Live More Think Less E-Book

Pia Callesen

• Herausgeber: Icon Books
• Kategorie: Ratgeber
• Sprache: Englisch
• Veröffentlichungsjahr: 2020

Seitenzahl: 188

Beschreibung

The Danish Bestseller Now Available in English Dr Pia Callesen presents the first practical book on metacognitive therapy, a groundbreaking new treatment proven to stop depression in its tracks. Many of us struggle with overthinking. We endlessly analyse what we've said and done or the decisions we have to make. Rarely does this treat the stresses of our lives. Often we become overwhelmed; we end up feeling powerless, spiralling into sadness and even depression. Live More Think Less presents a radical strategy to take back control of our thinking processes. From training our attention to leaving our negative trigger-thoughts on the conveyor belt, the book guides us towards living better through mastering the attention we pay to our thoughts and how we act upon them. Depression and sadness are something we all have the power to overcome.

Leseprobe

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NOTE FROM THE AUTHOR

If you suffer from severe depression, you should seek medical advice. You cannot be healed by reading and implementing the exercises in this book. This book cannot replace a course of metacognitive therapy at an MCT-I-registered clinic or with an MCT-I certified therapist, but it will give you inspiration and ideas for a new way out of dark thoughts and depression.

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CONTENTS

Title PageAbout the authorForeword by Pia CallesenForeword by Adrian WellsChapter 1No more endless self-analysisChapter 2Become aware of trigger thoughts and ruminationsChapter 3Take control – you can do itChapter 4Rumination is (just) a habitChapter 5Get out of your head and into your lifeChapter 6Does your brain really need medicine?Chapter 7End depression for goodGet to know the conceptsMCT-I registered therapistsReferencesCopyright

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ABOUT THE AUTHOR

Dr Pia Callesen is a therapist and specialist in metacognitive therapy, having trained at the MCT Institute in Manchester with Professor Adrian Wells, the originator of MCT. She completed her PhD at Manchester University and works as a therapist and clinic manager in Denmark. She has written two popular books on metacognitive therapy, Live More Think Less and Seize Life, Let Go of Anxiety, which have both been best-sellers in Denmark and are now being published in multiple languages across the world. Her clinic, Cektos, offers online therapy in English.

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‘Everyone has negative thoughts, and everyone believes their negative thoughts sometimes. But not everyone develops depression or emotional suffering.’

ADRIAN WELLS

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FOREWORD

By Pia Callesen

For decades, established psychotherapists have held firm to the assumption that depression is a biological disease of the brain and that symptoms of depression are primarily caused by a lack of the neurotransmitter serotonin. As a result, for many years many therapists have prescribed medication – so-called ‘happy pills’ – as the first step when patients have presented with depressive symptoms. Patients may also have been offered a consultation with a psychologist or psychotherapist trained in conversational therapy. The purpose of these conversations has been, in many cases, to map and process problems and trauma or to turn negative thoughts into more positive or realistic thoughts.

However, groundbreaking new research shows that depression is a condition that can largely be controlled by the individual themselves. Several studies – including my own PhD from Manchester University, completed at the end of 2016 – illustrate that depression occurs when we deal with negative thoughts and feelings in inappropriate ways and that we can, therefore, reduce the risk of melancholy and depression by learning to relate to our negative thoughts and feelings in a more appropriate way.

In this book I address the obsolete understanding of depression as an uncontrollable state which affects us, and xiiwhich we ourselves have no influence over. I also address the equally outdated treatment methods, year-long conversational therapies and medicine, and instead introduce a new and very effective method. It is called metacognitive therapy.

Metacognitive therapy was developed by British psychologist and professor Adrian Wells from Manchester University, based on 25 years of research into why some people develop mental illnesses, including depression, while others do not. When Wells presented his treatment manuals, he documented that it is not grief, accidents, sad feelings or negative thoughts that makes us depressed. Rather what makes us depressed is how we deal with our thoughts. When we ruminate – when we contemplate and let our thoughts go round and round for hours each day – we are at a greater risk of developing depression than if we were to passively observe our thoughts and let them be.

Wells also found that there are three main underlying reasons as to why some of us ruminate more than others: first, we are not aware that we are ruminating; second, we don’t believe we can control our ruminations; and third, we are convinced that our ruminations help us. When we constantly monitor our own well-being and check in as to how we are doing with one thing or another, we lead ourselves into a downward spiral that can cause and maintain symptoms of depression such as sadness and lack of energy. This still applies even if we try to think rationally, positively or in a caring manner towards ourselves. All these ways of dealing with thoughts create more thoughts. As Wells says, ‘You cannot xiiiovercome the problem of overthinking with more thinking – you can only overcome it by thinking less.’ Metacognitive therapy was tailored from his research into this.

