What it is
Metacognitive therapy is a cognitive approach that centers on your beliefs about thinking itself — sometimes called "thinking about thinking." Rather than digging into the details of each worry, it looks at the mental habits that keep worry and rumination going.
Metacognitive therapists often work with related skills such as attention training, which helps people practice flexibly directing their focus, and worry postponement, a way of changing the timing and grip of repetitive thoughts.
The idea behind this modality is that it may not be the thoughts themselves that cause distress, but how much attention and importance we give them. Therapists in this area aim to help people step back from unhelpful mental patterns.
How it’s traditionally been approached
For a long time, repetitive worry and rumination were understood mainly by examining their content — the specific fears, memories or problems a person kept returning to. Many approaches focused on challenging or reasoning with each individual worry.
Over time, clinicians began to notice that some people stayed stuck even after addressing the content, because the underlying habit of over-engaging with thoughts remained. This shift in understanding helped shape metacognitive approaches.
Today, metacognitive therapy is offered by trained, licensed therapists as one recognized option within cognitive and behavioral care. It is often chosen by people who find themselves caught in cycles of worry or replaying events in their minds.
How a therapist may help
A therapist using metacognitive and related cognitive approaches may help you notice when you're caught in worry loops and explore your beliefs about whether worrying is useful, controllable or dangerous. Sessions are usually collaborative conversations rather than fixed exercises.
Many people find it helpful to learn, with a therapist's guidance, new ways of relating to intrusive or repetitive thoughts — observing them without automatically following them down the rabbit hole. This is framed as a possibility, not a guaranteed outcome.
Over a course of sessions, a metacognitive therapist might gently introduce skills like attention training or worry postponement, tailored to you. What this looks like varies from person to person, which is why working with a licensed professional matters.
Where mind meets body
Worry and rumination don't live only in the mind. When thoughts spin, the body's stress response often joins in — a racing heart, tense muscles or a restless, wired feeling. Thoughts, emotions and physical sensations constantly influence one another, so calming one can affect the others.
Because of this two-way connection, some people pair thinking-based work like metacognitive therapy with body-based (somatic) practices for a more whole-person approach. To learn about body-centered options, you can explore our sister site, Somatic Experiences. Neither approach is better than the other — many people simply find value in having both available.
Explore on Somatic Experiences: nervous system regulation →Explore on Somatic Experiences: grounding techniques →Explore on Somatic Experiences: anxiety →
Keep in mind
- Metacognitive therapy is one option among many; what helps varies from person to person.
- Persistent worry or rumination can sometimes accompany trauma, depression or anxiety that deserve attention — licensed professionals should guide care.
- Any decisions about medication are made with a licensed prescriber, not through therapy alone.
- If you are in crisis or thinking about harming yourself, in the US you can call or text 988 or call 911.
Therapists
We’re welcoming founding metacognitive therapists now. Get matched or list your practice.
Frequently asked questions
What does a metacognitive therapist do?
A metacognitive therapist helps you change how you relate to your thoughts rather than focusing on the content of each worry. They work with the mental habits that keep worry and rumination going. Sessions are collaborative and led by a licensed professional trained in this approach.
What is metacognitive therapy used for?
People often seek metacognitive therapy for worry and rumination — those repetitive loops of thinking that are hard to switch off. It focuses on beliefs about thinking itself, such as whether worrying is useful or controllable. A licensed therapist can help you decide whether it fits your situation.
How is metacognitive therapy different from traditional CBT?
Metacognitive therapy pays less attention to the specific content of thoughts and more to how you engage with them. Traditional CBT often examines and challenges individual thoughts, while metacognitive work targets the underlying patterns of over-thinking. Both are cognitive approaches offered by licensed therapists.
What is attention training in metacognitive therapy?
Attention training is a skill some metacognitive therapists use to help people flexibly direct and shift their focus. The aim is to loosen the grip of worry and rumination by practicing where attention goes. How it is introduced depends on the individual and is guided by a trained professional.
What is worry postponement?
Worry postponement is a technique that changes the timing and grip of repetitive thoughts rather than trying to eliminate them. It's one tool a metacognitive therapist might tailor to a person's needs. A licensed therapist can explain whether it suits your circumstances.
How do I find a metacognitive therapist?
You can use a directory like Therapists.plus to find independent, licensed professionals who use metacognitive and related cognitive approaches. Look for someone trained in the methods you're interested in, and consider reaching out to ask about their experience with worry and rumination.
Educational resource. Therapists.plus shares general information and connects people with independent therapists, coaches and groups. It is not medical advice, diagnosis or treatment. Talk with a licensed professional about your health. In a crisis in the US, call or text 988 or call 911.
