By Lisa Rice-Rickman, Registered Nurse and Clinical Hypnotherapist (Pymble, NSW, and telehealth)
Worry is a common part of life in Australia. The Australian Bureau of Statistics’ National Study of Mental Health and Wellbeing 2020 to 2022 found that 17.2 per cent of Australians aged 16 to 85 had an anxiety disorder in the previous 12 months, making anxiety the most common group of mental disorders. Overall, 21.5 per cent had experienced any mental disorder in that period.
Numbers like these remind us that many people live with racing thoughts, stress and tension, and that these experiences are not a personal failing. Alongside professional care, many people are interested in a skill called metacognition: the ability to notice and understand your own thinking. This article explains what it is, why it matters, and how it can fit into a broader approach to wellbeing.
What is metacognition?
In short: metacognition means thinking about your own thinking. It is the ability to step back, notice what your mind is doing, and decide whether a thought, belief or habit is helping you. The term was developed by developmental psychologist John Flavell in the 1970s, and it is now widely used in psychology and education.
Metacognition usually involves three things: monitoring (noticing what you are thinking and feeling), evaluating (asking whether that thought is accurate or useful), and adjusting (choosing how to respond). Researchers link these skills with brain networks involved in attention, planning and self-reflection, including parts of the prefrontal cortex. This is an active area of research, and there is still a lot we do not know.
Metacognition is closely related to ideas you may have heard of, such as self-awareness, mindfulness and emotional regulation. They overlap, but they are not identical. Mindfulness, for example, focuses on observing the present moment, while metacognition is about understanding how your thinking works.
Why does noticing your thinking matter?
Much of our day runs on habit. We react to a message, a tone of voice or a sensation in the body without stopping to ask what is going on. Habits are useful, but some thought patterns can be unhelpful, such as replaying a conversation at 3am, assuming the worst, or telling yourself “I always get this wrong”.
Noticing a thought is the first step to relating to it differently. When you can say “I am having the thought that I cannot cope”, you create a small gap between you and the thought. In that gap, you may have more room to choose how to respond. This is a skill that can be practised, and many people find it becomes easier over time.
How is metacognition linked to anxiety?
Psychologist Adrian Wells has proposed that it is not only the content of a worry that keeps anxiety going, but also the beliefs we hold about our thinking. Examples include “I cannot control my worry” or “worrying is dangerous”. Wells’ metacognitive model, set out in his 2009 book, led to metacognitive therapy, a psychological therapy delivered by suitably trained mental health professionals.
The key idea is that learning to observe thoughts without getting caught up in them can change how much power they seem to have. This is general information about how researchers think about anxiety. It is not a substitute for assessment and care from your GP or a psychologist.
Is there a connection between the mind and the gut?
Yes. The gut and the brain communicate in both directions, a link often called the gut-brain axis. Stress and strong emotions can affect digestion for many people, and gut symptoms can in turn affect mood and attention.
It is important to say clearly that conditions such as irritable bowel syndrome (IBS) have real physical features. Symptoms are not “all in your head”, and they are not caused by thinking in a particular way. If you have ongoing digestive symptoms, see your GP first to rule out other causes.
For people who have already had a medical assessment, psychological approaches may be one part of managing IBS. A 2020 systematic review and network meta-analysis published in the journal Gut (Black and colleagues) found that several psychological therapies were efficacious for IBS, with cognitive behavioural therapy and gut-directed hypnotherapy having the largest evidence base. The authors also noted that many of the trials had a high risk of bias and that the benefit may be overestimated. In other words, the findings are encouraging, but they are not a guarantee for any one person.
Where does hypnotherapy fit in?
Hypnosis is a state of focused attention in which a person is usually more open to guided suggestions. In clinical hypnotherapy, a trained practitioner guides you into this state in a safe setting and uses imagery, relaxation and suggestion to work toward goals you have agreed together.
