Metacognitive therapy (hereafter MCT) is a rather new and effective treatment for anxiety disorders. Studies comparing MCT with usual treatment find MCT superior (1, 2). A 2024 meta-analysis shows that metacognitive beliefs are present in children as well as adults and that they are related to psychological distress in children (3).
MCT is based on another treatment paradigm than the most widespread treatment method, cognitive behavioral therapy, as it focuses on ‘thought processes’ instead of ‘thought content.’ These two treatment approaches are based on different theories of the mind: The goal of MCT is not to change or remove thoughts, as the mind is viewed as powerful and self-regulating, like a sieve where everything passes through.
Worries can become problematic if they take up too much time or stand in the way of doing things. Excessive and difficult-to-control worry occurs in most types of mental health problems. Worry can be defined as a thought process that arises out of uncertainty, where a person imagines possible scenarios in a given situation, perhaps to be prepared or to completely avoid it.
Worry constitutes a normal thought process, but it can get out of hand and lead to prolonged mental distress if the worries are experienced as and believed to be: 1) uncontrollable, 2) helpful or necessary, or 3) harmful. Over 30 years of research show that these metacognitive beliefs are significantly related to mental distress and disorders, and therefore they are the treatment target of MCT (see Adrian Wells’ work 4, 5).
Children begin to worry from an early age as their capacity for imagination matures and as they adopt thought patterns from close others who act as role models. We teach our children to worry in the same way we teach them to swim: by spending time together doing the activity. Adults can help children let go of worries; however, they can also strengthen the tendency to worry. In other words, worry can become a habit, a go-to thinking style, or a language we speak.
As adults, we can signal danger to a child, for example, through worry and overprotection. As caretakers, we should protect our children just enough to make them safe and let them have experiences with thrills so that they learn to manage anxiety. A child needs to feel uncertainty in the process of finding its way to float. It will only float as long as we don’t hold it too tightly. It can be tempting to intervene, but floating is floating—you have to let go of the grip at some point.
Children have a natural tendency to explore, and we can support this natural tendency. However, if they have become stuck in a situation, we can encourage them to take small steps towards more bravery and risk-taking and reinforce that behavior in the same way we reinforce prosocial behaviors.
We show our children how to swim in life by being role models ourselves (vicarious learning style) and by reinforcing every thing they do towards it.
Maybe you have already tried to stop a child’s worries by asking the child what he or she specifically thought could go wrong (so-called realistic thinking). Or perhaps you have tried to reassure the child (nothing-will-happen talk) without success. It can be difficult to stop the worry process with these strategies, as they risk activating more thinking in the child, which in the end can prolong the anxiety. Maybe you have also tried to distract the child with an activity.
This is a short-term strategy, as activities are time-limited, and distraction can therefore be considered a form of avoidance as well. The majority of the time, you will be distracted by one thing or another. Thus, the child can learn that all scary thoughts are important to deal with or that they should actively move away from them. In addition, they cannot tolerate them. A problem with these active thought management strategies is that their goal is to remove thoughts and feelings rather than tolerate them so they can self-regulate.
In this way, it is easy to fall into the I’m-still-afraid trap, a trap where one waits for something inside to feel different before starting. This trap activates a greater inner focus while the child waits for the anxiety to decrease, and therefore the child becomes more aware of the feeling. The same mechanism is at play when adults ask their children how something feels, whether it is pleasant or unpleasant.
The inner focus will, paradoxically, reinforce the same feelings the child is trying to get rid of. We can teach our children to manage life and solve problems along the way, even without thinking through all the scenarios in advance. In this way, worries will only take up a small space in life, and there will be more room for more play and joy.
The most effective way to let go of worries is to leave thoughts alone, which means to disengage from thoughts, or disrupt any further conceptual analysis of thoughts, in the form of so-called detached mindfulness. This is a key element in metacognitive therapy.
Metacognitive Books About Children’s Worries
- The Brainheimers: The Super Duo of Boss Breezy and Detective Dread Against the Empty Souls
- Manny and Max On The Rise: 7 Encouraging Stories About Manny’s Move From Worry to Independence
