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Reininger KM, Koulen H, Biel HM, Hennig T, Pietras L, Kokot MR, Löwe B, Briken P, Moritz S. A Pilot Study of Metacognitive Training in U.S. Republican Leaners: Reducing Polarization Toward LGBTIQ+ Persons. Arch Sex Behav 2024; 53:1609-1620. [PMID: 38647830 DOI: 10.1007/s10508-024-02856-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 03/07/2024] [Accepted: 03/11/2024] [Indexed: 04/25/2024]
Abstract
Negative attitudes and stigmatization toward sexual minorities is a cause of minority stress of non-heterosexual persons on an individual level and has a negative impact on democratic coexistence in postmodern, plural society on a societal level. Derived from clinical research, we developed a short metacognitive training (MCT) intended to induce doubt toward inaccurate beliefs about LGBTIQ+ persons. We expected this MCT to reduce homonegativity, threat perceptions of LGBTIQ+ persons, and to foster extended outgroup tolerance compared to an education and a no-treatment control condition. We tested this hypothesis in U.S. Republican leaners who represent a social group that is likely to hold homonegative attitudes. We randomly assigned 490 U.S. Republican leaners to an MCT condition comprising 16 questions and respective answers (n = 166) vs. an education control condition (n = 164) vs. a no-treatment control condition (n = 160). We found that Republican leaners after receiving MCT (1) had a significant reduction of homonegativity (ds ≥ 0.28), (2) significantly perceived LGBTIQ+ persons as less threatening (ds ≥ 0.30), and (3) were significantly more tolerant of various outgroups such as LGBTIQ+ persons, feminists, liberals, and climate activists (ds ≥ 0.23) relative to both control conditions. The small effects of this short intervention and the possibility of systematically applying MCT in social discourse to reduce homonegativity with its potential significance for LGBTIQ+ individuals' mental health are discussed. Furthermore, we highlight this pilot study's significance toward intervention possibilities regarding political division and polarization in postmodern, democratic societies.
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Affiliation(s)
- Klaus Michael Reininger
- Department for Psychosomatic Medicine and Psychotherapy, University-Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
- Institute of Psychotherapy, University-Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Helena Koulen
- Department for Psychosomatic Medicine and Psychotherapy, University-Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Institute of Psychotherapy, University-Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hannah Marie Biel
- Department for Psychosomatic Medicine and Psychotherapy, University-Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Institute of Psychotherapy, University-Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Timo Hennig
- Faculty of Human Sciences, Department of Inclusive Education, University of Potsdam, Potsdam, Germany
| | - Laura Pietras
- Department for Psychosomatic Medicine and Psychotherapy, University-Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Institute for Sex Research Sexual Medicine and Forensic Psychiatry, University-Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Rochus Kokot
- Department for Psychosomatic Medicine and Psychotherapy, University-Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Institute of Psychotherapy, University-Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Bernd Löwe
- Department for Psychosomatic Medicine and Psychotherapy, University-Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
- Institute of Psychotherapy, University-Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Peer Briken
- Institute of Psychotherapy, University-Medical Center Hamburg-Eppendorf, Hamburg, Germany
- Institute for Sex Research Sexual Medicine and Forensic Psychiatry, University-Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steffen Moritz
- Department for Psychiatry and Psychotherapy, University-Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Schneider BC, Veckenstedt R, Karamatskos E, Ahlf-Schumacher J, Gehlenborg J, Schultz J, Moritz S, Jelinek L. Efficacy and moderators of metacognitive training for depression in older adults (MCT-Silver): A randomized controlled trial. J Affect Disord 2024; 345:320-334. [PMID: 37865342 DOI: 10.1016/j.jad.2023.10.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 09/28/2023] [Accepted: 10/16/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Up to 79 % of older adults with depression do not receive treatments commensurate with guideline recommendations. Metacognitive Training-Silver (MCT-Silver) is a low-intensity group training, which aims to reduce depressive symptoms by targeting (meta)cognitive beliefs. METHODS A randomized controlled trial comparing MCT-Silver (n = 41) to cognitive remediation (n = 39) was conducted with older adults with major depressive disorder and/or dysthymia. Clinician-rated depression (Hamilton Depression Rating Scale [HDRS, primary outcome]), self-reported depression (Beck Depression Inventory-II [BDI-II]), negative cognitive beliefs, positive metacognitive beliefs, rumination, health status, quality of life, and neurocognitive functioning were assessed at baseline, eight weeks (post) and three months (follow-up). RESULTS Both groups demonstrated moderate to large reductions in depression. No superior effects of MCT-Silver on clinician-rated depression (HDRS) were detected. MCT-Silver led to greater reductions in self-reported depression and rumination at post- and follow-up. Despite this, scores at post- and follow-up assessments were similar for both groups. MCT-Silver's effect on depressive symptoms was moderated by baseline rumination, positive metacognitive beliefs and previous treatment experience. MCT-Silver was evaluated as superior according to patient appraisals. LIMITATIONS Conclusions are limited by divergent findings on measures of depression and that the study was conducted during the COVID-19 pandemic. CONCLUSIONS Whereas no superior effect of MCT-Silver was found for the primary outcome, there was a significant effect of MCT-Silver for self-reported depression and rumination. Patients endorsing rumination and positive metacognitive beliefs as well as those without previous psychological treatment may benefit more from MCT-Silver.
