“If you are struggling with your mental health and you’ve just heard of Metacognitive therapy (MCT), chances are that you are not yet convinced whether MCT is right for you. Here at Metacognitive Therapy Central, we support you in doing the research before deciding what type of therapy might be best for you.
This post will equip you with 10 reasons why MCT could be the right choice for you, all backed up by research and based on real-life client experiences.
Metacognitive therapy (MCT) works very well for treating mental disorders with over 70% recovery rates. Instead of reducing symptoms, MCT targets fixed thinking habits that, if not changed, will inevitably lead people back into mental illness.
Go to this post if you want to learn more about why MCT is effective and how it works in the brain.
Metacognitive therapy is based on the Self-regulatory executive function model (S-REF): the mind can heal itself from distressing thoughts and feelings. Since coping behaviors like rumination and worry cause and maintain mental illness, MCT focuses on reducing rumination and worry so that the mind can heal itself from mental illness.
Example of why we get a mental illness according to MCT (example of worry leading to anxiety):
1) You worry a lot
Overthinking is thinking about specific thoughts too much and for too long. An example of overthinking that most people do is worrying.
Worrying is a repetitive chain of negative thoughts and is oriented toward the future. Worrying is an active thinking strategy people typically use as a response to “What-if” thoughts:
“What if something bad happens?“
“What If I get a heart attack?“
“What if I say something stupid at the meeting?“
Although it is normal to worry and most people worry, worrying for extended periods of time leads to anxiety (illustrated in the model above). According to research, worrying is common in people who suffer from anxiety disorders, especially generalized anxiety disorder, which is defined as a worry illness (10).
When people worry excessively, they experience restlessness, fatigue, difficulties concentrating, irritability, muscle tension, and sleep difficulties (2).
MCT targets and reduces worry
MCT identifies that worry is an unhelpful coping strategy and aims to reduce it. Once worrying is brought under control, the anxiety and negative side effects get reduced considerably. An effective way to reduce worry is through worry postponement.
Research has proven that the benefits of reducing worry remain intact 12 months after treatment and only a few patients experience relapse after reducing worry with MCT(3).
See how MCT is better at treating generalized anxiety disorder than Cognitive behavioral therapy in this paper.
2) You don’t know how to stop worry
When people start to worry, they do that in an attempt to problem-solve real or imagined future scenarios. But since most problems don’t have an immediate solution that can be reached through worrying, some continue to worry and start to believe that they can no longer stop.
“What if I can’t do my sales pitch well tomorrow? I would make a fool of myself and no one will take me seriously. Maybe I won’t remember what to say and I will just stand there looking stupid. That will be terrible! Why am I feeling so anxious? I can’t stop worrying. What if I get sick from worrying?“
When people no longer believe that they can stop worrying, they will continue to worry and also use other (usually unhelpful) ways to stop. Examples of unhelpful strategies people use to stop worrying are using distractions, suppressing negative thoughts, or self-medicate with substances.
But as shown in the model above, these strategies maintain anxiety and don’t work well enough to stop worrying.
MCT helps you gain control over worrying
People have false beliefs about their inability to stop worrying (these beliefs are called metacognitive beliefs), however MCT recognizes that worrying can be stopped.
MCT’s success lies in identifying and meticulously changing metacognitive beliefs that maintain the endless cycle of worry (and rumination). This is very different than reducing symptoms of anxiety (or symptoms of other mental disorders), which is usually the aim of other therapeutic treatments.
Recent research shows that MCT is more effective than Cognitive-behavioral therapy, CBT, for treating depression. Similar results appear for anxiety disorder, post-traumatic stress disorder, and obsessive-compulsive disorder. These findings suggest that MCT is an effective treatment for mental illness.
3) You have difficulty concentrating
A lot of clients have told me how they experience difficulty concentrating and ask me whether I think they have ADHD. My experience is that they can’t concentrate because of too much overthinking.
Worry and rumination require a lot of mental resources and people allocate their attention to their worry and rumination. When someone is busy worrying inside their head, it is difficult to pay attention to other things that are going on in their surroundings.
Basically, it is not possible to pay full attention to both what’s going on inside your mind and at the same time concentrate on the book that you are reading. Likewise, it is not possible to think about your exam next week and concentrate on studying for the exam right now.
Excessive worry and rumination can cause concentration difficulties.
MCT helps you learn to control your attention
People who try MCT can improve mental skills like attention, working memory, flexible thinking, and self-control. Flexible thinking means that you can move your attention around from thoughts and feelings to your surroundings, regardless of how negative your thoughts are. This improves concentration tremendously.
