What Is Metacognitive Therapy?
Key takeaways:
Metacognitive therapy (MCT) is a type of therapy that focuses on changing the way that you think about your own thoughts.
It can help reduce worry and overthinking, and can be used to treat a variety of mental health conditions.
You can do MCT with a therapist, or practice metacognitive skills on your own through meditation and self-reflection.
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Metacognition is thinking about thinking. In other words, it’s paying close attention to your thoughts and to how your mind works.
In the past, it’s been used a lot in education to help students learn. And now it’s being used as part of metacognitive therapy (MCT), a type of therapy that can help with emotions, attention, and unhelpful thinking.
What is metacognitive therapy?
Metacognitive therapy (MCT) is a type of therapy where you learn about how you think, so you can better control your attention, thoughts, and feelings. It’s a brief, time-limited therapy that can help you cut down worry and overthinking. It’s offered individually and in group sessions. And so far, there’s evidence that it’s helpful for many different mental health conditions, like anxiety disorders, major depression, and more.
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Metacognitive therapists believe “metacognitive beliefs” contribute to emotional symptoms like anxiety and sadness. Metacognitive beliefs are your beliefs about your thoughts, and about your thinking patterns. These might include thoughts like:
“I can’t control my worrying.”
“If I don’t overanalyze, then something bad will happen.”
“If I think something, then it must be true.”
According to MCT, metacognitive beliefs lead to a pattern of unhelpful behaviors. This pattern is called the cognitive attentional syndrome (CAS). The CAS has three main parts:
Ongoing worry or overthinking
Being constantly on the lookout for threats
Using unhelpful coping mechanisms for temporary relief
And unfortunately, these strategies often make your stress, anxiety, or depression worse — rather than helping you feel better.
What does metacognitive therapy treat?
Metacognitive therapy has been studied for a wide variety of mental health conditions. Research has found that it can help treat:
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How does metacognitive therapy work?
In MCT, the goal is to stop the CAS. This is done through a variety of different techniques, like teaching you how to control your thinking, changing what you pay attention to, and challenging your beliefs.
For example, you might think, “I can’t stop worrying all the time.” If you believe this thought, it can activate the CAS, and lead to unhelpful behaviors — like overthinking, or being “on guard” against situations that make you feel anxious.
In MCT, you learn strategies to help you challenge your beliefs, to help stop the CAS in its tracks. Let’s take a closer look at some of the strategies used in MCT.
MCT strategies
Metacognitive therapists use specific strategies designed to stop the CAS and improve metacognition, and to help your symptoms get better. These include:
Socratic questioning: These are questions that challenge your metacognitive beliefs. The goal of questioning is for you to become more curious about your beliefs, and to develop new ones.
Attention training technique: In this technique, you listen to — and focus your attention on — different sounds in your environment. Practicing this can help you learn to control what you pay attention to in your life, including your thoughts.
Detached mindfulness: This technique involves detaching yourself from your thoughts. You learn to acknowledge their presence without pushing them away, or giving them too much power. With practice, detached mindfulness can help you stop worrying and overthinking.
What to expect when working with a metacognitive therapist
The first step of working with a metacognitive therapist begins with an assessment interview. This usually takes place over 1 to 2 hours. During the assessment, the therapist will ask you questions about your symptoms and history. They may also have you fill out surveys or questionnaires to better understand your symptoms.
The initial assessment also helps your therapist get a sense of your metacognitive beliefs, and how they might be contributing to your symptoms. All of this information can help your therapist create a treatment plan.
Once the assessment is complete, you and your therapist will decide on next steps. You might continue with one-on-one sessions, or instead choose group therapy. MCT is usually a time-limited (short-term) therapy, lasting between 6 and 14 sessions. In most cases, sessions are held once a week.
Can I develop metacognitive skills on my own?
Yes, you can develop metacognitive skills on your own. There are many resources available to help you learn new metacognitive skills, including books and courses. Many teachers also encourage metacognition in their students.
Most metacognition exercises are designed to help you improve understanding, critical thinking, and problem solving in an academic setting. Unfortunately, there isn’t a lot of information out there on how to develop metacognitive skills to help manage your emotions.
In a recent study, people with cardiovascular disease and anxiety and/or depression did a self-guided course of MCT at home. The study found that participants responded well to MCT exercises. Future research will hopefully take a deeper look at whether self-administered versions of MCT can be helpful in other situations.
