MCT Metacognitive Therapy

Applications: initially for Generalized Anxiety Disorder, but is also indicated for PTSD, OCD, social anxiety, depression and health anxiety.

Developed by Adrian Wells and Gerald Matthew in the 1990s.

Metacognition is the aspect of cognition that controls mental processes and thinking* – or the ability to be aware and to control thoughts and mental processes.

It originated from developmental psychology and neuropsychology.

 Metacognitive’s focus is more on how, rather than what, people think. Someone may, for example, be worried about worrying, thus focusing on the thought process.

The aim is to start knowing what thoughts are in one’s mind.   

How it works

Information is stored in memory, although not always remembered, and remains in the background.  

Thinking is difficult to control for anxious and depressed individuals. Both retrieved and buried memories may cause lack of control of their thoughts and interfere with their daily lives.

Their attention may become focused on the self or perceived threats, which is referred to as Cognitive-Attention Syndrome (CAS). This results in worry and rumination which maintain unwanted emotions.

The CAS is caused by metacognitions, and new ways to control attention is needed. Metacognitive beliefs which contribute to unhelpful thinking styles are changed. This is done in combination with CBT interventions.

The process

The CAS involves three processes which are extended ways of thinking in reaction to negative thoughts.

These are:

  • Worry
  • Threat monitoring
  • Coping behaviours which have not worked.

The individual may have a belief that these processes will aid them.

The Metacognitive Model consists of the S-REF (self-regulatory executive function model), which is the CAS, metacognitive beliefs, mental modes and executive functioning all together.

Metacognitive therapy comprises 8-12 sessions. Metacognitive beliefs are determined, then the model is discussed with the individual. Techniques are applied to change how the individual relates to thoughts.


Beth Cooper Howell Proof reader/copy editor

Contributions by
Prof David Edwards
Dr Linda Blokland
Matthew Watkin
Edgar Tyrone
Bertus Swanepoel
Dr Shane Pienaar-Du Bruyn