MCT & Relationship Health – Metacognitive Therapy Central

(10) The link between relationship problems and several psychological consequences is well documented in research. It seems that romantic relationship problems are the number one reason for acute emotional distress for couples. According to MCT, overthinking and coping strategies like fighting and co-ruminating maintain a dysfunctional relationship (1)(2). Postponing rumination, worry, and verbal quarrels to a set time during the day makes a tremendous difference in reducing overthinking and bringing peace into the relationship. Existing couples therapy methods are often extensive, and the treatment courses are long. Therefore, it is relevant to investigate alternative treatments for couples that are effective and less costly. In an attempt to solve their problems, couples also engage in co-rumination. Co-rumination is when couples together analyze and verbalize their problems, thoughts, and feelings extensively without reaching solutions. How to use postponement to improve your relationship It is a good idea to be aware of both worry and rumination and co-rumination. However, the same solution applies when you are trying to improve your relationship: Notice that you are ruminating/worrying. Whenever you become aware that you are dwelling on problems in your relationship without getting to a proper solution, it is a sure sign that you are ruminating / co-ruminating. Just take note of that or say it out loud to your partner: "We are co-ruminating right now, and we aren't getting anywhere". Decide together a set time later that day to ruminate or talk about the relationship with your partner (for example, after dinner). Meanwhile, focus your attention on something neutral (like chores) or decide to do something nice together (take a walk, cook dinner, or watch a movie). Later, if you don't feel like ruminating, you don't have to do it. However, if you want to ruminate, keep it to a 30-minute time frame and make a note of why you felt the need to ruminate. If you manage to follow this plan, you will experience that most of your problems feel less potent or get resolved by themselves, while only the important parts remain. That way, you won't get caught up in trivia, and it will be easier for you to discuss these problems with your partner. Remember that for postponement to work; you need to make it a regular part of your relationship routine. Postponing once isn't going to solve all of your problems but the daily habit of reducing ruminations and worry will help save your relationship. John, we have been going over this for days now and we haven't found a good solution. It's probably better to postpone dealing with it for now Okay, Alice, we are co-ruminating again. Let's postpone talking about this until we have more information to guide us. I am overthinking our relationship again. I don't know how things will turn out and it's too early to tell. It's better to postpone thinking about this to my worry time. (11) Why is postponement helpful for relationships? Postponement is an effective technique that will help you disengage from unhelpful thinking styles like worry and rumination and help you experience that you can control your thinking. Extensive worry and rumination cause negative thoughts and feelings like anxiety, sadness, and jealousy, and these feelings linger much longer, causing distress and problems in relationships (3)(4). Worry and rumination also affect concentration and cause hopelessness and depression. Postponing worry and rumination to a later time in the day is a simple but effective tool to deal with overthinking. Postponing worry helps the mind regulate difficult emotions faster and improves problem-solving skills (5). When the mind is no longer occupied with overthinking, it can come up with better solutions to problems. You can probably relate to this effect: Have you ever had difficulties remembering a name, a book title, or a specific word only to find the answer after you decided not to bother with it anymore? This is proof that the mind can better solve problems when it's not occupied with overthinking (7). Postponing worry or rumination works because it stops the overthinking process immediately and allows the mind's healthy self-regulation. How do rumination and worry impact relationship satisfaction? Studies suggest that rumination (and co-rumination (6)) has severe relational and psychological consequences (4). Some couples believe that rumination is helpful and therefore ruminate when they encounter challenges in the relationship. Other couples worry about threats in the relationship, like, for example, rejection from their partner. If the couple believes that they can stop worrying and ruminating, they will do so when they find a solution to their current problem. But if they don't believe that they can stop, they tend to activate the following strategies to manage worry and rumination: Rumination Worry Co-rumination Fighting Monitoring for threats Avoidance Punishment Seeking reassurance These coping strategies are part of the CAS (Cognitive Attentional Syndrome). Couples tend to use these backfiring coping strategies in an attempt to find solutions to problems, avoid feelings of rejection and hurt, and get their needs met. Not all couples use all the strategies above. For example, while some couples believe in the effectiveness of talking through every issue (co-rumination), other couples avoid conflict or talking about their relationship problems because they don't know how to deal with strong emotions. Other coping strategies include monitoring for threats to the relationship (for example, rejection, aggressiveness, and criticism) and overanalyzing (facial expression, one's own or partner's feelings, and doubts about the relationship). The less that couples believe in their ability to control worry and rumination, the more CAS strategies they may use. Coping Strategy (CAS)How the strategy is used by couplesRuminationCouples often ruminate about their partner's past behaviors and past hurts to understand the meaning and learn from those mistakes or they may ruminate every time they have doubts.Co-ruminationIn an effort to problem-solve, couples contemplate the same topics, often leading to disagreements and fights. FightingCouples fight in an effort to problem-solve difficult situations and to be heard by their partner. Some couples fight because fighting