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Metacognitive Therapy (MCT) is a newer treatment method that can help with issues such as general anxiety and other conditions. Here, we explain what MCT is and how it can assist you.

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.


12 FAQs 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 how people think about their thoughts, also known as metacognition. The principle is that many psychological problems are not only due to the content of our thoughts but also how we handle and relate to those thoughts.

What can be treated with MCT?

Many problems 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 individual’s needs and how well they respond to the therapy.

What methods and techniques are used in MCT?

MCT consists of various tools and techniques for changing thoughts, feelings, and behaviours. These include working with metacognition, attention training, and homework.

What is the basis of MCT?

The treatment is based on the principle that our thoughts affect our well-being, as well as the treatment of those thoughts.

Can you get MCT online?

It is possible to receive treatment digitally via video.

Is MCT helpful for any specific problems?

MCT is 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.

What does treatment with MCT involve?

Treatment with Metacognitive Therapy (MCT) involves several steps and techniques to change how people think about their thinking (metacognitions) and manage their thoughts. Here is an overview of what a typical MCT treatment might look like:

  1. Initial assessment: Treatment begins with assessing the client’s thoughts and metacognitions. The therapist also explains how MCT works and its relevance to the client’s 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 clients 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 question and re-evaluate their maladaptive metacognitions and develop more adaptive ways of 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 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 more adaptively, which can reduce psychological distress and improve their quality of life.


Written by Samantha Pieterse

Sr. Samantha Pieterse is a registered psychiatric nurse who is deeply committed to mental health and well-being. Samantha brings a unique and valuable perspective to her role as an editor for Lavendla South Africa. She has worked in Government and Private mental healthcare institutions in Gauteng and her expertise ensures that the articles on our website are accurate and accessible. Samantha is dedicated to enhancing mental health awareness and education in South Africa.