Thoughts about thoughts: Metacognitive Therapy for Social Anxiety

Thoughts about thoughts: Metacognitive Therapy for Social Anxiety 1 Thinking Styles in Metacognitive Therapy
Metacognitive therapy for social anxiety advocates different thinking styles.

“Try to pose for yourself this task: not to think of a polar bear, and you will see that cursed thing come to mind every minute.”

Fyodor Dostoevsky, Winter Notes on Summer Impressions, 1863

Negative Thoughts and Psychological Disorder

What if they notice my anxiety?  What if they reject me? I can’t give this presentation, I’m too nervous. People will ridicule me if I make a mistake.

These types of ideas typically pop up in the minds of socially anxious people before entering a social situation. Many experts believe that negative thoughts and ideas like the ones above are the reason why people develop psychological problems such as anxiety disorders (Beck, 1976; Ellis & Harper, 1961).

However, when thinking about this critically, we are likely to realize that most people are acquainted with negative thoughts of this kind. So, what determines whether you are negatively affected by these thoughts or not? Metacognitive therapy for social anxiety proposes a new perspective.

It Is Not What People Think, But How They Think

Adrian Wells (2009), Professor of Clinical and Experimental Psychopathology at the University of Manchester, argues that what regulates people’s emotional experiences and their ability to control them is not what they think, but how they think. He has coined the term metacognition, which refers to beliefs about thinking. Traditional cognitive behavior therapy (Beck, 1976) links anxiety to thoughts related to danger. Wells (1995) agrees with this theory, but points out that these thoughts do not cause anxiety disorders.

Wells (2009) advocates the view that certain metacognitions lead to maladaptive thinking styles, which he sees as the actual causes of psychological problems such as social anxiety. The metacognitions of socially anxious people typically include beliefs like:

  • “I can prepare myself for the worst-case outcomes by playing them through in my mind repeatedly.” – Anticipatory anxiety
  • “Analyzing in detail my performance in past social situations and dwelling on embarrassing situations will improve my future performance.” – Rumination
  • “Being alert to my physical arousal and external threats in social situations will help me control them.” – Heightened self-awareness and threat-focus
  • “It is possible and beneficial to avoid certain thoughts.” – Thought-suppression

Cognitive Attentional Syndrome and Psychological Disorder

The maladaptive thinking styles mentioned above refer to a way of thinking that Wells and Mathews (1996) have termed the Cognitive Attentional Syndrome (CAS). According to Wells (2009), the CAS is the reason why some individuals get trapped into certain emotions such as anxiety, while others can move on relatively quickly when facing them.

The cognitive attentional syndrome is the reason why some individuals get trapped into certain emotions such as anxiety. It is a common phenomenon in people with social anxiety disorder.
In stressful social situations, like when giving a presentation, many people pay attention to their physical arousal and try to control it.

Therefore, their metacognitions are what motivate certain people to engage in these thinking styles. They trust they will lower their anxiety by engaging in them. Paradoxically, their way of thinking is what causes them to experience more intense anxiety overall (Wells, 2009).

Metacognitive Therapy for Social Anxiety: Don’t Try to Fight the Polar Bear

Metacognitive therapy (Wells, 2007) proposes a shift in focus away from negative thoughts about the self, others and the world. Rather, Wells suggests an examination of the ideas we hold about thinking itself. He points out that patients can regain a good level of control over their emotions if they learn to accept intrusive, automatic thoughts. He recommends to question and adjust one’s metacognitions accordingly.

So, the next time you are engaging in anticipatory anxiety, excessive rumination, heightened self-awareness, focusing your attention on external social threats, or trying to avoid certain thoughts, ask yourself:

  • “Is it really helpful to worry excessively about everything that could possibly go wrong, or does it reach a point where it only increases my anxiety?”
  • “Do I really benefit from endlessly ruminating about past social faux-pas?”
  • “Does it make sense to focus on my physical arousal and external social threats instead of actively engaging in the social situation?”
  • “Are my attempts of suppressing specific thoughts working? What if I allowed them to emerge and shifted my focus back to the social situation?”

So, the next time you encounter a polar bear, don’t put up a fight. If you tolerate it, it won’t hurt you and both of you can live in peace.

To find out more about the treatment of social anxiety disorder, head over to the following section in which we summarize the different approaches that have been scientifically tested and proven effective.

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