Grappling with your thoughts will leave you even more entangled in worry. Use metacognitive strategies to break free
by Pia Callesen
is a therapist and metacognitive specialist, managing several clinics in Denmark and providing metacognitive therapy online in English. She has a PhD from Manchester University and trained with the founder of metacognitive therapy at the MCT Institute. She is the author of Live More Think Less (2020).
Edited by Christian Jarrett
If you’re an overthinker, you’ll know exactly how it goes. A problem keeps popping up in your mind – for instance, a health worry or a dilemma at work – and you just can’t stop dwelling on it, as you desperately try to find some meaning or solution. Round and round the thoughts go but, unfortunately, the solutions rarely arrive.
In my daily work as a metacognitive clinical psychologist, I encounter many people who, in trying to find answers or meaning, or in attempting to make the right decision, spend most of their waking hours scrutinising their minds for solutions. Ironically, in this process of trying to figure out how to proceed in life, they come to a standstill.
When we spend too much time analysing our problems and dilemmas, we often end up more at a loss than we were to begin with. On top of that, persistent overthinking can result in a wide range of symptoms such as insomnia, trouble concentrating and loss of energy which, in turn, often leads to further worries regarding one’s symptoms, thereby creating a vicious cycle of overthinking. In some cases, this eventually leads to chronic anxiety or depression.
When overthinking and the associated symptoms spiral and become unbearable, it’s usual for us to look for ways to calm down. Many common strategies sound reasonable or useful, but research shows that they can inadvertently cause more harm than good and typically lead to even more overthinking. You might recognise some of them in your own behaviour:
Constantly looking out for threats: there’s nothing wrong with this strategy if you feel in control, but it can quickly backfire. Take health concerns. If, as a way to calm your worries, you start to excessively scan yourself or the people you care about for signs of illness, this threat monitoring will lead only to a heightened sense of danger and more health-related worries. Another example is constantly keeping an eye out for whether people like you, trying to figure out what they think of you, which inadvertently results in you becoming more distant, non-participatory and worried, and not being able to enjoy their company.
Seeking answers and reassurance: it’s completely natural to seek reassurance from people close to you, and to look for answers as to how to cope better. However, if you come to a point where you depend on these strategies to calm you down and reduce your worries, you’re on a slippery slope. For instance, some of my clients spend several hours a day Googling, hoping to find reassurance or, at least, an explanation as to why they’re feeling down. Yet this strategy often leads to even more worries, since Googling relatively common symptoms typically yields a wide range of search results, including diagnoses that you hadn’t even thought of.
Excessive planning: of course, there’s nothing wrong with moderate levels of planning. It’s perfectly healthy to keep a calendar or to leave notes for yourself. However, some people plan their lives down to the tiniest detail and this can become problematic. In addition to being rather time-consuming, excessive planning can have other negative effects including exacerbating worries. For instance, when planning carefully, it’s tempting to try to predict all the things that could possibly interfere with a plan and how to potentially handle such events should they occur, thereby initiating a process of worry. Others plan meticulously because they believe that they won’t be able to cope otherwise, which can lead to excessive worries when planning isn’t possible or unexpected events arise.
Aside from these unhelpful strategies, another key factor that can perpetuate overthinking is your beliefs about thinking (the term ‘metacognitive’ in ‘metacognitive therapy’ – the clinical approach I use – actually refers to thinking about thinking). When my clients start metacognitive therapy, many of them are convinced that they have no control of their thought processes. They believe that their thoughts just appear and automatically attract attention – and that they can’t control whether these thoughts develop into hour-long ruminations about how bad things are now, or into catastrophic worries about what could go wrong in the future.
I have some good news: you don’t have to live with excessive worry. It’s an enduring myth that overthinking is an innate trait, like eye colour or crooked toes, meaning that it can’t be changed and you simply have to live with it. Adrian Wells, the clinical psychologist at the University of Manchester who founded metacognitive therapy, discovered that overthinking – that is, worrying and rumination – is a learned strategy that we choose, consciously or unconsciously, as a way to try to deal with our difficult thoughts and feelings. It’s not a fixed trait, but a habit that we fall into, and we can learn to change it if we want.
In my first 10 years practising as a clinical psychologist, I worked in traditional cognitive behavioural therapy. CBT teaches us that we need to spend time on our thoughts and beliefs in order to challenge them and transform them into more realistic or compassionate versions. When I was introduced to metacognitive therapy, in which the focus is on simply letting go of your thoughts (Wells jokingly calls it ‘lazy therapy’), it radically changed my understanding of mental illnesses.
