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Metacognitive therapy (MCT) is a newer treatment method that is helpful for problems such as general anxiety but also for other conditions. Here we explain what it is and how MCT can help you.

What is metacognitive therapy?

Metacognitive therapy (MCT) is a form of psychotherapy that focusses on changing thought patterns and beliefs that contribute to mental health problems. Developed by psychologist Adrian Wells , it is based on the principle that it is not only our thoughts that affect our wellbeing, but also our approach to those thoughts and how we deal with them. Metacognitive therapy can be helpful for various forms of mental health problems.

According to Beyond Blue, 3 million Australians are living with anxiety. Anxiety is the most common mental health condition in Australia. 1 in 4 people will experience anxiety at some stage in their life.

What is metacognitive therapy?

Metacognitive therapy (MCT) focuses on changing the way people think about their own thoughts, also known as metacognitions. The principle is that many psychological problems depend not only on the content of our thoughts, but also on how we manage and relate to those thoughts. For example, a person may not only worry about an event (a thought), but also believe that they need to worry to prevent bad things from happening (a metacognition).

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In MCT, the therapist works to help the client identify and challenge these maladaptive metacognitive beliefs, such as the idea that worrying is something necessary or useful. Unlike traditional cognitive behavioural therapy (CBT) which often focuses on changing the content of negative or dysfunctional thoughts, MCT concentrates more on the process of how we think.

This means teaching clients to develop more flexible control over their thinking, to break out of thought traps such as catastrophizing and overgeneralizing, and to reduce engagement in harmful thought patterns such as excessive rumination and worrying.

MCT has been shown to be effective for a variety of psychological conditions, including anxiety disorders, depression, PTSD and OCD. By teaching clients to manage their metacognitive processes in a more adaptive way, MCT aims to reduce the tendency to get stuck in negative thought patterns and thus reduce psychological distress.

What can metacognitive therapy help with?

Metacognitive therapy (MCT) is effective in treating several psychological problems. It is particularly useful for different types of anxiety problems, especially generalized anxiety disorder, by helping to manage worrying thoughts.

For people with depression, MCT reduces symptoms by breaking the cycle of negative thought patterns and rumination. It is also useful for treating obsessive-compulsive disorder by changing the approach to obsessive thoughts, and post-traumatic stress by managing intrusive thoughts.


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MCT can help with sleep problems, health anxiety, hypochondria and social anxiety by changing the way you think about these problems. In addition, it can help people with chronic pain manage their thoughts and feelings about the pain for better pain control.

By focusing on ‘thinking about thinking’, MCT teaches clients to reduce maladaptive rumination and worrying, leading to a reduction in psychological symptoms.

Metacognitive therapy for GAD

Metacognitive therapy has been shown to be particularly effective for the treatment of generalized anxiety disorder (GAD), an anxiety disorder characterized by chronic and excessive worrying about multiple topics or events. Treatment focuses on changing metacognitions – thoughts about thoughts – that are thought to maintain and reinforce anxiety and worrying behaviors.

By changing the metacognitive processes that maintain GAD, MCT aims to reduce chronic worry and improve the client’s ability to manage anxiety. This approach has been shown to be particularly effective for GAD, as it directly addresses the underlying thought processes that contribute to the disorder.


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Techniques used in metacognitive therapy

MCT can be used for several different conditions. Here is how MCT is typically used for GAD:

  1. Identifying metacognitions: The therapy begins by identifying the client’s maladaptive metacognitions that contribute to GAD, such as beliefs that worrying is useful to prevent negative events or that one cannot control their anxious thinking.
  2. Challenge metacognitions: The client is encouraged to question and challenge these beliefs, and explore how they contribute to their anxiety.
  3. Modifying thought patterns: MCT focuses on helping the client develop more adaptive ways of relating to their thoughts, such as reducing time and engagement in anxious thoughts and ruminations.
  4. Attention training: This is a central part of MCT, where the client learns techniques to intentionally direct their attention away from anxious thoughts and instead focus on tasks or activities in the present moment.
  5. Managing “detentional control”: The client is trained to have more flexible control over their thinking, meaning they can actively choose not to engage in anxious thoughts.
  6. Practical exercises and homework: The therapy often includes practical exercises during the sessions as well as homework where the client applies the learned strategies in real-life situations.

