Metacognitive Approaches

This chapter presents the theory underpinning metacognitive therapy (MCT) and evidence for the efficacy of MCT in psychological disorders generally and its application in addressing anxiety and mood disorders in psycho-oncology specifically. MCT is a third-wave therapy that targets the processes that maintain psychopathology, such as worry, rumination, and suppression, and the beliefs about how one should respond to intrusive and unwanted thoughts (metacognitions) that drive those responses. Because MCT does not target the content of thoughts or worries but rather the content of metacognitions and interrupts the process of worrying that often follows, it is particularly useful in the psycho-oncology context. Emerging evidence suggests that MCT may be an acceptable and effective treatment for cancer-related anxiety and fear of cancer recurrence.

Taming the Thoughts in the Writings of Maximos the Confessor

St. Maximos the Confessor, a 7th-century monk, wrote several ascetical treatises that addressed the monastic life. This article explores the role of unwanted intrusive thoughts, the logismoi, outlined in two of his earlier works, the Centuries on Love and the Questions and Doubts. The author encourages the reader to pay particular attention to one’s thoughts, take the time to familiarize oneself with the thoughts that enter one’s mind, and offers advice on how to eliminate the causes of unwanted intrusive thoughts. He concludes that the mind or nous is considered neutral ground and one is able to control, but not completely eradicate, the unwanted thoughts by utilizing specific spiritual techniques.

Changes to information in working memory depend on distinct removal operations

Holding information in working memory is essential for cognition, but removing unwanted thoughts is equally important. Here we use multivariate pattern analyses of brain activity to demonstrate the successful manipulation and removal of information from working memory using different strategies including suppressing a specific thought, replacing a thought with a different one, and clearing the mind of all thought. These strategies are supported by distinct brain regions and have differential consequences for allowing new information to be encoded.

Losing Control: Sleep Deprivation Impairs the Suppression of Unwanted Thoughts

Unwanted memories often enter conscious awareness when individuals confront reminders. People vary widely in their talents at suppressing such memory intrusions; however, the factors that govern suppression ability are poorly understood. We tested the hypothesis that successful memory control requires sleep. Following overnight sleep or total sleep deprivation, participants attempted to suppress intrusions of emotionally negative and neutral scenes when confronted with reminders. The sleep-deprived group experienced significantly more intrusions (unsuccessful suppressions) than the sleep group. Deficient control over intrusive thoughts had consequences: Whereas in rested participants suppression reduced behavioral and psychophysiological indices of negative affect for aversive memories, it had no such salutary effect for sleep-deprived participants. Our findings raise the possibility that sleep deprivation disrupts prefrontal control over medial temporal lobe structures that support memory and emotion. These data point to an important role of sleep disturbance in maintaining and exacerbating psychiatric conditions characterized by persistent, unwanted thoughts.

Hair pulling antecedents in trichotillomania: Their relationship with experiential avoidance

In this study, 285 adults who met criteria for trichotillomania (TTM) via self-report completed an online, cross-sectional survey examining antecedent phenomenological experiences pertaining to hair pulling along with measures of TTM severity and experiential avoidance (i.e., avoidance of or escape from unwanted thoughts or feelings). Results showed a heterogeneous depiction of antecedent experiences. Subsequent analyses revealed that certain antecedents were not significantly related to TTM severity but were significantly correlated with higher levels of experiential avoidance. In particular, four of five classes of antecedents (i.e., bodily sensations, physical symptoms, mental anxiety, and general uncomfortableness) were significantly related to greater experiential avoidance. The authors conclude that treatments may need to be designed to address specific private antecedents, and that this may be done through targeting experiential avoidance.

Thought Suppression

The idea that suppressing an unwanted thought results in an ironic increase in its frequency is accepted as psychological fact. Wegner’s ironic processes model has been applied to understanding the development and persistence of mood, anxiety, and other difficulties. However, results are highly inconsistent and heavily influenced by experimental artifact. There are a substantial number of methodological considerations and issues that may underlie the inconsistent findings in the literature. These include the internal and external validity of the paradigms used to study thought suppression, conceptual issues such as what constitutes a thought, and consideration of participants’ history with and motivation to suppress the target thought. Paradigms that study the products of failed suppression, such as facilitated recall and attentional deployment to thought relevant stimuli may have greater validity. It is argued that a shift from conceptualizing the persistence of unwanted thoughts as products of failed suppression and instead as internal threat stimuli may have merit.

Losing Control: Sleep Deprivation Impairs the Suppression of Unwanted Thoughts

Unwanted memories often enter conscious awareness when we confront reminders. People vary widely in their talents at suppressing such memory intrusions; however, the factors that govern suppression ability are poorly understood. We tested the hypothesis that successful memory control requires sleep. Following overnight sleep or total sleep deprivation, participants attempted to suppress intrusions of emotionally negative and neutral scenes when confronted with reminders. The sleep-deprived group experienced significantly more intrusions (unsuccessful suppressions) than the sleep group. Deficient control over intrusive thoughts had consequences: whereas in rested participants suppression reduced behavioural and psychophysiological indices of negative affect for aversive memories, it had no such salutary effect for sleep-deprived participants. Our findings raise the possibility that sleep deprivation disrupts prefrontal control over medial temporal lobe structures that support memory and emotion. These data point to an important role of sleep disturbance in maintaining and exacerbating psychiatric conditions characterised by persistent, unwanted thoughts.

Spirituality in the Context of Acceptance and Commitment Therapy (ACT)

In order to define the future, it is seen that the psychological support approaches that return to the past are replaced by the approaches that return to the essence. As the power of change that one can find in the essence; The combination of heart, mind and spirit is emphasized. Combining ACT and spiritual practice, this association contains two important concepts: awareness and acceptance. It is thought that integration of spirituality will contribute to the concepts presented by the Act against the inevitability of unwanted thoughts and experiences. The aim of this study is to provide a general framework for cooperation between ACT and spirituality.