In 2020, together with Wells and other colleagues, we published the results of a large randomised trial involving 174 clients with depression. We found that those who participated in metacognitive therapy benefited more than others allocated to receive CBT (74 per cent met the formal criteria for recovery at post-treatment, versus 52 per cent of those in the CBT group, and this was largely maintained at follow-up). Together with my own client work and the experiences of other therapists using metacognitive therapy, this finding has convinced me that the cause of mental illnesses isn’t our negative thoughts per se, and therefore the solution is not to spend yet more time on them. On the contrary, the cause of mental illnesses is too much time spent dwelling on our negative thoughts, and so the solution is to spend less time on them.
This realisation created a tsunami of thoughts within my own mind. For years, through CBT, I have helped my clients spend more time on their negative thoughts, but what if there were better ways I could have helped them? True, many of my clients felt CBT had helped them (and it certainly is beneficial to many), but I no longer believe it’s the optimal approach. For the past 10 years I have completely changed my methods and I exclusively use metacognitive therapy to help people think less and, in so doing, cope better with their mental health problems.
Whether you just worry a little more than you’d like to, or you suffer from an anxiety disorder or depression, metacognitive strategies can help you reduce the overthinking that contributes to your symptoms. Metacognitive therapy is about discovering that you can choose whether or not you engage in a thought regardless of its content or the feelings it gives rise to. In the following section, I’ll take you through some of the steps I use in metacognitive therapy to help my clients reduce their overthinking and learn that overthinking isn’t something that happens to us – it’s within our control.
Get to know your trigger thoughts and let them be
It is estimated that the human brain produces thousands of separate thoughts, associations and memories every single day. Most of these thoughts are without significance; they come and go without us noticing. Some thoughts, however, attract our attention. In metacognitive therapy, these thoughts are referred to as ‘trigger thoughts’. If you pay them enough attention, these thoughts can trigger an explosion of bodily sensations and feelings, and a myriad of associations.
Some trigger thoughts can activate warmth and joy about an exciting upcoming project, meeting a friend, or a holiday you’re looking forward to. These kinds of trigger thoughts are, of course, unproblematic. Other trigger thoughts, however, might activate a long series of further thoughts that can develop into worries or ruminations. Worries typically form around hypothetical scenarios and start with ‘What if…’ statements such as: ‘What if I make the wrong decision?’ ‘What if they won’t like me?’ ‘What if I get ill?’ and so on. Typical rumination, on the other hand, starts with thoughts about what, why and how: ‘What is wrong with me?’ ‘Why am I feeling this way?’ ‘How do I get better?’
You can compare these thoughts to trains at a busy railway station. There are departures all the time to a wide array of different destinations. Each train can represent a thought or a sequence of thoughts. For instance, a thought such as ‘What if they won’t like me?’ could arrive at the mental railway platform. You could ‘catch’ the thought and you’ll likely soon notice several other thoughts join in: ‘I won’t be able to handle it if they dislike me.’ ‘Perhaps, then, I shouldn’t go.’ Or you could dismiss the thought, similar to letting the train pass by, and turn your attention back to whatever you were doing. When you don’t expend energy on a thought, you’ll find it will either stay on the platform for later or simply pass you by.
So, it’s not the trigger thought in and of itself that will overwhelm you and lead to a variety of unpleasant symptoms; nor is it the amount of trigger thoughts you have (everyone has them). The problems arise if you continuously jump on to each train – that is, if you begin to analyse the thought and engage in extensive worry or rumination – then it’s like you’re adding more and more carriages to the train, one after another; the train gets heavier and slower, and will eventually have trouble passing even the slightest hill. The same goes for your trigger thoughts: the more time you spend engaging in these thoughts, the slower and heavier you will feel.
Recognise what you can and can’t control
If you’re used to boarding most trains rather uncritically – that is, continuously engaging in trigger thoughts and starting to worry and ruminate for long periods of time – then, unfortunately, you’re well on your way to developing an unhealthy pattern. If you repeat this pattern over and over again, it might begin to feel as if it happens automatically. You might, understandably, come to believe that it’s outside your control.
It’s true, the trigger thoughts themselves are completely automatic – you don’t have any say as to what trains will arrive at your mental railway station. However, you do have a choice over which trains to board. You can choose whether or not to engage in a trigger thought. You can control whether you ‘answer’ the thought or follow it up with more questions.
In trying to understand this differently, instead of in terms of trains, you might picture your thoughts as someone calling you on the phone. Of course, you don’t decide whether the phone rings, who calls or when it rings. (Unfortunately, in this case it’s not the kind of phone you can just turn off!) But you do choose whether to answer the phone or just let it ring and turn your attention back to whatever you were doing. The sound of the phone might be loud, annoying and attract your attention, but what happens if you just leave it be? Eventually it stops ringing. While thoughts and phones are, of course, different things, this metaphor carries a key message in metacognitive therapy: While trigger thoughts are beyond your control, you can control whether you engage with them.
