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David Baxter

Mar 26, 2004
Help for Changing How You Think
By Michael Craig Miller, M.D., Harvard Medical School
October 25, 2012

Cognitive behavioral therapy (CBT) helps people change their negative or distorted thoughts. It's used to help treat depression, phobias and anxiety, for example.

Metacognitive therapy (MCT) is related to CBT. Some people describe MCT as a way to help people change how they think rather than what they think.

Two psychologists, Dr. Adrian Wells of the University of Manchester and Dr. Gerald Matthews of the University of Cincinnati, developed the theory underlying metacognitive therapy in the early 1990s. Initially it was used to help patients with generalized anxiety disorder. Since then, metacognitive therapy helps treat a variety of mental health problems.

The Principles Behind Metacognitive Therapy
Troubled patterns of thinking tend to take on a life of their own. A person may start with thoughts about a specific situation, but the thoughts start to involve many other aspects of life.

Here is an example: People who are anxious may initially worry about situations that they run across in day-to-day life, such as missing a train. With time, however, they may begin to develop a second type of worry: They begin to worry about their thoughts. That is, according to this theory, they begin to worry about being worried.

More Than Anxiety Treatment
People who have attention deficit hyperactivity disorder (ADHD) often have difficulty planning or caryying out tasks. The goal of metacognitive therapy in ADHD is to improve organization skills, planning, and time management.

Most of the research evaluating metacognitive therapy has focused on anxiety disorders, such as social phobia, post-traumatic stress disorder and generalized anxiety disorder. Only a few studies have evaluated its use in helping adults with ADHD (none have been conducted in children). But so far the early research results are promising.

Research Results
In one study, researchers at the Mount Sinai School of Medicine recruited 88 adults with ADHD. They were diagnosed using a structured interview. The group was carefully selected; few had the coexisting psychiatric disorders (like substance abuse) that are so common in people with ADHD. The researchers randomly assigned half of the people to a metacognitive therapy group and the others to supportive group therapy. There were 12 weekly sessions.

People in the metacognitive therapy group started by learning specific skill sets (such as using a daily planner). Then they learned broader skills to help them organize and perform a complex project. Those assigned to supportive therapy received encouragement and reinforcement of productive behaviors. The response to the treatment was rated both by the researchers and by the participants.

Some participants improved after both interventions, but those assigned to metacognitive therapy showed more improvement on measures of organization, ability to complete tasks, and other practical components of attention skill. More people in the metacognitive therapy than supportive therapy group responded to the treatment, defined as at least a 30% improvement in ADHD symptoms. In all, 19 of 41 (42%) participants who completed metacognitive therapy improved, compared with five of 40 (12%) of those who completed supportive therapy.

Where Does MCT Fit In?
MCT is not a proven therapy yet. More research is needed on its effectiveness in different settings. Therefore it can't compare yet to its elder cousin CBT. And it can't be considered as a first line treatment for ADHD.

MCT is also being studied for the treatment of post-traumatic stress disorder, obsessive compulsive disorder, depression and even schizophrenia. The results of such studies will be interesting to see.

If you're interested in MCT, here is a more practical problem: This treatment is so new that you're unlikely to find a therapist formally trained to do it. Any therapist, however, can take lessons from the work already done in this area. And you can probably find people who can help you with organization, planning and time management ? those concepts are not new.

It's hard to know how widespread MCT will become, but the theory behind it is intriguing and attractive. Like other therapies before it, MCT asks you to step back from specific thoughts and instead understand your thinking style. Changing your patterns or style of thinking could have a broad impact on how you manage your life. You could acquire psychological tools that are both flexible and useful.

Michael Craig Miller, M.D Michael Craig Miller, M.D., is Senior Editor of Mental Health Publishing at Harvard Health Publications. He is an assistant professor of psychiatry at Harvard Medical School. Dr. Miller is in clinical practice at Beth Israel Deaconess Medical Center, where he has been on staff for more than 25 years.
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