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Chronic anxiety can be difficult to treat. Metacognitive therapy is a new and promising approach within the group of cognitive therapies. It is recommended as a first-hand treatment method for generalized anxiety disorder.

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This is what psychologist Henrik Nordahl writes in an article in the Journal of the Norwegian Psychological Association.


What is generalized anxiety disorder?

Generalized anxiety disorder (GAD) is an anxiety disorder, which is characterized by the person walking around with an almost endless series of worrying thoughts. For example, there may be concerns about a catastrophe happening, that life as it is now will only get worse, that one or the other of imaginable and unthinkable things will happen, and one concern. surpasses virtually the other.

In the metacognitive treatment model, it is claimed that the generalized anxiety arises and is maintained by:


  1. Excessive or prolonged thinking (such as worrying and pondering)
  2. Sustained attention to potential hazards (threat monitoring)
  3. Various forms of learned coping strategies that only serve to increase anxiety. For example, this may be an idea that it is useful to worry, because of a belief that this will give you a higher preparedness for any disasters or defeats that may occur.


Overall, this means that people on the one hand are very bothered by anxiety and worrying thoughts, and on the other hand cling to anxiety and worrying thoughts as an attempt to gain control over their life situation. There is thus a vicious circle that is not so easy to break.


What is metacognitive therapy?

Psychologist Henrik Nordahl writes further:

Over the past decade, metacognitive therapy (MCT) has developed into a comprehensive manual-based form of treatment that can be used for, among other things, anxiety disorders, depression, psychosis and personality disorders.

How you respond to your thoughts is more important than what you think.

This is a treatment model that describes psychological difficulties based on a failure of self-regulation, where unfortunate strategies for how to use one's own thoughts and actions lead to vicious circles where the person's thought and action patterns themselves contribute to creating mental problems.

The treatment model does not look alone what one thinks, but also about how one relates to and responds to one's own thoughts and (emotional) reactions. From this comes the central assumption that how one responds to one's thoughts is more important than what one thinks.


The way we use our attention can create mental problems

There are many examples of the use of one's own thoughts and what one pays attention to helping to perpetuate various mental difficulties. Nordahl mentions the following examples.

For example, in social phobia you have an internal focus on your bodily reactions (sweating, flushing, trembling), in depression you have a focus on mood and energy, and in OCD (obsessions and compulsions) you are aware of unwanted thoughts / feelings and potential external hazards.

For someone with social anxiety, it may thus be the case that constantly being alert to whether you have symptoms of sweating, flushing or trembling, may just be what leads to sweating, flushing or trembling - and which makes you trapped in a vicious circle - in a form of orbit around what one fears, which creates what one fears. 


Metacognitive therapy as a treatment for generalized anxiety disorder

When using metacognitive therapy as a treatment for generalized anxiety, the focus of the conversations is on what assumptions the person has about their own concerns. The question becomes what the person thinks he or she achieves by holding on to his or her worries, and constantly turning his or her attention around these worries, and one tries out alternative ways of relating to one's own thoughts.

Studies show that precisely this treatment effect has a good effect on generalized anxiety according to Nordahl, who among other things mentions the following sources:

Wells and King (2006) first conducted an open-label study in which they provided 6-12 hours of metacognitive therapy for generalized anxiety disorder. They reported recovery in 87,5% immediately after treatment, and 75% at 6 and 12 months of follow-up.

There are many indications that metacognitive therapy for generalized anxiety disorder will be a well-established treatment, as it already today meets the requirements for evidence-based treatment.

Nordahl concludes: 

Metacognitive therapy opens up a new approach to the understanding of mental disorders and uses new techniques that are suitable for patient groups who have chronic depression, generalized anxiety, PTSD and psychosis problems, disorders that have traditionally been difficult to treat.



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