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Acuña V, Cavieres Á, Arancibia M, Escobar C, Moritz S, Gaweda L, Lamarca M, Berna F, König C, Ochoa S. Assessing Patient Satisfaction With Metacognitive Training (MCT) for Psychosis: A Systematic Review of Randomized Clinical Trials. Clin Psychol Psychother 2024; 31:e3065. [PMID: 39377205 DOI: 10.1002/cpp.3065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2024] [Revised: 09/12/2024] [Accepted: 09/16/2024] [Indexed: 10/09/2024]
Abstract
OBJECTIVES Metacognitive training (MCT) for psychosis is a group intervention that combines cognitive-behavioural therapy and psychoeducation. It has proven efficacy in reducing psychotic symptoms and correcting cognitive biases implicated in the development and maintenance of psychotic symptoms. However, other outcomes, such as patient satisfaction with the intervention, have not been well studied despite their importance for adherence and overall success. A systematic review of randomized clinical trials was conducted to assess satisfaction with MCT among adults with psychotic spectrum disorders. METHODS The search was conducted in Ovid Embase, Ovid MEDLINE, PsycINFO and Cochrane Central Register of Controlled Trials (CENTRAL). PRISMA guidelines and the Cochrane Risk of Bias Tool were followed, and certainty of evidence was ascertained using the Grading of Recommendations Assessment, Development and Evaluation framework. The study is registered with PROSPERO (CRD42023418097). RESULTS Patient satisfaction was considered the primary outcome in 3 of the 10 studies reviewed. Four studies compared MCT with other psychosocial interventions (a newspaper discussion group, cognitive remediation and supportive therapy), two of which found significantly higher satisfaction with MCT. A high percentage of all patients found MCT comprehensible and considered it an important part of their treatment; they would recommend the training to others and found the group setting advantageous. Most participants expressed high subjective satisfaction or acceptance of MCT. CONCLUSIONS The authors found evidence that MCT may be associated with high levels of satisfaction in clinical trials whose main objective is to assess patient satisfaction, but more research is needed to consolidate the findings, especially for the extended version of MCT.
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Affiliation(s)
- Vanessa Acuña
- Department of Psychiatry, School of Medicine, Faculty of Medicine, Universidad de Valparaíso, Valparaíso, Chile
- Psychotic Disorders Unit, Hospital Del Salvador de Valparaíso, Valparaíso, Chile
| | - Álvaro Cavieres
- Department of Psychiatry, School of Medicine, Faculty of Medicine, Universidad de Valparaíso, Valparaíso, Chile
- Psychotic Disorders Unit, Hospital Del Salvador de Valparaíso, Valparaíso, Chile
- Center for Translational Studies in Stress and Mental Health (C-ESTRES), Faculty of Sciences, Universidad de Valparaíso, Valparaíso, Chile
| | - Marcelo Arancibia
- Department of Psychiatry, School of Medicine, Faculty of Medicine, Universidad de Valparaíso, Valparaíso, Chile
- Center for Translational Studies in Stress and Mental Health (C-ESTRES), Faculty of Sciences, Universidad de Valparaíso, Valparaíso, Chile
| | - Camila Escobar
- Research Department, Instituto Universitario Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lukasz Gaweda
- Experimental Psychopathology Lab, Institute of Psychology, Polish Academy of Sciences, Warsaw, Poland
| | - María Lamarca
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- Grup MERITT, Fundació Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
- Departament de Psicologia Clínica i de la Salut, Facultat de Psicologia, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Fabrice Berna
- University of Strasbourg, University Hospital of Strasbourg, Inserm, Strasbourg, France
| | - Caroline König
- Soft Computing Research Group, Intelligent Data Science and Artificial Intelligence Research Center Universitat Politècnica de Catalunya, Barcelona, Spain
| | - Susana Ochoa
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain
- Grup MERITT, Fundació Sant Joan de Déu, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Consorcio de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Salud Carlos III, Madrid, Spain
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Gussmann E, Lindner C, Lucae S, Falkai P, Padberg F, Egli S, Kopf-Beck J. Targeting metacognitive change mechanisms in acute inpatients with psychotic symptoms: feasibility and acceptability of a modularized group intervention. Eur Arch Psychiatry Clin Neurosci 2024; 274:963-979. [PMID: 37741946 PMCID: PMC11127867 DOI: 10.1007/s00406-023-01690-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/26/2023] [Indexed: 09/25/2023]
Abstract
Emerging evidence suggests the usefulness of psychological interventions targeting metacognitive change mechanisms in patients experiencing psychosis. Although many of these patients are treated in acute psychiatric contexts, only few studies have adapted such interventions for acute inpatient settings. The present study aimed to assess the feasibility, acceptability, and preliminary clinical outcomes of a novel modularized group intervention focusing on different aspects of metacognitive change mechanisms. In particular, the intervention aims to reduce patients' acute symptoms by enhancing cognitive insight and to relieve distress via cognitive defusion (i.e. coping). A sample of 37 participants with acute psychosis received up to nine sessions of the intervention. Baseline and post-intervention assessments were conducted for general psychopathology, psychotic symptoms, global functioning, and symptom distress. Measures of change mechanisms were assessed before and after the respective treatment module. Participants' experiences were explored in feedback questionnaires and interviews. Recruitment, retention, and attendance rate met the pre-set feasibility benchmark of 80%. The intervention was well received by participants, who emphasised the group's clear structure, positive atmosphere, and helpful contents. Response rates were high and linear mixed models revealed significant medium-to-large time effects on all clinical outcomes. As expected, increase in hypothesised change mechanisms cognitive insight and decrease in cognitive fusion was found. However, the uncontrolled design limits interpreting clinical effects. The study provides evidence that an intervention based on a metacognitive model is feasible and acceptable for acute inpatients with psychosis. Positive results on clinical outcomes and change mechanisms warrant further exploration in a randomized controlled trial.
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Affiliation(s)
- Eva Gussmann
- Max Planck Institute of Psychiatry, Munich, Germany.
| | | | - Susanne Lucae
- Max Planck Institute of Psychiatry, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Peter Falkai
- Max Planck Institute of Psychiatry, Munich, Germany
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - Samy Egli
- Max Planck Institute of Psychiatry, Munich, Germany
| | - Johannes Kopf-Beck
- Max Planck Institute of Psychiatry, Munich, Germany
- Department of Psychology, LMU Munich, Munich, Germany
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Hotte-Meunier A, Penney D, Mendelson D, Thibaudeau É, Moritz S, Lepage M, Sauvé G. Effects of metacognitive training (MCT) on social cognition for schizophrenia spectrum and related psychotic disorders: a systematic review and meta-analysis. Psychol Med 2024; 54:914-920. [PMID: 37772399 DOI: 10.1017/s0033291723002611] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
BACKGROUND Individuals with schizophrenia spectrum and related psychotic disorders (SSD) experience significant impairments in social cognition that impede functioning. Social cognition is a multidimensional construct consisting of four domains: 1. theory of mind, 2. emotion processing, 3. attributional style and 4. social perception. Metacognitive training (MCT) is an intervention designed to target cognitive biases in psychosis containing two modules addressing social cognition. METHODS A systematic review and meta-analysis was conducted to investigate the effects of MCT on social cognition and two of its domains: theory of mind and emotion processing. Ten electronic databases were scoured from 2007 to 1 February 2022 for MCT studies reporting social cognition outcomes for people with SSD (1050 identified, 282 assessed). Effect sizes were calculated using Cohen's d in R. RESULTS Nine studies were included in the meta-analysis (nMCT = 212, ncontrol = 194). MCT had a small but positive effect on global social cognition (d = 0.28 [95% CI 0.07-0.49]) and theory of mind (d = 0.27 [95% CI 0.01-0.52]). MCT showed no evidence of an effect on emotion processing (d = 0.03 [95% CI -0.26 to 0.32]). CONCLUSION MCT has a small but significant effect on social cognition for people with SSD. Our results add to other recent meta-analyses showing significant effects of MCT on clinically relevant outcomes such as positive symptoms, cognitive biases and cognitive insight. We recommend that future studies on MCT report outcomes on all four domains of social cognition. TRIAL REGISTRATION PROSPERO (in the process of registration) available at https://www.crd.york.ac.uk/prospero/#recordDetails.
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Affiliation(s)
- Adèle Hotte-Meunier
- Douglas Mental Health University Institute, Montreal, Canada
- Department of Psychology, McGill University, Montreal, Canada
| | - Danielle Penney
- Douglas Mental Health University Institute, Montreal, Canada
- Department of Psychology, Université du Québec à Montréal, Montreal, Canada
| | - Daniel Mendelson
- Douglas Mental Health University Institute, Montreal, Canada
- Department of Psychology, McGill University, Montreal, Canada
| | - Élisabeth Thibaudeau
- Douglas Mental Health University Institute, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Centre Hamburg, Hamburg, Germany
| | - Martin Lepage
- Douglas Mental Health University Institute, Montreal, Canada
- Department of Psychiatry, McGill University, Montreal, Canada
| | - Geneviève Sauvé
- Douglas Mental Health University Institute, Montreal, Canada
- Department of Education and Pedagogy, Université du Québec à Montréal, Montreal, Canada
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Ishigaki T, Shimada T, Tanoue H, Yoshinaga N, Nishiguchi Y, Ishikawa R, Hosono M. Reliability and validity of the Nepean Beliefs Scale for delusions and overvalued ideas in chronic schizophrenia: analysis of a preliminary pilot study. Front Psychiatry 2023; 14:1298429. [PMID: 38130290 PMCID: PMC10733475 DOI: 10.3389/fpsyt.2023.1298429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 11/15/2023] [Indexed: 12/23/2023] Open
Abstract
Introduction The Nepean Beliefs Scale by Brakoulias et al. is an interview-based multidimensional instrument that measures pathological beliefs in various psychiatric disorders. This study examined the reliability and validity of Nepean Beliefs Scale (NBS) for delusions and overvalued ideas in patients with chronic-phase schizophrenia. Methods: Multiple raters at two healthcare settings examined the beliefs of 28 individuals with schizophrenia using the NBS. Concurrently, PANSS, PDI-21, BCIS, PHQ-9 and GAD-7 were administered. Results The NBS had high reliability and correlation with relevant scales. Discussion The NBS was found to have sufficient reliability and validity for assessing the pathological beliefs of patients with chronic schizophrenia. Although NBS is an easy-to-instruct instrument, it should be noted that appropriate explanations and examples should be added to instructions to obtain reliable responses from patients with chronic schizophrenia.
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Affiliation(s)
- Takuma Ishigaki
- Graduate School of Arts and Sciences, The University of Tokyo, Meguro, Japan
| | - Takeshi Shimada
- Department of Rehabilitation, Mental Support Soyokaze Hospital, Ueda, Japan
| | - Hiroki Tanoue
- Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Naoki Yoshinaga
- Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | | | - Ryotaro Ishikawa
- Faculty of Psychology and Sociology, Taisho University, Tokyo, Japan
| | - Masahito Hosono
- Graduate School of Arts and Sciences, The University of Tokyo, Meguro, Japan
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Lüdtke T, Hedelt KS, Westermann S. Predictors of paranoia in the daily lives of people with non-affective psychosis and non-clinical controls: A systematic review of intensive longitudinal studies. J Behav Ther Exp Psychiatry 2023; 81:101885. [PMID: 37354896 DOI: 10.1016/j.jbtep.2023.101885] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 05/08/2023] [Accepted: 05/27/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND AND OBJECTIVES Worrying, self-esteem, sleep problems, anomalous internal experiences, reasoning biases, and interpersonal sensitivity are associated with paranoia. However, no review has examined whether these variables function as predictors of paranoia in everyday life. The present systematic review of intensive longitudinal studies (e.g., experience sampling) examined contemporaneous and time-lagged associations between paranoia and each candidate mechanism in individuals with non-affective psychosis and controls (pre-registration: https://osf.io/uwr9d). METHODS We searched electronic databases, PsyArXiv, and reference lists for studies published since 1994. RESULTS Of n = 5,918 results, n = 54 fulfilled inclusion criteria (n = 43 datasets). Most studies examined individuals with non-affective psychosis (n = 34). Strong evidence emerged for negative affect (subsumed under 'anomalous internal experiences') and sleep problems. For self-esteem, results suggest contemporaneous and lagged effects on paranoia but associations are likely driven by between-person variance. The low number of studies (n = 2 studies each) allowed no conclusions regarding worrying and reasoning biases. Findings on interpersonal sensitivity, which should be interpreted with caution because of the predictor's conceptual overlap with paranoia, indicate contemporaneous effects whereas time-lagged and within-person associations could not be judged due to insufficient data. LIMITATIONS The present review used a narrative data-synthetization and it did not cover outcomes such as hallucinations. CONCLUSIONS Despite convincing evidence for affect and sleep problems, it remains unclear whether affective states are precursors or also consequences of paranoia (vicious circle), and which of the actigraphy measures (sleep time, -efficiency, -fragmentation, etc.) best predicts paranoia.
