Metacognitive therapy (MCT) was originally developed for treating anxiety disorders. However, it has also proven to be an effective treatment for several other conditions, for instance depression and PTSD. The question is, therefore, could MCT also be a good treatment for relationship problems?
MCT seems like a good couple’s treatment because it reduces worry and rumination about relationship problems. Overthinking one’s relationship leads to unhelpful strategies like fighting and avoidance, which maintain a problematic relationship.
To understand how MCT can effectively treat relationship problems, we need to first establish how we conceive such problems, including how we understand the mechanisms underlying problematic relationships.
Relationship problems are, according to MCT, maintained by excessive rumination and worry and the assumption that one can’t stop rumination and worry.
What causes relationship problems according to MCT?
Couples who struggle with their relationship seem to use similar strategies:
- fighting and hostile communication
- ruminating (analyzing one’s relationship, partner, or past experiences and disappointments)
- worrying (thinking about worse-case scenarios that could happen in the future)
- threat-monitoring (scanning for intrusive thoughts or clues of rejection from one’s partner)
- reassurance seeking (asking one’s partner or friends and family for reassurance regarding doubts in the relationship, or engaging in extramarital affairs)
- avoiding (avoiding confrontation or talking about specific topics or avoiding one’s partner)
- suppressing thoughts (pushing down distressing thoughts and emotions)
- numbing out feelings (using distractions or alcohol to cope with distress in the relationship)
These strategies are, according to MCT, voluntary thinking styles and coping strategies and part of the cognitive-attentional syndrome (CAS). CAS leads to emotional distress and mental disorders like anxiety, PTSD, and depression(2), and creates interpersonal problems (5).
The reason why these strategies lead to emotional distress and problems in romantic relationships is that they interfere with the mind’s natural ability to regulate emotions.
The mind can regulate itself and deal with distressing thoughts. This process is called self-regulation.
Problems in romantic relationships negatively impact people’s well-being and lead to mental health problems, and poor social functioning. Despite the impact on the couple’s quality of life, most couples seek counseling too late or not at all (4).
The question is, therefore, what makes couples use unhelpful coping strategies in the first place?
Metacognitive beliefs cause interpersonal problems
According to research, inaccurate metacognitive beliefs lead to worry and rumination and to using coping strategies like reassurance-seeking, fighting, avoidance, and passive-aggressive behaviors in relationships. These strategies maintain negative emotions and lead to interpersonal problems.
Previous theories claim that personality traits and attachment styles cause interpersonal problems. However, it seems that metacognitive beliefs are more important in deciding how we interact in relationships.
Targeting metacognitive beliefs in couples counseling could potentially reduce interpersonal problems.
Metacognitive beliefs are beliefs about thinking.
How do metacognitive beliefs create interpersonal problems?
According to Metacognitive therapy, when couples, for example, pick fights with each other, it is probably because they have inaccurate metacognitive beliefs about their thinking. Examples of inaccurate metacognitive beliefs are:
I cannot control my worries about my relationship.
Worrying about my relationship is harmful to my mind and body.
Analyzing my relationship/partner will help me solve problems in our relationship
Ruminating about why I am this way helps me change for the better
These beliefs are called negative and positive metacognitive beliefs. Generally, metacognitive beliefs are false beliefs about our thinking.
Negative metacognitive beliefs lead to relationship problems because we don’t believe we can regulate negative thoughts and feelings.
For example, if someone doesn’t believe that they can control their worry about the fear of being rejected he or she will either continue to worry or use other coping strategies to stop worrying. Seeking reassurance from one’s partner or drinking alcohol are examples of ways to control worry. However, these coping strategies lead to conflict in the long term.
It is also very common for people to start fights or use aggressive communication with their partner if they don’t believe that they can control worrying.
Controlling worry is not the same thing as controlling thoughts. Worrying is a voluntary thinking process that we can learn to stop.
Another metacognitive belief that leads to relationship problems is that lengthy analysis (rumination) is helpful in solving relationship problems.
Couples who believe in the usefulness of rumination might analyze their problems for hours every day, despite arriving at the same conclusions. Some couples co-ruminate(6) (analyze their problems together), which leads to a sense of working on solutions but also leaves couples feeling exhausted and stuck.
