Metacognitive therapy (MCT) is an emerging treatment that focuses on changing how you think about your thoughts. Instead of analyzing negative beliefs, MCT teaches people how to stop ruminating—breaking the cycle of constant worry that fuels depression.

Unlike traditional therapies, the goal of MCT isn’t to challenge every negative thought. Instead, it helps you step back, acknowledge those thoughts, and let them pass without engaging.

What Is Metacognitive Therapy?

Metacognitive therapy trains people to reduce rumination, the repetitive cycle of dwelling on mistakes, fears, or feelings of inadequacy. Research shows that people who ruminate more often are at higher risk of developing or worsening depression.

According to experts, many patients believe their rumination is uncontrollable or even harmful. MCT helps shift those beliefs, offering healthier coping mechanisms and reducing emotional distress.

Though less common in the United States, MCT has been studied internationally and used to treat not only depression but also anxiety, OCD, PTSD, and substance use disorders.

How It Differs From Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) encourages people to analyze and challenge negative thoughts. By contrast, MCT teaches you to recognize those thoughts but not engage with them.

Instead of questioning whether a thought is true, MCT helps you weaken its influence and focus on healthier behaviors. Both therapies can help with depression, but MCT is unique in its emphasis on detached mindfulness—acknowledging thoughts without feeding them.

Other treatment options for depression include:

  • Antidepressant medication

  • Interpersonal therapy (IPT), which explores life events affecting mood

  • Brain stimulation therapies, such as experimental electrical treatments

How Metacognitive Therapy Works

MCT begins by identifying metacognitive beliefs, or what you believe about your own thought processes. From there, therapy sessions gradually introduce strategies to reduce worry and rumination.

Key techniques include:

  • Detached mindfulness: Notice thoughts without engaging in them.

  • Attention training: Focus on different sounds or stimuli to break the rumination cycle.

  • Postponing rumination: Delay engaging with negative thoughts until later.

  • Reality testing: Compare your negative beliefs with real-life outcomes.

  • Exposure exercises: Face your fears to reduce their hold over your thinking.

Most MCT programs last 10–12 sessions, during which therapists teach coping strategies and relapse prevention.

Evidence That MCT Works for Depression

Studies suggest MCT can be highly effective for depression. In one 2017 study, about 80% of patients recovered from depression symptoms after 10 sessions, compared to just 5% in a control group. Most participants maintained their progress six months later.

For many, MCT is a relief because it doesn’t require rehashing painful memories or analyzing every negative thought. Instead, it gives people tools to stop the cycle of rumination that keeps depression alive.

A Quick Review

Metacognitive therapy helps people with depression by teaching them how to step back from negative thoughts instead of endlessly analyzing them. With techniques like attention training, detached mindfulness, and rumination postponement, MCT can reduce symptoms and improve quality of life.

If you’re struggling with depression, a mental health provider may recommend MCT, CBT, medication, or a combination of treatments.