Understanding metacognitive therapy and patterns of attention
Learn how metacognitive therapy looks at worry, brooding, watching for threat and beliefs about thinking, and choose what you would like to discuss with your therapist.
Written by Tarun Vermani, Trainee Clinical Psychologist Last reviewed
Assign and Download open signup, then return you to this worksheet. No card required. Resource access depends on your plan or trial. Already have an account? Sign in
Worksheet preview
Understanding metacognitive therapy and patterns of attention
PreviewLive preview — type in any field to try it. Nothing is saved here.
Thinking about thinking
Metacognitive therapy (MCT) was developed by Adrian Wells. 'Metacognition' means thinking about thinking. Everyone has unwanted thoughts, doubts and worries, and most pass on their own. Difficulties can grow when we stay with these thoughts for a long time, keep watching for danger or try hard to control our thinking. This handout supports trained practice and does not replace it.
How the mind responds to a thought
Adrian Wells and Gerald Matthews described a model called the self-regulatory executive function, or S-REF. In everyday words, it has three parts. Thoughts and feelings pop up automatically. A deciding part of the mind chooses how to respond to them. Beliefs about thinking guide those choices, often without us noticing. Therapy looks most closely at the deciding part and the beliefs behind it.
When thinking gets stuck
Wells called the main unhelpful pattern the cognitive attentional syndrome, or CAS. It has three parts. The first is long spells of worry, going over 'what if' questions, or brooding, going over 'why' questions. The second is keeping attention fixed on possible threats, such as body sensations or how other people react. The third is ways of coping that backfire, such as pushing thoughts away, seeking reassurance, avoiding or checking. These can feel helpful at the time but keep the thoughts going. Fictional illustration: someone replays a chat with a neighbour all evening, looking for signs they caused offence. They ask their partner again and again whether it went well. The worry stays with them until bedtime.
Beliefs about thinking
Some beliefs say a thinking habit is useful, for example that worry keeps you ready or that going over the past will bring answers. Other beliefs say your thinking is out of your control or could harm you. Both kinds can keep a pattern going. In therapy, you look at these beliefs together, at a pace you agree. The aim is not to stop thoughts from coming. It is to change how much time and attention they take.
What sessions focus on
Therapy focuses less on whether each worry is true and more on how you respond to thoughts. You might look at how long you stay with a thought, where your attention goes and what you believe about thinking. Your therapist may introduce ways of practising a different response, such as noticing a thought without following it, or setting worry or brooding aside until later. They explain and guide these with you; this handout does not teach them. Thoughts will still come, and that does not mean therapy has failed.
Real problems still need action
Some worries are about real problems that need action now. Setting worry aside never means delaying help with safety, a health concern or a practical task. For example, a new symptom, or one that is changing, still needs checking with your GP. Your therapist can help you tell useful checks from checking that keeps worry going. If you are worried that someone is being harmed, tell your therapist or GP now. If anyone is in danger, call 999.
If your mood drops or worry becomes much harder to manage, contact your therapist or GP the same day.
Questions and support
This worksheet is for feelings you can manage. If you have urges to hurt yourself, or you feel unsafe, use your safety plan if you have one and tell your therapist. If you might act on the urges, call 999 or go to A&E. To talk to someone now, call Samaritans free on 116 123.
Try it here — nothing you type is saved. Sign up to assign it and let clients complete it on any device.
When to use ‘Understanding metacognitive therapy and patterns of attention’
‘Understanding metacognitive therapy and patterns of attention’ is a psychoeducation handout based on metacognitive therapy (MCT). Consider this resource when exploring beliefs about thinking, especially when a client feels drawn into worry or rumination or finds it difficult to shift their attention.
It is designed to be read within therapy rather than as a standalone self-help tool: a therapist introduces it and discusses it with the client. You can preview the full handout above, then assign it for clients to read between sessions on any device or download it as a print-ready PDF. Where a short reflection is included, it offers space to respond to the reading.
