Metacognitive therapy

Metacognitive Therapy (MCT) is a psychological "talking therapy" for the treatment of mental illness. It was created by Professor Adrian Wells based on an information processing model by Wells and Matthews. It is supported by scientific evidence from a large number of studies. The goals of MCT are to first discover what patients believe about their own thoughts and how their mind works (called metacognitive beliefs), then show the patient how these beliefs lead to unhelpful responses to thoughts that serve to unintentionally prolong or worsen symptoms, and finally to provide alternative ways of responding to thoughts in order to allow a reduction of symptoms. In clinical practice, MCT is most commonly used for treating anxiety disorders such as social anxiety disorder, generalised anxiety disorder (GAD), health anxiety, obsessive compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) as well as depression- though the model was designed to be transdiagnostic (meaning it focuses on common psychological factors thought to maintain all psychological disorders).

Background and origins

Metacognition [Greek for "after" (meta), "thought" (cognition)] refers to the human capacity to be aware of and control one's own thoughts and internal mental processes. Metacognition has been studied for several decades by researchers, originally as part of developmental psychology and neuropsychology. Examples of metacognition include a person knowing what thoughts are currently in their mind, where the focus of their attention is and a person's beliefs about their own thoughts (which may or may not be accurate).

The Metacognitive Model of Mental Disorder

In the metacognitive model, symptoms are caused by a set of psychological processes called the Cognitive Attentional Syndrome (CAS). The CAS includes 3 main processes, each of which constitutes extended thinking in response to negative thoughts. These 3 processes are:

1. Worry/rumination
2. Threat monitoring
3. Coping behaviours that backfire

All three are controlled by patients’ metacognitive beliefs, including the belief that such processes will help address their problems (although the processes all ultimately have the unintentional consequence of prolonging distress).

Therapeutic intervention

MCT is a time-limited therapy which usually takes place between 8-12 sessions. The therapist uses discussions with the patient to discover their metacognitive beliefs, experiences and strategies. The therapist then shares the model with the patient, pointing out how their particular symptoms are caused and maintained. Therapy then proceeds with the introduction of experiments tailored to the patient’s difficulties (e.g. “You believe that if you worry too much you will go ‘mad’- let’s try worrying as much as possible for the next 5 minutes and see if there is any effect”) and strategies such as Attentional Training Technique and Detached Mindfulness (this is a distinct strategy from various other forms of ‘mindfulness techniques’).

Research evidence

Clinical trials, (including randomised control trials) have found MCT to produce clinically significant improvements across a range of mental health disorders, although the total number of subjects studied is small and a recent meta-analysis concluded that further study is needed before strong conclusions can be drawn regarding effectiveness. A special issue of the Journal of Cognitive Therapy and Research was devoted to MCT research findings.

External links

• MCT Institute