4 Metacognitive Therapy ADRIAN WELLS
The metacognitive theory of psychological disorder (Wells & Matthews, 1994; Wells, 2009) is grounded on a basic principle: Negative thoughts and emotions are usually transient experiences. They persist and become psychological problems because the individual activates a specific pattern or style of thinking that is damaging for selfregulation and the elimination of these distressing experiences. This pattern is called the cognitive attentional syndrome (CAS), and it consists of worry, rumination, threat monitoring, and coping behaviors that interfere with self-regulation. Psychological disorder is the consequence of “mental perseveration”—that is, repeatedly returning to and thinking about a particular topic.
THE CAS Worry and rumination are central features of the CAS. They consist of chains of predominantly verbal thinking in which the individual contemplates past events (rumination) and future possible threats (worry). For most people, negative thoughts such as “I’m going to die” fade as the individual directs resources to other task-focused processing. However, for the depressed or anxious individual, these thoughts are met with sustained rumination concerning the reason for living or worry about how to avoid danger. In each case, sustained thinking is a means of finding answers to suffering (e.g., Nolen-Hoeksema, 2000; Wells & Davies, 1994; Wells & Carter, 2001). Unfortunately, the process achieves the obverse as it maintains intrusions and broadens the sense of threat (e.g., Wells & Papageorgiou, 1995). A further important feature of the CAS is threat monitoring: maintaining attention on potential sources of danger to the self and significant others. This takes different forms. For example, it may comprise “information searches” in which the person looks for facts or data. An individual with generalized anxiety may scan the Internet looking for facts and figures on the prevalence of illness within their region. The person suffering from trauma after being robbed in the street may scan the environment for people who are acting suspiciously. The problem with threat monitoring is that it maintains the sense of threat and personal vulnerability, so that negative emotions persist or escalate. This strategy is a means of configuring cognition so that 83
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