Metacognitive Therapy
Psychological disorder is maintained not by the content of thoughts but by a style of responding to them — worry, rumination, threat monitoring and unhelpful coping — which is driven by metacognitive beliefs, so treatment targets those beliefs and the processing style rather than the thoughts themselves.
It is not what you think. It is how long you think about it, and why you believe you have to.
Who built it
Adrian Wells
Psychologist, University of Manchester
Developed the self-regulatory executive function (S-REF) model and metacognitive therapy — the most rigorous critique of standard cognitive therapy from inside the cognitive tradition, with trials to support it.
MCT
Theory of personality
Wells and Matthews’ S-REF model proposes that disorder arises from the Cognitive Attentional Syndrome: a toxic style of processing consisting of perseverative thinking (worry and rumination), fixed attention on threat, and unhelpful coping such as avoidance, suppression and reassurance seeking.
Metacognitive beliefs
Positive metacognitive beliefs
- "Worrying keeps me prepared"
- "If I analyse this enough I will understand myself"
- "Thinking it through will stop it happening"
- These start the perseveration
Negative metacognitive beliefs
- "My worry is uncontrollable"
- "These thoughts could make me go mad"
- "Thinking it is as bad as doing it"
- These make the perseveration frightening and self-perpetuating
Theory of psychopathology
The same syndrome underlies every disorder; only the content varies. Depression is rumination; generalised anxiety is worry plus meta-worry; social anxiety is anticipatory processing and post-event processing; OCD is thought-fusion beliefs and neutralising; PTSD is a maladaptive response to a natural adaptive process that would otherwise resolve.
Wells’ account of PTSD is characteristic: the intrusive re-experiencing after trauma is a normal reflective adaptation process, and it resolves on its own unless the person interferes with it through worry, rumination, threat monitoring and avoidance. The treatment therefore removes the interference rather than processing the memory.
Theory of change
- 1Case formulation in metacognitive terms — the CAS and the beliefs driving it, with no attention to content.
- 2Detached mindfulness: relating to a thought as an event, without engaging or suppressing it.
- 3Attention Training Technique: an auditory exercise building flexible control over attention.
- 4Challenging negative metacognitive beliefs, particularly uncontrollability, with behavioural experiments — postponement, and deliberate loss of control.
- 5Challenging positive metacognitive beliefs about the usefulness of worry and rumination.
- 6New plans for processing: what the person will do instead, specified explicitly.
Key concepts
The vocabulary you need to read the literature and to be understood in supervision.
Where it sits in the transtheoretical grid
Which change processes the system leans on, and at what level of content it aims.
- Consciousness raising
Increasing information about oneself and the problem - feedback, interpretation, education, observation.
- Stimulus control
Restructuring the environment so that problem cues are less likely and healthy cues more likely.
- Counterconditioning
Substituting an incompatible response for the problem response - relaxation, assertion, exposure, defusion, opposite action.
- Self-liberation (choosing)
Choosing and committing to act, plus the belief that one can change - the deliberate exercise of agency.
- Maladaptive cognitions
- Symptom & situational problems