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Affiliation(s)
- Brooke C Schneider
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany.
| | - Ruth Veckenstedt
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Evangelos Karamatskos
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Jana Ahlf-Schumacher
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Josefine Gehlenborg
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Josephine Schultz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
| | - Lena Jelinek
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246 Hamburg, Germany
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Annette S, Falkai P. Introduction for the follow-up of the Eighth International Kraepelin Symposium at LMU Munich. Eur Arch Psychiatry Clin Neurosci 2023:10.1007/s00406-023-01615-9. [PMID: 37199806 PMCID: PMC10238296 DOI: 10.1007/s00406-023-01615-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Affiliation(s)
- Schaub Annette
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilians University Munich, Nussbaumstr. 7, 803336, Munich, Germany.
| | - Peter Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, Ludwig Maximilians University Munich, Nussbaumstr. 7, 803336, Munich, Germany
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Mehl S, Hesse K, Moritz S, Müller DR, Kircher T, Bechdolf A. [Current evidence for various inpatient psychotherapy programs in the treatment of psychoses-A narrative review article]. Nervenarzt 2023; 94:189-197. [PMID: 36695894 DOI: 10.1007/s00115-022-01433-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/14/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND The analysis of the efficacy of evidence-based psychotherapy for patients with psychotic disorders has mostly been carried out in the outpatient field. In the inpatient field the efficacy is sometimes difficult to assess due to different healthcare systems. OBJECTIVE The aim of this narrative review is to summarize international guidelines and meta-analyses on the efficacy of inpatient psychotherapeutic treatment strategies for patients with psychotic disorders. Based on this, recommendations for disorder-specific ward concepts for acute and postacute fields are formulated. METHODS The German S3 guidelines, international guidelines, current meta-analyses and primary studies on psychological interventions in the treatment of psychotic disorders were included. Based on the results, recommendations for the inpatient psychotherapeutic treatment in various phases of treatment were formulated (acute phase and postacute phase). RESULTS In the acute phase a combination of cognitive behavioral therapy (CBTp) in the individual setting and family interventions in the group setting as well as metacognitive training (MCT acute) is effective and recommended. In the postacute phase, in addition to individual and group CBTp and family interventions, psychoeducation, social skills training and cognitive remediation have been shown to be effective and are recommended. DISCUSSION The suggested recommendations for concrete interventions in various treatment phases and the evidence base are critically discussed and recommendations for the structure of wards are presented.
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Affiliation(s)
- Stephanie Mehl
- Universitätsklinik für Psychiatrie und Psychotherapie, Philipps Universität Marburg, Rudolf-Bultmann-Str. 8, 35039, Marburg, Deutschland.
