Metacognitions Questionnaire (MCQ-65)

1. Abstract

The Metacognitions Questionnaire (MCQ-65) is a 65-item self-report multidimensional assessment instrument developed by Adrian Wells and Susannah Cartwright-Hatton (1997) to measure individual differences in metacognitive beliefs, cognitive monitoring, and cognitive self-awareness. Founded upon the Self-Regulatory Executive Function (S-REF) model of psychological disorders, the instrument conceptualizes psychological distress not merely as an accumulation of negative automatic thoughts, but as the consequence of perseverative cognitive styles governed by metacognitive knowledge and regulation. The scale is organized into five robust factor-analytically derived subscales: (1) Positive Beliefs about Worry, which assesses the extent to which an individual believes perseverative thinking aids problem solving and coping; (2) Negative Beliefs about the Uncontrollability and Danger of Worry, which evaluates assessments that worrying thoughts are catastrophic, hazardous to physical or mental health, and beyond voluntary regulation; (3) Cognitive Confidence, measuring the individual’s subjective appraisal of their own memory and attentional efficacy; (4) Negative Beliefs Concerning the Need to Control Thoughts (including themes of superstition, responsibility, and punishment); and (5) Cognitive Self-Consciousness, capturing the tendency to continually monitor and attend to one’s internal cognitive processes. Each item is rated on a 4-point Likert scale ranging from 1 (Do not agree) to 4 (Agree very much). Psychometric investigations across diverse non-clinical and psychiatric cohorts confirm that the MCQ-65 possesses good to excellent internal consistency (subscale Cronbach’s alphas typically ranging from .72 to .89, with a total scale alpha exceeding .90), adequate to very good test-retest reliability across multi-week intervals, and strong convergent, discriminant, and incremental validity in predicting symptoms of generalized anxiety disorder, obsessive-compulsive disorder, hypochondriasis, and major depression.

2. Keywords

Metacognitions Questionnaire, MCQ-65, metacognition, metacognitive therapy, Self-Regulatory Executive Function, cognitive attentional syndrome, worry, cognitive self-consciousness, cognitive confidence, thought control

3. Authors

The Metacognitions Questionnaire was conceptualized and developed by:

• Adrian Wells, Ph.D. — Professor of Clinical and Experimental Psychopathology, Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, United Kingdom; Honorary Consultant Clinical Psychologist, Greater Manchester Mental Health NHS Foundation Trust. Pioneer of Metacognitive Therapy (MCT) and the S-REF framework.
• Susannah Cartwright-Hatton, D.Phil., Clin.Psy.D. — Professor of Clinical Child Psychology, School of Psychology, University of Sussex, United Kingdom; formerly affiliated with the Department of Clinical Psychology, University of Manchester.

Historical Correspondence & Inquiries: Dr. Adrian Wells, University of Manchester, Academic Division of Clinical Psychology, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL, United Kingdom.

4. Purpose

The Metacognitions Questionnaire (MCQ-65) was designed to bridge a prominent conceptual gap in traditional cognitive-behavioral paradigms. Standard cognitive models typically emphasize the content of cognition (such as cognitive distortions, conditional schemas, or automatic negative thoughts). In contrast, the MCQ-65 assesses metacognition—that is, the cognitive processes and enduring declarative and procedural beliefs that monitor, evaluate, interpret, and regulate thinking itself. The instrument systematically tracks how individuals interpret their internal cognitive experiences, why they engage in repetitive, iterative thinking patterns such as worry and rumination, and why they maintain unhelpful internal control strategies.

In clinical practice, the MCQ-65 serves as a core diagnostic and case conceptualization tool within Metacognitive Therapy (MCT). It enables clinicians to map the primary drivers of the Cognitive Attentional Syndrome (CAS), a transdiagnostic cognitive state characterized by prolonged worry, rumination, attentional threat monitoring, and counterproductive coping strategies (such as experiential avoidance or thought suppression). By isolating elevations across the instrument’s five domains, clinicians can determine whether a patient is driven primarily by positive beliefs that worry is an indispensable planning mechanism (e.g., “Worrying helps me to avoid disastrous situations”) or by terrifying negative metacognitions that worrying can precipitate somatic collapse or psychosis (e.g., “My worrying could make me go mad”). This functional profiling guides targeted metacognitive restructuring, challenging the perceived benefits and hazards of sustained mental rumination.

