Metacognition, mindfulness and the modification of mood disorders

A distinction is made between metacognitive knowledge (knowing that thoughts are not necessarily always accurate) and metacognitive insight (experiencing thoughts as events in the field of a awareness, rather than as direct readouts on reality). This distinction, and its relevance to preventing relapse and recurrence in depression, is examined within the Interacting Cognitive Subsystems (ICS) theoretical framework. This analysis suggests, as an alternative to cognitive therapy with its focus on changing the content of depression-related thought, the strategy of changing the configuration or mode, within which depression-related thoughts and feelings are processed, i.e. changing one's relationship to inner experience. Specifically, facilitating a metacognitive insight mode, in which thoughts are experienced simply as events in the mind, offers an alternative preventative strategy. Mindfulness training teaches skills to enter this mode, and forms a central component of Mindfulness-based Cognitive Therapy, a novel, cost-efficient group preventative programme, for which there is encouraging evidence of effectiveness. Copyright (C) 1999 John Wiley & Sons, Ltd.