Emotional Disorders and Metacognition

The clinical experience of cognitive therapies is adding to the understanding of emotional disorders. Based on clinical experience and evidence, this groundbreaking book represents a development of cognitive therapy through the concept of metacognition. It provides guidelines for innovative treatments of emotional disorders and goes on to offer conceptual arguments for the future development of cognitive therapy. Offers a new concept in cognitive therapy and guidelines for innovative treatment. Clinically grounded, based on a thorough understanding of cognitive therapies in practice. Written by a recognized authority and established author.

Adrian Wells, University of Manchester, UK.

List of Figures

x

List of Tables

xi

About the Author

xii

Preface

xiii

Acknowledgments

xiv

PART I THEORETICAL PERSPECTIVES

Setting the Stage: Metacognition and Cognitive Therapy

3

(11)

Metacognition

6

(3)

Varieties of metacognition

9

(3)

knowledge

9

(1)

experiences

9

(1)

metacognitive control strategies

10

(2)

Emotion, metacognitive monitoring and control

12

(1)

Conclusions

13

(1)

The Self-Regulatory Executive Function (S-Ref) Model

14

(19)

Cognitive-emotional regulation: the S-REF Model

16

(2)

outline of the S-REF model

16

(2)

Self-referent knowledge (beliefs)

18

(2)

plans and goals

19

(1)

System operating characteristics

20

(1)

Causes and effects of emotion

21

(1)

Internal events and feelings as metacognitive data

22

(1)

The maintenance of psychological disorder

23

(3)

Belief change: mental modes and coping

26

(3)

Functions of thought: a special role for imagery

29

(2)

Conclusions

31

(2)

Metacognition and Emotional Disorder: Evidence for the S-REF Model

33

(22)

Prediction 1(a): Metacognitive beliefs and trait emotion

34

(6)

Prediction 1(b): Effects of metacognitive belief manipulation

40

(1)

Prediction 2: Metacognitions and maladaptive coping

41

(2)

Prediction 3: Metacognitive thought control strategies

43

(5)

Prediction 4: Deleterious effects of worrying/rumination

48

(2)

Prediction 5: Cognitive efficiency

50

(4)

Conclusions

54

(1)

Emotional Processing, the S-REF and Trauma Therapy

55

(19)

Emotional processing

56

(3)

Bower's network model of mood and memory

59

(1)

Ingram's network model of depression

60

(1)

Summary of network limitations

60

(1)

The S-REF perspective on emotional processing

61

(4)

architecture

62

(1)

level of representation

62

(1)

goals and coping

63

(1)

metacognitions and attention

64

(1)

Failure and success in emotional processing

65

(4)

coping strategies

67

(1)

metacognitions

68

(1)

situational factors

68

(1)

symptom appraisals

69

(1)

Low-level maladaption

69

(1)

S-REF treatment guidelines for overcoming trauma reactions

70

(3)

Conclusions

73

(1)

S-REF, Schema Theory and Interactive Cognitive Subsystems (ICS)

74

(19)

S-REF and schema theory

75

(2)

S-REF and interacting cognitive subsystems (ICS)

77

(8)

architectural considerations

78

(1)

limitations of implicational codes

78

(2)

dynamics of cognitive control

80

(1)

simplistic view of self-awareness

81

(1)

modifying problematic processing modes

82

(1)

worry/rumination cycles

83

(1)

interruption of worry cycles

84

(1)

Comparative treatment implications of S-REF versus ICS

85

(4)

treatment goals

85

(2)

specific strategies: mindfulness training and attention training

87

(2)

Summary and conclusions

89

(4)

PART II CLINICAL APPLICATIONS

Metacognitive Focused Therapy: Basic Constructs

93

(11)

General treatment principles

94

(2)

Cognitive and behavioural responses change cognition

96

(1)

Stress management strategies

97

(1)

Developing metacognitive control

98

(2)

A dynamic view of cognitive-behavioural modification

100

(1)

Summary of general treatment implications

101

(2)

Conclusions

103

(1)

Clinical Assessment of Metacognitions

104

(13)