In research contexts, the MCQ-65 has catalyzed empirical investigations into the transdiagnostic mechanisms underlying mood, anxiety, and obsessive-compulsive spectra. Path-analytic, structural equation modeling, and longitudinal designs employ the MCQ-65 to dissect the mediation pathways between adverse life events, genetic predispositions, and clinical presentations of generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), health anxiety, major depressive disorder (MDD), and psychosis. By isolating cognitive self-consciousness and cognitive confidence from raw affective symptoms, researchers can systematically examine whether poor memory performance in anxious populations represents genuine neurocognitive impairment or, rather, metacognitive self-doubt induced by elevated monitoring.

5. Psychological Construct

The construct of metacognition operationalized in the MCQ-65 consists of five distinct, functionally interrelated cognitive-attentional dimensions:

Positive Beliefs about Worry

This dimension encompasses an individual’s explicit declarative appraisals that perseverative thinking serves an advantageous, protective, or preparatory role. Individuals scoring high on this subscale endorse beliefs that worrying facilitates effective problem solving, prevents catastrophic future outcomes, promotes personal organization, and signals conscientiousness or moral depth (e.g., “Worrying helps me cope”; “Worrying is a sign of a good person”). Within the clinical architecture of anxiety, positive metacognitive beliefs motivate the voluntary initiation and maintenance of worry episodes whenever potential threats are detected.

Negative Beliefs about the Uncontrollability and Danger of Worry

Often termed “Type 2 Worry” or meta-worry, this construct captures beliefs that intrusive perseverative thoughts operate outside of volitional control and exert hazardous, somatic, or psychiatric consequences. Items measure apprehensions that prolonged mental distress will induce physical disease, severe physiological strain, structural mental decompensation, or total insanity (e.g., “My worrying is dangerous for me”; “My worrying thoughts persist, no matter how I try to stop them”; “My worrying could make me go mad”). According to metacognitive theory, these negative appraisals convert transient worry into an acute crisis, producing elevated physiological arousal and intensifying distress.

Cognitive Confidence

This subscale assesses subjective appraisals regarding the dependability, accuracy, and operational efficiency of one’s memory and attentional faculties. Rather than measuring objective neurocognitive capacity, this domain evaluates metacognitive trust (e.g., “I do not trust my memory”; “I have little confidence in my memory for words and names”; “I have difficulty knowing if I have actually done something or just imagined it”). Low cognitive confidence plays an etiologic role in compulsive checking behaviors, repetitive questioning, and pervasive decision-making paralysis, as individuals attempt to compensate for perceived cognitive deficits through redundant verification.

Negative Beliefs Concerning the Need to Control Thoughts

This dimension reflects core beliefs regarding the imperative necessity to regulate, suppress, or neutralize unwanted mental phenomena, intertwined with themes of magical thinking, responsibility, and metaphysical punishment. Respondents endorsing these items view uncontrollable cognitive events as moral failings, signs of profound personal weakness, or predictive indicators of imminent harm (e.g., “If I do not control a worrying thought, and then it happened, it would be my fault”; “I could be punished for not having certain thoughts”; “I should be in control of my thoughts all of the time”). Such beliefs fuel maladaptive thought-suppression efforts, paradoxical cognitive rebounds, and compulsive neutralizing rituals.

Cognitive Self-Consciousness

This factor measures an individual’s chronic tendency to focus attention inwardly, scrutinizing, analyzing, and self-monitoring cognitive operations as they unfold (e.g., “I think a lot about my thoughts”; “I am constantly aware of my thinking”; “I monitor my thoughts”). While basic attentional monitoring is an adaptive component of self-regulation, excessive cognitive self-consciousness creates an internal processing bottleneck. It diverts finite executive bandwidth away from external reality, heightens the subjective salience of normative intrusive thoughts, and sustains the Cognitive Attentional Syndrome.