When you learn that you can control your attention, you are no longer bound by worry and rumination. You can have negative thoughts without paying attention to them. It also means not reacting to intense feelings, which is the key to emotional self-control and better concentration.
An important MCT technique for learning attentional control is called the attention training technique. The attention training technique is helpful for people who don’t believe that they can control their attention and get easily distracted by their thoughts instead of performing tasks. The attention training is also effective for people who suffer from social anxiety because it teaches them how they can choose not to pay attention to their anxiety in social situations.
4) You feel stressed, restless, and on edge most of the time
Do you feel nervous, on edge, and restless? Do you barely remember how feeling peaceful feels like? Then chances are that you are overthinking in the back of your mind.
People usually blame their external circumstances for feeling stressed. And they tend to think that their stressful lives will improve once their problems go away and people around them begin to behave better. But few people realize that their overthinking is what makes them stressed. Not so much their circumstances.
My clients are usually surprised at how much better they manage stressful situations when they don’t overthink them. Suddenly a busy schedule is okay and a heavy workload is easier to get through when you don’t constantly worry about the process and the outcome. When my clients spend less time worrying, they tell me that they make better decisions, feel more confident in handling life’s challenges, and less stressed out.
If you can work on a problem instead of worrying about it, you will realize how much easier your life becomes. Worrying is not the same as solving a problem. Rather, worrying is like riding a stationary bike; It feels like you are doing something, but you are not getting anywhere.
Worrying leads to stress and no solutions. Problem-solving leads to solutions.
MCT teaches people to reduce worrying, which creates more mental capacity for problem-solving.
Imagining future catastrophic scenarios (worrying) is not the same as solving problems.
5) You spend a lot of time pushing intrusive thoughts away
Any deliberate attempt to get rid of a thought is called thought suppression. According to studies made on the effects of thought suppression, there are several downsides to suppressing thoughts; one of them being that thought suppression does not work (4).
Suppresion experiment: Try not to think of a cup of coffee for 30 seconds
People try to suppress their thoughts due to several reasons. Thoughts can be reminders of a traumatic event that is painful to re-experience or they can be intrusive thoughts with violent, sexual, or bizarre content that are inconsistent with people’s fundamental beliefs and personality. For example, people with OCD struggle with intrusive thoughts and try to push them away.
The reason why suppressing thoughts does not work is due to the way the brain works. When someone tries to suppress the thought of a cup of coffee, part of their brain will continue to monitor for thoughts of coffee to make sure that the mission of suppression is accomplished. Basically, during suppression, the brain actively tries to find more of the same thought, which means that trying to suppress thoughts leads to more unwanted thoughts.
MCT views thought suppression as an unhelpful coping strategy that maintains mental disorders. For example, people suffer from OCD partially because they spend so much energy suppressing their intrusive thoughts (through neutralizing them and by performing rituals). The same goes for anxiety. People with anxiety continue to feel anxious because they try to suppress their anxious thoughts, which maintains the thoughts and creates more anxiety in the long run.
Since thought suppression is a coping strategy that preserves anxiety disorders, MCT teaches people to have a relaxed relationship with their thoughts instead of suppressing them. For example, our clients learn that having intrusive thoughts doesn’t mean that they come true or are important. And they learn to relate to them in a different way through detached mindfulness.
6) You spend a lot of time analyzing your thoughts
The average person experiences thousands of thoughts each day. Some of them are pleasant, some bad, and many neutral. According to professor Wells, the founder of MCT, we have some influence over the type of thoughts that come up in the mind, but the majority of the thoughts are produced subconsciously without our active influence (6). Therefore, it doesn’t make sense why we should spend so much time analyzing the reasons why we have particular thoughts.
Although analyzing our thinking can sometimes help understand ourselves and our behaviors, too much analysis, on the other hand, can be exhausting and eventually worsen our mood. Especially when we beat ourselves up over having certain thoughts.
“Why do I think this way?“
“Why can’t I think positive thoughts?“
“What’s wrong with me? Why is my mind thinking like this?
Rumination is the term used in MCT to describe analyzing thoughts
MCT teaches you to have a relaxed relationship with thoughts
Objectively, thoughts are just thoughts. Electrical impulses in the brain that come up at random times all day long. And we can learn to be the judge of which ones we want to deem important and which ones we should let go of. What is really the point in spending so much time analyzing why thoughts come up when you have little influence over them in the first place?