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Affiliation(s)
- Thies Lüdtke
- Department of Human Medicine, MSH Medical School Hamburg, Hamburg, Germany.
| | | | - Stefan Westermann
- Department of Psychology, MSH Medical School Hamburg, Hamburg, Germany
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de Pinho LG, Silva C, Fonseca C, Morgado B, Lopes M, Moritz S, Jelinek L, Schneider BC. A randomized controlled trial to evaluate the efficacy of metacognitive training for older adults with depression (MCT-Silver) in Portugal: study protocol. Front Psychol 2023; 14:1167860. [PMID: 38022953 PMCID: PMC10644621 DOI: 10.3389/fpsyg.2023.1167860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 09/18/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Depression is one of the most common psychological disorders in later life. Although psychological interventions are recommended by treatment guidelines, most older adults with depression remain untreated. The aim of this study is to evaluate the efficacy of the Portuguese version of Metacognitive Training for Depression in later life (MCT-Silver). Methods This is a study protocol of an observer-blind, parallel-group, randomized controlled trial to compare the efficacy of MCT-Silver with a treatment as usual (TAU) control group among older adults (age 65 years and older) with depressive symptoms according to the Montgomery-Asberg Depression Scale. Participants will be tested at three assessment time points (baseline, immediately following the intervention [8 weeks], and 3 months after the intervention). The primary outcome is change in self-rated depression symptoms assessed by the Beck Depression Inventory (BDI-II). Secondary outcomes include clinician-rated depression, self-esteem, dysfunctional beliefs, metacognitive beliefs, ruminations, attitudes toward aging and quality of life. A self-designed subjective appraisal rating scale consisting of 21-items will be used to assess participant acceptance of MCT-Silver. Discussion MCT-Silver is an innovative intervention, which aims to reduce dysfunctional thoughts as well as depression-related behaviors and coping strategies through the metacognitive perspective. Until now, the training has only been tested in Germany. It is expected that after 8 weeks of treatment and 3 months later, the experimental group will demonstrate significant reductions in depressive symptoms, metacognitive beliefs, dysfunctional attitudes and ruminative responses compared to the TAU group. Moreover, quality of life, self-esteem, and attitudes towards aging will be significantly improved in MCT-Silver compared to the TAU group. Clinical trial registration ClinicalTrials.gov, NCT05640492.
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Affiliation(s)
- Lara Guedes de Pinho
- Department of Nursing, University of Évora, Évora, Portugal
- Comprehensive Health Research Centre (CHRC), Évora, Portugal
| | - Celso Silva
- Comprehensive Health Research Centre (CHRC), Évora, Portugal
- Higher School of Health, Polytechnic Institute of Beja, Beja, Portugal
| | - César Fonseca
- Department of Nursing, University of Évora, Évora, Portugal
- Comprehensive Health Research Centre (CHRC), Évora, Portugal
| | - Bruno Morgado
- Universitat Rovira i Virgili, Tarragona, Spain
- Hospital Garcia de Orta, Almada, Portugal
| | - Manuel Lopes
- Department of Nursing, University of Évora, Évora, Portugal
- Comprehensive Health Research Centre (CHRC), Évora, Portugal
| | - Steffen Moritz
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lena Jelinek
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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7
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Gussmann E, Lucae S, Falkai P, Padberg F, Egli S, Kopf-Beck J. Developing a mechanism-based therapy for acute psychiatric inpatients with psychotic symptoms: an Intervention Mapping approach. Front Psychiatry 2023; 14:1160075. [PMID: 37324820 PMCID: PMC10267344 DOI: 10.3389/fpsyt.2023.1160075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 05/05/2023] [Indexed: 06/17/2023] Open
Abstract
Background Treatment guidelines for psychosis recommend offering psychotherapy already in the acute illness phase. However, there is a lack of available interventions adapted to the specific needs and key change mechanisms of inpatients experiencing severe symptoms and crisis. In this article we outline the scientific development process of a needs-oriented and mechanism-based group intervention for acute psychiatric inpatients with psychosis (MEBASp). Methods To guide our intervention design, we used Intervention Mapping (IM), a six-step framework for developing evidence-based health interventions that consisted of an extensive literature review, an in-depth problem definition and needs analysis, the modeling of change mechanisms and outcomes and the production of an intervention prototype. Results Our low-threshold modularized group intervention consists of nine stand-alone sessions (two per week) within three modules and targets different aspects of metacognitive and social change mechanisms. Module I and II aim to reduce acute symptoms by fostering cognitive insight, Module III focuses on reducing distress via cognitive defusion. Therapy contents are adapted from existing metacognitive treatments such as the Metacognitive Training and presented in a destigmatizing, simply understandable and experience-oriented way. Conclusion MEBASp is currently evaluated in a single-arm feasibility trial. Using a systematic and rigorous development methodology and providing a detailed description of the development steps demonstrated to be invaluable in improving the intervention's scientific foundation, validity, and replicability for similar research.
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Affiliation(s)
- Eva Gussmann
- Max Planck Institute of Psychiatry, Munich, Germany
| | - Susanne Lucae
- Max Planck Institute of Psychiatry, Munich, Germany
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | - Peter Falkai
- Max Planck Institute of Psychiatry, Munich, Germany
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | - Frank Padberg
- Department of Psychiatry and Psychotherapy, LMU University Hospital Munich, Munich, Germany
| | - Samy Egli
- Max Planck Institute of Psychiatry, Munich, Germany
| | - Johannes Kopf-Beck
- Max Planck Institute of Psychiatry, Munich, Germany
- Department of Psychology, LMU Munich, Munich, Germany
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Pishdadian S, Martins F, Milanovic M, Doell FK, Kidd SA, Grossman MJ. Emotion regulation relates to clinical characteristics and quality of life but not daily functioning in psychosis spectrum outpatients. J Psychiatr Res 2023; 161:289-297. [PMID: 36947960 DOI: 10.1016/j.jpsychires.2023.03.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/24/2023]
Abstract
Difficulties in emotion regulation (ER) can negatively impact the clinical course and outcomes of a range of psychiatric conditions, including psychosis spectrum disorders. Individuals with psychosis may exhibit poorer ER abilities, which have been associated with increased severity and distress of psychotic symptoms. A paucity of research has investigated the clinical correlates of ER in psychosis and the influence of these difficulties on indices of recovery, such as daily functioning and quality of life. In the present study, 59 outpatients presenting for Cognitive Behaviour Therapy for psychosis (CBTp) in a large psychiatric hospital completed an intake assessment of clinician-rated and self-reported measures prior to treatment. Poor ER abilities were positively correlated with positive symptoms (overall and delusions), social anxiety, depression, and self-reflectiveness and negatively correlated with quality of life and personal recovery. Multiple regression analyses showed ER was a significant predictor of quality of life but not daily functioning, which was predicted most by cognition and psychiatric symptoms. Overall, findings support the clinical utility of assessing emotion dysregulation in psychosis and provide a more nuanced understanding of how such challenges differentially influence recovery in psychosis, which can further inform treatment planning and intervention.
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Affiliation(s)
- Sara Pishdadian
- Complex Care and Recovery Program, 1051 Queen Street West, Centre for Addiction and Mental Health, Toronto, ON, M6J 1H3, Canada; Department of Psychology, 4700 Keele Street, York University, Toronto, ON, M3J 1P3, Canada
| | - Felicia Martins
- Complex Care and Recovery Program, 1051 Queen Street West, Centre for Addiction and Mental Health, Toronto, ON, M6J 1H3, Canada; Department of Psychology, 1265, Military Trail, University of Toronto Scarborough, Toronto, ON, M1C 1A4, Canada
| | - Melissa Milanovic
- Complex Care and Recovery Program, 1051 Queen Street West, Centre for Addiction and Mental Health, Toronto, ON, M6J 1H3, Canada
| | - Faye K Doell
- Complex Care and Recovery Program, 1051 Queen Street West, Centre for Addiction and Mental Health, Toronto, ON, M6J 1H3, Canada
| | - Sean A Kidd
- Complex Care and Recovery Program, 1051 Queen Street West, Centre for Addiction and Mental Health, Toronto, ON, M6J 1H3, Canada
| | - Michael J Grossman
- Complex Care and Recovery Program, 1051 Queen Street West, Centre for Addiction and Mental Health, Toronto, ON, M6J 1H3, Canada.
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Han M, Lee K, Kim M, Heo Y, Choi H. Effects of a Metacognitive Smartphone Intervention With Weekly Mentoring Sessions for Individuals With Schizophrenia: A Quasi-Experimental Study. J Psychosoc Nurs Ment Health Serv 2023; 61:27-37. [PMID: 35858205 DOI: 10.3928/02793695-20220706-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Application (app)-based interventions using smartphones could provide effective alternatives to traditional treatment programs during and beyond the coronavirus disease 2019 pandemic. The current quasi-experimental study with a non-equivalent comparison group tested the effects of a smartphone app-based metacognitive intervention program with weekly mentoring sessions on the meta-cognitive beliefs, psychotic symptoms, and social functioning of individuals with schizophrenia from community psychosocial rehabilitation centers. The study was conducted with 20 participants with severe psychotic symptoms and low social functioning and 24 participants with relatively light psychotic symptoms and good social functioning as a comparison group. For the experimental group, the app-based intervention was combined with weekly contact mentoring sessions over 10 weeks. The comparison group received only the app-based intervention over 10 weekly sessions. No differences were observed between groups' total scores; however, the experimental group showed a tendency toward improved psychotic symptoms and social functioning over time, unlike the comparison group. These findings provide an empirical basis for managing schizophrenia symptoms with smartphone apps. [Journal of Psychosocial Nursing and Mental Health Services, 61(2), 27-37.].
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Kim SW, Hyun S, Kim JK, Kim H, Jhon M, Kim JW, Park C, Lee JY, Kim JM. Effectiveness of group metacognitive training and cognitive-behavioural therapy in a transdiagnostic manner for young patients with psychotic and non-psychotic disorders. Early Interv Psychiatry 2023; 17:29-38. [PMID: 35338567 DOI: 10.1111/eip.13288] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 03/01/2022] [Accepted: 03/13/2022] [Indexed: 01/21/2023]
Abstract
AIM To investigate group metacognitive training and cognitive-behavioural therapy (MCT/CBT) prospectively in a young population with various psychiatric disorders, including psychotic and mood disorders. METHODS This was a prospective study to investigate the effectiveness of group MCT/CBT on quality of life, psychotic symptoms, depression, self-esteem, perceived stress, social function and social cognition. The objective measures included the Positive and Negative Syndrome Scale (PANSS), clinical global impression (CGI), personal and social performance scale for social functioning, a computerized continuous performance test for sustained attention and a computerized emotional recognition test for social cognition. Self-report measures administered included the Subjective Well-being under Neuroleptics for quality of life, Ambiguous Intentions Hostility Questionnaire for suspiciousness, Drug Attitude Inventory, Beck Depression Inventory, Perceived Stress Scale, Brief Resilience Scale, Rosenberg Self-esteem Scale and visual analogue scale for the EQ-5D. RESULTS Among 110 young patients with early psychosis and mood disorders who participated, 82 (74.5%) completed the study. Social functioning, quality of life, self-esteem, resilience, depression, suspiciousness, social cognition, sustained attention and scores on the PANSS and CGI improved significantly after completing group MCT/CBT. Perceived stress, resilience and suspiciousness improved significantly only in participants with a non-psychotic disorder. Improvements in subjective well-being of the participants were associated with increases in self-esteem and resilience and decreases in depression and perceived stress. CONCLUSIONS Our study showed that group transdiagnostic MCT/CBT for young patients with mental illness improved subjective wellbeing, self-esteem, resilience, social cognition and social functioning and significantly diminished suspiciousness, perceived stress and depression.
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Affiliation(s)
- Sung-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.,Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea
| | - Sumi Hyun
- Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea
| | - Jae-Kyoung Kim
- Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea
| | - Honey Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Min Jhon
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ju-Wan Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Cheol Park
- Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea.,Peace & Harmony Psychiatry Clinic, Gwangju, Republic of Korea
| | - Ju-Yeon Lee
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea.,Mindlink, Gwangju Bukgu Community Mental Health Center, Gwangju, Republic of Korea
| | - Jae-Min Kim
- Department of Psychiatry, Chonnam National University Medical School, Gwangju, Republic of Korea
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11
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Achim AM, Thibaudeau É, Huot A, Cellard C, Roy MA. What areas of everyday functioning are affected by theory of mind deficits in recent-onset schizophrenia spectrum disorders? Early Interv Psychiatry 2023; 17:57-64. [PMID: 35411646 DOI: 10.1111/eip.13291] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 02/01/2022] [Accepted: 03/13/2022] [Indexed: 01/21/2023]
Abstract
AIM Functional recovery is now a recognized treatment goal for schizophrenia. It is therefore important to better understand the cognitive and psychological factors that influence functioning. Theory of mind (ToM) deficits are common in schizophrenia and have been linked to greater impairments in functioning. The current study aimed to identify which specific areas of functioning are linked to ToM in a group of 54 patients with a recent-onset of a schizophrenia spectrum disorder. METHODS ToM was assessed with the Combined Stories Test (COST). Several areas of functioning were rated based on an extensive semi-structured interviews. RESULTS Among the different areas of functioning that were examined, ToM showed a significant, positive relationship with ratings for productive activities (e.g. work or school) as well as with collaboration to psychiatric care. CONCLUSION These results suggest that ToM can impair functioning especially in situations in which patients need to collaborate with others, including the interactions with the clinical team.
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Affiliation(s)
- Amélie M Achim
- Département de psychiatrie et neurosciences, Université Laval, Québec, Québec, Canada.,CERVO Brain Research Centre, Québec, Québec, Canada
| | - Élisabeth Thibaudeau
- Département de psychiatrie, Université McGill, Montréal, Québec, Canada.,Institut universitaire en santé mentale Douglas, Montréal, Québec, Canada
| | - Andréanne Huot
- Département de psychiatrie et neurosciences, Université Laval, Québec, Québec, Canada.,CERVO Brain Research Centre, Québec, Québec, Canada
| | - Caroline Cellard
- CERVO Brain Research Centre, Québec, Québec, Canada.,École de Psychologie, Université Laval, Québec, Québec, Canada
| | - Marc-André Roy
- Département de psychiatrie et neurosciences, Université Laval, Québec, Québec, Canada.,CERVO Brain Research Centre, Québec, Québec, Canada.,CIUSSS Capitale-Nationale, Institut Universitaire en Santé Mentale de Québec, Québec, Québec, Canada
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12
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Han M, Lee K. Effectiveness of a Metacognitive Intervention for Schizophrenia (MCI-S) Program for Symptom Relief and Improvement in Social Cognitive Functioning in Patients with Schizophrenia. Arch Psychiatr Nurs 2022; 41:43-50. [PMID: 36428074 DOI: 10.1016/j.apnu.2022.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 04/25/2022] [Accepted: 07/03/2022] [Indexed: 11/19/2022]
Abstract
This study investigated the effectiveness of a metacognitive intervention program for symptom relief and improvement in social cognitive functioning among adults with schizophrenia. The program focused on enhancing metacognition to encourage self-awareness and step-by-step perspective expansion. There were 24 participants in the experimental group and 19 participants in the control group. Delusions decreased, and social cognition and social functioning improved in the experimental group compared to the control group. The program demonstrated utility as a treatment modality, which can be part of an overall program of a mental health promotion institution to improve functioning in patients with schizophrenia.
