Metacognitive therapy (MCT) is a treatment approach developed by Adrian Wells. Its distinguishing move is to work on how thinking runs rather than on what any particular thought says — and the Attention Training Technique is one of its components, not the therapy itself.
That last distinction does a lot of work on this page.
The model in one paragraph
MCT holds that people get, in Wells’ phrasing, “locked into” unhelpful thinking patterns they find difficult to bring under control, and that the control of attention in psychological disorder becomes inflexible as attention is bound up with perseverative, self-focused, worry-based processing and monitoring for threat[1]. That bundle is the cognitive attentional syndrome, the CAS.
If the CAS is the problem, then redirecting attention away from that activity should provide a means of interrupting it and of strengthening the plans that control cognition — improving flexible executive control[1]. That sentence is the rationale for every attention technique in the approach.
The two attention techniques
Wells’ chapter on attentional modification presents two, with explicitly different aims[1]:
| ATT | SAR | |
|---|---|---|
| Full name | Attention Training Technique | Situational Attentional Refocusing |
| Aim | Increase executive control and interrupt perseverative self-focused processing[1] | Increase access to disconfirmatory information and correct counterproductive attentional strategies in situations[1] |
| Where it happens | A scheduled ~12-minute listening exercise[1] | Inside the stressful or problematic situation itself[1] |
Neither is distraction. Wells is explicit that neither strategy is a means of distraction from internal events or a means of managing or avoiding emotion[1] — a point developed on is ATT just distraction? and situational attentional refocusing.
How MCT differs from CBT
The short version: CBT characteristically works on the content of thoughts — examining them, testing them against evidence. MCT works a level up, on the processing style that keeps thinking locked in, and on beliefs about thinking itself. Wells describes the metacognitive approach as emphasising the role of control functions, proposing that these can be strengthened through attentional technologies such as ATT[1].
Two published comparisons, reported as the studies reported them:
- Major depression. A parallel single-blind randomized trial in Danish primary care randomized 174 adults (85 MCT, 89 CBT); 155 participated in the study analyses, 112 completed treatment and 115 provided six-month follow-up data. On the Beck Depression Inventory-II the adjusted difference was −5.49 points (95% CI −8.90 to −2.08, p = 0.002) favouring MCT, with recovery rates of 74% versus 52% at post-treatment; on the Hamilton Depression Rating Scale no significant difference emerged. The authors conclude that evidence from the study “suggests that MCT had considerable beneficial effects in treating depression that may exceed CBT”[2].
- Generalized anxiety disorder. A 2023 meta-analysis pooled 3 randomized trials with 205 participants and concluded that “MCT may be more effective than CBT in the treatment of GAD”[3].
Worth holding both of those lightly. Three trials and 205 participants is a small evidence base, one trial is not a literature, and MCT research is frequently conducted by the people who developed it. “Promising” is the accurate word.
Why none of this is a claim about ATT
This is the part that matters most for anyone arriving here from an attention-training app, including ours.
Those trials tested metacognitive therapy — a full course of treatment, delivered by trained clinicians, of which ATT is one component. They did not test twelve minutes of audio. Nothing in them supports the inference that practising ATT by yourself produces the outcomes they measured, and this site does not make it.
The manual itself does note that while ATT is generally considered a component of a wider MCT treatment package, Wells writes that evidence suggests it can be effective even when used alone, pointing the reader to a later chapter for that[1]. That is the manual’s own position, reported here as such — our summary of what has actually been measured about ATT specifically is on does attention training actually work?, and it is more cautious.
If you are looking for MCT itself
This site is about the technique, not the therapy. MCT is delivered by trained clinicians, and if you are considering it for something that is affecting your life, a qualified professional is the right place to take that question. Heed is a self-practice tool inspired by ATT research — not therapy, and not a medical device.
Questions and answers
- What is metacognitive therapy?
- A treatment approach developed by Adrian Wells that targets how you think rather than what you think — specifically a pattern of perseverative, self-focused, worry-based processing combined with threat monitoring, which it calls the cognitive attentional syndrome.
- How does MCT differ from CBT?
- CBT typically examines and tests the content of thoughts. MCT works on the processing style that keeps thinking locked in, and on the beliefs people hold about thinking itself.
- Is ATT the same as metacognitive therapy?
- No. ATT is one attention technique within MCT — the manual presents it alongside a second, situational attentional refocusing. Practising ATT on your own is not receiving MCT.
References
- Wells, A. (2009). Metacognitive Therapy for Anxiety and Depression. Guilford Press. Chapter 4: Attention Training Techniques.
- Callesen, P., Reeves, D., Heal, C., & Wells, A. (2020). Metacognitive Therapy versus Cognitive Behaviour Therapy in Adults with Major Depression: A Parallel Single-Blind Randomised Trial. Scientific Reports, 10, 7878. https://pmc.ncbi.nlm.nih.gov/articles/PMC7217821/
- Rawat, A., Sangroula, N., Khan, A., et al. (2023). Comparison of Metacognitive Therapy Versus Cognitive Behavioral Therapy for Generalized Anxiety Disorder: A Meta-Analysis of Randomized Control Trials. Cureus, 15(5), e39252. https://pmc.ncbi.nlm.nih.gov/articles/PMC10277900/
Published by the makers of Heed, an app for practicing ATT-style sessions. iPhone · Android. Heed is a self-practice tool inspired by ATT research — not therapy, and not a medical device.