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Metacognitive Therapy (MCT) is a psychotherapy developed by Adrian Wells and  founded on a specific theory proposed by Wells and Matthews (1994)[1] . , initially used to treat Generalised Anxiety and subsequently expanded as a general treatment approach (Wells, 1995, 2000, 2009).

Metacognitions are the aspect of cognition that monitors and controls mental processes and thinking. Most people have some direct conscious awareness of metacognition. For instance, when unable to remember a name one may feel sure that it is still stored in memory. This gives rise to a metacognitive state that occurs as the ‘tip-of the tongue-effect’. Metacognitive processes can then be set in train allowing eventual retrieval. Although we are aware of some metacognition operating most metacognitions that control our thinking and conscious experience operate in the background.

In psychological disorders such as anxiety or depression thinking becomes difficult to control and dominated by extended processing. This leads to the exacerbation and maintenance of emotional suffering which worsens as the persons thinking and attention becomes fixed in patterns of brooding and dwelling on the self and threatening information.

Metacognitive therapy labels this process the Cognitive-Attentional Syndrome (CAS). This pattern is charachterised by worry, rumination, fixation of attention on threat, and the development of maladaptive coping behaviours that the person believes are helpful but which are counter productive and maintain emotional problems. The CAS is controlled by metacognitions and it is necessary to remove the CAS by helping patients develop new ways of controlling their attention, new ways of relating to negative thoughts and beliefs, and by modifying metacognitive beliefs that give rise to unhelpful thinking patterns.

This approach has been developed into specific ways of understanding and treating mental disorders such as generalised anxiety disorder, post-traumatic stress, obsessive-compulsive disorder, social anxiety, depression, and health-anxiety.

Reliability & Validity[]

There is a growing amount of evidence published in professional peer-reviewed journals supporting the efficacy of this approach and a large volume of studies support the theoretical model behind it. For a recent meta-analysis see Normann, Van Emmerik & Morina (2014).

See also[]


  1. Wells, A. & Matthews G. (1994). Attention and Emotion: A Clinical Perspective. Hove, UK: Erlbaum.

Normann, N., Van Emmerik, A.A.P. & Morina, N. (2014). The efficacy of metacognitive therapy for anxiety and depression: A meta-analytic review. Depression and Anxiety, 31, 402-411

Further reading[]


  • Wells, A. (2009). Metacognitive Therapy for Anxiety and Depression. New York: Guilford Press.
  • Wells, A. (2000): Emotional Disorders & Metacognition: Innovative Cognitive Therapy. Chichester, UK: Wiley.
  • Fisher, P. & Wells A. (2009). Metacognitive therapy:Distinctive features

External links[]

Metacognitive Therapy Institute]