying a lot or avoiding certain thoughts and feelings.
One of the first goals in Metacognitive Therapy is for you to learn how to recognize and interrupt the CAS. And because the coping styles that make up the CAS are underlying mechanisms of more than one type of mental distress, you can improve several conditions at once. For example, limiting the time you spend dwelling on negative thoughts can reduce multiple types of anxiety and symptoms of depression.
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The advantages of a transdiagnostic approach
Targeting the underlying causes offers several advantages:
1. Efficiency in treatment
Metacognitive Therapy allows therapists to address multiple conditions without needing to switch between different treatment protocols for each specific disorder. Because all psychological disorders are fuelled by unhelpful metacognitive beliefs and the CAS in some form, by challenging these beliefs and reducing the CAS, you can reduce symptoms across several disorders at the same time.
2. Simplification of therapy
For both therapists and clients, having a unified approach can reduce the need for clients to understand and adapt to different treatment models and strategies for each individual problem. Instead, the same strategy and understanding can be applied to all types of diagnoses.
3. Treating the root of the problem
MCT effectively treats the root causes of prolonged psychological distress, rather than just managing symptoms, which can prevent mental health problems from popping up again after one problem is tackled.
For example, if you have a tendency to worry as a way of being prepared and this strategy is not addressed in therapy, it's quite likely that you will keep worrying about different types of situations, with can lead to your anxiety popping up repeatedly, in new circumstances.
Tackling the beliefs that sustain this strategy and make it feel out of your control, instead of the specific worry-topics can lead to more sustainable and long-lasting improvement in mental health.
4. Preventing relapse
By helping you understand and relate to your negative thoughts, symptoms, and feelings in new ways, you're equipped to handle future triggers and challenging situations. This can reduce the likelihood of relapse, and make you more able to deal with, and recover from, setbacks.
You don't need to discuss every new problem with your therapist, because you're able to identify trigger thoughts and unhelpful strategies, and follow the MCT-based plan you made together.
5. Feeling of empowerment
MCT empowers you by helping you change your relationship with your thoughts rather than changing the thoughts themselves. We often see that the method helps people feel a greater sense of control and self-efficacy in dealing with negative thoughts, difficult feelings, symptoms, and challenging situations. Because challenges and negative thoughts are a part of life, having confidence in your ability to deal with them in a productive way has a big impact on your mental well being and your outlook on the future.
If you want to learn more about whether MCT can help with your specific issues, you can check out this article to get started.
Selection of consulted references:
[1] Nordahl, H., Hjemdal, O., Johnson, S. U., & Nordahl, H. M. (2023). Metakognitiv terapi. Tidsskrift for Norsk psykologforening, 60(12), 781-791. https://doi.org/10.52734/CHIQ3716
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