MCT has proven effective for treating most mood disorders, including anxiety, depression, and social phobia. Recent data from 9 years after MCT treatment shows that 57% maintain recovery from Generalized anxiety disorder compared to 38% from CBT treatment.
Currently, there are no scientifically based critical claims against MCT. However, many professionals in the mental health field criticize MCT for being a superficial type of therapy that doesn’t get to the roots of psychological problems.
In earlier posts, I have mentioned five reasons that MCT may not be a helpful treatment. Here comes five reasons that block clients from experiencing the full effect of MCT, and these could be the reason that MCT is subject to criticism.
1) Clients hold on to self-limiting beliefs
Some people hold on to self-limiting metacognitive beliefs which is their biggest obstacle to achieving positive change in therapy. According to Adrian Wells, the founder of Metacognitive therapy, examples of such limiting beliefs are:
- I am unchangeable
- My mind is broken
- The problem is in my genes
Holding on to these beliefs interferes with treatment success and hinders patients from complying with homework tasks and treatment in general. These beliefs are often seen in patients who suffer from depression or patients with personality disorders, like Borderline personality disorder. (1)
The reason that these beliefs get in the way of therapeutic change is that they hinder patients from engaging in the therapeutic process. These patients often won’t do their homework between sessions and drop out of therapy prematurely. They may even not want to improve because deep down, they believe they are damaged and beyond help. (1)
Basically, these self-limiting beliefs have negative and self-defeating characteristics. Encountering patients with these beliefs can seem incredibly overwhelming in therapy, and if left unaddressed, these beliefs create hopelessness for both the therapist and the patient.
2) Clients don’t want to come to therapy
Loving spouses would do anything to help their partner recover from mental illness. This is often the idea behind sending their partners to metacognitive therapy. Usually, the spouse has been to therapy and found it successful. Therefore, they try to help their partner move on from distress and proactively seek treatment on their behalf.
However, these clients are not necessarily as motivated for therapeutic change as their partners are. This creates challenges in therapy because they usually won’t participate actively or don’t commit to homework tasks.
In some cases, clients associate their illness (anxiety, depression, OCD) with advantages in social and romantic relationships. For example, having depression can be a strategy for avoiding intimacy. Depression could also function as a means to express a dependency on their partner. In such cases, there may be advantages to staying ill that counteract the motivation for recovery. (2)
Viewing mental illness as means to other types of gains is also called secondary gains.
For those reasons (and there are more reasons), some clients sent to metacognitive therapy by their partners won’t benefit from it.
3) Clients with antisocial personality disorder
People with an antisocial personality disorder, also known as psychopathy or sociopathy, are, contrary to their name, not socially anxious. The name comes from back when these people were called anti-society. They would break the rules and norms of society. Antisocial personality disorder is the clinical term for psychopathy and sociopathy.
To meet the criteria for antisocial personality disorder, clients must have a long-term pattern of lacking empathy toward others, being calculating, cunning, smart, dangerous, and exploitative. They typically break the rules and moral and social codes and take risks that put others in danger.
People with antisocial personality disorder are also manipulative, malevolent, deceitful, and don’t care about the consequences of their actions. As a result, they typically lack remorse for the bad things they do.
According to psychologists, there is little hope for treatment outcome for this type of client because they don’t seek treatment by themselves. They aren’t motivated to change because they don’t think there is anything to change.
If they are forced into therapy (like in court-mandated therapy), therapists meet a lot of resistance from this type of client. And when they aren’t resistant, they lie, manipulate, and try to outfox the therapist.
The lack of insight is due to a different neurological activation: psychopaths don’t experience negative emotions like anxiety, shame, or remorse. And when they do, their emotions are down-regulated very quickly. The result: no experience of negative emotions and, therefore, no problems to come to therapy for.
4) Clients don’t believe that they have a problem
Some people lack insight into their psychological blind spots. These clients externalize their problems and think that other people and external situations are to blame for their problems.
Obviously, the external environment can sometimes put us under tremendous stress. For example, our boss can mistreat us, our colleagues can make life difficult for us, or we might struggle financially. But, whenever the suffering becomes long-term, the problem no longer only exists in the external environment but has become an overthinking problem.
I have had clients think that their low self-esteem was due to their partner or their superior’s critical comments. Upon further questioning, it always turned out that the comments were neutral and not at all personal, but that my clients would overthink them for hours every day.
If you want to learn more about Metacognitive therapy for low self-esteem, read this post.
No matter how bad you think your environment contributes to your problems, you feel depressed because you ruminate and worry about it.
In the end, it all comes down to how you deal with your thinking about your environment. But some clients refuse to view it that way when they enter therapy. Instead, they expect their environment to change before they can feel better. In that case, metacognitive therapy won’t be helpful.
There are, of course, a few exceptions to this. In the case of physical and psychological abuse, the safest solution would be to get away from the situation. Later on, you can go to therapy if you continue to worry and ruminate about it.
5) Clients with specific phobias
People with specific phobia perceive specific objects/situations as potentially harmful, for example, snakes, spiders, confined spaces, needles, etc. When encountering these feared objects/situations, they experience catastrophic metacognitive beliefs and intense anxiety symptoms. Therefore, they typically escape and avoid such situations altogether. (3)
Examples of catastrophic beliefs are:
“I would get a heart attack from the strong panic and die; because the heart can’t stand the very strong anxiety reactions with palpitations etc..”
“I would die from the shock. My heart would not stand it.”
An important consequence of the escape is that it prevents disconfirmation of the catastrophic belief (that the “catastrophe wouldn’t occur anyway), and the phobia thus remains unchanged.
The phobic person draws the conclusion that it was only by escaping or carrying out the safety behavior that the patient prevented the catastrophe from happening.
Clients with specific phobias who seek metacognitive therapy might quickly lose motivation and drop out. Especially if progress seems too slow or because therapy reminds them of their phobia, which they already want to avoid.
Treating specific phobia is definitely possible through metacognitive therapy. Still, the OST manual, a tailored therapy for specific phobias, is better suited to produce a significant and quick belief change (and prevent the client from dropping out of therapy too soon).
The purpose of the OST is to expose the patient to the phobic situation in a controlled way, thereby enabling them to realize that the catastrophic consequences do not occur. (3)
A final note
There are of course many more reasons that Metacognitive therapy would not be a good fit. But the above listed are what we typically come across in therapy. Ultimately, the best way to make sure that MCT works for you is to start therapy with a skilled (MCT-I certified) therapist. And make sure to do the homework and practice your newly acquired skills as much as possible. That is the only way to really assess the effectiveness of Metacognitive therapy.
Sources
- Adrian Wells, Level 1 MCTI masterclass, Copenhagen, 2021
- Roadblocks in Cognitive-Behavioral Therapy: Transforming Challenges into Opportunities for Change, Robert L. Leahy, 2003
- Ollendick & Davis, 2013, One-session treatment for specific phobias: a review of Öst’s single-session exposure with children and adolescents. https://pubmed.ncbi.nlm.nih.gov/23957749/