Thoughts are, in principle, ephemeral, although you might not see them this way. Try asking yourself how many of the thoughts you had yesterday you can remember today. To be honest, out of the several thousand I had, I’m not sure I can recall even 10 thoughts. Why is that? Most of the thoughts we have come and go almost instantly because we don’t grant them any special attention but leave them and return to whatever we were doing. Even though you might not be aware of it, you’re already capable of choosing not to engage in a conversation with your thoughts, just as you can ignore the phone that keeps calling.
Postpone and reduce your worries and ruminations
Many chronic overthinkers struggle to change their belief that their thoughts can be brought under control, and perhaps you’re still not convinced. One way of challenging your belief further is to explore whether you’re able to postpone worries and ruminations. I recommend that my clients introduce a so-called ‘worry/rumination time’. It has to be a set time of the day, for instance 7.30pm to 8pm, where you allow yourself to worry and ruminate freely. That way, when trigger thoughts or feelings occur during the day – for instance, you feel the need to evaluate your health or reflect upon what your friends think of you – try postponing these thoughts to your scheduled worry/rumination time (you might tell yourself: ‘I’ll deal with this later’). This set time is also useful for any planning or reassurance-seeking for which you feel the need. One note of caution: you might want to avoid scheduling your worry time within one or two hours of when you plan to go to bed, especially if you’re prone to insomnia or other sleep difficulties.
Introducing a set worry/rumination time serves several functions. First, it’s an experiment that challenges the belief that worries and ruminations are uncontrollable. When dedicating themselves to this experiment, most of my clients find that it is indeed possible to postpone worries or ruminations. While this might seem a hard goal, in fact it’s something you already do on a daily basis without realising. For instance, any time you notice an alarming newspaper headline on your way to work and start worrying, but then remember that you’re in a hurry and so turn your attention back to getting to work – that’s you controlling your thoughts. Or maybe you’re sitting in a café with a friend and you overhear a conversation at another table that triggers unpleasant memories, but instead of dwelling on them, you decide to redirect your attention back to the conversation with your friend. Again, that’s you controlling your thoughts. In the same way, you can learn to consciously ignore your own internal trigger thoughts, thereby experiencing that you really do have a choice in whether you choose to engage in them or not.
A second function of setting worry/rumination time is that it’s a way of discovering that trigger thoughts are ephemeral and ever-changing. For instance, the thoughts that seemed highly relevant and important in the morning will often seem less important when you arrive at your worry/rumination time later in the day. You might even discover that you’re not able to recall some of the thoughts that triggered you. All feelings, whether positive or negative, are usually ephemeral if we tolerate them and let them be. Of course, not all thoughts disappear forever when you postpone processing them – some thoughts might be about important issues that you really need to address. Regardless, as most of my clients find, it’s much more constructive to deal with these issues within a defined time of the day instead of endlessly problem-solving while you’re trying to go about your daily responsibilities.
Finally, while this might seem obvious, the worry/rumination time is a way of reducing and containing the amount of time you spend worrying and ruminating. As I explained earlier, it’s not the trigger thought in and of itself that causes unpleasant symptoms, nor is it the amount of trigger thoughts. It’s the time spent engaging in these thoughts, ruminating and worrying, that weighs us down. By allocating a set period of time for worry and rumination, you’re more likely to feel in control and prevent yourself becoming overwhelmed.
Avoid avoidance and train your attention
For people struggling under the burden of overthinking, it’s all too easy to develop a fear of one’s own trigger thoughts. After all, if you feel at their mercy, you might be tempted to avoid them occurring in the first place. Unfortunately, not only is this largely futile, it’s also counterproductive – avoidance of triggering situations will hamper your life and, moreover, to the extent that you’re at all successful in avoiding situations that prompt trigger thoughts, you won’t get the chance to practise letting go of these thoughts. After all, you can’t learn to ride a bike without a bike.
Inspired by the above, and if you feel ready, I recommend that you give yourself daily challenges that involve trigger thoughts, and that you practise instructing yourself to leave them alone until a designated worry-time. This will help you become more adept at leaving your trigger thoughts alone and to realise that you’re in control of your worries and ruminations. You won’t succeed every time but, just like learning to ride a bike, you need to get up again every time you fall and keep biking until you get the hang of it.
Some people struggle to develop this skill. In that case, in metacognitive therapy we use attention training to help clients realise that they can shift their attention regardless of inner inputs, such as trigger thoughts, and outer input, such as external stressors. I usually ask my clients to do the following 10-minute exercise. Maybe reading this will inspire you to try it out yourself:
Another exercise you could try that I use in my clinic is the windowpane exercise – this will further illustrate that your attention is under your control, independent of the existence of trigger thoughts in your head. I write one or two trigger thoughts in washable ink on a window (such as: ‘What if I fail my driving test?’ or ‘What if she finds me boring?’), then I ask my client to practise looking through the words to notice the scene beyond – the trees, the sky, the buildings, whatever the view is from the window. Then I ask them to switch their attention back to the words again, now back to the details of the view. The purpose here is to familiarise clients with the sensation that we can control our attention. If you give it a try, you’ll find that, while the written thoughts remain in view, you can control whether you focus on them or whether you let them fade and enjoy the world outside instead. Please note, if you find this exercise at all difficult, I recommend that you wait and try it with a professional metacognitive clinician (see the ‘Learn More’ section to find out how).
