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Lopez-Morinigo JD, Martínez ASE, Barrigón ML, Escobedo-Aedo PJ, Ruiz-Ruano VG, Sánchez-Alonso S, Mata-Iturralde L, Muñoz-Lorenzo L, Cuadras D, Ochoa S, Baca-García E, David AS. A pilot 1-year follow-up randomised controlled trial comparing metacognitive training to psychoeducation in schizophrenia: effects on insight. SCHIZOPHRENIA (HEIDELBERG, GERMANY) 2023; 9:7. [PMID: 36717598 PMCID: PMC9886217 DOI: 10.1038/s41537-022-00316-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 11/14/2022] [Indexed: 06/18/2023]
Abstract
Poor insight in schizophrenia spectrum disorders (SSD) is linked with negative outcomes. This single-centre, assessor-blind, parallel-group 1-year follow-up randomised controlled trial (RCT) tested whether metacognitive training (MCT) (compared to psychoeducation) may improve insight and outcomes in outpatients with SSD assessed: at baseline (T0); after treatment (T1) and at 1-year follow-up (T2). Insight (primary outcome) was measured with (i) the Schedule for Assessment of Insight-Expanded version- (SAI-E), including illness recognition (IR), symptom relabelling (SR), treatment compliance (TC) and total insight scores (TIS); and (ii) the Beck Cognitive Insight Scale (BCIS). Between-group comparisons were nonsignificant, while within the MCT group (but not within controls) there was a significant medium effect size for improved TIS at T2 (d = 0.67, P = 0.02). Secondary outcomes included cognitive measures: Jumping to Conclusions (JTC), Theory of Mind (ToM), plus symptom severity and functioning. Compared to psychoeducation, MCT improved the PANSS excitement (d = 1.21, P = 0.01) and depressed (d = 0.76, P = 0.05) factors at T2; and a JTC task both at T1 (P = 0.016) and at T2 (P = 0.031). Participants in this RCT receiving MCT showed improved insight at 1-year follow-up, which was associated with better mood and reduced JTC cognitive bias. In this pilot study, no significant benefits on insight of MCT over psychoeducation were detected, which may have been due to insufficient power.
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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.
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain.
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain.
| | | | - María Luisa Barrigón
- Departamento de Psiquiatría, IIS-Fundación Jiménez Díaz, Madrid, Spain
- Department of Psychiatry, University Hospital Virgen del Rocio, Seville, Spain
| | | | - Verónica González Ruiz-Ruano
- Departamento de Psiquiatría, Universidad Autónoma de Madrid, Madrid, Spain
- Departamento de Psiquiatría, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | | | | | | | - Daniel Cuadras
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- Etiopatogenia y tratamiento de los trastornos mentales graves (MERITT), Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Susana Ochoa
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- Etiopatogenia y tratamiento de los trastornos mentales graves (MERITT), Institut de Recerca Sant Joan de Déu, Barcelona, Spain
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain
| | - Enrique Baca-García
- Departamento de Psiquiatría, Universidad Autónoma de Madrid, Madrid, Spain
- Departamento de Psiquiatría, IIS-Fundación Jiménez Díaz, Madrid, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- Universidad Católica del Maule, Talca, Chile
- Department of Psychiatry, Centre Hospitalier Universitaire de Nîmes, Nîmes, Francia
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Heterogeneity in Response to MCT and Psychoeducation: A Feasibility Study Using Latent Class Mixed Models in First-Episode Psychosis. Healthcare (Basel) 2022; 10:healthcare10112155. [DOI: 10.3390/healthcare10112155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Revised: 10/21/2022] [Accepted: 10/22/2022] [Indexed: 11/17/2022] Open
Abstract
Metacognitive training (MCT) is an effective treatment for psychosis. Longitudinal trajectories of treatment response are unknown but could point to strategies to maximize treatment efficacy during the first episodes. This work aims to explore the possible benefit of using latent class mixed models (LCMMs) to understand how treatment response differs between metacognitive training and psychoeducation. We conducted LCMMs in 28 patients that received MCT and 34 patients that received psychoeducation. We found that MCT is effective in improving cognitive insight in all patients but that these effects wane at follow-up. In contrast, psychoeducation does not improve cognitive insight, and may increase self-certainty in a group of patients. These results suggest that LCMMs are valuable tools that can aid in treatment prescription and in predicting response to specific treatments.
