Metacognitive therapy

The central shift

In classic cognitive therapy, you examine whether a worry is true. Metacognitive therapy does something different: it works with your relationship to the thought. Not "is it true that something is wrong with me?" but "what happens if I let the thought be there without following it?"

The reasoning is that rumination rarely solves anything. It feels productive, and it almost never is.

What we work with

• Postponing worry to a set time — and discovering how much of it has gone by the time you get there
• Detached mindfulness: being able to notice a thought without going along with it
• Beliefs about worry: "if I don't think about it, something will go wrong"

It is well suited to generalised anxiety, OCD, health anxiety and rumination in depression.

How it fits into our work

We do not offer metacognitive therapy as a standalone course of treatment. We have integrated its methods and techniques into our treatment.

That is not an admission. It is a description of what ISTDP actually does — because the method works to a large extent with the same material, just under different names.

Metacognitive therapy moves attention away from the content of a thought and towards your relationship to it. That is exactly what happens in ISTDP when we stop and turn our attention to the fact that you are ruminating right now, here in the room — and what it is costing you. Detached mindfulness and identifying defences are close relatives.

The difference lies in what happens next. ISTDP does not settle for changing the thought pattern. It goes after the underlying feelings that set the pattern in motion.

Rumination is rarely a random bad habit. It is usually a way of keeping something at a distance that is too much to feel. Remove the worry without touching the feeling, and the system will often find a new way of doing the same job. That is why we work on both at once.