Everybody ruminates: It’s that familiar pattern of chewing over your thoughts and your feelings about them. For people with depression, it takes a turn toward the pathological: The spiral that comes from feeling bad about feeling bad (about feeling bad!) can be immobilizing. But a new therapeutic approach — called metacognitive therapy (MCT) — targets that process with Zen-like deftness, and it’s been shown to dramatically reduce clinical depression. It’s also useful to anyone who’s felt run over by an uncontrollable train of negative thoughts.
At the center of MCT is the understanding that you don’t have to do much of anything about your thoughts. Rather than trying to figure out if they’re right or wrong, you just observe them as they occur and let them float on by. Rather that being the thought, MCT helps you realize that you’re merely thinking the thought.
Right now, the go-to psychotherapeutic treatment for this type of never-ending rumination is cognitive-behavioral therapy, or CBT, which focuses on training patients to examine the validity of their ideas and feeling. (Like, is it true that my boss hates me because she didn’t say goodbye when she left for the day?) But the literature on CBT’s efficacy with depression is mixed; as one meta-analysis suggested, reports of CBT success may be influenced by publication bias. (There’s reason to believe that psychoanalysis may come back in fashion, too.)
Unlike CBT, the metacognitive approach is full-on pacifist: Rather than blocking or analyzing the thoughts, you let them bubble up and drift or pop on their own. The point is to help patients recognize and readjust their own patterns of thought — thus the metacognitive bit — so that they arrive at a place of “detached mindfulness.”
This is not your traditional coping strategy, but apparently it works.
Early proof can be found in a recent paper in Frontiers in Psychology, wherein a team of European researchers recruited 39 patients with depression. They split them into two groups — one received the therapy over 10 sessions while the other was waitlisted. About 80 percent of patients in the MCT group were considered to no longer exhibit depression during clinical interviews; six months later, it was about 69 percent. About 5 percent of the wait-listers had their depression abate. (It’s hard to say that a condition like depression is “cured,” since that implies a finality rarely available in mental health conditions.) As lead author Roger Hagen, a psychologist at Norwegian University of Science and Technology, told Thrive Global over email, patients often reported seeing their thoughts as “just thoughts” after MCT — not things to cling to or get anxious about. The therapy helps patients learn to “control a thinking process” that most people “suffering from depression think is uncontrollable,” he says.
These are hopeful findings, given that depression is so widespread and reliably effective treatments are still very much a work in progress. According to the National Institutes of Health, an estimated 16 million American adults — 6.7 percent of the population — had at least one major depressive episode in 2015. It already takes more years off of American lives than any other mental disorder. By 2030, it’s projected to take the second-most years off of lives globally, behind only HIV/AIDS. Though antidepressants are expected to be a $16 billion market by 2020, it’s still unclear just how effective and broadly suitable they are.
While similar to mindfulness meditation, MCT doesn’t require sitting practice, Hagen says, and it can be learned quickly. In MCT sessions, the therapist challenges patients’ beliefs about how cognition works — like if worry is uncontrollable, and if it actually protects you from the world — and helps develop patients’ awareness of the thoughts that trigger rumination. Like CBT, MCT tries to get you to “decenter,” or become less convinced that you are your thoughts.
In a 2005 paper, Adrian Wells, senior author on this study and a man who’s pushed detached mindfulness forward, sketched out concrete examples, like asking the patient to imagine their thoughts as a train whooshing by them or clouds drifting by overhead — with the lesson being that you don’t have to force the train or clouds to move, they just do it on their own.
If this sounds vaguely Buddhist, that’s because it sort of is. Evan Thompson, a philosopher at the University of British Columbia, has told me meditation and yoga traditions teach that people create suffering for themselves when they’re “habitually investing” more truth into their self-narrative than they need to. At a more moment-to-moment level, Ohio State University comparative philosopher Thomas Kasulis notes in Zen Action, Zen Person that meditation is a way to “open wide the hand of thought” that is always trying to grasp something. With metacognitive therapy and the detached mindfulness that it encourages, patients train in a similar open-handedness.
While a 39-person study is far from the final word, it is promising. Hagen says the results will be advanced with a one-year follow-up that will be published soon and a two-year study his team’s now collecting data on. Even if you’re not one of the millions of people living with depression, there’s a lesson to remember here: like the poet Mewlana Jalaluddin Rumi said, your thoughts are like house guests — you can make room for them, but don’t let them run the show.
Originally published at journal.thriveglobal.com