How long does a treatment with MCT take?

The length of a metacognitive therapy treatment varies depending on the needs of the individual, the severity of the condition being treated and the progress of the therapy. MCT is generally a short-term treatment, usually involving 8 to 16 sessions or more. The length of treatment is individualized, and there is no fixed rule.

The therapist continuously evaluates the client’s progress and can adjust the treatment if necessary. If the client reaches their goals, treatment can be terminated earlier. Follow-up sessions may also be relevant to maintain progress and manage possible relapses. MCT treatment is flexible and adapted to the client’s needs.


12 frequently asked questions about metacognitive therapy

What is metacognitive therapy?

Metacognitive therapy (MCT) is a form of psychotherapy that focuses on changing thought patterns and beliefs that contribute to mental illness.

How does MCT treatment work?

Metacognitive therapy (MCT) focuses on changing the way people think about their own thoughts, also known as metacognitions. The principle is that many psychological problems are not only due to the content of our thoughts, but also to how we handle and relate to those thoughts.

What can be treated with MCT?

There are many problems that can be treated with MCT, it is particularly effective for general anxiety disorder but is also helpful for other conditions such as depression, anxiety, stress and PTSD.

How long does an MCT treatment take?

MCT is a relatively short-term treatment compared to some other therapies. It can involve anywhere from 8 to 16 sessions or more, depending on the needs of the individual and how well they respond to the therapy.

What methods and techniques are used in MCT?

MCT consists of a number of different tools and techniques to change thoughts, feelings and behaviours. These include work with metacognitions, attention training and homework.

What is the basis of MCT?

The treatment is based on the principle that it is not only our thoughts that affect our wellbeing, but also our approach to those thoughts and how we deal with them.

Can you get MCT online?

It is possible to receive treatment digitally via video.

Is MCT helpful for any specific problems?

MCT has been shown to be a particularly effective treatment method for reducing anxiety in generalized anxiety disorder but it is also helpful for other conditions.

What are metacognitions?

Metacognitions are our thinking about our thinking, a perspective that is a little more distant from our thinking.

What is an MCT therapist?

An MCT therapist is a therapist, often a psychologist, who has further training in metacognitive therapy.

Where can I turn if I need help?

At Lavendla, we have experienced psychologists and therapists who can help you feel better. If you have thoughts of self-harm or suicide, call emergency services on 000 or Lifeline Australia on 13 11 14 (24 hour service).

What does treatment with MCT involve?

Treatment with metacognitive therapy (MCT) involves several steps and techniques aimed at changing the way a person thinks about their thinking (metacognitions) and manages their thoughts. Here is an overview of what a typical MCT treatment might look like:

  1. Initial assessment: Treatment begins with an assessment of the client’s thought patterns and metacognitions. The therapist also explains how MCT works and its relevance to the client’s specific problem.
  2. Identification of metacognitions: The client is helped to identify their maladaptive metacognitions, such as beliefs that worrying is necessary or that thoughts cannot be controlled.
  3. Attention training: A central part of MCT is teaching the client to direct their attention away from maladaptive thoughts. This can include exercises to practice selective attention or shifting attention.
  4. Challenging metacognitions: The therapist helps the client to question and re-evaluate their maladaptive metacognitions, and develop more adaptive ways of thinking about thinking.
  5. Modification of thinking style: The client learns to change their thinking style, such as reducing time spent brooding or worrying, and using more constructive thinking strategies.
  6. Evaluation and feedback: Throughout the process, the therapist and client together evaluate progress and adjust treatment as needed.
  7. Skills reinforcement: The client is encouraged to regularly practice the skills and strategies they have learned in therapy, even outside of sessions.

MCT is usually structured and time-limited, and its duration can vary depending on the individual’s problems and needs. By focusing on metacognitions, MCT aims to give clients tools to manage their thoughts in a more adaptive way, which can reduce psychological distress and improve their quality of life.

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Written by melissa

Melissa is a Certified Kinesiologist who focusses on a client-centred, holistic and integrative approach to health and wellness. She has extensive experience in managing stress, anxiety, fears, phobias and trauma in her clients. Melissa uses visual and auditory feedback to directly access and solve the cause of psychological stressors in the body so that optimal well-being and balance is achieved.