6. Theoretical Framework

The Metacognitions Questionnaire is grounded in the Self-Regulatory Executive Function (S-REF) model formulated by Adrian Wells and Gerald Matthews (1994, 1996). The S-REF architecture describes cognitive processing across three interconnected levels:

1. A Lower-Level, Automated, Stimulus-Driven Network: Operating largely outside conscious awareness, this system rapidly extracts salient information from environmental and internal cues, triggering primitive affective markers and spontaneous intrusive thoughts.
2. An Intermediate-Level, Supervisory, Conscious Processing System (The S-REF): This level allocates voluntary attention, executes problem-solving routines, directs coping behaviors, and actively manipulates verbal and propositional memory to resolve perceived discrepancies between the individual’s current state and their desired goals.
3. A Higher-Level Metacognitive Knowledge Store: Comprising both implicit procedural knowledge (rules governing the direction and allocation of processing resources) and explicit declarative knowledge (propositional beliefs concerning the properties, meaning, and power of thoughts).

According to the S-REF model, psychopathology does not emerge simply because negative automatic thoughts enter the stream of consciousness. Intrusions occur universally across healthy and clinical populations. Emotional disorders develop when these intrusions activate the Cognitive Attentional Syndrome (CAS). The CAS consists of three primary, mutually reinforcing components:

• Perseverative Thinking: Sustained verbal chains of prospective “what if” questions (worry) or retrospective self-critical evaluations (rumination).
• Attentional Threat Monitoring: Hypervigilant scanning of internal somatic cues, cognitive efficiency, or external stimuli for signs of danger.
• Maladaptive Coping Behaviors: Avoidance, thought suppression, alcohol use, and reassurance-seeking that prevent the natural disconfirmation of perceived threat.

The MCQ-65 directly assesses the declarative metacognitive beliefs stored in the top-level cognitive architecture that drive and sustain the CAS. Positive metacognitive beliefs initiate perseverative processing when an intrusion arises, while negative metacognitive beliefs cause individuals to appraise their ongoing worry as uncontrollable and catastrophic. Consequently, the metacognitive model shifts the therapeutic target from the content of cognitions (“Is the plane likely to crash?”) to the metacognitive regulation of cognitive styles (“Is worry uncontrollable? Does scanning my thoughts keep me safe?”).

7. Validity

The construct, convergent, discriminant, and predictive validity of the MCQ-65 have been confirmed across clinical, university, and community samples.

Construct and Factorial Validity

In the seminal validation study by Cartwright-Hatton and Wells (1997), exploratory factor analysis supported a robust five-factor structure accounting for a substantial proportion of total variance. Confirmatory factor analytic investigations across international cohorts (e.g., Spada et al., 2008) have replicated this five-factor latent structure. These findings confirm that while the subscales share modest-to-moderate intercorrelations, they represent empirically distinct facets of metacognitive architecture.

Convergent Validity

The subscales of the MCQ-65 correlate strongly with established measures of trait anxiety, pathological worry, obsessive-compulsive symptomatology, and depressive rumination. The Negative Beliefs about Uncontrollability and Danger subscale routinely demonstrates substantial positive correlations with the Penn State Worry Questionnaire (PSWQ) ($r = .55$ to $.72$) and the State-Trait Anxiety Inventory (STAI-Trait) ($r = .50$ to $.68$). The Cognitive Confidence subscale exhibits significant negative associations with self-rated cognitive competence and moderate correlations with obsessive-compulsive checking dimensions on the Maudsley Obsessional-Compulsive Inventory (MOCI). Furthermore, the Need to Control Thoughts subscale correlates positively with the Thought-Action Fusion (TAF) Scale and various indices of thought suppression (e.g., the White Bear Suppression Inventory).

Discriminant and Incremental Validity

Crucially, multiple hierarchical regression studies demonstrate that the MCQ-65 accounts for significant incremental variance in generalized anxiety and depressive symptom severity after controlling for traditional cognitive vulnerability markers, neuroticism, and baseline negative affectivity. Cartwright-Hatton and Wells (1997) observed that clinical cohorts diagnosed with generalized anxiety disorder, panic disorder, or major depressive disorder scored significantly higher across the MCQ-65 dimensions—most notably on uncontrollability, danger, and need for control—compared to non-clinical controls. The instrument discriminates well between normative worry and clinical meta-worry, confirming its utility in clinical assessment.

8. Reliability

The MCQ-65 demonstrates strong psychometric reliability across internal consistency and temporal stability metrics.

