METACOGNITIVE

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THERAPY

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Dr. Bidita Bhattacharya
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Associate Professor
Dept. of Clinical Psychology
IOP-COE, Kolkata
Concept
◦ Cognition applied to cognition, or “thinking about thinking”

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◦ Another CBT approach with a different way of interpreting the significance of NATs,

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and providing a new perspective to the management of psychological disorders

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(Fisher and Wells 2009).

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◦ It is an evidence based psychotherapy approach, where the main emphasis lies on the
thought processes rather than the content of the thoughts
Concept
◦ Aim of the therapy is to focus on, and modify the processes that underlie the

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mechanisms which are involved in the development and maintenance of

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psychological disorders

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◦ Metacognition is important in understanding how cognition operates and in shaping

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what someone pays attention to, or in controlling the appraisals and influences behind

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the types of strategies one uses to regulate his/her thoughts and behaviours (Wells
2009).
 Concepts contd…
Knowledge – related Appraisals or feelings
to a person’s own of a person has
thinking style & his regarding his own

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beliefs about them

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state of mind

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Knowledge

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Experiences

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& Beliefs

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Strategies Emotional & cognitive self
regulatory strategies
which are involved with
the control responses of
thoughts & beh.
Self-Regulatory Executive Function
(S-REF)
◦ Spreads into 3 levels which interact with each other and consists of

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An automatic information processing level
Level 1

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(low-level processing)

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A conscious information processing level
Level 2

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(cognitive style)

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A library of metacognitive knowledge (meta-
Level 3
system)
How psychological distresses
maintained

Cognitive Attentional

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Metacognitive beliefs

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Syndrome (CAS)

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Four major

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concepts

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Attention/ Executive
Mental modes
control
CAS
◦ Major factor underlying psychological disorders

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◦ Lead to the maintenance of negative emotions & strengthening of negative cognitions

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◦ Arises from metacognitive knowledge & beliefs, takes the form of worry/ rumination,

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attentional focusing on threat, & unhelpful coping behaviours – that backfire

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◦ Creates a sense of being stuck & conflict with self regulatory mechanisms – a loss of
control over feelings & cognitions were strengthened.
Metacognitive beliefs
◦ Related to the meaning & significance of cognitions – no further relevance is sought

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regarding the content of cognitions

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◦ Selection & execution of thinking styles rely on these beliefs

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◦ Negative ones are thought to be the most persistent

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◦ Acutely these beliefs increase the perception of threat, hopelessness or inefficacy

Positive Negative
Attention/ Executive control
◦ Non adaptive way of attention control

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◦ Rumination is considered as a solution rather than the problem itself

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◦ Individual engages in threat monitoring strategies.

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Mental modes
◦ Structures that define the relationship a person has with his own cognitions

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Default mode

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Object Mode Cognition & events are

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processed as
synonymous

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Metal Modes

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events
Metacognitive
Thoughts can be
Mode consciously observed
as separate events
 Meta
Cognitive

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Model

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The S-REF model of psychological disorder, Wells & Matthews (1994)

Basic principals
◦ Emotions of anxiety & sadness are basic internal signals of a discrepancy in self

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regulation & of threats to well being.

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◦ Such emotions are normally of limited duration because the person engages coping

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strategies to reduce threat & control cognition.

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◦ Psychological disorder results from the maintenance of emotional responses.

◦ They are maintained because of the individual’s thinking style & strategies.
Basic principals
◦ The unhelpful style, found in all disorders, is called the CAS, consisting of worry/

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rumination, threat monitoring, unhelpful thought control strategies, and other forms of

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behaviour (e.g., avoidance) that prevent adaptive learning.

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◦ The CAS is the result of erroneous metacognitive beliefs (knowledge) controlling &

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interpreting thinking & feeling states.

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◦ The CAS prolongs & intensifies negative emotional experiences through several clearly
specified mechanisms/ pathways.
Techniques
Identifying & shifting levels

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◦ Should enable the pt to become aware of maladaptive thinking styles & processes, & to

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change the mental model of cognition & ways of experiencing thoughts (more than simply

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reality testing).

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Detecting the CAS

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◦ Identifying worry, rumination, threat monitoring & counterproductive coping behaviours

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Socratic dialogue (Metacog.- focused)
◦ Explore meanings, underlying processes, & beliefs, to detect & arrest the CAS

◦ Detecting & modifying beliefs about thoughts & emotions rather than the thoughts about the
self & the world.
Techniques
Verbal Reattribution

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◦ Similar to those of CBT but they differ in focus

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◦ Used to modify negative & positive metacognitive beliefs rather than the content of other

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thoughts & beliefs

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Metacognitively delivered exposure

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◦ Used both to modify beliefs & to strengthen alternative & more adaptive processing

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◦ Three types of exposure are used to –
◦ Facilitate belief change in general
◦ Specifically challenge metacognitive beliefs
◦ Promote adaptive processing of trauma
Attention Training Techniques (ATT)
◦ Shifting attention to strengthen metacognitions that regulate thinking, remove

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unhelpful thinking styles that impede normal emotional processing, or modify beliefs.

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◦ Donot involve shifting attention to neutral or positive stimuli to control or avoid

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subjective experiences.