Metacognitive beliefs lead to unhelpful coping strategies in romantic relationships like excessive worry, rumination, co-rumination, avoidance, and quarreling.
Why is co-rumination a problem?
According to Dr. Robin Bailey, a senior lecturer at the University of Central Lancashire, co-rumination is more likely to make people panic about the future and feel anxious and depressed. Co-rumination can also lead to stress and burnout. Co-rumination is, according to Bailey, when people ruminate together and excessively discuss the same problems. This strategy comes from the belief that thinking about problems over and over will help to find solutions (6) (metacognitive beliefs).
However, it seems that co-rumination has contrasting effects. On the one hand, it creates anxiety and depression in people, on the other hand, it leads to feelings of interpersonal closeness. This might also be the reason why couples engage in lengthy talks about their relationships together or with friends and family members.
But focusing on problems increase a negative mood, leading to even more co-rumination (6).
Instead of co-rumination as a way to solve problems, couples can learn to actually problem-solve their problems, or postpone rumination to a set time during their day. Although it seems counter-intuitive, reducing the time couples spend ruminating about their problems will help solve them better.
What triggers worry, rumination, and co-rumination?
The couples I see tell me that they spend a lot of time and energy ruminating, worrying, and fighting with each other. When asked about what triggers them to do so, they point to experiencing intrusive thoughts or a negative feeling that they grab onto and try to analyze their way out of.
Examples of potential triggers could be:
“Why is he constantly checking his phone?“
“Why is she not more caring?“
“Does she even like me? Maybe I am not interesting enough?”
“He never helps out around the house.”
“What if he is not the right partner for me?“
“Why did she say it that way? Is something wrong?“
Interestingly, though, most people don’t notice what triggered them to ruminate and worry in the first place, and they are usually unaware that they are ruminating and worrying. It is only when the strategies are pointed out in therapy that couples become aware of their damaging effects on the relationship.
It is also important to mention, that these strategies don’t solve interpersonal problems:
Imagining catastrophic scenarios about the relationship, starting fights, or not communicating properly doesn’t get people’s needs met in their relationship. They may work as short-term relief from worry and feelings of insecurity, but they rarely lead to sustainable solutions. These strategies often maintain problems in relationships and exacerbate tension, insecurity, and hostility.
However, despite their rapid nature, coping strategies are voluntary efforts to manage distressing thoughts and feelings in relationships.
Seeking reassurance, starting fights, or not communicating your needs properly may provide short-term relief from negative feelings, but maintain problems in the relationship in the long term.
What are the consequences if relationship problems are not treated?
Interpersonal problems can cause anxiety, depression, OCD, PTSD, and eating disorders(8).
It is common for people who seek psychotherapy for general mental health issues to also having interpersonal problems. According to research (9), clients in such situations improve slower and have greater dropout rates (10).
Research on the role of metacognitive beliefs on interpersonal problems
Recent research supports the idea that metacognitive beliefs are related to negative feelings, early traumatic experiences, and attachment theory (5)(13)(14). Negative attachment experiences in childhood lead to the use of counterproductive coping strategies (worry, rumination, avoidance, reassurance seeking, aggression, etc.) and cause psychological problems.
According to Professor Adrian Wells (the founder of MCT and one of the leading researchers of the role of metacognitive beliefs and mental illness), people use counterproductive coping strategies because of their metacognitive beliefs (11).
For example, people with an anxious attachment style might have developed metacognitive beliefs (fx. worrying about being abandoned helps me be prepared) and therefore rely on worry and threat-monitoring strategies from an early age to help restore and gain love and attention.
In their current romantic relationships, they usually rely on worry, rumination, and threat-focused attention (for example looking for signs of abandonment from their partner) as strategies to receive care from their partner.
In addition, they also develop metacognitive beliefs about the uncontrollability and dangerousness of feelings (fx. I can’t stop worrying, and my emotions are unbearable, overwhelming, and uncontrollable.)
Metacognitive beliefs make couples struggle with regulating their thinking in adaptive ways. Therefore, they need to rely on coping strategies to regulate their negative feelings.
How can Metacognitive therapy reduce interpersonal problems?