| | - Klaus Hesse
- Universitätsklinik für Psychiatrie und Psychotherapie Tübingen, Tübingen, Deutschland
| | - Steffen Moritz
- Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - Daniel R Müller
- Universitätsklinik für Psychiatrie und Psychotherapie Bern, Universität Bern, Bern, Schweiz
| | - Tilo Kircher
- Universitätsklinik für Psychiatrie und Psychotherapie, Philipps Universität Marburg, Rudolf-Bultmann-Str. 8, 35039, Marburg, Deutschland
| | - Andreas Bechdolf
- Kliniken für Psychiatrie, Psychotherapie und Psychosomatik, Vivantes Klinikum am Urban und Vivantes Klinikum im Friedrichshain, Berlin, Deutschland
- Klinik für Psychiatrie und Psychotherapie, Charité Universitätsmedizin, Charité Campus Mitte (CCM), Berlin, Deutschland
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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: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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González-Blanch C, Birulés I, Pousa E, Barrigon ML, López-Carrilero R, Lorente-Rovira E, Ayesa-Arriola R, Setien-Suero E, Barajas A, Grasa EM, Ruiz-Delgado I, González-Higueras F, Cid J, Ochoa S. Moderators of cognitive insight outcome in metacognitive training for first-episode psychosis. J Psychiatr Res 2021; 141:104-110. [PMID: 34186271 DOI: 10.1016/j.jpsychires.2021.06.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/29/2021] [Accepted: 06/20/2021] [Indexed: 10/21/2022]
Abstract
Metacognitive training (MCT) is a promising treatment for improving cognitive insight associated with delusional beliefs in individuals with psychotic disorders. The aim of this study was to examine potential moderators of cognitive insight in individuals with first-episode psychosis (FEP) who received either MCT or psychoeducation. The present study was based on data from a randomized control trial comparing MCT to psychoeducation. Baseline sociodemographic and clinical characteristics in a sample of 122 patients with FEP were examined as potential moderators of the self-reflectiveness and self-certainty dimensions of cognitive insight using the SPSS PROCESS macro. The only variable that moderated self-reflectiveness at the post-treatment evaluation was age of onset (b = -0.27, p = .025). The effect of MCT in reducing self-certainty was stronger in women (b = -3.26, p = .018) and in individuals with average or above average baseline self-esteem (b = -0.30, p = .007). Overall, our findings support the generalization of MCT to a variety of sociodemographic and clinical profiles. While some patient profiles may require targeted interventions such as MCT to improve cognitive insight, others may do equally as well with less demanding interventions such as a psychoeducational group.
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Affiliation(s)
- César González-Blanch
- Mental Health Centre, University Hospital Marqués de Valdecilla, Santander, Spain; IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain.
| | - Irene Birulés
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain; MERITT, Institut de Recerca Sant Joan de Déu, Barcelona, Spain; Universitat de Barcelona (UB), Barcelona, Spain
| | - Esther Pousa
- Salut Mental Parc Taulí. Sabadell (Barcelona), Hospital Universitari, UAB Universitat Autònoma de Barcelona, Barcelona, Spain; Department of Psychiatry, Hospital de La Santa Creu I Sant Pau, Institut D'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Barcelona, Spain
| | - María Luisa Barrigon
- Department of Psychiatry, IIS-Fundación Jiménez Díaz Hospital, Madrid, Spain; Department of Psychiatry, Universidad Autonoma de Madrid, Madrid, Spain
| | - Raquel López-Carrilero
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain; Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; MERITT, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Esther Lorente-Rovira
- Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; Psychiatry Service, Hospital Clinico Universitario, Valencia, Spain
| | - Rosa Ayesa-Arriola
- IDIVAL, Valdecilla Biomedical Research Institute, Santander, Spain; Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Esther Setien-Suero
- Department of Methods and Experimental Psychology, Faculty of Psychology and Education, University of Deusto, Bilbao, Spain
| | - Ana Barajas
- Department of Research, Centre D'Higiene Mental Les Corts, Barcelona, Spain; Serra Húnter Programme, Government of Catalonia, Spain; Department of Clinical and Health Psychology, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Barcelona, Spain
| | - Eva M Grasa