One self-practice that seems to work well is meditation. Along with many other benefits, meditation is a great way to become more aware of your thought processes. It’s something that you can do on your own or with the help of a guided video or app. If you’re a beginner, start with just 2 minutes a day and work up from there.
What are the disadvantages of metacognitive therapy?
So far there aren’t any established risks of MCT. However, like any treatment, MCT may not be right for everyone, including:
People with mental health conditions who don’t seem to improve with MCT
People who prefer long-term therapy
People who have a hard time thinking about their own thinking
Some experts also believe that there are times when metacognition isn’t helpful. For example, it’s possible that metacognition could lead some people to negatively judge their thinking abilities, and leave them feeling worse.
If you’re concerned about whether MCT is right for you, talk with your therapist. Your therapist can discuss the pros and cons of this treatment approach and give you an opportunity to ask questions.
Is metacognitive therapy the same as CBT?
No, MCT is not the same as cognitive behavioral therapy (CBT). CBT is a type of talk therapy that focuses on identifying and changing unhelpful thoughts and beliefs. This, in turn, helps reduce negative emotions like sadness, anxiety, and anger.
In CBT the goal is to change negative thoughts. However, in MCT, the focus is on simply acknowledging your unhelpful thoughts — without getting swept away by them. MCT also targets your beliefs about your own thinking, while CBT focuses on specific thoughts that arise throughout the day.
What is cognitive vs. metacognitive thinking?
Cognitive and metacognitive thinking are similar but distinct terms. Cognitive thinking, or cognition, is the process of acquiring knowledge. It involves organizing and storing information. Cognitive thinking includes processes like:
Perceiving
Remembering
Conceiving
Reasoning
Judging
Imagining
Metacognitive thinking, or metacognition, is the awareness of your own thinking. It refers to how we understand and control our cognitive processes.
For example, if you’re completing a task at work that you do on a daily basis, you’re engaging in cognitive thinking. If you stopped and asked yourself “why am I doing it this way?”, you would be engaging in metacognitive thinking. The question inspires you to reflect on your own thinking processes.
Where to find a metacognitive therapist
Because MCT is a newer type of therapy it can be hard to find a mental health professional who practices it. There just aren’t as many therapists with experience and training in this area compared to longer-standing approaches like CBT.
One way to locate a metacognitive therapist is to conduct an online search. The Metacognitive Therapy Institute (MCTI) also offers a directory of international therapists who have completed the institute’s training program. Unfortunately, there’s not a directory of metacognitive therapists practicing in the United States at this time.
The bottom line
Metacognitive therapy is a brief, time-limited form of talk therapy that focuses on changing the way that you think about your own thinking. It uses strategies like detached mindfulness and the attention training technique to help your symptoms get better. So far, there’s evidence that MCT may be helpful for many different types of mental health conditions, including anxiety, depression, eating disorders, and more.
If you’re interested in MCT, consider talking with a therapist. They can help you understand whether MCT might be right for you, and for your unique symptoms. Practicing mindfulness on your own can also help you to be more aware of your thoughts, and to challenge your metacognitive beliefs.
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References
Mandell, B. (2015). That’s so meta (cognitive)! Smithsonian Science Education Center.
MCT Institute. (n.d.). Identifying psychological problems.
MCT Institute. (n.d.). Metacognitive therapy.
Merriam-Webster. (n.d.). Metacognition.
Norman, E. (2020). Why metacognition is not always helpful. Frontiers in Psychology.
Normann, N., et al. (2014). The efficacy of metacognitive therapy for anxiety and depression: A meta-analytic review. Depression and Anxiety.
Normann, N., et al. (2018). The efficacy of metacognitive therapy: A systematic review and meta-analysis. Frontiers in Psychology.
Sharma, V., et al. (2022). The scope of metacognitive therapy in the treatment of psychiatric disorders. Cureus.
Srivastava, A., et al. (2023). A review: How meditation can help to improve metacognition. Shodhdisha.
Wells, A., et al. (2022). Metacognitive therapy self-help for anxiety-depression: Single-blind randomized feasibility trial in cardiovascular disease. Health Psychology.
For additional resources or to connect with mental health services in your area, call SAMHSA’s National Helpline at 1-800-662-4357. For immediate assistance, call the National Suicide Prevention Lifeline at 988, or text HOME to 741-741 to reach the Crisis Text Line.
