Metacognitive Therapy: How It Might Treat Depression
This type of therapy teaches you how to change your way of thinking and end your worry cycle.
Medically reviewed by Dakari Quimby, PhD
Metacognitive therapy (MCT) teaches people how to change the way they think to stop ruminating, or focusing on negative thoughts and beliefs. Rumination is common with depression, or persistent feelings of sadness. Research has found that MCT is an effective way to learn how to beat depression.
MCT differs from other therapies that ask you to analyze and challenge your negative thoughts. Instead, you will eventually learn how to acknowledge those thoughts without engaging with them.
The goal of MCT is to give less power to negative thoughts that worsen depression symptoms. Read on to learn about MCT, what happens during sessions, and whether it works.
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What Is Metacognitive Therapy?
MCT trains people to lessen rumination, Stian Solem, PhD, a professor of psychology at the Norwegian University of Science and Technology, told Health. Rumination happens if you dwell on negative thoughts, like past missteps or feelings that you are not good enough. You might increase your risk of depression or worsen symptoms if you often ruminate.
"Many of our patients have conflicted beliefs concerning worry and rumination," said Solem. "They experience that it is uncontrollable, exhausting, and dangerous—'I can go mad,' 'I can make myself sick.'"
A study published in 2017 found that the secret to improved mental health might be learning not to dwell on those thoughts. Therapists have used MCT to treat other mental illnesses like anxiety, obsessive-compulsive disorder, post-traumatic stress disorder (PTSD), and substance use disorders.
MCT has yet to catch on in the United States. As of 2023, the MCT Institute's online database of registered therapists does not include healthcare providers in the United States. Still, many people can practice the principles of MCT, even without formal training, said Solem.
How Is It Different Than Cognitive Behavioral Therapy?
Experts often use cognitive behavioral therapy (CBT), or talk therapy, to help people analyze their negative thoughts and challenge whether they are true. In contrast, MCT teaches people to be aware of negative thoughts but not engage with them. As a result, MCT reduces negative thought processes and helps you take control over them, said Solem.
In addition to MCT and CBT, other options to treat depression include:
Brain stimulation therapies: These are experimental methods that use electricity to activate or inactive your brain. More research is needed to know the effects of brain stimulation therapies.
Interpersonal therapy (IPT): This is a type of psychotherapy, like CBT. IPT asks you to recall interpersonal and life events, such as childhood trauma, that affect your mood.
Medication: Antidepressants help improve depression symptoms, such as a lack of appetite, poor sleep, and trouble focusing.
Related: What Is Cognitive Behavioral Therapy?
How Does It Work?
MCT first asks you to identify your metacognitive beliefs, or what you think about your thought processes. A therapist will then teach you how those beliefs lead to excess worry and avoidance, which worsens depression symptoms.
"In MCT, we often start with postponing worry and rumination," said Solem. "Later, we use something called detached mindfulness. It involves being aware of the trigger thought but choosing not to engage in it."
Detached mindfulness helps you ruminate less by allowing negative thoughts to pass instead of challenging them. Research has found that focusing on negative thoughts does not alleviate worry but heightens it.
A therapist might give you other ways to change your beliefs and ease worrying thoughts, such as:
Attention training: You will listen and focus on different sounds that come from various locations. This helps control your attention and disrupt rumination.
Exposing yourself to your beliefs: This teaches you to control your worry when you have negative thoughts.
Postponing your beliefs: This involves identifying your negative thoughts and deciding to focus on them later.
Testing your beliefs: You will imagine scenarios in which your negative thoughts are true and see whether they match reality.
Steps
A therapist might split MCT into 10–12 sessions. They will gradually teach you to identify your metacognitive beliefs, employ coping strategies, and prevent relapses.
Here are steps a therapist might take over the course of several MCT sessions:
Provide information about your symptoms to a therapist. They will ask you to identify your metacognitive beliefs that cause you to ruminate.
Engage in attention training to reframe your beliefs.
Challenge your beliefs using a reality test, exposure, or postponement.
Modify your beliefs. Employ detached mindfulness to reduce rumination.
Learn how to prevent returning to rumination.
Can Metacognitive Therapy Help Depression?
Some evidence suggests that MCT effectively treats depression. For many people, realizing that they do not have to worry and ruminate about things can be quite liberating. You might be pleasantly surprised that you do not have to rehash all of your problems during your therapy sessions.
In the 2017 study, the researchers tested the MCT method in 20 people with depression who attended 10 therapy sessions over a 10-week period. The study involved a control group of 19 people who received no treatment for those 10 weeks.
About 80% of people in the MCT group reported a full recovery from depression symptoms, based on a standard screening questionnaire. No one had reported that their symptoms worsened. In contrast, about 5% of people in the control group had a similar recovery. Six months after completing MCT, only a few people reported relapses.
Related: What Is the Treatment for Depression?
A Quick Review
MCT is an effective depression treatment that helps you address your metacognitive beliefs, or ways of thinking. As a result, you might focus less on negative thoughts and beliefs. People typically need several MCT sessions to learn how to identify their thought patterns, challenge their negative thoughts, and employ ways to not engage with them.
Consult a mental healthcare provider if you have depression symptoms, such as a lack of appetite, poor sleep, and trouble focusing. They may recommend MCT or other treatments like CBT and medication.
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