- Department of Psychiatry, Hospital de La Santa Creu I Sant Pau, Institut D'Investigació Biomèdica-Sant Pau (IIB-Sant Pau), Barcelona, Spain; Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | | | | | - Jordi Cid
- Mental Health & Addiction Research Group, IdiBGi, Institut D'Assistencia Sanitàri, Girona, Spain
| | - Susana Ochoa
- Parc Sanitari Sant Joan de Déu, Barcelona, Spain; Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain; MERITT, Institut de Recerca Sant Joan de Déu, Barcelona, Spain
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Shan X, Liao R, Ou Y, Pan P, Ding Y, Liu F, Chen J, Zhao J, Guo W, He Y. Increased regional homogeneity modulated by metacognitive training predicts therapeutic efficacy in patients with schizophrenia. Eur Arch Psychiatry Clin Neurosci 2021; 271:783-798. [PMID: 32215727 PMCID: PMC8119286 DOI: 10.1007/s00406-020-01119-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 03/11/2020] [Indexed: 02/07/2023]
Abstract
Previous studies have demonstrated the efficacy of metacognitive training (MCT) in schizophrenia. However, the underlying mechanisms related to therapeutic effect of MCT remain unknown. The present study explored the treatment effects of MCT on brain regional neural activity using regional homogeneity (ReHo) and whether these regions' activities could predict individual treatment response in schizophrenia. Forty-one patients with schizophrenia and 20 healthy controls were scanned using resting-state functional magnetic resonance imaging. Patients were randomly divided into drug therapy (DT) and drug plus psychotherapy (DPP) groups. The DT group received only olanzapine treatment, whereas the DPP group received olanzapine and MCT for 8 weeks. The results revealed that ReHo in the right precuneus, left superior medial prefrontal cortex (MPFC), right parahippocampal gyrus and left rectus was significantly increased in the DPP group after 8 weeks of treatment. Patients in the DT group showed significantly increased ReHo in the left ventral MPFC/anterior cingulate cortex (ACC), left superior MPFC/middle frontal gyrus (MFG), left precuneus, right rectus and left MFG, and significantly decreased ReHo in the bilateral cerebellum VIII and left inferior occipital gyrus (IOG) after treatment. Support vector regression analyses showed that high ReHo levels at baseline in the right precuneus and left superior MPFC could predict symptomatic improvement of Positive and Negative Syndrome Scale (PANSS) after 8 weeks of DPP treatment. Moreover, high ReHo levels at baseline and alterations of ReHo in the left ventral MPFC/ACC could predict symptomatic improvement of PANSS after 8 weeks of DT treatment. This study suggests that MCT is associated with the modulation of ReHo in schizophrenia. ReHo in the right precuneus and left superior MPFC may predict individual therapeutic response for MCT in patients with schizophrenia.
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Affiliation(s)
- Xiaoxiao Shan
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011 Hunan China ,National Clinical Research Center on Mental Disorders, Changsha, 410011 Hunan China
| | - Rongyuan Liao
- grid.412990.70000 0004 1808 322XThe Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan China
| | - Yangpan Ou
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011 Hunan China ,National Clinical Research Center on Mental Disorders, Changsha, 410011 Hunan China
| | - Pan Pan
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011 Hunan China ,National Clinical Research Center on Mental Disorders, Changsha, 410011 Hunan China
| | - Yudan Ding
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011 Hunan China ,National Clinical Research Center on Mental Disorders, Changsha, 410011 Hunan China
| | - Feng Liu
- grid.412645.00000 0004 1757 9434Department of Radiology, Tianjin Medical University General Hospital, Tianjin, 300000 China
| | - Jindong Chen
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011 Hunan China ,National Clinical Research Center on Mental Disorders, Changsha, 410011 Hunan China
| | - Jingping Zhao
- grid.452708.c0000 0004 1803 0208Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011 Hunan China ,National Clinical Research Center on Mental Disorders, Changsha, 410011 Hunan China
| | - Wenbin Guo
- Department of Psychiatry, The Second Xiangya Hospital of Central South University, Changsha, 410011, Hunan, China. .,National Clinical Research Center on Mental Disorders, Changsha, 410011, Hunan, China.
| | - Yiqun He
- The Second Affiliated Hospital of Xinxiang Medical University, Xinxiang, Henan, China.
