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• Metacognitive therapy (MCT) is an effective treatment for anxiety and depression. • In this article we trace the historical development of MCT. • We explain why the metacognitive approach has developed into a promising perspective. • We argue that MCT may mark a paradigm shift in psychotherapy. • Its development may serve as a blueprint for advancement in clinical psychology. Metacognitive therapy (MCT) is proving to be an effective treatment for anxiety and depression with effects that may exceed CBT. It has been described as a paradigm shift in psychotherapy in its theory-driven cognitive science approach and systematic development and evaluation. MCT was developed by Adrian Wells based on an information processing theory, the Self-Regulatory Executive Function model by Wells and Matthews. MCT theory formulates psychological disorders as sharing common causal factors under the influence of metacognition, representing a particular top-down model of biases in cognitive regulation. A key clinical implication was that a core set of interventions could be developed to impact a wide range of symptoms and disorders. In this paper, we trace the historical development of MCT and the major studies that informed theory and practice with the aim of introducing clinicians and researchers to this area and to understand why the metacognitive approach has developed into a treatment that is proving to be potentially more effective than current gold-standard treatments. In doing so, we will draw out the distinctive features of the approach and explore how this might offer a blueprint for scientific advancement in clinical psychology and psychotherapy. [ABSTRACT FROM AUTHOR]

Cognitive-behavioral therapy including exposure and response prevention is the first-line treatment of pediatric OCD showing response- and remission rates around 70% and 53%. Thus, there is room for improvements. Metacognitive therapy (MCT) for OCD might be cost-effective and focuses on modifying metacognitive beliefs about the significance and dangerousness of intrusive thoughts/feelings, and about the need to perform rituals. MCT is effective in adults but needs to be evaluated in youths. In the current study, eleven adolescents divided in three groups received eight MCT group sessions of 75 min duration (and two 60 min workshop for parents) delivered by an MCT-therapist and an assistant. The within-group effect size (hedges g) from pre-to post-treatment on the CY-BOCS was 1.90, and the response and remission rates were 82% and 55%, respectively. Effect sizes for secondary outcomes were also large. Therapist time (one certified MCT-therapist and a clinical psychology student working together) used per patient to achieve these results were 2.18 therapy sessions of 75-min duration in addition to 33 min therapist time per patient of workshops for the parents. Follow-up assessments were not available, and the results should be interpreted with caution. However, they are encouraging and suggest that MCT for pediatric OCD should be evaluated further. • Metacognitive therapy can be an alternative treatment option to CBT/ERP. • MCT has proven efficacious for adults with OCD but is less explored in youths. • 11 patients received eight groups sessions of MCT delivered by two therapists. • Nine out of 11 patients responded and the treatment was associated with high effects. • MCT for pediatric OCD should be investigated further and may be cost-effective. [ABSTRACT FROM AUTHOR]

This open trial investigated the transdiagnostic effects of metacognitive therapy (MCT) in patients with severe major depressive disorder and comorbid psychiatric disorder. Ten patients were treated with MCT over 10 sessions and were assessed with measures of depression, anxiety, rumination, and metacognitions at pre- and posttreatment and at 6 months follow-up. None of the patients were diagnosed as depressed at posttreatment, and of the initial 21 total diagnoses at pretreatment only 3 diagnoses remained at postintervention. The effect sizes were large for symptoms of depression, rumination, and worry. At 6 months follow-up standardized recovery criteria on the BDI showed that 70% were recovered, 20% improved, and 10% unchanged. The results indicate that MCT was associated with high rates of transdiagnostic improvement. [ABSTRACT FROM AUTHOR]