I have been a psychologist since the beginning of the millennium and the first decade of my practice involved traditional cognitive behavioural therapy (CBT), which is one of the most tried and tested and well-documented methods in the world. Cognitive therapy is based on the idea that thoughts are central to our well-being and, therefore, need to be processed and changed in order to overcome depression and anxiety.

My introduction to metacognitive therapy – and to Adrian Wells – radically changed my understanding of mental illnesses. After a case study of hundreds of clients in metacognitive therapy, it was clear to me: the cause of mental illnesses is not, as I had believed for ten years, a combination of genetic heritage, environment and negative thoughts. The cause, as Wells describes, is flawed mental and behavioural strategies. We become depressed because we tackle our thoughts and beliefs in inappropriate ways. Therefore, depression is not a disease we have to live with.

This realisation created a tsunami of thoughts within my mind: could I have been much more helpful to my clients over the years? Many of my clients felt that cognitive therapy had been helpful, but I now discovered that with metacognitive therapy I could both reduce treatment time and significantly increase the effect of the treatment.

Shortly after being introduced to Wells and metacognitive therapy, I personally needed therapeutic help. My husband xivand I had just become parents to a little boy, and the doctors gave us the unhappy news that our little Louie had been born with a rare genetic defect which caused epileptic seizures. The seizures would damage his brain if we didn’t get them under control. I was shaken to my core and deeply unhappy, and thoughts whirled in my head: What would happen to Louie? How would my husband and I deal with things in the future if Louie became very brain damaged? What about all our hopes and dreams?

I felt a great urge to do my own research as well as ask the doctors questions, so that I could learn everything about my son’s genetic defect. I wanted to be a super-mother, problem-solver and expert in the field. But my new knowledge of metacognitive therapy helped me limit these contemplations. It wasn’t my place to use all my mental power to find solutions and heal Louie. It was the doctors’. I wasn’t going to think myself into a depressive state. Instead, I was going to be a mother who was there for Louie and a wife who supported her husband.

I decided to leave be the many thoughts and questions that arose throughout the day. So, I set a fixed time from 5 to 6pm, when I could contemplate and ruminate. As one of my colleagues observes, it’s like having a piece of chewing gum sitting in your mouth all day and only being allowed to start chewing it at 5 o’clock. This is not easy. It requires awareness, patience and determination to learn to let go of thoughts and to shift your focus to other areas of your life. But I experienced xvfirst-hand just how powerful metacognitive therapy is, and all three of us, Louie, my husband and I, came through the crisis unscathed.

My wish for readers of this book is that they – like me – realise that it is possible to control the strategies that either create or maintain depression. This book describes the phases of metacognitive therapy step by step, and at each step I show how I employ these methods in my clinic, and what exercises and tips my clients use when implementing metacognitive principles in their lives.

The book cannot replace a course of metacognitive treatment. If you are very depressed, I would recommend you seek immediate medical advice so that you get the best treatment for you. If you are very depressed, metacognitive therapy can still help. Trials on individuals have shown that attention training alone, which is part of metacognitive therapy (see Chapter 3), significantly relieves the symptoms of deeply depressed people. For a list of MCT-I registered therapists, please see page 169.

You will meet Natacha, Mette, Leif and Berit in this book, all of whom were depressed in relation to major life crises, which naturally led to negative thoughts and feelings. These four share their stories first-hand: their problems; how they felt down and depressed; and how they, through metacognitive therapy, developed a new relationship with their thoughts and feelings so that today each of them is free from depression. xvi

Metacognitive therapy is not a safeguard against life’s challenges. It is a tool for rediscovering control over contemplations and ruminations and for shifting focus to other areas of life beyond ourselves. That’s where we overcome depression and where life is lived.

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FOREWORD

By Adrian Wells, University of Manchester, UK

There is a need for more effective evidence-based psychological therapies. In this book Dr Pia Callesen describes the use of metacognitive therapy (MCT) in her clinic. Dr Callesen is a graduate of the Metacognitive Therapy Institute (www.mct-institute.com) and also completed a PhD under my supervision at the University of Manchester. She conducted a major trial of the effectiveness of MCT compared with cognitive behavioural therapy in people suffering from depression.

In this book the reader can find an overview of MCT richly illustrated with the experiences of patients who have completed treatment. The book will be an invaluable resource for people suffering from depression who wish to consider this new treatment approach, and for anyone interested in an introduction to some of the key principles.

Metacognitive therapy is concerned with how a person regulates thinking. No matter if life is bad or good, an individual can learn to reduce thinking patterns that cause depression. MCT is grounded in advances in psychological research and theory that a colleague and I set out in 1994. In that work we made some radical claims for the time. Backed by research, we identified that most problems of anxiety and depression are caused by a thinking pattern that is linked to a person’s underlying (metacognitive) belief system. If we could xviiiremove that thinking pattern and modify that belief system, then we would have a new type of therapy and perhaps more effective outcomes. After years of research and clinical work I developed MCT to do this. A large amount of data has accumulated supporting this approach.