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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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Moritz S, Menon M, Balzan R, Woodward TS. Metacognitive training for psychosis (MCT): past, present, and future. Eur Arch Psychiatry Clin Neurosci 2022:10.1007/s00406-022-01394-9. [PMID: 35338378 PMCID: PMC8956140 DOI: 10.1007/s00406-022-01394-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 03/01/2022] [Indexed: 11/26/2022]
Abstract
This article provides an overview and retrospective on metacognitive training for psychosis (MCT), which first appeared approximately 2 decades ago. We recount how our empirical understanding of psychosis at that time led to the first preliminary version of the program. We describe setbacks and challenges that led to major changes, including revisions to existing modules (e.g., more focus on metacognitive variables, particularly on decision confidence as one of the primary targets of treatment) and the creation of new modules addressing mood, as well as attempts to improve sustainability of effects via homework exercises and a smartphone app ( www.uke.de/mct_app ). We have also enhanced dissemination efforts by creating new culturally sensitive language versions and facilitating low-threshold training through e-learning courses ( www.uke.de/e-mct ). Finally, we discuss several meta-analyses on the efficacy of MCT that have been published over the last decade. While reviews were initially inconsistent, possibly reflecting the insufficient statistical power and lower design quality of the first MCT studies, more recent meta-analyses have confirmed the efficacy of MCT on positive symptoms, insight, and cognitive biases, which has led to the inclusion of MCT in some national treatment guidelines for schizophrenia.
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Affiliation(s)
- Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Mahesh Menon
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- BC Psychosis Program, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Ryan Balzan
- College of Education, Psychology and Social Work, Flinders University, Bedford Park, SA, Australia
- Orama Institute, Flinders University, Bedford Park, SA, Australia
| | - Todd S Woodward
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
- Mental Health and Addictions Research Institute, Vancouver, BC, Canada
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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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Lopez-Morinigo JD, Ruiz-Ruano VG, Martínez ASE, Estévez MLB, Mata-Iturralde L, Muñoz-Lorenzo L, Sánchez-Alonso S, Artés-Rodríguez A, David AS, Baca-García E. Study protocol of a randomised clinical trial testing whether metacognitive training can improve insight and clinical outcomes in schizophrenia. BMC Psychiatry 2020; 20:30. [PMID: 31996174 PMCID: PMC6990523 DOI: 10.1186/s12888-020-2431-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Accepted: 01/06/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Although insight in schizophrenia spectrum disorders (SSD) has been associated with positive outcomes, the effect size of previous treatments on insight has been relatively small to date. The metacognitive basis of insight suggests that metacognitive training (MCT) may improve insight and clinical outcomes in SSD, although this remains to be established. METHODS This single-center, assessor-blind, parallel-group, randomised clinical trial (RCT) aims to investigate the efficacy of MCT for improving insight (primary outcome), including clinical and cognitive insight, which will be measured by the Schedule for Assessment of Insight (Expanded version) (SAI-E) and the Beck Cognitive Scale (BCIS), respectively, in (at least) n = 126 outpatients with SSD at three points in time: i) at baseline (T0); ii) after treatment (T1) and iii) at 1-year follow-up (T2). SSD patients receiving MCT and controls attending a non-intervention support group will be compared on insight level changes and several clinical and cognitive secondary outcomes at T1 and T2, whilst adjusting for baseline data. Ecological momentary assessment (EMA) will be piloted to assess functioning in a subsample of participants. DISCUSSION To the best of our knowledge, this will be the first RCT testing the effect of group MCT on multiple insight dimensions (as primary outcome) in a sample of unselected patients with SSD, including several secondary outcomes of clinical relevance, namely symptom severity, functioning, which will also be evaluated with EMA, hospitalizations and suicidal behaviour. TRIAL REGISTRATION ClinicalTrials.gov: NCT04104347. Date of registration: 26/09/2019 (Retrospectively registered).
