Worry and rumination can take up a great deal of time and attention. In metacognitive therapy, we explore what keeps the worrying and ruminating going and how you relate to your thoughts. We try out other ways of using your attention. I am a certified MCT therapist and see clients in Hornstull or online through Kaddio.
Thoughts, feelings and bodily reactions can arise quickly. The work focuses mainly on what happens next and which strategies keep the difficulties going.
FIG. MCT · 01
01 · Mechanism
Worrying and ruminating as strategies.
Many people who get caught in worrying or ruminating have tried to think their way out with more counterarguments, more analysis or another round of thinking. Worrying and ruminating are cognitive strategies: something you do, rather than something you are. The strategies may be attempts to understand, anticipate or gain control and can, over time, become so automatic that they start without a conscious decision.
When worrying and ruminating become extensive, the cost may be that anxiety and low mood intensify or persist, while time and attention are taken away from other things in life. In MCT, we explore what you expect these strategies to help you with and what keeps them going.
How the training works
Part of the work is learning to notice when your attention gets stuck and practising directing it where you want it to go. You also practise letting thoughts and feelings be there without automatically starting to analyse, ruminate or worry.
The aim is not to get rid of thoughts or feelings, but for them to have less control over your time and attention. MCT has a short-term focus. How soon change becomes noticeable and how many sessions are needed vary, and we review the work as we go.
02 · Application
When MCT may help
Metacognitive therapy is transdiagnostic. This means that the same cognitive processes or strategies can occur across many different difficulties and diagnoses. Worrying, ruminating, threat monitoring and repeated attempts at control are examples of strategies for dealing with thoughts, feelings or uncertainty. They can become so habitual that they feel automatic and uncontrollable.
How the strategies can show up
Describing them as strategies does not mean that you consciously choose them every time. It means that we can examine and influence them, and gradually replace them with other ways of using attention and responding to thoughts. The belief that worrying or ruminating cannot be controlled may itself help to keep the strategy going.
Anxiety and low mood can interact with worrying, ruminating and the way attention is used. With health anxiety, part of the work may therefore be to explore worrying, checking and the attention directed towards the body, bodily signals or the risk of illness. Medical conditions also need to be assessed when relevant.
persistent worry that feels uncontrollable, for example in GAD
low mood and depression where rumination keeps the difficulties going
health anxiety, compulsions and OCD
trauma and stress-related difficulties
procrastination, avoidance and performance anxiety
difficulties involving self-esteem, self-confidence, self-criticism or negative self-monitoring
The same difficulty can have several underlying causes, and the strategies often overlap. That is why it is not the diagnosis or a single symptom alone that decides how we work. We explore what keeps the difficulties going and adapt the work using MCT, ISTDP or a combination of the two.
03 · Evidence
What the research says
The research evidence for MCT has grown, particularly for worry, anxiety and depression. An updated meta-analysis of randomised studies found better average outcomes for MCT than for waiting-list conditions and the CBT treatments included. However, the studies varied considerably and several had methodological limitations. The findings therefore do not mean that MCT is always better, nor do they tell us what an individual person can expect.
MCT has been studied for a shorter time than CBT, and the research continues to develop. For you, the findings mean that MCT is a treatment option with a growing body of research evidence. At the same time, we follow up on whether the work is helping you in particular.
If you would like to read more, there is a more detailed review of the studies, their limitations and links to the original publications on the research page.
04 · Approach
Working with me
We begin by mapping your situation and formulating what you want to change. I bring questions and knowledge, and you bring your experience of your life. Together, we explore what keeps the difficulties going and how MCT, ISTDP or both approaches can help us work with them.
The problem formulation may change as we understand more. We follow what changes in your everyday life and check whether we are working on the right things. I want you to tell me if something feels unclear or is not helping.
Common questions
Is MCT the same as CBT?
No. MCT is a treatment method in its own right. In MCT, the emphasis is on how you relate to thoughts and how you use your attention, for example when worrying, ruminating or repeatedly monitoring. CBT includes several different approaches, so the differences depend on which CBT treatment you compare it with.
How does work with MCT begin?
We begin by mapping the problems you are seeking help with so that they make sense to both you and me. We then explore what maintains them: what makes the problems continue. In MCT, we look particularly at what happens when worries, thoughts or bodily signals arise, for example whether you start worrying, ruminating, trying to gain control or directing attention towards threats. Based on this understanding, we begin to sketch out and try ways of counteracting what keeps the problems going. This may involve other ways of acting, using attention and letting thoughts be. We also formulate what you want to get out of therapy and what changes it is reasonable to expect, given your goals and what we know about MCT. We then follow what actually happens and adjust the work accordingly.
How many sessions are needed?
MCT has a short-term focus, but the number of sessions needed depends on what you are seeking help with. Early on, we can make a rough estimate of whether the plan is likely to be shorter or longer. We review and adjust the plan together as we go. It is always you who decides whether you want to continue the work.