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Affiliation(s)
- Mihwa Han
- Department of Nursing Science, Sunlin University, 30, 36beon-gil, Chogok-gil, Heunghae-eup Pohang-si, Gyeongbuk 37560, Republic of Korea
| | - Kyunghee Lee
- Research Institute of Nursing Science, Keimyung University, 1095 Dalgubeol-daero, Dalseo-Gu, Daegu 42601, Republic of Korea.
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13
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Comparison of Metacognition Features and Social Functionality of Patients with Mental Disorder. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00968-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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14
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Moritz S, Göritz AS, Franz C, Sibilis A, Voßberger H, Balzan R, Scheunemann J. Whodunit - A novel video-based task for the measurement of jumping to conclusions in the schizophrenia spectrum. Psychiatry Res 2022; 317:114862. [PMID: 36228437 DOI: 10.1016/j.psychres.2022.114862] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/16/2022] [Accepted: 09/22/2022] [Indexed: 01/04/2023]
Abstract
Jumping to conclusions (JTC) is implicated in the formation and maintenance of the positive symptoms of psychosis and over the years has become a prominent treatment target. Yet, measures designed to detect JTC are compromised by a number of limitations. We aimed to address some of these shortcomings with a new video-based "Whodunit task" among participants scoring high and low on the Community Assessment of Psychic Experiences (CAPE). We recruited a large sample (N = 979) from the general population who were divided into subgroups high vs. low on psychotic-like experiences (PLE), matched for depression and background characteristics. In the Whodunit task, participants were asked to rate the likelihood that one out of six suspects was the perpetrator of a crime (deliberately ambiguous with no clear clues until the end). The primary measure was the number of sequences-to-decision (STD). In line with the hypothesis, participants scoring high on the CAPE positive subscale displayed significantly lower STD and a higher rate of JTC. Response confidence in the assessments was elevated in the PLE-High group. The number of overall decisions was also significantly elevated for the PLE-High group. No group differences were found when comparing those scoring high versus low on depression. The STD index correlated significantly with a corresponding index from another JTC task. The study presents a new paradigm for the measurement of data gathering in the schizophrenia spectrum. Speaking to its validity, the Whodunit task was correlated with another JTC measure. Future research should test abbreviated versions of the paradigm, preferably using multiple trials with differing topics/emotional themes.
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Affiliation(s)
- Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Anja S Göritz
- Occupational and Consumer Psychology, University of Freiburg, Germany
| | - Cynthia Franz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Arne Sibilis
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Henry Voßberger
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ryan Balzan
- College of Education, Psychology & Social Work, Flinders University, Australia
| | - Jakob Scheunemann
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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15
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Gregersen M, Rohd SB, Jepsen JRM, Brandt JM, Søndergaard A, Hjorthøj C, Knudsen CB, Andreassen AK, Veddum L, Ohland J, Wilms M, Krantz MF, Burton BK, Greve A, Bliksted V, Mors O, Clemmensen L, Nordentoft M, Thorup AAE, Hemager N. Jumping to Conclusions and Its Associations With Psychotic Experiences in Preadolescent Children at Familial High Risk of Schizophrenia or Bipolar Disorder-The Danish High Risk and Resilience Study, VIA 11. Schizophr Bull 2022; 48:1363-1372. [PMID: 35849023 PMCID: PMC9673250 DOI: 10.1093/schbul/sbac060] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND The jumping to conclusions (JTC) bias, ie, making decisions based on inadequate evidence, is associated with psychosis in adults and is believed to underlie the formation of delusions. Knowledge on the early manifestations of JTC and its associations with psychotic experiences (PE) in children and adolescents is lacking. DESIGN Preadolescent children (mean age 11.9 y, SD 0.2) at familial high risk of schizophrenia (FHR-SZ, n = 169) or bipolar disorder (FHR-BP, n = 101), and controls (n = 173) were assessed with the Beads Task to examine JTC. The number of beads drawn before making a decision, "draws to decision" (DTD) was used as a primary outcome. PE were ascertained in face-to-face interviews. General intelligence was measured with Reynolds Intellectual Screening Test. RESULTS Children at FHR-SZ took fewer DTD than controls (4.9 vs 5.9, Cohen's d = 0.31, P = .004). Differences were attenuated when adjusting for IQ (Cohen's d = 0.24, P = .02). Higher IQ was associated with a higher number of DTD (B = 0.073, P < .001). Current subclinical delusions compared with no PE were associated with fewer DTD in children at FHR-SZ (P = .04) and controls (P < .05). Associations between delusions and DTD were nullified when accounting for IQ. CONCLUSIONS JTC marks familial risk of psychosis in preadolescence, not reducible to general intelligence. JTC is associated with subclinical delusions, but this may be an expression of intellectual impairment. Future studies should establish temporality between JTC and delusion formation and examine JTC as a target for early intervention.
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Affiliation(s)
- Maja Gregersen
- To whom correspondence should be addressed; CORE–Copenhagen Research Center for Mental Health, Mental Health Services in the Capital Region of Denmark, Mental Health Center Copenhagen, Gentofte Hospitalsvej 15, 4th Floor, 2900 Hellerup, Denmark; tel: +45 23 41 21 62, e-mail:
| | - Sinnika Birkehøj Rohd
- CORE–Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research–iPSYCH, Aarhus, Denmark
| | - Jens Richardt Møllegaard Jepsen
- CORE–Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research–iPSYCH, Aarhus, Denmark,Child and Adolescent Mental Health Center, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark,Center for Neuropsychiatric Schizophrenia Research and Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Julie Marie Brandt
- CORE–Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research–iPSYCH, Aarhus, Denmark,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Søndergaard
- CORE–Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research–iPSYCH, Aarhus, Denmark,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Carsten Hjorthøj
- CORE–Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research–iPSYCH, Aarhus, Denmark,Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark
| | - Christina Bruun Knudsen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research–iPSYCH, Aarhus, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark,Psychosis Research Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark
| | - Anna Krogh Andreassen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research–iPSYCH, Aarhus, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark,Psychosis Research Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark
| | - Lotte Veddum
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research–iPSYCH, Aarhus, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark,Psychosis Research Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark
| | - Jessica Ohland
- CORE–Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research–iPSYCH, Aarhus, Denmark
| | - Martin Wilms
- CORE–Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research–iPSYCH, Aarhus, Denmark
| | - Mette Falkenberg Krantz
- CORE–Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research–iPSYCH, Aarhus, Denmark,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Birgitte Klee Burton
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark,Child and Adolescent Mental Health Center, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Aja Greve
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research–iPSYCH, Aarhus, Denmark,Psychosis Research Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark
| | - Vibeke Bliksted
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research–iPSYCH, Aarhus, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark,Psychosis Research Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark
| | - Ole Mors
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research–iPSYCH, Aarhus, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, Aarhus University, Aarhus, Denmark,Psychosis Research Unit, Aarhus University Hospital Psychiatry, Aarhus, Denmark
| | - Lars Clemmensen
- CORE–Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Merete Nordentoft
- CORE–Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research–iPSYCH, Aarhus, Denmark,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Amalie Elgaard Thorup
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research–iPSYCH, Aarhus, Denmark,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark,Child and Adolescent Mental Health Center, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - Nicoline Hemager
- CORE–Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark,The Lundbeck Foundation Initiative for Integrative Psychiatric Research–iPSYCH, Aarhus, Denmark,Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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16
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Özgüç S, Tanriverdi D. Effects of Metacognitive Training (D-MCT) on Metacognition and Ruminative Thought Levels of Major Depression Patients. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00869-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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17
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Hauke DJ, Roth V, Karvelis P, Adams RA, Moritz S, Borgwardt S, Diaconescu AO, Andreou C. Increased Belief Instability in Psychotic Disorders Predicts Treatment Response to Metacognitive Training. Schizophr Bull 2022; 48:826-838. [PMID: 35639557 PMCID: PMC9212107 DOI: 10.1093/schbul/sbac029] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND HYPOTHESIS In a complex world, gathering information and adjusting our beliefs about the world is of paramount importance. The literature suggests that patients with psychotic disorders display a tendency to draw early conclusions based on limited evidence, referred to as the jumping-to-conclusions bias, but few studies have examined the computational mechanisms underlying this and related belief-updating biases. Here, we employ a computational approach to understand the relationship between jumping-to-conclusions, psychotic disorders, and delusions. STUDY DESIGN We modeled probabilistic reasoning of 261 patients with psychotic disorders and 56 healthy controls during an information sampling task-the fish task-with the Hierarchical Gaussian Filter. Subsequently, we examined the clinical utility of this computational approach by testing whether computational parameters, obtained from fitting the model to each individual's behavior, could predict treatment response to Metacognitive Training using machine learning. STUDY RESULTS We observed differences in probabilistic reasoning between patients with psychotic disorders and healthy controls, participants with and without jumping-to-conclusions bias, but not between patients with low and high current delusions. The computational analysis suggested that belief instability was increased in patients with psychotic disorders. Jumping-to-conclusions was associated with both increased belief instability and greater prior uncertainty. Lastly, belief instability predicted treatment response to Metacognitive Training at the individual level. CONCLUSIONS Our results point towards increased belief instability as a key computational mechanism underlying probabilistic reasoning in psychotic disorders. We provide a proof-of-concept that this computational approach may be useful to help identify suitable treatments for individual patients with psychotic disorders.
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Affiliation(s)
- D J Hauke
- To whom correspondence should be addressed; 250 College St., 12th Floor, Toronto, ON M5T 1R8, Canada; tel: +1 (416) 535-8501 ext. 30585, fax: +1 416-583-1207, e-mail:
| | - V Roth
- Department of Mathematics and Computer Science, University of Basel, Basel, Switzerland
| | - P Karvelis
- Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health (CAMH), Toronto, Canada
| | - R A Adams
- Centre for Medical Image Computing, Department of Computer Science, University College London, London, UK,Max Planck Centre for Computational Psychiatry and Ageing Research, University College London, London, United Kingdom
| | - S Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - S Borgwardt
- Department of Psychiatry and Psychotherapy, Translational Psychiatry Unit, University of Lübeck, Lübeck, Germany,Center of Brain, Behaviour and Metabolism, University of Lübeck, Lübeck, Germany
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18
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Penney D, Sauvé G, Mendelson D, Thibaudeau É, Moritz S, Lepage M. Immediate and Sustained Outcomes and Moderators Associated With Metacognitive Training for Psychosis: A Systematic Review and Meta-analysis. JAMA Psychiatry 2022; 79:417-429. [PMID: 35320347 PMCID: PMC8943641 DOI: 10.1001/jamapsychiatry.2022.0277] [Citation(s) in RCA: 38] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/24/2022] [Indexed: 11/14/2022]
Abstract
Importance A substantial increase in the number of trials examining metacognitive training (MCT) for psychosis necessitates an updated examination of the outcomes associated with MCT. Objectives To review the immediate and sustained associations of MCT with proximal (directly targeted) and distal (indirectly influenced) outcomes and assess treatment- and participant-related moderators to identify the potential factors associated with the expected heterogeneity of effect sizes. Data Sources Eleven electronic databases were searched from 2007 to June 3, 2021 (alert until September 10, 2021). Reference lists of earlier meta-analyses and included reports were screened. Study Selection Reports examined MCT and included participants with schizophrenia spectrum and related psychotic disorders (1045 reports identified; 281 assessed). There were no age, sex, gender, race and ethnicity, language, or study design restrictions. Two reviewers performed the selection of studies to be analyzed. Data Extraction and Synthesis The Preferred Reporting Items for Systematic Reviews and Meta-analyses reporting guideline was followed. Data were extracted by 3 reviewers and pooled using random effects models. Hedges g effect sizes were computed. The Mixed-Methods Appraisal tool was used to assess study quality. Main Outcomes and Measures Proximal outcomes were global positive symptoms, delusions, hallucinations, and cognitive biases. Distal outcomes were self-esteem, negative symptoms, quality of life, well-being, and functioning. Immediate and sustained outcomes were examined. Meta-regressions, subgroup, and sensitivity analyses assessed moderators. Results This systematic review and meta-analysis included 43 studies (46 reports). Forty reports were synthesized in meta-analysis (N=1816 participants) and 6 reports were included in narrative review. In the studies examined, MCT was associated with positive symptoms (g = 0.50; 95% CI, 0.34-0.67), delusions (g = 0.69; 95% CI, 0.45-0.93), hallucinations (g = 0.26; 95% CI, 0.11-0.40), cognitive biases (g = 0.16; 95% CI, 0.03-0.29), self-esteem (g = 0.17; 95% CI, 0.03-0.31), negative symptoms (g = 0.23; 95% CI, 0.10-0.37), and functioning (g = 0.41; 95% CI, 0.12-0.69). These associations were maintained up to 1 year. The quality of life effect size was nonsignificant (g = 0.20; 95% CI, -0.07 to 0.47); only 1 study assessed well-being. Publication year was associated with moderated hallucinations (β = 0.04; 95% CI, 0.00-0.07). Overall, narrative review results corroborated meta-analytic findings. Conclusions and Relevance In this meta-analysis, MCT for psychosis was associated with benefits up to 1 year postintervention in several treatment contexts. These findings suggest that MCT may merit integration in treatment guidelines for schizophrenia.