Internal Consistency

In the foundational validation paper by Cartwright-Hatton and Wells (1997), Cronbach’s alpha coefficients for the five subscales were reported as follows:

• Positive Beliefs about Worry: $\alpha = .87$
• Negative Beliefs about Uncontrollability and Danger: $\alpha = .89$
• Cognitive Confidence: $\alpha = .84$
• Need to Control Thoughts (Punishment / Responsibility): $\alpha = .74$
• Cognitive Self-Consciousness: $\alpha = .72$

The total scale internal consistency demonstrated an overall Cronbach’s alpha of $\alpha = .91$. Subsequent replications across independent clinical and non-clinical cohorts have mirrored these findings, with alpha values consistently ranging between .70 and .90 across all subscales, confirming strong item homogeneity within each latent factor.

Test-Retest Reliability

The temporal stability of the MCQ-65 was evaluated over a 5-week retest interval by Cartwright-Hatton and Wells (1997). Test-retest correlation coefficients ($r$) indicated high consistency over time:

• Positive Beliefs about Worry: $r = .85$
• Negative Beliefs about Uncontrollability and Danger: $r = .89$
• Cognitive Confidence: $r = .79$
• Need to Control Thoughts: $r = .76$
• Cognitive Self-Consciousness: $r = .84$
• Total Score: $r = .87$

These values demonstrate that the MCQ-65 captures stable, trait-like metacognitive architectures rather than transient, state-dependent affective fluctuations.

9. Factor Analysis

The psychometric derivation of the MCQ-65 stems from exploratory factor analysis (EFA) performed on an initial pool of over 80 prospective items generated from clinical interviews with patients suffering from generalized anxiety disorder, obsessional neuroses, and hypochondriasis (Wells, 1997; Cartwright-Hatton & Wells, 1997).

Exploratory Factor Structure

Principal Axis Factoring and Principal Components Analysis with both orthogonal (Varimax) and oblique (Direct Oblimin) rotations identified five distinct factors with eigenvalues strictly greater than 1.5, collectively explaining the majority of item variance. Items displaying weak primary loadings ($< .35$) or significant cross-loadings onto multiple factors ($> .30$ discrepancy) were systematically eliminated, yielding the definitive 65-item instrument.

Subscale Factor Distribution

• Factor 1: Positive Beliefs about Worry — 19 items (e.g., Items 1, 9, 12, 22, 26, 27, 30, 32, 35, 38, 46, 52, 54, 56, 60, 62, 63, 65). This factor reflects beliefs that worrying aids coping, problem solving, motivation, and character.
• Factor 2: Negative Beliefs about Uncontrollability and Danger — 16 items (e.g., Items 2, 5, 8, 11, 13, 18, 21, 31, 33, 34, 36, 42, 44, 45, 48, 53). These items capture fears of mental breakdown, somatic injury, and the involuntary persistence of intrusive thoughts.
• Factor 3: Cognitive Confidence — 9 items (e.g., Items 3, 10, 16, 24, 28, 47, 51, 57, 58). This factor reflects subjective evaluations of memory fallibility, concentration problems, and cognitive doubts.
• Factor 4: Negative Beliefs Concerning Need to Control Thoughts — 14 items (e.g., Items 7, 15, 17, 19, 29, 37, 39, 40, 41, 49, 50, 55, 59, 64). These items address the moral consequences of unmanaged thoughts, superstitious responsibility, and the imperative need for cognitive control.
• Factor 5: Cognitive Self-Consciousness — 7 items (e.g., Items 4, 6, 14, 20, 23, 25, 61). This factor captures explicit, inward-directed attentional monitoring of cognitive mechanisms.

Confirmatory Factor Analytic Findings

Subsequent structural modeling by Wells and colleagues, as well as subsequent cross-cultural adaptations, have subjected the 65-item configuration to confirmatory factor analysis (CFA). The five-factor oblique model consistently outperforms one-factor, two-factor, or unconstrained hierarchical models, yielding acceptable goodness-of-fit indices (RMSEA $le .06$, CFI $ge .90$, SRMR $le .07$). The preservation of these distinct factors laid the psychometric foundation for the later development of the abbreviated 30-item Metacognitions Questionnaire (MCQ-30; Wells & Cartwright-Hatton, 2004).