Studies have shown that Metacognitive therapy positively impacts interpersonal problems in people who suffer from anxiety, depression(14), and borderline personality disorder (15).
Targeting and challenging false metacognitive beliefs like worrying is uncontrollable helps people regulate their emotions and insecurities in romantic relationships in healthier ways. That way, they don’t need to rely on conflictful coping strategies that perpetuate problems in the relationship.
Therefore, changing metacognitive beliefs in treatment creates change in interpersonal problems, even when these problems are not targeted directly. This is the initial proof that MCT is an effective treatment for relationship problems.
Not trusting our ability to regulate negative thoughts and feelings in romantic relationships lead to counterproductive coping strategies, which lead to more problems in the relationship.
Summary
- According to MCT, people with problems in romantic relationships often use counterproductive coping strategies, also known the Cognitive-attentional syndrome (CAS).
- Examples of CAS strategies in problematic romantic relationships are worrying, ruminating, threat-monitoring, avoiding, reassurance-seeking, threatening, and starting fights.
- The CAS is activated by metacognitive beliefs, for example, worrying is uncontrollable and harmful
- MCT has proven to reduce the CAS effectively and is a potentially suitable treatment for couples who experience relationship difficulties.
References
- Photo by Charlie Foster
- Wells, A. (2009). Metacognitive therapy for anxiety and depression. Guilford Press.
- Photo by Jd Mason
- Keller A, Babl A, Berger T, Schindler L. Efficacy of the web-based PaarBalance program on relationship satisfaction, depression and anxiety – A randomized controlled trial. Internet Interv. 2020 Dec 29;23:100360. doi: 10.1016/j.invent.2020.100360. PMID: 33520669; PMCID: PMC7820550.
- 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. Psychol. 12:694565. doi: 10.3389/fpsyg.2021.694565
- https://www.dailymail.co.uk/health/article-5133267/A-problem-shared-problem-doubled.html
- Photo by Candice Picard
- Hopwood CJ, Wright AG, Ansell EB, Pincus AL. The interpersonal core of personality pathology. J Pers Disord. 2013 Jun;27(3):270-95. doi: 10.1521/pedi.2013.27.3.270. PMID: 23735037; PMCID: PMC3675800.
- Newman MG, Jacobson NC, Erickson TM, Fisher AJ. Interpersonal Problems Predict Differential Response to Cognitive Versus Behavioral Treatment in a Randomized Controlled Trial. Behav Ther. 2017 Jan;48(1):56-68. doi: 10.1016/j.beth.2016.05.005. Epub 2016 Jun 6. PMID: 28077221; PMCID: PMC5240795.
- Renner F, Jarrett RB, Vittengl JR, Barrett MS, Clark LA, Thase ME. Interpersonal problems as predictors of therapeutic alliance and symptom improvement in cognitive therapy for depression. J Affect Disord. 2012 May;138(3):458-67. doi: 10.1016/j.jad.2011.12.044. Epub 2012 Feb 4. PMID: 22306232; PMCID: PMC3306447.
- Wells A (2019) Breaking the Cybernetic Code: Understanding and Treating the Human Metacognitive Control System to Enhance Mental Health. Front. Psychol. 10:2621. doi: 10.3389/fpsyg.2019.02621
- Photo by Charl Folscher
- Strand ER, Hjemdal O, Anyan F, Nordahl H, Nordahl HM. Change in interpersonal problems and metacognitive beliefs as predictors of improvement in patients with generalized anxiety disorder. Clin Psychol Psychother. 2023 Feb 16. doi: 10.1002/cpp.2841. Epub ahead of print. PMID: 36797996.
- Strand ER, Hagen R, Hjemdal O, Kennair LEO and Solem S (2018) Metacognitive Therapy for Depression Reduces Interpersonal Problems: Results From a Randomized Controlled Trial. Front. Psychol. 9:1415. doi: 10.3389/fpsyg.2018.01415
- Nordahl HM, Wells A. Metacognitive Therapy of Early Traumatized Patients With Borderline Personality Disorder: A Phase-II Baseline Controlled Trial. Front Psychol. 2019 Jul 30;10:1694. doi: 10.3389/fpsyg.2019.01694. PMID: 31417453; PMCID: PMC6682682.