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Affiliation(s)
- Danielle Penney
- Douglas Mental Health University Institute, Montréal, Québec, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, Québec, Canada
| | - Geneviève Sauvé
- Douglas Mental Health University Institute, Montréal, Québec, Canada
- Department of Education and Pedagogy, Université du Québec à Montréal, Montréal, Québec, Canada
| | - Daniel Mendelson
- Douglas Mental Health University Institute, Montréal, Québec, Canada
- Department of Psychology, McGill University, Montréal, Québec, Canada
| | - Élisabeth Thibaudeau
- Douglas Mental Health University Institute, Montréal, Québec, Canada
- Department of Psychiatry, McGill University, Montréal, Québec, Canada
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg, Hamburg, Germany
| | - Martin Lepage
- Douglas Mental Health University Institute, Montréal, Québec, Canada
- Department of Psychiatry, McGill University, Montréal, Québec, Canada
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19
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Zonp Z, Bilgin H. The effectiveness of metacognitive training on impairments in social cognition in patients with schizophrenia: mental health nursing practice in a community mental health center. Nord J Psychiatry 2022; 76:295-306. [PMID: 34428118 DOI: 10.1080/08039488.2021.1965653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Social cognition is an independent structure from the positive symptoms of schizophrenia and contributes to negative symptoms, neurocognitive impairment, and social functioning. AIM To examine the effectiveness of the metacognitive training intervention on social cognition in people with schizophrenia. DESIGN This study was conducted as a randomized quasi-experimental (pre-test/post-test and follow-up) design with a control group. METHODS Thirty-nine patients with schizophrenia were enrolled and randomly assigned to either the control group (n = 19) or the metacognitive training group (n = 20). A 10-week metacognitive training program was offered to the intervention group. The study involved a pre-test/post-test design with a 3-month follow-up assessment. The primary outcome was social cognition, as measured by the Facial Emotion Discrimination/Identification Tests, Reading the Mind in the Eyes Test, and Attributional Style Questionnaire. The secondary outcome was measured by the metacognitive training subjective efficacy form. RESULTS Completion at follow-up was high (92.3%). The results show that the changes over time in the False Belief Task 1st level, Attributional Style Questionnaire negative events global-specific dimension, and positive events stable-unstable dimension mean scores, time interaction, were statistically significant. Metacognitive Training was efficacious on the theory of mind and in performing more functional attributions. Patients in the intervention group showed high-level positive feedback. CONCLUSION Metacognitive Training applied by psychiatric and mental health nurses demonstrated a user and practitioner-friendly, safe and effective program on social cognition. Also, the social and cultural feasibility and effectiveness of the Metacognitive Training program were shown for the first time in a Turkish population.
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Affiliation(s)
- Zeynep Zonp
- Postdoctoral Resesarch Fellow, School of Nursing, University of Michigan, Ann Arbor, MI, USA; Health Science Faculty, Kocaeli University, Kocaeli, Turkey
| | - Hülya Bilgin
- Professor, Florence Nightingale School of Nursing, Istanbul University-Cerrahpaşa, Istanbul, Turkey
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20
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Haga S, Kobayashi M, Takehara A, Kawano K, Endo K. Efficacy of Metacognitive Training for Patients With Schizophrenia in Psychiatric Emergency Wards: A Pilot Randomized Controlled Trial. Front Psychol 2022; 13:861102. [PMID: 35478760 PMCID: PMC9035885 DOI: 10.3389/fpsyg.2022.861102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionMetacognitive training (MCT) is a group program for improving cognitive bias in patients with schizophrenia. MCT has a reported positive effect on psychiatric symptoms and cognitive bias in patients with schizophrenia, but the effect of the intervention on patients with schizophrenia in the early recovery stage during hospitalization is not comprehensible. Therefore, this study aimed to investigate the efficacy of MCT in the early recovery stage of patients with schizophrenia in a Japanese emergency psychiatric ward.MethodThis unblinded, pilot randomized controlled trial recruited 24 patients with schizophrenia aged 20–65 years. Patients were randomly divided into two groups: occupational therapy (OT) + MCT group and OT-only group. Using the two-way repeated-measures analysis of variance (ANOVA), changes in cognitive function, psychiatric symptoms, cognitive insight, and intrinsic motivation were compared between those at baseline and post-intervention and between the two groups. Furthermore, patient readmission during the year after discharge was compared between the groups.ResultsThe final analysis included eight patients in each group, owing to the withdrawal of some patients from the study. The two-way repeated-measures analysis of variance revealed significant differences in cognitive function in several domains within subjects. However, no significant differences between subjects were observed. Psychiatric symptoms showed significant within-subject improvement, and interaction was found for general psychopathology (p = 0.03). The variable of cognitive insight and self-reflectiveness was significantly different between subjects (p = 0.03). There was no significant difference in intrinsic motivation. Readmission within a year was significantly lower in the OT + MCT group than in the OT-only group (2 [25%] vs. 6 [75%]; p = 0.046).ConclusionIn a Japanese emergency psychiatric ward, this pilot randomized controlled study was the first attempt to investigate the efficacy of MCT in patients with schizophrenia suggesting that MCT may be effective in preventing psychiatric symptoms, poor self-reflectiveness, and readmissions.The study was registered in the University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR; UMIN000034106).
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Affiliation(s)
- Saori Haga
- Department of Rehabilitation, Tikumaso Mental Hospital, Ueda, Japan
| | - Masayoshi Kobayashi
- Department of Health Sciences, Graduate School of Medicine, Shinshu University, Matsumoto, Japan
- *Correspondence: Masayoshi Kobayashi,
| | - Ayako Takehara
- Department of Rehabilitation, Tikumaso Mental Hospital, Ueda, Japan
| | - Kojiro Kawano
- Department of Rehabilitation, Tikumaso Mental Hospital, Ueda, Japan
- Department of Health Sciences, Graduate School of Medicine, Shinshu University, Matsumoto, Japan
| | - Kenji Endo
- Department of Rehabilitation, Tikumaso Mental Hospital, Ueda, Japan
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21
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The Efficacy of Extended Metacognitive Training on Neurocognitive Function in Schizophrenia: A Randomized Controlled Trial. Brain Sci 2022; 12:brainsci12030413. [PMID: 35326369 PMCID: PMC8945894 DOI: 10.3390/brainsci12030413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/18/2022] [Accepted: 03/18/2022] [Indexed: 11/17/2022] Open
Abstract
The aim of this study was to evaluate the effect of metacognitive training (MCT) on improving the neurocognitive function of Chinese patients with schizophrenia. One hundred inpatients with schizophrenia were selected by regional group randomization and divided into the control (treated as usual, TAU) group (n = 50) and the TAU + MCT group (n = 50). In this study, a 10-module MCT was used and the intervention process lasted 30 days. Cognitive function was assessed blindly using the Repeatable Battery of Neuropsychological Status (RBANS) scale at baseline, 24 h post-treatment, and 12 weeks’ post-treatment. The differences between the total RBANS score and baseline (pre-test) for the post-test and 12-week-follow-up tests were used as the primary outcome, and the difference between the RBANS dimension scores and baseline (pre-test) were used as a secondary outcome in this study. The completion rate at follow-up was high in the TAU + MCT group (94%). Intention-to-treat analysis and per-protocol analysis showed a significant increase in total neurocognitive function scores and three-dimensional scores (delayed memory, visual breadth, and attention) in the TAU + MCT group immediately after the intervention and at the 12-week follow-up compared with baseline. This study provides support for the efficacy of 10 module MCT concerning neurocognition.
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22
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Strube W, Cimpianu CL, Ulbrich M, Öztürk ÖF, Schneider-Axmann T, Falkai P, Marshall L, Bestmann S, Hasan A. Unstable Belief Formation and Slowed Decision-making: Evidence That the Jumping-to-Conclusions Bias in Schizophrenia Is Not Linked to Impulsive Decision-making. Schizophr Bull 2021; 48:347-358. [PMID: 34554260 PMCID: PMC8886605 DOI: 10.1093/schbul/sbab108] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Jumping-to-conclusions (JTC) is a prominent reasoning bias in schizophrenia (SCZ). While it has been linked to not only psychopathological abnormalities (delusions and impulsive decision-making) but also unstable belief formation, its origin remains unclear. We here directly test to which extend JTC is associated with delusional ideation, impulsive decision-making, and unstable belief formation. METHODS In total, 45 SCZ patients were compared with matched samples of 45 patients with major depressive disorder (MDD) and 45 healthy controls (HC) as delusions and JTC also occur in other mental disorders and the general population. Participants performed a probabilistic beads task. To test the association of JTC with measures of delusions (Positive and Negative Syndrome Scale [PANSS]positive, PANSSpositive-factor, and Peter Delusions Inventory [PDI]), Bayesian linear regressions were computed. For the link between JTC and impulsive decision-making and unstable beliefs, we conducted between-group comparisons of "draws to decision" (DTD), "decision times" (DT), and "disconfirmatory evidence scores" (DES). RESULTS Bayesian regression obtained no robust relationship between PDI and DTD (all |R2adj| ≤ .057, all P ≥ .022, all Bayes Factors [BF01] ≤ 0.046; α adj = .00833). Compared with MDD and HC, patients with SCZ needed more time to decide (significantly higher DT in ambiguous trials: all P ≤ .005, r2 ≥ .216; numerically higher DT in other trials). Further, SCZ had unstable beliefs about the correct source jar whenever unexpected changes in bead sequences (disconfirmatory evidence) occurred (compared with MDD: all P ≤ .004 and all r2 ≥ .232; compared with HC: numerically higher DES). No significant correlation was observed between DT and DTD (all P ≥ .050). CONCLUSIONS Our findings point toward a relationship of JTC with unstable belief formation and do not support the assumption that JTC is associated with impulsive decision-making.
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Affiliation(s)
- Wolfgang Strube
- Department of Psychiatry and Psychotherapy, Ludwig Maximillian University, Munich,Germany,Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Medical Faculty, University of Augsburg, Bezirkskrankenhaus Augsburg, Augsburg, Germany,To whom correspondence should be addressed; BKH Augsburg, Dr. Mack-Straße 1, D-86156 Augsburg, Germany; tel: +49-821-4803-1011, fax: +49-821-4803-1012, e-mail:
| | - Camelia Lucia Cimpianu
- Department of Psychiatry and Psychotherapy, Ludwig Maximillian University, Munich,Germany
| | - Miriam Ulbrich
- Department of Psychiatry and Psychotherapy, Ludwig Maximillian University, Munich,Germany
| | - Ömer Faruk Öztürk
- Department of Psychiatry and Psychotherapy, Ludwig Maximillian University, Munich,Germany,International Max Planck Research School for Translational Psychiatry, Munich, Germany
| | | | - Peter Falkai
- Department of Psychiatry and Psychotherapy, Ludwig Maximillian University, Munich,Germany
| | - Louise Marshall
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, Queen Square, London, UK
| | - Sven Bestmann
- Department of Clinical and Movement Neurosciences, UCL Queen Square Institute of Neurology, Queen Square, London, UK,Wellcome Centre for Human Neuroimaging, UCL Queen Square Institute of Neurology, Queen Square, London, UK
| | - Alkomiet Hasan
- Department of Psychiatry, Psychotherapy and Psychosomatics of the University Augsburg, Medical Faculty, University of Augsburg, Bezirkskrankenhaus Augsburg, Augsburg, Germany
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Effect of metacognitive training applied on depression and cognitive distortion levels of depression patients. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-02202-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Brar PS, Sass L, Beck D, Kalarchian MA. Metacognitive training for schizophrenia: a scoping review and phenomenological evaluation. PSYCHOSIS-PSYCHOLOGICAL SOCIAL AND INTEGRATIVE APPROACHES 2021. [DOI: 10.1080/17522439.2021.1918753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Pavan S. Brar
- Department of Psychology, Duquesne University, Pittsburgh, PA, USA
| | - Louis Sass
- Graduate School of Applied and Professional Psychology, Rutgers University, Pittsburgh, PA, USA
| | - Donna Beck
- Gumberg Library, Duquesne University, Pittsburgh, PA, USA
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Lejeune JA, Northrop A, Kurtz MM. A Meta-analysis of Cognitive Remediation for Schizophrenia: Efficacy and the Role of Participant and Treatment Factors. Schizophr Bull 2021; 47:997-1006. [PMID: 33772310 PMCID: PMC8266668 DOI: 10.1093/schbul/sbab022] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
The number of randomized, controlled studies of cognitive remediation (CR) for schizophrenia, a therapeutic approach designed to improve cognitive skills and function, has grown substantially over the past 20 years. Active elements of CR treatment, however, remain unknown. The current meta-analysis investigated treatment, study, and participant factors in the size of observed treatment effects. Electronic databases were searched up to May 2020 using variants of the key words "cognitive remediation," "clinical trials," and "schizophrenia." This search produced 73 unique, randomized, controlled trials. Data were independently extracted by 3 reviewers with excellent reliability. Random-effects models were used to assess primary cognitive and secondary symptom and functional outcomes. Moderator analyses investigated the role of a variety of treatment, study, and participant factors. The meta-analysis (4594 participants) revealed that CR produced significant small-to-moderate size improvements in all domains of cognition studied (Hedge's gs = .19-.33). and a significant small improvement in function (Hedge's g = .21). CR programs that included a discussion ("bridging") group to help apply acquired cognitive skills to everyday life produced larger effects on global cognition and verbal memory. CR programs with strategy-coaching produced larger effects on episodic memory. Sample age, gender, positive, negative, and overall symptoms, and medication dose did not serve as barriers to treatment gains. CR produces small-to-moderate improvements in cognition and function in schizophrenia. Programs of CR that utilize bridging groups and strategy-coaching are more cognitively potent. Future research should focus on ways to modify CR to bolster generalization of cognitive improvements to function.