Dr Callesen’s book will have achieved its aims if it motivates sufferers of depression and also therapists to find out more about MCT. It will have succeeded if it brings hope and signposts an escape route from the personal suffering that depression brings.

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CHAPTER 1

NO MORE ENDLESS SELF-ANALYSIS

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Do you know the expression ‘to be hit by depression’?

Well, I’m going to provoke you with an assertion: we are not hit by depression. It doesn’t come from the outside. We ourselves provoke it. Therefore, we ourselves can also fight it if we want to. We can take control so that depressive thoughts don’t take control of us.

It may be hard for you to believe this. Most of us have learned that depression is a condition that strikes us either because of an emotional crisis or because of a chemical imbalance in the brain. There is no avoidance of depression in these assumptions. It is nothing we can effect. We have learned that depression arises according to the situation – no matter how we handle it.

Despite this being a commonplace and firm opinion, new research shows that this is not how depression works. We all get scrapes and scratches on our bodies and souls throughout life. We experience crises, defeats, illnesses and disappointments. And we feel pain, grief, fear, sadness, frustration and anger. But we don’t all become depressed. Why not? The answer is 4found in those strategies we each use whenever we face a crisis and negative thoughts. Some strategies are so inappropriate that they lead us straight into depression. Others lead us past depression – we can learn these strategies and help ourselves. These strategies comprise metacognitive therapy.

When I tell my clients that they can take responsibility for easing their depression, some experience it as a lot of pressure. ‘Is it now my own responsibility to get better?’ they ask. I want to assure you that it’s quite normal to find it difficult in the beginning. But I would also like to assure that you can do it with the right help. Later in the book you will meet Natacha, Mette, Leif and Berit, who after just six to twelve sessions of metacognitive therapy all recovered from depression.

With metacognitive therapy, we finally get rid of the remains of ancient Freudian psychoanalysis, which believed that talking about childhood experiences was the way to treat depression. We also challenge cognitive therapy, which seeks to change the negative beliefs a depressed person holds into more realistic or nuanced beliefs. Metacognitive therapy, which neither scapegoats childhood nor alters dark thoughts to brighter versions, is a groundbreaking paradigm shift within psychology. With it, endless self-analysis is no longer the way to break free from depression. This form of therapy is based on doing less, not more with your thoughts and feelings.

Understandably, people who have participated in other forms of therapy can perceive metacognitive therapy as a ‘reverse’ form of therapy. Because when we seek therapy, we 5have an expectation that to get better we need to process our problems and talk through our feelings.

Metacognitive therapy, on the other hand, starts with the premise that extensive processing of your thoughts and feelings gives rise to symptoms of depression. If we spend several hours a day thinking about, talking about, processing and analysing our negative experiences and feelings, or if we grapple with finding solutions to our emotional issues, we risk ruminating ourselves into depression. When we fall into symptoms of depression or a depressive state, we give ourselves even more to contemplate – namely the depression itself – and with lots of analysis and thought processing about the depression we are at risk of keeping it alive.

SURPRISING RESEARCH RESULTS

Metacognitive therapy is currently taking the world by storm with its proven effect on depression. The treatment has been cited in National Health Service guidelines in the UK as a treatment to consider for generalised anxiety. I am convinced that we will soon see similar recommendations for the treatment of depression and anxiety in other countries.

It was actually the mention of other researchers’ and psychologists’ promising results within metacognitive therapy that made me decide to combine my clinical work with research. I was deeply inspired by the research published by Professor Adrian Wells: 70–80 per cent of people in metacognitive therapy recovered from anxiety or depression. This is a significantly higher result than with other therapeutic forms, 6including cognitive therapy. However, the positive results were based primarily on small-scale studies and trials. I was curious to find out whether or not metacognitive therapy could produce equally strong results when applied to a target group in my clinic. So, I wrote to Wells about starting a PhD project. We planned to carry out a series of so-called effectiveness trials among the people seeking help in my clinic. In other words, I was going to investigate the direct effect of the therapy.

First, I conducted a systematic review of all the research into the effect of therapeutic treatment on depression. This revealed that about 50 per cent of participants in the described studies recovered from depression using methods such as cognitive therapy and other therapies which focus on a client’s thoughts, current life circumstances and relationships with other people. Fifty per cent is not a statistic to shout about.

Next, I set out to investigate whether or not the impressive results achieved by Wells could be reproduced with Danes. My investigation was to be conducted first as single-client trials and later as a larger scale randomised trial. In concrete terms this meant that in the weeks prior to the therapy session, I measured the participants’ level of depression several times to ensure that any effect was not just based on the passing of time. A colleague and I then offered metacognitive therapy to four Danes suffering from depression, under the supervision of Adrian Wells.