is familiar and somehow feels safer than feeling happy. Monitoring for threatsThreat monitoring is fixating attention on specific "threatening" cues like one's partner's facial expression and body language to anticipate anger or rejectionAvoidanceAvoidance can take many forms: keeping busy to avoid confrontations, or avoiding physical intimacy. Some couples completely avoid talking about problems and change the topic or go silent. Consequences of the CAS in relationships Most of the CAS strategies are time-consuming and lead to little to no solutions. When couples spend hours dwelling on problems through rumination and co-rumination, they escalate the conflict and feel worse. Essentially, the CAS backfires, and couples risk affecting their mental health in the long term. There is an urgent need for treating relationship problems effectively. Studies show that the negative effects arising from relationship problems are not only limited to affecting the couple in the relationship. In fact, couples who experience relationship problems are more likely to use maladaptive coping strategies when interacting with their children (8). These maladaptive strategies could lead to tough, conflicting, or abusive patterns that create psychological distress for the child. Several studies convincingly highlight the association between relationship problems and psychological diagnoses such as anxiety, depression, and drug and alcohol abuse(14). According to MCT, these mental issues are linked to the CAS (for example through worry and rumination). MCT can effectively reduce worry and rumination and help people recover from mental illness (15). The question is, therefore, whether MCT can also be helpful in reducing relationship problems. (9) Can metacognitive therapy save your relationship? Since MCT focuses on limiting rumination and other CAS strategies, it can be an effective treatment to preserve a healthy romantic relationship. An important aspect of MCT for couples is to teach couples to reduce and control worry and rumination. Postponement is one of the tools used for this purpose. Other MTC strategies include detached mindfulness and the attention training technique. Reducing unhelpful strategies may not in itself solve problems in the relationship but it will make it much easier to manage them in constructive ways. At this stage, however, there is a need for more research about MCT for treating relationship problems to determine its effectiveness over traditional couples treatments. Since couples in troubled relationships use maladaptive coping strategies (CAS), MCT can be a suitable treatment for treating relationship problems because it focuses on reducing the CAS. What other types of couple's therapy exist? The current standard methods for treating relationship problems include Emotionally Focused Couples Therapy (EFCT) Imago Relationship Therapy (IRT), Cognitive Behavioural Therapy (CBT) Narrative Couples Therapy Solution Focused Couples Therapy Relational Life Therapy Psychodynamic Couples Therapy Cognitive-Behavioral Therapy for couples (CBT) CBT aims to help the couple discover negative automatic thoughts, shared and unshared core beliefs (beliefs about oneself, other people, and the world), and behaviors. Here, couples learn to evaluate the accuracy of these thoughts to reduce negative behavioral responses. Emotionally Focused Couples Therapy (EFCT) EFCT is based on attachment theory and aims to access unacknowledged emotions from unresolved relationship patterns from childhood. Therefore, the purpose of EFCT is to resolve the negative attachment patterns, which lead to conflict, instability, and disconnection in the relationship. Imago Relationship Therapy (IRT) IRT relies on the assumption that loss of connectedness (with parents) is the root of all human suffering. This vulnerability makes people likely to re-experience childhood trauma in adult relationships, often leading to protection of the self, which can destroy the relationship's intimacy. Therefore, IRT focuses on accepting and understanding each partner's childhood wounds and reestablishing intimacy in the relationship. (12) What does the research say about couples' therapies? Both CBT and EFCT treatments show medium effect sizes after treatment, small effect sizes after six months, and no significant effect size after 12 months. These findings suggest that neither CBT nor EFCT creates a desirable improvement in relationship problems after 12 months of ending therapy (14). Results from randomized controlled trials of IRT (13) show that married couples receiving IRT experience significant increases in marital satisfaction during treatment. But this effect significantly declines with time. Metacognitive therapy looks more and more promising as a treatment option for interpersonal problems (1). The reason is that it targets and changes metacognitive beliefs about worry and rumination. Metacognitive beliefs play an important role in whether people use dysfunctional coping strategies like rumination and worry. Examples of metacognitive beliefs are: I can't stop ruminating Only when I feel safe can I stop worrying I can't handle feelings of rejection Rumination and worry is helpful for solving problems And as long as these metacognitive beliefs remain unchanged (as is probably the case in CBT, EFCT, and IRT, because these treatments don't include changing metacognitive beliefs), couples are set up for poor long-term treatment outcomes because they will activate the CAS to every new challenge they encounter in the relationship. Summary Couples with relationship problems tend to worry and ruminate a lot (including co-rumination) Worry and rumination prolong negative emotions and maintain relationship problems Postponing worry and rumination can be very helpful in reducing these unhelpful thinking styles Worry and rumination are controlled by metacognitive beliefs (beliefs about thinking) Current relationship treatments are helpful but these effects decline with time. Metacognitive therapy appears to be an effective treatment for relationship problems because it changes metacognitive beliefs and creates long-term improvements References Nordahl H, Hjemdal O and Wells A (2021) Metacognitive Beliefs Uniquely Contribute to Interpersonal Problems: A Test Controlling for Adult Attachment, Big-5 Personality Traits, Anxiety, and Depression. Front. 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