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Affiliation(s)
- Javier-David Lopez-Morinigo
- Departamento de Psiquiatría, IIS-Fundación Jiménez Díaz, Madrid, Spain. .,Departamento de Psiquiatría, Universidad Autónoma de Madrid, Madrid, Spain. .,Centro de Especialidades Pontones, Salud Mental, 2ªPlanta, Ronda de Segovia, 52, 28005, Madrid, Spain.
| | - Verónica González Ruiz-Ruano
- grid.419651.eDepartamento de Psiquiatría, IIS-Fundación Jiménez Díaz, Madrid, Spain ,0000000119578126grid.5515.4Departamento de Psiquiatría, Universidad Autónoma de Madrid, Madrid, Spain
| | - Adela Sánchez Escribano Martínez
- grid.419651.eDepartamento de Psiquiatría, IIS-Fundación Jiménez Díaz, Madrid, Spain ,0000000119578126grid.5515.4Departamento de Psiquiatría, Universidad Autónoma de Madrid, Madrid, Spain
| | - María Luisa Barrigón Estévez
- grid.419651.eDepartamento de Psiquiatría, IIS-Fundación Jiménez Díaz, Madrid, Spain ,0000000119578126grid.5515.4Departamento de Psiquiatría, Universidad Autónoma de Madrid, Madrid, Spain
| | - Laura Mata-Iturralde
- grid.419651.eDepartamento de Psiquiatría, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | - Laura Muñoz-Lorenzo
- grid.419651.eDepartamento de Psiquiatría, IIS-Fundación Jiménez Díaz, Madrid, Spain
| | | | - Antonio Artés-Rodríguez
- 0000 0001 2168 9183grid.7840.bDepartamento de Teoría de Señal y de la Comunicación, Universidad Carlos III, Madrid, Spain
| | - Anthony S. David
- 0000000121901201grid.83440.3bInstitute of Mental Health, University College London, London, UK
| | - Enrique Baca-García
- grid.419651.eDepartamento de Psiquiatría, IIS-Fundación Jiménez Díaz, Madrid, Spain ,0000000119578126grid.5515.4Departamento de Psiquiatría, Universidad Autónoma de Madrid, Madrid, Spain ,grid.459654.fDepartment of Psychiatry, University Hospital Rey Juan Carlos, Mostoles, Spain ,Department of Psychiatry, General Hospital of Villalba, Madrid, Spain ,0000 0004 0425 3881grid.411171.3Department of Psychiatry, University Hospital Infanta Elena, Valdemoro, Spain ,0000 0000 9314 1427grid.413448.eCIBERSAM (Centro de Investigación en Salud Mental), Carlos III Institute of Health, Madrid, Spain ,0000 0001 2224 0804grid.411964.fUniversidad Católica del Maule, Talca, Chile
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Concepts of Metacognition in the Treatment of Patients with Mental Disorders. JOURNAL OF RATIONAL-EMOTIVE AND COGNITIVE-BEHAVIOR THERAPY 2019. [DOI: 10.1007/s10942-019-00333-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Simón-Expósito M, Felipe-Castaño E. Effects of Metacognitive Training on Cognitive Insight in a Sample of Patients with Schizophrenia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224541. [PMID: 31744146 PMCID: PMC6888430 DOI: 10.3390/ijerph16224541] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 11/07/2019] [Accepted: 11/13/2019] [Indexed: 12/04/2022]
Abstract
Metacognitive training (MCT) is a group intervention that addresses cognitive biases and distortions that could help maintain delusions and hallucinations in people with schizophrenia. This program has proven its effectiveness in reducing the symptoms, but its impact on cognitive insight has scarcely been investigated. Therefore, the aim of the study was to assess the program’s impact on cognitive insight in patients with long-term schizophrenia. A sample of 22 patients with schizophrenia was divided into two groups: one received 16 sessions of MCT (n = 11), while the other received the usual treatment (n = 11). They were assessed using the Beck Cognitive Insight Scale which measures two components, self-reflection and self-certainty, and the Positive and Negative Syndrome Scale (PANSS). The experimental group showed high levels of adherence, an increase in self-reflection, and a decrease in self-assurance levels as hypothesized. We found statistically significant differences between the control and experimental groups in excitation, hostility, positive symptomatology total score, hallucinatory behavior, and suspicion. In the usual treatment group, a non-significant decrease in positive symptoms was also observed. The findings showed that the implementation of the MCT program in real clinical settings can contribute to an improvement in the metacognitive ability and symptomatology of people with schizophrenia.