Reformulated A--B--C analysis

105

(2)

Metacognitive profiling

107

(3)

meta-beliefs/appraisals

108

(1)

coping strategies

108

(1)

attention

109

(1)

memory

109

(1)

judgements

109

(1)

mode

110

(1)

Three questionnaire measures of metacognition

110

(6)

metacognitions questionnaire (MCQ)

111

(2)

anxious thoughts inventory (AnTI)

113

(1)

thought control questionnaire (TCQ)

113

(3)

Conclusions

116

(1)

Modifying Beliefs

117

(15)

Modulating influences on belief change

118

(2)

Knowledge acquisition

120

(8)

establishing a metacognitive mode

121

(2)

regulating on-line processing

123

(2)

changing maladaptive self-regulatory guides

125

(2)

developing new processing routines

127

(1)

Stages of knowledge acquisition

128

(1)

Imagery: a virtual world programming environment

129

(1)

Writing new plans: a summary

130

(1)

Conclusions

130

(2)

New Pathways for Cognitive Restructuring: Attention Modifications (ATT and SAR)

132

(23)

Distraction

133

(4)

studies of simple distraction

133

(4)

Oversimplistic view of attention in psychotherapy

137

(2)

Attention training (ATT)

139

(5)

effectiveness of ATT

139

(2)

description of ATT

141

(1)

the rationale for ATT

142

(1)

examples of basic rationales

142

(2)

Overview of basic instructions

144

(3)

therapist dialogue

145

(1)

eliciting feedback

146

(1)

homework practice

147

(1)

First session outline

147

(1)

Situational attentional refocusing (SAR)

147

(4)

The design of effective SAR strategies

151

(2)

Inclusion of SAR in cognitive therapy of social phobia

153

(1)

Conclusions

153

(2)

Treating Pathological Worry and Generalized Anxiety Disorder

155

(24)

A definition of worry

156

(1)

Generalized anxiety disorder

157

(1)

A meta-cognitive model of GAD

158

(6)

empirical status of the model

162

(2)

Implications for treatment

164

(1)

Eliciting metacognitions

165

(1)

Generating a case formulation

166

(5)

Socialisation

171

(2)

Modifying Type 2 worry and negative beliefs

173

(2)

challenging uncontrollability beliefs

173

(1)

behavioural experiments

174

(1)

modifying danger-related beliefs

175

(1)

Modifying positive beliefs

175

(1)

Strategy shifts (developing new plans)

176

(1)

Relapse prevention and co-morbidity

177

(1)

Conclusions

177

(2)

Treating Obsessive-Compulsive Disorder

179

(21)

Prevalence of obsessions and compulsions

180

(1)

A metacognitive perspective

180

(1)

A prototypical model

181

(4)

domains of metacognitive beliefs

183

(2)

Empirical support for a metacognitive model

185

(1)

General implications for treatment

185

(2)

Generating a case formulation

187

(1)

Eliciting dysfunctional beliefs and appraisals

187

(4)

Socialisation

191

(1)

Cognitive de-fusion

192

(4)

behavioural experiments

194

(1)

exposure and response prevention experiments

195

(1)

Stop signals and criteria for knowing

196

(3)

doubt reduction

198

(1)

Detached mindfulness

199

(1)

Conclusions

199

(1)

Concluding Remarks

200

(20)

Future directions

202

(3)

depression and rumination

202

(1)

varieties of thought

203

(1)

auditory hallucinations

204

(1)

Closing comment

205

(4)

APPENDICES

I. Metacognitions Questionnaire (MCQ)

209

(4)

II. Scoring key for the MCQ

213

(1)

III. Anxious Thoughts Inventory (AnTI)

214

(2)

IV. Scoring key for the AnTI

216

(1)

V. Thought Control Questionnaire

217

(2)

VI. Generalized Anxiety Disorder Scale (GADS)

219

(1)

References

220

(9)

Author Index

229

(4)

Subject Index

233

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Emotional Disorders and Metacognition Innovative Cognitive Therapy

Summary

Author Biography

Table of Contents

Supplemental Materials