Metacognitive therapy (MCT) is a psychological "talking therapy" for the treatment of mental disorders. It was created by 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 first to discover what patients believe about their own thoughts and about how their mind works (called metacognitive beliefs), then to 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).
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 and knowing where the focus of their attention is, and a person's beliefs about their own thoughts (which may or may not be accurate).
Model of mental disorders
In the metacognitive model, symptoms are caused by a set of psychological processes called the cognitive attentional syndrome (CAS). The CAS includes three main processes, each of which constitutes extended thinking in response to negative thoughts. These three processes are:
All three are controlled by patients' metacognitive beliefs, such as the belief that these processes will help to solve their problems (although the processes all ultimately have the unintentional consequence of prolonging distress).
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 techniques tailored to the patient's difficulties aimed at changing how the patient relates to thoughts and that bring extended thinking under control. Experiments are used to challenge metacognitive beliefs (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 mindfulness techniques).
Clinical trials (including randomized controlled trials) have found MCT to produce large clinically significant improvements across a range of mental health disorders, although as of 2014 the total number of subjects studied is small and a meta-analysis concluded that further study is needed before strong conclusions can be drawn regarding effectiveness. A special issue of the journal Cognitive Therapy and Research was devoted to MCT research findings. A 2018 meta-analysis confirmed the effectiveness of MCT in the treatment of a variety of psychological complaints with depression and anxiety showing the strongest evidence.
- Wells, Adrian (2011). Metacognitive therapy for anxiety and depression. New York: Guilford Press. ISBN 9781593859947. OCLC 226358223.
- Wells, Adrian; Matthews, Gerald (November 1996). "Modelling cognition in emotional disorder: The S-REF model". Behaviour Research and Therapy. 34 (11–12): 881–888. doi:10.1016/S0005-7967(96)00050-2.
- Georghiades, Petros (16 May 2012). "From the general to the situated: three decades of metacognition". International Journal of Science Education. 26 (3): 365–383. doi:10.1080/0950069032000119401.
- Normann, Nicoline; van Emmerik, Arnold A. P.; Morina, Nexhmedin (May 2014). "The efficacy of metacognitive therapy for anxiety and depression: a meta-analytic review". Depression and Anxiety. 31 (5): 402–411. doi:10.1002/da.22273. PMID 24756930.
- Biggs, J. (1 August 1988). "The role of metacognition in enhancing learning". Australian Journal of Education. 32 (2): 127–138. doi:10.1177/000494418803200201.
- Brown, Anne L. (1978). "Knowing when, where, and how to remember: a problem of metacognition". In Glaser, Robert. Advances in instructional psychology. 1. Hillsdale, N.J.: Lawrence Erlbaum Associates. pp. 77–165. ISBN 9780470265192. OCLC 4136451.
- Forrest-Pressley, Donna-Lynn, ed. (1985). Metacognition, cognition, and human performance. Vol. 2: Instructional practices. Orlando: Academic Press. ISBN 978-0122623028. OCLC 11290806.
- Shimamura, Arthur P. (2000). "Toward a cognitive neuroscience of metacognition". Consciousness and Cognition. 9 (2 Pt 1): 313–23, discussion 324–6. doi:10.1006/ccog.2000.0450. PMID 10924251.
- Fergus, Thomas A.; Wheless, Nancy E.; Wright, Lindsay C. (October 2014). "The attention training technique, self-focused attention, and anxiety: a laboratory-based component study". Behaviour Research and Therapy. 61: 150–155. doi:10.1016/j.brat.2014.08.007. PMID 25213665.
- Gkika, Styliani; Wells, Adrian (February 2015). "How to deal with negative thoughts?: a preliminary comparison of detached mindfulness and thought evaluation in socially anxious individuals". Cognitive Therapy and Research. 39 (1): 23–30. doi:10.1007/s10608-014-9637-5.
- "Special issue on metacognitive theory, therapy and techniques". Cognitive Therapy and Research, Volume 39, Issue 1, Springer Verlag. February 2015.
- Morina, Nexhmedin; Normann, Nicoline (2018). "The Efficacy of Metacognitive Therapy: A Systematic Review and Meta-Analysis". Frontiers in Psychology. 9. doi:10.3389/fpsyg.2018.02211. ISSN 1664-1078.
- Wells, Adrian; Fisher, Peter L., eds. (2016). Treating depression: MCT, CBT and third wave therapies. Chichester, UK; Malden, MA: Wiley-Blackwell. doi:10.1002/9781119114482. ISBN 9780470759059. OCLC 908699035.
- Wells, Adrian; Simons, Michael (2014). "Metacognitive therapy: thinking differently about thinking". In Hofmann, Stefan G. The Wiley handbook of cognitive behavioral therapy. Chichester, UK; Malden, MA: Wiley-Blackwell. pp. 107–130. doi:10.1002/9781118528563.wbcbt06. ISBN 9781118533208. OCLC 843010463.
- Herbert, James D.; Forman, Evan M. (2011). "The evolution of cognitive behavior therapy: the rise of psychological acceptance and mindfulness". In Herbert, James D.; Forman, Evan M. Acceptance and mindfulness in cognitive behavior therapy: understanding and applying the new therapies. Hoboken, NJ: John Wiley & Sons. pp. 1–25. doi:10.1002/9781118001851.ch1. ISBN 9780470474419. OCLC 612189071.
- Fisher, Peter L.; Wells, Adrian (2009). Metacognitive therapy: distinctive features. The CBT distinctive features series. London; New York: Routledge. ISBN 9780415434980. OCLC 229466109.