How it works
Most people work through it in around 10 minutes. It moves through six short sections to read:
- Thinking about thinking: Metacognitive therapy (MCT) was developed by Adrian Wells. 'Metacognition' means thinking about thinking. Everyone has unwanted thoughts,…
- How the mind responds to a thought: Adrian Wells and Gerald Matthews described a model called the self-regulatory executive function, or S-REF. In everyday words, it has three…
- When thinking gets stuck: Wells called the main unhelpful pattern the cognitive attentional syndrome, or CAS. It has three parts. The first is long spells of worry,…
- Beliefs about thinking: Some beliefs say a thinking habit is useful, for example that worry keeps you ready or that going over the past will bring answers. Other…
- What sessions focus on: Therapy focuses less on whether each worry is true and more on how you respond to thoughts. You might look at how long you stay with a…
- Real problems still need action: Some worries are about real problems that need action now. Setting worry aside never means delaying help with safety, a health concern or a…
The handout can be read on a phone, tablet or computer, or downloaded as a print-ready PDF. If it includes a reflection, answers entered on the Formulate platform are saved automatically and shared back with the therapist for review before the next session.
The MCT approach behind it
‘Understanding metacognitive therapy and patterns of attention’ draws on metacognitive therapy (MCT). MCT focuses on beliefs about thinking, such as whether worry is useful or feels uncontrollable. It explores worry and rumination as processes, rather than examining only the content of individual thoughts. Attention is part of this work: noticing where it goes, how it becomes fixed and what happens when the client relates differently to thoughts.
It is intended as one part of a wider course of therapy rather than as advice or a diagnosis. The therapist can help decide how it fits the work and discuss what emerges.
Evidence & sources
This handout draws on metacognitive therapy. Key sources include:
- Wells, A. (2009). Metacognitive Therapy for Anxiety and Depression. Guilford Press.
- Wells, A., & Matthews, G. (1994). Attention and Emotion: A Clinical Perspective. Lawrence Erlbaum Associates.
- Wells, A., & Matthews, G. (1996). Modelling cognition in emotional disorder: The S-REF model. Behaviour Research and Therapy, 34(11-12), 881-888.
For use alongside professional support
Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.
If you need urgent help now:
- Emergency services: 999 — if you or someone else is in immediate danger
- NHS 111 (NHS 24 in Scotland): 111 — choose the mental health option for urgent help, in England, Scotland and Wales (in Wales, press 2)
- Lifeline: 0808 808 8000 — for urgent help in Northern Ireland, free, day or night
- Samaritans: 116 123 — free, day or night, 365 days a year
- Shout: 85258 — text SHOUT, free, day or night
- SANEline: 0300 304 7000 — 4pm–10pm, every day
More Psychoeducation worksheets
View all Psychoeducation worksheets →Psychoeducation
Understanding the CBT model
An introduction to how thoughts, feelings, body sensations and behaviour connect in a loop, and how CBT uses this to help you feel differently.
Psychoeducation
The stress response: fight, flight or freeze
An explainer on how the body's threat system works, why the physical feelings of fear are uncomfortable but not harmful in themselves, and why false alarms happen. Based on Cannon (1915) and Clark and Beck (2010): adds a symptom checklist and general psychoeducation.
Psychoeducation
Understanding Core Beliefs
A plain-language explainer on the levels of thinking in CBT: automatic thoughts, underlying assumptions, and the deep core beliefs about ourselves, others, and the world.
Psychoeducation
The window of tolerance
A plain-language guide to your window of tolerance: the zone where you can think, feel and cope. It shows what it looks like to go above it (overwhelmed) or below it (shut down). Based on Siegel (1999) and Ogden, Minton and Pain (2006): adds checklists of your own signs and ways to come back.
Psychoeducation
The three emotion systems
A simple introduction to the three systems that shape our feelings: threat, drive, and soothe. Learn why modern life and self-criticism can leave the soothe system underused, and how compassion helps bring them back into balance. Simplified from Gilbert (2009): covers the three systems and a short menu of soothing practices, not the full compassionate mind training.
Psychoeducation
Naming your emotions
Putting accurate words to feelings can lower how strong they feel. This handout explains the idea of name it to tame it and gives you an emotion-word list, from basic feelings to more precise ones. Based on Lieberman et al. (2007) and Ekman (1992): adds a word list in our own words, grouped by basic emotion.
Want to assign this to a client?
Create a free therapist account to use the homework and library download tools. Clients can complete assigned homework online or use a blank PDF. See how the homework workflow works.
No card required. The Free plan includes 10 worksheet uses a month. Check plan access and limits.