Metacognitive therapy, attention training technique, detached mindfulness

Domain II · Behavioural & cognitive · Adrian Wells · 1994

What it is

MCT is a brief, transdiagnostic cognitive therapy. It grew out of the Self-Regulatory Executive Function (S-REF) model (Wells & Matthews, 1994, 1996). Its core claim is that distress lasts not because of what negative thoughts say but because of how a person responds to them. The model calls this…

Format

• Format and dose
• Individual: brief and time-limited, usually 8–12 weekly sessions. Depression: 5–10 sessions at the clinician's discretion, or a standard 8. Trials used 6–8 weekly sessions of 45–60 minutes, with booster sessions at 3 and 6 months.

Who practises it, and how they are trained or regulated

• MCT is a brief, transdiagnostic cognitive therapy. It grew out of the Self-Regulatory Executive Function (S-REF) model (Wells & Matthews, 1994, 1996). Its core claim is that distress lasts not because of what negative thoughts say but because of how a person responds to them. The model calls this response the cognitive attentional syndrome (CAS): worry or rumination, threat monitoring, and coping that backfires…
• Technique families covered: case formulation and socialisation, meta-level Socratic dialogue, the Attention Training Technique (ATT), the Spatial Attention Control Exercise (SPACE), detached mindfulness (DM) techniques, worry and rumination postponement, verbal and experimental challenges to uncontrollability, danger and positive beliefs, disorder-specific procedures, and new plans and relapse prevention.

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• How do you and the practitioner understand what is happening, in spiritual or cultural terms? Is that a source of comfort, worry, or both?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• the same issues as ATT.
• subtle substitutes, such as mental checking or asking family indirectly.
• Clients actively animating the image. Repeat with an emphasis on passive watching.
• the client holding back during the experiment as a safety behaviour. Ask them to push harder.
• group discussion slipping into sharing worry content. Keep the conversation at the meta-level.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.