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Moritz S, Bernardini J, Lion D. Effects and side effects of a transdiagnostic bias modification intervention in a mixed sample with obsessive-compulsive and/or depressive symptoms-a randomized controlled trial. Eur Arch Psychiatry Clin Neurosci 2020; 270:1025-36. [PMID: 31705201 DOI: 10.1007/s00406-019-01080-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 10/24/2019] [Indexed: 10/25/2022]
Abstract
Obsessive-compulsive disorder (OCD) and major depression disorder (MDD) are underdiagnosed and undertreated mental disorders. Prior studies have verified the efficacy of the self-help manual My Metacognitive Training (myMCT) for patients with primary OCD. As depression and OCD share a number of (meta)cognitive biases and dysfunctional coping strategies, we examined the efficacy of myMCT in a mixed patient sample with OCD and/or depression. A total of 80 Italian-speaking individuals with symptoms of OCD and/or depression were randomized to either myMCT or to a waitlist control group (both groups had access to care as usual during the intervention). Post-assessment was carried out 6 weeks after inclusion. Scores on the Beck Depression Inventory-II scale (BDI-II) served as the primary outcome. Adverse effects were assessed with a newly devised self-report scale. Participants in the myMCT condition showed significant symptom improvement on the BDI-II scale at a medium to large effect size compared to the control group (using intention-to-treat and per protocol analyses). The intention-to-treat analyses yielded significant positive effects on the PHQ-9 scores and psychological as well as environmental well-being in favor of myMCT; for the OCI-R total score, group differences bordered significance in favor of the myMCT. The most prevalent adverse effects were feeling pressured by the suggested exercises or feeling bad due to not performing the exercises correctly. Our results indicate that the myMCT manual represents an effective program for patients with OCD as well as those with depressive symptoms in an Italian-speaking population. Adverse events due to unguided self-help deserve more attention in the future.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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10
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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11
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Alvarez-Astorga A, Sotelo E, Lubeiro A, de Luis R, Gomez-Pilar J, Becoechea B, Molina V. Social cognition in psychosis: Predictors and effects of META-cognitive training. Prog Neuropsychopharmacol Biol Psychiatry 2019; 94:109672. [PMID: 31228639 DOI: 10.1016/j.pnpbp.2019.109672] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/07/2019] [Accepted: 06/17/2019] [Indexed: 11/25/2022]
Abstract
Social cognition deficits are found in schizophrenia and bipolar disorder, but its neural underpinnings are poorly understood. Given the complexity of psychological functions underlying this kind of cognition, we hypothesized that alterations in global structural connectivity could contribute to those deficits. To test this hypothesis, we studied a group of schizophrenia and bipolar patients with connectomics based on diffusion magnetic resonance imaging and assessments of general and social cognition. The latter was assessed using the Mayer, Salovey and Caruso Emotional Intelligence Test (MSCEIT) for emotional intelligence and the Spanish Group for Schizophrenia Treatment Optimization (Grupo Español para la OPtimización del Tratamiento de la Esquizofrenia, GEOPTE) test for behavioral aspects of social cognition. Graph theory applied to fractional anisotropy for the connections among cortical regions was used to obtain the small-world (SW) index of the structural connectivity network. In addition, we assessed the possibility of predicting the response of social cognition deficits to Meta-cognitive Training based on their possible underpinnings in a subgroup of patients. Patients showed lower scores in emotional intelligence and behavioral social cognition. MSCEIT scores were associated with SW index and working memory, and GEOPTE scores were related to verbal memory. Improvement in social cognition after Meta-cognitive Training was associated with lower scores of the social cognition in the baseline, according to the GEOPTE scale. Our findings support structural connectivity as one of the factors underlying emotional intelligence in schizophrenia, and the use of Meta-cognitive Training to improve social cognition in patients with larger deficits.
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Affiliation(s)
| | - Eva Sotelo
- Psychiatry Service, Clinical University Hospital of Valladolid, Valladolid, Spain
| | - Alba Lubeiro
- Psychiatry Department, School of Medicine, University of Valladolid, Spain
| | - Rodrigo de Luis
- Imaging Processing Laboratory, University of Valladolid, Valladolid, Spain
| | - Javier Gomez-Pilar
- Biomedical Engineering Group, University of Valladolid, Valladolid, Spain
| | - Begoña Becoechea
- Psychiatry Service, Clinical University Hospital of Valladolid, Valladolid, Spain
| | - Vicente Molina
- Psychiatry Service, Clinical University Hospital of Valladolid, Valladolid, Spain; Psychiatry Department, School of Medicine, University of Valladolid, Spain.
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12
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Pos K, Meijer CJ, Verkerk O, Ackema O, Krabbendam L, de Haan L. Metacognitive training in patients recovering from a first psychosis: an experience sampling study testing treatment effects. Eur Arch Psychiatry Clin Neurosci 2018; 268:57-64. [PMID: 28828697 PMCID: PMC5778181 DOI: 10.1007/s00406-017-0833-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 08/06/2017] [Indexed: 11/29/2022]
Abstract
Cognitive biases, negative affect and negative self-esteem are associated with paranoia in people with psychotic disorders. Metacognitive group training (MCT) aims to target these biases although research has shown mixed results. Our objective was to establish the effect of MCT on paranoid ideation in patients with recent onset psychosis in a powerful experience sampling design. 50 patients between the age of 18 and 35 were included in a single-blind, parallel group RCT comparing MCT with occupational therapy (OT) as an active control condition. We assessed via questionnaires and experience sampling treatment effects on paranoid ideation, delusional conviction, the cognitive bias jumping to conclusion (JTC), and cognitive insight, as well as treatment effects on associations between negative affect, negative self-esteem and paranoid ideation. Patients in the MCT group did not show a decrease in paranoid ideation, delusional conviction, JTC-bias or an increase in cognitive insight compared with OT. However, negative affect showed a weaker association with paranoid ideation post-treatment in the MCT condition. In the OT condition, this association was stronger post-treatment. We tentatively suggest that patients with an early psychosis seemed to benefit from MCT in emotional learning compared with the OT condition. Despite the fact that the group training is well-received by patients, subsequent individual MCT (MCT+) may be indicated for stronger favorable effects on paranoid ideation.
