Why are some people more prone to anxiety than others?

What the science tells us

You might have been told that your anxiety can be attributed to your background or to traumatic life events. However, when looking at people with similar backgrounds and life experiences, consistently some go on to develop anxiety (or another mental disorder), while others don't.

If life experiences were the main cause of mental disorders, there should be a clear pattern. People who experience x, develop y disorder. However this doesn't seem to be the case.

In fact, two similar individuals being exposed to one or more similar situations can experience wildly different effects on their mental health. On a group level, for example, only about 25% of those exposed to a traumatic event go on to develop PTSD.

But why is that, and how can we predict who will develop a mental disorder?

Researchers and clinical psychologists have been scrathing their heads for decades: might the cause be genetic differences? Differences in the social or physical environment? Or could there be important micro differences in the events themselves that cause some events to be more harmful than others?

While all of these factors probably have some influence, over the last 30 years researchers at the University of Manchester have discovered another and more important factor that seems to explain most of the variance in how people react to difficult events, and how they are affected by them. And their insights are today shaking the field of psychology to its foundations.

Metacognitions: What you believe about your mind is what causes (or protects you from) mental disorders

Have you ever thought about what you believe about your mind? How does it work? And what's the best way to deal with difficult thoughts and emotions? What you believe about your mind is what we call metacognitions.

Should you process or ignore them? Focus a lot on your thoughts or not? Is it helpful to think through everything that could possibly go wrong, or is it counter-productive? Is worry uncontrollable and can make you go crazy? Or is worry simply a tiring thought process that is fully under your control?

Your answers to these sort of questions are, hands down, the best predictor of whether you have (or will go on to develop) a mental disorder.

"What I believe about my mind? ... really?"

Yes. What you believe about your mind, strongly affects how you deal with difficult thoughts, symptoms, and emotions. We call these negative mental events triggers.

While some ways of responding to triggers are helpful, others are counter-productive and can cause negative mental states and events to escalate.

For example, if you believe that you need to answer every negative thought that you have, you'll probably spend a lot of time arguing with your own thoughts. And if you believe that thinking the worst is helpful, then you'll probably spend a lot of time thinking about horrific and tragic events that could happen - which will cause you to escalate feelings of sadness and anxiety.

Moreover, the more time you spend doing this, the easier it becomes for you to think of frightening possibilities, and the more automatic this process will feel.

But it's not automatic, it's a coping strategy. Something that you do to cope with your triggers. And what you do is affected by what you believe to be helpful, necessary, or out of your control.

"What are my metacognitions?"

Here are some questions you can ask yourself to become more aware of what you yourself believe about your own mind:

• Are worries uncontrollable?
• Is worrying helpful and useful?
• Can worrying be dangerous?
• Is it helpful to process negative thoughts and painful memories?
• Is a strong negative thought more important than a weak one?
• Can one go mad from worrying?

Turns out, your answers to questions such as these can be wildly different to those of your neighbor. Also certain beliefs are more predicitive of certain mental disorders. For example: 

• My memories can be mentally harmful.
• It is helpful to think through painful memories.
• My mind is broken and I'll never be the same again.
• Only by thinking through (e.g. process) my trauma I 'll be able to stop thinking about it.
• I need to fill my memory gaps in order to move on.
• If I worry I can avoid something similar happening to me again.
• Going through the memories will help me to process it.
• I have to look out for dangers to keep safe.

These are beliefs that are more often found in people suffering from post-traumatic stress disorder (PTSD). While someone suffering from health anxiety (hypochondria) more often has beliefs such as: 

• It's risky to assume my symptoms are not dangerous.
• Assuming I'm not healthy makes me more prepared.
• Assuming I'm not healthy helps me discover a disease earlier.

While nothing can be concluded from these questions alone (especially since many of these are disorder-specific), there are some clear and reoccuring patterns in the answers of people suffering from anxiety disorders.

Recent studies have shown that by changing these beliefs, you thereby change how you relate to your thoughts, leading to large and quick improvements in mental health.

‍Beliefs about thoughts seems to have a tremendous affect on the development of mental disorders.

This discovery is so impactful that it challenges much of what is currently believed about mental health disorders. In short, it is changing our understanding of the root causes of mental health problems.

But more importantly, it has also lead to the development of a radically new approach to treating mental health disorders, such as anxiety. A treatment approach with recovery results that seems to be outperforming all other methods.

Introducing Metacognitive therapy

Metacognitive Therapy (MCT) is a new method of therapy based on more than 30 years of research on the causes of mental disorders. By meticulously studying what people with mental disorders think and do differently from people without mental disorders, and why, Dr Adrian Wells and his colleagues were able to identify certain factors that seems to lead to the development of, and recovery from, mental disorders.

