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Metacognitive therapy (MCT) was developed by Dr. Adrian Wells and Dr. Gerald Matthews in the early 1990s.  It shares elements in common with but is distinct from, cognitive-behavioral therapy (CBT).

The main difference is that whilst CBT concentrates upon the negative CONTENT of a person’s thoughts and strives to alter that content, MCT, in contrast, focuses not on the contents of a person’s thoughts but rather on the WAY IN WHICH THE PERSON THINKS – it aims to help the person experience their negative thoughts in a new and accepting way which can greatly reduce the emotional distress that they had previously been causing.

Although MCT was first devised in order to treat anxiety, it is now used to treat a wide range of psychiatric conditions associated with childhood trauma. These include :

– Borderline Personality Disorder (BPD)

– Generalized Anxiety Disorder (GAD)

– Social Phobia

– Post Traumatic Stress Disorder (PTSD)

Research into the effectiveness of MCT for the above conditions has so far yielded promising results.


Essentially, metacognitions are THOUGHTS ABOUT OUR THOUGHTS. This might sound a little odd at first, so I will illustrate what is meant by the definition with the assistance of an example :

Suppose a person started to suffer clinical depression – at first, his/her thoughts (or ruminations, as they are referred to by psychiatrists) may be quite specific; for example, worries about being made redundant at work, the breakdown of an important relationship, ruinous debt, etc…etc…

As time goes on, however, the worries can become more abstract, and the individual can start worrying about the fact s/he is always worrying. This is also referred to as meta-worrying. Similarly, s/he might begin to feel depressed about always being depressed,

Examples of metacognitions include:

  • These tormenting thoughts are going to send me permanently insane
  • I can’t escape from this feeling of mental pain, I must have irreversible brain damage
  • My anxious thoughts will go on forever and nothing and nobody will ever be able to alleviate my suffering


Cognitive Attentional Syndrome

It is very easy to get tied up with this type of thinking, and many do. Essentially, it adds another layer of worry or depression that is clearly superfluous and serves no purpose other than to further lower mood and further torment the hapless individual.

Metacognitions such as those illustrated above frequently become OBSESSIVE and OUT OF CONTROL, dominating our mental state and making it extremely hard to think about anything else – thoughts circle around and around our tortured and exhausted minds in a futile, painful and incessant manner.

Indeed, one of the main behaviors that exacerbate depression and anxiety is OVER-THINKING ABOUT, AND OVER-ANALYZING, THE PARTICULAR PREDICAMENT IN WHICH WE FIND OURSELVES SO CRUELLY PLACED (I know this from my own experience, as I was particularly badly afflicted by obsessional anxieties and over-analysis). Dr. Wells refers to getting ‘stuck in our thoughts’ as Cognitive Attentional Syndrome.

Metacognitive Therapy:

MCT works by helping people, as I stated in the first paragraph, change the way in which they think, and subsequently how they experience their negative thoughts, rather than trying to change the content of their thoughts. One of the aims is to help them accept their thoughts much more without those thoughts triggering psychological distress; and, also, to help them realize they do not need constantly to engage in an exhausting mental fight with their thoughts.

Research has so far shown MCT to be highly effective at treating a range of conditions. Another promising finding is that the therapy can achieve very significant positive effects in as little as 8 weeks.

Metacognitive Therapy And Borderline Personality Disorder (BPD):

A study by Nordahl and Wells (2019) was conducted to investigate the effectiveness of metacognitive therapy for the treatment of a group of twelve BPD sufferers with a history of severe early childhood trauma and emotional instability.  All 12 participants undertook the treatment on a voluntary basis and the results were encouraging. No participants withdrew from the course of treatment only one of the 12 withdrew from the follow-up assessments prematurely. The follow-up assessments continued for a 2 year period after the treatment ended.

RESULTS: There was a significant reduction in the severity of BPD-related symptoms, symptoms related to trauma, and interpersonal problems amongst the group, and these improvements in their conditions were still apparent at the end of the 2-year follow-up.

However, a review of several studies that investigated the effectiveness of metacognitive therapy for BPD concluded that whilst long-term MCT focused on metacognitive deficits seemed to be effective in reducing BPD-related symptoms and improving BPD sufferer’s metacognitive abilities further research is necessary. They identified 3 metacognitive deficits that seemed to be particularly relevant to the treatment of BPD. These were: INTEGRATION, DIFFERENTIATION, and MASTERY (the use of mentalistic knowledge to adapt to situations and solve problems).

Brief Metacognitive Therapy For Psychological Morbidity:

A study conducted by Fisher et al f(2019) found that psychological morbidity could be effectively reduced with just six 1-hour sessions of MCT. Those in the study experienced a significant reduction in symptoms related to :

  • anxiety
  • PTSD
  • depression
  • negative metacognitions.



Fisher PL, Byrne A, Fairburn L, Ullmer H, Abbey G, Salmon P. Brief Metacognitive Therapy for Emotional Distress in Adult Cancer Survivors. Front Psychol. 2019;10:162. Published 2019 Jan 31. doi:10.3389/fpsyg.2019.00162

Ludovica D’Abate, Giuseppe Delvecchio, Valentina Ciappolino, AdeleFerro, Paolo Brambilla. Borderline personality disorder, metacognition and psychotherapy. Journal of Affective Disorders. Volume 276, 1 November 2020, Pages 1095-1101

Nordahl HM, Wells A. Metacognitive Therapy of Early Traumatized Patients With Borderline Personality Disorder: A Phase-II Baseline Controlled Trial. Front Psychol. 2019;10:1694. Published 2019 Jul 30. doi:10.3389/fpsyg.2019.01694


MCT – Institute (click here).

David Hosier BSc Hons; MSc; PGDE(FAHE).