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Affiliation(s)
- Julia A Lejeune
- Department of Psychology and Program in Neuroscience and Behavior, Wesleyan University, Middletown, CT, USA,Department of Psychiatry, Boston Medical Center, Boston, MA, USA
| | - Andrew Northrop
- Department of Psychology and Program in Neuroscience and Behavior, Wesleyan University, Middletown, CT, USA
| | - Matthew M Kurtz
- Department of Psychology and Program in Neuroscience and Behavior, Wesleyan University, Middletown, CT, USA,To whom correspondence should be addressed; Department of Psychology and Program in Neuroscience and Behavior, Wesleyan University, Middletown, CT 06459, US; tel: 860-685-2072, fax: 860-685-2761, e-mail:
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Tripoli G, Quattrone D, Ferraro L, Gayer-Anderson C, Rodriguez V, La Cascia C, La Barbera D, Sartorio C, Seminerio F, Tarricone I, Berardi D, Szöke A, Arango C, Tortelli A, Llorca PM, de Haan L, Velthorst E, Bobes J, Bernardo M, Sanjuán J, Santos JL, Arrojo M, Del-Ben CM, Menezes PR, Selten JP, Jones PB, Jongsma HE, Kirkbride JB, Lasalvia A, Tosato S, Richards A, O’Donovan M, Rutten BPF, van Os J, Morgan C, Sham PC, Murray RM, Murray GK, Di Forti M. Jumping to conclusions, general intelligence, and psychosis liability: findings from the multi-centre EU-GEI case-control study. Psychol Med 2021; 51:623-633. [PMID: 32327005 PMCID: PMC8020493 DOI: 10.1017/s003329171900357x] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 10/07/2019] [Accepted: 11/21/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND The 'jumping to conclusions' (JTC) bias is associated with both psychosis and general cognition but their relationship is unclear. In this study, we set out to clarify the relationship between the JTC bias, IQ, psychosis and polygenic liability to schizophrenia and IQ. METHODS A total of 817 first episode psychosis patients and 1294 population-based controls completed assessments of general intelligence (IQ), and JTC, and provided blood or saliva samples from which we extracted DNA and computed polygenic risk scores for IQ and schizophrenia. RESULTS The estimated proportion of the total effect of case/control differences on JTC mediated by IQ was 79%. Schizophrenia polygenic risk score was non-significantly associated with a higher number of beads drawn (B = 0.47, 95% CI -0.21 to 1.16, p = 0.17); whereas IQ PRS (B = 0.51, 95% CI 0.25-0.76, p < 0.001) significantly predicted the number of beads drawn, and was thus associated with reduced JTC bias. The JTC was more strongly associated with the higher level of psychotic-like experiences (PLEs) in controls, including after controlling for IQ (B = -1.7, 95% CI -2.8 to -0.5, p = 0.006), but did not relate to delusions in patients. CONCLUSIONS Our findings suggest that the JTC reasoning bias in psychosis might not be a specific cognitive deficit but rather a manifestation or consequence, of general cognitive impairment. Whereas, in the general population, the JTC bias is related to PLEs, independent of IQ. The work has the potential to inform interventions targeting cognitive biases in early psychosis.
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Affiliation(s)
- Giada Tripoli
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, LondonSE5 8AF, UK
| | - Diego Quattrone
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, LondonSE5 8AF, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
- South London and Maudsley NHS Mental Health Foundation Trust, London, UK
| | - Laura Ferraro
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Via G. La Loggia 1, 90129Palermo, Italy
| | - Charlotte Gayer-Anderson
- Department of Health Service and Population Research, Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, LondonSE5 8AF, UK
| | - Victoria Rodriguez
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, LondonSE5 8AF, UK
| | - Caterina La Cascia
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Via G. La Loggia 1, 90129Palermo, Italy
| | - Daniele La Barbera
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Via G. La Loggia 1, 90129Palermo, Italy
| | - Crocettarachele Sartorio
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Via G. La Loggia 1, 90129Palermo, Italy
| | - Fabio Seminerio
- Department of Experimental Biomedicine and Clinical Neuroscience, University of Palermo, Via G. La Loggia 1, 90129Palermo, Italy
| | - Ilaria Tarricone
- Department of Medical and Surgical Science, Psychiatry Unit, Alma Mater Studiorum Università di Bologna, Viale Pepoli 5, 40126Bologna, Italy
| | - Domenico Berardi
- Department of Medical and Surgical Science, Psychiatry Unit, Alma Mater Studiorum Università di Bologna, Viale Pepoli 5, 40126Bologna, Italy
| | - Andrei Szöke
- INSERM, U955, Equipe 15, 51 Avenue de Maréchal de Lattre de Tassigny, 94010 Créteil, France
| | - Celso Arango
- Department of Child and Adolescent Psychiatry, Hospital General Universitario Gregorio Marañón, School of Medicine, Universidad Complutense, IiSGM (CIBERSAM), C/Doctor Esquerdo 46, 28007Madrid, Spain
| | - Andrea Tortelli
- Etablissement Public de Santé Maison Blanche, Paris75020, France
| | | | - Lieuwe de Haan
- Department of Psychiatry, Early Psychosis Section, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZAmsterdam, The Netherlands
| | - Eva Velthorst
- Department of Psychiatry, Early Psychosis Section, Amsterdam UMC, University of Amsterdam, Meibergdreef 5, 1105 AZAmsterdam, The Netherlands
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Julio Bobes
- Department of Medicine, Psychiatry Area, School of Medicine, Universidad de Oviedo, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), C/Julián Clavería s/n, 33006Oviedo, Spain
| | - Miguel Bernardo
- Barcelona Clinic Schizophrenia Unit, Department of Medicine, Neuroscience Institute, Hospital clinic, University of Barcelona, IDIBAPS, CIBERSAM, Barcelona, Spain
| | - Julio Sanjuán
- Department of Psychiatry, School of Medicine, Universidad de Valencia, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), C/Avda. Blasco Ibáñez 15, 46010Valencia, Spain
| | - Jose Luis Santos
- Department of Psychiatry, Servicio de Psiquiatría Hospital “Virgen de la Luz”, C/Hermandad de Donantes de Sangre, 16002Cuenca, Spain
| | - Manuel Arrojo
- Department of Psychiatry, Psychiatric Genetic Group, Instituto de Investigación Sanitaria de Santiago de Compostela, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago, Spain
| | - Cristina Marta Del-Ben
- Division of Psychiatry, Department of Neuroscience and Behaviour, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Paulo Rossi Menezes
- Department of Preventive Medicine, Faculdade de Medicina, Universidade of São Paulo, São Paulo, Brazil
| | - Jean-Paul Selten
- Rivierduinen Institute for Mental Health Care, Sandifortdreef 19, 2333 ZZLeiden, The Netherlands
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, P.O. Box 616, 6200 MDMaastricht, The Netherlands
| | | | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- CAMEO Early Intervention Service, Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, CB21 5EF, UK
| | - Hannah E Jongsma
- Psylife Group, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road London, W1T 7NF, UK
| | - James B Kirkbride
- Psylife Group, Division of Psychiatry, University College London, 6th Floor, Maple House, 149 Tottenham Court Road London, W1T 7NF, UK
| | - Antonio Lasalvia
- Section of Psychiatry, Azienda Ospedaliera Universitaria Integrata di Verona, Verona, Italy
| | - Sarah Tosato
- Section of Psychiatry, Department of Neuroscience, Biomedicine and Movement, University of Verona, Piazzale L.A. Scuro 10, 37134, Verona, Italy
| | - Alex Richards
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, CF24 4HQ, UK
| | - Michael O’Donovan
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Cardiff, CF24 4HQ, UK
| | - Bart PF Rutten
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, P.O. Box 616, 6200 MDMaastricht, The Netherlands
| | - Jim van Os
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, LondonSE5 8AF, UK
- Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, South Limburg Mental Health Research and Teaching Network, Maastricht University Medical Centre, P.O. Box 616, 6200 MDMaastricht, The Netherlands
- Department Psychiatry, Brain Centre Rudolf Magnus, Utrecht University Medical Centre, Utrecht, The Netherlands
| | - Craig Morgan
- Department of Health Service and Population Research, Institute of Psychiatry, King's College London, De Crespigny Park, Denmark Hill, LondonSE5 8AF, UK
| | - Pak C Sham
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, LondonSE5 8AF, UK
- Centre for Genomic Sciences, Li KaShing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Robin M. Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, De Crespigny Park, Denmark Hill, LondonSE5 8AF, UK
| | - Graham K. Murray
- Department of Psychiatry, University of Cambridge, Cambridge, UK
- CAMEO Early Intervention Service, Cambridgeshire & Peterborough NHS Foundation Trust, Cambridge, CB21 5EF, UK
| | - Marta Di Forti
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, LondonSE5 8AF, UK
- National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College London, London, UK
- South London and Maudsley NHS Mental Health Foundation Trust, London, UK
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Chen Q, Sang Y, Ren L, Wu J, Chen Y, Zheng M, Bian G, Sun H. Metacognitive training: a useful complement to community-based rehabilitation for schizophrenia patients in China. BMC Psychiatry 2021; 21:38. [PMID: 33441093 PMCID: PMC7805146 DOI: 10.1186/s12888-021-03039-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 01/04/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The traditional general practitioner-based model (community-based rehabilitation [CBR]) for Chinese schizophrenia patients lacks sufficient content, usefulness, and theoretical basis for rehabilitation. Based on previous research, we postulate that Metacognitive Training (MCT) is effective in the community for schizophrenic patients. METHOD A randomized controlled, assessor-blinded trial was conducted. A total of 124 schizophrenia patients were recruited from Ningbo China and were randomly assigned to an intervention or a control group. A general practitioner (GP) training plan was carried out before intervention. Intervention and control groups received two CBR follow-ups once a month, while the intervention group, received an additional eight once-a-in-week session of MCT. The Positive and Negative Syndrome Scale (PANSS), and the Psychotic Symptom Rating Scales (PSYRATS) were the primary outcome instruments, while the Quality of Life Scale (SQLS) was the secondary outcome instrument. RESULTS In the post-treatment between-groups assessment, the patients in the intervention group showed significantly more reductions on PSYRATS delusions, PSYRATS total, PANSS P6, PANSS core delusions, PANSS positive, PANSS negative, PANSS general and PANSS total, and a significant improvement in SQLS psychosocial aspect. CONCLUSIONS The study provides preliminary evidence for the usefulness of MCT as a complementary measure for community-based rehabilitation of schizophrenia patients. TRIAL REGISTRATION ISRCTN, ISRCTN17333276 . Registered 09 August 2020 - Retrospectively registered.
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Affiliation(s)
- Qi Chen
- Department of Chronic Disease and Mental Health, YinZhou Center for Disease Control and Prevention, Ningbo, China.
| | - Yueyun Sang
- Ningbo Mental Health Center, Ningbo Kangning Hospital, Ningbo, China.
| | - Lifang Ren
- Department of Chronic Disease and Mental Health, YinZhou Center for Disease Control and Prevention, Ningbo, China
| | - Jinping Wu
- Department of Community Health, Hengxi Community Health Center, Ningbo, China
| | - Yajun Chen
- Department of Community Health, Maoshan Community Health Center, Ningbo, China
| | - Menglei Zheng
- Department of Community Health, Shounan Community Health Center, Ningbo, China
| | - Guolin Bian
- grid.452715.00000 0004 1782 599XNingbo Mental Health Center, Ningbo Kangning Hospital, Ningbo, China
| | - Hanying Sun
- Department of Chronic Disease and Mental Health, YinZhou Center for Disease Control and Prevention, Ningbo, China ,grid.194645.b0000000121742757LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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de Pinho LMG, Sequeira CADC, Sampaio FMC, Rocha NB, Ozaslan Z, Ferre-Grau C. Assessing the efficacy and feasibility of providing metacognitive training for patients with schizophrenia by mental health nurses: A randomized controlled trial. J Adv Nurs 2020; 77:999-1012. [PMID: 33222210 DOI: 10.1111/jan.14627] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 08/05/2020] [Accepted: 10/19/2020] [Indexed: 01/10/2023]
Abstract
AIM To evaluate the efficacy of metacognitive group training in reducing psychotic symptoms and improving cognitive insight and functions in people with schizophrenia. DESIGN Randomized controlled trial. It was carried out between July 2019 -February 2020. METHODS Fifty-six patients with schizophrenia were enrolled and randomly assigned to either a control group (N = 29) or a metacognitive training group (N = 27). Blinded assessments were made at baseline, 1-week post-treatment and at follow-up 3 months after treatment. The primary outcome measure was psychotic symptoms based on the Psychotic Symptom Rating Scales (PSYRATS). Secondary outcomes were assessed by the Beck Cognitive Insight Scale (BCIS), the Personal and Social Performance (PSP) scale and the World Health Organization Disability Assessment Schedule (WHODAS). RESULTS Completion at follow-up was high (92.86%). The intention-to-treat analyses demonstrated that patients in the metacognitive training group had significantly greater improvements of the Psychotic Symptom Rating Scales delusion score and total score and the Personal and Social Performance Scale, after 3 months, compared with the control group. The effect size was medium to large. The intention-to-treat analyses also demonstrated that patients in the metacognitive training group had significantly greater reductions of the Psychotic Symptom Rating Scales hallucination score and Beck Cognitive Insight Scale self-certainty score post-treatment, compared with the control group. The effect size was medium to large. CONCLUSION The metacognitive training administered by psychiatric and mental health nurses was effective in ameliorating delusions and social functioning over time and it immediately reduced hallucinations post-treatment. IMPACT Metacognitive training for treating psychosis in patients with schizophrenia is efficacious and administration is clinically feasible in the Portuguese context. TRIAL REGISTRATION NUMBER ClinicalTrials.gov ID NCT03891186.