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Affiliation(s)
- Karin Pos
- Department of Psychiatry, Academic Medical Center (AMC), Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands.
| | - Carin J. Meijer
- Early Psychosis Department, Department of Psychiatry, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Oukje Verkerk
- Early Psychosis Department, Department of Psychiatry, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Onno Ackema
- Early Psychosis Department, Department of Psychiatry, Amsterdam Medical Center, Amsterdam, The Netherlands
| | - Lydia Krabbendam
- Department of Educational Neuroscience, VU University Amsterdam, Amsterdam, The Netherlands ,LEARN! Research Institute for Learning and Education, Amsterdam, The Netherlands
| | - Lieuwe de Haan
- Early Psychosis Department, Department of Psychiatry, Amsterdam Medical Center, Amsterdam, The Netherlands
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13
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Andreou C, Schneider BC, Balzan R, Luedecke D, Roesch-Ely D, Moritz S. Neurocognitive deficits are relevant for the jumping-to-conclusions bias, but not for delusions: A longitudinal study. Schizophr Res Cogn 2015; 2:8-11. [PMID: 29379755 PMCID: PMC5779293 DOI: 10.1016/j.scog.2015.02.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 02/08/2015] [Accepted: 02/13/2015] [Indexed: 11/28/2022]
Abstract
Patients with delusions exhibit an increased tendency to arrive at decisions based on very limited evidence (jumping-to-conclusions; JTC), making this reasoning bias relevant for the treatment of delusions. Neurocognitive deficits contribute to JTC, but it is not known whether this has any bearing on the clinical syndrome of delusions. We addressed this question by reanalyzing data from an efficacy study of non-pharmacological interventions as adjunctive treatments in schizophrenia. We investigated the longitudinal associations of cognitive functioning, JTC and delusions in patients with psychotic disorders receiving either a metacognitive intervention addressing reasoning biases (n = 59), or cognitive remediation (n = 58). Both interventions improved JTC; in the cognitive remediation group, tentative evidence suggested that better neurocognitive performance contributed to this improvement. However, JTC gains were associated with delusion improvement only in the metacognitive intervention group, suggesting a content-specific mechanism of action.
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Affiliation(s)
- Christina Andreou
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Brooke C Schneider
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Ryan Balzan
- School of Psychology, Flinders University, Sturt Road, Bedford Park 5042, South Australia, Australia
| | - Daniel Luedecke
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
| | - Daniela Roesch-Ely
- Department of General Adult Psychiatry, University of Heidelberg, Vossstrasse 2, 69115 Heidelberg, Germany
| | - Steffen Moritz
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246 Hamburg, Germany
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14
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Balzan RP, Delfabbro PH, Galletly CA, Woodward TS. Metacognitive training for patients with schizophrenia: preliminary evidence for a targeted, single-module programme. Aust N Z J Psychiatry 2014; 48:1126-36. [PMID: 24159051 DOI: 10.1177/0004867413508451] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Metacognitive training is an eight-module, group-based treatment programme for people with schizophrenia that targets the cognitive biases (i.e. problematic thinking styles) thought to contribute to the genesis and maintenance of delusions. The present article is an investigation into the efficacy of a shorter, more targeted, single-module metacognitive training programme, administered individually, which focuses specifically on improving cognitive biases that are thought to be driven by a 'hypersalience of evidence-hypothesis matches' mechanism (e.g. jumping to conclusions, belief inflexibility, reasoning heuristics, illusions of control). It was hypothesised that a more targeted metacognitive training module could still improve performance on these bias tasks and reduce delusional ideation, while improving insight and quality of life. METHOD A sample of 28 patients diagnosed with schizophrenia and mild delusions either participated in the hour-long, single-session, targeted metacognitive training programme (n = 14), or continued treatment as usual (n = 14). All patients were assessed using clinical measures gauging overall positive symptomology, delusional ideation, quality of life and insight, and completed two cognitive bias tasks designed to elucidate the representativeness and illusion of control biases. RESULTS After a 2-week, post-treatment interval, targeted metacognitive training patients exhibited significant decreases in delusional severity and conviction, significantly improved clinical insight, and significant improvements on the cognitive bias tasks, relative to the treatment-as-usual controls. Performance improvements on the cognitive bias tasks significantly correlated with the observed reductions in overall positive symptomology. Patients also evaluated the training positively. CONCLUSIONS Although interpretations of these results are limited due to the lack of an optimally designed, randomised controlled trial and a small sample size, the results are promising and warrant further investigation into targeted versions of the metacognitive training programme.
