Metacognition and Cognitive-Behaviour Therapy: A Special Issue

Adrian Wells1* and Christine Purdon2

1Manchester University, Manchester, UK2University of Waterloo, Canada

Cognitive-behavioural approaches explaining thedevelopment and persistence of psychologicaldisorder have resulted in the development ofsome of the most effective treatment interventionsto date. However, there is still much to accomplishin understanding and treating psychological dis-order. Moreover, a number of recent theorists haveemphasized the limitations of general cognitivetheory such as Schema theory, and have suggestedrevised frameworks for conceptualizing cognitionin emotional dysfunction.

Cognitive-behavioural approaches have tended tofocus on a limited range of cognition in explainingpsychological disorder. In particular, the focus hasbeen dominated by a consideration of the content ofthoughts and beliefs rather than cognitive processessuch as attention. It is also unclear how key aspectsof cognition such as beliefs and their effects oninformation processing should be represented ininformation processing terms. Beliefs about thesocial and physical self figure predominantly incognitive models of anxiety and depression, andtreatment focuses on modifying the content of theseanxiogenic or depressogenic thoughts and beliefs.However, there are many other categories ofbelief and self-knowledge, such as the knowledgethat individuals have about their own thinking.Such knowledge undoubtedly imparts an effecton appraisals and behaviour, two key variablesimplicated in the maintenance of psychologicaldisorder.

It is our view that a consideration of the area ofmetacognition will allow us to proceed beyondthese limitations. Flavell (1979) introduced the term`meta-cognition' in the context of developmentalpsychology to describe the cognitive processesand structures that monitor and control aspects of

cognition. Metacognition is the aspect of theinformation processing system that monitors, inter-prets, evaluates, and regulates the contents andprocesses of its own organization. According toFlavell (1979) and Moses and Baird (1998), there aretwo general components of metacognition, that theyreferred to as `meta-cognitive knowledge' and`metacognitive regulation'. Metacognitive knowl-edge consists primarily of knowledge or beliefsabout the factors that affect the course and outcomeof cognitive enterprises. This knowledge may beaccurate or inaccurate and, like other types ofinformation stored in memory, can be triggeredunintentionally by retrieval cues. Once activated,metacognitive knowledge is likely to influence thecourse of thought processes. Metacognitive regula-tion refers to a number of executive functions, suchas planning, resource allocation (i.e. selective atten-tion), monitoring, checking, and error detection andcorrection, which in turn reflect either monitoringor control processes. The monitoring process keepstrack of ongoing cognition, whereas the controlprocess modifies ongoing cognitive (e.g. by shiftingattentional focus). The control and monitoringprocesses interact with metacognitive knowledge.

Recent models of psychopathology, particularlyobsessive-compulsive disorder, have begun toemphasize the role of beliefs about one's thoughtsand appraisal of thoughts themselves in thedevelopment and persistence of the disorder, andthis emphasis has proven valuable in advancing ourunderstanding and treatment of emotional prob-lems. However, such models have not focused onthe metacognitive elements of these beliefs/apprai-sals explicitly. In independent writings we haveargued for a specific consideration of metacognitionin theoretical and treatment approaches to psycho-logical disorder. There are several potential advant-ages to explicitly examining metacognition in thiscontext. In a broader context metacognition hasbeen conceptualized as general purpose plans that

CCC 1063±3995/99/020071±02$17.50Copyright # 1999 John Wiley & Sons, Ltd.

Clinical Psychology and PsychotherapyClin. Psychol. Psychother. 6, 71±72 (1999)

*Correspondence to: Dr A Wells, University of Manchester,Dept. of Clinical Psychology, Rawnsley Building, ManchesterRoyal Infirmary, Oxford Road, Manchester M13 9WL, UK.

guide information processing, and maintain mal-adaptive processing configurations responsible foremotional vulnerability, such as those typified byrumination and threat monitoring (Wells andMatthews, 1994, 1996). It follows from this thatthe effectiveness of cognitive therapy may beenhanced by strategies that retrain metacognitiveregulation and monitoring processes. Furthermore,general beliefs about the functioning of mind couldplay a considerable role in how specific thoughtevents are interpreted and responded to. Suchbeliefs would have obvious relevance to emotionaldisorder that is characterized by the persistentrecurrence of unwanted thoughts.

Through this Special Issue we aim to increase theprofile of metacognition as an area of investigationin Cognitive Therapy. To this end we have invitedcontributions from eminent researchers who havebeen working in areas that we believe are directly orindirectly related to metacognition and can help inachieving this aim. In this Special Issue, Nelson andStuart present an extension of theory on metacogni-tion in emotional regulation. Rachman and Shafrandelineate the role of Thought Action Fusion, a typeof cognitive distortion, in obsessions. Wells presentshis metacognitive model and treatment of general-ized anxiety disorder, and reviews evidence for themodel. Bouman and Meijer present a study ofmetacognition and worry specificity in hypo-chondriasis. Purdon and Clark examine the role ofmetacognition in obsessive-compulsive disorderand consider the roles of ego-dystonicity and exces-sive thought control efforts. Matthews, Hillyard andCampbell report a study of metacognition andmaladaptive coping in which both are componentsof Test Anxiety. Borkovec, Hazlett-Stevens, andDiaz discuss the role of positive beliefs about worryin generalized anxiety disorder and in treatment.Emmelkamp and Aardema present an empiricalstudy testing specific relationships between meta-cognitive beliefs and obsessive-compulsive symp-toms. Teasdale examines metacognition andmindfulness and their relevance to preventingdepressive relapse. Finally, Papageorgiou andWells present a study comparing the processand metacognitive dimensions of depressive and

anxious thoughts and their associations withemotional intensity.

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Papageorgiou, C. and Wells, A. (1999). Process and meta-cognitive dimensions of depressive and anxiousthoughts and relationships with emotional intensity.Clinical Psychology and Psychotherapy, 6, 156±162.

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Copyright # 1999 John Wiley & Sons, Ltd. Clin. Psychol. Psychother. 6, 71±72 (1999)

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