- Metacognitive therapy (MCT) has proved more effective than current treatments for treating anxiety and depression.
- The new therapy has reduced session times and improved outcomes for patients with long-term symptoms.
- MCT has been widely adopted into clinical services in the UK and abroad.
Mental health treatments falling short for patients
Globally, one in six adults experiences a mental health problem, such as anxiety or depression, in their lifetime. People with these conditions suffer a poorer quality of life and can be at risk of other health problems, including heart disease and reduced life expectancy. Effective mental health treatments are needed urgently.
Professor Adrian Wells
Adrian Wells is Professor of Clinical and Experimental Psychopathology at The University of Manchester.
Supporting mental wellbeing through gold-standard research
Treatments for psychological disorders were not keeping pace with advances in cognitive science and theory. Cognitive Behavioural Therapy (CBT) was viewed as a benchmark for treating anxiety and depression. However, only 50% of patients who have a chronic mental health problem improved or recovered using the technique.
Adrian Wells, Professor of Clinical and Experimental Psychopathology, and colleagues at The University of Manchester sought to improve patient recovery rates. Through their research, they discovered Cognitive Attentional Syndrome (CAS) – a central set of thinking processes common to psychological disorders. The CAS is made up of difficult-to-control, extended negative thinking, often in the form of worry, rumination and threat monitoring. A breakthrough in this discovery was that metacognition (the ability to think about and regulate one’s thoughts) plays a major role in controlling CAS.
From this, Wells developed a new form of psychotherapy called Metacognitive Therapy (MCT). With it, he conducted clinical trials covering a number of disorders such as social anxiety, depression, obsessive compulsive disorder, post-traumatic stress, generalised anxiety, and mental health problems experienced by patients who have cardiovascular disease.
The development of MCT has been described by the scientific community as a model for the progression of psychotherapy. Patients undergoing the treatment become more self-aware and changed their way of thinking in response to stress, to alleviate the unhelpful thought patterns that prolong worry and worsen their symptoms.
“I am fascinated to see how rapidly patients get better. I have learnt great skills from metacognitive therapy training that will guide my therapy.”
Dr Anil Gündüz
Metacognitive Therapist in Turkey
Major advances in patient treatments and recovery
MCT has also resulted in faster treatment outcomes for patients, as they require fewer and shorter sessions compared to other therapies. It has proven to be more effective than existing treatments for anxiety and depression, such as CBT. A Manchester-led study conducted in Denmark showed that 74% of patients with depression recovered when treated with MCT, compared to 52% treated with CBT.
The study PATHWAY, funded by the National Institute of Health Research (NIHR) and conducted by Manchester (2014–2021), in collaboration with Greater Manchester Mental Health NHS Trust, also showed that adding MCT to cardiac rehabilitation in patients with heart disease significantly improved symptoms of anxiety and depression.
With conditions such as generalised anxiety disorder, MCT has improved outcomes for patients with long-term symptoms. So much so that a study, in collaboration with the Norwegian University of Science and Technology, showed that in this case, MCT was more effective than CBT. Furthermore, the advantages of MCT remained present nine years after treatment.
Widespread adoption into clinical services in the UK and Europe
Following its success, MCT has been integrated into clinical services in the NHS and health services abroad. In Norway, it is the first-choice treatment for patients hospitalised with anxiety and depression, and has even improved return-to-work rates for those on long-term sick leave.
In the UK, treatments drawing on MCT principles are recommended in NICE guidelines for social anxiety disorder and generalised anxiety disorder. The social anxiety model recommended in the guidelines is a core competency in UK clinical psychology training programmes and an essential part of the national training programme for IAPT (talking therapy) practitioners each year.
In England, approximately 170,000 patients in 2019–2020 had talking therapy treatment for social anxiety or generalised anxiety disorder, with the majority aided by MCT-informed techniques.
Training healthcare professionals across the globe
MCT prompted the establishment of a not-for-profit spin-out company, the Metacognitive Therapy Institute (MCTI), in 2008. MCTI delivers training, dissemination and governance of MCT and currently trains approximately 250 healthcare professionals across 25 countries each year. Therapists trained in MCT have reported a substantial improvement in their clinical practice, as MCT allows them to treat a wide range of mental health disorders with greater success.
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- David Reeves, Professor of Biostatistics
- Sam Cartwright-Hatton, Clinical Senior Lecturer
- Metacognitive therapy versus cognitive behaviour therapy in adults with major depression: a parallel single-blind randomised trial (open access article)
- Improving the effectiveness of psychological interventions for depression and anxiety in cardiac rehabilitation: PATHWAY – a single-blind, parallel, randomized, controlled trial of group metacognitive therapy (open access article)
- Metacognitive therapy versus cognitive-behavioural therapy in adults with generalised anxiety disorder (open access article)
- How to stop worrying: metacognitive therapy helps this writer learn to leave her anxious thoughts on the 'sushi conveyor belt' (South China Morning Post website)