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 health problems. Developed by psychologist Adrian Wells, it is based on the principle that not only our thoughts affect our well-being 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.

What is metacognitive therapy?

Metacognitive therapy (MCT) focuses on changing how people think about their thoughts, also known as metacognition. 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 or an idea but also believe they need to worry about preventing bad things from happening (metacognition).

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In MCT, the therapist helps the client identify and challenge maladaptive metacognitive beliefs, such as the idea that worrying is necessary or valuable. 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 thinking.

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 is effective for a variety of psychological conditions, including anxiety disorders, depression, PTSD and OCD. By teaching clients to manage their metacognitive processes more adaptively, 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 beneficial 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 helpful in 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, which reduces psychological symptoms.

Metacognitive therapy for GAD

Metacognitive therapy is 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 behaviours.

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 is efficient for GAD, as it directly addresses the underlying thought processes contributing 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 helpful to prevent adverse events or that one cannot control one’s 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 “Attentional 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 and 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 individual’s needs, the severity of the condition being treated, and the progress of the therapy. MCT is generally a short-term treatment 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.