Metacognitive therapy (MCT)
A structured method for reducing worry and rumination – available individually, in groups or online.
Metacognitive therapy (MCT) is a psychological treatment method that focuses on the way a person relates to their thoughts, rather than on the content of the thoughts themselves. The method was developed by Professor Adrian Wells at the University of Manchester and is used for anxiety, depression, stress, racing thoughts and OCD. At Charlottenlund Private Hospital, treatment is provided by authorised psychologist Sarah Østergaard Kokholm, who is MCT-I certified by the MCT Institute, and is offered individually, as a group programme in Charlottenlund and online.
Clinically responsible: Sarah Østergaard Kokholm, authorised psychologist · Reviewed September 2026
What is metacognitive therapy?
Metacognitive therapy is a form of talking therapy that reduces worry and rumination by changing the way a person relates to their thoughts. The method is based on the principle that psychological distress is not caused by negative thoughts themselves, but by the amount of time and attention devoted to them. Everyone has worrying or sad thoughts. The problem arises when a person responds to them with persistent worry, rumination, threat monitoring or attempts to control their thoughts, what Wells calls the cognitive attentional syndrome.
In therapy, you learn to recognise these patterns and allow thoughts to pass without engaging with them. The treatment includes attention training, postponing worry and working with the beliefs you have about your own thoughts, for example that worrying is useful or that rumination is impossible to stop. The method is described as transdiagnostic because the same mechanisms occur across anxiety, depression and stress.
How does MCT differ from cognitive behavioural therapy?
Cognitive behavioural therapy (CBT) focuses on the content of thoughts, while metacognitive therapy focuses on the relationship to them. In CBT, you examine whether a thought is realistic and challenge it. In MCT, the content of thoughts is not analysed; instead, you learn to spend less time engaging with them. An MCT session therefore typically does not involve reviewing the past or discussing in detail what the thoughts are about. Both methods are structured and time-limited, and both are used at Charlottenlund Private Hospital. The choice depends on the individual problem.
| – | Cognitive behavioural therapy (CBT) | Metacognitive therapy (MCT) |
|---|---|---|
| Focus | The content of thoughts | The relationship to thoughts |
| Works with | Examining and challenging negative thoughts and changing behaviour that maintains the problem | Spending less time worrying and ruminating and managing attention |
| Typical content of a session | Review of specific situations and thoughts, behavioural experiments | Attention training, postponed worry, working with beliefs about one’s own thoughts |
| Developed by | Aaron T. Beck, 1960s | Adrian Wells, University of Manchester |
| Recommendation for anxiety (NCG 2021) | Recommended first-line treatment | Not routinely recommended as first-line treatment for generalised anxiety; effectiveness compared with CBT remains uncertain |
| Formats at Charlottenlund Private Hospital | Individual, online | Individual, group programme, online |
What does the research say about metacognitive therapy?
Meta-analyses from 2018 and 2024 show that metacognitive therapy reduces symptoms of anxiety and depression. The systematic review from the University of Copenhagen and Universität Münster (Normann & Morina, 2018) reviewed 25 studies, including 15 randomised trials with a total of 681 participants, and found an effect compared with both waiting-list controls and other active treatments. An updated meta-analysis (2024) including 21 MCT studies confirms the findings but calls for more large-scale studies.
The Danish Health Authority’s national clinical guideline for anxiety disorders in adults (2021) recommends cognitive behavioural therapy as the first-line treatment and assesses that it remains uncertain whether metacognitive therapy has the same effect for generalised anxiety. MCT is therefore not routinely recommended as the first-line treatment for this group. We provide clear information about what the evidence shows for the individual condition before treatment is chosen.
Who may benefit from metacognitive therapy?
Metacognitive therapy is suitable for racing thoughts and persistent worry, anxiety, depression, stress and OCD, as well as sleep problems where rumination keeps a person awake. Metacognitive treatment is often suitable for people who feel that they “think too much” and who want a concrete, structured approach without having to go through their life history. MCT is also used for children and adolescents in an adapted form. Whether the method is appropriate is always assessed during the initial consultation.
What does an MCT treatment programme at Charlottenlund Private Hospital involve?
An MCT treatment programme consists of an initial consultation, an agreed number of structured sessions with exercises and homework, and a final plan for maintaining what has been learned. During the initial consultation, the psychologist assesses the problem and the patterns that maintain it, and an expected number of sessions and a clear treatment goal are agreed. The techniques are practised in everyday life between sessions. The number of sessions in MCT depends on the individual problem and is assessed continuously. Treatment is always individualised.
