Bruce Fernie, psychologist

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London, UK

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Metacognitive Theapy

​What is Metacognitive Therapy (MCT)?

MCT is a type of psychological therapy. In MCT you will talk with a trained therapist about the problems you are going through. It is collaborative (meaning you and your therapist work together) and transparent (i.e., your therapist will openly discuss what is going on in your sessions). You and your therapist will work together to try and understand how your thinking and behaviour might be causing your problems or making them worse.

In MCT, your therapist will focus more on how you think and less on what you think. Studies show that most people (with and without mental health problems) have negative thoughts. According to MCT, such thoughts are a normal part of being human. How we judge these thoughts and how we respond to them is important for our mental wellbeing. For example, you may have become aware that you spend a lot of time dwelling (or ruminating) on, and worrying about, certain thoughts, memories, and events. Such ways of thinking are often upsetting and exhausting, especially when we engage in them for long periods of time. Also, sometimes you might feel like your focus of attention has become ‘locked’ on threatening things (which could be thoughts, memories, and both emotional and physical feelings) and find it difficult to control your thinking. In MCT, you will work with your therapist to help with these problems, learning more flexible ways of thinking and using your attention.

During a course of MCT your therapist might introduce some tasks and techniques for you to experiment with, or practice, as ‘homework’. These are activities for you to try and do in the days between your sessions. It is fair to say that the time between your sessions is more important than the sessions themselves. If you have any concerns about your homework, it is helpful if you can let your therapist know so you can talk about them together. Sometimes, this may result in changes to your homework, whilst other times you may end up feeling better about trying a task. It is also important to let your therapist know if you do not understand what they have said (therapists do not always explain things clearly) or if you have concerns about what is happening in your sessions. You are likely to get more out of MCT the sooner you bring up any concerns you may have.


What sort of problems can MCT help with?

MCT is a relatively new kind of talking therapy, first developed in the 1990s. Studies looking at how effective MCT is have reported promising results, particularly with people who have problems with anxiety and depression. There is also evidence MCT is beneficial for people who are having problems after experiencing a traumatic event, in treating obsessive-compulsive disorder and panic attacks, in reducing symptoms of attention-deficit hyperactivity disorder, and in helping to manage the some of the symptoms of schizophrenia.

Are there any side effects?

As with any kind of talking therapy, you will be talking to your therapist about your problems and this may be upsetting for you. However, in terms of MCT, we are unaware of a single published study that has described the treatment causing serious side effects. In MCT you might decide with your therapist to try out new thinking styles and behaviours. Sometimes these ‘experiments’ might make you feel more anxious at first; however, in the long run they tend to play an important role in helping most people.

How long is a course of MCT and how often are the sessions?

There is not a fixed length for a course of MCT. The length of treatment is based on your individual needs and the goals that you set with your therapist. However, typically treatment lasts between six and 18 sessions. Each session lasts about 50 minutes. The sessions tend to be arranged on a once-per-week basis, although sometimes they are scheduled once-per-fortnight.

Will MCT work for me?

There are no guarantees with any psychological therapy. However, MCT has already built up quite a strong evidence-base that suggests it is effective. Therapy is usually reviewed after your sixth session. This gives the opportunity to identify problems and find solutions. If no solutions can be found, your therapist might suggest ending therapy early.

Typically, people who do best with MCT work hard during their sessions and on their homework tasks. Also, having a clear and measurable goal that you would like to achieve through therapy is often beneficial.