• When we try to control our intrusive or anxious thoughts, we might just make them more intractable

  • Therapist Kelly Britton breaks down how therapists can work with unhelpful thinking traps


I was always a worrier. I worried all the time, about everything. I worried about not worrying. For me life was like a constant game of whack-a-mole; trying to get ahead of my worries, ignore them, outsmart them, negotiate with them, pummel them with a big mallet. Nothing worked. 

I resigned myself to being a worrier and tried to see it as an advantage. I would never be blindsided, I would always be prepared, I would imagine the worst case scenarios and act accordingly, I would be super-organised and nothing would go wrong. A great plan, right?

In theory. The reality? I was always on edge, never slept through the night, I couldn’t relax or enjoy things. Having worked in mental health for years, I trained as a cognitive behavioural therapist. The Professor training me in CBT made a statement which changed my life. He said “Worry is a behaviour, we can choose whether or not to do it”. 

Generalised anxiety disorder or GAD is one of the most prevalent presentations in primary care, yet fewer than half of people with GAD seek treatment so it appears to be significantly under-diagnosed. In my work most of my time is spent helping people manage worry. 

During my CBT training I became aware of metacognitive theory and its approach in working with worry. Metacognitive Therapy (MCT), developed by Professor Adrian Wells, emerged from CBT principles to explore alternative ways of working. 

MCT differs from CBT in a key aspect; rather than focusing on the content of thoughts and evidencing them, MCT takes a metacognitive view – exploring the thoughts about the thoughts. It suggests it is rigid and recurrent thinking styles which maintain certain disorders and reducing these, through challenging beliefs around them and interrupting unhelpful thinking, can help people move into recovery. 

MCT argues that these thinking styles, known as the Cognitive Attentional Syndrome, involve focusing attention on potential danger leading to unhelpful behavioural strategies such as worry, rumination, threat monitoring, avoidance and reassurance seeking. 

For example, a client is worrying about the common core belief “I am not good enough”. 

As a CBT therapist I would ask: “what is the evidence that you are not good enough?”

However, as an MCT therapist I would ask: “what is the effect of analysing thoughts about whether you are good enough?” thus enabling them to explore whether worrying and ruminating is actually keeping them stuck in this belief rather than moving them forward.

The difficulty with evidencing thoughts is two-fold; firstly, it might not go our way – sometimes I am not good enough, sometimes I will fall short, because I am a fallible human being. Secondly, even if it does go our way and we agree “I am good enough”, another thought will replace it – “I am unlovable, I will make a mistake, I will be judged” and we have to start all over again evidencing each one. In essence, we are back to whack-a-mole.

MCT would say: “how does ruminating about the thought you are unlovable help you feel better about yourself?” or “how does worrying about making a mistake help you feel more confident?”. By challenging beliefs about worry being helpful, clients can discover that the advantages they attribute to worry – planning, being prepared, staying safe for instance – are things they would do anyway and that the worrying thoughts are superfluous. 

Likewise, by challenging beliefs that worry is harmful we help clients to reduce the behaviours that keep their worries going such as using thought control strategies like suppression and avoidance. MCT suggests that worry is not uncontrollable but that we are too focused on managing the intrusions, uncomfortable thoughts which no-one can control, rather than our response – worry, rumination, avoidance and so forth – which we can control. Trying not to think about a thought is, in itself, thinking about a thought, our attention remains on it. So, when we try to stop worrying using thought control strategies, it is like trying to change a tyre with a can opener – it’s never going to work. 

Metacognitive theory sees the mind as self-regulating. In the same way I don’t have to consciously breathe in and out, I also don’t have to control my thoughts. Instead, if I allow my cognitive system to function without trying to over-ride it, my thoughts will take care of themselves. This is a process known as Detached Mindfulness, leaving the thoughts alone. We are interrupting the worry cycle by doing nothing with the thoughts, rather than maintaining it by engaging with them or trying to distract ourselves. 

Now often my clients will ask me if this is also avoidance or denial. It is not. In MCT we keep problem solving at the fore front, if we can take action about a problem we do. When there is a problem we cannot immediately resolve or a thought which upsets us, we have to tolerate uncertainty and discomfort around this. When we worry, we ironically try to avoid the discomfort of uncertainty by getting ahead of things, but it creates more anxiety. When we reduce worry, we are allowing ourselves to tolerate discomfort (note, you don’t have to like it!)

So, MCT addresses worry by exploring and challenging beliefs which keep it going, it provides space to practise new strategies to reduce worry such as detached mindfulness so that consequently clients see they can function without it (usually more effectively), and it focuses on reducing behaviours like avoidance and threat monitoring which maintain their anxiety.  

I still practice CBT, but I see myself now primarily as an MCT therapist. This way of working has had a positive effect on my clients, who report huge improvements in how they are feeling. Personally, I have felt calmer, happier and more productive since reducing my overthinking. Like everyone I still experience anxiety at times and fluctuations in mood, but they are appropriate responses, and I am able to let them pass and move on. And by the way, I don’t play whack-a-mole anymore!

For information about MCT please visit www.mct-institute.co.uk

NB: There are individuals on the web claiming to be MCT Therapists, some do not have even a basic mental health qualification, they are not qualified to teach or provide MCT.  If you are interested in further details of MCT, please visit the site above which is the only organisation in the world training Registered MCT Therapists who adhere to protocols and ethical guidelines for treatment. If someone claiming to be MCT qualified is not listed here, they are not trained and cannot practice Metacognitive Therapy.

Kelly Britton is a verified Welldoing therapist in Great Yarmouth and online


Further reading

What does therapy actually feel like?

The key principles of acceptance and commitment therapy

How getting to know your 'ideal self' can reduce anxiety

Deciding on therapy: A leap of faith?