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Affiliation(s)
- Lara Manuela Guedes de Pinho
- University of Évora, Évora, Portugal.,Comprehensive Health Research Centre (CHRC), Évora, Portugal.,Universitat Rovira and Virgili, Tarragona, Spain
| | - Carlos Alberto da Cruz Sequeira
- School of Nursing of Porto, Porto, Portugal.,NursID - Innovation & Development in Nursing Research Group, CINTESIS - Center for Health Technology and Services Research, Porto, Portugal
| | - Francisco Miguel Correia Sampaio
- NursID - Innovation & Development in Nursing Research Group, CINTESIS - Center for Health Technology and Services Research, Porto, Portugal.,Higher School of Health of the Instituto Politécnico de Portalegre, Porto, Portugal
| | | | - Zeynep Ozaslan
- Faculty of Health Sciences, Kocaeli University, Kocaeli, Turkey.,Postdoctoral Scholar at the University of Michigan School of Nursing, Ann Arbor, MI, USA
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Lopez-Morinigo JD, Ajnakina O, Martínez ASE, Escobedo-Aedo PJ, Ruiz-Ruano VG, Sánchez-Alonso S, Mata-Iturralde L, Muñoz-Lorenzo L, Ochoa S, Baca-García E, David AS. Can metacognitive interventions improve insight in schizophrenia spectrum disorders? A systematic review and meta-analysis. Psychol Med 2020; 50:2289-2301. [PMID: 33050956 PMCID: PMC7610184 DOI: 10.1017/s0033291720003384] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/20/2020] [Accepted: 08/28/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with schizophrenia spectrum disorders (SSD) tend to lack insight, which is linked to poor outcomes. The effect size of previous treatments on insight changes in SSD has been small. Metacognitive interventions may improve insight in SSD, although this remains unproved. METHODS We carried out a systematic review and meta-analysis of randomized controlled trials (RCTs) to examine the effects of metacognitive interventions designed for SSD, namely Metacognitive Training (MCT) and Metacognitive Reflection and Insight Therapy (MERIT), on changes in cognitive and clinical insight at post-treatment and at follow-up. RESULTS Twelve RCTs, including 10 MCT RCTs (n = 717 participants) and two MERIT trials (n = 90), were selected, totalling N = 807 participants. Regarding cognitive insight six RCTs (n = 443) highlighted a medium effect of MCT on self-reflectiveness at post-treatment, d = 0.46, p < 0.01, and at follow-up, d = 0.30, p < 0.01. There was a small effect of MCT on self-certainty at post-treatment, d = -0.23, p = 0.03, but not at follow-up. MCT was superior to controls on an overall Composite Index of cognitive insight at post-treatment, d = 1.11, p < 0.01, and at follow-up, d = 0.86, p = 0.03, although we found evidence of heterogeneity. Of five MCT trials on clinical insight (n = 244 participants), which could not be meta-analysed, four of them favoured MCT compared v. control. The two MERIT trials reported conflicting results. CONCLUSIONS Metacognitive interventions, particularly Metacognitive Training, appear to improve insight in patients with SSD, especially cognitive insight shortly after treatment. Further long-term RCTs are needed to establish whether these metacognitive interventions-related insight changes are sustained over a longer time period and result in better outcomes.
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Affiliation(s)
- Javier-David Lopez-Morinigo
- Departamento de Psiquiatría, Universidad Autónoma de Madrid, Madrid, Spain
- Departamento de Psiquiatría, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Olesya Ajnakina
- Department of Biostatistics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Behavioural Science and Health, Institute of Epidemiology and Health Care, University College London, London, UK
| | | | | | - Verónica González Ruiz-Ruano
- Departamento de Psiquiatría, Universidad Autónoma de Madrid, Madrid, Spain
- Departamento de Psiquiatría, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | | | | | | | - Susana Ochoa
- Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
- Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Enrique Baca-García
- Departamento de Psiquiatría, Universidad Autónoma de Madrid, Madrid, Spain
- Departamento de Psiquiatría, IIS-Fundación Jiménez Díaz, Madrid, Spain
- Departamento de Psicología, Psychology Clinical and Health, Universidad Católica del Maule, Talca, Chile
| | - Anthony S David
- Institute of Mental Health, University College London, London, UK
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Sauvé G, Lavigne KM, Pochiet G, Brodeur MB, Lepage M. Efficacy of psychological interventions targeting cognitive biases in schizophrenia: A systematic review and meta-analysis. Clin Psychol Rev 2020; 78:101854. [DOI: 10.1016/j.cpr.2020.101854] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 04/01/2020] [Accepted: 04/04/2020] [Indexed: 12/14/2022]
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Combined Neurocognitive And Metacognitive Rehabilitation In Schizophrenia: Effects On Bias Against Disconfirmatory Evidence. Eur Psychiatry 2020; 30:615-21. [DOI: 10.1016/j.eurpsy.2015.02.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2014] [Revised: 01/30/2015] [Accepted: 02/02/2015] [Indexed: 11/19/2022] Open
Abstract
AbstractBackgroundA Metacognitive Training for Schizophrenia patients (MCT) was developed to target the cognitive biases that characterize the illness. Results suggest positive MCT effects encompassing several aspects of psychopathology and subjective well-being. There are still open questions concerning the effect on different cognitive biases and the interplay between them and both psychopathology and neurocognition. Specifically, the bias against disconfirmatory evidence (BADE) has never been tested in previous trials on MCT. In this study we evaluated the feasibility of MCT combined with a cognitive remediation therapy (CACR) in schizophrenia and its effect on BADE. Moreover, we investigated the relationships between BADE and both neuropsychology and psychopathology, taking into account mutual influences on the degree of improvement.MethodsFifty-seven schizophrenia outpatients were randomly assigned to CACR + control group or MCT+CACR and assessed at baseline and after treatment for psychopathology, neurocognition and BADE.ResultsAfter MCT+CACR patients showed significantly greater improvements on BADE. Although BADE baseline performances correlated with several cognitive domains, no association was found between BADE improvement and neurocognitive nor psychopathological measures.ConclusionsThis study enlightened for the first time the efficacy of MCT+CACR on BADE in schizophrenia, suggesting the importance to develop a more specific intervention tailored on individual needs of patients.
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Serrano-Guerrero E, Ruiz-Veguilla M, Martín-Rodríguez A, Rodríguez-Testal JF. Inflexibility of beliefs and jumping to conclusions in active schizophrenia. Psychiatry Res 2020; 284:112776. [PMID: 31981941 DOI: 10.1016/j.psychres.2020.112776] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/06/2020] [Accepted: 01/06/2020] [Indexed: 10/25/2022]
Abstract
Jumping to conclusions (JTC) has been questioned as sufficient cognitive bias for the onset, maintenance, and severity of delusions compared to the bias of inflexibility of beliefs. The WIT (What is this?) test was designed to evaluate JTC and its capacity for classifying participants into a group of patients with active schizophrenia and a comparison group. It was also attempted to determine whether the presence/absence of answer choices, considered a measure of induced inflexibility of beliefs, influences decision-making and is related to the tendency to repeat the first decision, or spontaneous inflexibility of beliefs. The sample was made up of 160 participants, 80 patients with schizophrenia diagnosed at hospital admission and 80 healthy controls. The Beads Task and the WIT test were administered. The WIT classified the participants reasonably well (82.7%) compared to the Beads Task (86.3%). The presence of answer choices favored JTC (d = 0.33), decreasing the number of lines necessary to make a decision (d = 1.78), and influencing keeping to the original answer (d = 1.36), in interaction with the group (d = 0.42). The WIT test overcame some limitations of the Beads Task. The presence/absence of answer choices influenced decision-making and how thinking was flexibilized, more clearly in the case of controls.
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Affiliation(s)
- Estrella Serrano-Guerrero
- U.G.C. Salud Mental, Hospital Universitario Virgen Macarena, C/ Dr. Fedriani, n° 3, CP: 41009, Sevilla, España.
| | - Miguel Ruiz-Veguilla
- U.G.C. Salud Mental, Hospital Universitario Virgen del Rocío/CIBERSAM/IBIS/CSIC/Universidad de Sevilla, Unidad de Hospitalización de Salud Mental, Avenida Manuel Siurot, s/n, CP: 41013, Sevilla, España.
| | - Agustín Martín-Rodríguez
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universidad de Sevilla, C/ Camilo José Cela, s/n, CP: 41018, Sevilla, España.
| | - Juan F Rodríguez-Testal
- Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Universidad de Sevilla, C/ Camilo José Cela, s/n, CP: 41018, Sevilla, España.
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Ishikawa R, Ishigaki T, Shimada T, Tanoue H, Yoshinaga N, Oribe N, Morimoto T, Matsumoto T, Hosono M. The efficacy of extended metacognitive training for psychosis: A randomized controlled trial. Schizophr Res 2020; 215:399-407. [PMID: 31471248 DOI: 10.1016/j.schres.2019.08.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 07/30/2019] [Accepted: 08/03/2019] [Indexed: 10/26/2022]
Abstract
This study investigated the efficacy of 10-module metacognitive training (MCT) among Japanese patients with schizophrenia by conducting a multicenter randomized controlled trial to test the influence of the most recent and extended version of MCT on positive symptoms. A six-center, randomized, assessor-blind, controlled trial between "treatment as usual" (TAU) and TAU + MCT was conducted. Fifty inpatients and outpatients with schizophrenia, schizotypal, and delusional disorders (ICD 10) were enrolled, then randomly assigned to TAU (n = 26) or TAU + MCT (n = 24). Assessments were made at baseline, after six weeks, immediately posttreatment, and 1-month post-treatment. The primary outcome was positive symptom score, as measured by the Positive and Negative Syndrome Scale (PANSS). General assessment of functioning (GAF) and measures of cognitive biases were secondary outcomes. Completion at post-treatment (10 weeks later) and 1-month follow-up was high-TAU + MCT, n = 22 (91.67%) and TAU, n = 23 (88.46%). The severity of PANSS positive symptoms declined significantly in the TAU + MCT treatment group compared with the TAU group. GAF also showed significantly greater improvement in the TAU + MCT group compared with the TAU group. There was also a trend for greater efficacy of MCT on cognitive biases. In conclusion, this study provides support for the efficacy of 10 module MCT concerning positive symptomatology (especially, delusion) and general functioning.
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Affiliation(s)
| | - Takuma Ishigaki
- Graduate School of Arts and Sciences, University of Tokyo, Japan
| | | | - Hiroki Tanoue
- Graduate School of Medicine and Veterinary Medicine, University of Miyazaki, Miyazaki, Japan; School of Nursing, Faculty of Medicine, University of Miyazaki, Miyazaki, Japan
| | - Naoki Yoshinaga
- Organization for Promotion of Tenure Track, University of Miyazaki, Japan
| | - Naoya Oribe
- National Hospital Organization Hizen Psychiatric Center Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Japan
| | | | | | - Masahito Hosono
- Graduate School of Arts and Sciences, University of Tokyo, Japan
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Pinho LMG, Sequeira CADC, Sampaio FMC, Rocha NB, Ferre‐Grau C. A randomized controlled trial to evaluate the efficacy of metacognitive training for people with schizophrenia applied by mental health nurses: Study protocol. J Adv Nurs 2019; 76:356-363. [DOI: 10.1111/jan.14240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2019] [Revised: 10/03/2019] [Accepted: 10/09/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Lara Manuela Guedes Pinho
- Nursing School of São João de Deus University of Évora Évora Portugal
- Health School of the Portalegre Polytechnic Institute Portalegre Portugal
- NURSID group of Center for Health Technology and Services Research (CINTESIS)Porto Portugal
- Universitat Rovira y Virgili Tarragona Spain
| | - Carlos Alberto da Cruz Sequeira
- NURSID group of Center for Health Technology and Services Research (CINTESIS)Porto Portugal
- School of Nursing of Porto Porto Portugal
| | - Francisco Miguel Correia Sampaio
- NURSID group of Center for Health Technology and Services Research (CINTESIS)Porto Portugal
- Faculty of Health Sciences University Fernando Pessoa Porto Portugal
- Faculty of Medicine University of Porto Porto Portugal
| | - Nuno Barbosa Rocha
- School of Health Polytechnic of Porto Porto Portugal
- Center for Rehabilitation Research Porto Portugal
| | - Carmen Ferre‐Grau
- Universitat Rovira y Virgili Tarragona Spain
- Nurse and Health URV Tarragona Spain
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Rodriguez V, Ajnakina O, Stilo SA, Mondelli V, Marques TR, Trotta A, Quattrone D, Gardner-Sood P, Colizzi M, Wiffen BD, Dazzan P, Di Forti M, Falcone MA, David AS, Murray RM. Jumping to conclusions at first onset of psychosis predicts longer admissions, more compulsory admissions and police involvement over the next 4 years: the GAP study. Psychol Med 2019; 49:2256-2266. [PMID: 30392491 DOI: 10.1017/s0033291718003197] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Jumping to conclusions (JTC), which is the proneness to require less information before forming beliefs or making a decision, has been related to formation and maintenance of delusions. Using data from the National Institute of Health Research Biomedical Research Centre Genetics and Psychosis (GAP) case-control study of first-episode psychosis (FEP), we set out to test whether the presence of JTC would predict poor clinical outcome at 4 years. METHODS One-hundred and twenty-three FEP patients were assessed with the Positive and Negative Syndrome Scale (PANSS), Global Assessment of Functioning (GAF) and the probabilistic reasoning 'Beads' Task at the time of recruitment. The sample was split into two groups based on the presence of JTC bias. Follow-up data over an average of 4 years were obtained concerning clinical course and outcomes (remission, intervention of police, use of involuntary treatment - the Mental Health Act (MHA) - and inpatient days). RESULTS FEP who presented JTC at baseline were more likely during the follow-up period to be detained under the MHA [adjusted OR 15.62, 95% confidence interval (CI) 2.92-83.54, p = 0.001], require intervention by the police (adjusted OR 14.95, 95% CI 2.68-83.34, p = 0.002) and have longer admissions (adjusted IRR = 5.03, 95% CI 1.91-13.24, p = 0.001). These associations were not accounted for by socio-demographic variables, IQ and symptom dimensions. CONCLUSIONS JTC in FEP is associated with poorer outcome as indicated and defined by more compulsion police intervention and longer periods of admission. Our findings raise the question of whether the implementation of specific interventions to reduce JTC, such as Metacognition Training, may be a useful addition in early psychosis intervention programmes.
