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Metacognitive Therapy for Anxiety and Depression


"This book explains the "whats" and "how-tos" of metacognitive therapy (MCT), a cutting-edge form of cognitive-behavioral therapy with a growing empirical evidence base. MCT originator Adrian Wells shows that much emotional distress results from how a person responds to negative thoughts and beliefs - for example, by ruminating or worrying - rather man the content of those thoughts. Helping people develop new relationships to their own thought processes is the focus of the approach. Rich with clinical wisdom, this authoritative guide covers
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"This book explains the "whats" and "how-tos" of metacognitive therapy (MCT), a cutting-edge form of cognitive-behavioral therapy with a growing empirical evidence base. MCT originator Adrian Wells shows that much emotional distress results from how a person responds to negative thoughts and beliefs - for example, by ruminating or worrying - rather man the content of those thoughts. Helping people develop new relationships to their own thought processes is the focus of the approach. Rich with clinical wisdom, this authoritative guide covers everything from theoretical underpinnings to procedures for assessment, intervention, and relapse prevention." "Initial chapters introduce the foundations of MCT, illuminating the role of metacognition in the development and maintenance of psychological problems. Vivid case examples and sample dialogues illustrate clear-cut ways to identify harmful patterns and explore them with patients. Presented are innovative, practical strategies for promoting change by using Socratic dialogue, behavioral experiments, metacognitive exposure, attention training, and detached mindfulness techniques. Chapters on specific disorders serve as mini-manuals for conceptualizing and treating generalized anxiety disorder, obsessive - compulsive disorder, posttraumatic stress disorder, and major depression. Throughout, commonalities and differences between MCT and standard cognitive-behavioral therapy are highlighted. Useful appendices provide reproducible questionnaires and rating scales, case formulation interviews, and session-by-session treatment plans." Grounded in research and real-world clinical experience, this book offers therapists of any orientation powerfulnew insights and tools for addressing tough-to-treat problems. It will be indispensable reading for clinical psychologists, psychiatrists, clinical social workers, and counselors, as well as students and trainees in these fields.
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Editorial Reviews

From the Publisher

"Wells has written a very important book, rich in clinical understanding and practical guidance. Metacognitive therapy is based on a well-developed and thoroughly tested model that addresses core disordered processes, including attentional bias and rumination. The procedures he describes will be enormously useful to therapists of all persuasions, and can form the bedrock of low-intensity and high-intensity interventions for a wide range of disorders."--Chris R. Brewin, PhD, Clinical, Educational, and Health Psychology, University College London, UK
"Metacognitive Therapy for Anxiety and Depression offers a strategy for addressing those well-learned and hard-to-fix thinking patterns that can be tough to change. As a clinician who has struggled with helping people work through dysfunctional thinking patterns, I can appreciate the usefulness of Wells's methods. Metacognitive therapy helps both the patient and the therapist take a step back from the sometimes repetitive work of cognitive therapy, and lends a new perspective with the potential for breaking through treatment roadblocks. Well done!"--Monica Ramirez Basco, PhD, PhD, Scientific Review Officer, National Institutes of Health
"The metacognitive model is based on years of research on the nature of different levels and processes of thinking underlying psychological disorders. Clinicians who read this revolutionary book will be able to utilize techniques found nowhere else. Intriguing, creative, and effective clinical strategies are illustrated with clear case examples that demonstrate how to modify recurrent patterns of rumination, worry, and overreliance on problematic processes of thinking. Chapters on specific disorders provide tools and conceptualizations that take the cognitive model in new and exciting directions. I highly recommend this brilliant contribution."--Robert L. Leahy, PhD, Department of Psychiatry, Weill Cornell Medical College, New York Presbyterian Hospital

"This book presents a new and innovative approach that focuses on how patients think, as much as what they believe. It is firmly grounded in basic science and packed full of powerful clinical strategies for helping people change the way they think. Wells shows how attention training and detached mindfulness techniques can be applied to a full array of anxiety and depressive disorders with impressive and lasting results. His approach will appeal to clinical practitioners, students, and mental health researchers alike, and should find widespread acceptance in the clinical community. It should prove to be a valuable tool for graduate training across professional disciplines."--Steven D. Hollon, PhD, Department of Psychology, Vanderbilt University


"Adrian Wells' publication of MCT is an excellent practical guide for practitioners and provides substantial scientific evidence. This book will be of great value to post-graduate students, researchers, academicians, clinicians, and practitioners."--Anxiety, Stress, and Coping

