What are the differences between CBT and Metacognitive Therapy (MCT)

In CBT you challenge the content of your thoughts.

Today Cognitive Behavioral Therapy (CBT) is among the most popular methods for the treatment of anxiety. CBT offers an increase in life quality for many and is considered a significant improvement over traditional methods of therapy.

Both CBT and Metacognitive therapy are evidence-based treatment methods, meaning that it has been scientifically proven to actually work. The result is that only those ideas which showed measurable positive effects are considered for becoming part of the method. But this is also where many of the similarities end.

Simply put, the core principle of CBT is that mental illness is the result of a disproportionate relation between a thought and reality. As an example, let's take a worry that is common for someone with social anxiety:

‍"People don't like me."

In CBT your therapist would train you to challenge this thought and explore whether this thought is founded in truth or not. And by truth-testing you are restoring the balance between the thought and reality. When challenging yourself to go out there and ask your friends and family what they really think of you, you are likely find that it's not all that bad. And that most (if not all) find that you are not as unbearable to be around as you initially thought. And according to research, many start feeling much better after such a truth-testing experience.

But what if you actually DO have something to worry about?

But what if you actually do have something to worry about? For instance, someone who has a terminal illness. Here it doesn't help to truth-test, because the severity of the situation is indisputable. This is an example of a situations where CBT methods usually wouldn't help much. But does this mean that everyone with such an indisputable outcome is then suffering from endless worrying? Certainly not. In practice we see large differences in levels of anxiety.

Generally, CBT cannot explain why two very similar individuals, with a very similar problem, can have such massive variations in recovery results. And for a lack of having a better explanation, in CBT these differences are typically attributed to factors such as a variety in genes, environment, unknown childhood traumas, and so on. (But often it's just fancy way of saying "we don't really know.")

Searching beyond CBT

These inconsistencies within CBT have caused suspicion amongst researchers that there must be a deeper layer to mental illnesses which CBT doesn't target directly. This motivated researchers to find a more complete explanation to what causes and sustains mental illness.

In recent years, psychiatric research has provided us with an improved understanding of human behavior. And it wasn't until the early 1990s when British researchers, led by Dr. Adrian Wells, started noticing a pattern in how individuals relate to their thoughts differently and how some would continue to develop a mental disorder while some wouldn't. They discovered that what matters is not the number or content of negative thoughts, but how (and how much) you engage in them once they pop up in your head.

Thoughts don't matter - how you respond to them does.

And this was such an impactful understanding that it continues to challenges everything we know about mental disorders today. In the following years researchers continued building upon this discovery and developed a revolutionary type of treatment which today is called Metacognitive Therapy (MCT). It is a brand new method that proves to be highly effective in the treatment of a wide range of mental disorders, and in particular anxiety.

Let's explore some key differences between CBT and Metacognitive therapy

(Tip: If you are interested in learning more about how MCT works on a fundamental level, you can read our article: Why are some people more prone to anxiety than others?)

The differences in a nutshell

Difference between CBT and MCT for the patient

Simply stated, the CBT model treats worrying as something that is uncontrollable - essentially something that just happens to you. To remedy this, in CBT you will you engage with your thoughts and see whether they are founded in reality or not. Often when you find out that the thought is irrational, you are able to leave this thought alone. Or you try to change a negative thought into a positive one.

Metacognitive theory considers CBT to be an overly complex way to reach the only result that matters; your ability to leave a thought alone. In fact, the entire metacognitive model is based on that understanding. It doesn’t even matter whether your thoughts are founded in truth or not. In metacognitive therapy your therapist will first demonstrate that worries are actually controllable - and can even be controlled relatively simply using practical techniques. After you experienced that your worries are controllable, your therapist will continue to train you in using these techniques, which in turn will help you avoid getting stuck in endless worries and racing thoughts.

(tip: The GAD Workshop is our 12-week virtual program where you learn using these techniques)

Patients often experience metacognitive therapy to be a treatment where instead of endlessly talking about your thoughts and feelings, you get practical tools where you feel that you are actively working together with your therapist.

Interestingly, in CBT you are stimulated to do the opposite: engage with your thoughts in order for you to not be bothered by them anymore. The Metacognitive model considered this to be inefficient (and for some even to be counter-productive).

Another difference is that Metacognitive therapy is a step-by-step approach. From the start of treatment it is quite clear what the path to recovery is. This is often experienced as a positive element of Metacognitive therapy, as the patients feels that their progress is measurable.

This is made possible by Metacognitive therapy being one single model, where the model has been applied successfully to the most prevalent mental problems. Ranging from anxiety to depression, PTSD, OCD and several more. This enables a to-the-point approach which can contribute to the effectiveness of the therapy.

Difference between CBT and MCT for the therapist

On a similar note, CBT is often characterized by the therapists as being complex to use. When you are receiving CBT your therapist has to pick and choose from a number models selected for your situation. Each of these models were designed to cover one or more psychiatric disorders. This element leaves a bit of room for interpretation by the individual therapist, while the models themselves are already quite complex to begin with.

In metacognitive theory there is only one universal model. And since many mental disorders are considered to have a single root cause, it is considered that only one model should be needed. And now recent scientific research suggests this to be be the case indeed. The simplicity of the metacognitive model may be possible because it is targeting the mental illness on a more fundamental level.

Why is CBT more popular than MCT?

While CBT is recognized by the entire industry today as the gold standard for the treatment of many disorders, this was certainly not always so. In fact, from its introduction it took CBT nearly 40 years to reach this status. This was at a time where basically every therapist was schooled in the classical methods.

Generally, insights found through clinical testing typically take a long time to find its way into the treatment rooms of the therapist. As the treatment of choice for any therapist is often influenced by what was taught in medical school, one could say that a fundamental change in treatment methods (paradigm shift) will occur only once in a generation.

In our view, today Metacognitive therapy seems to be where CBT was four decades ago: a new and more effective method that challenges the accepted gold-standard. Even though the research is quite clear that it's a more effective method for a wide range of mental problems, not many psychologists are familiar with it (or have not even heard about the method).

The downside? For the therapist to master the method requires expert supervision. While in theory anyone can call themselves a 'metacognitive therapist', only a handful of therapists worldwide have received adequate training. Each year The MCT Institute trains a limited number of therapists. If you want to ensure that you receive quality treatment, you can ask your psychologist if they are certified by The MCT Institute as a level 1 MCT therapist.