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Initial consultation
We assess your situation, your symptoms and what you would like to achieve from the treatment.
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Plan and goals
Together, we agree on an expected number of sessions and a clear goal for the treatment programme.
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Sessions
Individually in Charlottenlund, online or as part of a metacognitive group programme. The number of sessions is assessed continuously.
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Review
We conclude with a review and a plan for how you can maintain what you have learned.
Individual, group or online – which is most suitable?
Metacognitive therapy is offered in three formats: individually, as a group programme in Charlottenlund and online. Individual therapy makes it possible to work with the individual person’s specific patterns and is suitable for all types of problems. The metacognitive group programme in Charlottenlund works with the same techniques in a small group; because the focus is on the way participants relate to their thoughts, they do not need to share personal details. Metacognitive therapy online follows the same structure as in-person treatment via a secure connection and is suitable for people who live far away or prefer to participate from home. The format is selected during the initial consultation.
Individual therapy
One-to-one sessions focusing on the individual person’s patterns.
- Suitable for
- All types of problems
- Where
- Charlottenlund or online
Group programme
The same techniques in a small group. The focus is on the relationship to thoughts, and participants do not share personal details.
- Suitable for
- Racing thoughts, worry, stress, anxiety
- Where
- Charlottenlund
Online
The same structure as in-person treatment via a secure connection, individually or in a group.
- Suitable for
- Long travel distances or a preference for participating from home
- Where
- From home, nationwide
Who provides the treatment?
Metacognitive therapy at Charlottenlund Private Hospital is provided by Sarah Østergaard Kokholm, authorised psychologist and cand.psych. She holds specialist accreditation from the Danish Psychological Association and is MCT-I certified by the MCT Institute in Manchester following a two-year specialisation under the founder of the method, Professor Adrian Wells. As a metacognitive psychologist, she receives ongoing supervision in the method as part of her certification.
Do you need a referral, and how much does it cost?
No referral is required for self-paying patients, and appointments can be booked directly. Prices for the initial consultation, subsequent sessions and group programmes are listed in the price list. Some patients attend through private health insurance; insurance companies generally require prior approval. Psychological treatment at Charlottenlund Private Hospital is not covered by the public health insurance subsidy for psychological treatment or by the extended free choice of hospital scheme.
Treatment at Charlottenlund Private Hospital
Charlottenlund Private Hospital is located in Charlottenlund and has medical specialists and authorised psychologists. Appointments can be booked online around the clock or by telephone on 44 98 19 21, Monday to Friday from 08:00 to 14:00. Outside telephone opening hours, the digital telephone assistant Anna can book, cancel and reschedule appointments and answer general questions. Email: info@chph.dk.
What is metacognitive therapy in brief?
A psychological treatment method that changes the way a person relates to their thoughts instead of working with the content of the thoughts. The aim is to spend less time worrying and ruminating.
What is the difference between metacognitive therapy and cognitive therapy?
Cognitive behavioural therapy challenges the content of thoughts; metacognitive therapy changes the relationship to thoughts without analysing them.
What is the criticism of metacognitive therapy?
Many of the studies are small, and only a few compare MCT directly with cognitive behavioural therapy. The Danish Health Authority therefore remains cautious about its use for generalised anxiety until larger studies are available.
What are the criticisms of metacognitive therapy?
That many of the studies are small, and that few compare MCT directly with cognitive behavioural therapy. Therefore, the Danish Health Authority advises caution regarding generalized anxiety until larger studies are available.
Can you do metacognitive exercises on your own?
Attention training and postponed worry can be practised at home, and homework is a regular part of the treatment programme. For persistent symptoms, it is recommended that the exercises are completed as part of a treatment programme with a psychologist.
Can metacognitive therapy be used for OCD?
Yes. MCT works with the beliefs that maintain obsessive thoughts and compulsive behaviours. Whether the method is appropriate is assessed during the initial consultation.
Can metacognitive therapy be used for ADHD?
Metacognitive therapy does not treat ADHD itself, but it can help with worry, rumination and stress that often accompany it. ADHD assessment is a separate evaluation.
Do you offer metacognitive therapy for children and adolescents?
Yes, in a form adapted to their age and together with their parents.
How many sessions should you expect?
It depends on the individual issue and is agreed during the initial consultation. MCT treatment programmes are typically shorter and more focused than many other forms of therapy, but treatment is always tailored to the individual.
Can you have metacognitive therapy online?
Yes. Both individual sessions and group programmes are offered online via a secure connection.