Analyzing why you have unwanted thoughts is making it harder for your brain to forget those thoughts
People who suffer from depression, anxiety, and other mental disorders spend a lot of time thinking about their thoughts to the point where they no longer believe they can stop analyzing. Suddenly, they are trapped in their mind, constantly analyzing and worrying in an attempt to get themselves out of their thinking. But analyzing thoughts is not necessary and there are better and less exhausting ways to deal with thoughts.
Thoughts are like background noise. You can choose which ones you tune in on while you leave the rest alone.
7) You feel tired, down, and overwhelmed most of the time
Overthinking (worrying, analyzing) is a mentally draining process. It takes up mental space, it affects concentration and makes people feel exhausted.
If you often feel tired, down, and overwhelmed you might be spending a great deal of time overthinking. Thinking about work, past experiences, or anticipating future events may not seem as overthinking to you at first, but doing them in excess is overthinking.
The reason why overthinking worsens one’s mood is that it prevents self-regulation, which is the mind’s natural ability to sort out thoughts, feelings, and experiences. When self-regulation is blocked because of too much overthinking, it can lead to feeling drained and overwhelmed.
Think about your own experiences. Do you feel more or less tired on the days you overthink for hours? Can you concentrate on the things you need to do well? Do you easily feel stressed and overwhelmed when challenges come your way, compared to the days you haven’t been overthinking?
Luckily, overthinking can be reduced and the negative effects reversed. And MCT can help you learn how to do it. Here is a blog post on how to try MCT to reduce rumination. The main goal of therapy is to help clients reduce overthinking and gain control over it.
8) You don’t feel that conventional therapy has been helpful
The most studied psychological treatment is cognitive behavior therapy, CBT. CBT is as effective as antidepressant medications in the short term but more effective than antidepressant medications in the long term. However, the overall recovery results show that only 50 percent of patients who receive CBT clinically recover from depression. Most of these patients also relapse and fall back into depression after treatment.
Many of my clients have been trying CBT prior to coming to MCT. Although they have benefited from CBT on some aspects of their anxiety or depression, they still struggle with anxiety and depression. One explanation could be that the effect of CBT is weakening over time. According to studies made on the effects of CBT, there have not been any improvements in treatment for depression in forty years (11).
MCT, in comparison, looks very promising for treating depression and preventing relapse. It reduces rumination and worry and changes metacognitive beliefs permanently so that both symptoms and the root cause of depression are effectively dealt with. MCT’s focus on treating the root cause of depression could explain why MCT works better than CBT.
The effectiveness of MCT is tested in clinical people (people who are diagnosed with mental illness) and non-clinical people. The data shows that MCT effectively reduces anxiety and depression symptoms.
This paper compares Metacognitive therapy with Cognitive behavioral therapy for people with depression (2020).
9) You want to handle life’s challenges in a better way
Life can sometimes be challenging. We all have negative experiences that make us feel unhappy, sad, stressed, frustrated, and anxious. Whether it is losing an important business prospect, going through a break-up, or having financial difficulties, negative experiences often give rise to negative thoughts and feelings that can be difficult to navigate.
Some people blame their circumstances for feeling unwell and wait for the perfect moment before they can move on with life. Whether it is to start a business, write a resume, or go on dates. And they are too consumed by the negative emotions that arise from experiencing challenging situations.
MCT helps you to move forward and engage in meaningful activities despite having negative emotions. It teaches you to handle difficult situations in a healthy way instead of falling victim to your negative thoughts.
In a way, MCT changes your psychological self-image so that you no longer see yourself as someone at the mercy of mood swings and negative thoughts. Instead, you will begin to see yourself as a strong and resilient person who isn’t bothered by negative emotions. And you will know that you can rely on your metacognitive skills to get through challenging experiences without becoming depressed.
This article systematically reviews the effects of Metacognitive Therapy. (2018).
10) You’re sick and tired of prolonged exposure techniques
Exposure in therapy means gradually exposing yourself to a feared situation or object and experiencing a decrease in anxiety as time passes. Exposure techniques are used in therapy to test dangerous situations and to ensure habituation to anxiety (a decrease in anxiety).
For example, someone with contamination fear will be exposed to an infected object for as long as it takes for anxiety to decrease on its own. Although this technique is helpful in decreasing anxiety, exposure can be time-consuming and stressful for the client.
MCT uses a short type of exposure, also called a metacognitively delivered exposure. The goal of this type of exposure is to learn that you have control over your worrying in fearful situations.