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Affiliation(s)
- Ryan P Balzan
- School of Psychology, Flinders University, Australia School of Psychology, University of Adelaide, Australia Discipline of Psychiatry, University of Adelaide, Australia
| | | | | | - Todd S Woodward
- Department of Psychiatry, University of British Columbia, Canada
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15
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Lam KCK, Ho CPS, Wa JC, Chan SMY, Yam KKN, Yeung OSF, Wong WCH, Balzan RP. Metacognitive training (MCT) for schizophrenia improves cognitive insight: a randomized controlled trial in a Chinese sample with schizophrenia spectrum disorders. Behav Res Ther 2014; 64:38-42. [PMID: 25513971 DOI: 10.1016/j.brat.2014.11.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 10/21/2014] [Accepted: 11/17/2014] [Indexed: 12/19/2022]
Abstract
Metacognitive training (MCT) is a group-based treatment program for people with schizophrenia that targets the cognitive biases thought to contribute to the pathogenesis and maintenance of delusions. Although effective in reducing the severity of delusions, the influence of MCT on cognitive insight, and its feasibility in Chinese culture, has yet to be investigated. The present randomized-controlled trial attempted to address these inconsistencies. A Chinese sample of 80 participants with schizophrenia spectrum disorders was randomized to the eight-module MCT program or continued treatment as usual (TAU). All participants were assessed using the Beck Cognitive Insight Scale, which assesses two components of cognitive insight (self-reflectiveness and self-certainty). Participants in the MCT condition subjectively rated their satisfaction with the training. Retention rates were high after four-weeks of MCT (n = 38) or TAU (n = 39). Clients randomized into the MCT condition rated the program favourably and showed significant improvements in cognitive insight (i.e., increased self-reflectiveness), relative to TAU controls, who exhibited decreases in cognitive insight at follow-up. These findings suggest that the MCT program is not only subjectively efficacious in Chinese samples, but also improves metacognitive awareness of the processes underlying delusional symptoms.
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Affiliation(s)
- Kino C K Lam
- Occupational Therapy Department, Kwai Chung Hospital, Hong Kong
| | - Christy P S Ho
- Occupational Therapy Department, Kwai Chung Hospital, Hong Kong
| | - Jimmy C Wa
- Occupational Therapy Department, Kwai Chung Hospital, Hong Kong
| | - Salina M Y Chan
- Occupational Therapy Department, Kwai Chung Hospital, Hong Kong
| | - Kevin K N Yam
- Occupational Therapy Department, Kwai Chung Hospital, Hong Kong
| | | | - Willy C H Wong
- Department of Psychiatry, Kwai Chung Hospital, Hong Kong
| | - Ryan P Balzan
- School of Psychology, Flinders University, South Australia, Australia.