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◦ Involve three components:
1. Selective attention,
2. Rapid attention switching,
3. Divided attention
Rationale for the ATT
◦ The inner events that intrude into consciousness should be treated as additional noise & should not

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be resisted.

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◦ Unwanted intrusive experiences should be regarded as additional noise – it is desirable to be

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aware of these intrusions & continue to direct attention as instructed even in the presence of this

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awareness.

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◦ It counteracts the effects of some unhelpful processes.

◦ This increase compliance with the procedure.

Situational Attentional Refocusing
(SAR)
◦ It is an attentional modification technique

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◦ It intended to explicitly enhance the processing of information that is incompatible with the

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patient’s dysfunctional beliefs

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◦ Or it is used to counteract external threat monitoring

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◦ Applied as a means of configuring processing in a way that is beneficial for developing adaptive
appraisals & beliefs

◦ Can be used explicitly to modify beliefs & incorporated as a feature of behavioural experiments.
Detached Mindfulness Techniques
◦ Originally described by Wells & Matthews (1994)

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◦ The manner in which an individual relates to his or her cognition & the development of flexible

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control of attention & thinking styles.

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◦ Focused more on developing meta-awareness in the context of suspending conceptual

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processing & separating self from cognitive events.

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◦ Two features:
1. Mindfulness
2. Detachment
 DM Techniques…
◦ Mindfulness
1. Being aware of inner cognitive events, viz., thoughts, beliefs, memories & feelings of knowing

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2. Intended to refer to metacognitive awareness of thoughts & beliefs where attention can be flexibly

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focused on such inner experiences without being locked onto any one of them

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◦ Detachment

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1. Detachment of any reactive engagement with the inner event, i.e., the person refrains from further

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appraisal of or attempts to cope in response to the inner event

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2. Stopping any conceptual or behavioural involvement with inner experiences

3. It involves the person experiencing an inner event as an occurrence that is independent of general
consciousness of the self

4. It is as if the person is aware of the perspective of the self as an observer of the thought or belief.
Aims of DM
◦ Can be used to shift patients away from the object mode of experiencing & into the

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metacognitive mode.

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◦ Means of interrupting perseverative processing in the form of worry & rumination.

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◦ To increase executive control over the allocation of attention.

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◦ It enables the patients to escape the influence of thoughts on self concept.

◦ It is not a means of avoiding thoughts – it is about relating to thoughts & experiencing them in a
new way that necessitates overt & covert inaction.
Elements of DM
◦ DM is simply awareness without judgement of the position of the self in relation to a mental event
◦ Its elements are:

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1. Meta-awareness (i.e., consciousness of thoughts)

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2. Cognitive decentering (i.e., comprehension of thoughts as events separate from facts)

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3. Attentional detachment & control (i.e., attention remains flexible & not anchored to any

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one thing)

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4. Low conceptual processing (i.e., low levels of meaning based analysis or inner dialogue)

5. Low goal-directed coping (i.e., behaviours & goals to avoid or remove erroneous threat
are not implemented)

6. Altered self-awareness (i.e., experience of a singularity in consciousness of self as an

observer separate from thoughts & beliefs)
Basic techniques of DM
◦ Metacognitive guidance – use of structured questioning to promote metacognitive self reflection

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during exposure to problematic situations or stimuli.

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◦ Free-Association task

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◦ Tiger task – asked to passively observe nonmotivational aspects of imagery as a means of

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experiencing DM

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◦ Suppression-Countersuppression experiment

◦ Clouds metaphor
Basic techniques of DM
◦ Recalcitrant child metaphor

◦ Passenger train metaphor

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◦ Verbal loop – repeated presentation of thoughts either by a recording device or through

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repeated vocalization – has the effect of decreasing their attentional salience & diminishing their

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meaning

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◦ Detachment: the observing self – individual is observer of the thought & separate from any
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◦ Daydreaming techniques – practice of shifting to detached observer during daydreaming can

provide a powerful subjective experience of DM
DM & other forms of mindfulness
◦ Does not involve meditation

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◦ Does not require extensive & continuous practice

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◦ Does not require broader features of mindfulness such as increasing present-moment awareness.

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◦ Mindfulness in meditation tends to use body-focus exercises (focusing on breathing etc.,); DM

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does not have body-focused anchors for attention

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◦ DM specifically concerns developing meta-awareness of thoughts rather than present moment
awareness.
DM & other forms of mindfulness
◦ Mindfulness has many meanings with a limited consensus. The definition & features of DM are more
tightly specified in advance.

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◦ DM separates meta awareness from detachment.

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◦ Specific about the suspension of conceptual processing.

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◦ DM is specific concerning the suspension of goal directed coping.

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◦ DM is specific in the concept of separation of sense of self from mental phenomena
Conclusion
◦ MCT is a form of cognitive therapy – it modifies thinking.

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◦ It differs significantly from the latter in its theoritical & conceptual underpinnings,

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disorder specific models, focus on processes & metacognitive knowledge, &

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techniques.

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◦ It provides an alternative to traditional procedures.

◦ The experience of using MCT in disorders suggest that it often has large & rapid effects.
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THANK YOU