So far, I have talked about overthinking on the premise that it’s something that most of us would rather be without, and therefore we’re likely to be highly motivated to reduce it. However, you might be one of the many people who hold more ambivalent views toward your lifelong habit of overthinking – deep down, you might believe that there are some advantages in thinking or worrying excessively. If so, not only will it be challenging for you to change this habit, you might also find it a little scary to let go of what for you has felt like a crutch or coping mechanism that has helped you through life. Despite the problems of overthinking, perhaps it feels safe because this is the strategy you’re familiar with – it’s what you’ve always done. Maybe you see overthinking as both a problem and a solution.
This ambivalence reflects specific assumptions that you, like many others, might have about your thoughts and strategies. If you’re to succeed in reducing your overthinking, then it might be necessary to confront these assumptions head on. For instance, one common assumption is: ‘If I worry about what could go wrong, I’ll be able to handle it better.’ Another is: ‘If I go over what I did wrong, I’ll be able to do better next time.’ It goes without saying that, if you live by these beliefs about the supposed benefits of worry and rumination, you’ll find it especially difficult to let go of them.
To challenge these beliefs, I propose you ask yourself if your ruminations have ever led to better decisions, fewer symptoms and more control? Most people’s answers are ambivalent. On the one hand, you might feel that your worries and ruminations have given you some sense of safety and control. On the other hand, you recognise that these worry strategies cause tension, restlessness and perhaps even anxiety, and that they don’t usually lead to better decisions. One way of challenging positive beliefs about the usefulness of worry is to evaluate the pros and cons on a piece of paper, and then make up your mind if you want to practise limiting your worry time or not.
The stark truth is that you can’t worry and ruminate extensively about everything that’s gone wrong, or will go wrong, and at the same time stay emotionally balanced and without burdensome symptoms. Naturally, you’ll sometimes need to thoroughly think things through. So, what to do? My advice is that, if you want the best of both worlds – fewer symptoms and room for contemplation – then set yourself the worry/rumination time, as I described in the ‘What to Do’ section, and postpone your worries and ruminations to that specific time.
You might find this a little scary at first, if you’re a firm believer that worries or rumination do in fact help in keeping you (or others) safe and well-functioning. It will take a good amount of courage for you to explore whether you can do without extensive overthinking. But I strongly encourage you to do so. Perhaps try seeing it as an experiment where you explore what really happens when you let go of these strategies. If you succeed in doing so, my bet is that you’ll feel a great relief, and that the decisions you make won’t suffer from it. If it doesn’t work, well then, you can always go back to your old strategies.
If you follow the guidelines in this article and yet still feel that overthinking is dragging you down, perhaps some of the resources that I have listed below might be of help. If, by then, you’re still having trouble controlling your overthinking, I recommend that you seek additional help from a qualified metacognitive therapist. Accreditation of therapists is managed by the Metacognitive Therapy Institute (MCTI) established by Hans Nordahl, a clinical psychologist at the Norwegian University of Science and Technology in Trondheim, together with Wells, the creator of metacognitive therapy. If you’re considering seeking additional help, you’ll get the best metacognitive treatment from a psychologist who is MCTI registered. In my clinic, all psychologists are either MCTI registered or in the process of becoming registered. You can see the full list of MCTI registered practitioners here. If you’re unable to find a therapist near you, bear in mind that some clinics, including my own, provide online therapy in English.
I believe that the metacognitive therapy approach is the most effective way to deal with overthinking. Although research trials suggest that this modality is an effective treatment for the most common forms of anxiety disorders and depression, available resources are limited simply because this therapeutic approach is still rather new.
I would like to recommend my own book Live More Think Less: Overcoming Depression and Sadness with Metacognitive Therapy (2020). Although primarily focused on depression, it also applies to overthinking in general. It’s an easy read and doesn’t require any prior knowledge of the field. It is also available as an audiobook.
In this Salon London online event from Dec 2020, now available on YouTube, I gave an introduction to the basic premises of metacognitive therapy.
In this five-minute interview from March 2020, available on YouTube, the clinical psychologist Adrian Wells, the founder of metacognitive therapy, gives a concise overview of this therapeutic approach, which is focused on reducing overthinking.
If you’re a mental healthcare professional and are interested in MCT, you might find the following treatment manual useful: Metacognitive Therapy for Anxiety and Depression (2008) by Adrian Wells.