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Affiliation(s)
- Victoria Rodriguez
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Olesya Ajnakina
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Simona A Stilo
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Valeria Mondelli
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Tiago Reis Marques
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Antonella Trotta
- Social, Genetics and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Diego Quattrone
- Social, Genetics and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Poonam Gardner-Sood
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Marco Colizzi
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Benjamin D Wiffen
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Paola Dazzan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Marta Di Forti
- Social, Genetics and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - M Aurora Falcone
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Anthony S David
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Robin M Murray
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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Asensio-Aguerri L, Beato-Fernández L, Stavraki M, Rodríguez-Cano T, Bajo M, Díaz D. Paranoid Thinking and Wellbeing. The Role of Doubt in Pharmacological and Metacognitive Therapies. Front Psychol 2019; 10:2099. [PMID: 31572275 PMCID: PMC6751329 DOI: 10.3389/fpsyg.2019.02099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 08/29/2019] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Pathological confidence in one's thoughts is a key mechanism of chronic paranoid thinking. For this reason, many of the current therapies focus on trying to reduce it. In fact, the way some antipsychotics (e.g., haloperidol) work seems to be through the induction of doubt. Because of the impact of these pathological thoughts on positive health, studying the well-being of people who experience paranoid thoughts is fundamental. The first objective of this research is to apply the Complete State Model of Health (CSMH) to a sample of patients characterized by the presence of paranoid thinking. Our second objective is to evaluate the impact of therapies based on reducing pathological confidence on patients' well-being. METHODS Sixty participants with SCID-5 confirmed DSM-5 diagnosis related with paranoid thinking and without mood symptoms were recruited. In order to test the existence of a two continua model of mental health (CSMH), we conducted a parallel analysis and an exploratory factor analysis. To test our hypothesis regarding the partially mediating role of doubt between paranoid thinking and patients' well-being, we conducted a biased corrected bootstrapping procedure. RESULTS As expected, two different unipolar dimensions emerged from the measures used to assess paranoid thinking and positive health (two continua model of mental health). When patients received metacognitive and pharmacological treatment, more paranoid thinking led to more doubt in all thoughts, which in turn affected well-being. The analyses carried out confirmed the partial mediating role of doubt. CONCLUSION Despite the efficacy shown by both metacognitive therapies and antipsychotics, it seems that they not only reduce pathological confidence, but can also affect other thoughts not linked to delirium. This effect of generalization of doubt in all thoughts negatively affected patients' well-being and quality of life.
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Affiliation(s)
| | - Luis Beato-Fernández
- Mental Health Unit, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
- Ciudad Real Medical School, Universidad de Castilla – La Mancha, Ciudad Real, Spain
| | - Maria Stavraki
- Ciudad Real Medical School, Universidad de Castilla – La Mancha, Ciudad Real, Spain
| | - Teresa Rodríguez-Cano
- Mental Health Unit, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
- Ciudad Real Medical School, Universidad de Castilla – La Mancha, Ciudad Real, Spain
| | - Miriam Bajo
- Ciudad Real Medical School, Universidad de Castilla – La Mancha, Ciudad Real, Spain
| | - Darío Díaz
- Ciudad Real Medical School, Universidad de Castilla – La Mancha, Ciudad Real, Spain
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de Jong S, Hasson-Ohayon I, van Donkersgoed RJM, Timmerman ME, van der Gaag M, Aleman A, Marieke Pijnenborg GH, Lysaker PH. Predicting therapy success from the outset: The moderating effect of insight into the illness on metacognitive psychotherapy outcome among persons with schizophrenia. Clin Psychol Psychother 2019; 26:650-660. [PMID: 31270887 DOI: 10.1002/cpp.2388] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/20/2019] [Accepted: 05/13/2019] [Indexed: 12/16/2022]
Abstract
The degree to which a person recognizes their mental disorder, attributes symptoms to the disorder, and recognizes that treatment may be necessary is frequently referred to as clinical insight. The current study investigates whether clinical insight at baseline moderates the effects on metacognitive capacity of 40 sessions of metacognitive reflection and insight therapy among 35 participants with psychosis. Findings showed that clinical insight did not predict drop-out from therapy. Multilevel analyses provided support for our hypotheses that insight at baseline significantly moderates metacognitive gains at both postmeasurement and follow-up. Our findings demonstrate that lacking clinical insight substantially hampers the effect of this psychosocial intervention. We posit that research efforts should shift from developing interventions, which enhance clinical insight, to interventions, which are effective in absence of clinical insight.
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Affiliation(s)
| | | | | | - Marieke E Timmerman
- Psychometrics and Statistics, University of Groningen, Groningen, The Netherlands
| | - Mark van der Gaag
- Psychosis Research, Parnassia Psychiatric Institute, The Netherlands.,Department of Clinical Psychology and Amsterdam Public Health Research, VU University, Amsterdam, The Netherlands
| | - Andre Aleman
- Department of Neuroscience, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands
| | - G H Marieke Pijnenborg
- Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, The Netherlands.,Department of Psychotic Disorders, GGZ Noord-Drenthe, Assen, The Netherlands
| | - Paul H Lysaker
- Department of Psychiatry, Roudeboush VA Medical Center, Indianapolis, IN, USA.,Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA
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Moritz S, Stojisavlevic M, Göritz AS, Riehle M, Scheunemann J. Does uncertainty breed conviction? On the possible role of compensatory conviction in jumping to conclusions and overconfidence in psychosis. Cogn Neuropsychiatry 2019; 24:284-299. [PMID: 31311460 DOI: 10.1080/13546805.2019.1642863] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Jumping to conclusions (JTC) and overconfidence in errors are well established in individuals with a liability to psychosis. Experimental research suggests that subjecting individuals to dilemmas and doubt prompts a subsequent hardening of attitudes and may foster delusion-like convictions. For the present study, we examined whether this compensatory conviction process is exaggerated in individuals with a liability to psychosis and might in part explain JTC and overconfidence. Methods: A large sample of participants from the general population were screened for psychotic experiences with the Community Assessment of Psychic Experiences scale (CAPE) and then randomly allocated to either a condition in which they should experience doubt or a control condition. Participants (final sample, n = 650) were then tested on JTC and overconfidence. Results: Participants who scored high on the positive subscale of the CAPE made fewer draws to decision, showed greater confidence, and made more errors relative to low scorers. Yet, none of the parameters was modulated by experimental condition. Conclusions: Our results at present do not support the idea that JTC is elevated by a prior experience of a dilemma or doubt. Yet, this possibility should not be entirely dismissed as the presumed process may take time to evolve and perhaps needs to be more pervasive.
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Affiliation(s)
- Steffen Moritz
- a Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Marko Stojisavlevic
- a Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Anja S Göritz
- b Department of Occupational and Consumer Psychology, University of Freiburg , Freiburg , Germany
| | - Marcel Riehle
- a Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - Jakob Scheunemann
- a Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf , Hamburg , Germany
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de Vos C, Leanza L, Mackintosh A, Lüdtke T, Balzan R, Moritz S, Andreou C. Investigation of sex differences in delusion-associated cognitive biases. Psychiatry Res 2019; 272:515-520. [PMID: 30616118 DOI: 10.1016/j.psychres.2018.12.121] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 12/21/2018] [Accepted: 12/22/2018] [Indexed: 11/19/2022]
Abstract
In the past few decades, sex differences have been identified in a number of clinical, cognitive and functional outcomes in patients with schizophrenia spectrum disorders. However, to date, sex differences in higher-order cognitive biases have not been systematically studied. The present study aimed to examine sex differences in jumping-to-conclusions and evidence integration impairment based on data collected in two previous studies in patients with schizophrenia spectrum disorders and healthy controls. For this purpose, data from n = 58 patients and n = 60 healthy controls on the Fish Task (as a measure of jumping to conclusions) and bias against disconfirmatory evidence (BADE; as a measure of evidence integration) task were analyzed. Results indicated a lack of sex differences in jumping-to-conclusions and evidence integration impairment both in patients with schizophrenia spectrum disorders and healthy controls. Although the present study was adequately powered to detect sex differences of a low medium effect size, larger studies are warranted to exclude differences of a smaller magnitude between men and women regarding delusion-associated cognitive biases.
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Affiliation(s)
- Chloé de Vos
- Center for Psychotic Disorders, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland
| | - Letizia Leanza
- Center for Psychotic Disorders, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland
| | - Amatya Mackintosh
- Center for Psychotic Disorders, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland
| | - Thies Lüdtke
- Neuropsychology Unit, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Ryan Balzan
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia; ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, Australia
| | - Steffen Moritz
- Neuropsychology Unit, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany
| | - Christina Andreou
- Center for Psychotic Disorders, University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, 4002 Basel, Switzerland.
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Thinking dispositions and cognitive reflection performance in schizotypy. JUDGMENT AND DECISION MAKING 2019. [DOI: 10.1017/s193029750000293x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
AbstractSchizotypy refers to the continuum of normal variability of psychosis-like characteristics and experiences, often classified as positive schizotypy (‘unusual experiences’; UE) and negative schizotypy (‘introvertive anhedonia’; IA). Here, we investigated the link between schizotypy and cognitive processing style and performance. A particular focus was on whether schizotypy is associated more with Type 1 (automatic/heuristic) than Type 2 (reflective/effortful) processes, as may be expected from findings of impaired top-down control in schizophrenia. A large sample (n = 1,512) completed online measures pertaining to schizotypy (Oxford-Liverpool Inventory for Feelings and Experiences; O-LIFE), thinking style (Rational Experiential Inventory-10, Actively Open-Minded Thinking Scale), and reasoning performance (Cognitive Reflection Test). Higher positive (UE) and negative (IA) schizotypy were associated with more pronounced Type 1 processing, i.e. greater self-reported Faith in Intuition (FI), lower Need for Cognition (NFC), lower Actively Open-Minded Thinking (AOT), and lower cognitive reflection test (CRT) scores. Canonical correlation analysis confirmed a significant association between UE and increased FI, lower AOT and lower CRT performance, accounting for 12.38% of the shared variance between schizotypy and thinking dispositions. IA was more highly associated with reduced NFC. These findings suggest that schizotypy may be associated with similar thinking dispositions to those reported in psychosis, with different patterns of associations for positive and negative schizotypy. This result informs research on reasoning processes in psychosis and has clinical implications, including potential treatment targets and refinements for cognitive therapies.
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Ward T, Garety PA. Fast and slow thinking in distressing delusions: A review of the literature and implications for targeted therapy. Schizophr Res 2019; 203:80-87. [PMID: 28927863 PMCID: PMC6336980 DOI: 10.1016/j.schres.2017.08.045] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Revised: 08/16/2017] [Accepted: 08/21/2017] [Indexed: 12/21/2022]
Abstract
The recent literature on reasoning biases in psychosis and delusions is reviewed. The state-of-the-art knowledge from systematic reviews and meta-analyses on the evidence for jumping to conclusions is briefly summarised, before a fuller discussion of the more recent empirical literature on belief flexibility as applied to delusions. The methodology and evidence in relation to studies of belief flexibility and the Bias Against Disconfirmatory Evidence (BADE) across the delusional continuum will be critically appraised, and implications drawn for improving cognitive therapy. It will be proposed that dual process models of reasoning, which Kahneman (Kahneman, 2011) popularised as 'fast and slow thinking', provide a useful theoretical framework for integrating further research and informing clinical practice. The emergence of therapies which specifically target fast and slow thinking in people with distressing delusions will be described.
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Affiliation(s)
- Thomas Ward
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychology, United Kingdom; South London and Maudsley NHS Foundation Trust, United Kingdom
| | - Philippa A Garety
- King's College London, Institute of Psychiatry, Psychology & Neuroscience, Department of Psychology, United Kingdom; South London and Maudsley NHS Foundation Trust, United Kingdom.
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Kimoto S, Makinodan M, Kishimoto T. Neurobiology and treatment of social cognition in schizophrenia: Bridging the bed-bench gap. Neurobiol Dis 2018; 131:104315. [PMID: 30391541 DOI: 10.1016/j.nbd.2018.10.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 10/01/2018] [Accepted: 10/31/2018] [Indexed: 01/15/2023] Open
Abstract
Social cognition refers to the psychological processes involved in the perception, encoding, storage, retrieval, and regulation of information about others and ourselves. This process is essential for survival and reproduction in complex social environments. Recent evidence suggests that impairments in social cognition frequently occur in schizophrenia, mainly contributing to poor functional outcomes, including the inability to engage in meaningful work and maintain satisfying interpersonal relationships. With the ambiguous definition of social cognition, the neurobiology underlying impaired social cognition remains unknown, and the effectiveness of currently available intervention strategies in schizophrenia remain limited. Considering the advances and challenges of translational research for schizophrenia, social cognition has been considered a high-priority domain for treatment development. Here, we describe the current state of the framework, clinical concerns, and intervention approaches for social cognition in schizophrenia. Next, we introduce translatable rodent models associated with schizophrenia that allow the evaluation of different components of social behaviors, providing deeper insights into the neural substrates of social cognition in schizophrenia. Our review presents a valuable perspective that indicates the necessity of building bridges between basic and clinical science researchers for the development of novel therapeutic approaches in impaired social cognition in schizophrenia.
