Thinking about thinking: What is Metacognitive Therapy?

Metacognitive therapy (MCT) is a newer and effective form of cognitive therapy, which is used to treat a range of psychological disorders, such as anxiety and depression.

Metacognitive therapy is based on the principle that worry and rumination are universal processes that lead to psychological disorders. These processes are related to erroneous beliefs about thinking and inappropriate self-regulatory strategies. 

As the name implies, Metacognitive therapy focuses on metacognitions, which are the processes of cognition, or simply put, “thoughts about thoughts”. As such, Metacognitive therapy is concerned with how a person thinks rather than what a person thinks. In Metacognitive therapy, the therapist works with beliefs about thinking (metacognitions), and in particular on strategies that characterize a range of mental disorders, such as rumination, worrying, paying attention to specific dangers and maladaptive coping behaviors, such as avoidance, substance abuse, or thought control strategies. 

Let’s look at an example: 

Mary is a 24-year old student whose long term boyfriend recently ended their relationship. She has spent a lot of time thinking about the reasons why her boyfriend broke up with her. Mary has found herself ruminating and worrying about the problem:

“Without my boyfriend I can’t have a family, get a house, a job, or have a happy life. I will just be unhappy for the rest of my life. No one wants me.” 

Although it might seem strange to others, Mary feels like she has found some comfort (positive metacognitive beliefs) by engaging in depressive rumination and worry. She believes that if she ruminates and worries enough about these things, she might find a solution and get her boyfriend back. However, as time goes by, Mary comes to the realization that rumination and worry have their disadvantages (negative metacognitive beliefs). As such, she eventually believes that the intrusive thoughts are uncontrollable and dangerous, which makes her feel anxious and distressed. She finds herself thinking “If I can’t stop thinking about this, I will become crazy”. As a way to cope with difficult thoughts and feelings, Mary has started to drink more often. By using an inappropriate coping mechanism like alcohol, Mary will only maintain the problem. 

In Metacognitive therapy, the therapist works with how people relate to their inner experiences. The focus is therefore not on the content of thoughts that causes anxiety or sadness (‘trigger’ thoughts) as in other psychotherapies, but on how people respond to these thoughts, and which cognitive strategies we choose to use when the trigger thoughts occur. As such, the psychologist role in therapy is centred around identifying the trigger thoughts and how to relate to them in a new and flexible way. In the course of Metacognitive therapy, people are taught new strategies in order to control attention and to choose which thoughts to spend energy and resources on. Through conversation, old beliefs and strategies in relation to thoughts and feelings are challenged. Together with their psychologist, clients do concrete exercises in order to practice and learn how to control their attention, and thus what to use energy on. That way, people are equipped to ruminate less and use strategies that can better regulate thoughts and feelings - and thereby increase well-being.

Ongoing Awareness

In summary, the therapist works with identifying thinking styles and other coping strategies and explores the connection between these and difficult emotions. Metacognitive therapy is also concerned with identifying which metacognitive beliefs maintain these strategies. The treatment is about creating awareness around the regulation of thoughts and emotions, challenging erroneous metacognitive beliefs, and acquiring better self-regulation skills.