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16
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Briki M, Monnin J, Haffen E, Sechter D, Favrod J, Netillard C, Cheraitia E, Marin K, Govyadovskaya S, Tio G, Bonin B, Chauvet-Gelinier JC, Leclerc S, Hodé Y, Vidailhet P, Berna F, Bertschy AZ, Vandel P. Metacognitive training for schizophrenia: a multicentre randomised controlled trial. Schizophr Res 2014; 157:99-106. [PMID: 24972754 DOI: 10.1016/j.schres.2014.06.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 05/20/2014] [Accepted: 06/04/2014] [Indexed: 11/18/2022]
Abstract
A psychotherapeutic approach for schizophrenia is now recommended as an adjuvant for psychopharmacology, since antipsychotic medications only have a partial impact especially as regards positive symptoms and insight. In addition, cognitive distortions and the lack of metacognitive skills might increase positive symptoms leading to poor social functioning. This underlines the need for specific approaches which target cognitive processes relevant for insight, and abilities in metacognition. Metacognitive training (MCT) is a structured group intervention, which enhances a patient's reflection on cognitive biases and improves problem-solving. The aim of our study was to assess MCTs' short term impact on insight, symptoms and quality of life. Fifty patients with schizophrenia or schizoaffective disorders and persistent positive symptoms (delusions or hallucinations) were enrolled in the study. After baseline assessment participants were randomised either to supportive therapy or MCT. Both groups used the same design (1h-session twice a week during 8weeks) although the basic knowledge given to participants was different between interventions. Participants were assessed at eight weeks based on the Scale to Assess Unawareness of Mental Disorder, Positive and Negative Syndrome Scale (PANSS), Psychotic Symptom Rating Scales, the Calgary Depression Scale for Schizophrenia and the Quality of Life Scale. Between-group differences were significant in favour of MCT on the PANSS positive scale. Between-group differences in post- and pre-test values showed a trend in favour of MCT for insight on hallucinations. Results of our study indicate that the MCT has an effect on reducing positive symptomatology, and a trend impact on insight and social functioning.
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Affiliation(s)
- Malick Briki
- Clinical Psychiatry Department, Dijon University Hospital, 21000 Dijon, France; EA 481 "Neurosciences Laboratory", Franche-Comté University, 1 place du Maréchal Leclerc, 25030 Besançon Cedex, France
| | - Julie Monnin
- Clinical Psychiatry Department, Besançon University Hospital, 25030 Besançon Cedex, France; INSERM Technological Innovation Clinical Investigation Centre (INSERM CIC-IT 808), Besançon University Hospital, 25030 Besançon Cedex, France
| | - Emmanuel Haffen
- EA 481 "Neurosciences Laboratory", Franche-Comté University, 1 place du Maréchal Leclerc, 25030 Besançon Cedex, France; Clinical Psychiatry Department, Besançon University Hospital, 25030 Besançon Cedex, France; INSERM Technological Innovation Clinical Investigation Centre (INSERM CIC-IT 808), Besançon University Hospital, 25030 Besançon Cedex, France
| | - Daniel Sechter
- EA 481 "Neurosciences Laboratory", Franche-Comté University, 1 place du Maréchal Leclerc, 25030 Besançon Cedex, France; Clinical Psychiatry Department, Besançon University Hospital, 25030 Besançon Cedex, France
| | - Jérôme Favrod
- Community Psychiatry, Department of Psychiatry, University Hospital Center and University of Lausanne, Switzerland; La Source, School of Nursing Science, University of Applied Sciences of Western Switzerland, Lausanne, Switzerland
| | - Christian Netillard
- Clinical Psychiatry Department, Hospital of Novillars, 25220 Novillars, France
| | - Elisabeth Cheraitia
- Clinical Psychiatry Department, Hospital of Novillars, 25220 Novillars, France
| | - Karine Marin
- Clinical Psychiatry Department, Hospital of Saint-Ylie, 39100 Dole, France
| | | | - Grégory Tio
- Clinical Psychiatry Department, Besançon University Hospital, 25030 Besançon Cedex, France; INSERM Technological Innovation Clinical Investigation Centre (INSERM CIC-IT 808), Besançon University Hospital, 25030 Besançon Cedex, France
| | - Bernard Bonin
- Clinical Psychiatry Department, Dijon University Hospital, 21000 Dijon, France
| | | | - Stéphanie Leclerc
- Clinical Psychiatry Department, Dijon University Hospital, 21000 Dijon, France
| | - Yann Hodé
- Clinical Psychiatry Department, Hospital of Rouffach, 68250 Rouffach, France
| | - Pierre Vidailhet
- Clinical Psychiatry Department, Strasbourg University Hospital, 67000 Strasbourg, France
| | - Fabrice Berna
- Clinical Psychiatry Department, Strasbourg University Hospital, 67000 Strasbourg, France
| | - Anna Zinetti Bertschy
- Clinical Psychiatry Department, Strasbourg University Hospital, 67000 Strasbourg, France
| | - Pierre Vandel
- EA 481 "Neurosciences Laboratory", Franche-Comté University, 1 place du Maréchal Leclerc, 25030 Besançon Cedex, France; Clinical Psychiatry Department, Besançon University Hospital, 25030 Besançon Cedex, France; INSERM Technological Innovation Clinical Investigation Centre (INSERM CIC-IT 808), Besançon University Hospital, 25030 Besançon Cedex, France
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