The methods and results from base research were collected and further studied in clinical trials, and eventually became what is today known as Metacognitive Therapy. 

The results of this research go against much of what is currently believed by practicing therapists (e.g. "in the field") about mental disorders. Many of today's common principles are more than a century old. The science has gone forward a lot since then, but in many ways the therapy has not. It became clear that there's a general lack of picking up on new knowledge created through base research.

A truly science-based approach

Metacognitive therapy is based on a very specific and testable model of how the mind works. A main principle is that over-handling of mental events (such as overthinking, checking, worrying, avoiding etc.) lies at the heart of all mood and anxiety disorders. Therefore successful treatment involves bringing overthinking under control.

For example, it was found that the negative thoughts of people with and without anxiety do not differ much from each other. And that everyone has negative thoughts, not only those with a mental disorder. Therefore negative thoughts could not be the cause of a mental disorder.

It was found, however, that people diagnosed with anxiety or depression, tended to spend a lot more time dwelling on, responding to, and worrying about their negative thoughts.

And this tendency to over-respond, was more predictive of mental disorder than life events. For example someone who has a tendency to overthink things and worry a lot is more likely to have anxiety. And this is true, irrespective of whether they've had a problem-free of problem-filled life.

In the same way, a person who has been through a lot of trauma, but who does not respond a lot to painful inner events, such as negative thoughts and feelings, has a low likelihood of developing a mental disorder.

Because of its efficiency, metacognitive therapy is now rapidly becoming a preferred method of treatment for a wide range of mental disorders worldwide. It is for example a treatment of choice for GAD, and is included in the NICE guidelines. At GAD-Specialists we exclusively use methods from metacognitive therapy in our content. So if you’re wondering what a new therapy like this can do for your mental well-being, read on to learn more.

Metacognitive Therapy in a nutshell

Imagine your thoughts as being like sushi going round and round on a conveyor belt. Each plate of sushi is representing a thought such as:

• “Stuff I need to do at the weekend”
• “What’s for dinner tonight?”
• “What if I get a panic attack here?”
• “We’re running low on milk”
• “I really have to fill out those legal documents”
• “Why doesn’t my boss like me?”

Some of the sushi almost scream at you to be picked and devoured, while others seem much less tempting and are easier to leave on the belt.

Thoughts like, “What if I get a panic attack here?” may seem more tempting because of the emotional weight they carry. But you can choose to leave it alone, and wait for another thought to come by.

And yes, chances are that the thought will come back at some point, asking to be picked up again. But if you're able to leave it alone then you can simply let is pass by again. And you'll get better at it over time!

In the end how you respond to the thought depends on what you believe about it. Is it helpful and necessary to keep thinking about it, and do you believe you can choose not to?

Instead of compulsively choosing the most anxiety-provoking thought over and over again, metacognitive therapy provides a set of practical tools and techniques enabling you to let painful thoughts be - and enabling you to steer your focus of attention independently of what's going on inside of you.

By learning to ask yourself questions like, “Is it helpful for me to deal with this thought right now?” metacognitive therapy gives you the tools to see thoughts and emotions for what they are. And when you’re able to do that you’re no longer at the mercy of constantly reacting to the next thought that occurs to you.

Metacognitive therapy is designed to help you gain awareness over the strategies you employ that are backfiring or otherwise negatively affecting your mental health, so that you can reduce them and make better mental choices for yourself.

In metacognitive therapy your therapist will first demonstrate that worries are actually controllable - and can even be controlled relatively simply using practical techniques.

The method has only been around since 2009 and so is a very new approach to treating people with anxiety, stress, depression, and many other mental disorders. However, with a reported success rate of around 75-80% in the treatment of generalized anxiety, OCD, and PTSD it is already considered in many clinical circles to be significantly more effective than current gold standard treatments.

What are the differences between metacognitive therapy and CBT? 

A question we often get is what are the differences between metacognitive therapy (MCT) and CBT or cognitive behavioral therapy. While CBT was a great improvement from existing methods of its time, there has been room for improvement.

Simply put, the core principle of CBT is that mental illness is the result of a disproportionate relation between a thought and reality. In CBT you learn to challenge the content of your thoughts. Are your thoughts true or not?

According to Metacognitive theory, it doesn't really matter if your thoughts are true or not. We all have negative thoughts, and we all believe in them from time to time. But still not everyone has anxiety. What matters is not the content of your thoughts, but how (and how much) you respond to them.

An increasing amount of studies on metacognitive therapy is showing superior results to CBT and classical talk therapy in the treatment of anxiety, and a variety of other mental disorders.

If you are interested in learning more you'll be happy to know that we wrote an article about this topic: What are the differences between CBT and Metacognitive Therapy (MCT)