This study evaluated the effectiveness of metacognitive therapy in improving physical intelligence, anxiety tolerance, and sense of cohesion in patients with essential hypertension. The research method was quasi-experimental with a pretest-posttest design with a control group. The population under study included all men with essential hypertension referring to Shams boarding clinic in Bonab city in the first half of 2022. The research sample consisted of 40 people selected voluntarily and randomly assigned to two groups of 20 people (experimental and control). Metacognitive therapy was held in nine sessions of 90 minutes and one session per week for the experimental group. The sense of cohesion (Antonovsky, 1987), physical intelligence (Anderson, 2006) and distress tolerance (Simons and Gaher, 2005) questionnaires were used to collect data. Multivariate analysis of covariance (MANCOVA) was applied to analyze the data. Based on the results, metacognitive therapy increased physical intelligence, distress tolerance, and sense of cohesion in the experimental group compared to the control group (p<0.01). The results suggested that the counselors and psychologists of psychotherapy centers apply metacognitive therapy to improve psychological conditions and reduce the physical problems of people with essential hypertension.