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Affiliation(s)
- Miguel Simón-Expósito
- Clinical Psychologist, SESPE, Regional Government of Extremadura, 1003 Cáceres, Spain;
| | - Elena Felipe-Castaño
- Lecturer in Psychological Treatment, Evaluation & Personality, University of Extremadura, 1003 Cáceres, Spain
- Correspondence: ; Tel.: +34-605-468-088
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An Overview of the Evidence for Psychological Interventions for Psychosis: Results From Meta-Analyses. CLINICAL PSYCHOLOGY IN EUROPE 2019. [DOI: 10.32872/cpe.v1i1.31407] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
There are numerous psychological approaches to psychosis that differ in focus, specificity and formats. These include psychodynamic, humanistic, cognitive-behavioural and
third-wave-approaches, psychoeducation, various types of training-based approaches and family interventions.
We briefly describe the main aims and focus of each of these approaches, followed by a review of their evidence-base in regard to improvement in symptoms, relapse and
functioning. We conducted a systematic search for meta-analyses dating to 2017 for each of the approaches reviewed. Where numerous meta-analyses for an approach were available,
we selected the most recent, comprehensive and methodologically sound ones.
We found convincing short- and long-term evidence for cognitive behavioural approaches if the main aim is to reduce symptom distress. Evidence is also strong for psychoeducative
family interventions that include skills training if the main aim is to reduce relapse and rehospitalisation. Acceptance and commitment therapy, mindfulness-based approaches,
meta-cognitive and social skills training, as well as systemic family interventions, were also found to be efficacious, depending on the outcome of interest, but meta-analyses
for these approaches were based on a comparatively lower number of outcome studies and a narrower selection of outcome measures. We found no convincing evidence for
psychodynamic approaches, humanistic approaches or patient-directed psychoeducation (without including the family).
An array of evidence-based psychological therapies is available for psychotic disorders from which clinicians and patients can choose, guided by the strength of the evidence and
depending on the outcome area focused on. Increased effort is needed in terms of dissemination and implementation of these therapies into clinical practice.
Meta-analyses show convincing evidence for CBT if the main target is psychotic symptoms.
Meta-analyses show convincing evidence for family interventions if the main target is relapse.
Effects are promising for ACT, mindfulness-based and systemic approaches, but more research is needed.
The array of effective approaches allows clinicians and patients to select the most appropriate one.
Meta-analyses show convincing evidence for CBT if the main target is psychotic symptoms.
Meta-analyses show convincing evidence for family interventions if the main target is relapse.
Effects are promising for ACT, mindfulness-based and systemic approaches, but more research is needed.
The array of effective approaches allows clinicians and patients to select the most appropriate one.
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Silberstein J, Harvey PD. Impaired introspective accuracy in schizophrenia: an independent predictor of functional outcomes. Cogn Neuropsychiatry 2019; 24:28-39. [PMID: 30477401 PMCID: PMC6370513 DOI: 10.1080/13546805.2018.1549985] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Individuals with schizophrenia present across a spectrum of symptomatology. Disability remains a debilitating reality across varying disease presentations and remains pervasive despite psychiatric medications. Cognition (neuro/social cognition) and negative symptoms have emerged as the strongest predictors of real-world disability, but account for <50% of the variance in outcomes. METHODS Our attempts to determine what accounts for the remaining 50% of variance has shown that poor introspective accuracy (IA) may be the most potent predictor of functional outcomes 25% of individuals with schizophrenia. We define IA as the adequacy of self-assessments of ability, skills, performance, or decisions. We suggest that IA is a progression of metacognition and can extend beyond cognition to include misestimation of prior and likely future performance in social or other adaptively relevant situations. RESULTS Additionally, IA is bidirectional and self-orientated. Emerging research has found that IA of neurocognitive ability better predicts everyday functional deficits than scores on performance-based measures or neurocognitive skills and has found that IA of social cognition accounts unique variance in real-world disability above social cognitive performance. DISCUSSION We argue that impaired IA, affecting 25-50% of patients with schizophrenia, in the absence or minimal presence of other impairments might be the most powerful predictor of functional outcomes.
