Breaking the Cybernetic Code: Understanding and Treating the Human Metacognitive Control System to Enhance Mental Health

HYPOTHESIS AND THEORY published: 12 December 2019 doi: 10.3389/fpsyg.2019.02621 Breaking the Cybernetic Code: Understanding and Treating the Human Metacognitive Control System to Enhance Mental Health Adrian Wells1,2* School of Psychological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, United Kingdom, 2 Greater Manchester Mental Health NHS Foundation Trust, Manchester, United Kingdom 1 Edited by: Changiz Mohiyeddini, Northeastern University, United States Reviewed by: Giancarlo Dimaggio, Centro di Terapia Metacognitiva Interpersonale (CTMI), Italy Gabriele Caselli, Sigmund Freud University Vienna, Austria *Correspondence: Adrian Wells Specialty section: This article was submitted to Psychology for Clinical Settings, a section of the journal Frontiers in Psychology Received: 21 June 2019 Accepted: 06 November 2019 Published: 12 December 2019 Citation: Wells A (2019) Breaking the Cybernetic Code: Understanding and Treating the Human Metacognitive Control System to Enhance Mental Health. Front. Psychol. 10:2621. doi: 10.3389/fpsyg.2019.02621 Frontiers in Psychology | www.frontiersin.org The self-regulatory executive function (S-REF) model explains the role of strategic processes and metacognition in psychological disorder and was a major influence on the development of metacognitive therapy. The model identifies a universal style of perseverative negative processing termed the cognitive attentional syndrome (CAS), comprised of worry, rumination, and threat monitoring in the development of disorder. The CAS is linked to dysfunctional metacognitions that include beliefs and plans for regulating cognition. In this paper, I extend the theoretical foundations necessary to support further research on mechanisms linking metacognition to cognitive regulation and effective treatment. I propose a metacognitive control system (MCS) of the S-REF that can be usefully distinguished from cognition and is comprised of multiple structures, information, and processes. The MCS monitors and controls activity of the cognitive system and regulates the behavior of neural networks whose activities bias the way cognition is experienced. Metacognitive information involved in the regulation of on-line processing includes metacognitive beliefs, metacognitive procedural commands, and more transient cybernetic code. Separation of the cognitive and metacognitive systems and modeling their relationship presents major implications concerning what should be done in therapy and how it should be done. The paper concludes with an in-depth consideration of methods that strengthen the psychological basis of psychotherapy and aid in understanding and applying metacognitive therapy in particular. Finally, limitations of the model and implications for future research on self-awareness, self-regulation, and metacognition are discussed. Keywords: metacognitive therapy, metacognition, self-awareness, transdiagnostic mechanisms, cognitive behavior therapy, neural networks, embodiment, attention INTRODUCTION Throughout the last 25 years, the Self-Regulatory Executive Function (S-REF) model (Wells and Matthews, 1994, 1996) has stimulated a large volume of research on cognitive control processes in psychological disorder and is the grounding of an effective psychological treatment: metacognitive therapy (MCT: Wells, 1995, 2009). In this paper, I consider the central principles of the model in light of recent evidence and expand on the functional components of its metacognitive control system. The aim is to provide a theoretical framework to stimulate and 1 December 2019 | Volume 10 | Article 2621 Wells Metacognitive Control System advance future research on varieties of metacognitive information, processes, and structures in psychological disorder, self-awareness, and treatment. failed to account for the individuals influence over whether or not to continue with current processing. For instance, the content of self-knowledge or schemas (e.g. “I’m a failure as a mother”) does not explain bias in attention or cognitive regulation because the individual retains choice in whether or not to continue analyzing their failures. In effect, the role of top-down or executive processes in the regulation of processing necessitated elaboration. Therefore, our model aimed to explain how voluntary (executive processes) and involuntary processes interacted with stored knowledge, especially metacognition in the regulation of processing. Metacognition refers to the structures, content, and processes involved in the monitoring, appraisal, and control of cognition. Sometimes loosely defined as that part of cognition that is turned onto itself, this simple definition may be misleading, because it suggests a single structure of cognition responsible for cognition and metacognition. Seminal work on metacognition prior to the S-REF model was predominantly in developmental, educational, and memory psychology with defining contributions of Flavell (1979), Nelson and Narens (1990), and colleagues. In order to develop a comprehensive model of cognitive control and the prioritizing of negative processing, we predicted a central contribution of dysfunctional metacognition and attentional control plans stored in long term memory. Subsequently, the metacognitive component of the model was elaborated as the basis for metacognitive therapy (Wells, 1995, 2000, 2009), and the model was extended with greater detail of features of its architecture and metacognitive components (especially metacognitive beliefs). However, the central tenets of the theory and its implications, emphasizing universal top-down influences, remain the same. The S-REF model has influenced the development of other treatment approaches. For example, Clark and Wells (1995) advanced a model and treatment of social phobia that has proven effective (Clark et al., 2006; Nordahl et al., 2016) and is a recommended intervention in health guidelines (NCCMH, 2013). Wider influences of the S-REF on psychotherapy are apparent as extensions of CBT, for example, “emotional schema” theory and treatment (Leahy, 2015). While in a separate line of work, metacognition has been formulated differently by Dimaggio et al. (2015) in their therapeutic approach of interpersonal therapy in personality disorder and by Moritz and Woodward (2007) in metacognitive training for schizophrenia. HISTORICAL CONTEXT OF THE SELF-REGULATORY EXECUTIVE FUNCTION MODEL Our initial aim in the work leading to the S-REF was to take a robust scientific approach that was deeply rooted in cognitive psychology to develop an explanation of the mechanisms behind psychological disorder. That aim culminated in our book, Attention and Emotion: A Clinical Perspective; first published in 1994 and since re-published (Wells and Matthews, 1994, 2015). Our goal was to generate testable theory-based predictions that would lead to clinical innovation. The S-REF model aimed to explain la (...truncated)