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Affiliation(s)
- Sohei Kimoto
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan.
| | - Manabu Makinodan
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
| | - Toshifumi Kishimoto
- Department of Psychiatry, Nara Medical University School of Medicine, Kashihara, Japan
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Lysaker PH, Gagen E, Moritz S, Schweitzer RD. Metacognitive approaches to the treatment of psychosis: a comparison of four approaches. Psychol Res Behav Manag 2018; 11:341-351. [PMID: 30233262 PMCID: PMC6130286 DOI: 10.2147/prbm.s146446] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
In light of increasing interest in metacognition and its role in recovery from psychosis, a range of new treatments focused on addressing metacognitive deficits have emerged. These include Metacognitive Therapy, Metacognitive Training, metacognitive insight and reflection therapy, and metacognitive interpersonal therapy for psychosis. While each of these treatments uses the term metacognitive, each differs in terms of their epistemological underpinnings, their structure, format, presumed mechanisms of action, and primary outcomes. To clarify how these treatments converge and diverge, we first offer a brief history of metacognition as well as its potential role in an individual's response to and recovery from complicated mental health conditions including psychosis. We then review the background, practices, and supporting evidence for each treatment. Finally, we will offer a framework for thinking about how each of these approaches may ultimately complement rather than contradict one another and highlight areas for development. We suggest first that each is concerned with something beyond what people with psychosis think about themselves and their lives. Each of these four approaches is interested in how patients with severe mental illness think about themselves. Each looks at immediate reactions and ideas that frame the meaning of thoughts. Second, each of these approaches is more concerned with why people make dysfunctional decisions and take maladaptive actions rather than what comprised those decisions and actions. Third, despite their differences, each of these treatments is true to the larger construct of metacognition and is focused on person's relationships to their mental experiences, promoting various forms of self-understanding which allow for better self-management. Each can be distinguished from other cognitive and skills-based approaches to the treatment of psychosis in their emphasis on sense-making rather than learning a new specific thing to say, think, or do in a given situation.
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Affiliation(s)
- Paul H Lysaker
- Department of Psychiatry, Richard L Roudebush VA Medical Center, Indianapolis, IN, USA,
- Department of Psychiatry, Indiana University School of Medicine, Indianapolis, IN, USA,
| | - Emily Gagen
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Robert D Schweitzer
- School of Psychology and Counselling, Queensland University of Technology, Brisbane, QLD, Australia
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Andreou C, Steinmann S, Leicht G, Kolbeck K, Moritz S, Mulert C. fMRI correlates of jumping-to-conclusions in patients with delusions: Connectivity patterns and effects of metacognitive training. NEUROIMAGE-CLINICAL 2018; 20:119-127. [PMID: 30094162 PMCID: PMC6077165 DOI: 10.1016/j.nicl.2018.07.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 06/14/2018] [Accepted: 07/03/2018] [Indexed: 12/17/2022]
Abstract
Background Reasoning biases such as the jumping-to-conclusions bias (JTC) are thought to contribute to delusions. Interventions targeting these biases such as metacognitive training (MCT) may improve delusions. So far, it is not clear whether JTC depends on dopaminergic reward areas that constitute the main action locus of antipsychotic drugs, or on additional cortical areas. The present study aimed to investigate fMRI activation and functional connectivity patterns underlying JTC, and their changes following MCT, in patients with delusions. Methods Participants were 25 healthy individuals and 26 patients with current delusions who were either medication-free or on stable medication without sufficient response. We assessed (1) BOLD activity in the task-positive (TPN), task-negative (TNN), and subcortical reward network (RN); (2) Psychophysiological interactions (PPI) of peak activation areas. Results Presence of JTC (irrespective of group) was associated with lower RN activity during conclusion events, and with increased effective connectivity between TPN and TNN during draw events. Following MCT, changes were observed in TPN activity and in effective connectivity of inferior parietal cortex (part of the TPN) with all three target networks. Conclusion JTC is associated not only with reward system areas that constitute the main target of antipsychotic drugs, but also with cortical areas, particularly of the TPN. Faulty evidence gathering (jumping to conclusions, JTC) is associated with delusions. We assessed data gathering with fMRI in patients with delusions vs healthy controls. JTC was associated with abnormal activity and connectivity patterns. Changes in the task-positive network were observed following metacognitive training.
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Affiliation(s)
- Christina Andreou
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; University Psychiatric Clinics Basel, University of Basel, Basel, Switzerland; Neuropsychology Unit, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Saskia Steinmann
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gregor Leicht
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Kolbeck
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Neuropsychology Unit, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steffen Moritz
- Neuropsychology Unit, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christoph Mulert
- Psychiatry Neuroimaging Branch, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Centre for Psychiatry and Psychotherapy, Justus-Liebig-University, Giessen, Germany
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Schneider BC, Cludius B, Lutz W, Moritz S, Rubel JA. An Investigation of Module-Specific Effects of Metacognitive Training for Psychosis. ZEITSCHRIFT FUR PSYCHOLOGIE-JOURNAL OF PSYCHOLOGY 2018. [DOI: 10.1027/2151-2604/a000336] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Metacognitive training for psychosis (MCT) is a group training program that targets cognitive biases, which play a role in the pathogenesis of delusions. It remains unclear to what extent individual MCT modules lead to within- or between-session changes in positive symptoms, sadness, cognitive biases, or theory of mind (ToM) distortions. A one-armed open-label intervention study was conducted with 176 psychiatric inpatients with psychotic symptoms. Patients were asked to fill out a questionnaire on cognitive biases, symptoms, and ToM distortions before and after each session. Multilevel (ML) modeling was used to assess associations between participation in a respective module and subsequent changes in self-reported symptoms. ML analyses indicated an overall improvement in all outcomes as well as within-session decreases in positive symptoms for a module addressing ToM distortions with a small effect. Two MCT modules addressing cognitive biases (jumping to conclusions, a bias against disconfirmatory evidence) were associated with reductions in the module-specific bias with a small and small to medium effect, respectively. The study provides initial evidence regarding module-specific associations with positive symptoms, cognitive biases, and ToM distortions in MCT.
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Affiliation(s)
- Brooke C. Schneider
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Barbara Cludius
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Wolfgang Lutz
- Department of Psychology, University of Trier, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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McLean BF, Mattiske JK, Balzan RP. Towards a reliable repeated-measures beads task for assessing the jumping to conclusions bias. Psychiatry Res 2018; 265:200-207. [PMID: 29730540 DOI: 10.1016/j.psychres.2018.04.043] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Revised: 03/29/2018] [Accepted: 04/12/2018] [Indexed: 11/28/2022]
Abstract
The jumping to conclusions bias (JTC), in which some people gather less information than others before making a decision, has been linked to delusions in psychosis. JTC is usually identified via the beads task, in which a sequence of beads (the "target" sequence) is used to measure the amount of evidence participants require before making a decision. Yet, despite its common use, the reliability of the task has never been properly investigated. We investigated its reliability, and tested an alternate version which used distractor sequences to obfuscate the target sequence. Healthy participants (N = 212) were randomised into two groups. One group completed ten trials using the target sequence, while the other completed ten trials of the target sequence and three distractor sequences. Our data indicated the standard task may not be reliable over repeated measures, but that by including distractor sequences, the task becomes more believable, repeatable, and reliable. Additionally, excluding first-trial data (a "silent" practice trial) also improves repeatability. These improvements to the task are relevant to single trial studies, and will be especially useful to repeated-measures longitudinal, experimental, and treatment studies. Such repeated-measures studies are important for investigating the causal link between JTC and delusions.
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Affiliation(s)
- Benjamin F McLean
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia; ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, Australia.
| | - Julie K Mattiske
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia.
| | - Ryan P Balzan
- College of Education, Psychology and Social Work, Flinders University, Adelaide, Australia; ARC Centre of Excellence in Cognition and its Disorders, Macquarie University, Sydney, Australia
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Andreou C, Veckenstedt R, Lüdtke T, Bozikas VP, Moritz S. Differential relationship of jumping-to-conclusions and incorrigibility with delusion severity. Psychiatry Res 2018; 264:297-301. [PMID: 29660572 DOI: 10.1016/j.psychres.2018.04.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 02/05/2018] [Accepted: 04/03/2018] [Indexed: 10/17/2022]
Abstract
Reasoning biases such as jumping-to-conclusions (JTC) and incorrigibility have been suggested to contribute to the generation and maintenance of delusions. However, it is still debated whether these biases represent stable traits of patients with delusions, or are related to state fluctuations of delusion severity. The present study aimed to elucidate this question by combining a cross-sectional with a longitudinal approach. JTC, incorrigibility and delusion severity were assessed in 79 patients with a history of delusions over a 6-month period. To allow for a differentiated look into effects of time vs. symptom changes, patients were divided into patients with (D+) and without (D-) current delusions at baseline. Significant improvement of delusions was noted in D+ at follow-up. JTC did not differ between the two patient groups either at baseline or over time. In contrast, incorrigibility was significantly higher in D+ than D- at baseline; this difference remained stable throughout the 6-month follow-up period. The two biases did not significantly co-vary over time. Our results suggest a dissociation between incorrigibility and JTC as regards their relation to current presence of delusions, and tentatively support theoretical accounts attributing different roles to the two biases in the generation (JTC) and maintenance (incorrigibility) of delusions.
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Affiliation(s)
- Christina Andreou
- Center for Psychotic Disorders, University of Basel Psychiatric Clinics, Basel, Switzerland; Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Ruth Veckenstedt
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thies Lüdtke
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vasilis P Bozikas
- 1st Department of Psychiatry, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Moritz S, Bentall RP, Kolbeck K, Roesch-Ely D. Monocausal attribution and its relationship with reasoning biases in schizophrenia. Schizophr Res 2018; 193:77-82. [PMID: 28732799 DOI: 10.1016/j.schres.2017.06.057] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Revised: 06/20/2017] [Accepted: 06/27/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Aberrant attributional styles are counted to a set of circumscribed cognitive biases that are implicated in the pathogenesis of (paranoid) psychosis. However, evidence for a specific profile (e.g., an exaggerated self-serving bias, other-blaming bias) has become equivocal over the years. More recently, one-sided (monocausal) attributions have been reported in patients with psychosis. METHODS We compared a large sample of patients with diagnosed schizophrenia (n=145) to nonclinical controls (n=30) on a revised version of the Internal, Personal and Situational Attributions Questionnaire (IPSAQ-R). In this task, participants have to assign probability estimates to each of three potential causes (i.e., myself, others, circumstances) for a specific (negative or positive) event. RESULTS Participants with schizophrenia displayed an abolished self-serving bias and showed a significant preference for one-sided/monocausal attributions, which was neither correlated with jumping to conclusions nor overconfidence in errors. School education correlated with less monocausal attributions. We did not find any congruence between attributional styles with core delusional ideas. CONCLUSIONS Our study corroborates earlier investigations showing that monocausal attributions may play a role in the pathogenesis of psychosis; this bias unlikely represents an epiphenomenon of established biases. Unexpectedly, attributional styles (e.g., external-blaming) did not shape delusional contents. The true prevalence of monocausal attributions in psychosis is perhaps underestimated in the study, as groups were equated on school education, which was correlated with monocausal attributions.
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Affiliation(s)
- Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Richard P Bentall
- School of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Katharina Kolbeck
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniela Roesch-Ely
- Research Group Neurocognition, Department of General Psychiatry, Centre for Psychosocial Medicine, University of Heidelberg, Germany
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Liu Y, Tang C, Hung T, Tsai P, Lin M. The Efficacy of Metacognitive Training for Delusions in Patients With Schizophrenia: A Meta‐Analysis of Randomized Controlled Trials Informs Evidence‐Based Practice. Worldviews Evid Based Nurs 2018; 15:130-139. [DOI: 10.1111/wvn.12282] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Yu‐Chen Liu
- Master, Department of Nursing, College of MedicineNational Cheng Kung University Tainan City Taiwan Republic of China
| | - Chia‐Chun Tang
- Pre‐doctoral fellow of Behavioral Cooperative Oncology Group Center for Symptom Management, School of NursingIndiana University Purdue University at Indianapolis Indianapolis IN USA
| | - Tsai‐Tzu Hung
- Master's student, Department of Nursing, College of Medicine, National Cheng Kung University, and Cancer Center Tainan City Taiwan Republic of China
| | - Pei‐Ching Tsai
- Master's student, Department of Nursing, College of MedicineNational Cheng Kung University, and Ditmanson Medical Foundation Chia‐Yi Christian Hospital Tainan City Taiwan Republic of China
| | - Mei‐Feng Lin
- Professor, Department of Nursing, College of MedicineNational Cheng Kung University Tainan City Taiwan Republic of China
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Ward T, Peters E, Jackson M, Day F, Garety PA. Data-Gathering, Belief Flexibility, and Reasoning Across the Psychosis Continuum. Schizophr Bull 2018; 44:126-136. [PMID: 28338872 PMCID: PMC5768047 DOI: 10.1093/schbul/sbx029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND There is evidence for a group of nonclinical individuals with full-blown, persistent psychotic experiences (PEs) but no need-for-care: they are of particular importance in identifying risk and protective factors for clinical psychosis. The aim of this study was to investigate whether reasoning biases are related to PEs or need-for-care. METHOD Two groups with persistent PEs (clinical; n = 74; nonclinical; n = 92) and a control group without PEs (n = 83) were compared on jumping-to-conclusions (JTC) and belief flexibility. A randomly selected subset of interviews (n = 104) was analyzed to examine differences in experiential and rational reasoning. RESULTS As predicted JTC was more common in the clinical than the other 2 groups. Unexpectedly no group differences were observed between clinical and nonclinical groups on measures of belief flexibility. However, the clinical group was less likely to employ rational reasoning, while the nonclinical group was more likely to use experiential reasoning plus a combination of both types of reasoning processes, compared to the other 2 groups. CONCLUSIONS Reasoning biases differ in groups with PEs with and without need-for-care. JTC is associated with need-for-care rather than with PEs. The ability to invoke rational reasoning processes, together with an absence of JTC, may protect against pathological outcomes of persistent PEs. However, marked use of experiential reasoning is associated with the occurrence of PEs in both clinical and nonclinical groups. Implications for theory development, intervention and further research are discussed.
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Affiliation(s)
- Thomas Ward
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,To whom correspondence should be addressed; Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King’s College London, PO77, Henry Wellcome Building, De Crespigny Park, London SE5 8AF, UK; tel: 44-207-848-0594, fax: 44-207-848-5006, e-mail:
| | - Emmanuelle Peters
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
| | - Mike Jackson
- School of Psychology, Bangor University, North Wales, UK,Betsi Cadwaladr University Health Board, North Wales, UK
| | - Fern Day
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Philippa A Garety
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK,NIHR Biomedical Research Centre for Mental Health, South London and Maudsley NHS Foundation Trust, London, UK
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