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Affiliation(s)
| | - Philip D. Harvey
- University of Miami Miller School of Medicine, Miami, FL, USA 33136,Research Service, Bruce W. Cater VA Medical Center, Miami VA Healthcare System. Miami, FL, USA
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Kühne F, Meister R, Jansen A, Härter M, Moritz S, Kriston L. Effectiveness of metacognitive interventions for mental disorders in adults: a systematic review protocol (METACOG). BMJ Open 2017; 7:e015428. [PMID: 28645966 PMCID: PMC5734416 DOI: 10.1136/bmjopen-2016-015428] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 04/03/2017] [Accepted: 04/21/2017] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Whereas the efficacy of cognitive-behavioural therapy has been demonstrated for a variety of mental disorders, there is still need for improvement, especially regarding less prevalent or more severe disorders. Recently, metacognitive interventions have been developed and are now available for a variety of diagnoses. Still, a systematic review investigating the effectiveness of different metacognitive interventions for various mental disorders is missing. METHODS AND ANALYSIS Randomised controlled trials (RCTs), cross-over and cluster RCTs and non-randomised controlled trials on metacognitive interventions (ie, metacognitive therapy, metacognitive training, others) in adults with any mental disorder will be included. As comparators, another psychological or pharmacological treatment, a combined psychological and pharmacological treatment, treatment as usual or no active treatment are eligible. Outcomes refer to efficacy and acceptability of metacognitive interventions. ETHICS AND DISSEMINATION In light of the popularity of metacognitive interventions, the systematic review will provide researchers, clinicians and patients with substantial information on the intervention's effectiveness across different mental disorders. Results will be published in peer-reviewed journals and disseminated through a patient workshop.
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Affiliation(s)
- Franziska Kühne
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Department of Psychology, University of Postdam, Potsdam, Germany
| | - Ramona Meister
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alessa Jansen
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- The Federal Chamber of Psychotherapists in Germany (BPTK), Berlin, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Levente Kriston
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Eichner C, Berna F. Acceptance and Efficacy of Metacognitive Training (MCT) on Positive Symptoms and Delusions in Patients With Schizophrenia: A Meta-analysis Taking Into Account Important Moderators. Schizophr Bull 2016; 42:952-62. [PMID: 26748396 PMCID: PMC4903058 DOI: 10.1093/schbul/sbv225] [Citation(s) in RCA: 133] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Metacognitive training (MCT) is a new, widely used intervention for psychosis. The present meta-analysis examines the efficacy of MCT in schizophrenia. Fifteen studies comparing effects of MCT on positive symptoms, delusions or acceptance of MCT with a control group were included in this meta-analysis. These studies comprised a total of 408 patients in the MCT condition and 399 in the control condition. The moderating effects of masking of outcome assessment, randomization, incomplete outcome data, use of an active control intervention, and individual vs group MCT were investigated. Possible effects of sensitivity analyses and publication bias were also examined. The results show a significant overall effect of MCT for positive symptoms (g = -0.34, 95% CI [-0.53, -0.15]), delusions (g = -0.41, 95% CI [-0.74, -0.07]) and acceptance of the intervention (g = -0.84, 95% CI [-1.37, -0.31]). Using only studies being at low risk for bias regarding randomization, masking and incomplete outcome data reduced effect sizes for positive symptoms and delusions (g = -0.28, 95% CI [-0.50, -0.06] and g = -0.18, 95% CI [-0.43, 0.06]), respectively. This meta-analysis demonstrates that MCT exerts a small to moderate effect on delusions and positive symptoms and a large effect on acceptance of the intervention. The effect on delusions is reduced, but remains significant when potential biases are considered.
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Affiliation(s)
- Carolin Eichner
- Faculty of Psychology, University of Hamburg, Hamburg, Germany
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In this issue (June 2015). SHANGHAI ARCHIVES OF PSYCHIATRY 2015; 27. [PMCID: PMC4526824 DOI: 10.11919/j.issn.1002-0829.215069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 12/06/2022]
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