Within the cognitive stream, it is argued that most of the discomfort a person suffers is due more to his or her way of seeing and interpreting reality than to the problem itself.

One of the therapies that takes this into account is metacognitive therapy , which not only focuses on the patient’s dysfunctional thoughts, but on how he perceives them, that is, it takes into account his metacognition.

Throughout this article we will go into more detail about metacognitive therapy, as well as explain in more detail the idea behind the concept of metacognition and what disorders it is used for.

What is metacognitive therapy?

Traditionally, cognitive therapies have held that alterations or biases in thinking are the cause of the patient’s psychological discomfort, rather than the situation itself. The discomfort comes from the way reality is interpreted, not from the reality itself.

Metacognitive therapy, which was developed by Adrian Wells, is in accordance with the fundamental premise of cognitive therapies, giving importance to cognitive factors in the appearance and maintenance of psychological disorders . This is why it is included in therapies of this type.

However, a key point of metacognitive therapy is its focus. This type of therapy tries to understand why there are people who, when faced with an adverse situation, are capable of not worrying about it while others, faced with the same situation, show depressive and anxious symptoms.

According to Wells’ theory, what would be behind this discomfort is the person’s metacognitions , that is, the way he sees his own thinking. These metacognitions would be responsible for the individual having a healthy or pathological control of his mind.

On this basis, the goal of metacognitive therapy is to eliminate modes of thinking that incur dysfunctional beliefs. In other words, the aim is to change the inflexible way a person sees stimuli that, within his or her mentality, are considered to be threatening. By changing this way of seeing and interpreting things, the person stops being trapped by the situation and acquires a greater degree of well-being by knowing how to deal with problems.

What is meant by metacognition?

On many occasions, the discomfort experienced in the face of a given situation is not due to the situation itself, but to the way in which it is interpreted. This means that the same situation can be seen in very different ways depending on the person . In this way, it is understood that there are people who, when faced with an adverse situation, know how to deal with it and do not worry too much, while others suffer to such an extent that they become paralysed.

Within the cognitive current, therapy aims to identify, question and change those automatic thoughts that, when activated in a given situation, are the real source of the person’s discomfort. By questioning the strength of these dysfunctional thoughts, the negative emotions associated with these harmful beliefs will diminish.

However, in order to do this, it is necessary to make the person aware of his own thoughts . That is to say, to think about what he is thinking and how he thinks it. According to Wells, the term ‘metacognition’ refers to a wide range of interrelated factors composed of all cognitive processes that are involved in interpreting, monitoring and controlling one’s own cognition.

Metacognition is an aspect that has been closely related to the theory of mind . This concept can be subdivided into several components, being mainly the knowledge, the experiences and the strategies that the person has to face the situations he or she is presented with. Metacognition is composed of beliefs and theories about our own way of thinking.

Within the model of metacognitive therapy, a distinction is made between explicit or declarative beliefs, and implicit or procedural beliefs.

1. Explicit beliefs

Explicit beliefs can be expressed verbally, and refer to concrete thoughts of the patients that make them feel uneasy .

An example of this type of belief would be ‘I have bad thoughts, which makes me a bad person’, ‘worrying can give me a heart attack’, ‘this thought is a sign that something is not right’.

Explicit metacognitive knowledge can be shown in the form of positive or negative beliefs . Explicit positive beliefs are those that the patient believes are advantageous, such as ‘if I worry, I will be prepared for when things are worse’, ‘focusing on the threat will help me know what to do’.

On the other hand, the negatives refer to negative evaluations of sensations and thoughts related to the perceived danger . They are formulated in terms of the uncontrollability, meaning, importance and dangerousness of thoughts.

Some examples of negative metacognitive beliefs would be that I don’t have control over my thoughts.

2. Implicit beliefs

With implicit beliefs, reference is made to those rules or programs that guide the person’s thinking , such as paying attention to a particular stimulus, ruminating on particular memories or the way in which other people are judged.

How and for what disorders is it used?

Metacognitive therapy has been shown to be effective and efficient in terms of improving patients’ well-being. This has been observed empirically in research, for example in the case of Normann and Morina (2018) who saw how this type of therapy improved the mental health of patients. However, it should be noted that is especially useful for anxiety disorders and depression .

In fact, in the clinical field it has been possible to see how effective it is with multiple anxiety problems. Some of them are social anxiety, generalized anxiety disorder, obsessive-compulsive disorder, post-traumatic stress disorder. However, when this model was formulated, the aim was for it to be used transdiagnostically, that is, for multiple psychological disorders, of any kind.

Therapy is usually carried out between 8 and 12 sessions. The therapist discusses with the patient how tightly they interpret their own cognition , that is, thoughts, past experiences and applied strategies. Once it has been possible to see what is causing the discomfort, the therapy focuses on promoting more adaptive thinking styles in the patient that are more appropriate to the situations they have previously associated with problems.

Attentional cognitive syndrome

The metacognition of people who suffer from psychological disorders, according to Wells, gives rise to a particular way of responding to internal experience, that is, their thoughts and emotions. This makes these negative feelings chronic and the person continues to suffer . This pattern of thinking has been called Attentional Cognitive Syndrome (ACS) which would be composed of the following three aspects:

  • Rumination and worry.
  • Fixed attention: attentional bias especially around threats.
  • Negative self-regulation strategy.

This syndrome is of vital importance in understanding the model of metacognitive therapy. This is especially understandable for those who suffer from an anxiety disorder: their attention is fixed on a threat , which causes them great concern and, trying to get rid of this negative emotionality, they carry out coping strategies that, in the long run, make them think even more about this problem. So, they end up having thoughts like “what if this happens?2, “I should be worried that this won’t get any worse”…

Bibliographic references:

  • American Psychiatric Association. (1994). Diagnostic and statistical manual on mental disorders (4th ed.). Washington DC: Author.
  • Ashouri, A., Atef-Vahid, M.K., Gharaee, B., Rasoulian, M. (2013). Effectiveness of Meta-Cognitive and Cognitive-Behavioral Therapy in Patients with Major Depressive Disorder. Iranian Journal of Psychiatry and Behavioral Sciences, 7(2), 24-34.
  • Normann, N., & Morina, N. (2018). The Efficacy of Metacognitive Therapy: A Systematic Review and Meta-Analysis. Frontiers in psychology, 9, 2211. doi:10.3389/fpsyg.2018.02211
  • Garay, C. J and Keegan, E. (2016). Metacognitive therapy. Attentional cognitive syndrome and cognitive processes. Argentine Journal of Clinical Psychology. 25(2). 125-134.