All four were deeply depressed at the beginning. Three recovered from depression after 5–11 sessions of MCT 7while one remained mildly depressed. Six months later, all four participants indicated that they were now free from depression – maintaining the effect. The results were impressive, and the trial is now published in the Scandinavian Journalof Psychology.

After the single-client trial, I completed a larger study over six years of more than 150 depressed Danes, whom I randomly divided into two groups: one group received cognitive therapy, while the other received metacognitive therapy. The study left no doubt: metacognitive therapy had a significantly better effect – in both the short and long term. Parallel to my research, a group of Norwegian researchers, headed by psychologist Roger Hagen, studied the effect of metacognitive therapy on 39 depressed Norwegians. Again, the results were outstanding. Between 70 and 80 per cent recovered, and at a follow-up assessment six months later, the same number of participants were still free from depression. The results from these studies document that metacognitive therapy has – at present – probably the best observed effect against depression.

ARE YOU IN COGNITIVE THERAPY?

If you are in cognitive therapy or other forms of therapy and would like to continue with that method, I would not recommend you use the principles of metacognitive therapy at the same time as these methods can negate each other’s effect. Metacognitive therapy works best in its pure form. 8

THE MIND REGULATES ITSELF

As mentioned earlier, therapists have suggested that depression and other mental illnesses hit us externally when life is painful. Treatment methods have, as a result, focussed on processing the traumas and bad experiences believed to have accumulated in a person’s mind. This was repeated in therapeutic circles when Adrian Wells and his colleague Gerald Matthews presented an entirely new model of the human mind in the early 1990s, after many years of research. They documented that, as a rule, the mind regulates itself; just as our body can often heal itself, so too can our psyche.

Over thousands of years, the human body has developed the ability to heal wounds and bones after cuts and breaks. We all learn early in childhood that a bloody knee after a fall from a bike doesn’t continue to bleed for the rest of our lives. It is cured in the most wonderful way, without us having to do anything ourselves, and it happens relatively quickly. But if we pick, scratch and rub at the wound, then it won’t knit together. On the contrary, we risk making things worse by creating infection and scar tissue.

The same happens in our psyche, as Wells and Matthews’ research demonstrates. In the aftermath of an unpleasant or unhappy experience, such as a divorce, accident or fire, thoughts will naturally focus on this experience. The experience will appear in our mind again and again, several times a day, in the form of thoughts and images. It is natural that these thoughts and feelings will be negative and dominated by grief, fear, sadness, disappointment and perhaps even anger. 9Immediately after the bad experience, the psyche will hurt and suffer – exactly like a knee when the skin is scratched off. In the same way that our knee will heal if we resist picking at it, so too will our mind if we refrain from fostering feelings by ruminating on them. Thoughts, images and impulses visit us briefly but will disappear again if we don’t grab them, suppress them or otherwise try to deal with them. If we don’t keep them in the front of our mind for regular access, they will pass through like grains of sand in a sieve.

This new understanding puts an end to the earlier perception of the causes of depression. Because if we take the mind being able to heal itself as the starting point, then why do some people become depressed after a life crisis while others don’t?

THE MIND WORKS ON THREE LEVELS

Wells challenged the widespread perception that unprocessed negative experiences contribute to depression. He explained that everyone has negative thoughts sometimes, and everyone occasionally believes these negative thoughts, but not everyone develops a mental illness. Therefore, Wells and Matthews posed the question: if having negative experiences and thoughts does not in itself lead to depression, what does? What are the underlying factors that make a person depressed?

Their research led to a metacognitive model of the human mind. The S-REF model (Self-Regulatory Executive Function Model of Emotional Disorder) shows that the mind operates on three levels: 10

A lower level that is constantly hit by impulses, thoughts and feelings. If we don’t engage these impulses, thoughts and feelings, then they are fleeting and disappear again by themselves.A middle strategic level where we choose our strategies for dealing with our thoughts.An upper, metacognitive level that contains our knowledge of possible strategies.

Let’s look at these levels in greater detail.

1. Lower level: automatic thoughts and images

At this level we are constantly being hit by impulses, thoughts, images, feelings, memories and metacognitive beliefs about ourselves, which our brain is built to produce thousands of. We can’t control all these thoughts, associations and impulses coming. They are natural and arise unconsciously from encounters, events and experiences – both good and not so good. For instance, if you have been disappointed and hurt by a romantic partner whom you loved, you will naturally feel nervous and unsure about entering into a new romantic relationship. Those kinds of automated thoughts and feelings, created by experiences earlier in life, are quite common and not a problem in themselves. It is the handling of these involuntary thoughts and feelings that determine our mood and well-being. How that handling occurs is decided at the middle strategic level.

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122. Middle level: strategies