"In sum, MCT is a new and novel treatment and an exciting addition to the third wave of behavior therapy....Serves as a repository/summary of [Wells'] work to date—a treatment manual that combines his theories, conceptualizations, assessment measures, and interventions into a cohesive approach....Therapists trained in more traditional CBT will undoubtedly be very interested in how some of the MCT techniques might work with their current patients who are seemingly 'stuck' using more traditional cognitive techniques."--PsycCRITIQUES
Doody's Review Service
Reviewer: Christopher J Graver, PhD, ABPP-CN(Madigan Healthcare System)
Description: Cognitive therapy has been expanding by leaps and bounds. This is a guide to metacognitive therapy (MCT) straight from the originator of this new variant.
Purpose: The purpose is to provide readers with an introduction to metacognitive therapy, illustrate parallels and areas of divergence with traditional cognitive therapy, and to prepare therapists to employ the skills necessary for this approach.
Audience: Unsurprisingly, this book will be relevant and of interest to psychologists, psychiatrists, and other mental health workers, as well as students of these disciplines. As the originator of this therapy, Dr. Wells is the logical author of this book.
Features: It begins with an introduction to MCT and a discussion of a key difference between MCT and CBT, that of metacognitions. While the distinction is clear, the reason why CBT theory is not sufficient does not emerge as a clear component of this chapter. The next chapter discusses assessment within the context of MCT and then moves on to the basics of working with patients. Sample questions and dialogues are provided, similar to the classic CBT texts. These are continued throughout the chapters on MCT in the treatment of generalized anxiety disorder, PTSD, and major depression. While the chapters delve deeply into the approach particularly for the first few sessions, appendixes at the end provide a long-term structure. Examples of assessment instruments are also included for both symptoms and relevant MCT techniques, such as case formulation interviews. However, more in-depth examples and sample dialogues throughout the process would be welcome, as would a companion workbook. The references are current and the index is adequate, but missing some key terms.
Assessment: For readers who have already bought into the necessity of metacognitive therapy, this book provides a reasonable introduction to the approach, as well as tools to help implement it. On the other hand, readers seeking scientific literature on the approach and its status as an empirically supported treatment should continue their search elsewhere.
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Product Details

  • ISBN-13: 9781609184964
  • Publisher: Guilford Publications, Inc.
  • Publication date: 5/23/2011
  • Edition description: Reprint
  • Pages: 316
  • Sales rank: 1,029,486
  • Product dimensions: 5.90 (w) x 8.90 (h) x 1.00 (d)

Meet the Author

Adrian Wells, PhD, is Professor of Clinical and Experimental Psychopathology at the University of Manchester, United Kingdom, and Professor II in Clinical Psychology at the Norwegian University of Science and Technology, Trondheim, Norway. He is internationally known for his contributions to understanding psychopathological mechanisms and advancing cognitive-behavioral therapy, particularly for anxiety disorders. The originator of metacognitive therapy, Dr. Wells has published over 130 scientific papers, chapters, and books. He is Associate Editor of the journals Behavioural and Cognitive Psychotherapy and Cognitive Behaviour Therapy, and is a Founding Fellow of the Academy of Cognitive Therapy. Dr. Wells is a founder and director of the Metacognitive Therapy Institute and a patron of the charity Anxiety UK.

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Table of Contents

1. Theory and Nature of Metacognitive Therapy
2. Assessment
3. Foundation Metacognitive Therapy Skills
4. Attention Training Techniques
5. Detached Mindfulness Techniques
6. Generalized Anxiety Disorder
7. Posttraumatic Stress Disorder
8. Obsessive–Compulsive Disorder
9. Major Depressive Disorder
10. The Evidence for Metacognitive Theory and Therapy
11. Concluding Thoughts
1. Metacognitions Questionnaire 30 (MCQ-30)
2. Meta-Worry Questionnaire (MWQ)
3. Thought Fusion Instrument (TFI)
4. Attention Training Technique Summary Sheet
5. Self-Attention Rating Scale
6. CAS-1
7. Generalized Anxiety Disorder Scale—Revised (GADS-R)
8. Posttraumatic Stress Disorder Scale (PTSD-S)
9. Obsessive–Compulsive Disorder Scale (OCD-S)
10. Major Depressive Disorder Scale (MDD-S)
11. GAD Case Formulation Interview
12. PTSD Case Formulation Interview
13. OCD Case Formulation Interview
14. Depression Case Formulation Interview
15. GAD Treatment Plan
16. PTSD Treatment Plan
17. OCD Treatment Plan
18. Depression Treatment Plan
19. New Plan Summary Sheet

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