It is possible to be in a triggering situation and not worry about it at the same time. Through MCT, people learn that they can stop worrying and let their mind self-regulate. This then leads to a decrease in anxiety. A metacognitively delivered exposure is brief and time-effective compared to traditional exposure techniques.
Usually, what keeps anxiety going in triggering situations is that people worry: “The floor is contaminated, what if I get infected with bacteria and get sick? What if I pass that on to my children? What if someone died and it was my fault?…” But since worrying can be stopped, there is no need to engage in prolonged exposure, when instead, all you need to do is learn not to worry.
So if you are tired and stressed out from time consuming exposure techniques, MCT could be a good alternative to get over your anxiety and stop avoiding triggering situations.
The research behind MCT
MCT is built on 25 years of scientific research. The effectiveness of MCT is tested in clinical people (people who are diagnosed with mental illness) and non-clinical people. The data shows that MCT effectively reduces anxiety and depression symptoms. The data also indicates that MCT works very well in treating personality disorders, Post-traumatic stress disorder (PTSD), Obsessive-compulsive disorder (OCD), Social anxiety disorder (SAD), and Bipolar-II disorder.
MCT works well for personality disorders
Researchers have used MCT for treating traumatized patients with Borderline Personality Disorder, BPD. People with borderline personality disorder have difficulty regulating their emotions and therefore react disproportionately in different situations. They tend to self-harm as a way to soothe their feelings and act impulsively.
Research suggests that MCT is a suitable treatment for Borderline personality disorder because it creates flexibility in attention and helps control impulsivity. When MCT is compared with other forms of therapy for BPD, the results are better with MCT.
MCT shows significant improvement for PTSD
Studies of MCT for PTSD in children and adolescents have been associated with significant improvements in PTSD symptoms and high recovery rates. MCT can treat traumatized children as young as eight years old and has generally proven to reduce PTSD symptoms in 80 percent of patients and prevent relapse.
Metacognitive therapy is very gentle to both patients. The main reason is that MCT therapists don’t address the content of the thoughts or the trauma. MCT as a non-trauma-focused treatment approach seems superior to established trauma-focused treatments.
MCT can treat OCD, Bipolar-II, and SAD
The evidence base of MCT for reducing symptoms of mental illness keeps growing. Recent research shows that Metacognitive therapy can successfully treat Obsessive-compulsive disorder, Bipolar II disorder, Social anxiety disorder, and psychosis.
These effects of MCT also apply to people who do not suffer from mental illness: studies show that MCT, for instance, also reduces stress levels among college students.
MCT works well as group therapy
MCT is well suited for group therapy because the underlying mechanism for maintaining mental illness is the same across disorders (worry, ruminations, threat-monitoring, and other unhelpful coping strategies like avoidance and substance use).
It means that patients who suffer from depression can join MCT group therapy session with both anxious and obsessive-compulsive patients. Danish studies applied to a group of patients with different diagnoses showed significant improvements in their symptoms during the group treatment sessions. The results were also stable when researchers followed up after the treatment.
References
- Photo by Eutah Mizushima
- American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edn. Washington, DC: American Psychiatric Association. doi: 10.1176/appi.books.9780890425596
- Normann N, Morina N. The Efficacy of Metacognitive Therapy: A Systematic Review and Meta-Analysis. Front Psychol. 2018 Nov 14;9:2211. doi: 10.3389/fpsyg.2018.02211. PMID: 30487770; PMCID: PMC6246690.
- Wegner, D. M., Schneider, D. J., Carter, S. R., & White, T. L. (1987). Paradoxical effects of thought suppression. Journal of personality and social psychology, 53(1), 5.
- Photo by Zhu Liang
- Wells, A. Personal communication, 2022.
- Photo by Adrian Swancar
- Photo by Umit Bulut
- Photo by Etienne Boulanger
- Borkovec, Thomas D., & Newman, Michelle G. (1998). Worry and generalized anxiety disorder. In A. S. Bellack, & M. Hersen (Series Eds.), & P. Salkovskis (Vol. Ed.), Comprehensive clinical psychology: Vol. 6. Adults: Clinical formulation and treatment. (pp. 439-459). Oxford, England: Pergamon Press.
- Johnsen TJ, Friborg O. The effects of cognitive behavioral therapy as an anti-depressive treatment is falling: A meta-analysis. Psychol Bull. 2015 Jul;141(4):747-68. doi: 10.1037/bul0000015. Epub 2015 May 11. Erratum in: Psychol Bull. 2016 Mar;142(3):290. PMID: 25961373.