10. Instrument / Measurement Tool

• Instrument Name: Metacognitions Questionnaire (MCQ-65)
• Alternate Titles: The 65-Item Metacognitions Questionnaire, Wells Metacognitions Questionnaire
• Construct Assessed: Declarative and procedural metacognitive beliefs, cognitive monitoring, and cognitive self-consciousness
• Administration Modality: Paper-and-pencil self-report or computerized assessment
• Target Population: Adults and adolescents aged 16 and older; applicable across clinical and non-clinical populations
• Administration Time: Approximately 10 to 15 minutes
• Item Count: 65 individual declarative items
• Subscale Breakdown:
  • Positive Beliefs about Worry (19 items)
  • Negative Beliefs about the Uncontrollability and Danger of Thoughts (16 items)
  • Cognitive Confidence (9 items)
  • Need for Control, Responsibility, and Punishment (14 items)
  • Cognitive Self-Consciousness (7 items)
• Response Scale: 4-point Likert scale:
  • 1 = Do not agree
  • 2 = Agree slightly
  • 3 = Agree moderately
  • 4 = Agree very much
• Scoring Procedures:
  • Items are scored directly from 1 to 4 according to the endorsed response option.
  • Certain items formulated in the reverse direction (e.g., Item 20: “I rarely question my thoughts”; Item 41: “It is alright to let my thoughts roam free”) are reverse-scored ($1=4, 2=3, 3=2, 4=1$) prior to summing.
  • Subscale scores are obtained by calculating the sum of the items assigned to each respective factor. Higher subscale scores denote stronger endorsement of the specific metacognitive belief or higher cognitive monitoring.
  • A total global metacognition score can be computed by summing all 65 items (theoretical range: 65 to 260), with higher total scores reflecting elevated transdiagnostic metacognitive vulnerability.

11. Permissions & Fee and Test Year

The Metacognitions Questionnaire (MCQ-65) was formally published in 1997 by Adrian Wells and Susannah Cartwright-Hatton in the journal Behaviour Research and Therapy (Copyright © 1997, 1999 Elsevier Science Ltd. and Adrian Wells). The scale is accessible for academic research, educational use, and non-commercial clinical work without licensing fees, provided that standard academic attribution is maintained.

For commercial use, institutional integration within digital health systems, or publication in print manuals, formal permissions should be directed to the primary author:

• Primary Author: Professor Adrian Wells, Ph.D.
• Institution: University of Manchester, Academic Division of Clinical Psychology, Manchester Royal Infirmary, Manchester, UK.
• Official MCT Resource Portal: Metacognitive Therapy Institute (MCT-I)

12. References

• Cartwright-Hatton, S., & Wells, A. (1997). Beliefs about worry and intrusions: The Meta-Cognitions Questionnaire and its correlates. Journal of Anxiety Disorders, 11(3), 279–296. https://doi.org/10.1016/S0887-6185(97)00011-X
• Roemer, L. (2001). Metacognitions Questionnaire (MCQ). In M. M. Antony, S. M. Orsillo, & L. Roemer (Eds.), Practitioner’s Guide to Empirically Based Measures of Anxiety (pp. 77–79). Springer. https://doi.org/10.1007/978-1-4615-1393-3
• Spada, M. M., Mohiyeddini, C., & Wells, A. (2008). Measuring metacognitions: Psychometric properties of the Metacognitions Questionnaire-30. Clinical Psychology & Psychotherapy, 15(2), 111–117. https://doi.org/10.1002/cpp.562
• Wells, A. (1995). Meta-cognition and worry: A cognitive model of generalized anxiety disorder. Behavioural and Cognitive Psychotherapy, 23(3), 301–320. https://doi.org/10.1017/S1352465800015897
• Wells, A. (1997). Cognitive Therapy of Anxiety Disorders: A Practice Manual and Conceptual Guide. John Wiley & Sons.
• Wells, A. (2009). Metacognitive Therapy for Anxiety and Depression. Guilford Press.
• Wells, A., & Cartwright-Hatton, S. (2004). A short form of the Metacognitions Questionnaire: Properties of the MCQ-30. Behaviour Research and Therapy, 42(4), 385–396. https://doi.org/10.1016/S0005-7967(03)00147-5
• 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. https://doi.org/10.1016/S0005-7967(96)00050-2

13. Items of the Scale