Some people find that the focused, calm state helps them observe thoughts, sensations and feelings from a little distance. That experience can feel similar to the “step back” quality of metacognition. Brain imaging research on hypnosis is interesting, but it is still early, and it does not tell us that hypnotherapy suits everyone or works the same way for every condition.
The evidence for hypnotherapy varies. It is strongest for IBS, as described above, and more limited for many other concerns. Hypnotherapy is not a substitute for medical care, and it may not be suitable for everyone, so it is important to tell your practitioner about your health history and any current treatment.
Some practitioners, including me, also use techniques drawn from neuro-linguistic programming (NLP) and visualisation to help clients reflect on beliefs and patterns. The research evidence for these methods is more limited than for approaches such as cognitive behavioural therapy, so they are best seen as one option among several rather than a proven treatment.
Simple ways to build metacognitive awareness
These are general ideas, not a treatment plan, and they will not suit everyone.
- Name the thought. Try “I am having the thought that...” instead of treating the thought as a fact.
- Check in with your body. Notice where you feel tension, tightness or restlessness. The body often signals stress before the mind catches up.
- Pause and breathe. A few slow breaths can create a moment of space before you react.
- Write it down. A few lines in a journal about what happened, what you thought and what you did can make patterns easier to see.
- Ask a helpful question. “Is this thought helpful right now?” is often more useful than “Is this thought true?”
When to seek support
Consider speaking with your GP or another qualified health professional if worry, low mood or physical symptoms are affecting your sleep, relationships, work or daily life, or if symptoms are new, severe or getting worse. A GP can also help you decide which kinds of support may suit you.
If you are in distress, call Lifeline on 13 11 14 or Beyond Blue on 1300 22 4636. In an emergency, call 000.
Frequently asked questions
What is metacognition in simple terms?
It is thinking about your own thinking: noticing what is going on in your mind and deciding how you want to respond.
Is metacognition the same as mindfulness?
They are related but not the same. Mindfulness focuses on paying attention to the present moment, while metacognition is about understanding and evaluating your own thought processes. Many people find the two skills support each other.
Can metacognition help with anxiety?
Metacognitive approaches are used in psychological therapy for anxiety, and learning to observe thoughts can be a useful skill for some people. Results vary, and anxiety that affects daily life should be assessed by a health professional.
Does hypnotherapy work for irritable bowel syndrome?
Research suggests gut-directed hypnotherapy may help some people with IBS, although the quality of the studies varies. It is best considered after a medical assessment and alongside advice from your GP.
Is hypnotherapy safe?
Hypnotherapy is generally considered low risk when delivered by a trained practitioner, but it is not suitable for everyone. Always tell your practitioner about your health history, including any mental health conditions and medications.
About the author
Lisa Rice-Rickman is a Registered Nurse (AHPRA registration NMW0001617979), a clinical hypnotherapist and a practitioner of NLP, with a Bachelor of Science (Honours) in Health Psychology. She is based in Pymble, NSW, and offers telehealth. View Lisa’s Health Hunter profile to learn more or request an appointment.
This article is general information only and is not a substitute for advice from a qualified health professional. It does not consider your personal circumstances.
References
- Australian Bureau of Statistics (2023). National Study of Mental Health and Wellbeing, 2020 to 2022, media release 5 October 2023. https://www.abs.gov.au/media-centre/media-releases/two-five-australians-have-experienced-mental-disorder
- Flavell, J. H. (1979). Metacognition and cognitive monitoring: a new area of cognitive-developmental inquiry. American Psychologist, 34(10), 906 to 911.
- Wells, A. (2009). Metacognitive Therapy for Anxiety and Depression. Guilford Press.
- Black, C. J., Thakur, E. R., Houghton, L. A., Quigley, E. M. M., Moayyedi, P., & Ford, A. C. (2020). Efficacy of psychological therapies for irritable bowel syndrome: systematic review and network meta-analysis. Gut, 69(8), 1441. https://gut.bmj.com/content/69/8/1441
