The metacognitive approach gets us thinking about how we think. This relatively new type of therapy is interested in our thinking styles and how they create and maintain high levels of distress. While some therapies focus on childhood memories or set out to disprove anxious beliefs, metacognitive therapy invites you to mindfully detach from your thoughts and reduce excessive self-focus.
This evidence-based therapy proposes that it’s not just the content of our thoughts that creates emotional distress, but the meaning we attach to our thoughts in the first place. It teaches a much more flexible and mindful stance toward mental activity that enables you to move through distress, rather than lingering on it.
To explore this approach in-depth, we’ll discuss:
Metacognitive therapy (MCT) is a psychotherapy approach developed over the last 30 years. It’s based on the work of Adrian Wells and Gerald Matthews, who dedicated their careers to understanding:[1]
Put simply, their theory gets us to think about thinking and how our thoughts contribute to stress and symptoms of mental health conditions.[1]
MCT might be confused for cognitive behavioral therapy (CBT), but there are key differences. At its heart, CBT is interested in the content of someone’s thoughts and works to challenge their accuracy in the real world. In contrast, MCT suggests that thinking styles are of greater interest, and aims to challenge what people give their attention to.[1]
Metacognitive therapy is founded on the belief that it’s not just what a person thinks that determines their feelings and the control they have over them, but how they think.[2]
Furthermore, MCT is interested in the beliefs people have about themselves and their mental activity, as these can lead to or perpetuate mental health conditions.[1] For example, some people with anxiety develop an unhelpful belief that worrying is good because it’s a way to keep themselves safe. A belief like that quietly gives worry a job to do, which makes it far harder to let go of.
The sections that follow look at how this key principle shapes what MCT can treat, how it works, and how it compares to CBT.
MCT is an evidence-based mental health treatment that’s effective for treating both anxiety and depression.[1] However, as we’ll explore, it can potentially be used to treat a wider range of mental health conditions if research continues to prove its effectiveness. We’ll also explore a metacognitive concept known as cognitive attentional syndrome.
Metacognitive therapy is very well-suited to treating people who live with rumination and obsessive thinking.
In its early days of development, researchers found that people with anxiety tend to have an attentional bias towards real and imagined threats.[1] This means that they’re significantly more preoccupied with danger than people without anxiety. The researchers also found that greater self-consciousness, or paying excess attention to yourself, is correlated with social anxiety.[1]
For these reasons, a key part of MCT for anxiety is to challenge what someone is paying attention to. The work may then turn to refocusing attention onto things that provoke less anxiety.[3]
If you seek MCT for depression treatment, you’ll find that it focuses on how rumination contributes to the condition. Furthermore, an MCT therapist will also look at any metacognitions, or beliefs about thoughts, that keep depression symptoms going.[4]
For example, MCT would challenge thoughts like:
Wells and Matthews identified and labeled cognitive attentional syndrome (CAS), which they saw as a cluster of processes that happen during stress and lead to mental health disorders. An understanding of CAS is integrated into treatments for both anxiety and depression. CAS involves:[1][3]
According to metacognitive therapy theory, CAS is a universal mechanism for causing and maintaining mental health disorders, including anxiety and depression.[1]
While most research into MCT focuses on its applications for anxiety and depression, some experts suggest it could benefit people with the following diagnoses too:[3]
There’s limited research on how effective MCT is at treating these conditions.[3] Even so, there is promise where the mental health condition involves dysfunctional metacognitive beliefs, rumination, worry, and excessive self-focus.
Metacognitive therapy might also be an effective psychological treatment for people with attention-deficit hyperactivity disorder (ADHD) because of how the condition influences their cognition. ADHD often causes difficulties with:[5]
To explore whether MCT might be helpful for ADHD, a study gave groups of people with ADHD either metacognitive therapy or supportive group therapy. It found that the people who received MCT showed much more improvement in their ability to complete tasks, stay organized, and use other attention skills.[5]
Although MCT is relatively new and there’s not much research into the many conditions it can support, the early results are promising.
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Many people experience emotional discomfort as temporary and transitory if they’ve got coping mechanisms for negative thoughts and beliefs. However, many others become stuck in negativity because their thinking patterns set up a pattern of responding that maintains and strengthens their distress.[2]
To help people break out of these cycles, metacognitive therapy draws on techniques from information processing theory and the Self-Regulatory Executive Function model. Here is what each involves:[1]
Self-attentional processes: As MCT holds that psychological conditions are maintained by excessive self-consciousness, interventions challenge a person’s relationship with their awareness.
For instance, ruminating and threat-monitoring are classic examples of rigid and counter-productive self-attentional processes that maintain anxiety and depression.
Techniques to combat this involve shifting attention elsewhere, through practicing detached mindfulness.
Self-Regulatory Executive Function model: Metacognitive therapists explain the S-REF model to get people thinking about their mental lives. This model includes everything described so far:
By teaching this model, an MCT therapist will support you in mindfully detaching from your thoughts, developing greater metacognitive control, and deepening self-understanding.
With these key ideas at the center, MCT aims to reduce CAS, challenge metacognitive beliefs, and help with emotional processing.[3]
If you are looking for CBT alternatives, metacognitive therapy is one of the many psychotherapy approaches available. There is some opinion that MCT could be more effective than cognitive behavioral therapy in certain cases.[1][6]
If you’ve already tried CBT, you will likely find the MCT experience a little different. Here’s how the approaches differ:[2]
In simple terms, a CBT therapist explores the content of someone’s anxious or depressive thoughts. An MCT practitioner takes a different approach and encourages someone to question why the thought content is worth thinking about at all.
MCT is also likely to challenge someone’s beliefs about their thoughts. For example, the idea that worrying protects someone with anxiety from harm. Rather than weighing evidence for and against, the work helps someone test the belief in practice. This can show them that worrying does real harm to their mental wellness while doing little to keep them safe.
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If you’re tired of the same thoughts pulling you back down, the work of changing how you relate to them is something we can help with. At AMFM (A Mission For Michael) Mental Health Treatment, we offer a range of evidence-based therapies that work on the same territory this article has covered. This includes the relationship between your thoughts and your distress, and the thinking styles that keep it going.
Our licensed professionals provide a safe space for you to explore your personal difficulties and develop strategies for moving forward. We believe in treatment persistence and will personalize your treatment plan so you can achieve lasting, life-changing outcomes.
We offer an intimate, focused mental health treatment experience for adults in home-like settings that are carefully maintained to be peaceful, comfortable spaces. AMFM Mental Health Treatment provides the full spectrum of care, including residential treatment and multiple levels of outpatient treatment programs.
Our locations accept insurance and are in-network with most major providers. To check your insurance coverage for mental health care, simply complete our confidential online verification form or call us at 866-478-4383.
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